A 6-year-old boy was admitted with infective endocarditis and aortic regurgitation. Clinical signs of infection were severe. The leukocyte count was 13, 100/μl and the C-reactive protein (CRP) was elevated to 17.2mg/dl. Blood culture was positive for Staphylococcus aureus. Echocardiography showed a vegetation 3mm in diameter on the aortic valve, and a perforation of the right coronary cusp with moderate aortic regurgitation. With antibiotic therapy, clinical signs and laboratory data of infection improved at an early stage. We decided to operate after his complete recovery from infection. Laboratory data normalized completely in 6 weeks, but echocardiography demonstrated aneurysmal change of the right coronary sinus and severe aortic regurgitation. The Ross operation was performed on the 44th day. At operation, it was noted that the non-coronary cusp was destroyed completely leaving only strings of fibrous tissue. A perforation of 3mm in diameter was also found on the right coronary cusp. There was a mural aneurysm near the right coronary orifice without abscess formation in the surrounding structure. A pulmonary autograft was transplanted to the aortic root after resection of the destroyed aortic cusps, aortic root and the mural aneurysm. The right ventricular outflow tract was reconstructed using an autologous pericardium as a posterior wall and the Monocusp ventricular outflow patch (MVOP) #22 as an anterior transannular patch. The postoperative course was uneventful. Postoperative echocardiography revealed no aortic regurgitation.

We performed gamma knife treatment for multiple brain metastases including a left frontal lobe lesion in a patient in his 60s who had renal cell carcinoma. After treatment, the left frontal lobe lesion initially shrank but then began to grow again, resulting in extensive edema, right hemiparesis, impaired activities of daily living (ADL), and decreased motivation. Although the renal cell carcinoma was in the terminal stage, we judged that recovery of ADL could be expected by removing the left frontal lobe lesion and therefore performed craniotomy tumor removal. As a result, the patient’s motivation and right hemiplegia markedly improved and ADL dramatically improved. Although the period from craniotomy tumor removal to death was as short as 2 months, significant improvement of ADL during this time was achieved by removing the tumor. Tumor resection for metastatic brain tumors is rarely performed in the setting of end-stage cancer. However, this case highlights the potential of brain tumor resection as palliative treatment that can be considered for improving ADL even in patients with terminal cancer.

Objective: This study examines the job satisfaction of Mongolian hospital nurses by comparing their status and workload of Mongolian nurses with Japanese nurses’ one.Settings and participants/Methods: Survey data were collected from randomly selected 200 nurses (100 were Mongolians and the other 100 were Japanese) who agreed to participate in the survey. Data were collected through a self-administered survey questionnaire. Survey items were age, the duration of work experience, work position, health condition, accumulated fatigue, stress level, and whether having family members who need child care or nursing care. Collected data were analyzed by t-test and Wilcoxon Rank Sum test.Results: The average age of Mongolian nurses was significantly lower than that of Japanese nurses. Consequently, the average work experience of Mongolian nurses was less than that of Japanese nurses. More Japanese than Mongolian nurses had family members in need of care. Job satisfaction and status were significantly higher among Japanese than Mongolian nurses. However, Japanese nurses have family members who need child care or nursing care at a higher rate than Mongolian nurses. Job satisfaction of Japanese nurses about their work and job status was significantly higher than Mongolian nurses’ one. However, the opposite result was found in the job satisfaction about their workload. The influence of the relationships among nurses on the job satisfaction was significantly greater in Mongolian nurses than in Japanese nurses. Job satisfaction of Japanese nurses about their salaries was significantly higher than Mongolian nurses’ one.Conclusion: In order to raise nurses’ job satisfaction in Mongolia, it is necessary to raise their “occupational status” and salary of nurses.