Pseudoaneurysm of the uterine artery is rare as a cause to delayed postpartum hemorrhage. Nowadays, uterine pseudoaneurysm is often treated by uterine artery embolization. The outcome is favorable. Here, we report a case of delayed postpartum hemorrhage following Cesarean section, which was caused from a rupture of uterine pseudoaneurysm. The patient was at the point of death from excessive bleeding but successfully treated by uterine artery embolization (UAE). In encountering a case of postpartum hemorrhage after Cesarean delivery or Dilation & Curettage, it is indispensable to check the abnormal blood flow in a color Doppler examination.

The form and electromyographic pattern of archery shooting were compared between experts and amatures. Using methods are electromyography, photography and X-ray photography.
In the expert group, the shoulder joint of the pushing arm is in neutral position of rotation and the forearm is in supinated position. In the amature group the shoulder joint is in externally rotated and forearm is pronated. The delta muscle provides more powerful abduction of the shoulder in neutral position of rotation.
The different discharge pattern of shoulder girdle muscles between two groups suggests that fixation of the bow is essentially important from release to follow-through.

Bacteremia from dental disease is the most important cause of infective endocarditis in patients with heart valve disease. However, the prevalence of dental disease in patients undergoing valve surgery has not been clarified. One hundred thirty-seven patients had a dental check-up before heart valve surgery, 82 patients (59.9%) had significant dental disease which could have caused bacteremia. All patients with the dental disease underwent extraction preoperatively. There was neither complication in extraction nor any influence on heart valve surgery. Postoperative hospital stay was not prolonged due to the extraction. During the mean follow-up period of 30 months, no infective endocarditis was seen. The prevalence of dental disease was high in patients undergoing heart valve surgery. Preoperative treatment of dental disease did not have a negative impact on the postoperative course and hospital stay in heart valve surgery.

Ulcer developed on the left leg of a 47-year-old man, in 1989, and phlebography showed deep vein thrombosis extending from the politeal to the common femoral vein. Subfascial ligation of the perforators achieved healing of the ulcers. In November 1991, at the age of 52 years the patient noticed a pulsatile mass on the right side of his neck. CT scanning showed a carotid artery aneurysm 4cm in diameter. Angiography indicated that the aneurysm was located at the bifurcation of the carotid artery. In February 1992, reconstructive surgery was performed with a Dacron graft, but an anterile abscess developed around the graft. In September 1992, the graft was removed and the carotid artery was ligated. Only seven cases of carotid aneurysm associated with Behçet's disease have previously been reported in Japan. Five of them underwent reconstructive surgery and two of them underwent carotid ligation due to complications. Because of the clinical course of Behçet's disease, carotid aneurysmectomy without reconstructive surgery may be the procedure of choice.

Seventy patients with liver cirrhosis hospitalized into our clinic were divided into a compensatory group and a decompensatory group according to three clinical findings, ascites, hepatic encephalopathy and bleeding from gastrointestinal tract. It was suggested that five items of biochemical data for liver function were very important on discriminating these two grops. The five items were cholinesterase, indocyanine green test, albumin, prothrombin time and hematocrit.
We have tried to devise a new staging system for liver cirrhosis by scoring method using the five items. According to the total score calculated from scoring method, clinical stages were divided into four such as stage I, stage II, stage III, and stage IV. It was suggested that cases of stage III had to be treated very carefully.
Liver and spleen volume of patients with liver cirrhosis were calculated by computed tomography. It was suggested that liver volume/spleen volume ratio was very important on discriminating these two groups.

We report 2 cases of successful treatment by percutaneous catheter drainage and irrigation for methycillin-resistant Staphylococcus aureus (MRSA) prosthetic graft infection after abdominal aortic aneurysm (AAA) repair. Case 1 was a 71-year-old man in whom MRSA graft infection was diagnosed on the basis of high fever and CT-guided taps of the perigraft fluid 11 days after AAA repair, and a percutaneous catheter was inserted into the perigraft space by the CT-guided method. Case 2 was a 77-year-old man in whom MRSA graft infection was diagnosed because of high fever and purulent discharge from the wound of retroperitoneal drainage 5 days after AAA repair. A percutaneous catheter was placed into the retroperitoneal space via an extraperitoneal route. In both cases, intermittent irrigation by 0.5% Povidone-iodine solution and saline was performed as well as systemic and local antibiotic administration. The graft infection was well controlled and both patients were discharged after 4 months. Percutaneous catheter drainage and irrigation can be one of the choices for critically ill patients with graft infection after AAA repair.

We encountered 15 cases of surgical site infection (SSI) by Methicillin-resistant Staphylococcus aureus (MRSA) among 153 patients who underwent a cardiovascular operation in 2000. SSIs consisted of 5 mediastinal infections, 9 surface wound infections and 1 artificial graft infection after an abdominal aortic surgery. All infected cases had been operated on between June and December 2000. Eighty-three cases, which underwent cardiovascular operations during this period, were divided into SSI or no-SSI groups and their clinical data were analyzed. The data included age, gender, preoperative diabetes, urgency, preoperative usage of a device like Swan-Ganz catheter or IABP, preoperative albumin level, preoperative physical state by ASA score, National Nosocominal Infections Surveillance index, duration of operation, usage of a cardiopulmonary bypass, duration of bypass, type of operation, and number of distal anastomoses in CABG operations. Multivariate analysis showed gender (male), diabetes, and emergency operation as independent risk factors for the incidence of SSI by MRSA. One patient, who suffered a mediastinal infection after CABG, had confirmed as demonstrating the colonization of MRSA in sputum preoperatively. Microbiological screening of medical staff showed 2 of the 6 surgical doctors and 3 of the 25 ward nurses exhibited colonization with MRSA. DNA analysis of MRSA, harvested from 5 infected patients, indicated at least 2 strains of MRSA and 1 of the 2 strains was identical to the MRSA that was detected in a doctor. We applied prophylactic measures with reference to the guideline for prevention of surgical site infection announced by CDC in 1999, which included the following: routine work-up of MRSA-colonization, and treatment of all MRSA colonized patients and those undergoing emergency operations with Mupirocin. Preoperative patients were isolated from MRSA-infected or colonized patients. MRSA-colonized surgical personnel were treated with Mupirocin ointment. Cephazoline was administered shortly before and after the operation as a prophylactic antibiotic. Vancomycin was added to Cephazoline in patients with a history of MRSA-colonization or infection. Through hand washing before and after daily contact with patients was emphasised to all medical staff. SSI surveillance conducted by an infection control team was implemented. After the introduction of the prophylactic measurements, one MRSA-SSI was observed among 113 cases who underwent a cardiovascular operation between January and September 2001.

The preparation for influenza pandemic has become very important. However, no standardized educational package against pandemics has been established to date. We developed a simulation–based education drill for Japanese medical students based on the package developed by U.S. medical school. The drill was adapted to 201 medical students, and was evaluated by self–administered questionnaires.
1)More than 90% of the students indicated that the use of this drill is appropriate to experience a simulated pandemic situation, and to learn skills and attitudes such as teamwork and communication.
2)Up to 65% of the students answered they learned a "very clear image" for the "Importance of working as a team with other professionals".
3)The results suggest that this simulation–based education drill make the students aware not only of the need for the preparation for pandemic but also the importance of team–based approach.

Background: A supervised physiotherapy program (SPP) is a standard regimen after surgical rotator cuff repair (RCR); however, the effect of a home-based exercise program (HEP), as an alternative, on postoperative functional recovery remains unclear. Therefore, the purpose of this meta-analysis was to compare the functional effects of SPP and HEP after RCR. Methods: We searched electronic databases including Central, Medline, and Embase in April 2022. The primary outcomes included the Constant score, American Shoulder and Elbow Surgeons score, University of California Los Angeles shoulder score, and pain score. Secondary outcomes included range of motion, muscle strength, retear rate, and patient satisfaction rate. A meta-analysis using random-effects models was performed on the pooled results to determine the significance. Results: The initial database search yielded 848 records, five of which met our criteria. Variables at 3 months after surgery were successfully analyzed, including the Constant score (mean difference, −8.51 points; 95% confidence interval [CI], −32.72 to 15.69; P=0.49) and pain score (mean difference, 0.02 cm; 95% CI, −2.29 to 2.33; P=0.99). There were no significant differences between the SPP and HEP. Other variables were not analyzed owing to the lack of data. Conclusions Our data showed no significant differences between SSP and HEP with regard to the Constant and pain scores at 3 months after RCR. These results suggest that HEP may be an alternative regimen after RCR.Level of evidence: I.