[Bentall Procedure and Total Arch Replacement with an Open Stentgraft after Ascending Aortic Replacement for Acute Type A Aortic Dissection].

A 40-year-old man underwent ascending aortic replacement for acute type A aortic dissection. Eight years later, Bentall procedure and total arch replacement with an open stentgraft (OSG) were performed due to enlargement of the aortic root and distal arch dissection as well as exacerbation of aortic valve incompetence. The computed tomography(CT) taken at 22 months postoperatively showed better stentgraft expansion than that immediately after the operation, reduction in the diameter of the distal aortic arch, and thrombosis of the false lumen from the aortic arch to the entire descending aorta. However, the CT taken at 33 months postoperatively revealed a new entry to the distal end of the stentgraft and blood flow in the false lumen. Although OSG is useful for extensive aortic aneurysm, strict follow-up is necessary in OSG for aortic dissection.

Massive right pleural effusion and ascites caused by a primary constrictive pericardial band.

A previously healthy 57-year-old woman with peripheral edema and exertional dyspnea had diminished right breath sounds and edema of both legs. Chest radiography showed massive right pleural effusion, and abdominal computed tomography showed ascites. During cardiac catheterization, pressure curves of both ventricles showed "dip-and-plateau" patterns. We diagnosed constrictive pericarditis and conducted pericardiectomy. During surgery, we found a thick fibrous pericardium surrounding the entire heart and a band of calcium in the atrioventricular groove. Histological examination of excised pericardial tissue showed fibrosis, hyalinization, and calcification, with thickening of < or = 18 mm. Cases of localized pericardial thickening, including constricting bands in the atrioventricular groove, are rare and many such complications occur postoperatively. We report a rare case of primary constrictive pericardial band resulting in massive right pleural effusion and ascites.

Adverse drug events and medication errors in Japanese paediatric inpatients: a retrospective cohort study.

OBJECTIVES: Knowledge about the epidemiology of adverse drug events (ADEs) and medication errors in paediatric inpatients is limited outside Western countries. To improve paediatric patient safety worldwide, assessing local epidemiology is essential. DESIGN: The Japan Adverse Drug Events (JADE) Study was a cohort study. SETTING: Paediatric inpatients at two tertiary care teaching hospitals in Japan. MAIN OUTCOME MEASURES: ADEs and medication errors identified by onsite review of all medical charts, incident reports and prescription queries by pharmacists. Two independent physicians reviewed all incidents and classified ADEs and medication errors, as well as their severity and preventability. RESULTS: We enrolled 1189 admissions which included 12,691 patient-days during the study period, and identified 480 ADEs and 826 medication errors. The incidence of ADEs was 37.8 (95% CI 34.4 to 41.2) per 1000 patient-days and that of medication errors was 65.1 (95% CI 60.6 to 69.5) per 1000 patient-days. Among ADEs, 4%, 23% and 73% were fatal or life-threatening, serious and significant, respectively. Among the 480 ADEs, 36 (8%) were considered to be preventable which accounted for 4% of all medication errors, while 668 (81%) of all medication errors were judged to have the potential to cause harm to patients. The most common error stage for preventable ADEs was monitoring (78%) whereas 95% of potential ADEs occurred at the ordering stage. CONCLUSIONS: ADEs and medication errors were common in paediatric inpatients in Japan, though the proportion of ADEs that were preventable was low. The ordering and monitoring stages appeared most important for improving safety.

Removal of a splenic artery with a large aneurysm adhered to the pancreas without pancreatectomy: report of a case.

Splenic artery aneurysms account for about 60% of all visceral aneurysms. The treatment include surgical procedures that sometimes require pancreatectomy. This report describes the case of a 64-year-old woman who had multiple splenic artery aneurysms with various visceral artery dilatations. Because there was no obvious cause for the splenic artery aneurysms and other arterial abnormalities, we suspected an anomaly of the connective tissue, which was subsequently confirmed by a postoperative histopathologic examination. Thus, we decided to remove the whole splenic artery, to eliminate the formation of any further aneurysms, as well as a splenectomy. During the operation, the largest splenic artery aneurysm was found to be adhered to the pancreas too tightly to ablate. It initially appeared that pancreatectomy would be necessary, but considering the associated risk of postoperative complications, we tried to avoid this. Thus, we cut open the aneurysm and excised it, leaving the anterior wall which was adhered to the pancreas. Our procedure proved the best way to preserve the pancreas and eliminate further aneurysmal formation.

A novel cellulolytic, anaerobic, and thermophilic bacterium, Moorella sp. strain F21.

A cellulolytic and thermophilic anaerobe was isolated from soil. This bacterium made a halo on a roll-tube culture containing Avicel. Analysis of the PCR-based 16S rRNA gene sequence showed that the bacterium was closely related to Moorella thermoacetica. Scanning electron microscopy showed the bacterium is a rod and has no protuberant structure on the surface of cells growing on cellulose, suggesting that this strain is a non-cellulosomal cellulolytic bacterium. Carboxymethyl cellulase and xylanase activities were detected in the culture broth. A major fermentation product from ball-milled cellulose was acetate. This strain has a potential to convert cellulosic biomass to acetate, directly.