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.
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.
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
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