Aims: The crew members of an endurance motor sports rally team developed acute high-altitude illness (AHAI) during the first year of a route that included driving at high altitude for three days. Therefore, a health care manager (HCM) was assigned to the team to help prevent AHAI during the second and third years. We evaluated the effect of the HCM on the prevalence of AHAI. Methods: The numbers of individuals who presented at the official medical tent of the rally were recorded. Reports from another team without an HCM served as the control. Results: The rates of visits were essentially the same between the two teams (5 [20.8%] of 24 vs. 3 [20.0%] of 15) respectively during 2016. These values were reduced in the team with the HCM during 2017 and 2018, but did not change in the control team (1 [4%] of 25 and 0 [0%] of 25, respectively vs. 3 [18.8%] of 16; P = 0.0128 Fisher exact test). Conclusions: An HCM with knowledge of AHAI was effective in preventing the development of AHAI among endurance rally crews.

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Deep brain stimulation (DBS) has become the treatment of choice for medically refractory essential tremor. Although there have been many reports on the effectiveness of this treatment, some patients require further increased stimulation with progression of the disease. In such cases, the occurrence of stimulation-induced side-effects often limits the potential to increase stimulation further. Herein, we report a case of a 53-year-old man with medically-refractory essential tremor, who underwent thalamic DBS. His symptoms improved after surgery, but gradually deteriorated a few years later. We exchanged the stimulator with a new conductive device, and introduced a new program of stimulation. The tremor was then controlled. In recent years, new devices and programs have been developed, and we should consider using more beneficial treatments by selecting the devices and stimulation programs that can improve movement disorders effectively

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In today’s aging society, there are mixed opinions about the indications for gastrostomy. When performing a gastrostomy, the incision should be positioned carefully, bearing in mind the physical structure and anatomical variations of the stomach. Some reports have recommend using bumper-type tubes ,as opposed to balloon-type tubes. Herein, we report a case of duodenal obstruction caused by a percutaneous endoscopic gastrostomy (PEG) tube in an elderly patient. [Case] The patient was an 89-year-old female who had been maintained on enteral nutrition therapy for 2 years. She was suspected as having a bowel obstruction based on her symptoms that lasted for 3 days before her visit, including not being able to pass gas or have a bowel movement, vomiting, and abdominal distention, and she was referred to our department. She had a medical history of dementia, bilateral femoral neck fracture, and dysphagia. With respect to her progress after admission, she was initially bedridden and unable to communicate. In addition, the skin around the gastrostomy site showed redness and erosion, and the imaging findings indicated a duodenal obstruction. After removing and replacing the PEG tube, the obstruction was released, and the gastrointestinal symptoms disappeared. The diagnosis of ball valve syndrome was made. A stomach tumor impacting the duodenal lumen presents a similar clinical state, and thus, attention is necessary.

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Hemophilia is a bleeding disorder caused by a congenital deficiency of coagulation factors VIII or IX. Because an increasing number of patients with hemophilia are achieving a near-normal lifespan, some of them develop age-related cardiovascular disease. Herein, we report successful off-pump coronary artery bypass grafting in a patient with hemophilia A. A 55-year-old man with hemophilia A developed chest pain and cardiac catheterization revealed severe triple vessel disease. Before surgery, a bolus of 100 IU/kg of recombinant factor VIII (rFVIII) was administered to maintain factor VIII activity around 100%. Coronary artery bypass grafting was then performed under heparinization without cardiopulmonary bypass or blood transfusion. Subsequently, continuous infusion of rFVIII was administered until the 10th postoperative day. No bleeding complications occurred. Coronary artery computed tomography revealed patency of all bypass grafts on the 7th postoperative day. The postoperative course was uneventful and the patient was discharged on the 13th postoperative day.

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Von Meyenburg complex (VMC), also known as biliary microhamartoma, is a rare clinical condition. Herein, we report a rare case of VMC associated with acute exacerbation of chronic cholecystitis in the context of chronic hepatitis C. In this 53-year-old male patient, cholecystectomy and intraoperative liver biopsy were performed for acute exacerbation of chronic cholecystitis in the context of hepatitis C. Pathological findings included chronic cholecystitis, mild liver fibrosis, biliary hyperplasia in the portal area, and scattered VMCs. Precancerous lesions cannot be ignored and are important in the differentiation from malignant diseases.

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A 72-year-old woman developed back pain, leg pain, and weakness of the legs after lifting heavy weights. The patient was referred to our hospital 3 months after symptom onset. Lumbar spinal magnetic resonance imaging revealed vertebral fractures and an epidural mass lesion compressing the dural sac. Removal of the tumor was successfully performed, leading to a pathological diagnosis of lumbar spinal angiolipoma. The symptoms improved immediately and no recurrence was evident in the postoperative follow-up 12 months later. This is the first case report of pure lumbar spinal angiolipoma presenting with symptoms after lumbar vertebral fracture.

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Cytomegalovirus septic shock is rarely reported in a term infant. Case presentation: The patient was a male infant born at full-term and had respiratory distress and low systolic blood pressure. We diagnosed the case as septic shock and initiated treatment with antibiotics, polymyxin Bimmobilized fiber column direct hemoperfusion, and hydrocortisone. However, his overall condition did not improve. We considered cytomegalovirus infection because of the increased number of atypical lymphocytes. Cytomegalovirus DNA was detected in dried umbilical cord. We diagnosed this case as congenital cytomegalovirus infection and started ganciclovir for 3 weeks. He had also been found to have cleft lip, micro penis, and hypoglycemia on admission. MRI of the pituitary gland and glucagon loading test confirmed congenital panhypopituitarism. We treated him with hormone replacement therapy and achieved good growth and improved weight gain thereafter. Conclusions: Our case suggests the need to suspect panhypopituitarism, when hypoglycemia and micro penis are observed in patients with cleft lip. Cytomegalovirus infection should be kept in mind in infants with septic shock

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