We recovered Giardia cysts from sewage and estimated the prevalence of giardiasis among inhabitants in Hyogo Prefecture, western Japan. Two 200-ml sewage samples were collected once a month from two different sewage plants (A and B) during a one-year period. After pretreating the samples by filtration and centrifugation in the presence of alcohol and diethyl ether, an immunomagnetic separation method was applied to isolate Giardia cysts. The mean number of cysts recovered from plants A and B were 880⁄L and 2,000⁄L, respectively. Circadian rhythms in the number of cysts detected on each of two examination days were observed with a peak at 10:00 a.m., and seasonal variations in cyst numbers were also observed with two peaks in May and December. By using the data obtained from this survey, we estimated that the prevalence of Giardia infection in habitants in the areas serviced by plants A and B were 0.1-1.1 and 0.1-1.3%, respectively.

A 31-year-old Japanese female came to our outpatient clinic because of a 15-year history of recurrent episodic chest pain accompanied by fever, each lasting for three days. The patient was diagnosed with familial Mediterranean fever (FMF) because of the following: 1) short attacks of fever recurring at varying intervals; 2) pleuritic chest pain accompanied by fever; 3) the patient's sisters had similar episodes of fever accompanied by abdominal or chest pain; and 4) absence of any other causative factors responsible for her symptoms or pathologic findings. Although FMF has been described primarily in several limited ethnic groups, only a few cases have been reported in Japan. No diagnostic tests are commercially available for FMF so identifying the characteristic clinical picture of FMF is important.

Endovascular treatment for chronic aortic dissection in patients with Marfan syndrome is still controversial. A 60-year-old man developed an extended chronic type B dissection involving the aortic arch and thoraco-abdominal aorta with a large entry at the distal aortic arch and patent false lumen. He had undergone David procedure for type A aortic dissection at age 42, and aortic valve replacement for recurrent aortic valve insufficiency at 58, which was complicated with mediastinitis. He also suffered drug-induced interstitial pneumonitis. Considering his complicated surgical history and impaired pulmonary function, conventional graft replacement of thoraco-abdominal aorta was thought to be quite a high risk. Thus, we chose debranch TEVAR with a staged approach. First, debranching and Zone 0 TEVAR with the chimney technique were performed. Then, 4 months later, abdominal debranching and TEVAR was performed. The patient tolerated both procedures well and was discharged home. Two years after last procedure, he is in good condition and computed tomography shows that complete entry closure and false lumen had thrombosed. This strategy may be worthy to be considered even for a patient with Marfan syndrome, in case the patient's condition is unsuitable for conventional surgery.

Folic acid contained in potato (Solanum tuberosum L.) tubers is concentrated in potato chips by dehydration during frying. It is a vitamin recommended to young women which helps protect fetus from congenital disease. Additionally, folic acid can lower plasma homocysteine concentrations, a known independent risk factor for cardiovascular disease. This study was designed to determine whether the dietary consumption of potato chips affect serum folic acid concentration and plasma homocysteine concentration in human subjects. Results showed a significant increase in serum concentrations of folate 1, 3, and 6 hours after ingestion. Vitamin B₆, on the other hand, increased significantly after 3 hours of intake. In contrast, plasma homocysteine concentration decreased significantly 6 hours after ingestion. These results suggest that potato chips would be a good dietary source of folic acid for humans.

A 31-year-old pregnant woman with no remarkable past medical history presented with mild hypoxemia, which worsened after she underwent cesarean section. To determine the cause of hypoxemia, we performed chest computed tomography after the cesarean section and found a pulmonary arteriovenous fistula of the A10-V10 shunt in the lower lobe of the right lung and V10 had expanded to 12 mm. Forty-nine days after giving birth, the patient underwent thoracoscopic right lower lobectomy. The results of blood gas analysis improved after surgery; before surgery, the partial pressure of oxygen was 66.4 Torr, which increased to 98.4 Torr after surgery. The patient was discharged on the ninth day after surgery. 　　Pulmonary arteriovenous fistula may be exacerbated by changes in cardiac output and circulating blood volume during pregnancy. If hypoxemia progresses after pregnancy, pulmonary artery fistula must be identified.

Patients with Behçet disease often develop postoperative valve detachment and pseudoaneurysm as a potentially fatal complication following aortic valve surgery, necessitating re-operation in a few cases. A 37-year-old man underwent 5 aortic valve and aortic root surgeries for the management of valve detachment after initial aortic valve replacement. Evaluation during the course of his disease revealed incomplete Behçet disease. He presented with high fever and Staphylococcus epidermidis bacteremia during the introduction of immunosuppressive therapy with infliximab. Contrast computed tomography revealed a pseudoaneurysm around the aortic root, and an aortic root replacement was performed using an aortic homograft after administration of a 6-week course of vancomycin. The patient is being observed at our outpatient clinic and has demonstrated no complications after 5 years from his last surgery.

A 67-year-old man developed the recurrence of postoperative constrictive pericarditis. He had two operation histories : the one was CABG for old myocardial infarction and the other was pericardiectomy for postoperative pericarditis at 57 and 59 years old respectively. Both operations were performed in our hospital. We used an ePTFE sheet for covering the heart in the pericardiectomy. The course post operation was good, but eight years after the pericardiectomy, he had abdominal distension and leg edema. Detailed studies revealed a recurrence of constrictive pericarditis, and reoperation was performed. The re-operative finding showed thickened sclerotic tissues on both sides of an ePTFE sheet which was applied to the cardiac surface during the previous surgery. No abnormal tissue was detected where the ePTFE sheet was not applied. The ePTFE sheet and the sclerotic tissues were removed under cardiopulmonary bypass support, and then diastolic dysfunction improved dramatically. His chest was closed without applying an ePTFE sheet. His post-operative course was uneventful and he was discharged on the 20th postoperative day. The ePTFE sheet was highly suspected as a cause of the recurrent constrictive pericarditis. An ePTFE sheet-induced constrictive pericarditis should be considered as one of the postoperative complications even in the mid and long-term period. The ePTFE sheet is useful for preventing heart or vascular injury when we perform resternotomy, but in rare cases, there is some possibility of association with a risk of pericarditis.