A false aneurysm in a coronary anastomotic region is known to be an important complication after a modified Bentall procedure. We report a successful case of a 40-year-old woman in whom we performed repair of a false aneurysm in the left main trunk (LMT), using transection of the main pulmonary artery. The modified Bentall procedure and coronary artery bypass grafting (CABG) on the right coronary artery had been performed 6 years earlier, with diagnoses of Marfan syndrome, annuloaortic ectasia, aortic regurgitation, aortic dissection (DeBakey type II), and right ventricular infarction. The patient was admitted with a syncopal attack, and we diagnosed a false aneurysm in the anastomotic region of the left coronary artery. Repair of the LMT and CABG on the left anterior descending coronary artery with the left internal thoracic artery (LITA-RAD) was performed. For repair of the LMT, we used a surgical approach using transection of the main pulmonary artery to create a favorable surgical field.

We describe a case where a thrombus was effectively removed with a 20 Fr argyle^® thoracic catheter (Nippon Sherwood Medical Industries Ltd.) and the life of the patient was saved by thrombectory for an acute pulmonary thromboembolism. The patient was a 43-year-old woman. Emergency operation was indicated by a severe acute pulmonary thromboembolism and intracardiac floating thrombi afte an orthopedic surgery. A 20 Fr thoracic catheter connected to a cleaning type intraoperative blood salvage device was used to remove thrombi in a pulmonary artery and a good result was obtained. The advantages of this catheter include: 1) suitable hardness; 2) a protective round tip; 3) an aperture at the tip for the suction of small or crushabe thrombi and the removal of thrombi having a certain level of hardness with the shape intact; and 4) adjustable flexion of the catheter to easily detect a peripheral pulmonary artery. However, care should be taken when using the catheter to avoid damage to pulmonary artery walls.

A 44-year-old woman in whom multiple descending aortic aneurysms with pseudocoarctation was diagnosed underwent graft replacement. The aneurysms consisted of two large and one small aneurysms. One of the large aneurysms was a fusiform type aneurysm (38mm in diameter), and another one was a saccular type aneurysm (53mm in diameter). There was a small saccular type aneurysm (12mm in diameter) the site of the at stenotic lesion, and the wall of the small aneurysm was very thin. Atherosclerotic changes were not found inside the aneurysmal wall. Aneurysm occurring at the proximal side of the stenotic lesions of pseudocoarctation are rare, and only four cases have been reported in Japan.

We report a case of rupture of the thoracic descending aorta due to blunt chest trauma. An 18-year-old man was transferred to our hospital after a car accident. He was in a state of shock. The admission chest X-ray film demonstrated mediastinal widening and blurring of the aortic arch. Chest and abdominal helical CT scan showed left hemothorax, pseudoaneurysm, and hematoma of the cervix, mediastinum, and retroperitoneal space. We diagnosed rupture of the thoracic descending aorta without other injuries. An emergency operation was performed under partial cardiopulmonary bypass with systemic heparinization. The descending aorta had completely lost its continuity. Graft replacement was performed with a collagen-sealed woven Dacron graft. The postoperative course was uneventful. We suggest that high awareness and a systematic approach are needed to diagnose traumatic aortic rupture, and that enhanced helical CT scanning is helpful for diagnosis and management strategy.

A 72-year-old woman complaining of lumbago was transferred to our hospital in a state of shock. An admission abdominal CT scan showed infrarenal aortic aneurysm reaching 8cm in maximal diameter and hematoma of the retroperitoneal space. A clinical diagnosis of ruptured abdominal aortic aneurysm was rapidly established. An emergency operation was performed under general anesthesia. Laparotomy disclosed an infrarenal abdominal aortic aneurysm and hematoma. The aorta was clamped just below the bilateral renal arteries. Straight graft replacement was performed. There was enough heparinization during the surgical procedure. Postoperative findings involved paraplegia and hypoesthesia from dermatome Th 10 with associated urinary and fecal incontinence. The patient was discharged from our hospital. Spinal cord ischemia is a rare and unpredictable complication in surgery of infrarenal abdominal aortic aneurysms. Presence of intra- and postoperative episodes of hypotension and the duration of the crossclamping seem to have been the most important factors for spinal cord ischemia in this case.

[Purpose] This study investigated the safety of acupuncture and moxibustion in Japan. A questionnaire about infection control was developed based on the “Guidelines on basic training and safety in acupuncture” published by the World Health Organization (WHO) in 1999.
[Method] The questionnaire was sent to the members of the Japan Society of Acupuncture and Moxibustion (JSAM) and the Japan Acupuncture and Moxibustion Association (JAMA) in August 2000 and in September 2001, respectively. The items on the questionnaire were “a clean working environment”, “clean hands of the practitioner”, “preparation of the needling sites”, “sterile needles and equipment, and appropriate storage”, “aseptic technique” and “careful management and disposal of used needles and swabs”.
[Result&Conclusion] The questionnaire response rate was 49.6% (443/894). The results suggest that approaches to infection control are better than those in our previous report in 1996. However, the rate of using disposable needles was still low and most acupucturists held the needle with bare hands during inserting. It is necessary to improve pre-and postgraduate education regarding safety in performing acupuncture and moxibustion, including the infection control.

An adult Japanese man who had just returned from Thailand developed dengue hemorrhagic fever (DHF). A primary infection of dengue virus (DENV) was confirmed, specifically DENV serotype 2 (DENV-2), on the basis of the detection of the virus genome, a significant increase in the neutralizing antibody and the isolation of DENV-2. DHF is often observed following a secondary infection from another serotype of dengue virus, particularly in children, but this case was a primary infection of DENV. Japan is a non-endemic country for dengue disease. In fact, only Japanese encephalitis (JE) is known to be a member of the endemic flavivirus family. In this study, IgG antibody against Japanese encephalitis virus (JEV) was detected. JEV belongs to the family of dengue virus and prevails in Japan, particularly Kyushu. Among many risk factors for the occurrence of DHF, a plausible candidate could be a cross-reactive antibody-dependent enhancement (ADE) mechanism caused by JEV antibody. This indicates that most Japanese travelers who living in dengue non-endemic areas, particularly Kyushu, should be aware of the occurrence of DHF.

A patient, an adultJapanese traveler who had just returned from Thailand, had developed denguehemorrhagic fever (DHF). A primary infection of dengue virus (DENV) wasconfirmed, in particular, DENV serotype 2 (DENV-2) via the detection of the virusgenome, a significant increase in its specific neutralizing antibody and the isolationof DENV-2. DHF is often observed following a secondary infection from another serotypeof dengue virus, particularly in children, but this case was a primaryinfection of DENV. Japan is a non-endemic country of dengue disease. Instead,only Japanese encephalitis (JE) is known to be an endemic flavivirus family. Inthis study, IgG antibody against Japanese encephalitis virus (JEV) was detected.JEV belongs to the family of dengue virus and prevails in Japan, particularly inKyushu. Among many risk factors for the occurrence of DHF, a plausiblecandidate could be a cross-reactive antibody-dependent enhancement (ADE)mechanism by JEV antibody. This indicates that most Japanese travelers, wholive in non-endemic areas of dengue, particularly in Kyushu, should payattention to the occurrence of DHF.

Autoimmune enteropathy (AIE) is a rare disease, characterized by intractable diarrhea, villous atrophy of the small intestine, and the presence of circulating anti-enterocyte autoantibodies. Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome, and mutations in FOXP3, which is a master gene of regulatory T cells (Tregs), are major causes of AIE. Recent studies have demonstrated that mutations in other Treg-associated genes, such as CD25 and CTLA4, show an IPEX-like phenotype. We present the case of a 13-year-old girl with CTLA4 haploinsufficiency, suffering from recurrent immune thrombocytopenic purpura and intractable diarrhea. We detected an autoantibody to the AIE-related 75 kDa antigen (AIE-75), a hallmark of the IPEX syndrome, in her serum. She responded well to a medium dose of prednisolone and a controlled dose of 6-mercaptopurine (6-MP), even after the cessation of prednisolone administration. Serum levels of the soluble interleukin-2 receptor and immunoglobulin G (IgG) were useful in monitoring disease activity during 6-MP therapy. In conclusion, autoimmune-mediated mechanisms, similar to the IPEX syndrome, may be involved in the development of enteropathy in CTLA4 haploinsufficiency. Treatment with 6-MP and monitoring of disease activity using serum levels of soluble interleukin-2 receptor and IgG is suggested for such cases.