Introduction: Patients often refer to information on the Internet when selecting a medical institution, and some patients provide feedback on their experiences. In this study, we analyzed the content of patients' evaluations of medical institutions on Google.Methods: This study evaluated Google reviews and ratings of medical institutions in Shizuoka Prefecture. We coded the reviews with 12 items according to their content, and further categorized them into "positive," "negative," "unclassifiable," and "no description." We used modified Poisson regression analysis to investigate the relationship between ratings and assessment items.Results: Our sample consisted of 2,044 medical institutions. The number of reviews included in the analysis was 13,769. Reviews frequently commented on "doctor's behaviors," and positive comments about doctor's behaviors were significantly associated with high ratings (B: 0.76, 95%CI: 0.70 to 0.82), whereas negative comments were associated with low ratings (−4.65, −5.24 to −4.06).Conclusion: Within the reviews on Google, doctors' behavior had an impact on the ratings of medical institutions.

A 71-year-old man who had undergone repair of a ruptured abdominal aortic aneurysm with a tube graft 3 months ago was transferred from another hospital with an Aortoenteric Fistula (AEF) for surgical treatment. Computed tomographic (CT) angiography revealed pseudoaneurysm formation at the proximal anastomotic site. Waiting for the elective operation, he developed massive hematemesis with shock. Endovascular stent-graft repair was emergently performed because of high risk for conventional open surgery. Gastrointestinal bleeding was successfully controlled. The psuedoaneurysm disappeared, which was confirmed by postoperative CT angiography. At 1-year follow-up, he has shown no clinical and radiographic evidence of recurrent infection or bleeding. For the case with shock, Endovascular repair could be a bridge to open surgery because it is fast and minimally invasive. Endovascular repair of AEF is technically feasible and may be the definitive treatment in selected patients without signs of infection and gastrointestinal bleeding.

Fifteen consecutive patients with true or dissecting aneurysms of the thoracic descending aorta, and thoraco-abdominal aorta were operated upon under left thoracotomy with the support of partial cardiopulmonary bypass, equipment composed of a membrane oxygenator, centrifugal pump, and percutaneous thin wall cannulae which were all coated with covalently bonded heparin. The polyvinyl tube was coated with Biomate. The administration of systemic heparin was determined by an ACT of around 200 seconds. One perioperative death in a case treated by emergency operation for a ruptured descending aortic aneurysm occurred due to acute myocardial infarction. Other patients tolerated their operation well and are alive. No thromboembolic accident, bleeding tendency, nor organ failure were observed postoperatively in any other patients. In conclusion, the cardiopulmonary bypass using an antithrombotic circuit is safe and recommendable for thoracic descending or thoraco-abdominal aneurysm operations.