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Background and Purpose: Various studies have addressed risk factors for recurrence of ischemic stroke in patients with symptomatic carotid artery stenosis. However, no investigations have compared common localized carotid artery lesions and internal carotid artery lesions, including carotid bifurcation. This retrospective study investigated risk factors for ischemic stroke recurrence in patients with symptomatic carotid artery stenosis, including a comparison of lesion sites., Methods: Of 61 consecutive patients admitted to the authors' hospital due to a diagnosis of symptomatic carotid artery stenosis between April 2015 and March 2018, data from 59 were retrospectively reviewed(2 patients diagnosed with arterial dissection were excluded). The primary end point was recurrence of ischemic stroke caused by symptomatic carotid artery stenosis, the cause of the first event. Patients were censored at the time of surgical intervention;events occurring during and after surgical intervention were not included. In the ischemic stroke recurrence and non-recurrence groups, each item was analyzed using the Kaplan-Meier method, and a log-rank test was performed with a significance level set to 5%., Results: Ischemic stroke recurrence before surgical intervention was observed in 5(8.5%)patients. In comparing the recurrence and non-recurrence groups, a significant difference was observed in age(p=0.027)and lesion site(p <0.001)., Conclusion: A localized lesion in the carotid artery was a risk factor for recurrence of ischemic stroke in patients with symptomatic carotid artery stenosis. For individuals with symptomatic localized lesions in the common carotid artery, surgical intervention should be considered-in addition to medical treatment-regardless of the degree of stenosis.

An 80-year-old woman with a history of rheumatoid arthritis and steroid diabetes had been given a diagnosis of multiple bilateral pulmonary cystic lesions 16 months previously, and these lesions were observed to gradually increase on follow-up. She presented with a fever of 38 degrees C, cough, and sputum for 2 weeks, and the pulmonary cystic lesions had enlarged, and therefore she was admitted. A chest X-ray film revealed multiple cystic lesions 4 cm in greatest dimension in both the left upper and middle lung fields, and chest computed tomography (CT) scans revealed that the lesions of the left S1+2 had niveau formation with a partially thickened wall. However, the lesions in the left S4 and S5 areas and the right S8 area had thin, smooth walls. Transbronchial lung biopsy of the left S4 lesion yielded granuloma formation and yeast-like fungus bodies within multinucleated giant cells, while bronchial lavage fluid culture showed cryptococcus neoformans. It is known that pulmonary cryptococcosis presents various images and histopathologic findings, according to the immune interactions between the fungus body and the host. We report a rare case that presented with multiple cryptococcal cystic lesions.

We had a case of upper airway stenosis after accidental ingestion of neutral detergent containing cationic surfactant (HDQ Neutral). An 85-year-old man was transported to our hospital by ambulance after ingesting 50 mL of HDQ Neutral. On arrival, he had an edematous buccopharyngeal membrane with bleeding. Laryngeal edema was observed by laryngoscopy, and severe upper airway stenosis occurred. He also had hypoxemia and was therefore intubated and put on mechanical ventilation. After admission, his respiratory condition was stable. On day 3, upper airway edema had improved and extubation was performed. He was cured without other complications. Surfactants generally have low toxicity but can cause damage to the mucous membrane of the respiratory tract and gastrointestinal tract. Therefore, immediate evaluation and treatment are needed for intoxication with them. They can also cause harm to circulation dynamics or the central nerve system, and careful follow-up is therefore needed.

We experienced a case of alachlor herbicide (Lasso) intoxication. A 57-year-old man was transported to our hospital by ambulance after ingesting 450 mL of Lasso. He was unconscious and had difficulty in breathing. Gastric lavage was performed after tracheal intubation and the patient was placed on mechanical ventilation. Activated charcoal and laxative were administrated. Even after admission, disturbance of consciousness persisted. He had liver and kidney disorders but these did not progress to multiple organ failure. He experienced convulsions from day 4 and was administered anticonvulsants. Convulsion was intractable and needed long-term treatment. His general condition improved until discharge. He was weaned from mechanical ventilation and recovered consciousness, but he still displayed tremors. The herbicide (Lasso) is a combination of alachlor and monochlorobenzene. Studies have shown that alachlor is neurotoxic and monochlorobenzene accumulates in the brain. In case of intoxication with the herbicide Lasso, treatment is required for ameliorating neurotoxic effects and intractable convulsion as well as liver and kidney disorders, gastrointestinal mucosal damage, hematopoietic disorder, and acute circulatory failure.

We have evaluated 48 cases of viper (Agkistrodon halys blomhoffii "Mamushi") bite treated in our hospital from 2001 to 2005. Of all the patients, 21 were bitten in rice field/farm, 10 were in path, 9 were in yard and 8 were in other places. Most cases occurred between July and September. The most frequently bitten regions were fingers and toes. Because swelling reached its maximum at 1.1+/-0.5 day, it was difficult to judge the severity of Mamushi bite by the degree of swelling at the first examination. There was no significant relation between the grade classification of swelling and CPK values. Value of CPK became its peek at 2.0+/-1.1 days after bites. Some reports recommend giving antivenin judging from the grade classification. However we could not estimate the severity of Mamushi bite from the degree of swelling and CPK values at the first examination. The degree of swelling and CPK values at the first examination will not be an index to determine the choice of the treatment including use of the antivenin.

A 32-year-old woman with Marfan syndrome was diagnosed as annuloaortic ectasia and acute aortic dissection at 20 weeks of gestation. At 24 weeks of gestation, she got heart failure. Bentall's procedure was performed under cardiopulmonary bypass. Anesthesia was given using sevoflurane, midazolam and fentanyl. Normothermic high-flow high-pressure non-pulsatile perfusion was performed during cardiopulmonary bypass. We used dopamine, dobutamine, milrinone and nitroglycerin for weaning of cardiopulmonary bypass. Fetal heart rate was monitored, and was stable at 120 bpm throughout the operation. At 33 weeks of pregnancy a healthy baby was delivered by cesarian section.