A 57-year-old female was admitted for severe back pain. CT, aortography and transesophageal echocardiography showed enlargement of the ascending aorta with large entry and dissection of the descending thoracic and abdominal aorta with entry located at the distal arch. She had left leg ischemia due to a narrow true lumen. Using cardiopulmonary bypass with circulatory arrest and cervical perfusion, the ascending aorta and arch were replaced and three cervical vessels were reconstructed. A stent graft was inserted into the descending aorta and anastomosed to the distal end of the graft and native aorta. There were no postoperative complications. Postoperative CT showed no leakage at the stent graft attachment. This surgical stent graft operation for chronic type A and acute type B dissection was a relatively minimal invasive and effective method.

An 84-year-old woman was admitted on an emergency basis for dyspnea and cyanosis. Large left ventricular aneurysm with uncontrollable ventricular tachycardia was diagnosed. After intubation and intraaortic balloon pumping insertion, ventricular aneurysmal exclusion with patch plication (Dor's method) was successfully performed. The postoperative course was uneventful and the patient was discharged 2 months after the operation. Left ventricular function improved and ventricular tachycardia disappeared. The patient is now doing well with (NYHA functional class 2) eight months after the operation.

At Anjo Kosei Hospital, all staff has been working concertedly on a project to establish a community hospital in line with our future vision. Hospital staff in charge of the Medical Affairs Division has been involved in measures aimed at achieving the slogan “health and happiness of local residents” as part of this project. To address this, three goals were set as follows: improvement of recoveries in accounts receivable management, a reduction of money held in trust, and a decrease in the number of outsourced transactions. To achieve the goals described above, the following specific measure were carried out: (1) collection of accounts receivable using convenience store settlement; (2) collection of high-cost medical expenses by wider use of Eligibility Certificates for Ceiling-Amount Applications and promotion of the Major Medical Cost Loan System for national health insurance holders; and (3) support in acquiring family registration for nonregistered family members and for health insurance benefits. Recoveries of accounts receivable through convenience store settlement was about 90,000 yen/month, and our support activities for family registration and health insurance benefits provided the recoveries of about 80,000 yen/month. Furthermore, the promoted use of the certificate and loan system resulted in recoveries of about 17 million yen/year. The average commission fee and number of outsourcing was 890,188 yen and 12 cases, respectively, from April to August 2016. However, in 2017, it was 305,615 yen and 10 cases, respectively. Our project aimed at achieving slogan-elicited patient voluntary payment of medical expenses, leading to improved recoveries, with reduced money held in trust and fewer outsourced transactions.