Abstract:The number of patients with heart failure （HF） has been rapidly increasing with aging.　Despite the recent advancement in medical therapy, mortality rates of heart failure remain still high, and the hospitalization cost of HF is a significant concern worldwide.　This article has focused on valvular heart diseases and cardiac amyloidosis, which are leading causes of HF in the elderly population.　Several randomized trials have demonstrated that transcatheter aortic-valve implantation （TAVI） reduces mortality in high-risk patients with severe aortic stenosis.　Additionally, transcatheter mitral-valve repair （TMVr） improves clinical outcomes in patients with HF who have mitral regurgitation due to left ventricular dysfunction.　Transcatheter approach is much less invasive and can be performed in high-risk patients who are not candidates for surgical replacement.　Furthermore, after transcatheter treatments, patients can be discharged and returned to a normal life earlier than surgical procedures.　Recently, two novel therapeutic agents are available for cardiac amyloidosis.　Randomized clinical trials have shown that tafamidis and patisiran reduce all-cause mortality in patients with transthyretin amyloid cardiomyopathy.　With these advanced medical treatments, our goal is to reduce cardiovascular mortality in Fukushima.

The number of cancer deaths is increasing every year.　Lung cancer, in particular, is the leading cause of cancer death, and further improvements in treatment are needed.　The major topics in cancer treatment in recent years are the robotic surgery as a less invasive surgery and the emergence of immunotherapy.　In 2021, we have introduced robotic surgical support devices （Da Vinci Xi and X system） and start treatment using these two units.　In addition, immune checkpoint inhibitors （ICIs） have been on the market since 2015 to cancel immunosuppressive state of patients, and are expected to provide long-term survival for patients with advanced lung cancer, for which no cure has been expected until now.　While such major changes in treatment methods are expected to improve treatment outcomes, prevention of adverse events associated with treatment are also becoming increasingly important.　Our hospital has been working on the reconstruction of medical safety and established an action plan in 2019 to improve medical safety from various perspectives.　In addition, to improve the safety of advanced cutting edge medical care, we established the Center for Advanced Minimally Invasive Surgery in April 2022, and established a system that enables cross-departmental information sharing and mutual review of medical care.　Furthermore, ACiST Fukushima was established as a consultation team for immune-related adverse events in ICI to share countermeasures against adverse events and to support safty.　This paper describes the evolution of ICI treatment and our efforts to date, with a focus on lung cancer treatment.

Abstract:Placenta accreta is one of the most common obstetric complications;it causes massive hemorrhage that is sometimes life-threatening to the mother.　Known risk factors include previous cesarean section and placenta previa.　In our department, for patients who are strongly suspected of having placenta accreta via diagnostic imaging and the presence of risk factors, we perform, after autologous blood storage, cesarean section （transverse incision at the uterine fundus） after using ultrasound to determine a site other than the location of the placenta, followed by hysterectomy with a resuscitative endovascular balloon occlusion of the aorta （REBOA）.　A study of 37 cases of placenta accreta requiring hysterectomy from 2003 to 2022 confirmed the safety and efficacy of REBOA in reducing the amount of blood loss during total cesarean hysterectomy without increasing the operative time.　We will continue to manage difficult deliveries using a multidisciplinary approach, directed by expert obstetrical surgeons, in order to ensure safe childbirths.

Abstract:Acetaminophen （AAP） is an antipyretic and analgesic drug with fewer side effects than NSAIDs, and is frequently prescribed for the elderly and patients with hepatic and renal dysfunction.　On the other hand, known side effects of AAP include hepatic damage, for which reason its dose is recommended to be less than 1,500 mg/day in patients with hepatic disease.　Herein, we describe a case of acute hepatic failure with hepatic coma attributed to regular doses of AAP.　A 73-year-old woman in a coma was brought to our hospital.　She had been taking 1,200 mg/day of AAP for 2 months after a total knee arthroplasty for left knee osteoarthritis.　At the time of admission, the patient’s Japan Coma Scale （JCS） score was 200;she had jaundice and generalized edema.　With severe liver dysfunction, coagulopathy, and hepatic atrophy, she was diagnosed with acute hepatic failure and hepatic coma.　Despite aggressive multidisciplinary treatment, the patient died on the seventh day of hospitalization, with convulsions and worsening of respiratory status.　We concluded that this was a case of drug-induced liver injury （DILI） caused by AAP.　The risk of DILI was considered to be high due to the presence of nonalcoholic fatty liver disease （NAFLD）, previously diagnosed, and advanced age.　In patients at risk of DILI, as in the present case, periodic liver function tests should guide the cessation or dose reduction of AAP to minimize risks of hepatic dysfunction and possible mortality.

Abstract:We report a case of appendiceal neuroendocrine tumor （NET）.　A 58-year-old man came to our hospital complaining of recurrent right lower abdominal pain.　After series of clinical examinations, we considered this symptom to be caused by fecal stone in appendix, thereafter, we performed laparoscopic appendectomy.　Pathological examination revealed an appendiceal NET in the body of the appendix, but there were no risk factors for recurrence or metastasis, and we decided to follow up the patient without adjuvant therapy.　Appendiceal NETs are rare tumors and are often discovered incidentally on posterior pathological examination.　In Japan, neuroendocrine tumors of the appendix are classified according to histological atypia, whereas the WHO classification is based on cell proliferative capacity.　And Japanese guidelines for neuroendocrine tumors provide surgical protocols in accordance with the WHO classification.　In reviewing this case, we referred to the latest 5th edition of the WHO classification and reviewed the case reported in Japan.