A 29-year-old woman with severe chest and back pain was referred to our hospital. She exhibited the following physical symptoms of Marfan syndrome : arachnodactyly, wrist sign, thumb sign, pectus excavatum, pes planus, scoliosis, and myopia. Computed tomography revealed a Stanford type A aortic dissection with dilatation of the aortic root, therefore, emergency surgery was performed. Total arch replacement, including an elephant trunk procedure, was performed, followed by valve-sparing aortic root replacement using the reimplantation technique. Following an initially uneventful postoperative course, she was reintubated on the third postoperative day due to laryngeal edema and aspiration. On the sixth postoperative day, it was difficult to ventilate her due to severe tracheal stenosis. Although we managed to return her to spontaneous breathing under proper sedation, it was difficult to maintain stable ventilation. She developed a recurrent respiratory distress following physical irritation such as intratracheal aspiration or a postural change. We believe that during the perioperative management of patients with Marfan syndrome with thoracic deformities, such as pectus excavatum and scoliosis, the possibility of postoperative tracheal stenosis due to tracheal fragility, tracheal edema, and compression of the surrounding tissues must be considered.

The concordance rate between the Objective Structured Clinical Examination (OSCE) evaluators and the SP evaluation evaluators, in the analyses conducted during the past two years was investigated and compared by the acupuncture department at the College for Japanese Judo-Therapy Acupuncture and Moxibustion Therapy.
The subjects were third year students who sat for the OSCE during FY 2004-FY 2005, and consisted of thirteen and thirty-two students, respectively. Four stations were set up which were comprised of medical interviews, physical examinations, and practical skill evaluations on acupuncture, and moxibustion.
The concordance rate at each station was compared, and the improvements in these rates could be seen particularly for physical examinations and practical skills on acupuncture stations. The relationship between the evaluator and the SP was that a correlation between the medical interview evaluator and the SP evaluation was recognized
Improvements were due to segmentation and clarification of the assessment items, more meetings being held, and simulated trials conducted prior to the actual examination. These factors lead to a comprehensive interpretation of the manual.
However, a correlation between the evaluator of the practical skills for acupuncture and the SP evaluation was not recognized. Therefore, it is vital to include the assessment of SP evaluation, and ensure it is performed uniformly.

Aortitis syndrome is a disease of non-specific inflammation of the arterial wall which produces necrosis and fibrosis of the intima. Indications, timing, and the choice of operative procedures should be determined carefully because of its complex pathology. We encountered a patient with combined aortic valve incompetence and left main coronary artery stenosis due to aortitis syndrome. The patient received adequate steroid therapy and the inflammatory reaction was well controlled before surgery. The patient underwent concomitant aortic valve replacement using an intravalvular implantation technique and coronary artery bypass grafting. The hospital course of the patient was uneventful. Neither paravalvular leakage nor inflammatory recurrence was observed during 18 months of follow-up.

Abstract
Objective : Laninamivir Octanoate (LO) is a novel anti-influenza drug administered by inhalation only once administration, and with a very simple dosage adjustment regimen. Conversely, inhalation might be expected to fail in some groups of patients, particularly the very young and very elderly because of poor inhalation technique. Therefore, we undertook a study to investigate the success and failure rates of the dry powder inhalation formulation of LO.
Methods : We observed 159 patients who were prescribed LO. Pharmacists observed the administration technique after explaining how to inhale the drug. Success was defined as patients who could inhale the drug without a problem. Failure was defined as those patients who were judged to have inhaled less than 75％ of the drug. We also examined the success rate between pharmacies and the success and failure rates according to age.
Results : A 4-years-old patient was the youngest to fail LO therapy whereas a 5-years-old patient was the youngest to succeeded with the therapy. The success rate did not differ significantly between pharmacies. The success rate was 88.9％ in patients under the age of 9 years, but which was significantly lower compared with 97.9％ in the group of patients over 10 years of age.
Conclusion : This survey revealed that many cases of inhalation failure of LO anti-influenza therapy occur below the age of 9 year.

Fifty consecutive patients who underwent elective repair for abdominal aortic aneurysms were preoperatively evaluated on blood coagulation tests and retrospectively classified into three groups. Class I had a normal profile on the tests. Class II had either high FDP (≥20ng/ml), TAT (≥20ng/ml), or positive results on the FM test. Class III had either thrombocytopenia (≤120/μl) or bleeding symptoms with Class II conditions. Operative mortality was 0% (0/26) in Class I, 13% (2/15) in Class II, and 22% (2/9) in Class III patients. This classification is considered to be simple and useful to assess specific coagulopathy for aortic aneurysms.

We report a case of constrictive pericarditis with repeated hepatic encephalopathy due to hepatic cirrhosis. A 69-year-old man with exertional dyspnea and leg edema was admitted to our hospital. He had been admitted to our hospital thrice in the past 1 year owing to hepatic encephalopathy. He had hyperammonemia, hyperbilirubinemia, and renal dysfunction. Computed tomography revealed a thick pericardium with calcification and bilateral pleural effusion, and transthoracic echocardiography revealed abnormal early diastolic septal movement and right ventricular restriction. Further, cardiac catheterization identified increased central venous (36 mmHg) and a mean pulmonary arterial of 53 mmHg and a dip-and-plateau right ventricular pressure curve. We diagnosed constrictive pericarditis. Accordingly, pericardiectomy without extracorporeal circulation was performed. A hypertrophic calcified pericardium was found to be expanded throughout the right atrium to the free wall of the right ventricle. Postoperatively, the patient's exertional dyspnea and leg edema resolved, and he recovered without any complications.

Methods: We enrolled 20 patients (13 men and seven women) who underwent DB-ACLR between October 2017 and March 2019. The mean patient age was 28.5 years. The ipsilateral ST tendon was measured using ultrasonography before surgery. Measurements included the diameter and breadth of the short-axis image. The cross-sectional area (CSA) was calculated from these measurements. During surgery, when two grafts with diameters of ≥ 5.0 mm could not be made, the G tendon was also harvested. Patients were categorized into two groups: the ST group where only the ST tendon was harvested, and the semitendinosus gracilis tendon (STG) group where the ST and G tendons were both harvested. The CSA value was compared between the two groups, and the cutoff value was calculated. Results: In the ST group (n = 8), the mean diameter and breadth of the semitendinosus tendon were 4.21 and 2.34 mm, respectively. In the STG group (n = 12), the mean diameter and breadth of the ST tendon were 3.39 and 1.78 mm, respectively.The CSAs calculated for the ST group and the STG group were 7.74 mm 2 and 4.79 mm 2, respectively. A cutoff value of 7.0 mm 2was found to correspond to a specificity and sensitivity to harvest the G tendon of 87.5% and 75.0%, respectively. Conclusions The preoperative CSA of the ST tendon determined using ultrasonography can, therefore, be informative for deciding whether to harvest the G tendon for DB-ACLR. The results of this study provide valuable information for graft selection in anterior cruciate ligament reconstruction.Level of Evidence: IV (Retrospective case series design).