Background/Aims: Inflammatory bowel disease (IBD) patients frequently have zinc deficiency. IBD patients with zinc deficiency have higher risks of IBD-related hospitalization, complications, and requiring surgery. This study aimed to examine the effectiveness of zinc acetate hydrate (ZAH; Nobelzin) in IBD patients with zinc deficiency. Methods: IBD patients with zinc deficiency who received ZAH from March 2017 to April 2020 were registered in this two-center, retrospective, observational study. Changes in serum zinc levels and disease activity (Crohn’s Disease Activity Index [CDAI]) before and after ZAH administration were analyzed. Results: Fifty-one patients with Crohn’s disease (CD, n = 40) or ulcerative colitis (UC, n = 11) were registered. Median serum zinc level and median CDAI scores significantly improved (55.5–91.0 μg/dL, P< 0.001; 171.5–129, P< 0.001, respectively) in CD patients 4 weeks after starting ZAH administration. Similarly, median serum zinc levels and CDAI scores significantly improved (57.0–81.0 μg/dL, P< 0.001; 177–148, P= 0.012, respectively) 20 weeks after starting ZAH administration. Similar investigations were conducted in groups where no treatment change, other than ZAH administration, was implemented; significant improvements were observed in both serum zinc level and CDAI scores. Median serum zinc levels in UC patients 4 weeks after starting ZAH administration significantly improved from 63.0 to 94.0 μg/dL (P= 0.002), but no significant changes in disease activity were observed. One patient experienced side effects of abdominal discomfort and nausea. Conclusions ZAH administration is effective in improving zinc deficiency and may contribute to improving disease activity in IBD.

Purpose: To clarify the differences in the interpretation between the medical staffs and the patients / their families (hereinafter called “patients-families”) when the wording like “a yearly, monthly or weekly basis” and “the words suggesting seasons” are used on the medical sites. Method: The questionnaires were provided to both the medical staffs and the patients-families. Results: Regarding “a yearly basis”, 100% of the medical staffs use as “less than five years” and 67.1% of the patients-families interpret the same. Regarding “a monthly basis”, 100% of the medical staffs use as “less than six months” and 68.3% of the patients-families interpret the same. Regarding “a weekly basis”, 100% of the medical staffs use it as “less than eight weeks”, whereas it is 77.2% of the patients-families that interpret so. Approximately 20% of the patients-families have no ideas about the wording like “a yearly, monthly and weekly basis”. When the medical staffs mention “the cherry blossom season”, 71.4% of them are trying to indicate “the late March” or “the early April”, on the other hand, it is 58.9% of the patients-families that understand so. Regarding the expressions like “the season when the leaves turn red”, “the time when it gets warmer” or “the time when it gets colder”, there is not definite mutual understanding between the medical staffs and the patients-families. Conclusion: This awareness survey shows there is a case that the medical staffs and the patients-families may differ in the interpretation of words commonly used on medical sites.

RibotestMycoplasma (Ribotest™), a rapid antigen detection assay for ribosomal protein L7/L12 for the diagnosis of Mycoplasma pneumoniae infection, has become available in Japan. However, the clinical utility of Ribotest remains controversial. We enrolled 1,140 children admitted to our hospital between January 2014 and March 2016 due to community-acquired pneumonia. We prospectively obtained two throat swabs during the acute phase; DNA detection using a loop-mediated isothermal amplification (LAMP) assay and antigen detection using Ribotest were performed for each sample. We also collected paired serum samples during the acute and convalescent phases for determining M. pneumoniae antibody titers using the particle agglutination test. M. pneumoniae pneumonia was diagnosed through either a positive LAMP assay or a 4-fold increase in antibody titers. Overall, 237 children (21%) were diagnosed with M. pneumoniae pneumonia. We evaluated the utility of Ribotest both in the non-epidemic period (January 2014–July 2015) and the epidemic period (August 2015–March 2016). Sensitivity of Ribotest for M. pneumoniae pneumonia was 23% in the non-epidemic period and 22% in the epidemic period, respectively. When serology was used as the standard, sensitivity of Ribotest was 25% in the non-epidemic period and 22% in the epidemic period, significantly lower than those of the LAMP assay (80% and 91%, respectively). Ribotest yielded false-positive results in 16 cases in the non-epidemic period and in 6 cases in the epidemic period. Thus, positive predictive values of Ribotest were significantly lower in the non-epidemic period (50%) than in the epidemic period (86%). Multivariate analysis showed that a shorter duration of fever before sampling (OR = 1.7) and a higher incidence of co-infection with other pathogens (OR = 29.4) were observed in children showing false-positive results of Ribotest. Thus, we conclude that Ribotest is unsuitable for rapid diagnosis of pediatric M. pneumoniae pneumonia.

Papillary fibroelastoma (PFE) is the second most common type of benign cardiac tumor after myxoma, and is most commonly found in the left side of the heart. In this study, we report a case of PFE located in the tricuspid valve chordae. The patient was a 65-year-old woman in whom a heart murmur was detected during a routine medical examination. A follow-up examination identified a cardiac tumor, and she was subsequently referred to our medical department. Echocardiography and contrast-enhanced computed tomography indicated a mobile mass of approximately 1 cm in the right ventricle, and she was determined to be a candidate for surgery. After cardiopulmonary bypass, we instigated cardioplegic arrest, made an incision in the right atrium, and observed the right ventricle through the tricuspid valve. We observed a yellowish sea-anemone-like mass approximately 9 mm from the chordae of the anterior leaflet of the tricuspid valve. Thus, the mass was resected with the chordae and tricuspid annuloplasty. Postoperative progress was satisfactory, and the subject was discharged on the 19th day of hospitalization. Histopathological examination indicated a mixture of thick fibrous and adipose tissues, which led to the diagnosis of PFE. PFE is a relatively rare disease that comprises 8% of primary cardiac tumors. IA often occurs in the left heart and can cause cerebral infarction, myocardial infarction, and other symptoms of embolism. However, because small masses and those that occur in the right heart are not accompanied by clinical symptoms, such cases are often discovered during routine echocardiography. The present study reports a case of PFE that occurred in the tricuspid valve chordae that was diagnosed via echocardiography.

A false aneurysm in a coronary anastomotic region is known to be an important complication after a modified Bentall procedure. We report a successful case of a 40-year-old woman in whom we performed repair of a false aneurysm in the left main trunk (LMT), using transection of the main pulmonary artery. The modified Bentall procedure and coronary artery bypass grafting (CABG) on the right coronary artery had been performed 6 years earlier, with diagnoses of Marfan syndrome, annuloaortic ectasia, aortic regurgitation, aortic dissection (DeBakey type II), and right ventricular infarction. The patient was admitted with a syncopal attack, and we diagnosed a false aneurysm in the anastomotic region of the left coronary artery. Repair of the LMT and CABG on the left anterior descending coronary artery with the left internal thoracic artery (LITA-RAD) was performed. For repair of the LMT, we used a surgical approach using transection of the main pulmonary artery to create a favorable surgical field.

We describe a case where a thrombus was effectively removed with a 20 Fr argyle^® thoracic catheter (Nippon Sherwood Medical Industries Ltd.) and the life of the patient was saved by thrombectory for an acute pulmonary thromboembolism. The patient was a 43-year-old woman. Emergency operation was indicated by a severe acute pulmonary thromboembolism and intracardiac floating thrombi afte an orthopedic surgery. A 20 Fr thoracic catheter connected to a cleaning type intraoperative blood salvage device was used to remove thrombi in a pulmonary artery and a good result was obtained. The advantages of this catheter include: 1) suitable hardness; 2) a protective round tip; 3) an aperture at the tip for the suction of small or crushabe thrombi and the removal of thrombi having a certain level of hardness with the shape intact; and 4) adjustable flexion of the catheter to easily detect a peripheral pulmonary artery. However, care should be taken when using the catheter to avoid damage to pulmonary artery walls.

We report a case of rupture of the thoracic descending aorta due to blunt chest trauma. An 18-year-old man was transferred to our hospital after a car accident. He was in a state of shock. The admission chest X-ray film demonstrated mediastinal widening and blurring of the aortic arch. Chest and abdominal helical CT scan showed left hemothorax, pseudoaneurysm, and hematoma of the cervix, mediastinum, and retroperitoneal space. We diagnosed rupture of the thoracic descending aorta without other injuries. An emergency operation was performed under partial cardiopulmonary bypass with systemic heparinization. The descending aorta had completely lost its continuity. Graft replacement was performed with a collagen-sealed woven Dacron graft. The postoperative course was uneventful. We suggest that high awareness and a systematic approach are needed to diagnose traumatic aortic rupture, and that enhanced helical CT scanning is helpful for diagnosis and management strategy.

A 72-year-old woman complaining of lumbago was transferred to our hospital in a state of shock. An admission abdominal CT scan showed infrarenal aortic aneurysm reaching 8cm in maximal diameter and hematoma of the retroperitoneal space. A clinical diagnosis of ruptured abdominal aortic aneurysm was rapidly established. An emergency operation was performed under general anesthesia. Laparotomy disclosed an infrarenal abdominal aortic aneurysm and hematoma. The aorta was clamped just below the bilateral renal arteries. Straight graft replacement was performed. There was enough heparinization during the surgical procedure. Postoperative findings involved paraplegia and hypoesthesia from dermatome Th 10 with associated urinary and fecal incontinence. The patient was discharged from our hospital. Spinal cord ischemia is a rare and unpredictable complication in surgery of infrarenal abdominal aortic aneurysms. Presence of intra- and postoperative episodes of hypotension and the duration of the crossclamping seem to have been the most important factors for spinal cord ischemia in this case.

A 69-year-old man in whom two stents had been implanted on segments 6 and 7 was admitted to our hospital with acute myocardial infarction (AMI). Coronary angiography suggested a total occlusion of the left anterior descending (LAD) between two stents. Percutaneous transluminal coronary angioplasty (PTCA) was performed, but it made an acute coronary occlusion due to a dissection of left main trunk (LMT). As cardiogenic shock occurred, he was put on percutaneous cardioplumonary support (PCPS), and a perfusion catheter was introduced to the LAD and a guide wire to the circumflex (Cx). Emergency coronary artery bypass grafting (CABG) was performed on cardioplumonary bypass (CPB). First, an SVG was grafted to the LAD on ventricular fibrillation, and the other SVG was grafted to segment 13 on cardiac arrest after the perfusion catheter and guide wire was removed. This method allowed this operation to be performed with suitable myocardial protection.

A 44-year-old woman in whom multiple descending aortic aneurysms with pseudocoarctation was diagnosed underwent graft replacement. The aneurysms consisted of two large and one small aneurysms. One of the large aneurysms was a fusiform type aneurysm (38mm in diameter), and another one was a saccular type aneurysm (53mm in diameter). There was a small saccular type aneurysm (12mm in diameter) the site of the at stenotic lesion, and the wall of the small aneurysm was very thin. Atherosclerotic changes were not found inside the aneurysmal wall. Aneurysm occurring at the proximal side of the stenotic lesions of pseudocoarctation are rare, and only four cases have been reported in Japan.