A 61-year-old woman was admitted to our hospital because of acute heart failure. The angiogram showed an enlarged aortic root and aortic incompetence which indicated annulo-aortic ectasia. An aortic valve-sparing operation was impossible because of severe prolapse of the aortic valve and the patient hesitated to have anti-coagulation therapy. Thus we performed aortic root replacement with the Freestyle™ stentless porcine valve (Medtronic Inc.). We plicated each original commissure in order to narrow the enlarged annulus and attach the Freestyle valve to the annulus directly by continuous suture. There was no significant difference in surgical technique and aortic cross-clamping time, compared to conventional operation. Aortic root replacement with the Freestyle valve seems an attractive option especially for elderly patients or cases in which of contraindicated for anti-coagulation therapy.

In 46-year-old man who had had general fatigue due to hypertension for about 20 years, only hypertension of the upper part of the body had been pointed out; the blood pressure of the upper limbs was 190mmHg and that of the lower limbs was 80mmHg. Computed tomography showed severe aortic stenosis with advanced calcification from the proximal descending thoracic aorta to the infra-renal abdominal aorta, the minimum caliber of the aorta being only 5mm. Hypertension was not controlled in spite of administration of 5 anti-hypertensive agents. Because renal factors were not related to hypertension, we chose a minimally invasive procedure: axillo-bifemoral artery bypass. After operation, the difference of blood pressure between upper and lower limbs reduced and symptoms disappeared. There are many case reports of aorto-aortic bypass for atypical coarctation, but we think that the less invasive axillo-bifemoral artery bypass is also an alternative procedure.

A 67-year-old man with aortic insufficiency underwent aortic valve replacement (AVR) with a Freestyle^TM valve (Medtronic Inc.), using the complete subcoronary technique. Although a trivial aortic insufficiency remained on postoperative echocardiography, he continued without chest symptoms. A cardiac murmur developed and dyspnea on effort appeared five months postoperatively. Echocardiography and aortography showed severe aortic insufficiency, and a re-do AVR was performed seven months after the first procedure. Examination of the Freestyle valve revealed that two loops of the suture line on the inflow side of the valve had become detached from the muscular tissue. It is most important to keep the geometry of the Freestyle valve at the time of the implantation using the subcoronary technique, and an unsuitable implantation can cause consequent perivalvular leakage.

A 33-year-old woman underwent aortic root replacement for aortic regurgitation and an aneurysm of the ascending aorta due to annuloaortic ectasia. Ehlers-Danlos syndrome was diagnosed by skin biopsy when she was 23 years old. At operation, to avoid mechanical stress to the residual aorta, cardiopulmonary bypass was established via cannulation of the left femoral artery and we used the open distal anastomosis method under hypothermic circulatory arrest with selective cerebral perfusion. Moreover, the sutures of the aortic annulus were reinforced sewing the aortic wall together. Her postoperative course was uneventful. Despite the fragility of the cardiovascular tissues in Ehlers-Danlos syndrome, cardiac surgery could be performed safely with appropriate surgical procedures.

We report 2 patients with unilateral pulmonary edema after heart surgery who were successfully treated using venovenous extracorporeal membrane oxygenation (VV ECMO). Case 1 : A 35-year-old woman presented with dyspnea. Echocardiography showed severe mitral regurgitation (MR) and tricuspid regurgitation (TR) and therefore, mitral valve plasty (MVP) and tricuspid annular plasty (TAP) were performed via right thoracotomy. After weaning from cardiopulmonary bypass, respiratory failure occurred with expectoration of foamy sputum and it was difficult to maintain oxygenation. Therefore, we performed VV ECMO to maintain oxygenation. A chest X-ray film after surgery showed ipsilateral pulmonary edema. After weaning from VV ECMO, deep venous thrombosis occurred and therefore we inserted an IVC filter. Case 2 : A 67-year-old man, who had previously received aortic valve replacement experienced dyspnea and visited our hospital. Echocardiography showed an aortic root abscess, and therefore Bentall operation was performed. After weaning from cardiopulmonary bypass, oxygenation was difficult to maintain, and therefore we performed VV ECMO. A chest X-ray film post operatively showed right ipsilateral pulmonary edema. The patient was weaned from VV ECMO 5 days post operatively and was discharged 60 days post operatively. We believe that VV ECMO can be beneficial for patients with respiratory failure after heart surgery, but complications related to this approach such as DVT should also be considered.

The primary aim of this study was to estimate the number of cancer patients who wanted home death based on the bereaved family survey.A postal survey performed on 1,137 bereaved family members in 4 regions to clarify the degree what they believed that the patient actually died where s/he had wanted on the Good Death Inventory, and to explore the preferred place of death. We calculated estimated number of patients who had wanted home death as a total of (1) the actual number of home death × the percentages of the family members who agreed that the patient actually died where s/he had wanted, and × the actual number of hospital death × the percentages of the family members who disagreed that the patient actually died where s/he had wanted and home was the preferred place of death. Estimated number of cancer patients who wanted home death was 32.8%［95%C.I., 31.7, 33.9］ in the surveyed regions, and 31.2%［95%C.I., 31.1, 31.4］ for national data.

We report a patient who underwent an operation for an infectious abdominal aortic aneurysm 10 months after intravesical bacillus Calmette-Guerin therapy. A 68-year-old man had previous gastrectomy for early gastric cancer and intravesical BCG therapy for early stage urinary bladder cancer. His follow up CT scan revealed an abdominal aorta pseudoaneurysm. We performed aneurysmectomy, omentopexy and bilateral axillo-femoral bypass. The culture of an abscess in the aneurysm identified Mycobacterium bovis. The patients improved clinically with antituberculosis agents after operation. Intravesical bacillus Calmette-Guerin therapy is effective in the treatment of early stage urinary bladder cancer. Although this treatment is generally considered safe, serious complications including vascular complications have been reported.

Objective: Many patients in Kagawa University Hospital are administered medicines prepared by the simple suspension method.  Pharmacists in charge of these patients receive inquiries from doctors and nurses regarding the suitability of medicines for the simple suspension method.  Answering these inquiries is complicated and time-consuming as multiple data sources need to be searched.  In order to simplify these complicated procedures, we herein attempted to develop a novel database to provide valuable information that could contribute to the safe performance of the simple suspension method, and evaluated its usefulness.
Method: The specifications of the database were determined by analyzing previously answered inquiries.  To evaluate the usefulness of the database, we used test prescriptions and compared the amount of time required to gather information using the database and the conventional method, i.e., using books alone.  We also analyzed previous prescriptions with the database in order to determine what kinds of problems could be detected.
Results: The investigation of previous prescriptions indicated that some medicines needed to be examined not only for their suitability for the simple suspension method, but also their incompatibility.  Therefore, we added a feature regarding the incompatibility of medicines to the database.  The time required to gather the information needed to answer the test prescription was shorter with our database than with the conventional method.  Furthermore, the database improved the detection of medicines that require particular attention for their properties including incompatibility.  An analysis of previous prescriptions using our database indicated the possibility of incompatibility in half of the previous prescriptions examined.
Conclusion: Our database could rapidly provide information related to the simple suspension method, including the incompatibility of medicines.

Behçet’s disease (BD) is a multisystem inflammatory disease of unknown origin. Rarely, BD occurs together with myelodysplastic syndrome (MDS). Interestingly, it is speculated that these are not simple coexistence but that the etiology of intestinal BD is at least partly derived from MDS itself. Furthermore, there is a relationship between MDS in patients with intestinal BD and trisomy 8. Immunosuppressive agents alone are insufficient to control MDS-associated BD, and many of these patients die of infection or hemorrhage. Surgery is considered for intestinal BD patients who are unresponsive to medical treatment or those with bowel complications such as perforation or persistent bleeding. We report a case of intestinal BD associated with MDS and trisomy 8. The patient was unresponsive to oral steroids and immunosuppressive treatment; the patient improved by surgical repair of a bowel perforation. Five years after the surgery, the patient is free of recurrence and not on medication. Our experience suggests that surgery may provide an effective therapeutic option for the treatment of MDS-related BD.