This case involves a man in his 60s who was undergoing rituximab therapy and developed COVID-19 pneumonia and showed persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Despite treatments with dexamethasone, remdesivir, tocilizumab, and other drugs, the patient remained SARS-CoV-2 positive and ultimately died of respiratory failure. Patients receiving B-cell depletion therapy have an increased risk of persistent viral infections due to immunosuppression, underscoring the importance of early intervention with antiviral drugs and neutralizing antibodies in such cases.

The purpose of this study was to assess the negative effects of some factors on medicine-taking behavior. For the patients taking oral medication who visited a health insurance pharmacy, we enacted the actual situation of medication and conducted an attitude survey on the feeling of burden and resistance of taking the drugs. The survey also covered the factors that can influence medicine-taking behavior and the extent of the influence. For differences in each factor such as patient characteristics, lifestyle, and medication status, we used the 2 test to analyze the association with medicine-taking behavior. We found significant differences in age, dietary habits, occupation, periodic consultation with the pharmacy/doctor, and unpleasant experiences. In addition, in patients with multiple factors that cause noncompliance with medication, we observed a strong influence of age and occupation. From the factor analysis, we obtained data on time, quantity, and pharmaceutical factors (three factors called regular factors). These factors negatively influenced the use of medication by the patients. Next, in the covariance structure analysis, the influence of time and the quantity factor on medication-related stress was the observed to be the strongest, whereas the influence of the regular factors was not significant. Furthermore, there were differences in the influence of these factors depending on patient characteristics.

A 16-year-old schoolgirl had aortic valve insufficiency, detected incidentally on electrocardiogram taken for a physical checkup. She was noted to have hyperextensibility of joints, hyperelasticity of the skin and an atrophic scar over the knees on physical examination and type II Ehlers-Danlos syndrome (EDS) was diagnosed by skin biopsy after admission. A Carpentier-Edwards pericardial bioprosthesis was chosen for aortic valve replacement because she was of childbearing age and had EDS. Seven years after the replacement she became pregnant, resulting in spontaneous vaginal delivery of a healthy male infant at 39 weeks. However, a second aortic valve replacement was staged for structural failure of the bioprosthesis which was accelerated during the gestation. Aortic valve re-replacement was carried out using a 21-mm Sorin Bicarbon mechanical prosthesis 4 months after the delivery. She was discharged on the 10th postoperative day without any complications.

A 77-year-old man with diabetes mellitus and hypertension presented with acute onset of pain and swelling of the right thigh. Physical examination showed a pulsatile mass in the mid-portion of the right thigh. Computed tomography revealed the presence of a 7-cm diameter aneurysm at superficial femoral artery with gas shadow around the aneurysmal wall. A diagnosis of infected superficial femoral aneurysm was made and emergency surgery was undertaken. The total resection of the aneurysmal wall, debridement of necrotic tissues including part of sartorius and quadriceps muscles were done. Femoro-popliteal bypass through subcutaneous route using a 6-mm diameter Dacron prosthesis was used as the mean of vascular reconstruction procedure. Citrobacter koseri was cultured from the infected aneurysmal wall. The antibiotic treatment was continued for total of 2 weeks. Although additional debridement was required, the patient was amkulabony when discharged on the 37th postoperative day.

A semicomatose 53-year-old woman who had been injured in an automobile accident was admitted. Injury to the thoracic descending aorta was suspected because of widening of the upper mediastinum on a chest X-ray film and confirmed by chest contrast-enhanced computed tomography (CT). We postponed surgical treatment because brain CT showed traumatic intracerebral hemorrhage. She was maintained in an intensive care unit and had pharmacological treatment and medical support. Two days later, brain CT showed that the intracerebral hematoma was a stable and inactive lesion, so she underwent aortic repair 3 days after the accident. Left thoracotomy was performed and an artificial vascular prosthesis was interposed under hypothermic circulatory arrest (open proximal method). The postoperative course was uneventful and the patient was discharged 44 days after the operation. Hypothermic circulatory arrest may be a valuable adjunct for traumatic injury of the thoracic aorta at risk for impending rupture.