The patient, a 63-year-old man was admitted to the emergency clinic of our hospital complaining of severe abdominal pain. Ruptured aortic abdominal aneurysm was diagnosed by abdominal CT. The abdominal aortic aneurysm was successfully replaced with a prosthetic graft, and good urination was obtained postoperatively. On the second hospital day, hemoglobinemia with myoglobinuria suddenly appeared, urine volume decreased with high levels of both the serum CPK and GOT. Acute renal failure secondary to rhabdomyolysis of unknown cause was diagnosed. The patient was successfully treated by plasmapheresis and continuous hemodiafiltration (CHDF), and is now doing well.

A case of successful surgical treatment for a ruptured infected aneurysm of the abdominal aorta is presented. A 63-year-old man was admitted with a history of persistent fever of unknown cause and lumbago. During medical treatment, a new abdominal pulsatile mass was revealed on physical examination. Leucocytosis and elevation of C-reactive protein were demonstrated. Abdominal echogram and CT scan showed a ruptured aneurysm of the abdominal aorta. Ruptured infected aneurysm of abdominal aorta was diagnosed, and an emergency operation was performed. We found a tight inflammatory adhesion around the aneurysm, but there was no abcess formation. The aneurysm had the mural thrombi and necrotic tissue. As usual infected tissue was removed as possible with aneurysmectomy, and an artificial graft was replaced. The culture of the aneurysmal wall tissue was negative, but the infiltration of the inflammatory cells, mainly neutrophilic segmented leukocytes, were found on pathological examination. He is doing well without recurrent infection at 8 months after operation. Twenty five cases of infected abdominal aortic aneurysm (AAA) were reported in Japan, and 21 cases of them received surgical treatment. Management of infected AAA is discussed.

CHDF was applied to 8 patients who developed acute renal failure following cardiogenic shock. Four of 8 patients also underwent PCPS (percutaneous cardiopulmonary bypass) and all were weaned from PCPS. Five patients were weaned from CHDF. CHDF was very effective to control the concentration of serum potassium, creatinine, blood urea nitrogen and diuresis.

Postoperative cardiac function and the occurrence of arrythmia depend upon myocardial protection during open heart surgery in severe concentric hypertrophy. The effect of myocardial protection was evaluated in terms of several released cardiac enzymes before and after reperfusion, and postoperative left ventricular (LV) cardiac function from cardiac pool scintigram in 21 cases with aortic stenosis (AS Group). These data were compared with 20 cases with aortic regurgitation (AR Group). Heart weight and aortic cross-clamping time were not significantly different in these two groups. The enzymatic values in peak total creatine-kinase (CK) and peak CK-MB fraction were higher in the AS group than in the AR group, and peak GOT was significantly elevated in the AS group (peak GOT: 93±32 in AS group, 64±17IU/l in the AR group, p<0.01). Among the cases in the AS group, six cases with LV small cavity (LVDd<4cm) and severe concentric hypertrophy were associated with high values of released enzyme and the occurrence of ventricular arrythmia. Postoperative cardiac function was estimated from both systolic parameters such as LV ejection fraction (LVEF) or peak ejection rate (PER) and diastolic parameters such as peak filling rate (PFR) or early diastolic filling rate (1/3PFR). Postoperative LVEF and PER improved to normal control levels in the AS group with preoperatively depressed systolic function, although values were decreased in the AR group with impaired systolic function. The postoperative early diastolic peak filling rate did not recover to control levels in the AS group as well as the AR group, and was impaired in the AS group with severe concentric hypertrophy due to elevated chamber stiffness and the delay of time to peak filling rate. In severe concentric hypertrophy, we used several techniques for myocardial protection of terminal blood cardioplegia, and gradually increased reperfusion pressure and LV venting after reperfusion. Late results revealed a good clinical course in all 21 cases except for the occurrence of arrythmia in three.

A 37-year-old man who had received graft replacement of right iliac artery 20 years ago was admitted to our hospital because of massive intestinal hemorrhage. CT scan and angiogram showed a pseudoaneurysm originating from a graft anastomosis and the case was diagnosed as aorto-enteric fistula. Emergency operation was performed. Following aneurysmectomy and direct closure of split anastomosed portions, colostomy was performed in descending colon. Femorofemoral artery bypass was made as an extra-anatomical bypass. Fortunately, he has been successfully treated and is doing well now. The most important point for the rescue of cases of aneurysm-enteric fistula is to consider such cases of intestinal hemorrhage after the arterial graft replacement in the abdomen.

A 72-year-old man was admitted with an abnormal shadow on chest X-ray. Chest CT and aortography showed double saccular aneurysms at the aortic arch and the descending thoracic aorta. Three-dimensional CT was useful to detect the association between the arch aneurysm and neck vessels. Graft replacement, from the distal arch to the descending thoracic aorta, was performed by the lateral approach with hypothermic arrest and open proximal method. The aorta had severe atherosclerotic changes and the intima was absent at the orifices of the aneurysms. Pathological examination showed the aneurysmal wall to be composed of fibrous tissue without medial components. These macroscopic and pathological findings of aneurysms corresponded with double pseudo-aneurysms originating from the penetrating atherosclerotic ulcer.

The aim of this article is to describe the 2017 revised consensus criteria for the clinical diagnosis of dementia with Lewy bodies (DLB) with future directions for the diagnostic criteria. The criteria for the clinical diagnosis of probable and possible DLB were first published as the first consensus report in 1996 and were revised in the third consensus report in 2005. After discussion at the International DLB Conference in Fort Lauderdale, Florida, USA, in 2015, the International DLB Consortium published the fourth consensus report including the revised consensus criteria in 2017. The 2017 revised criteria clearly distinguish between clinical features and diagnostic biomarkers. Significant new information about previously reported aspects of DLB has been incorporated, with increased diagnostic weighting given to rapid eye movement (REM) sleep behavior disorder (RBD) and iodine-123-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. Future directions include the development of the criteria for early diagnosis (prodromal DLB) and the establishment of new biomarkers that directly indicate Lewy-related pathology, including α-synuclein imaging, biopsies of peripheral tissues (skin, etc.) for the demonstration of α-synuclein deposition, and biochemical markers (cerebrospinal fluid/blood), as well as the pathological evaluation of the sensitivity and specificity of the 2017 revised diagnostic criteria. In conclusion, the revised consensus criteria for the clinical diagnosis of DLB were reported with the incorporation of new information about DLB in 2017. Future directions include the development of the criteria for early diagnosis and the establishment of biomarkers directly indicative of Lewy-related pathology.

Physical function measurements were obtained and the 7-item Loco-Check questionnaire for evaluation of locomotive syndrome was administered to individuals who had given informed consent at a fall prevention seminar. In total, 49 of 113 middle-aged women (age 40-69 years) with no history of fragility fracture or gait disturbance responded positive to 1 or more Loco-Check items. Multiple logistic regression analysis revealed significant association with increased body mass index (BMI), Timed-Up-and-Go delay, decreased grip strength, and aging. These findings are consistent with reports from previous research and suggest that proper maintenance of BMI, dynamic trunk balance, and grip strength are important for extension of health and vitality of the musculoskeletal system. Also, early recognition of the risk of locomotive syndrome by the Loco-Check is considered essential.

Objective: Colonoscopy is useful in diagnosing intestinal tuberculosis. However, the terminal ileum is generally not examined during routine colonoscopy. Therefore, even with colonoscopy, the diagnosis can be missed in patients with lesions confined to the terminal ileum. Herein, we report the case of an asymptomatic patient with intestinal tuberculosis, in whom a colonoscope insertion into the terminal ileum led to the diagnosis.Patient: An asymptomatic 71-year-old man visited our hospital for a colonoscopy after a positive fecal occult blood test.Results: Colonoscopy revealed diffuse edematous and erosive mucosa in the terminal ileum. Mycobacterium tuberculosis was detected by polymerase chain reaction and culture of biopsy specimens from the erosions, leading to the diagnosis of intestinal tuberculosis. The patient was treated with antitubercular agents for 6 months, and a follow-up colonoscopy revealed healing of the lesions.Conclusion: Asymptomatic intestinal tuberculosis may occasionally be detected on colonoscopy following a positive fecal occult blood test and is sometimes confined to the terminal ileum. Therefore, clinicians should consider intestinal tuberculosis in the differential diagnosis of the causes of positive fecal occult blood test results and perform colonoscopies, including observation of the terminal ileum.