In recent years, the use of automated systems for routine blood transfusion tests has increased. These systems are better than manual tube tests with respect to accuracy, management and standardization. In October 2014, our hospital switched from manual tube tests to fully automated column agglutination methods for routine antibody screening. We compared the sensitivity and specificity of antibody detection after nine months with those of tests conducted between January 2011 and September 2014. The sensitivity of detection increased from 1.19% (53/4432) to 2.94% (30/958). Among 83 positive sera samples, the rate of detection of clinically significant redcell antibodies increased from 62% (33/53) to 83% (25/30). A decrease in the number of recognized non-significant antibodies reflected the low sensitivity of the indirect antiglobulin test (IAT) to anti-Lewis and anti-P1 antibodies. In contrast, two anti-E antibodies reacted positively with the two-stage enzymatic methods but not with the lowionic-strength solution (LISS)-IAT test. Fully automated systems can contribute to safe and efficient routine antibody screening. However, manual techniques applied by experienced technologists are still important when determining clinically significant antibodies.

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Background: High-sensitivity C-reactive protein (hs-CRP) elevation is a known contributor to the inflammatory response. This study was designed to assess whether the inflammatory state influences the recurrence of atrial fibrillation (AF) after treatment of paroxysmal AF by pulmonary vein isolation (PVI). Methods and Results: Twenty three patients who were referred to undergo PVI for drug refractory paroxysmal AF (mean duration: 70.1 ± 69.2 months) were included in the study. Body weight (BW), serum hs-CRP, brain natriuretic peptide (BNP), interleukin-6 (IL-6), carboxyl-terminal telopeptide of collagen I (ICTP), left atrial diameter (LAD), and left ventricular ejection fraction (LVEF) were measured before cardioversion. PVI was successful in all patients, but the AF recurred in 7 patients (30%) during the 2-24 month follow-up period. There were no significant differences in age, AF duration, LVEF, or baseline BNP, IL-6, ICTP levels between patients with recurrent AF and those without. However, baseline hs-CRP was significantly higher in the patients with recurrent AF than in those without (1,256 ± 940 vs. 745 ± 841 ng/ml, respectively, P = 0.02). BW and LAD tended to be greater in patients with recurrent AF than in those without (BW: 73.1 ± 13.8 vs. 62.3 ± 12.1 kg, P = 0.06; LAD: 41.0 ± 8.2 mm vs. 34.9 ± 5.9 mm, P = 0.08). Conclusion: The inflammatory state may contribute to the pathogenesis of paroxysmal AF and may be useful for predicting the recurrence of AF after PVI.

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A 46-year-old man was admitted to our hospital because of fever and general fatigue. He was diagnosed with heart failure on the basis of chest radiography that showed pulmonary congestion, as well as elevated B-type natriuretic peptide on blood examination. The diagnosis of infective endocarditis was made on the basis of blood culture results and the observation of aortic valve vegetation on echocardiography. Antibiotic therapy was administered, but the heart failure worsened rapidly. The patient underwent emergency aortic valve replacement and mitral valvuloplasty. A ventricular septal defect (VSD) was identified during the surgery, and a patch closure procedure was performed. Infective endocarditis is a relatively rare disease. Our case is considered a rare case, because the left to right shunting with VSD is usually associated with infection on the right side of the heart, whereas in our patient the left side of the heart was infected.

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We experienced a patient with pulmonary edema caused by treatment with ritodrine. A 40-year-old pregnant woman had been treated with intravenous ritodrine to prevent premature uterine contraction. After 24 hours, she complained of acute dyspnea. Chest X-ray showed a butterfly shadow and bilateral effusion. We considered pulmonary edema associated with ritodrine, because the dyspnea had developed just after taking the medication and no other causes were evident. As there was the risk of progression to respiratory failure, caesarean section was performed. After surgery, the respiratory failure progressed, which we managed successfully with noninvasive positive pressure ventilation (NPPV).

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Herein, we describe the treatment of breast cancer tailored specifically to the needs of the patient in three nonagenarians. A 92-year-old woman was admitted to our hospital with a mass in the right breast. Wide excision of the tumor was performed under local anesthesia. Histologically, the lesion was invasive scirrhous carcinoma. Immunohistological staining was positive for ER and PgR, but was negative for HER2. Adjuvant therapy was effective in controlling the tumor growth without recurrence. A 94-year-old woman was admitted to our hospital with a mass in the left breast, which was diagnosed as breast cancer. Neo-adjuvant hormone therapy did not control the tumor growth. Wide excision of the tumor was performed under local anesthesia. Histologically, the lesion was invasive scirrhous carcinoma. Immunohistological staining was positive for ER and PgR, but negative for HER2. Treatment of elderly breast cancer patients should be selected taking into account the patient′s life enviroment and QOL.

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An 84-year-old woman who was suffering from lower abdominal distention was referred to our hospital. In her medical history, she had previously undergone colectomy for colon cancer and partial hepatectomy for metastatic hepatic cancer. Upon diagnosis of a large abdominal incisional hernia during the medical examination, a laparoscopic repair operation was performed. At present, the patient is undergoing follow up with no recurrence. We report our experience of successful laparoscopic surgery for a large abdominal incisional hernia. Laparoscopic surgery enabled us to observe the incisional hernia and precisely fix the mesh. We conclude that laparoscopic repair is a useful treatment option for a large abdominal incisional hernia.

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