A 26-year-old man with Marfan's syndrome suffered aortic dissection repeatedly during hospitalization. He was admitted with a diagnosis of annuloaortic ectasia with severe aortic regurgitation. A type A aortic dissection occurred after diagnostic angiography. Three weeks after the onset of the dissection, an aortic root replacement in combination with a total arch replacement was performed. Eight months later, residual dissection in the descending thoracic aorta was replaced with distal perfusion by a temporary bypass from the left subclavian artery to the descending thoracic aorta. At the termination of the operation, abdominal aortic dissection occurred with acute bilateral limb ischemia, which was treated with abdominal aortic intimal fenestration. He recovered uneventfully and was discharged 3 weeks after operation. In light of our experience, because of vascular fragility, great care should be taken in treating patients with Marfan's syndrome to avoid iatrogenic aortic dissection.

Treating a thoracic aortic aneurysm (TAA) after coronary artery bypass graft (CABG) surgery requires an appropriate surgical procedure to preserve the functional graft. We present a case of hybrid procedure of thoracic endovascular aortic repair combined with a redo off-pump CABG via median sternotomy. The patient was a 76-year-old man with a history of CABG and abdominal aortic replacement in a different country. Chest computed tomography revealed a saccular-shaped aortic aneurysm in the distal aortic arch with diameter of 5.6 cm. Coronary angiography revealed theLIMA graft was patent but anastomosed to the diagonal branch and the left anterior descending artery (LAD) was totally occluded and was opacified through the right coronary artery. Significant ischemic change in the anteroseptal wall suggested a requirement of surgical revascularization of LAD. The chest was opened via re-midsternotomy. Then the 3 arch vessels were reconstructed with a trifurcated artificial graft attached to the ascending aorta and coronary artery bypass grafting was performed on the beating heart. Finally, the aneurysm was excluded by introducing a stent graft through the graft to zone 0. The patient's postoperative course was uneventful and he was discharged on postoperative day 16. A hybrid procedure via median sternotomy was useful in the surgery for TAA with the functional LIMA after CABG.

This study aimed to investigate the changes in physical function, fatigue, and psychiatric symptoms in patients with hematological malignancy undergoing chemotherapy and low-intensity exercise training. Sixty-two hospitalized patients with hematological malignancy undergoing chemotherapy and low-intensity exercise were recruited. At the time of exercise initiation and hospital discharge, grip strength, knee extension muscle strength, maximum walking speed, Eastern Cooperative Oncology Group (ECOG) performance status, a measure of functional independence, cancer fatigue pain, and hospital anxiety and depression were evaluated. When longitudinal data were analyzed in each group, changes in grip strength and knee extension muscle strength were unevenly distributed: some patients showed a decrease in knee extension strength. On the other hand, maximum walking speed, the measure of functional independence, and ECOG performance status were maintained or improved in more than 90% of the patients. Results of fatigue, anxiety, and depression tended to show an improvement in female patients, but not in male patients. In conclusion, physical function was maintained in nearly all patients with hematological malignancy undergoing chemotherapy and low-intensity exercise training. Sex differences were found in changes of fatigue, anxiety, and depression.

Objective: This study aimed to investigate the effectiveness of an intervention that applied a behavioral change approach to the usual rehabilitation for patients with hematological malignancies undergoing chemotherapy. Methods: Patients with hematological malignancies undergoing chemotherapy were divided into two groups: patients who underwent conventional rehabilitation (control group, n=12) and a counterpart who received a behavioral change intervention with feedback on motor function and physical activity (feedback group, n=13). We analyzed the changes in motor function and physical activity between the two groups from the start of rehabilitation to discharge. Results: There were a significant difference in walking speed between baseline and discharge. Changes in weekly steps were significantly higher in the feedback group than those in the control group. Conclusion: A behavioral change intervention with feedback on motor function and physical activity may improve voluntary exercise in patients with hematological malignancies undergoing chemotherapy.

Objective: This study aimed to identify factors associated with fatigue in patients with hematological malignancies undergoing chemotherapy. Method: A total of 90 patients with hematological malignancies undergoing chemotherapy were enrolled in this study. Simple regression analysis was performed using total, physical, emotional, and cognitive fatigue as dependent variables. On the other hand, the patient’s sex, age, blood test findings, physical function, activities of daily living (ADL), performance status, presence or absence of anxiety or depression, physical symptoms, and nutritional status were used as independent variables. Multiple regression analysis was conducted with the items that showed significant differences in the simple regression analysis as independent variables. Results: Multiple regression analysis with total fatigue as the dependent variable identified depression as an associated factor. Additionally, physical fatigue was noted to be associated with pain and depression, while emotional fatigue was reported to be associated with ADL and depression. Conclusion: Our results suggest that patients with hematological malignancies who have symptoms of fatigue should be managed taking in consideration possible causes of their fatigue, such as depression, pain, and ADL.

Purpose: This study aimed to understand the details of osteoporosis treatment for cancer patients provided by designated cancer hospitals. Methods: This web-based survey included questions on the evaluation and treatment of osteoporosis in cancer patients provided by physicians in the departments of urology, gynecology, hematology, respiratory medicine, respiratory surgery, gastroenterology medicine and gastroenterology surfery. Results: The gynecology, hematology, breast surgery, and urology departments had high rates of bone densitometry and prescriptions of osteoporosis treatment for cancer patients. The most frequently used selection criteria were age, hormone therapy, and steroid use. Conclusion: Osteoporosis treatment and associated selection criteria for cancer patients is different in each department, so we need to educate the evaluation and treatment of cancer treatment-induced bone loss.

Objective: This study aimed to clarify the details of inpatient cancer rehabilitation interventions provided by designated cancer hospitals in Japan. Methods: This questionnaire-based survey asked specialists regarding the outline of their facilities’ inpatient cancer rehabilitation, Dietz classification, disease, and intervention details. Results: Restorative interventions were the most common, and the most common cancer was lung cancer followed by colorectal cancer; hematologic malignancy; gastric cancer; and liver, gallbladder, and pancreatic cancer. Intervention proportions for colorectal and gastric cancer were significantly higher in general hospitals than in university hospitals and cancer centers; in contrast, those for hematological malignancy were significantly higher in university hospitals than in general hospitals. For bone and soft tissue sarcomas, intervention proportions in cancer centers were significantly higher than those in university and general hospitals; and for oral, pharyngeal, and laryngeal cancers, they were significantly higher in university hospitals and cancer centers than in general hospitals. The most common intervention was walking training, followed by resistance training, basic motor training, activities of daily living training, and respiratory rehabilitation. Respiratory rehabilitation was performed significantly more frequently in university and general hospitals than in cancer centers.Conclusion: The diseases had differed according to the characteristics of the facilities, and the interventions were considered accordingly. In future, it will be necessary to verify the effectiveness of inpatient cancer rehabilitation according to facility characteristics and to disseminate information on inpatient cancer rehabilitation.