We report a rare case of a ruptured mycotic aneurysm (MA) of the deep femoral artery (DFA) associated with infective endocarditis (IE). A 59-year-old woman was referred to our hospital with acute IE. Six days after anti-bacterial therapy, she complained of sudden pain in her right thigh. This condition was diagnosed as a bacterial thrombus in the right DFA. Three weeks after valve replacement, she again complained of pain and swelling of her right thigh. CT angiography revealed a ruptured MA of the right DFA. Since the infection was completely controlled at that time, we only ligated the proximal right DFA to attain hemostasis and did not attempt excision of the MA. However, because signs of recurrent infection appeared to slightly increase after surgery, we completely excised the MA to prevent infection of the prosthetic valves. Thus far, there is no evidence of recurrent aneurysm formation and infection.

Patients requiring simultaneous surgical repair for severe pectus excavatum and cardiac disease are rare, and most are children with congenital heart disease and chest deformity or young adults with Marfan syndrome. We experienced an old non-Marfan patient who had cardiac disease associated with severe pectus excavatum which needed thoracoplasty to approach the heart. A 69-year-old man with pectus excavatum was admitted because of dyspnea. We diagnosed acute congestive heart failure due to severe mitral regurgitation. A left atrial tumor and coronary artery disease were also diagnosed. Because of severe pectus, the heart was displaced to the left lower chest cavity. The distance between the sternum and the vertebrae was only 1 cm. It was impossible to approach the heart without thoracoplasty. We simultaneously performed mitral valve replacement, 3-vessel coronary artery bypass grafting, resection of the left atrial tumor and thoracoplasty. His postoperative course was uneventful.

Following the Great East Japan Earthquake, many pharmacy students conducted support activities which was no requirement of pharmacist’s license. Although some pharmacy students reported their activities, there are no studies comprehensively analyzing this phenomenon. The purpose of this study was to survey the support activities of pharmacy students and to analyze the corresponding conditions. We conducted personal interviews with 22 pharmacy students involved in the support activities. The questionnaire included items about a student’s general attributes, activities, activity duration, and relevant locations. Further, we analyzed data on their attributes and personal information with respect to the support activities. Data on the activities were classified into 10 categories and evaluated based on pharmaceutical knowledge levels required for the support activities. According to the results of the interviews, the phases of the activities were classified into “sub-acute phase” and “chronic phase.”The relevant locations were medication collection points, shelters, and transit points for medical teams, temporary clinics, and temporary housing. Furthermore, according to the classification of activities by knowledge levels, activities depended on the students’ pharmaceutical knowledge; if they appropriately selected the activities (based on their pharmaceutical knowledge level), they could effectively participate in the support activities. The results of our survey suggest that pharmacy students can assist healthcare professionals, although the relevant activities are limited by the duration and pharmaceutical knowledge.

Percutaneous endoscopic gastrostomy (PEG) is a common procedure for placing a feeding tube in the stomach to provide fluids and nutrition to patients who have difficulty in swallowing or in taking enough noutrishment through the mouth. Thought the procedure is simple and easy, PEG is not without its risks. The reported complication ratio is not low-, -between 5.7% and 33.3%. This is probably because the patients are lacking in reserves of physical faculties.The present study was conducted to work out measures to reduc the incidence of PEG complications by reviewing the complications cases treated in our hospital.From March 1997 to December 2005, we performed PEG on 110 patients, of which 11 patients (9.6%) had complications. In some cases, we inadvertently perforated the colon. From our experience, we have learned that it is not safe to perform PEG with the aid of radiography alone on cases in which the intervention of the transverse colon between stomach and abdominal wall was suspected by CT scan, and concluded PEG should be done using gastrography of the transverse colon, to guide the placement of a feeding tube in the stomach. In view of the systemic condition of the patients, we thought it necessary to take safety measures by all possible means.
Percutaneous endoscopic gastrostomy ; Complications Specific to Antepartum or Postpartum ; Stomach ; Management ; Prevention

A rare case of abdominal aortic aneurysm associated with crossed-fused ectopic kidney in a 74-year-old man is reported. On enhanced CT scans, the maximum diameter of his infrarenal aortic aneurysm was 55mm, and he lacked a right kidney. A crossed ectopic kidney was fused to the lower part of the left kidney. On preoperative examinations, only one feeding artery to the ectopic kidney separated from the right common iliac artery. However, laparotomy confirmed the presence of three aberrant renal arteries, the middle one of which was very slim. Aneurysmectomy and a bifurcated artificial graft replacement was performed. After proximal anastomosis, the two larger aberrant renal arteries were reconstructed under renal protection with intermittent infusion of cold Ringer's solution. The smallest aberrant renal artery was ligated. Postoperatively, this patient recovered without any complications. In operations for abdominal aortic aneurysm associated with renal anomaly including ectopic kidney, horseshoe kidney, and pelvic kidney, it is important to elucidate the anatomy of aberrant renal arteries preoperatively, and reconstruct as many of these arteries as possible. This report is apparently the fourth on abdominal aortic aneurysm associated with crossed ectopic kidney.

A 34-year-old woman who was suffering from aortitis syndrome with annuloaortic ectasia (AAE) and severe aortic regurgitation (AR) from 18 years of age was admitted for an aortic root replacement. She has been on 5mg predonine daily. Aortography, CT and echocardiography examinations revealed dilated aortic annulus (D=30mm) and valsalva sinuses (D=43mm) and overstretched aortic valve leaflets. The ascending aorta was aneurysmal (D=50mm). Because of the patient's strong desire to have children, a Freestyle bioprosthesis was chosen for replacement. A collagen impregnated tube graft was interposed between the Freestyle and the proximal end of the transverse aorta. In order to reconstruct the coronary arteries, the Cabrol technique was utilized because of severe inflammatory adhesion of the aortic root. The patient had an uneventful postoperative course. This case shows that an aortic root replacement with Freestyle bioprosthesis offers a great benefit to those patients who are not suitable to receive postoperative anti-coagulation therapy to enable future pregnancy and child delivery.

A 69-year-old man, who had undergone coronary artery bypass grafting using the right gastroepiploic artery 2 years previously, was hospitalized with acute epigastralgia. Gastroscopy showed an early gastric cancer in the greater curvature of the corpus and ultrasonography of the abdomen revealed acute cholecystitis due to a stone impacted in the cystic duct. The subtotal gastrectomy and the cholecystectomy with preservation of the right gastroepiploic artery graft were performed. The surgical margin of the resected specimen was negative for cancer. The postoperative course was uneventful. After coronary artery bypass grafting using the right gastroepiploic artery, annual gastroscopy is recommended.

Objective: We conducted a two-way crossover trial to investigate the effects of a personal air-conditioning system on fatigue induced by mental load. Design: Sixteen healthy volunteers performed mental fatigue-inducing tasks that consisted of a 2-back task for 30 min and the A, B, and C tasks of the advanced trail making test (ATMT) for 30 min on four occasions (4-hour mental load) with or without the personal air-conditioning system with a 1-week interval. We evaluated work performance by mean reaction time, number of errors, total trial number, and reaction time from the previous task to the next task in the ATMT and subjective fatigue sensation by the visual analogue scale (VAS). Results: The mean reaction time, the number of errors, and reaction time from the previous task to the next task were significantly lower, and the total trial number was significantly higher when the personal air-conditioning system was used. On the other hand, the personal air-conditioning system did not affect fatigue sensation in VAS. Conclusion: We found that the personal air-conditioning system attenuated mental fatigue and increased the subjects’ motivation.

Background/Aims: 5-Aminosalicylic acid (ASA) causes intolerance reactions in some patients. This study was performed to examine the prognosis of patients with ulcerative colitis (UC) and 5-ASA intolerance, and to evaluate the potential interaction between 5-ASA intolerance and the intestinal microbiota. Methods: We performed a retrospective cohort study of patients with UC who visited participating hospitals. The primary endpoint was to compare the incidence of hospitalization within 12 months between the 5-ASA intolerance group and the 5-ASA tolerance group. The secondary endpoint was to compare the risk of adverse clinical outcomes after the start of biologics between the 2 groups. We also assessed the correlation between 5-ASA intolerance and microbial change in an independently recruited cohort of patients with UC. Results: Of 793 patients, 59 (7.4%) were assigned to the 5-ASA intolerance group and 734 (92.5%) were assigned to the 5-ASA tolerance group. The admission rate and incidence of corticosteroid use were significantly higher in the intolerance than tolerance group (P< 0.001). In 108 patients undergoing treatment with anti-tumor necrosis factor biologics, 5-ASA intolerance increased the incidence of additional induction therapy after starting biologics (P< 0.001). The 5-ASA intolerance group had a greater abundance of bacteria in the genera Faecalibacterium, Streptococcus, and Clostridium than the 5-ASA tolerance group (P< 0.05). Conclusions In patients with UC, 5-ASA intolerance is associated with a risk of adverse clinical outcomes and dysbiosis. Bacterial therapeutic optimization of 5-ASA administration may be important for improving the prognosis of patients with UC.

We present a successful case of redo-tricuspid valve replacement for tricuspid prosthetic valve endocarditis. A 78-year-old man who underwent tricuspid bioprosthetic valve replacement for severe tricuspid regurgitation thirty-two years earlier was referred to our institution with persistent high fever and back pain. The blood culture was positive for Streptococcus oralis, and echocardiography revealed a mobile vegetation attached to the tricuspid prosthetic valve with moderate tricuspid regurgitation. A clinical diagnosis of prosthetic valve endocarditis was established. Redo-tricuspid bioprosthetic valve replacement was performed following antibiotics therapy. The patient was discharged on postoperative day 49 after 6 weeks of additional antibiotic treatment, and had no recurrence of infection for 6 months after redo-surgery.