A 79 year-old woman was given a diagnosis of acute myocardial infarction and was immediately transferred to our hospital by a helicopter. Cardiologists successfully revascularized the occluded left anterior descending artery which was considered to be the care of this case. After that, they detected a large ventricular septal perforation by transthoracic echocardiography. We performed repair of the ventricular septal perforation 4 days later, with a modified infarct exclusion technique. Residual shunt flow was not seen by echocardiography after the operation. This patient recovered uneventfully and was discharged on postoperative day 55.

A rare case of abdominal aortic aneurysm associated with crossed-fused ectopic kidney in a 74-year-old man is reported. On enhanced CT scans, the maximum diameter of his infrarenal aortic aneurysm was 55mm, and he lacked a right kidney. A crossed ectopic kidney was fused to the lower part of the left kidney. On preoperative examinations, only one feeding artery to the ectopic kidney separated from the right common iliac artery. However, laparotomy confirmed the presence of three aberrant renal arteries, the middle one of which was very slim. Aneurysmectomy and a bifurcated artificial graft replacement was performed. After proximal anastomosis, the two larger aberrant renal arteries were reconstructed under renal protection with intermittent infusion of cold Ringer's solution. The smallest aberrant renal artery was ligated. Postoperatively, this patient recovered without any complications. In operations for abdominal aortic aneurysm associated with renal anomaly including ectopic kidney, horseshoe kidney, and pelvic kidney, it is important to elucidate the anatomy of aberrant renal arteries preoperatively, and reconstruct as many of these arteries as possible. This report is apparently the fourth on abdominal aortic aneurysm associated with crossed ectopic kidney.

We encountered a rare case of a 75-year-old woman who fell into right ventricular failure and shock with a comparatively rapid course due to a huge primary right atrial angiosarcoma occupying the right atrium. An emergency surgical excision of the tumor was performed and the right atrium was reconstructed with an EPTFE patch under cardiopulmonary bypass. On account of the positive margin, postoperative radiotherapy was added. There was no local recurrence, but adjuvant chemotherapy was performed for multiple lung and liver metastases 14 months after surgery. Primary cardiac angiosarcomas are extremely rare and have dismal prognoses. Although a complete surgical resection is the cornerstone of treatment, multidisciplinary therapy may improve patient outcomes.

We analyzed the causes of death in 74 non-insulin-dependent diabetes mellitus (NIDDM) patients who died in Koseiren Takaoka hospital between 1982 and 1988 and compared with 334 non-diabetic dead patients.
The first cause of death in NIDDM was malignant neoplsma (35.1% of NIDDM). The second was ischemic heart disease (17.6%). The third was infection (12.2%). The ratios of cerebral infarction and diabetic nephropathy were 9.5% each. The ratios of ischemic heart disease and cerebral infarction in diabetics were twice those in non-diabetics. The tratio of uremia in diabetics wassix-fold. In patients over 61 years old, the ratios of ischemic heart disease and diabetic nephropathy were large. Nevertheless, in patients under 60 years old, the proportion of cerebral infarction was higher. The proportions of cerebral infarction and ischemic heart disease were higher in the group of long diabetic duration than in group of short duration.
Compared with past Japanese reports, the proportions of malignant neoplasma and ischemic heart disease in diabetics increased and the proportions of diabetic nephropathy and coma decreased.
This study concluded that not only the control of diabetes mellitus but also the examination of malignant neoplasma was important in management of diabetes mellitus. The proportion of the causes of death in diabetics will change with changes of the circumstances and the progress of medical treatment.

A 72-year-old woman underwent a double aortic valve replacement with the Freestyle aortic bioprosthesis and subcoronary implantation with the Mosaic mitral bioprosthesis because of rheumatic multivalvular heart disease in 2000. During her annual follow-up, her Sinotubular junction was observed to have gradually increased in diameter on echocardiography and computed tomography. Therefore, 9 years after surgery we performed a reoperation for severe aortic regurgitation. Intraoperatively, the stentless bioprosthesis was found to be structurally intact. We believe that the dilation of the Sinotubular junction associated with a stentless bioprosthesis in the subcoronary position have caused her severe aortic regurgitation.

A 78-year-old woman underwent mitral valve replacement (MVR) with bioprosthesis in 1984. By 1997 the valve had become dysfunctional and was replaced with a Mosaic valve. Dyspnea on exertion occurred in 2005 and a systolic murmur was detected at that time. Echocardiography revealed severe mitral regurgitation (MR). The mitral valve was replaced for the third time. The explanted valve showed commissural dehiscence at the stent position and calcified leaflets. The mitral valve of a 70-year-old man was replaced with a bioprosthesis in 1986, and again with a Mosaic valve in 1997 because the original bioprosthesis had become dysfunctional. Seven years later, a systolic murmur appeared and echocardiography revealed severe MR. The valve was replaced for the third time. A leaflet tear was found in the removed valve. The Mosaic valve is a third generation porcine bioprosthesis that reportedly has excellent long-term durability. However, in these cases, the Mosaic valves deteriorated prematurely, and no obvious causes of this early structural deterioration could be identified. Continued long-term follow up is necessary, and the possibility of premature deterioration should be considered when selecting bioprostheses.

Vasculo-Behçet disease (VBD) is a special type of Behçet disease (BD) involving some vascular disorders like aneurysmal formation, arterial occlusion, and venous thrombosis in various vessels. VBD has a poor prognosis due to aneurysmal rupture or recurrence of vascular disorders despite optimal treatment. However, definite diagnosis in BD is made on the basis of clinical features, and early diagnosis is difficult. We report 2 patients whose first clinical symptoms were femoral-pseudoaneurysms. They received a diagnosis of VBD after surgery. The first patient was a 69-year-old man, who underwent autologous-vein patch closure of a perforated region in the left femoral artery. One year later, he had a pseudoaneurysm of the right profunda femoris artery, which was ligated. The second patient was a 51-year-old man, who underwent the interposition of the saphenous vein for defective artery due to left superficial femoral-pseudoaneurysm.

This study was designed to evaluate the optimal surgical treatment strategy for abdominal aortic aneurysm (AAA) coexisting with coronary artery disease (CAD). Twenty-six patients (21 men and 5 women with a mean age of 72.6±3.7 years old) who required surgical treatment of both conditions were examined. Eleven patients underwent a one-stage operation. Four of them had on-pump CABG and 7, including 3 high-risk-patients, underwent off-pump CABG. There were no operative mortalities, but 3 patients had severe morbidity (respiratory failure, acute renal failure, pneumonia). Fifteen patients underwent a two-stage operation. None of them had rupture of the AAA during the interval between the two operations, but 2 patients with large AAA (more than 6cm in diameter) required emergency operation due to impending rupture of the AAA. There was no operative mortality, but one patient suffered acute renal failure. One-stage operation for low-risk patients seems to be a safe and reasonable strategy. One-stage operation for high-risk patients should be performed cautiously, and off-pump CABG is especially useful in such patients.

Objective: Uterine carcinosarcoma (UCS) is uncommon high-grade endometrial cancer with limited treatment options. We evaluated the prognostic significance of human epidermal growth factor receptor 2 (HER2) expression and HER2 gene amplification within large cohorts of UCS, and clarify clinicopathologic characteristics of HER2-low UCS. Methods: We examined HER2 protein expression in 148 patients of UCS using in vivo diagnostic HER2 immunohistochemistry (IHC) kits and HER2 gene amplification using fluorescence in situ hybridization (FISH) in 72 patients. Results: HER2 IHC score was evaluated according to the latest American Society of Clinical Oncology/College of American Pathologists criteria for gastric cancer, which was negative in 41 patients, low expression of 1+ was observed in 57 patients, and HER2 high expression was observed in 50 patients (2+ in 38 and 3+ in 12 patients). There was no significant statistical difference in clinicopathological characteristics based on HER2 protein expression status.HER2 negative and low expression compared to high expression revealed poor overall survival in stage I/ II. The concordance between IHC and FISH results were relatively low compared to other cancer types (HER2 IHC score 1+, 2+, and 3+ were 5%, 15%, and 50%), and combining these results was not efficient as a prognostic factor in UCS. In contrast, the HER2 IHC score alone was a prognostic factor in stage I/II UCS. HER2 low group did not show specific clinicopathologic features. Conclusion Since the HER2 IHC score low in advanced UCS is a predictive factor, stratification of UCS using HER2 IHC score for HER2 IHC score low group and developing adjuvant therapy may be proposed in the near future.

Objective: Uterine carcinosarcoma (UCS) is uncommon high-grade endometrial cancer with limited treatment options. We evaluated the prognostic significance of human epidermal growth factor receptor 2 (HER2) expression and HER2 gene amplification within large cohorts of UCS, and clarify clinicopathologic characteristics of HER2-low UCS. Methods: We examined HER2 protein expression in 148 patients of UCS using in vivo diagnostic HER2 immunohistochemistry (IHC) kits and HER2 gene amplification using fluorescence in situ hybridization (FISH) in 72 patients. Results: HER2 IHC score was evaluated according to the latest American Society of Clinical Oncology/College of American Pathologists criteria for gastric cancer, which was negative in 41 patients, low expression of 1+ was observed in 57 patients, and HER2 high expression was observed in 50 patients (2+ in 38 and 3+ in 12 patients). There was no significant statistical difference in clinicopathological characteristics based on HER2 protein expression status.HER2 negative and low expression compared to high expression revealed poor overall survival in stage I/ II. The concordance between IHC and FISH results were relatively low compared to other cancer types (HER2 IHC score 1+, 2+, and 3+ were 5%, 15%, and 50%), and combining these results was not efficient as a prognostic factor in UCS. In contrast, the HER2 IHC score alone was a prognostic factor in stage I/II UCS. HER2 low group did not show specific clinicopathologic features. Conclusion Since the HER2 IHC score low in advanced UCS is a predictive factor, stratification of UCS using HER2 IHC score for HER2 IHC score low group and developing adjuvant therapy may be proposed in the near future.