Coarctation of a right aortic arch is rare congenital anomaly. We report a rare case of a 24-year-old female with coarctation of the right aortic arch with aberrant left subclavian artery between the right common carotid and right subclavian arteries. The coarctation progressed into complete obstruction as the interruption of the aorta in adulthood. To prevent cerebral complications and progression to heart failure, surgical procedure was selected. Extraanatomical bypass grafting between the ascending and descending aorta was successfully performed using cardiopulmonary bypass. Some patients diagnosed with interruption of the aortic arch in adulthood might be displaying progression of undiagnosed coarctation, as our in case. Three-dimensional computed tomography was useful to detect the obstructive lesion and to determine the surgical approach and methods.

BackgroundDesmoid-type fibromatosis is characterized by desmoid tumors, which are benign soft tissue tumors that can be locally aggressive but typically do not metastasize. Desmoid tumors can manifest anywhere in the body, and those in the abdominal cavity account for approximately 30 to 50% of all such tumors. Complete resection with free margins has been the standard treatment, but non-surgical therapies have been implemented recently. However, if tumors are strongly invasive and/or persistently recur, radical surgical resection with free margins remains the primary treatment. Unfortunately, radical resection may cause large abdominal defects and hinder reconstruction. Several reports and recommendations have addressed this issue; however, to the best of our knowledge, few reports have described complete resection and the subsequent reconstruction of the rectus abdominis muscle.Case presentationA 35-year-old Asian woman presented at our hospital with a chief complaint of abdominal pain. She had abdominal desmoid tumors that required complete resection of her rectus abdominis muscle. Due to necrosis in her own reconstructed tissue, we failed to cover her anterior abdominal wall; thus, we used an abdominal binder as a substitute material to avoid exacerbating the incisional hernia and help her generate intra-abdominal pressure.ConclusionsThis case report may be informative and helpful for the treatment of patients with desmoid tumors, as managing desmoid-type fibromatosis is difficult.

Cold agglutinins are autoantibodies that agglutinate red blood cells at low temperatures, leading to haemagglutination and haemolysis. They are generally of no clinical significance. However, when people with cold agglutinins undergo cardiac operation with hypothermia and cold cardioplegia, they can experience complications. Thus, different perioperative management is required for such patients. We describe a 74-year-old man with cold agglutinins incidentally detected on the preoperative screening test. He had never experienced any complications or developed a haematological disease. Since cold agglutinins were incidentally detected on the preoperative test, a special strategy was used to manage the temperature of cardiopulmonary bypass (CPB) and cardioplegia. He successfully underwent normothermic cardiac operation with warm cardioplegia. A continuous retrograde hyperkalaemic infusion and intermittent antegrade infusion of warm cardioplegia with normothermic CPB is one of the best methods to avoid hypothermia and excessive activity and metabolism of the heart, and to provide a suitable operative field.

(thiamazole, 30 mg, and potassium iodide, 50 mg daily) in combination with a beta-blocker (bisoprolol, 2.5 mg daily). The physician paid the utmost attention to prevent agranulocytosis, which can be induced by thiamazole, and the patient's dose was within the recommended range (30-40 mg daily if serum FT4 is 2-3 times the upper limit of the normal). 1,2,6 Coronary artery bypass grafting was rescheduled 3 weeks after the commencement of the hyperthyroidism treatment because serum FT4 and FT3 were still abnormally high (2.32 ng/dL and 6.61 pg/mL, respectively; see Fig 1) as a result of his angina pectoris becoming more unstable with the frequent chest discomfort. The patient received midazolam, 3 mg, intravenously (IV) and fentanyl, 200 mg, IV upon induction of anesthesia and had a target-controlled infusion of propofol at 1 to 2 mg/mL and remifentanil at 0.1 to 0.5 mg/kg/min for maintenance. Multiple

症例報告 緒 言 下大静脈 (inferior vena cava, IVC) を切断する手術 では腎傷害，下肢浮腫，深部静脈血栓といった合併症 が報告されている 1),2) が，IVC 部分切除後に同様の合 併症を生じたとする報告は少ない。我々は，傍腎静脈 IVC 部分切除を伴う膵頭十二指腸切除術後に IVC が血 栓閉塞し，急性腎傷害，下肢浮腫，腹水貯留をきたし た症例を経験したので報告する。 本症例報告の学術集会発表および学術雑誌への掲載 について，患者より文書で同意を得た。 症 例 症例：70 歳，女性。膵頭部癌に対し，膵頭十二指腸 切除術が予定された。既往に高血圧症があり，ニフェ ジピン，テルミサルタンを内服していた。来院時の CT で 腫 瘍 の IVC 浸 潤 を 認 め，gimeracil oteracil potassium tegafur，gemcitabine ＋ nab-paclitaxel によ 膵癌，下大静脈切除後の急性腎傷害 Abstract Acute kidney injury due to inferior vena cava occlusion after pancreaticoduodenectomy with segmental inferior vena cava resection: a case report