A 72-year-old woman was admitted as an emergency case to our hospital because of chest oppression. She had a history of admission due to the same symptoms about 9 months previously. Her chest computed tomography showed a dissection of the ascending aorta (DeBakey type II). We suspected an acute aortic dissection and an emergency operation with CPB was performed. The ascending aorta was markedly enlarged, but the dissected adventitia did not appear weakened. Moreover, there was no bloody pericardial effusion which is specific to acute aortic dissection. When the pseudo-lumen was exposed, a firm intimal flap and single entry hole were recognized. The chronic phase of aortic dissection was finally diagnosed. Then the dissected adventitia and intimal flap were removed and a patch graft aortoplasty with a tailored 26mm gelatin-impregnated knitted Dacron vascular graft was employed because the residual aortic wall was normal in size and consisting. Her postoperative course was uneventful and there was no evidence of recurrence of aortic dissection or enlargement 2 years after the operation. We conclude that patch aortoplasty for repair of chronic aortic dissection can be effective when the range of dissection is restricted and to residual aortic wall is normal.

Rare complications-1) Sarcoidosis, 2) Amyloidosis, 3) Phycomycosis-following surgical therapy for aortitis syndrome are reported. Sarcoidosis occurred in 39 y.o. female following Bentall operation for AAE and AR was diagnosed by biopsy and was controlled with drug completely 1 year after the onset. Amyloidosis found in 56 y. o. male after AVR and AAo plication for AAE and AR started with severe diarrhea and the diagnosis was made by autopsy. Phycomycosis was diagnosed by necropsy in 49 y. o. female after CABG and thoraco-abdominal bypass operation. Poor control of inflammation and administration of gluco-corticoid are the common problems for the 3 cases. Aortitis syndrome is autoimmune disease and some immunological factor has a role for the cause of the three complications. We must be very strict about the administration of the gludo-corticoid and the control of the inflammation.

X-linked inhibitor of apoptosis (XIAP) deficiency is a rare primary immunodeficiency and gastrointestinal (GI) lesions in XIAP deficiency are similar to Crohn’s disease. For patients with Crohn’s disease, endoscopic balloon dilation (EBD) is known to be a standard procedure for intestinal strictures including upper GI tract. However, there are no articles which mention the efficacy of EBDs for the strictures in upper GI tract in patients with XIAP deficiency. Herein, we describe an 18-year-old male with XIAP deficiency in whom EBDs for the rectum, ileocecal valve (ICV), and duodenum were performed. Before hematopoietic stem cell transplantation (HSCT), GI endoscopy revealed strictures of the rectum, ICV and duodenum with active ulcers. Although these ulcers healed after HSCT, the strictures progressed. Therefore, we performed EBDs for the strictures of the rectum, ICV, and duodenum. In contrast studies, we did not find any other strictures in the small intestine. Throughout the patient’s clinical course, no complications of EBD occurred. He started eating after EBDs, but abdominal symptoms did not relapse without any dietary restrictions. Our case suggests that EBD could be an effective and safe procedure for intestinal strictures including upper GI tract after HSCT in patients with XIAP deficiency.

A 72-year-old woman underwent thoracic endovascular aortic repair (TEVAR) for an aortic arch aneurysm at a previous hospital. During follow-up, although the aneurysm was found to have become bigger, no further treatments were given, except for conservative follow-up. The patient sought a second opinion and thus visited our hospital. Enhanced computed tomography (CT) revealed a type I endoleak that required repair. Total arch replacement with removal of the partial stent-graft system was performed under deep hypothermic circulatory arrest. The patient made a steady progress postoperatively and was discharged without any complications. Endovascular repair is minimally invasive and frequently used in various medical facilities but carries a considerably high risk of reintervention. Treatment strategies for aortic aneurysm, including open surgery, should be carefully chosen.

BACKGROUND: To examine changes in psychological distress prevalence among pregnant women in Miyagi Prefecture, which was directly affected by the Great East Japan Earthquake and tsunami, and compare it with the other, less damaged areas of Japan. METHODS: This study was conducted in conjunction with the Japan Environment and Children`s Study. We examined 76,152 pregnant women including 8270 in Miyagi Regional Center and 67,882 in 13 other regional centers from the all-birth fixed data of the Japan Environment and Children's Study. We then compared the prevalence and risk of distress in women in Miyagi Regional Center and women in the 13 regional centers for 3 years after the disaster. RESULTS: Women in the Miyagi Regional Center suffered more psychological distress than those in the 13 regional centers: OR 1.38 (95% CI, 1.03-1.87) to 1.92 (95% CI, 1.42-2.60). Additionally, women in the inland area had a consistently higher prevalence of psychological distress compared to those from the 13 regional centers: OR 1.67 (95% CI, 1.18-2.38) to 2.19 (95% CI, 1.60-2.99). CONCLUSIONS The lack of pre-disaster data in the Japan Environment and Children's Study made it impossible to compare the incidence of psychological distress before and after the March 2011 Great East Japan Earthquake. However, 3 years after the Great East Japan Earthquake, the prevalence of pregnant women with psychological distress did not improve in Miyagi Regional Center. Further, the prevalence of mental illness in inland areas was consistently higher than that in the 13 regional centers after the disaster.
Adolescent ; Adult ; Disasters ; Earthquakes ; Female ; Humans ; Japan/epidemiology* ; Pregnancy ; Pregnancy Complications/psychology* ; Pregnant Women/psychology* ; Prevalence ; Psychological Distress ; Tsunamis ; Young Adult