Right pulmonary artery-left atrial communication is a rare congenital heart disease that is usually diagnosed before adulthood, and its main symptoms are cyanosis and dyspnea on exertion. We report a 51-year-old man with a large aneurysm of the right pulmonary artery and left atrial communication, which was diagnosed after a brain abscess. We are concerned that simple ligation alone may cause embolism, so we report on the use of an autologous pericardial patch to close the opening to the left atrium.

Background: Invasive pneumococcal disease (IPD) is an infectious disease where Streptococcus pneumoniae can be detected in the cerebrospinal fluid or blood.Methods: Eight patients presented to our hospital with adult IPD. We compared with 69 cases of pneumococcal pneumonia treated in our department between 2012 and 2014. None of the patients had a history of pneumococcal vaccine administration.Results: Hematological examination showed the platelet count was significantly lower and the serum C-reactive protein level was significantly higher in the IPD group. There was a significant difference in the use of a respirator and mortality in the IPD group. About antibiotics, Carbapenem and quinolone were used for the treatment of many patients in the IPD group. In the fatal three cases of IPD, the age of all members were 65 years or younger. Two of three had no underlying disease.Conclusion: IPD develops without elderly people and in those without underlying disease. Also, the patients who took a sudden course may result in death. In line with previous studies that have reported the effectiveness of the pneumococcal vaccine, our study findings emphasize the need of administering vaccination for prevention of IPD in person who was younger than 65 years old.

We report the successful treatment of a rare case of chronic expanding hematoma and visceral pericardium thickening constrictive pericarditis with no history of trauma or surgery. A 70-year-old woman, who had no history of trauma or surgery was admitted for exertional dyspnea. An echocardiographic study demonstrated a mass located anterior to the right ventricle that severely compressed the right ventricle toward the ventricular septum. Enhanced chest computed tomography demonstrated pericardial calcification and a 125-mm heterogeneous mass in the middle mediastinum. A mosaic pattern was seen on T1, T2-weighted magnetic resonance imaging. Surgical resection of the mass and removal of the visceral pericardium were planned to treat heart failure and to confirm the diagnosis of the mass. The mass was old degenerated coagula. Histopathological examination confirmed the diagnosis of chronic expanding hematoma. The postoperative course was uneventful. There has been no sign of recurrence 19 months after the operation.

A 62-year-old man with Marfan syndrome had a modified Bentall procedure and total arch replacement for annuloaortic ectasia, aortic insufficiency and thoracic aortic aneurysm fifteen years ago at another hospital. A follow-up CT revealed bilateral coronary artery aneurysms and an aortic root pseudoaneurysm, and thus he was referred to our hospital. The previous prosthetic valve was removed, followed by the re-Bentall procedure. Coronary artery aneurysms were resected and consequently coronary arteries were reconstructed directly. Although the shortcoming of the Bentall procedure was pseudoaneurysm, the outcomes of the modified Bentall procedure have shown some improvements. However, as there is still a high risk of postoperative complication in connective tissue diseases, long-term follow-up is required.

We report on an apparently healthy woman in her 50s who noticed pain in the left side of her neck anteriorly and was prescribed an antimicrobial agent at a nearby clinic. However, she developed hypotension and hypoxemia and was brought to our hospital. Laboratory investigations revealed evidence of inflammation, and imaging findings showed low-density areas corresponding to the left lobe of the thyroid gland. The low-density areas extended to the superior mediastinum, raising suspicion of a thyroid gland mediastinal abscess. We performed inferior mediastinal drainage with video-assisted thoracoscopic surgery and resection of the left lobe of the thyroid gland. Culture of mediastinal aspirate yielded Streptococcus viridans. Based on these findings, the final diagnosis was descent-related mediastinitis secondary to acute suppurative thyroiditis.

An 82 year-old-woman was referred to our hospital because of infiltrative shadow of the lingula in 201X. She was asymptomatic, so we followed up with imaging observation. After 1 year, the infiltrative shadow had progressed, so we performed bronchoscopy. Glandular epithelium with the mild aberrant type was detected, but did not lead to a definitive diagnosis. There was increased eosinophilic compartmentalization of immune response in the bronchoalveolar lavage, so we started treatment with corticosteroids for chronic eosinophilic pneumonia. However, there was no improvement of the shadow. Subsequent computed tomography-guided lung biopsy revealed evidence of papillary adenocarcinoma.

From April 2009 to April 2017, we experienced on average 40 cases of spontaneous pneumothorax per year at our hospital, but we encountered only 2 cases of nontraumatic hemopneumothorax over the entire 8-year period. In one of these cases, we performed transcatheter artery embolization. Extravasation of contrast media was observed on CT near the apex of the lung, and angiography revealed the culprit vessel. We performed embolization and were able to achieve hemostasis and symptomatic improvement. However, hemopneumothorax recurred as a result of adhesion tear due to re-collapse of the lung and required surgical treatment. In this report, we describe our experience of this relatively rare condition and discuss the case with reference to the literature.

A woman in her 60s was being treated for diabetes and hypertension but had impaired activities of daily living (ADL) due to severe obesity (150 kg). She was transported to the emergency department because of disturbance of consciousness in August 201X. Imaging findings showed decreased permeability of the whole right lung field. She was intubated and started on ceftriaxone plus levofloxacin for severe infection with respiratory failure. Erysipelothrix rhusiopathiae was detected in blood cultures, leading to a diagnosis of sepsis due to a large pressure ulcer on the posterior aspect of the thigh. We switched levofloxacin to clindamycin and continued medical treatment, and she was extubated on the 10th day of illness. However, type 2 respiratory failure was prolonged because of alveolar hypoventilation due to obesity and she required noninvasive positive pressure ventilation. Also, she had difficulty getting out of bed due to obesity, disuse syndrome, and pressure ulcer. Cooperation among staff from many professions, including respiratory nursing, intensive care nursing, wound, ostomy and continence nursing, physical therapy, and nutrition management, led to improvement of ADL and weight loss (to 109 kg), allowing her to be transferred out of the intensive care unit.

The purpose of this study was to explore issues arising from the promotion of collaboration between general practitioners (GPs) and community pharmacists in the management of leftover medicine. The 2016 Revision of Medical Fee newly added the check boxes in the prescription form in which a physician requests the correspondence of a pharmacy when confirming leftover medicine. In this study, we conducted a questionnaire survey among GPs in three wards of Tokyo in the month of November 2016. Of the 1,256 clinics queried, 283 responded to the survey. Among those GPs responding, 86.6% were concerned about leftover medicine of their patients, while 29.3% used the check boxes. GPs who received an explanation about the change of the prescription form demonstrated a significant increase in the use of the check boxes, compared to GPs who did not (p<0.01). Of the GPs surveyed, 71.0% thought that the check boxes were an advantage in recognizing medicines that the patients did not take. An overall 67.5% of the GPs who used the check boxes revised prescriptions based on the information from pharmacists. The study suggests that by increasing collaboration between GPs and pharmacists, the information from pharmacists could be utilized to revise prescriptions and lead optimization of drug treatment.

The purpose of this study was to examine the effects of knee flexion angles during maximum isometric hip extension. Ten healthy men performed maximum isometric hip extension in prone position at 15° and 90° knee flexion. Then, the hip extension torque was measured, and electromyographic (EMG) data were obtained from the biceps femoris long head, semitendinosus, semimembranosus, adductor magnus, and gluteus maximus muscles. The EMG data were full-wave rectified and integrated (IEMG). The IEMG values obtained during the measurement of isometric hip extension were normalized with the values collected at 90° knee flexion (normalized IEMG [NIEMG]). The hip extension torque at 15° knee flexion was significantly greater than that at 90° knee flexion. The NIEMG values from the hamstrings at 15° knee flexion significantly increased compared with those at 90° knee flexion. Meanwhile, the NIEMG values from the gluteus maximus at 90° knee flexion were significantly greater than those at 15° knee flexion. However, the NIEMG values from the adductor magnus did not significantly differ between 15° and 90° knee flexion. These results indicate that the hamstrings effectively generate contracting force during isometric hip extension and at knee extended position because its fiber length was close to the optimal length.