A 77-year-old woman was referred to our hospital for treatment of a ruptured thoracoabdominal aortic aneurysm (TAAA) with a maximum diameter of 7cm. Considering her age and level of daily activity, the placement of an endovascular stent graft was performed as an emergency rescue procedure. For termination of the endoleak from the distal portion of the stent graft detected by CT the next day, another stent graft placement was added after establishment of blood supply to the superior mesenteric and celiac arteries by placing a Y-shaped graft from the abdominal aorta to each artery with success. The patient was discharged from our hospital 25days after surgery with disappearance of endoleak and good graft patency. A hybrid technique with grafting to abdominal branches, followed by placement of stent graft, can be an alternative treatment for such high-risk patients with ruptured TAAA.

The purpose of this study was to examine the effect of two kinds of neck muscle training on the isometric cervical extension strength (ICES) and cross-sectional area (CSA) of the neck extensor muscles.The subjects which were examined consisted of 22 male college judo athletes. Each was assigned to one of three groups: shrug and upright rowing training (SU); shrug, upright rowing and dynamic neck muscle training (COM); and control (CONT). The SU and COM groups trained 3 days per week for 9 weeks. The ICES and CSA of the neck muscles were measured before and after muscle training.The ICES of the COM group showed a significant increase after training. For the CSA, although a significant increase was only found in a superficial area of the neck extensor muscles in the SU group, the COM group showed significant increases in all areas.This study determined that combined neck muscle training is effective for developing the neck extensor muscles.

The purpose of this study was to examine the effects of dynamic neck muscle training using a cervical extension machine (CEM) on isometric cervical extension strength (ICES) and a cross-sectional area of neck extensor muscles.Subjects were 18 male college judo athletes divided into a control group (n=10) and training group (n=8), respectively. In the training group, dynamic neck muscle training was performed for a 6 week training period, followed by a 10 week training period. There was a detraining period of 12 weeks between the first training period and the second. The ICES was measured at eight angles using a CEM, and the neck muscle cross-sectional area was determined using magnetic resonance imaging.The ICES and cross-sectional area of neck extensor muscles in the training group showed significant increases after the second training period. In particular, the increase in the cross-sectional area was greater in the deepest layer of the neck extensor muscles (rotator, multifidus and semispinaris cervicis muscles) than in the superficial layer (trapezius muscle). In the control group, no significant changes in ICES or cross-sectional area were observed.In conclusion, it was shown that dynamic neck muscle training using a CEM was effective in developing both ICES and the cross-sectional area of neck extensor muscles, especially in the deepest layer.

A 68-year-old woman with a diagnosis of atrial septal defect (ASD) presented with dyspnea. Chest radiography demonstrated cardiomegaly and infiltration in both lungs, suggestive of cardiac decompensation due to ASD. Detailed evaluation with transthoracic echocardiography revealed a mobile tumor on the aortic valve. Intraoperatively, tumors were identified on all aortic cusps. Preservation of the aortic valve was difficult. We therefore performed aortic valve replacement and patch closure of the ASD. The existing literature suggests that mobile papillary fibroelastoma should be excised irrespective of size, to prevent the risk of embolism. Excision of the tumor alone is usually sufficient. However, the present case showed clustered tumors on the aortic valve, so preservation of the cusps could not be achieved in this case.

It has been proposed that transgenic mosquitoes can be used as a “flying syringe” for infectious disease control. We succeeded in generating a transgenic (TG) mosquito, Anopheles stephensi, excreting and discharging DsRed in saliva. DsRed was deposited on the membrane where the TG mosquito probed with its proboscis. Repeated feeding by the TG mosquitoes induced anti-DeRed as well as anti-SG antibodies in mice. This indicates that the TG mosquitoes can immunize the animal. Moreover, in this report, we employed a pre-immunization method before exposing mice to the TG mosquitoes. We injected DsRed to mice to prepare memory B cells and exposed the mice to bites by the TG mosquitoes excreting DsRed. The mice produced a higher titer of antibody to DsRed, suggesting that the bites from TG mosquitoes act as a booster and that primary immunization with a vaccine protein and exposure to TG mosquitoes excreting the vaccine protein in the saliva produces a synergistic effect.

An 84-year-old man, who had been given a diagnosis of advanced aortoventricular block 2 years previously, underwent implantation of a pacemaker (PM) through the left subclavian vein. However, 7 months later a skin ulcer developed at the implantation site, but without any evidence of bacterial infection. Therefore, a PTFE-covered PM battery was reimplanted at the same site. Three months later, the skin ulcer recurred and he received a third implantation in the right side. However, another skin ulcer with infection developed in the right side. He was then transferred to our hospital for another PM reimplantation. We covered the battery and the entire lead with PTFE, then placed the PM lead directly into the cardiac muscle, and implanted the PM battery below the rectal muscle under general anesthesia. A patch test 4 months later revealed a positive reaction to nickel and silicon. Finally, we diagnosed pacemaker dermatitis. The patient has remained free of skin ulcers for over 1 year.

The purpose of this study was to examine the relationship between isometric cervical extension strength and the cross-sectional area (CSA) of neck extensor muscles in order to obtain fundamental data for conducting neck muscle training to prevent neck injuries. Subjects were 8 males belonging to the judo or American football club in N University. Isometric cervical extension strength was measured at eight positions (0°, 18°, 36°, 54°, 72°, 90°, 108°, maximum flexion) using a cervical extension machine (Medx Inc., USA) . A transaxial magnetic resonance imaging (MRI) image of neck muscles was obtained at the intervertebral disk between C4 and C5 (using an MRI machine made by Hitachi medical Corp., JAPAN) . The findings were as follows.
1. The correlation between isometric cervical extension strength at 36°, 54°and 72°in a neutral position (60.8±1.4°) and the CSA of neck extensor muscles were higher than at other degrees (0°, 18°, 90°, 108°, maximum flexion) . In particular, there was a significant linear relationship at 54° (slightly extended position) .
2. A significant linear relationship was observed between the neck girth and CSA of neck extensor muscles.
In conclusion, there was a closer relationship between isometric cervical extension strengths at certain angles in a neutral position and the CSA of neck extensor muscles. Therefore, it was shown that isometric cervical extension strengths at certain angles in a neutral position mainly represented the CSA of neck extensor muscles.

Objective: To identify the clinical and epidemiological characteristics of pernicious anemia (PA) in patients treated at Miyagami hospital on Tokunoshima Island.

Methods: We evaluated 14 patients with PA who were enrolled and treated from March 2009 to May 2014.

Results: The majority of patients were older than 50 years of age and primarily consisted of elderly women. Routine medical examinations revealed macrocytic anemia in 6 of the 14 patients (43%), although they were clinically asymptomatic and subsequently diagnosed with PA. The average number of patients per year was reported to be 3 (95% confidence interval [CI]: 1.25-3.42).

Conclusions: The annual incidence of PA per 100,000 individuals on Tokunoshima Island is possibly much higher than that previously reported in Japan. An increase in the elderly population, a negligence of the disease, and an ethnic and regional diversity may explain this discrepancy. As the annual incidence of PA may be higher than that previously reported, anemia must be carefully evaluated in the differential diagnosis of PA.

Type II endoleak after stent graft for abdominal aortic aneurysm generally permits a wait-and-see approach, however, additional second therapy is necessary if the aneurysm increases. A 78-year-old woman had undergone endovascular treatment with a stent-graft for abdominal aortic aneurysm. Computed tomography (CT) 3 months after the operation showed type II endoleak, and enlargement of the aneurysm was noted at 1 year. She underwent transarterial embolization for third and fourth lumbar arteries, but endoleak from the fourth lumbar artery remained, and the aneurysm was further enlarged. Surgical conversion was performed 2 years after the first operation. We applied a ligature to the forth lumbar artery by a laparotomy. Postoperative CT revealed disappearance of the endoleak. As endovascular treatment for abdominal aortic aneurysm is increasing and the number of cases necessitating additional therapy appears to be rising, we need to develop processes and strategies for coping with endoleaks.