A 68-year-old woman complained of hemoptic shock and recovered with conservative treatment. Ruptured descending aorta into the left lung was diagnosed. Graft replacement of the descending aorta was successfully performed. We speculated that spontaneous rupture of the descending aorta into the left lung might have occurred due to high blood pressure affecting the weak aortic wall with sclerotic change, causing hemoptysis. The ruptured descending aorta was successfully replaced without dissection between the ruptured aorta and the left lung. The postoperative course was uneventful with neither pulmonary nor infectious complications.

A 45-year-old woman who was a Jehovah's Witness was admitted to our hospital with a complaint of palpitation and sort on-effort. A ruptured aneurysm of the sinus of Valsalva (RASV) associated with stenosis of the right ventricular outflow was diagnosed. Operative findings revealed a RASV with a double chambered right ventricle (DCRV) and a ventricular septal defect (VSD). RASV, DCRV and VSD were successfully repaired with extracorporeal circulation without use of homologous blood. We reported this case because congenital combination of RASV, DCRV and VSD is very rare.

A 69-year-old man complained of abdominal pain with inflammatory reaction. Abdominal aortic aneurysm (AAA) with a left main trunk lesion was diagnosed and he successfully underwent Y-graft replacement of the abdominal aorta and coronary artery bypass grafting. Finally AAA was classified as “inflammatory” by histopathological findings. We present this case of “inflammatory AAA” associated with coronary artery disease, and discuss it with a review of literatures.

Retroperitoneal hematoma (RH) due to radiologic intervention for an intracranial lesion is relatively rare, difficult to diagnose, and can be life-threatening. We report a case of RH that developed in a patient on anticoagulant therapy following endovascular coiling of a ruptured anterior communicating artery (AcoA) aneurysm. An 82-year-old man presented with a 12-day history of headache. Computed tomography (CT) on admission demonstrated slight subarachnoid hemorrhage, and left carotid angiography revealed an AcoA aneurysm. The next day, the aneurysm was occluded with coils via the femoral approach under general anesthesia. The patient received a bolus of 5,000 units of heparin immediately following the procedure, and an infusion rate of 10,000 units/day was initiated. The patient gradually became hypotensive 25 hours after coiling. Abdominal CT showed a huge, high-density soft-tissue mass filling the right side of the retroperitoneum space. The patient eventually died of multiple organ failure five days after coiling. RH after interventional radiology for neurological disease is relatively rare and can be difficult to diagnose if consciousness is disturbed. This case demonstrates the importance of performing routine physical examinations, sequentially measuring the hematocrit and closely monitoring systemic blood pressures following interventional radiologic procedures in patients with abnormal mental status.
Aged, 80 and over ; Anesthesia, General ; Aneurysm ; Angiography ; Arteries ; Consciousness ; Headache ; Hematocrit ; Hematoma ; Heparin ; Humans ; Intracranial Aneurysm ; Multiple Organ Failure ; Physical Examination ; Radiology, Interventional ; Subarachnoid Hemorrhage

A clinico-epidemiological analysis was performed of 2,414 consecutive stroke patients who were treated in our hospital during the 6-year period from 1997 through 2003. All the patients were neurologically examined and diagnostic studies were made by use of computed tomography. Cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage accounted for 68%, 22%, and 10% of the stroke cases, respectively. The incidence of these subtypes of stroke in this region during the past 20 years was characterized by a singnificant decrease in cerebral hemorrhage, and an increased proportion of cerebral infarction. Men exceeded women in the incidences of both cerebral infarction and hemorrhage, whereas characteristically women far exceeded men in subarachnoid hemorrhage. The incidence reached a peak in the 70-79 age group regardless of the subtypes of stroke, and 64% of the entire stroke patients were those 70 and older. Women were found to suffer from stroke at much older age than men. As to the site of hemorrhage, putaminal hemorrhage was the most frequent, experienced by 36% of the patients, followed by thalamic hemorrhage in 34% of the patients. Putaminal and pontine hemorrhages predominated in the age groups younger than 60;thalamic, cerebellar and subcortical hemorrhages were predominant in the age groups older than 70. The incidence of these subtypes of hemorrhage during the past 20 years was characterized by a dramatic decrease in putaminal hemorrhage in a younger population, and a significant increase in thalamic, cerebellar, and subcortical hemorrhages in an older population.
Cerebrovascular accident ; Hemorrhage ; seconds ; Age Group Unspecified ; incidence of cases

The Ministry of Health and Welfare of Japan is planning a pooling system for multiple-choice questions (MCQs) for the national examination for medical practitioners. To clarify possible problems of such a system, a field study was performed by 10 medical schools in Japan using 90 MCQs from previous examinations. Nine hundred twenty-four 6th-year students participated in the field test. For each MCQ, the correct-response rates at the originating school and those obtained in the field test were significantly correlated. Thus, the correct-response rates to questions on the field test could be predicted from the rates at the originating schools. However, for each question the correct-response rate was significantly higher for students of the originating school than for students of other schools. In the national examination, care should be taken to prevent differences in scores on the basis of question sources.