Constrictive pericarditis is usually a chronic inflammatory process. We encountered a case of acute constrictive pericarditis caused by infectious pericarditis in a patient receiving pericardial drainage for pericardial effusion. We performed emergency pericardiectomy and primary closure in the active phase of infection. An 82-year-old man was referred to our hospital for investigation and management of pericardial effusion. The patient was admitted, and continuous pericardial drainage was performed. After 2 days of drainage, he had fever, and after 7 days, there was purulent exudate in the drain tube. Methicillin-sensitive Staphylococcus aureus was identified by culture of the purulent exudate. Despite administration of antibiotics, he developed malaise, anorexia, and generalized edema, and he also began to suffer from dyspnea. Computed tomography demonstrated infected pericardial effusion, while a right ventricular pressure study showed a “dip and plateau” pattern. Pericardial drainage and irrigation were done via a small subxyphoid skin insicion. However, his hemodynamics did not improve and oliguria was noted. Because more extensive drainage was necessary, we performed emergency on-pump beating pericardiectomy via median sternotomy. Along with administration of antibiotics, continuous mediastinal irrigation with saline was done via mediastinal, pericardial, and chest drain tubes for 7 days after the operation. His postoperative course was relatively uneventful, and he was discharged after recovery.

A 76-year-old male was admitted to our hospital because of melena. However, no remarkable findings of rupture were shown by enhanced CT scan and angiography. On the 9th day of admission, he fell into a state of shock because of sudden massive bloody intestinal discharge. Colonofiberscopic findings revealed a primary arterio-enteric fistula. Therefore, an emergency operation was undertaken. Following aneurysmectomy, colostomy was performed in the descending colon. Right axillo-femoral artery bypass was finally performed as an extra-anatomical bypass to secure the right leg blood flow.

A 55-year-old man was admitted with anterior chest pain. He had received aorto-renal bypass for left renal artery stenosis at the age of 24. His coronary angiography with ergotamine malate provocation showed 99% stenosis in the left anterior descending artery and circumflex artery and abdominal aortography revealed an aneurysm with a diameter of 4cm at the proximal site of the graft anastomosis. The patient was surgically treated with aneurysmectomy and PTFE grafting (7mm) between abdominal aorta and the already-implanted graft to the left renal artery. His postoperative course was uneventful and no major complication such as renal failure were observed. Anastomotic aneurysm is a fairly common complication associated with arterial reconstruction which is most common in the common femoral artery. This is the first reported case of anastomotic aneurysm complicated by aorto-renal bypass.

A 54-year-old man consulted our hospital because of nocturnal and mild exertional chest pain. Echocardiography demonstrated a mobile mass in the right atrium. There were no abnormal findings on the coronary angiogram. Because of the large size of the mass, surgical removal was carried out and a yellowish, globular tumor, sized 20×15×13mm, attached to the anterior tricuspid leaflet with a short stalk was excised. Postoperative recovery was uneventful. The patient was discharged from the hospital with no symptoms. The diagnosis of papillary fibroelastoma (PFE) was confirmed on histologic examination. PFE is a well-known tumor that usually arises on the heart valves. Although, historically, this tumor has incidentally been discovered at necropsy, clinical case reports have recently increased. However, the vast majority of clinically reported PFEs were the cases of the left side of the heart, for which the operative indication is quite definite because of serious complications such as cerebral or myocardial infarction caused by this tumor, irrespective of size. On the contrary, only a small number (17 cases) of the right heart PFEs have been reported in the literature and its operative indications are unclear. Review with regard to the operative indications for the right heart PFEs was made based on the total of 18 cases including our patient.

A case of clinical1y unsuspected nonspecific inflammatory aortic regurgitation is reported. A 69-year-old female patient underwent aortic valve replacement for aortic regurgitation. Pathological examination of resected aortic valve showed abscess formation and inflammatory granulation tissue in the non-coronary cusp. Therefore, we diagnosed nonspecific inflammatory aortic regurgitation. It is generally considered that the use of prednisolone for vasculitis syndrome is effective ; however, for nonspecific inflammatory aortic regurgitation its use has not been established. Prednisolone treatment could be an option for nonspecific inflammatory aortic regurgitation.

Objective: To evaluate the efficacy and safety of niraparib in Japanese women with heavily pretreated ovarian cancer. Methods: This Phase 2 open-label, single-arm study enrolled Japanese women with homologous recombination deficiency-positive relapsed, high-grade serous ovarian, fallopian tube, or primary peritoneal cancer who had completed 3–4 lines of therapy. The starting dose of niraparib was 300 mg administered once daily in continuous 28-day cycles until objective progressive disease, unacceptable toxicity, consent withdrawal or discontinuation. The primary endpoint, objective response rate (ORR), was assessed by the investigator using RECIST version 1.1. Safety evaluations included the incidence of treatment-emergent adverse events (TEAEs), including serious TEAEs. Results: Twenty women were enrolled and the confirmed ORR in the full analysis set (FAS) was 35.0% (7/20), consisting of 1 complete response and 6 partial responses. Disease control rate in the FAS was 90.0%. The most frequently reported TEAEs (>50%) were anemia, nausea, and platelet count decreased. One patient (5.0%) had TEAEs leading to discontinuation of niraparib whereas reductions or interruptions were reported in 14 (70.0%) and 15 (75.0%) patients, respectively. The median dose intensity (202.9 mg daily) corresponded to a relative dose intensity of 67.6%. Conclusion Efficacy and safety of niraparib in heavily pretreated Japanese women was comparable to that seen in an equivalent population of non-Japanese women. No new safety signals were identified.