Suwa Maternity Clinic (SMC) has provided pre-adoption consultation to infertile couples since the consultation section for patients (Kounotori Sōdan-shitsu) was opened in the hospital in 2003. In this research, we analyzed cases of consultation to evaluate the significance of adoption-related information and support activities to sterile couples by medical organizations. We collected the treatment histories of couples who had sought pre-adoption consultation from their medical records which were kept by SMC. We explained the purpose of our research and obtained their consent to cooperate by telephone, and conducted a survey by e-mail asking them about their experience of adoption and their current circumstances. SMC provided consultation to 32 couples over 14 years. Nineteen couples adopted 21 children through the special adoption system (tokubetsu yōshi engumi). Fourteen out of the 19 began adoption procedures while they were undertaking infertility treatments, and 5 couples began after giving up treatment. The age of the adopted children when they started to live with adoptive parents ranged from 0 days to 23 months old ; 15 children were less than 7 days old. The adoptions of 11 children were coordinated by a public organization, the local Child Consultation Center (Jidō Sōdan-sho), while those of 10 were coordinated by private adoption agencies. SMC set up networking opportunities for adoptive families. We conclude that pre-adoption consultation at medical organizations for treatment of sterility is meaningful for the well-being of adopted children as well as infertile couples who have given up treatment.

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Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by ventricular arrhythmia and right heart failure due to right ventricular (RV) fibrofatty atrophy. A 70-year-old male with ARVC underwent elective endoscopic left upper lobectomy for treatment of lung cancer. We found that one-lung ventilation (OLV) caused flattening of the interventricular septum (IVS) during diastole and changed the left ventricular (LV) configuration from a circle to a “D-shape” in the patient, which was imaged with transesophageal echocardiography (TEE). The LV “D-shape” returned to a normal circular configuration immediately after conversion from OLV to two-lung ventilation. Since flattening of the IVS is a sign of RV overload and since continuous RV overload may result in the development of RV dysfunction, early diagnosis is important. We recommend monitoring of IVS movement by TEE during OLV in patients with ARVC.

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A 71-year-old man was referred to our hospital complaining of gross hematuria. Cystoscopy revealed a wide based papillary bladder tumor. We perfomed transurethral resection of the bladder tumor followed by total cystectomy and ureterocutaneostomy. Pathologically, the tumor was found to be a pT3b pN0 choriocarcinoma. Immunohistochemical staining showed human chorionic gonadotropin (HCG)-positive tumor cells. One month after surgery, serum HCG level was elevated, and computed tomography revealed multiple lung, liver, and lymph node metastases. Four cycles of salvage chemotherapy with bleomycin, etoposide, plus cisplatin (BEP) were administered. The metastatic lesions showed partial response, and the serum HCG level fell to within the normal range. Soon afterwards, however, serum HCG was again elevated, and four cycles of chemotherapy with gemcitabine plus cisplatin (GC) were administered followed by one cycle of chemotherapy with gemcitabine plus paclitaxel (GP). However, there was no response and the patient died 17 months after surgery.

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