A 62 year-old man presented with severe septic shock complicated by prosthetic graft infection, 7 years after aortic root replacement with a Freestyle stentless valve and graft replacement of the ascending aorta. We initially managed the patient with antimicrobial therapy for 2 months and subsequently surgery was performed, replacing the infected aortic graft with rifampicin-bonded prostheses, and added omentopexy. The infection was cured and has not recurred.

OBJECTIVEThe aim of our study was to explore the relationship between a medium-scale earthquake and maternal depression and child-rearing in a depopulated community in the Noto Peninsula of Japan.

METHODSThree months after a major earthquake, self-rating questionnaires were distributed to women who were pregnant at the time of the earthquake or who became pregnant immediately thereafter, and who were receiving care at any of four major hospitals in the most devastated area. A total of 155 women who had given birth returned the completed questionnaire for analysis. Maternal postnatal depression among the participants was assessed using the Edinburgh Postnatal Depression Scale (EPDS).

RESULTSThe EPDS score was significantly associated with decreased "satisfaction with delivery" (beta = -0.28, p = 0.01), increased artificial "lactation" (beta = 0.31, p = 0.002), and increased "trouble with infant care" (beta = 0.47, p < 0.001) in multivariate analysis. It was also significantly associated with increased "anxiety about earthquakes" (beta = 0.30, p = 0.001), and "anxiety about earthquakes" was significantly associated with increased "fear of the earthquake" (beta = 0.20, p = 0.04).

CONCLUSIONSEarthquake-related factors such as "anxiety about earthquakes" and "fear of the earthquake" did not have a direct effect on child-rearing factors; however, they did have a significant relationship with increased EPDS. Based on these results, we conclude that screening strategies for maternal depression in peri- and postnatal women under emergency circumstances are necessary.

A 66-year-old man was referred to our hospital for the treatment of a right subclavian artery aneurysm. Computed tomography showed a 35-mm aneurysm in the right subclavian artery, and occlusion of the right internal carotid artery. A surgical approach with maintenance of intracranial blood flow was required. During anastomosis of the graft to the native vessel, we clamped the distal and proximal portions of the right subclavian artery, to maintain the blood flow of the right common carotid artery. The INVOS® cerebral oximeter (Somanetics Corp., Troy, MI, USA) was useful in determining the clamping site and surgical strategy. The procedure was completed without complications, and the patient was discharged from the hospital on postoperative day 8 following a good clinical course.

A 71-year-old man with Behçet's disease was admitted to our hospital for treatment of a thoracic aortic aneurysm. On admission, there was marked inflammatory response, but blood culture was negative and there was no significant accumulation of gallium scintigraphy. The aorta was shaggy and there were two aneurysms in the descending aorta. We performed endovascular aortic repair for this aneurysm in consideration of the inflammatory aortic aneurysm. After treatment, the patient had paraparesis, however he underwent physical rehabilitation to regain function. He was followed up for 1 year and remains in good clinical condition without anastomotic aneurysm, dilatation or aneurysm at another site.

Alkaptonuria is a rare genetic disease, in which amino acids and tyrosine cannot be processed. A 72-year-old man with a history of aortic valve stenosis presented with coronary 3-vessel disease. Intraoperative findings included ochronosis, which is pigmentation caused by the accumulation of homogentistic acids in connective tissues, or on the severely calcified aortic valve, the intima of the aorta, and the coronary arteries. The pigmented region of the coronary arteries had significant stenosis. Aortic valve replacement and coronary artery bypass were performed. From these findings and his past history of arthritis, we diagnosed alkaptonuria. The patient had an uneventful recovery.