1.A Case of Thoracic Aortic Aneurysm Associated with Dysphagia, Hoarseness and Asthma-like Attack
Hiroki Matsunaga ; Hideki Mishima ; Susumu Ishikawa ; Akira Oshima ; Kyu Rokkaku
Japanese Journal of Cardiovascular Surgery 2017;46(1):49-53
A 69-year-old woman had dysphagia, hoarseness, and asthma-like symptoms such as cough and wheeze. Inhaled corticosteroids and long-acting β2 stimulants was not effective. Gastrointestinal endoscopy showed compression of the esophagus wall from outside. Enhanced computed tomography (CT) showed thoracic descending aortic aneurysm compressing esophagus and left lower lobe bronchus. Immediately thoracic endovascular aortic repair (TEVAR) was performed. After surgery, significant improvement of hoarseness and asthma-like attack was obtained at the time of 1 month after surgery. This is the first reported case of TEVAR which improved compression symptoms of both esophagus and bronchus due to thoracic aortic aneurysm in Japan.
2.Risk factor for difficult cases at the comprehensive consultation services about medical, welfare and legal problems
Michiki NARUSHIMA ; Chiaki ANDO ; Makoto MOCHIZUKI ; Osamu TERADA ; Hiroki SUZUKI ; Nozomi KANI ; Motoyoshi MATSUNAGA
Journal of Rural Medicine 2025;20(1):53-57
It is very important to cooperate with interprofessional personnel is in order to establish the community-based integrated care system, but this is very difficult. We have held comprehensive consultation services regarding medical, welfare, and legal problems to support the community.Objectives: This study aimed to identify the associations between background factors (such as medical conditions, intractable diseases, welfare problems, disabilities, economic difficulties, legal problems, elderly adults, children, and foreign persons) and difficult cases to provide more thorough consultation services.Patients and Methods: A survey was conducted on people who participated in comprehensive consultation services on medical, welfare, and legal issues related to medical care, welfare, and legal matters held from April 2021 to March 2024. We analyzed risk factors that may be difficult to resolve using multivariate logistic regression.Results: Multivariate analysis showed that the factor of “economic difficulty” was significantly more difficult to solve.Conclusion: When treating patients, doctors must consider the possibility of multiple underlying issues. It is advisable for doctors to be aware of the need to consult with social workers and legal professionals when necessary.