A 6-year-old girl who had undergone repair of an endocardial cushion defect 4.5 years previously, developed discrete subaortic stenosis requiring surgical intervention. On two-dimensional echocardiography a membrane was visualized below the aortic valve. A pressure gradient of 97mmHg was recorded across the left ventricular outflow tract by cardiac catheterization. Operative findings showed a fibrous ring tissue just below the aortic valve, which was peeled away by sharp dissection. Postoperative cardiac catheterization revealed a 25mmHg pressure gradient across the left ventricular outflow tract. Two years later, she continues to do well and the pressure gradient remains unchanged on Doppler echocardiography.

We present a case of solitary arteriosclerotic aneurysm of the profunda femoris artery (PFA), which is very rare among peripheral aneurysms and a reviewed the 19 cases reported in the Japanese literature. A 78-year-old man had a chief complaint of a painful pulsatile mass in the left thigh. Enhanced CT showed the ruptured solitary aneurysm of the PFA. The aneurysm was 6.8cm in diameter. It was removed after ligation of the the PFA. In the Japanese literature, the mean age of patients with solitary arteriosclerotic aneurysm of the PFA was 73 (64-84), all patients were males, the rate of rupture of PFA aneurysm was 47%, and the mean diameter was 8.9cm. In our case, we simply ligated the aneurysm because the patient did not have any evidence of peripheral artery occlusive disease and the distal artery of the aneurysm was very small. However, there is a need to reconstruct the PFA whenever possible because the surgical importance of PFA in occlusive arterial disease has been recognized.

  We examined how difficult it would be for the elderly living in mountainous areas to go to the nearest hospital using a Voronoi tessellation representing the mathematical concept of neighborhood. We defined the index of the nursing-care capacity for the elderly as the ratio of the number of caregivers to the number of the elderly receiving nursing-care.
  The mean age of those who drive to the hospital by themselves worked out at 70±9.8 years. Meanwhile, that of those who go to the hospital by bus or taken to hospital in a car driven by a family member came to 80±7.0years. The latter was significantly older than the former.
  The areas of the Voronoi tessellation generated by patients' places of residence were divided into three groups according to the size. The plots of these three groups of the the places of residence on the map had a three-layer and doughnut-like structure, i. e., inner-, middle-, and outer-layer.
  The index of the nursing-care capacity in 2008 was less than 1.0 for the patients under 80 years of age. This means that when those who were at the age of 50 in 2008 become old and need nursing-care, access to the hospital will become harder to them than at present. For those who are over 80 years of age and live in the outer layer that is far away from arterial road, it will be almost impossible.
  These findings suggest that outpatient care with transportation assistance by a family member at present should be reconsidered because of the future lack of care personnel. It would also be necessary to consider the welfare of older people from the geographical point of view in order to manage the problems concerning the various physical and sociological difficulties of the elderly.