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BACKGROUND AND AIM This study aimed to determine the efficacy and safety of vedolizumab treatment with or without concomitant immunomodulator use in Japanese patients with moderate-to-severe ulcerative colitis. METHODS Among enrolled patients in a phase 3 study conducted in Japan (clinicaltrials.gov, NCT02039505), data from patients allocated to 300-mg intravenous vedolizumab for induction and maintenance phases were used for this exploratory analysis. Efficacy endpoints were clinical response, clinical remission, and mucosal healing at week 10 and clinical remission and mucosal healing at week 60, and disease worsening and treatment failure during the maintenance phase. RESULTS At week 10, the differences in clinical response, clinical remission, and mucosal healing rates between the subgroups (those with concomitant immunomodulator use minus those without) were 0.7 (95% confidence interval: -14.3, 15.7), 3.3 (95% confidence interval: -8.5, 15.2), and 1.8 (95% confidence interval: -13.0, 16.5), respectively. At week 60, the differences in clinical remission and mucosal healing between the subgroups with and without concomitant immunomodulator use were 26.1 (95% confidence interval: -3.5, 55.6) and 29.9 (95% confidence interval: 1.4, 58.4), respectively. The proportions of patients without treatment failure at day 330 of the maintenance phase were 90.7% with concomitant immunomodulator use and 73.7% without. No marked differences in incidence of infections were observed between subgroups. CONCLUSIONS This study suggested the possibility that concomitant immunomodulator use may be beneficial to maintain the clinical efficacy of vedolizumab.

A 48-year-old woman presented with abnormal electrocardiogram was diagnosed as having a left atrial tumor by echocardiography. She was asymptomatic and had no history of cardiac abnormality. Transthoracic echocardiography revealed a relatively hyperechoic and heterogenous tumor with the diameter of 5~6 cm originated from the left atrial septum but could not detect atrial septal defect. Transesophageal echocardiography showed atrial septal defect of fossa ovalis but failed to uncover shunt flow behind the tumor. We diagnosed as left atrial myxoma complicated with atrial septal defect, and an operation was performed through small right intercostal thoracotomy. The tumor was excised and the atrial septal defect was completely repaired after pulmonary vein isolation. The post-operative course was uneventful. Cardiac myxoma coexisting atrial septal defect is rare, and preoperative transesophageal echocardiography is considered essential for the diagnosis of coexistent lesions especially in the patients minimally invasive cardiac surgery is planned.was uneventful. Cardiac myxoma coexisting atrial septal defect is rare, and preoperative transesophageal echocardiography is considered essential for the diagnosis of coexistent lesions especially in the patients minimally invasive cardiac surgery is planned.

Tomiki Sumiyoshi,1 Koichiro Watanabe,2 Shinichi Noto,3 Shigeru Sakamoto,4 Yoshiya Moriguchi,5 Lene Hammer-Helmich,6 Jovelle Fernandez4 1Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan; 2Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan; 3Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan; 4Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan; 5Medical Affairs, Lundbeck Japan KK, Tokyo, Japan; 6Medical Affairs Value Evidence, H. Lundbeck A/S, Valby, DenmarkCorrespondence: Tomiki SumiyoshiDepartment of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8551, JapanTel +81 42 341 2711Fax +81 42 346 3569Email sumiyot@ncnp.go.jpBackground: Accumulating evidence suggests the presence of cognitive impairment in patients with major depressive disorder (MDD), which affects their psychosocial function and quality of life (QoL). PERFORM-J (Prospective Epidemiological Research on Functioning Outcomes Related to MDD in Japan) is an observational, multicenter study to assess longitudinal changes in depressive symptoms, psychomotor speed, subjective cognitive function, and psychosocial function.Methods: Five hundred and eighteen Japanese outpatients with MDD initiating new antidepressant monotherapy (first-line or switch from previous drug) as part of their routine medical care participated in this study. Assessments at baseline and over the 6-month observation period included physician-rated depression severity (Montgomery–Åsberg Depression Rating Scale), psychomotor speed (Digit Symbol Substitution Test; DSST), subjective cognition (Perceived Deficits Questionnaire–Depression), psychosocial function (Sheehan Disability Scale), and QoL (EuroQol-5 Dimension-5 Level).Results: Antidepressant treatment for 6 months improved depressive symptoms and subjective cognitive impairment (cognitive complaints), whereas psychomotor speed remained impaired (ie, DSST total score was > 1 standard deviation below the norm) in 35.6% of patients at 6 months. Impairment of subjective cognition, but not psychomotor speed at month 2 was associated with poor psychosocial function and QoL at 6 months. There was a trend for higher relapse rates at 6 months in patients with greater subjective cognitive impairment at 2 months.Conclusion: These findings highlight the importance of evaluating cognitive difficulties to predict long-term outcomes in patients with MDD. Early intervention for cognitive complaints may decrease the relapse rate, which warrants further study.Keywords: cognition, depression, functional outcome, quality of life, Japan

Berry syndrome is a trilogy involving an aorto-pulmonary window, right pulmonary artery from ascending aorta and an interrupted aortic arch. Surgical repair for this anomaly is associated with a high mortality rate and incidence of right pulmonary arterial stenosis. Herein, we present the case of a patient with Berry syndrome, who underwent a rapid two-stage repair involving bilateral pulmonary arterial banding and complete repair. Postoperative computed tomography scan showed well-repaired great vessels free of obstruction.

The patent foramen ovale (PFO) is known as a risk of paradoxical embolism in patients with deep venous thromboses. However, PFO is usually found after systemic embolic symptoms become apparent. A 60-year-old male had complained of dyspnea for two weeks. Ultrasound echocardiography showed a thrombus straddling PFO, and venous echography showed blood clots in the right popliteal and soleus veins. Contrast computed tomography revealed multiple pulmonary embolisms and a thrombus in the right atrium expanding to the left atrium through the atrial septum. The straddling thrombus in the atrium and pulmonary thrombi were extirpated under circulatory arrest with deep hypothermia. An inferior vena cava filter was inserted intravenously four days after surgery. The patient was discharged on the 19th postoperative day without any signs of thromboembolism. Prompt surgery is considered important to prevent thromboembolism in the case of impending paradoxical embolism.

We present a case of 5 year-old female with funnel chest, by which cardiovascular structures were displaced into the left chest cavity. This caused left bronchial compression by the pulmonary artery and the descending aorta, for which an external stenting was successfully performed. The patient had features suggestive of skeletal dysplasia with tracheobronchial malacia. One possible mechanism of vascular compression could be an association of fragility of the thoracic cavity and inspiratory dyspnea, causing thoracic deformity.

Background Evidence is accumulating for the presence of cognitive impairment in patients with major depressive disorder (MDD). The Prospective Epidemiological Research on Functioning Outcomes Related to Major Depressive Disorder in Japan (PERFORM-J) study is a 6-month, non-interventional, prospective, multicenter, epidemiological study. Using baseline data, the relationship between cognitive symptoms and psychosocial function was analyzed in Japanese patients with MDD. Methods A total of 518 Japanese outpatients (aged 18–65 years) with MDD initiating new antidepressant monotherapy (first-line or switch from a previous drug) participated. Assessment measures were: physician-rated Montgomery-Asberg Depression Rating Scale (MADRS) (depression severity); Digit Symbol Substitution Test (DSST) (objective cognition); and patient-rated Perceived Deficits Questionnaire – Depression (PDQ-D) (subjective cognition); Sheehan Disability Scale (SDS); Work Productivity and Activity Impairment questionnaire (WPAI) (psychosocial function); and EuroQol-5 Dimension-5 Level (quality of life). Results Over half of patients exhibited a greater than 1 standard deviation decline below norm in objective cognition, as measured by the DSST. Severity of depressive symptoms correlated positively with subjective (PDQ-D), but not objective (DSST) cognition. Depression severity and subjective cognition were significantly associated with psychosocial function, as measured by the SDS and WPAI (except the absenteeism items). Conversely, the association between objective cognition and psychosocial function was not significant. Limitations Only outpatients were recruited. Occupations and job-related stress levels were not taken into account. Conclusions Japanese patients with MDD presented a high incidence of cognitive impairment. The relationships between cognitive and psychosocial function in these patients suggest a need for therapeutics targeting cognitive impairment of MDD.

We conducted a multicenter, open-label, observational study to evaluate the effectiveness and safety of ramelteon in patients with insomnia, and patient characteristics affecting treatment response in routine clinical practice. Eligible patients were aged ≥ 20 years, had a diagnosis of insomnia with difficulty falling asleep, and were scheduled to receive ramelteon 8 mg/day for 12 weeks. The primary objective was to evaluate the relationship between changes in insomnia severity [measured by the Insomnia Severity Index (ISI)] and patient characteristics. Changes in the physical (PCS-8) and mental (MCS-8) components of the Short Form-8 (SF-8), and safety were also investigated. 1527 patients received therapy; 40.5% were aged ≥ 65 years and 29.7, 56.9, and 13.4% had mild, moderate, or severe insomnia, respectively. At week 12, significant improvements in ISI score [mean change (standard deviation) from baseline, − 5.0 points (6.3); p

Background and Aim: To evaluate the onset of symptomatic response with vedolizumab in patients with moderate-to-severe ulcerative colitis in Japan. Methods: Patients were randomized to receive vedolizumab 300 mg or placebo at Weeks 0, 2, and 6. Mayo subscores were analyzed in patients with baseline stool frequency (SF) ≥1 and rectal bleeding (RB) ≥1. In patients with baseline SF ≥2 and RB ≥1, the proportion who achieved SF ≤1 and RB = 0 was determined. Results: Patients were randomized to vedolizumab (n = 164) or placebo (n = 82). Decrease from baseline in mean SF subscore was greater with vedolizumab versus placebo from Week 2 (−6.6%; 95% confidence interval [CI], −16.2, 3.0), with a greater difference in anti-tumor necrosis factor (TNF)α-naive patients (vedolizumab vs. placebo, −13.2%; 95% CI, −29.7, 3.3). Mean percentage decrease from baseline RB subscore was numerically greater with vedolizumab versus placebo from Week 6 in anti-TNFα-naive patients (−10.7%; 95% CI, −33.0, 11.5). More patients in the anti-TNFα-naive subgroup achieved SF ≤1 and RB = 0 with vedolizumab versus placebo at Week 2 (14.8%; 95% CI, 2.5, 27.0) and Week 6 (20.3%; 95% CI, 4.4, 36.2). Patients with SF ≤1 and RB = 0 at Week 2 had higher clinical response, clinical remission, and mucosal healing rates at Week 10 than those without. Conclusions: Our results indicate that vedolizumab induces a rapid symptomatic response, particularly in anti-TNFα-naive patients, and suggest that early symptomatic improvement predicts treatment response at Week 10 (NCT02039505).

Objective This study was performed to explore the association between circulating B-type natriuretic peptide (BNP) and other mortality-related factors in patients undergoing cardiovascular surgery. Methods In this observational study, multilevel linear regression analysis and multilevel survival analysis were performed to measure the log-transformed BNP (lnBNP) value at four time points in 197 patients with 788 repeated data measurements. Effects of the interaction between the time points and the two intervention groups (cardiac surgery and vascular surgery) were also investigated. Six models were evaluated to identify the best fit for the data. Stata/MP® version 14.2 (Stata Corp., College Station, TX, USA) was used to analyze the two-level variance component model fitting. Results There were significant differences in the fixed-effect parameters of lnBNP, such as the time point, age, body mass index, emergency operation, prognostic nutritional index, and estimated glomerular filtration rate. According to the multilevel survival analysis for all-cause death and vascular death, lnBNP significantly differed and was a common prognostic marker. Conclusion As lnBNP increased by 1 point, all-cause death increased 2.07 times and vascular death increased 3.10 times. lnBNP is an important prognostic predictor and quantitative biochemical marker in patients undergoing cardiovascular surgery.

A new type of silica–organic hybrid nanoparticle (HNPs) ∼30 nm in size, consisting of vinylsilylated silica nanoparticles (SNPs) of size ∼2 nm and 1,6-hexanedithiol as the organic linker, were prep...

Brentuximab vedotin (BV) was initially approved in Japan for the treatment of relapsed/refractory (R/R) CD30-positive Hodgkin lymphoma (HL) and systemic anaplastic large cell lymphoma (sALCL). As requested by the Japanese Ministry of Health, Labour and Welfare, we conducted a post-marketing surveillance (PMS) study to assess the safety of BV in Japanese patients with R/R HL or sALCL. PMS forms were collected from 284 patients (182 with HL, 101 with sALCL and one with another lymphoma) treated between April and September 2014. The median age was 62 (range 14–93) years and the median number of treatment cycles was 5.5 for HL and 4 for sALCL. Adverse drug reactions (ADRs) were reported in 74.3% of patients. The most commonly observed ADRs included peripheral sensory neuropathy (39.1%; grade ≥ 3, 6.3%), neutropenia (34.5%; grade ≥ 3, 22.2%) and lymphopenia (7.0%; grade ≥ 3, 5.3%). Ten patients had fatal ADRs including interstitial lung disease (n = 3). This study showed that BV has an acceptable safety profile in Japanese patients with R/R HL and R/R sALCL in the clinical practice setting. However, close monitoring rare, but potentially fatal, ADRs such as pulmonary toxicity may be warranted, especially in patients with prior or ongoing pulmonary disorders.

A 4-year-old girl with pulmonary regurgitation after complete repair of tetralogy of Fallot, underwent an alternative surgical repair for pulmonary valve replacement. Hand-sewn trileaflet valve reconstruction using expanded polytetrafluoroethylene membrane is a feasible method for pulmonary regurgitation in such a young child in whom a large-sized bioprosthetic valve cannot be implanted.

Background and Aim Non-erosive reflux disease (NERD) and functional dyspepsia (FD) share some common features, and the appropriateness of managing these diseases independently has been questioned. A post-hoc subgroup analysis of the LEGEND study was performed to compare demographics and treatment response between patients with NERD and patients with FD. Methods Patients with reflux and dyspepsia symptoms who had no endoscopic evidence of mucosal breaks and/or erosions were included and divided into groups with predominant NERD (n = 1546) or FD (n = 614). Patients received lansoprazole for 4 weeks, and their symptoms were evaluated using questionnaires. Results FD patients were significantly younger than NERD patients (54 vs 60 years), more likely to have a body mass index 60% of both patients reported an improvement in reflux symptoms and in most dyspepsia symptoms. The improvement rate for reflux symptoms was lower in FD patients than in NERD patients (P

We describe the case of an 85-year-old man who presented with a large pericardial effusion. The patient was admitted because of anorexia and general malaise. Chest X-ray revealed an increased cardiothoracic ratio and a small amount of bilateral pleural effusion. Two-dimensional ultrasonographic echocardiography showed pericardial effusions with atrial and right ventricular early diastolic collapse, establishing the diagnosis of cardiac tamponade. Signet-ring cell cancer with pericardial involvement was diagnosed by subxiphoid pericardiostomy. The clear fluid was removed through pericardial drainage. The signet-ring cell carcinoma of the stomach was revealed by gastric fiberscope examination after pericardial biopsy proved malignancy. Virchow lymph node metastasis was also found. We diagnosed the patient with gastric cancer stage IV and suggested him the best supportive therapy. He died of cardiac arrest 1 month after best supportive care.

Objective Although gastroesophageal reflux disease (GERD), a very common disorder worldwide, is considered to be a lifestyle disease, the pathogenic role of lifestyle factors and consequently the efficacy of lifestyle interventions, remains controversial. Lifestyle factors associated with GERD and the beneficial effect of specific recommended lifestyle interventions in the primary care setting were evaluated as a post-hoc analysis of the LEGEND study which investigated the effect of lansoprazole in patients with GERD who reported dyspeptic symptoms. Methods GERD patients with dyspepsia were treated with lansoprazole 15 mg or 30 mg daily for four weeks. Reflux and dyspeptic symptoms were evaluated using patient-reported questionnaires before and four weeks after the administration of lansoprazole. Results Among 12,653 patients, "feelings of continued stress" was the most common lifestyle factor (45.6% of patients), and >30% of the patients reported "eating sweet foods at least once every two to three days," "eating greasy foods at least once every two to three days" and "drinking coffee almost daily." Introducing lifestyle interventions had a significant effect on both reflux and dyspeptic symptoms. Conclusion Lifestyle interventions are thus considered to be important in GERD patients with dyspepsia who receive a proton pump inhibitor.

There are emerging demands for single-digit nanoscale particles in multidisciplinary fields, such as nanomedicine, optics, catalysis, and sensors, to create new functional materials. Here, we report a novel route to prepare silica nanoparticles less than 3 nm in size via the evaporation-induced self-assembly of silicate species and quaternary trialkylmethylammonium surfactants, which usually form reverse micelles. The solvent evaporation induces a local concentration increase and simultaneous polycondensation of silicate species within the hydrophilic region of the surfactant mesophases. Extremely small silica nanoparticles in the silica-surfactant mesostructures can be stably dispersed in organic solvents by destroying the mesostructure, which is in clear contrast to the preparation of silica nanoparticles using the conventional reverse micelle method. The surface chemical modification of the formed silica nanoparticles is easily performed by trimethylsilylation. The particle size is adjustable by changing the ratio of the surfactants to the silica source because the hydrophobic/hydrophilic ratio determines the curvature and diameter of the resulting spherical silica-surfactant domains in the mesostructure. The versatility of this method is demonstrated by the fabrication of very small titania nanoparticles. These findings will increase the designability of oxide nanoparticles at the single-digit nanoscale because conventional methods based on the generation and growth of nuclei in a solution cannot produce such nanoparticles with highly regulated sizes.

The design of siloxane-based nanoparticles is important for many applications. Here we show a novel approach to form core-shell silica nanoparticles of a few nanometers in size through the principle of "dispersion of ordered mesostructures into single nanocomponents". Self-assembled siloxane-organic hybrids derived from amphiphilic alkyl-oligosiloxanes were postsynthetically dispersed in organic solvent to yield uniform nanoparticles consisting of dense lipophilic shells and hydrophilic siloxane cores. In situ encapsulation of fluorescent dyes into the nanoparticles demonstrated their ability to function as nanocarriers.

A 6-year-old boy with pulmonary regurgitation after complete repair of congenital heart disease underwent an alternative surgical repair for pulmonary valve replacement. Trileaflet pulmonary valve reconstruction using expanded polytetrafluoroethylene membrane is a clinically feasible technique for pulmonary regurgitation in such a young child in whom large-sized bioprosthetic valves cannot be implanted.

We investigated the degradation of membrane electrode assemblies (MEAs) utilizing PtRu catalysts by way of an accelerated anode degradation test (anode potential cycling) that simulated localized fuel starvation. We predicted that anode potential would be high (approx. 1.4 V vs. RHE) when localized fuel starvation occurred during start-up of the stack. Although the dissolution of Ru in the anode increased with increasing upper potential limits in anode potential cycling that simulated localized fuel starvation, the Ru crossover from anode to cathode and Ru deposition in the cathode reached a maximum at an upper potential limit of 1.2 V. In addition, we investigated a method for restoring the performance of MEAs deteriorated by Ru deposition. With this method more than 90% of cathode performance (H 2 –O 2 voltage) and 79% of H 2 –Air voltage can be recovered.

We developed a practical analytical system for high-throughput and comprehensive lipid profiling using a supercritical fluid chromatography (SFC) system coupled to an Orbitrap Fourier transform mass spectrometer (Orbitrap FT-MS). Using our SFC method, polar lipid molecular species were separated based on not only their fatty acyl moieties but also their polar head groups, using a single octadecylsilyl (ODS) column. In addition, because automatic data processing software was used for the identification of lipid molecular species, the analysis time including data processing was about a half an hour per sample. A variety of lipid molecular species were detected in mouse plasma, and isomers which often co-elute in reverse phase separation were identified accurately and quantified individually. To the best of our knowledge, this is the first report describing the chromatographic separation of lipids based on both fatty acyl moieties and polar head groups, using a single ODS column. Our results demonstrate that SFC/MS is a powerful tool for the simultaneous analysis of diverse lipid molecular species.

症例1は，58歳男性．B型およびアルコール性肝硬変と2型糖尿病の既往あり．主訴は，全身倦怠感と体重減少であった．RBC 707x104/mm3，Hb 20.4 g/dl，Hct 59.6%と多血症があり，血清エリスロポエチン値（以下Epoと略す）113 mU/mlは高値であった．喫煙・ビタミン欠乏症などによる2次性多血症は除外された．肝右葉に17 cmの肝細胞癌（以下HCCと略す）を認めた．肝右葉切除後に，高Epo血症と多血症は改善した．低分化型肝細胞癌で，stage IIIであった．術後2年間無再発である．症例2は，58歳男性．B型肝硬変の既往あり．肝右葉に径9 cmのHCCと，右門脈1次分枝に腫瘍栓を認めた．血液生化学検査で多血症と高コレステロール血症と高Epo血症を認めた．肝拡大右葉切除後に，多血症は改善した．低分化型肝細胞癌，stage IVAであった．術後1年1カ月目に多発肺・肝転移が出現した．高Epo値を伴う多血症合併HCCの2例に，文献的考察を加え報告する．

We have designed and synthesized a novel [2]pseudorotaxane-based molecular machine in which the interconversion between end-to-interior and end-to-end loop structures is reversibly controlled by electrochemical stimuli. Cucurbit[8]uril (CB[8]) and the thread molecule 3(4+) with an electron-rich hydroxynaphthalene unit and two electron-deficient viologen units form the 1:1 complex 4(4+) with an end-to-interior loop structure, which is reversibly converted into an end-to-end structure upon reduction. Large changes in shape and size of the molecule accompany the reversible redox process. The key feature of the machine-like behavior is the reversible interconversion between an intramolecular charge-transfer complex and viologen cation radical dimer inside CB[8] triggered by electrochemical stimuli.

The degradation of Pt supported on carbon catalysts (Pt/C) due to four anion species (Cl − , F − , SO 4 2− , NO 3 − ) was investigated by operation tests using single cells of a polymer electrolyte fuel cell (PEFC). A loss of cell voltage and of electrochemical surface area (ECA) of the cathode catalyst, and an increase in oxygen gain were shown only when a solution containing Cl − was supplied. Scanning electron microscope (SEM) and transmission electron microscope (TEM) analysis after 50 h tests showed partial Pt dissolution and deposition in the membrane (Pt band) only in the inlet-side of the membrane electrode assembly (MEA). The partial loss of Pt led to the concentration of current density and degradation of cell performances.

By taking advantage of the fact that cucurbit[6]uril (CB[6]) forms exceptionally stable host-guest complexes with protonated amines, and that its homologue CB[8] can encapsulate a pair of electron-rich and electron-deficient guest molecules to form a stable 1:1:1 complex, we synthesized a novel dendritic [10]pseudorotaxane, or second-generation rotaxane dendrimer (from a topological point of view), in which 13 molecular components are held together by noncovalent interactions. A triply branched molecule containing an electron-deficient bipyridinium unit on each branch formed a branched [4]pseudorotaxane with 3 equivalents of CB[8]. Addition of 3 equivalents of 2,6-dihydroxynaphthalene produced a first-generation rotaxane dendrimer, which was characterized by NMR spectroscopy and CSI-MS. The reaction of the branched [4]pseudorotaxane with 3 equivalents of a triply branched molecule that has an electron-donor unit at one arm and CB[6]-containing units at the other two gave the dendritic [10]pseudorotaxane, the structure of which was confirmed by NMR spectroscopy, UV/Vis titration experiments, and CSI-MS.

Mitral valve replacement in the presence of severe annular calcification and an infectious lesion may be complicated by atrioventricular rupture, left circumflex coronary artery injury, and recurrence of infective endocarditis. Confronted with these circumstances, we have developed a technique of annular reconstruction for mitral valve replacement. The prosthetic valve is made by enlarging the circumference of the sewing ring with a Dacron collar. The collar can be sutured to the left atrial wall above the mitral annulus. This technique has been employed in five patients: three had extensive annular calcification, and two had acute valve endocarditis with destruction of mitral annulus. In all cases, the circumferential or partial annular reconstruction permitted secure implantation of the prosthetic valve. The one postoperative death was related to hemodialysis due to chronic renal failure. There were no other fatalities during the postoperative course, and the valves functioned normally. Our results suggest that this technique can be performed in high operative risk patients when mitral valve replacement is impossible using conventional techniques.

腹部動脈瘤の手術のさいに偶然指摘される小さな嚢胞も含めると,腎嚢胞を合併する腹部動脈瘤は希ではないと思われるが,本邦での腎嚢胞あるいは嚢胞腎を伴った腹部大動脈瘤手術の報告はきわめて少ない.大きな腎嚢胞は動脈瘤の手術中に腎嚢胞が破裂・出血の報告もあり,さらに手術操作に支障をきたすこともあり,なんらかの対策が必要である.今回,77歳,男性の腹腔を圧迫する両側巨大多発性腎嚢胞を合併した腹部動脈瘤に対して,術前に巨大な両側腎嚢胞を超音波ガイド下に経皮的に穿刺吸引を行い約1,550mlを除去した.3日後,5.2cmの大動脈瘤と3.0cmの左総腸骨動脈瘤,2.6cm右総腸骨動脈瘤に対して腹部正中切開,腹膜外到達法で動脈瘤切除+Y字型人工血管置換術を施行した.術後経過は順調で,巨大な嚢胞性腎疾患を合併する腹部動脈瘤に対し経皮的穿刺内容液吸引は有用な方法であった.