Unsuccessful surgical treatment of thoracic aortic thrombosis in a patient with essential thrombocythemia

Essential thrombocythemia (ET) is a rare condition with an incidence of several persons per million in Japan, while the incidence of thrombosis ranges from 11% to 25%. We present a woman in her 70 seconds with ET who developed small intestinal necrosis and thrombosis in the proximal descending aorta. The patient underwent partial small bowel resection and replacement of the descending aorta, followed by multiple reoperations for thrombotic and hemorrhagic complications. She eventually died of empyema and sepsis caused by Klebsiella oxytoca. In patients with ET and large vessel thrombosis, we have to carefully judge the indications for surgery.     

Challenges in management of a giant left ventricular pseudoaneurysm complicated by intracerebral hemorrhage

Urgent surgery is generally indicated for left ventricular (LV) pseudoaneurysms, especially for large or expanding lesions. However, management of pseudoaneurysms complicated by acute intracerebral hemorrhage is controversial. This case of a giant LV pseudoaneurysm followed a successful postoperative course after 4 weeks of conservative management followed by surgical repair and may suggest a safe and efficient management.     

Multiple excimer laser phototherapeutic keratectomies for Avellino corneal dystrophy: a case report

Dear Editor,I am Chihiro Koiwa,from the Department of Ophthalmology,Juntendo University Hospital.I am writing this letter to present a case of multiple excimer laser phototherapeutic keratectomies(PTKs)for Avellino corneal dystrophy(ACD).Corneal dystrophy is a common type of hereditary,noninflammatory,and bilateral corneal disorder that involves various pathological,histological,and clinical manifestations[1].Advanced molecular gene sequencing has identified specific mutations that are associated with most dystrophies of this type.ACD,also known as granular corneal dystrophy typeⅡ[2],is autosomal dominant and associated with the R124H mutation of the transforming growth factor beta-induced(TGFBI)gene and characterized by deposits consistent with both discrete granular and lattice corneal opacities[3-4].An analysis of the TGFBI gene is essential to differentiate ACD because heterozygous R124H mutation carriers have minimal corneal abnormalities,whereas homozygotes have severe visual impairment,starting from early childhood,and early postoperative recurrence of corneal opacity.