A 66-year-old man with an abnormal electrocardiogram during a health examination sought evaluation at the cardiology department. Contrast-enhanced computed tomography (CT) revealed the presence of aneurysms associated with aortopulmonary and left coronary artery-pulmonary artery fistulas. One of the identified aneurysms measured 20 mm. The patient was then referred to our department for surgical intervention. Although the patient was asymptomatic, surgery was planned due to the risk of rupture. Initially, coil embolization was performed to address the aortopulmonary fistula, which was followed by a median sternotomy. Intraoperatively, multiple tortuous abnormal vessels connecting both coronary arteries to the pulmonary artery were observed, along with aneurysms at the base of the pulmonary artery. The aneurysms were excised under cardiopulmonary bypass, and the opening of the pulmonary artery fistula was closed. Subsequent coronary angiography during surgery and postoperative cardiac CT confirmed the complete resolution of the abnormal vessels and aneurysms. The patient had an uneventful postoperative course and was discharged. We present the case of a patient with aneurysms associated with thoracic aortopulmonary and left coronary artery-pulmonary artery fistulas and review the relevant literature. The case was managed with a single-stage surgery involving coil embolization, aneurysm resection, and fistula closure.

BACKGROUND: Recently, the prevalence of food allergies during childhood is increasing, with fruits being common allergens. However, data on allergens that cause fruit and vegetable allergies and pollen-food allergy syndrome (PFAS) in childhood are relatively few. This study aimed to examine the allergens in fruit and vegetable allergies in pediatric patients and to determine the association between fruit and vegetable allergies and PFAS.OBJECTIVE: This study aimed to examine the current status of fruit and vegetable allergies in Japanese children.METHODS: This was a multicenter case series observational study. The participants included children aged <15 years who developed allergic symptoms after eating fruits and vegetables and subsequently received treatment in the Pediatric Department of 6 hospitals in the Osaka Prefecture in Japan during the study period from August 2016 to July 2017. Participants' information was obtained using a questionnaire, and data were obtained by performing several types of allergy tests using blood samples.RESULTS: A total of 97 children (median age, 9 years; 56 males) were included in the study. Apple was the most common allergen, followed by peach, kiwi, cantaloupe, and watermelon. A total of 74 participants (76%) exhibited allergic symptoms due to PFAS; moreover, pathogenesis-related protein-10 (PR-10) was the most common allergen superfamily. On the contrary, in the group where neither PR-10 nor profilin was sensitized, kiwi and banana were the most common allergens, and the age of onset was lower than that in the PFAS group. Specific antibody titer was significantly associated with Birch for Bet v1 and latex for Bet v2 (r = 0.99 and r = 0.89).CONCLUSION: When we examine patients with fruit and vegetable allergies, we should first consider PFAS even in childhood specifically for children greater than 4 years old.
Age of Onset ; Allergens ; Asian Continental Ancestry Group ; Betula ; Child ; Citrullus ; Clinical Study ; Cucumis melo ; Eating ; Food Hypersensitivity ; Fruit ; Humans ; Hypersensitivity ; Japan ; Latex ; Musa ; Observational Study ; Prevalence ; Profilins ; Prunus persica ; Rhinitis ; Rhinitis, Allergic, Seasonal ; Vegetables

Objective: Ritodrine, a β agonist, is a uterine tocolytic agent used to suppress preterm labor. In 2013, the European Medicines Agency (EMA) recommended that short-acting β agonists should be used for a maximum of 48 h. However, in Japan, they are widely used for long-term therapy (＞48 h). The EMA recommendation was informed to physicians by pharmacists. We retrospectively evaluated the safety of ritodrine by comparing outcomes before and after the provision of drug information (DI). We investigated whether the physicians' knowledge of the DI of ritodrine influenced performance, and affected the dose administered and the number of side effects reported.Methods: Women administered ritodrine for preterm labor between November 2011 and December 2015 were included in this single-centered retrospective study, which comprised two groups: before (Pre, from November 2011 to November 2013) and after (Post, from December 2013 to December 2015) DI provision. The frequency of cardiovascular side effects was the primary endpoint and the rate of long-term use was the secondary endpoint. The chi-squared test was used for statistical comparison and p＜0.05 was considered to indicate a significant difference.Results: The study comprised 91 patients administered ritodrine for preterm labor: 43 in the Post and 48 in the Pre. The frequency of cardiovascular side effects was 48.8 and 45.8 % in the Post and Pre, respectively (p＝0.64). The rate of long-term use was 65.1 and 79.2 % in the Post and Pre, respectively (p＝0.13).Conclusion: The DI provided by pharmacists increased physicians’ awareness of ritodrine use, which may have improved the safety of the drug. Thus, the provision of DI by pharmacists may enhance patient safety by promoting behavioral change in physicians.