Obstruction of an endotracheal tube (ETT) is a potentially life-threatening event. We present a case report of a 76-years-old female with an unusual partial obstruction of the Hi-Lo Evac (Mallinckrodt Medical; Athlone, Ireland) ETT (Evac ETT) caused by kinked port of dorsal suction lumen. She had severe skeletal deformity (gibbus). Thereby, her cervical spine is assumed to be severe backward tilt position at supine position. The kinked port appears to be due to severe cervical lordosis. We discuss how early consideration of the diagnosis and optimal initial management reduce the risk of an adverse outcome.

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Information sharing of a hospital and dispatched medical teams influences an appropriate remote support. Yokosuka Kyosai Hospital dispatched medical teams to Fukushima prefecture for the medical support of East Japan great earthquake disaster. METHANE report, which Major Incident Medical Management and Support introduced as an English initial of seven items that the first emergency person at the scene should convey, was modified for the communication between medical teams and the hospital. During the 31 days between 16th March 2011 and 15th April excluding 4th, 5th, 10th, 11th April, eight medical teams, total of 39 staffs, were dispatched. Before 25th March, which is the acute and sub-acute period, the restoration situation of the lifeline, food supply, accommodation, gas station, road condition and weather were reported. Whereas after 25th March, which is the chronic and withdrawal period, the type of disease, medical equipments and medicines were conveyed in detail. Although the area of operation was extensive and duration was long, the modified METHANE is useful for the information sharing because it covers information of operation, life lines, a gas station, food supply, accommodation, personal belongings, medical equipments, and medicines. Moreover it made remote support efficient by giving information for appropriate selection of the next team member, vehicle, personal belongings, medical equipments and medicines.

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We present two cases of transient global amnesia during pruning. Both presented at the emergency department with sudden memory loss. They could not recall recent events. Neurological and physical examination, and blood tests were normal. Case 1 was suspected of having a meningioma. Brain imaging studies should not be dismissed prematurely when evaluating patients with no neurological examination findings because they could reveal latent organic lesions and can help exclude fatal illnesses.

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Objective: There is potentially airway obstruction in children with congenital heart disease, and it is associated with complications during perioperative management. The purpose of this study was to evaluate the frequency and severity of these phenomena in children with congenital heart disease and to appreciate the value of examination with a bronchoscopy and cineangiography.Methods: Ninety-eight children with congenital heart disease who showed airway obstruction were reviewed. Fiberoptic bronchoscopy and cineangiography were performed in case of clinical respiratory signs and systematically performed in case of preoperative assessment of a cardiopathy known to possibly provoke airway compression.Results: Between July 1991 and 2005, airway obstruction occurred in a total of 98 children (96 cases in National Cardiovasucular Center, Osaka, and 2 cases in The University of Tokyo Hospital, Tokyo) who had been operated for congenital heart disease. Except 13(13%) of children (11 with congenital tracheal stenosis, 1 with bronchomalacia, 1 with laryngomalacia), all other 85(87%) children showed airway obstruction by external compression. 13(13%) of children required surgical repair, and the others could be treated preservatively. In 8(8%) of children, airway compression was disappeared in itself after the operation. In 85 showed external airway compressions, 6 were tracheal compression, 59 were left main bronchial compression, 2 were both main bronchial compression, 13 were right main bronchus or right main intermediate truncus, 2 were right upper bronchus, and 3 were left upper or lower. Conclusion: Precise evaluations of the airway obstruction by both bronchoscopy and cineangiography are important for the management of congenital heart disease children who show symptoms of the airway obstruction. Perioperative airway obstruction and the requirement of surgical restoration of major vascular can be estimate from these evaluations.

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An aorto-enteric fistula (AEF) is a fistula formed between the aorta and the GI tract that causes severe rectal bleeding or large amounts of blood in vomit. It is a rare form of gastrointestinal hemorrhage and generally has a poor prognosis. AEF is often accompanied by a herald bleed. Immediate diagnosis and treatment is required once a herald bleed has been detected. Here, we report on a case of unsuccessful treatment of secondary AEF following stomach cancer. AEF is commonly referred to a lethal, and because of the interesting symptomatic and treatment aspects of the case, we have chosen to report it.

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Diabetes mellitus and the oral administration of drugs such as statins, etc. have been reported as triggers of atraumatic compartment syndrome. This study reports on an obese woman with diabetes mellitus and hypertension in whom compartment syndrome developed with no clear trauma trigger and examines the pathology of atraumatic compartment syndrome.

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The case is a 39-year-old parous female with a history of untreated hyperlipidemia. She presented at another hospital at 37 weeks gestation with the chief complaint of epigastralgia, and was diagnosed with acute pancreatitis due to elevated pancreatic enzymes. Complication with severe neonatal asphyxia led to her transferal to this hospital, where an emergency cesarean section was performed the same day. Severe acute pancreatitis was diagnosed based on three prognostic factors and CT Grade 3, and the patient was admitted to the ICU. Progress with conservative treatment was favorable, and she was discharged from hospital on the 20th day of admission after her symptoms receded. While acute pancreatitis in pregnancy is rare, there are reports of approximately 100 cases in Japan. The rate of gestational pancreatitis due to hyperlipidemia in Japan is high, and swift diagnosis and treatment is required as the prognosis is often poor. In this case, familial type IV hyperlipidemia was suspected due to the patient's history of hyperlipidemia and family history. Exacerbation of hyperlipidemia due to pregnancy is thought to have induced onset of pancreatitis.

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