A 32-year-old woman was referred to our hospital during the 35th week of pregnancy because of chest pain and dyspnea. The cesarean section was performed and a healthy infant was delivered. On the 16th hospital day, she developed heart failure. Echocardiograms revealed protrusion of the mitral valve into the left atrium in systole, vegetation and worsening of mitral regurgitation. CT showed splenic infarction. Mitral valve replacement was performed after inflammatory findings were improved by antibiotics. We reported here a case of infective endocarditis during the perinatal period.

The lifetime incidence of cancer in women is about 50%, with some gynecological cancers increasing, and the prevalence of depression in patients is assumed to be about 12-25%1）. Depression is thought to affect not only suicide but also death from cancer2）, and it is important to provide psychological care to patients as survivors from the time they are diagnosed with cancer. Psychotropic drugs are often chosen for treatment, but side effects such as extrapyramidal symptoms, drowsiness, and constipation are observed, and the quality of life of cancer patients can be increasingly compromised.In this article, we report on seven cases of gynecological cancer survivors who experienced significant efficacy of kososan for the depression and anxiety resulting from stress they felt during various processes such as diagnosis, notification, treatment, recurrence, and best supportive care (BSC). Kososan is a qi-regulating formula, and its efficacy in improving depression has been described since ancient times. In particular, it can be widely used for qi problems of women with a deficiency pattern, and its application to gynecological cancer treatment is considered to be very useful.

Food and eating are of great significance to humans, as we are the only creatures that establish relationships and sustain a social network through food and eating. Recent studies revealed that patients with advanced cancer and their family members often experience complicated eating-related distress due to tumors themselves, side effects of cancer treatments, and negative impacts of cancer cachexia. Therefore, we suggested the importance of the integration of palliative, supportive, and nutritional care to alleviate eating-related distress among patients and family members, and the significance of the development of tools to measure their distress in supportive and palliative care settings. No care strategies for eating-related distress experienced by patients and family members have been established, and the development of an interdisciplinary psychosocial approach and integrative care is required. As such, we are planning to start a nutritional support and cancer cachexia clinic in the National Cancer Center, and disseminate a newly developed care program across Japan.

Patients with severe coronavirus disease 2019 (COVID-19) have poor prognosis, with many cases being difficult to treat and many reports of neurological complications in patients who have been in the intensive care unit for a long time. Rehabilitation of patients with severe COVID-19 is important；however, no rehabilitation program has shown effectiveness. Thus, this study aimed to investigate the effects of a rehabilitation program developed and used at our hospital for patients with severe COVID-19. We enrolled 28 patients with severe COVID-19 (age 61［23-88］years；female/male, 9/19, body mass index, 25.0［18.0-33.6］kg/m2). We assessed the medical research council scoring (MRC) of the patients at the time of entry and exit from the ordinary ward using Wilcoxon signed-rank tests. MRC was significantly improved after exiting the ordinary ward compared with that on entering the ordinary ward (43 vs. 50 points；P＜.001). Moreover, Barthel index improved significantly after exiting the ordinary (32.5 vs. 77.5 points, P＜.001). Therefore, our acute rehabilitation treatment for patients with severe COVID-19 may be effective in improving their muscle strength and daily living.

Placenta accreta spectrum (PAS) disorders may lead to massive postpartum hemorrhage but optimal treatment strategies have yet to be determined. This retrospective analysis involved 35 cases of PAS that occurred at our hospital between January 2014 and November 2021. Mean maternal age was 37 (21-43) years and 8 pregnancies were the result of assisted reproductive therapy. Fifteen patients had placenta previa, 12 had a history of cesarean delivery, and one had a history of PAS. Mean gestational age was 36 (26-41) weeks. Twenty deliveries were by cesarean section and 15 were vaginal deliveries. Mean blood loss was 2,970 (300-14,727) mL. Nine patients were treated by manual placenta removal, one of whom had a delayed hysterectomy because of bleeding. Eleven patients were treated by cesarean hysterectomy and 2 were treated by curettage. Thirteen patients were treated by conservative management, and in 3 of them, treatment was changed to curettage, abdominal placenta resection, or hysterectomy because of vaginal bleeding or intrauterine infection. Four patients thought to have PAS before delivery were treated by cesarean hysterectomy and the amount of bleeding was not severe. Conservative treatment for placenta accreta was successful in 10 patients (77%), and the uterus could be preserved in 12 women (92%). In cases thought to be PAS before delivery, if the placenta is not removed, cesarean hysterectomy should be selected. Conservative management tends to be selected in cases of PAS when the main part of the placenta can be removed. However, in cases of life-threatening hemorrhage or infection, clinicians might need to perform peripartum hysterectomy or uterine artery embolization when bleeding or infection occurs. Therefore, clinicians should obtain informed consent for such treatment in advance.

Patients with severe coronavirus disease 2019 (COVID-19) have poor prognosis, with many cases being difficult to treat and many reports of neurological complications in patients who have been in the intensive care unit for a long time. Rehabilitation of patients with severe COVID-19 is important；however, no rehabilitation program has shown effectiveness. Thus, this study aimed to investigate the effects of a rehabilitation program developed and used at our hospital for patients with severe COVID-19. We enrolled 28 patients with severe COVID-19 (age 61［23-88］years；female/male, 9/19, body mass index, 25.0［18.0-33.6］kg/m2). We assessed the medical research council scoring (MRC) of the patients at the time of entry and exit from the ordinary ward using Wilcoxon signed-rank tests. MRC was significantly improved after exiting the ordinary ward compared with that on entering the ordinary ward (43 vs. 50 points；P＜.001). Moreover, Barthel index improved significantly after exiting the ordinary (32.5 vs. 77.5 points, P＜.001). Therefore, our acute rehabilitation treatment for patients with severe COVID-19 may be effective in improving their muscle strength and daily living.

We report a case of ureteral endometriosis thought to have developed following relapse of pelvic peritoneal endometriosis after laparoscopic surgery. The patient was a woman in her late 40s who had undergone laparoscopic right adnexectomy for an endometrial cyst 5 years earlier. Electrocoagulation was performed for residual endometriosis of adherent cyst wall on the right sacrouterine ligament. The normal left ovary was preserved and she received no postoperative hormonal therapy. She developed right back pain during menstruation 5 years after the surgery. Pyeloureterography revealed stenosis of the ureter to the right of the uterus. Urinary cytology revealed endometrial cells with no atypia. Conservative management was opted for because malignant transformation of endometriosis was considered unlikely and she was expected to reach menopause within a few years. She is now doing well 24 months after initiation of progestin treatment with placement of a ureteral stent. Postoperative hormonal therapy is recommended for patients who are considered to have possible lesions of residual endometriosis and for whom ovarian function is preserved.