A 64-year-old woman who had a fever and low back pain was referred to our institution. Abdominal computed tomography revealed a low density area around the aorta and inferior mesenteric artery and liver abscess. Under the diagnosis of mycotic abdominal aneurysm, intravenous administration of antibiotics was started and her symptoms improved. On the 12th day after admission, the patient developed hematemesis and an emergency CT scan revealed enlargement of the low density area around the aorta and dilatation of the inferior mesenteric artery diameter to 16mm. Urgent operation was performed under the diagnosis of impending rupture of the mycotic aneurysm. Necrotic tissue and hematoma was recognized outside the aorta, and this mass firmly adhered to the duodenum. Communication between the abdominal aorta and the duodenum through the inferior mesenteric artery was confirmed. The infected aneurysmal area of the aorta was almost completely resected by closing the infra-renal aorta and terminal aorta above the bifurcation and a left axillo-femoral bypass was established. The culture of the necrotic tissue revealed Klebsiella pneumoniae. Antimicrobial therapy was continued and the patient was discharged from the hospital on postoperative day 46. Because the mortality rate of mycotic aneurysm penetrating to the duodenum is high, early diagnosis and treatment is important. We present a successfully treated case of mycotic aneurysm in which the formative course was observed from an early stage of infection. We observed the process of mycotic aneurysm formation and aorto-duodenal fistula generation despite antibiotic therapy. Close observation of periaortic inflammation and early surgical intervention is necessary in such patients.

We investigated the prevalence of, and factors in, urinary incontinence among the people of middle to advanced age, using a yes/no questionnaire. The total number of respondents was 4, 020 (1, 520 males and 2, 500 females). Seventy-five percent of them were over 65 years old (median age: 67 years). The prevalence of urinary incontinence was 14% for the males and 30% for the females. The data were analyzed by standard statistical tests, such as χ² tests. The factors closely associated with urinary incontinence were aging, the high urinary frequency in a day, a history of cerebrovascular accidents, difficulty of urination in the males and UTI in the females. Urinary incontinence of the urge type account for 64% of the males and that of the stress type 81% of the females. Fifteen percent of the males and 6% of the females had consulted with physicians or urologists about urinary incontinence. These percentages were lower than those in European countries. However, we suspect that there may be much more latent patients who suffer from urinary incontinence in their daily community life.