The patient was a 63-year-old man. He underwent total arch replacement for Stanford type A acute aortic dissection. Eleven years after surgery, blood tests showed anemia, elevated LDH and direct bilirubin levels, and a visual blood test detected crushed red blood cells, leading to a diagnosis of hemolytic anemia. The Computed tomography showed a highly kinked graft, and the catheter test showed an increase in the pressure gradient before and after the kinked graft, suggesting that the patient had hemolytic anemia caused by the kinked graft. Because he also had moderate aortic regurgitation and a patent foramen ovale, he underwent resection of the kinked graft, ascending aortic replacement, aortic valve replacement, and closure of the foramen ovale. The postoperative course was good, and hemolytic anemia was not observed.

We report a case of mitral valve replacement without aortic cross clamp in a patient with MitraClip failure. The patient is an 83-year-old man with a history of coronary artery bypass surgery 31 years earlier. He developed heart failure due to severe mitral regurgitation. He underwent MitraClip, but it caused mitral stenosis and hemodynamic instability. Considering the severe calcification of the ascending aorta and previous bypass grafts, typical median sternotomy surgery with cross clamp had to be avoided. We performed mitral valve replacement via right thoracotomy under ventricular fibrillation. The postoperative course was favorable. Mitral valve surgery with ventricular fibrillation could be undertaken safely for a patient with difficulty in aortic cross clamp.

Objective: The purposes of this trial were to demonstrate the feasibility and effectiveness of the hybrid of intracavitary and interstitial brachytherapy (HBT) for locally advanced cervical cancer patients in the phase I/II prospective clinical trial. Methods: Patients with FIGO stage IB2-IVA uterine cervical cancer pretreatment width of which was ≥5 cm measured by magnetic resonance imaging were eligible for this clinical trial. The protocol therapy included 30–30.6 Gy in 15–17 fractions of whole pelvic radiotherapy concurrent with weekly CDDP, followed by 24 Gy in 4 fractions of HBT and pelvic radiotherapy with a central shield up to 50–50.4 Gy in 25–28 fractions. The primary endpoint of phase II part was 2-year pelvic progression-free survival (PPFS) rate higher than historical control of 64%. Results: Between October 2015 and October 2019, 73 patients were enrolled in the initial registration and 52 patients proceeded to the secondary registration. With the median follow-up period of 37.3 months (range, 13.9–52.9 months), the 2- PPFS was 80.7% (90% confidence interval [CI]=69.7%–88%). Because the lower range of 90% CI of 2-year PPFS was 69.7%, which was higher than the historical control ICBT data of 64%, therefore, the primary endpoint of this study was met. Conclusion The effectiveness of HBT were demonstrated by a prospective clinical study. Because the dose goal determined in the protocol was lower than 85 Gy, there is room in improvement for local control. A higher dose might have been needed for tumors with poor responses.

OBJECTIVE: Electroconvulsive therapy (ECT) has proven to be effective in treatment-resistant depression (TRD). In recent reports, 70% to 90% of patients with TRD responded to ECT. However, post-ECT relapse is a significant problem. There are no studies investigating risk factors associated with reintroducing ECT in depressive patients after remission previously achieved with former ECT. The aim of the present study is to examine such risk factors using a sample of TRD patients. METHODS: We conducted a chart review to examine patient outcomes and adverse events over short- and long-term periods. Forty-two patients met the criteria for major depressive disorder. RESULTS: The response rate was 85.7% (36/42). There were no significant differences in the baseline characteristics of patients exhibiting remission, response or non-response. The rate of adverse events was 21.4% (9/42). Among 34 patients who were available for follow-up, 18 patients relapsed (relapse rate, 52.9%), and 6 patients were reintroduced to ECT. The patients' age and age of onset were significantly higher in the re-ECT group than non re-ECT group. CONCLUSION: Our results suggest that older age and older age of onset might be considered for requirement of re-ECT after remission previously achieved with former ECT.
Age of Onset ; Aging ; Depression ; Depressive Disorder, Treatment-Resistant ; Electroconvulsive Therapy ; Follow-Up Studies ; Humans ; Recurrence ; Risk Factors