We report a case of redo aortic valve replacement by right minithoracotomy approach for aortic stenosis after coronary artery bypass grafting (CABG). An 81-year-old man was followed-up once a year for 9 years after CABG. He complained of increasing respiratory distress, showed narrowing of the aortic valve area, elevation of the aortic valve pressure gradient, and tricuspid valve regurgitation by echocardiography. He was admitted for surgery. We considered minimally invasive operation would be better for him and performed aortic valve replacement (Carpentier-Edwards Perimaunt valve 19 mm) by a right minithoracotomy approach because graft injury could occur by median sternotomy after CABG, and he had the risks of advanced age, low activities of daily living, and mild dementia. His postoperative course was uneventful. On echocardiography performed at postoperative days 9, the ejection fraction recovered to 75% from 53% before surgery and the mean aortic valve pressure gradient was 8 mmHg. He was discharged on postoperative day 12. Right minithoracotomy approach with port access is a good option for redo operation for aortic valve stenosis after CABG.

Bilateral lesions damaging the primary auditory cortex or the auditory radiation may cause auditory agnosia. We describe a 67-year-old woman with auditory agnosia after bilateral thalamic hemorrhage. Initially, she showed subcortical deafness for words and environmental sounds. Pure tone audiometry showed a moderate-to-severe hearing loss (mean hearing level, right 56 dB ; left 57 dB), while the recording of auditory brainstem response was normal. Brain CT demonstrated a hematoma in the left thalamus and a narrow low density area suggesting a sequel of the right thalamic hemorrhage. Hearing training was begun using sound sources that were easily recognizable for the patient. Her recognition was better for words than for individual Japanese vowel or consonant-vowel sounds, and the use of lip reading contributed to her better recognition of words. After 2 months, she was able to communicate with medical staff and family members in daily conversation.

Alpha-fetoprotein-Producing gastric cancer is associated with poor prognosis because of frequent liver and lymph node metastasis. We present a case with synchronous liver metastasis who survived for 5 years. A 69-year-old man with upper abdominal pain was referred to our hospital. Gastrointestinal endoscopy revealed a Borrmann II-like tumor in the lower part of the stomach. Computed tomography revealed a tumor in the left lobe of the liver. Serum alpha-fetoprotein levels were markedly increased. We performed distal gastrectomy after administering oral tegafur/gimeracil/oteracil potassium and administered hepatic intra-arterial cisplatin injection. Liver metastasis showed partial response on computed tomography. Despite left hepatic lobectomy, further metastases to the liver and mediastinal lymph nodes became difficult to control. After sorafenib tosylate administration, stabilization of the disease was observed for 4 months. We conclude that hepatic intra-arterial chemotherapy and oral administration of sorafenib tosylate may potentially improve the prognosis in such cases.
Abdominal Pain ; Administration, Oral ; alpha-Fetoproteins ; Cisplatin ; Endoscopy, Gastrointestinal ; Gastrectomy ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Niacinamide ; Phenylurea Compounds ; Potassium ; Prognosis ; Stomach ; Stomach Neoplasms

Objective：The number of heart failure （HF） patients is increasing in Japan as its population continues to age, but little is known about current medication strategies. We investigated the relationship between medication changes during hospitalization and the readmission rate among older Japanese patients with new-onset HF.Design：Retrospective cohort study.Methods：We analyzed medical record data from Toho University Medical Center Omori Hospital between March 2004 and April 2018. Initial admissions for new-onset HF in patients aged≥75 years were examined (n＝329). The class Ⅰ recommended medications stipulated in the JCS 2017/JHFS 2017 guidelines were used as the target medications for this study. Patients with dose titrations or additions of the target medications during hospitalization (dose titrations or additions group) were compared with patients without these changes (the other group). The primary outcome was readmission due to HF within one year of discharge. A hazard ratio, adjusted for potential confounders, was estimated using a Cox proportional hazards model.Results：There were 231 patients in dose titrations or additions group and 98 patients in the other group.The one-year readmission rate was 26.5％ in dose titrations or additions group and 31.8％ in the other group. The adjusted hazard ratio of medication changes for readmission was 0.82 (95％ confidence interval, 0.51-1.33, P＝0.415), but was not statistically significant.Conclusion：The older HF patients in dose titrations or additions group showed a reduced risk of readmission, but lacked significance due to low statistical power.