A 50-year-old man had undergone an initial original Bentall operation 19 years previously and replacement of the descending thoracic aorta 3 years previously. Computed tomography and an angiogram revealed a distal arch aneurysm and an ascending aortic aneurysm, neither of which had been detected 3 years previously. Detached anastomosis of the distal site and both coronary ostia were confirmed in the operation. Redo aortic root replacement and total arch replacement were performed successfully. His postoperative course was excellent.

A 70-year-old woman, who had a history of a percutaneous transvenous mitral commissurotomy for rheumatic heart disease 34 years previously, was admitted with progressive right heart failure. Massive calcification of the left wall was observed on multidetector CT. She underwent a mitral valve replacement, tricuspid annuloplasty and permanent pacemaker implantation. Massive calcification of the left atrial wall is a rare condition, and constitutes a major complication and risk to mitral valve surgery because of the difficulty in entering the left atrium, potential embolization, and impaired hemostasis.

This paper presents the case of a man in his 70's with local advanced bladder cancer with hospital-developed Fournier's gangrene. The patient was hospitalized at the palliative care unit, and drainage with incision of the scrotum for symptom relief was performed to relieve severe pain. The patient experienced pain only during changing of the wound's dressing and no pain at rest after the operation. Furthermore, he reached his birthday and spent time in peace with his family. Fournier's gangrene is the necrotizing fasciitis of perineal and anal lesions, in which inflammation progresses rapidly in wide lesions, and it is associated with a high mortality rate. For Fournier's gangrene in a terminally ill patient, current agreement might depend on the patient's goal of treatment. The drainage provided for spiritual care of the patient and his family as well as pain relief. In conclusion, local drainage for Fournier's gangrene can be feasible as a choice of palliative treatment. Palliat Care Res 2011; 6(2): 340-343

An 11-year-old boy experienced right flank pain on October 12, 2005. The pain was once alleviated but recurred on the following day, and the patient visited our hospital on October 13, 2005. An imaging study revealed a tumor, sized approximately 12.0 × 7.5 × 8.0 cm, in the right kidney without metastases, for which right nephrectomy was performed. The tumor was solid, although degenerative necrosis and hemorrhage were partially observed inside the tumor. A histopathological study revealed poorly-defined, almost round tumor cells which were strongly stained with vimentin but not with cytokeratin or epithelial membrane antigen (EMA). Based on these findings, a diagnosis of clear cell sarcoma of the kidney in Stage II was made. A review of 10 previous cases reported in Japan during the past 10 years revealed that the affected patients were mostly aged 1 month to 4 years, while our case, occurring in an 11-year-old patient, was uncommon in respect to age.
Neoplasms ; Japan ; Procedures on Kidney ; Cases ; Review of

Superior mesenteric artery (SMA) aneurysms (SMAAs) are rare and account for approximately 7% of all visceral artery aneurysms. If the anatomical complexity permits and the patency of organ perfusion is allowed, then an endovascular approach is the first choice for minimally invasive procedures. We report the case of a 92-year-old female with a giant SMAA and challenging anatomy, including a short proximal sealing zone from the origin of the SMA and a short distal sealing zone from the hepatic artery bifurcation. In view of her advanced age, she was treated endovascularly with covered stents. Reintervention was required to correct a postoperative endoleak; however, a favorable outcome was achieved with endovascular therapy.

Introduction: Mirtazapine is a noradrenergic and specific serotonergic antidepressant (NaSSA) and the previous reports show that may reduce nausea by inhibition of the serotonin 5-HT3receptor. Case report: A 38-year-old woman with advanced renal cancer with distant metastases was administered by sunitinib and oxycodone. Refractory nausea and vomiting developed during the course and mirtazapine at a daily dose of 1.875 mg was begun. The patient's nausea improved during the next day, and furthermore, by increasing the daily dose to 3.75 mg, vomiting was also improved on the third day. The therapy could be continued without withdrawal of sunitinib and oxycodone due to digestive symptoms. Although somnolence might be induced at a daily dose of 15 mg, the present low-dose mirtazapine could improve digestive symptoms without somnolence. Conclusion: We conclude that low-dose mirtazapine is one effective option for refractory nausea and vomiting during administration of sunitinib and oxycodone.

Acute heart failure is associated with high mortality and frequent rehospitalization, resulting in enormous healthcare costs and declining physical function, activities of daily living, and quality of life. Cardiac rehabilitation has been recommended as one of the nonpharmacologic treatments for patients with heart failure. However, much of the evidence for cardiac rehabilitation interventions reported to date has been limited to chronic heart failure. In recent years, the effectiveness of rehabilitation intervention in patients with acute heart failure has been reported, led by the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial. This review overviews the recent evidence of rehabilitation in patients with acute heart failure.

Objective：To investigate the relationship between clinical assessment of pain and muscle activity during walking in patients with severe knee osteoarthritis (OA)．Methods：Eleven patients diagnosed as having severe knee OA (13 knees) were evaluated with electromyography and numerical rating scale (NRS) of pain during walking. Electromyography was recorded from the vastus medialis (VM), semitendinosus (ST), vastus lateralis (VL), and biceps femoris (BF) muscles. Co-contraction indexes (CCIs) for the extensor and flexor muscles of the knee joint were calculated as follows：using the VM and ST data for CCI at the medial aspect of the knee and the VL and BF data for CCI at the lateral aspect. Spearman's rank correlation coefficients between the average individual muscle activities or CCI and pain were calculated.Results：During the terminal stance of walking, NRS significantly correlated with the activation patterns of BF (r ＝－0.61, p＜0.05), the CCI of VL-BF (r ＝－0.582, p＜0.05), and the CCI of VM-ST (r ＝－0.596, p＜0.05)．Conclusion：This study suggests that pain severity is reflected in increasing CCI at the medial and lateral aspects during the terminal stance phase in severe knee OA.