The purpose of this study was to review short-term results of aortic arch aneurysm treatment that were performed with fenestrated stent grafts (Najuta stent grafts) in our hospital. Nine patients of aortic arch aneurysm were treated with Najuta stent grafts between January 2015 and March 2018. Eight patients had a saccular aneurysm and one a dissecting aneurysm. A Najuta stent graft was deployed in the aortic arch in each patient. If necessary, a non-fenestrated stent graft was added, and bilateral axillary artery bypass or left subclavian artery embolisation was performed. Computed tomography (CT) examination was performed postoperatively, at 6 months, and yearly. In all patients, the stent grafts were deployed as planned. The blood flow of the brachiocephalic artery and left common carotid artery was maintained through fenestrations of the stent graft. Eight patients required occlusion of the left subclavian artery to get a sufficient proximal sealing zone; five of them were reconstructed. All patients were treated with fewer branch reconstructions than would have been required with conventional stent grafts. In one patient, a lower limb embolism occurred during the operation. On postoperative CT, endoleaks were observed in three patients. Coil embolisation of the left subclavian artery was performed within a year for two patients. The clinical course was evaluated for up to 4 years. Aneurysms shrank slightly in five patients, remained unchanged in three patients, and expanded in one patient. Najuta stent grafts performed well and enabled treatment of aortic arch aneurysms with minimal aortic branch reconstruction.

The present study aimed to compare the step-wise and real-time techniques for computed tomography (CT) fluoroscopy-guided biopsy of lung nodules. It included 72 consecutive patients (50 men, 22 women; mean age: 71.8 years; range: 45–89 years) with lung nodules. Between March 2017 and April 2019, 72 CT fluoroscopy-guided biopsy procedures were performed using either the step-wise (n = 34) or real-time technique (n = 38). The diagnostic accuracy was 97.1% for biopsies performed using the step-wise technique and 94.7% for those performed using the real-time technique (p = 0.39). The mean CT dose index was 48.8 ± 16.9 mGy/s for the step-wise method and 59.9 ± 25.6 mGy/s for the real-time method; the dose length product was 1956 ± 729 mGy and 2613 ± 1300 mGy for the two techniques, respectively (p < 0.05). There was a significant difference in mean exposure time (81 ± 43 s for the step-wise technique and 162 ± 120 s for the real-time technique; p < 0.05). The mean lung nodule size was also significantly different (29.9 ± 17.6 mm for the step-wise method and 17.8 ± 12.2 mm for the real-time method; p < 0.01). Of the 34 step-wise procedures, 11 (32.4%) resulted in pneumothorax, as did 24 of 38 (63.2%) real-time procedures (p < 0.01). The real-time technique is particularly useful in patients with small nodules. The CT dose, exposure time, and incidence of pneumothorax were significantly lower when the step-wise technique was applied to CT fluoroscopy-guided biopsy of lung nodules.

Hyperleukocytosis is a typical presentation of chronic myelogenous leukemia (CML). It sometimes induces leukostasis, the symptoms of which include visual change, headache, tinnitus, dizziness, and occasional disturbance of consciousness. In the present study, a 26-year-old male patient visited a general physician, who observed marked hyperleukocytosis and referred the patient to our hospital. The patient was diagnosed with CML and treated with a tyrosine kinase inhibitor and hydroxycarbamide. On the fourth day after admission, the patient suddenly complained of left-sided hearing loss. An audiogram revealed profound left sensorineural hearing loss. Magnetic resonance imaging of the head showed no lesions in the inner ear, cerebellum, or brain stem; therefore, we diagnosed sudden hearing loss due to leukostasis. Subsequently, his hearing did not improve, despite a decrease in leukocytes. The pathophysiology of leukocytosis involves increased leukocytes and thrombi, which induce high blood viscosity in the microcirculation. Leukostasis-related infarction and hemorrhage can lead to occlusion of the labyrinthine artery, causing deafness. Physicians should be aware that deafness can develop when diagnosing marked leukocytosis because such deafness is irreversible in most cases.

Actinomyces neuii can grow under aerobic culture conditions and shows a gram-positive rod morphology, similar to that of Corynebacterium spp. A. neuii is usually detected in local pus samples, and published cases of A. neuii bloodstream infections are rare. Here, we report a case of bloodstream infection caused by A. neuii subsp. anitratus. A 53-year-old woman with fever and hypotension was referred to our hospital. The patient underwent surgery for breast cancer and received chemotherapy after central venous (CV) port placement. On day 2, a blood culture in an anaerobic bottle yielded positive results, and A. neuii subsp. anitratus was identified via matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI–TOF MS) and 16S rRNA sequencing. The patient was diagnosed with bloodstream infection caused by A. neuii subsp. anitratus with CV port infection. The CV port was removed and antibiotic treatment resulted in symptom improvement so the patient was discharged on day 28 of hospitalization. MALDI–TOF MS and 16S rRNA sequencing were found to be more useful for the identification of A. neuii than for phenotypic identification. Further research on A. neuii subsp. anitratus infections is required to avoid delayed or missed diagnoses.