A 68-year-old woman with distal arch aortic aneurysm was admitted. Preoperative magnetic resonance angiography revealed occlusion of the right middle cerebral artery. Single photon emission computed tomography showed decreased cerebral blood flow at rest and decreased reactivity to acetazolamide in the right temporal lobe. At first, a superficial temporal artery to middle cerebral artery anastomosis was made by neurosurgeons. Improvement of both the cerebral blood flow and the reactivity to acetazolamide was confirmed by single photon emission computed tomography 18 days after the operation. Twenty-two days after the operation, a total arch replacement was performed. The postoperative course was uneventful without any neurological complication.

Left ventricular (LV) thrombus is an uncommon primary disease, but following acute myocardial infarction (AMI) it is a common complication associated with a risk of systemic embolism. Especially if the thrombus is ball-shaped, there is a higher risk of systemic embolism. We reviewed 4 cases of thrombectomy including 1 with the acute phase of AMI and another with Takotsubo disease. Between January 2000 and August 2005, 4 consecutive patients underwent thrombectomy for ball-like thrombus in the left ventricle (all men, mean age 53.5 years). We performed thrombectomy through left ventriculotomy. In 3 patients ventriculotomy was repaired with direct closure with double PTFE felt reinforcement, and in the other large acute AMI with the infarction exclusion technique (Komeda-David) because the LV wall was remarkably fragile. All thrombi were ball-like and fresh (mean size 15.8mm). Concomitant coronary artery bypass grafting was performed in 3 cases, the Maze procedure in 2, and mitral annuloplasty (MAP) in 1. All patients survived and have been doing well without any major complications. Surgical thrombectomy is safe and can improve prognosis without systemic embolism. In the acute phase of AMI, the infarction exclusion technique is excellent to prevent bleeding and postoperative remodeling of the left ventricular wall.

We described here five patients with Alzheimer's disease (AD) who have behavioral and psychological symptoms of dementia (BPSD), and who have shown a remarkable improvement as a result of Yokukansan treatment. All five patients exhibited irritability and excitement, four of the patients suffered from aggression and insomnia, and three suffered from wanderings. All of the patients started recovering from these symptoms within 1-2 weeks from the start of the treatment, without any adverse reaction. In conclusion, our case study suggests that Yokukansan is a safe and effective treatment for AD patients with BPSD. Our study further suggests that Yokukansan is especially useful for patients who are difficult to treat with neuroleptics, such as patients with insomnia and wandering, patients exhibiting a depressive state as well as irritability and excitement, and those with physical symptoms, including gait disturbances and urinary incontinence.

Between January and December 2006, 3 patients with aortic abdominal aneurysm (AAA) receiving home oxygen therapy (HOT) and 20 patients without HOT were studied. The 3 patients with HOT were all men, the mean age was 72 years (range, 69-74), and they had been treated with HOT for 37.3 months (1-102) due to chronic obstructive pulmonary disease (COPD) with a mean %VC of 96.9% and FEV1.0% of 42.8%. Only the FEV1.0% value in the preoperative data was significantly lower than in patients without HOT. In the 3 patients with HOT, extubation was performed immediately after operation, and minitracheotomy tubes (Mini-trach^®) to control sputum were inserted in the operation room. The minitracheotomy tubes were removed 5 or 6 days after operation. Postoperatively, no one with HOT had any major complications, while in those without HOT one patient had ileus and another had prolonged intubation. There were no significant differences between the 2 groups in operative time, blood loss, blood transfusion, or hospital stay. In conclusion, based on detached preoperative close estimation and careful postoperative supervision, patients receiving HOT can undergo AAA operations as safely as those not receiving HOT.

Carcinoma arising from the remnant of branchial epithelium or branchial cleft cyst is known as branchiogenic carcinoma. It is very rare, and its existence is a matter of controversy. We report a case of cystic carcinoma of the upper neck that fully met Martin's criteria for branchiogenic carcinoma. A 53-year-old male visited Tsurumi University Dental Hospital with a swelling on the left side of the neck. Three tumors were excised from the neck, and histopathology revealed squamous cell carcinoma in a cystic lesion. As metastatic carcinoma of the cervical lymph nodes was suspected, the appropriate clinical tests and imaging were performed to determine the possible presence of a primary tumor. However, no primary carcinoma was found. These findings suggest that this was a case of branchiogenic carcinoma. The patient was treated with radiotherapy and followed up over an 8-year period. No evidence of recurrence was found.

Background: Rotavirus vaccines were introduced in Japan in November 2011. We evaluated the subsequent reduction of the health-care burden of rotavirus gastroenteritis. Methods: We conducted active surveillance for rotavirus gastroenteritis among children under 5 years old before and after the vaccine introduction. We surveyed hospitalization rates for rotavirus gastroenteritis in children in Tsu City, Mie Prefecture, Japan, from 2007 to 2015 and surveyed the number of outpatient visits at a Tsu City clinic from 2010 to 2015. Stool samples were obtained for rotavirus testing and genotype investigation. We assessed rotavirus vaccine coverage for infants living in Tsu City. Results: In the pre-vaccine years (2007-2011), hospitalization rates for rotavirus gastroenteritis in children under 5 years old were 5.5, 4.3, 3.1 and 3.9 cases per 1000 person-years, respectively. In the post-vaccine years (2011-2015), the rates were 3.0, 3.5, 0.8 and 0.6 cases per 1000 person-years, respectively. The hospitalization rate decreased significantly in the 2013-2014 and 2014-2015 seasons compared to the average of the seasons before vaccine introduction (p < 0.0001). In one pre-vaccine year (2010-2011), the number of outpatient visits due to the rotavirus infection was 66. In the post-vaccine years (2011-2015), the numbers for each season was 23, 23, 7 and 5, respectively. The most dominant rotavirus genotype shifted from G3P[8] to G1P[8] and to G2P[4]. The coverage of one dose of rotavirus vaccine in Tsu City was 56.5% in 2014. Conclusion: After the vaccine introduction, the hospitalization rates and outpatient visits for rotavirus gastroenteritis greatly decreased.