A 73-year-old woman complaining of increased dyspnea, but no shock, was admitted under an echographic diagnosis of right atrial tumor. Echo-cardiogram at the time of admission did not reveal the right atrial tumor, and a massive pulmonary embolus was detected a pulmonary arteriography. After the infusion of tissue plasminogen activator and heparin, pulmonary arterial systolic pressure was decreased from 66 to 43mmHg, and dyspnea was improved. However, repeated pulmonary arteriograms showed no change of the pulmonary embolus, thus emergency pulmonary embolectomy was indicated. Massive thrombi, which were suspected to have moved from the lower extremities, were successfully removed. During operation, the following critical events were encountered; shock during IVC taping and severe hypoxia immediately after the pulmonary revascularization. These problems were successfully controlled by partial extracorporeal circulation. Pulmonary pressure decreased to 25mmHg postoperatively and she is doing well with anticoagulant therapy.

We report a case of ulcerative colitis (UC) after mitral valve replacement (MVR) surgery due to infective endocarditis (IE). A 59-year-old woman underwent MVR for mitral regurgitation due to IE. Six days after the surgery, melena was observed suddenly, and she received a blood transfusion. Ulcer and erosion were observed in the rectum 5 to 10 cm from the anal ring by endoscopy. We changed her antibiotic treatment and stopped warfarin potassium. Heparin sodium was started 2 days after melena. We diagnosed ulcerative colitis from the finding of the rectal lesion and biopsy. We gave mesalazine and betamethasone as treatment for UC. The patient's condition improved and her general condition stabilized. She was discharged 36 days after surgery.

 The purpose of this study was to systematically review non-randomized controlled trials of balneotherapy effects on locomotorium diseases in order to assess their quality and organize the evidence.
 We searched the databases of PubMed, CINAHL, Web of Science, JDream ll, and lchushi-Web forpapers published from 1990 to December 2, 2008. Eligible studies were non-randomized controlled trials in which balneotherapy exclusive of underwater exercise was the primary intervention. There was no limitation on the language in which the paper was written.
 We found only 4 papers (2 in English, 1 in Croatian, and 1 in Japanese) that fulfilled the eligibility criteria. These papers differed in the type of diseases studied, so a meta-analysis could not be applied. Their individual results showed that hot springs treatment in combination with a comprehensive fitness class was more effective than hot springs treatment alone, and that balneotherapy had therapeutic effects on arthrosis deformans, psoriatic arthritis, and lumbago. However, it was difficult to accurately interpret the effects because these papers were deficient in providing descriptions of important details of the studies.
 To improve the quality of future investigations performed with non-randomized controlled trials, we suggest that investigators design a study based on various checklists, implement interventions, conduct evaluations, finally write papers summarizing their findings.

A 51-year-old man with osteogenesis imperfecta and who had aortic regurgitation was admitted to our hospital for aortic valve replacement. His height was 146cm and his weight was 49kg. The patient had suffered from bone fractures several times since childhood. Bone deformity, blue sclera and his status were clinically indicative of osteogenesis imperfecta. Aortic valve replacement with a 25mm SJM^® prosthetic valve was successfully performed for aortic valve insufficiency and slight annulo-aortic ectasia. Soft tissues and the sternum were fragile. Pathological examination (Elastica-Masson stain) of the aortic valve and left ventricular wall revealed a loss of fibrous tissues and remarkable thickening due to elastic fibers. The patient was discharged 31 days after surgery. Osteogenesis imperfecta is one of the collagen diseases caused by gene abnormality, in which fragile bones are easily fractured. Cardiovascular disease is rarely associated with it and the surgery-related mortality rate is reported to be approximately 30%, due to bleeding.