Recently, many deaths while bathing in the home bath have been reported. During the winter season, hot water at a high temperature is commonly used for bathing. The circulatory system may thus be seriously affected by the hyperthermia load produced by undressing in a cold environment and subsequent bathing in a bathtub at a high temperature followed by a rapid temperature change due to exposure to cold air after bathing. However, death while bathing also occurs in the summer season.
From the cases of death while bathing in the summer season, we found commonality in terms of sex, age, water temperature, bathtub size, and causes of death.
The average age in all cases was 69.7. There were 47 male and 46 female deaths indicating an almost equal ratio. The average water temperature at the time of deaths while bathing was 40.7°C. The typical bathtub size was small, 750 to 900mm. In a small Japanese style bathtub, one must compress the body and therefore become more vulnerable to water pressure.
From these results, warming, drawing in of limbs, and effects of water pressure on the body may contribute to deaths while bathing in the summer season and also are factors produced by bathing throughout the year.

  A 59-year-old female was started on oral carbamazepine for her psychological disorder on April 21 2004. Four weeks later, she developed generalized erythemas on the trunk and extremities, and ran a high fever of 38°C. A physical examination showed erythroderma, and laboratory examination revealed liver dysfunction and hypereosinophilia. Three days after admission, a number of small pustules emerged on the erythrodermic backgrounds. The skin lesions were improved by the withdrawal of carbamazepine and systemic prednisolone (50mg per day). However, acute pancreatitis was also developed during the course. HHV-6 IgG was increased up to x1280 on June 17. Also, HHV-6 DNA was detected with two peaks during the therapy. DLST with carbamazepine showed a high titer of stimulation index. This case was unique in the acute generalized exanthematous pustulosis (AGEP)-like clinical appearance and the development of acute pancreatitis. HHV-6 DNA was increased with double peaks, which might suggest a “re-reactivation” of HHV-6 by carbamazepine.

We experienced a case that right massive pleural effusion was successfully controlled with Denver shunt from the right chest cavity to right femoral vein. A 80-years-old woman had received hemodialysis due to chronic renal failure twice in a week. She was diagnosed as right breast cancer and underwent right breast conserving surgery at December, 2008. In postoperative follow-up duration, she had difficulty in breathing and visited to the emergency room in our hospital. She was diagnosed as respiratory failure due to right massive pleural effusion from the X-ray result and the blood gas analysis. There was no pleural effusion within the left chest space. No malignant cell was detected in the effusion. We thought that diuretics and shunt tube from the right chest cavity to the abdominal cavity would be ineffective because of her chronic renal failure, and for that reason, we placed the shunt tuve from the chest cavity to the right femoral vein. Respiratory failure and the quality of life were successfully improved for about 7 months by using it. Palliat Care Res 2011; 6(1): 301-307

Infected aortic aneurysm is very difficult to treat and is associated with a high mortality rate. A 78-year-old man had been scheduled to undergo selective endovascular repair for distal aortic arch aneurysm. While standby, however, he was admitted to our emergency room because of hemoptysis. Rapid dilatation of the aneurysm shown on serial CT and elevated of inflammatory reactions yielded a diagnosis of infected aortic aneurysm. Because the aneurysm had ruptured into the left lung, emergency surgery was performed. Six days after the first operation, critical bleeding due to anastomotic disruption of the distal aorta caused by infection and subsequent cardiac arrest occurred. We immediately started open chest massage and controlled the bleeding manually in the ICU, while an operating room was prepared. In the redo operation, anastomotic disruption was repaired using the visceral pleura under deep hypothermic circulatory arrest. Anastomotic bleeding is a potentially life-threatening condition, therefore extremely prompt measures are vital. Appropriate management based on the assumption of anastomotic bleeding was very important in the postoperative course of this case of infectious aortic aneurysm.