An 87-year-old woman with unknown fever origin was admitted to our internal department. We could not determine the fever origin from clinical findings, serious blood data, urine data, bacteriological data, and images obtained by ultrasonography, computed tomography and magnetic resonance. Body inflammatory findings did not respond to several antibiotics we used. Gallium scintiphotography revealed abnormal radioisotope uptake in the bilateral inguinal region. And ultrasonography and enhanced computed tomography showed tumors in front of the bilateral femur neck. Moreover, bone scintiphotography (^99mTc) revealed abnormal radioisotope uptake in the bilateral hip joints. We performed resection of the right inguinal tumor. The tumor was solid mass 30×20×20mm in size. It was covered with an articular capsule in front of the right femur neck. We identified the mass as bilateral tuberculous granulation with Langhans-type giant cells pathologically. It was only with difficulty that we firmly diagnosed the case as tuberculous arthritis of bilateral hip joints because the fever origin was unknown. It is important to diagnose tuberculous arthritis by use of various imaging techniques. We should take tuberculous infection into consideration when we encounter a case of arthritis of unknown fever origin or a case of antibiotics resistant arthritis.

Upper gastrointestinal endoscopy is an invasive examination. Cardiovascular and respiratory adverse effects are commonly observed in patients undergoing endoscopy. We investigated prospectively the cardiovascular and respiratory changes every oneminute before, during and after routine endoscopy. Sixteen healthy adult patients were enrolled in this study. Systolic blood pressure, diastolic blood pressure, pulse rate and percutaneous arterial oxygen saturation (SpO₂) were recorded every one-minute throughout the procedure. Systolic and diastolic blood pressure increased significantly one minute after the insertion of the endoscope. Increases in pulse rate were noted after the insertion of the endoscope. Rate pressure product increased significantly one minute after the insertion of the endoscope. No significant change in SpO₂ was observed during endoscopy. Our results indicated that upper gastrointestinal endoscopy might induce cardiovascular stress and abnormality. Therefore, we should carefully insert and manipulate upper gastrointestinal endoscope.

Background: /Aim: The aim of this study was to compare the therapeutic efficacy of ablation and surgery in solitary hepatocellular carcinoma (HCC) measuring ≤5 cm with a large HCC cohort database. Methods: The study included consecutive 2,067 patients with solitary HCC who were treated with either ablation (n=1,248) or surgery (n=819). Th e patients were divided into three groups based on the tumor size and compared the outcomes of the two therapies using propensity score matching. Results: No significant difference in recurrence-free survival (RFS) or overall survival (OS) was found between surgery and ablation groups for tumors measuring ≤2 cm or >2 cm but ≤3 cm. For tumors measuring >3 cm but ≤5 cm, RFS was significantly better with surgery than with ablation (3.6 and 2.0 years, respectively, P=0.0297). However, no significant difference in OS was found between surgery and ablation in this group (6.7 and 6.0 years, respectively, P=0.668). Conclusion The study suggests that surgery and ablation can be equally used as a treatment for solitary HCC no more than 3 cm in diameter. For HCCs measuring 3-5 cm, the OS was not different between therapies; thus, ablation and less invasive therapy can be considered a treatment option; however, special caution should be taken to prevent recurrence.