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The epidemiology of Panton-Valentine leukocidin (PVL)-positive MRSA in community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) was examined. Three hundred and forty-two CA-MRSA strains that were susceptible to imipenem and cefazolin were isolated from 1107 samples (intravenous catheter, blood, sputum, urine, skin, wound, and pharynx) from outpatients at Showa University Hospital in Japan between September 2009 and March 2017. The PVL gene was detected in 46 of 342 CA-MRSA strains, accounting for 13.5%. The type of SCC mec was determined by detection of each SCC mec -specific region, class complex, and ccr . SCC mec type IV comprised 33 strains, type V comprised 5 strains, type VII comprised 4 strains, and the unclassified type comprised 4 strains. Among the type IV strains, subtype IVa was dominant, comprising 23 of 33 strains, and the remaining 10 strains were of varying subtypes. The SCC mec type III-specific region, CZ049, was amplified in 2 type V strains, 4 type VII strains, and 4 unclassified strains. In 4 unclassified strains, CZ049 and ccr5 were detected, but neither the SCC mec -specific region nor class complex was detected. The PVL-positive rate was lower than that in Western countries. The SCC mec types of PVL-positive CA-MRSA strains were found to vary, indicating a diverse spreading route.

A 53-year-old man with Behçet's disease was admitted to our hospital for investigation of back and lower abdominal pain. Computed tomography (CT) showed a projecting saccular aneurysm below the right renal artery. We placed a stent-graft just below the right renal artery, successfully excluding the abdominal aortic aneurysm (AAA). His C-reactive protein level and white blood cell count remained elevated after stent-grafting. About 5 months later, he was readmitted with recurrent back and lower abdominal pain and CT showed progression of the AAA. Thus, we performed straight grafting using a woven Dacron graft just below the right renal artery. The patient had an uneventful postoperative course. We discuss the controversial issue of treating AAA in patients with Behçet's disease, focusing on the indications and timing of surgery.

hronic ischemic mitral regurgitation (MR) is a cause of congestive heart failure in patients with ischemic cardiomyopathy. Various mitral valve plasty (MVP) techniques have been reported, but the best surgical intervention is still controversial and the development of new techniques is necessary to give better outcome for patients with ischemic MR. We initiated our original procedure called "papillary muscle sandwich plasty" 1 in 2004 and in this study, we evaluated its early and late surgical results. Methods PatientsOf 602 ischemic heart disease patients, 46 underwent MVP for ischemic MR between 1999 and 2007 and of them, 23 patients since 2004 underwent papillary muscle sandwich plasty. The mean age of the patients was 67 (47-82) years and there were 16 men and 7 women. The patients' preoperative characteristics, examination results and operative procedures are summarized in Table 1.According to preoperative echocardiography, the mean left ventricle diastolic and systolic diameters were 54±6 mm and 43±7 mm, respectively. The mean mitral annulus diameter and tenting height was 29.5±2.4 mm and 12.0±2.8 mm, respectively. The grade of preoperative MR was severe in 10 patients and moderate in 13. Mitral ring-annuloplasty was performed in 9 (39%) patients and left ventricular volume reduction in 5 (22%). Postoperative early and late results were evaluated. The mean follow-up period was 24±10 months (range 7-39 months). TechniqueOur technique of "sandwich plasty" is usually performed (Received June 16, 2008; revised manuscript received January 12, 2009; accepted February 19, 2009; released online May 18, 2009 Methods and Results:The present study was a review of 23 patients who underwent an original technique known as "papillary muscle sandwich plasty" in which the mitral valve is approached via either the left atrium or left ventricle. The heads of the papillary muscles of the anterior leaflet and leaflets are plicated using Teflon-pledgeted 3-0 Ticron sutures in both the anterolateral and posteromedial commissural portions. Postoperative residual mild MR occurred in 1 patient (4%), but moderate or severe MR was not observed. In the follow-up study, prominent MR occurred in 1 patients and the MR-free rate at 2 years after surgery was 93%. Late cardiac death was significantly (P<0.05) fewer in patients without prominent MR than that in patients with MR. Conclusions: "Sandwich plasty" is an effective technique for patients requiring left ventricular plasty and may improve the prognosis of ischemic heart failure. (Circ J 2009; 73: 1240 -1242

SUMMARYTwo episodes of hypotension caused by oral beraprost sodium administration following cardiac surgery are described. The first case was a 67-year-old female who underwent concomitant surgery for mitral valve replacement, tricuspid annuloplasty, and a radiofrequency maze procedure for atrial fibrillation. The second case was a 45-year-old female who underwent 4-vessel coronary artery bypass grafting associated with endarterectomy in the right coronary artery. Beraprost sodium was administered for the treatment of residual pulmonary hypertension in the first case, and was initiated as an antiplatelet agent following coronary endarterectomy in the second case. Hypotension occurred at approximately one hour after beraprost sodium administration in both cases. Careful observation to prevent this adverse effect is critical after the administration of beraprost sodium, especially in patients who have undergone cardiac surgery. (Int Heart J 2006; 47: 319-323) Key words: Beraprost sodium, Prostacyclin, Hypotension, Cardiac surgery PROSTACYCLIN (PGI 2 ) and its analogues are potent vasodilators and possess antithrombotic and antiproliferative properties. Beraprost sodium, an oral prostacyclin analogue, has among other effects antiplatelet and vasodilating effects, which have been widely used for patients with pulmonary hypertension and chronic arterial occlusive disease. We describe here 2 episodes of hypotension induced by oral beraprost sodium administration following cardiac surgery, and discuss the clinical use of beraprost sodium and the etiology of this adverse phenomenon. CASE REPORTSCase 1: A 67-year-old female was diagnosed as having mitral valve stenosis (area, 0.79 cm 2 ) and regurgitation (Seller's grade 3), tricuspid valve regurgitation,From the