A 67-year-old man who had undergone robot-assisted laparoscopic radical prostatectomy 16 days before suffered from high fever. A screening CT showed an aortic arch aneurysm was 40 mm in diameter, and Bacteroides fragilis was identified from blood culture. A few days after the first CT, the size of the aneurysm increased rapidly to 50 mm in diameter, subsequently an urgent procedure of total arch replacement using rifampicin-soaked Dacron graft was performed. Although the postoperative course was unremarkable, pyrexia recurred on the ninth post operative day. The third CT showed a new aneurysm in the thoraco-abdominal aorta just below the celiac artery. The second urgent procedure of graft replacement of the thoraco-abdominal aorta with the reconstruction of the celiac artery was performed. Preoperative FDG-PET/CT was useful to decide the level of the resection and the suture. The intravenous administration of the antibiotics continued for six weeks after surgery. The patient is doing well without any signs of infection on oral antibiotics at 7 months after the second surgery.

Introduction: This study assessed the changes in outpatient visits during the COVID-19 pandemic.Methods: Subjects were patients who visited the outpatient clinic of the Family Medicine Centre at Kanai Hospital between April and May in 2019 and 2020. We compared the number of outpatients, their age, and their reasons for encounter (RFEs) classified according to the International Classification of Primary Care, 2nd Edition between 2019 and 2020.Results: A total of 1159 patients in 2019 and 859 patients in 2020 were evaluated. There were 553 male patients in 2019 and 452 in 2020 (P =0.029). The mean age of the patients was 48.4 years in 2019 and 52.4 years in 2020 (P =0.010). The mean number of patients per day was 25.2 in 2019 and 17.9 in 2020 (P < 0.001), with a significant reduction in patients aged 0-4 years in 2020 relative to 2019 (3.64 in 2019 vs.1.02 in 2020; P < 0.001). On evaluation of RFEs classified by organic system, the proportion of respiratory RFEs decreased from 45.3% in 2019 to 31.6% in 2020 (P =0.026), and gastrointestinal RFEs decreased from 17.9% to 5.3% (P =0.003) among children. Among adults, the proportion of respiratory RFEs decreased from 22.6% in 2019 to 15.6% in 2020 (P < 0.001) and skin RFEs decreased from 20.1% in 2019 to 15.3% in 2020 (P =0.011).Conclusion: The number of outpatients decreased during the COVID-19 pandemic. There were differences in the proportion of RFEs between the two periods.

Low-profile fixation devices for medial opening wedge high tibial osteotomy (OWHTO) were developed in order to avoid skin irritation and additional invasion. However, the low-profile system is associated with additional risks. We report three cases of locking pin back out with the low-profile locking plate system for medial OWHTO.
Knee ; Osteotomy ; Skin