A 67-year-old man receiving treatment for choledocholithiasis was found to have an abdominal aortic aneurysm on CT. The maximum diameter of the aneurysm was 60mm, and the isthmus of a horseshoe kidney was also observed. A total of four renal arteries, two each on the right and left sides, was detected by angiography and helical CT. Two of four arteries bifurcated from the aneurysm. Laparotomy confirmed the presence of a fifth renal artery, which extended from the left common iliac artery to the isthmus. It was not difficult to free the isthmus from the aneurysm. A Y-shaped prosthesis was placed between the normal portion of the aorta and the common iliac arteries without severing the isthmus. The left renal artery arose from the aneurysm and was reconstructed with 6mm knitted Dacron. The right renal artery, which was located below the isthmus, was ligated. The absence of postoperative renal dysfunction confirmed the patency of the reconstructed renal artery. Eleven such cases have been reported in Japan, including the present case. In 5 cases, renal artery reconstruction was performed, and the isthmus was preserved in 8 cases. However, the sites of renal artery bifurcation were correctly detected preoperatively in only 3 of these patients. It appears that accurate preoperative imaging is very important, along with renal artery reconstruction.

Since malaria vaccine development is slow and parasite resistance to anti-malarial drugs is developing rapidly, vector control is still the most practical method for reducing malaria transmission in developing countries. House spraying and treated bed nets have been popular control measures targeting indoor resting mosquitoes; however, chemical insecticides should be treated and managed with great care. In this proposed study, we will evaluate the efficacy of bacterial larvicides combined with environmental management strategies for controlling malaria vectors and transmission in western Kenya. These control methods are less harmful to the environment. The article describes the study design and methods.

We report one case of bullous pemphigoid that did not respond to the standard western medical treatment with topical and oral steroid therapy. This case achieved complete remission after the application of Yizongjinjion seihijoshitsuinkagen (Yizongjinjion Qing Pi Chu Shi Yin Hua Cai), a spleen-dampness-eliminating beverage. The patient was a 78-year old female who had soy bean or 5 mm to 25 mm sized blisters covering a wide area of her back since two years ago. She had visited a neighborhood physician who diagnosed her with bullous pemphigoid and initiated the standard treatment. Although some improvements were observed after the start of western medical treatment, her symptoms eventually grew worse. Therefore, she visited our clinic and requested the traditional Chinese treatment. We diagnosed her skin blisters as the heart-fire spleen-dampness type of bullous pemphigoid using the four diagnostic examinations, and treated her with the modulated spleen-dampness-eliminating beverage which resulted in a complete remission within 10 months. Taken together, our results suggest that the modulated spleen-dampness-eliminating beverage (Yizongjinjion seihijoshitsuinkagen) is effective for the treatment of the heart-fire spleen-dampness type of bullous pemphigoid.
Pemphigoid, Bullous ; therapeutic aspects ; Spleen ; Yin ; Beverages

Ulcer developed on the left leg of a 47-year-old man, in 1989, and phlebography showed deep vein thrombosis extending from the politeal to the common femoral vein. Subfascial ligation of the perforators achieved healing of the ulcers. In November 1991, at the age of 52 years the patient noticed a pulsatile mass on the right side of his neck. CT scanning showed a carotid artery aneurysm 4cm in diameter. Angiography indicated that the aneurysm was located at the bifurcation of the carotid artery. In February 1992, reconstructive surgery was performed with a Dacron graft, but an anterile abscess developed around the graft. In September 1992, the graft was removed and the carotid artery was ligated. Only seven cases of carotid aneurysm associated with Behçet's disease have previously been reported in Japan. Five of them underwent reconstructive surgery and two of them underwent carotid ligation due to complications. Because of the clinical course of Behçet's disease, carotid aneurysmectomy without reconstructive surgery may be the procedure of choice.

No abstract available.
Aorta, Thoracic ; Transcatheter Aortic Valve Replacement

A 31-year-old woman infected with severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) at 33-weeks pregnant was subject to cesarean delivery due to a worsening respiratory condition. On the fourth day of illness, the patient was placed on a ventilator, with extracorporeal membrane oxygenation (ECMO) treatment initiated on the ninth day. Passive range of motion (ROM) training started on the day 33 of illness. She was weaned off ECMO on day 55 of illness and taken off of the ventilator on day 8. The tracheostomy tube was replaced with a speech cannula on day 87 of illness, at which time the patient began to complain of pain during passive ROM training. Plain X-ray photography and computed tomography (CT) showed ossification around the bilateral shoulder and hip joints, as well as on medial thighs, accompanied by an alkaline phosphatase (ALP) value of 942 U/L. She was subsequently diagnosed with heterotopic ossification, after which passive ROM training was changed to protective ROM training, in addition to treatment with indomethacin farnesyl and etidronate disodium. The patient was transferred to our hospital on day 122 of illness for the purpose of continuing rehabilitation. On day 155 of illness, ossification decreased on the medial thighs, according to CT. She was able to walk independently indoors and was discharged home on day 181 of illness. This case demonstrates the importance of checking the ALP levels and palpating the periarticular area in patients infected with SARS‑CoV‑2 before initiating passive ROM training, as well as being aware of any pain experienced during training. In the case of any abnormalities, assessing the ossification around the joints of extremities by imaging examination is a priority.