A 52-year-old woman had undergone colectomy and adjuvant chemotherapy for stage IV cecal cancer with peritoneal dissemination and multiple metastases to the lung and liver. After two years of follow-up, she suddenly had right upper limb pain and was reffered to our hospital for treatment of acute upper limb ischemia. Enhanced CT revealed obstruction of the right brachial artery and metastatic lung cancer with pulmonary vein invasion. We performed emergency embolectomy with local anesthesia. The patient's perioperative course was uneventful. Pathological findings of the removed embolus revealed that it contained adenocarcinoma cells. We concluded that the embolus had originated from the metastatic lung cancer with pulmonary vein invasion.

Purpose: Most studies have investigated the differences in postgastrectomy quality of life (QOL) based on the surgical procedure or reconstruction method adopted; only a few studies have compared QOL based on tumor location. This large-scale study aims to investigate the differences in QOL between patients with esophagogastric junction cancer (EGJC) and those with upper third gastric cancer (UGC) undergoing the same gastrectomy procedure to evaluate the impact of tumor location on postoperative QOL. Methods: The Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) questionnaire was distributed in 70 institutions to 2,364 patients who underwent gastrectomy for EGJC or UGC.A total of 1,909 patients were eligible for the study, and 1,744 patients who underwent total gastrectomy (TG) or proximal gastrectomy (PG) were selected for the final analysis. These patients were divided into EGJC and UGC groups; thereafter, the PGSAS-45 main outcome measures (MOMs) were compared between the two groups for each type of gastrectomy. Results: Among the post-TG patients, only one MOM was significantly better in the UGC group than in the EGJC group. Conversely, among the post-PG patients, postoperative QOL was significantly better in 6 out of 19 MOMs in the UGC group than in the EGJC group. Conclusions Tumor location had a minimal effect on the postoperative QOL of post-TG patients, whereas among post-PG patients, there were definite differences in postoperative QOL between the two groups. It seems reasonable to conservatively estimate the benefits of PG in patients with EGJC compared to those in patients with UGC.

We prospectively studied the effectiveness of byakkokaninjinto added gypsum powder for the treatment of atopic dermatitis (AD) by using the skin disease severity score, visual analogue scale (VAS) score for assessing itch severity, and Skindex-16 for assessing the quality of life (QOL) in 12 patients who were refractory to conventional treatments including steroid repellents. In addition, we retrospectively investigated for what types of “sho” (Kampo diagnosis) and eruptions this treatment was more effective. The results showed that the skin disease severity score and Skindex-16 significantly improved in 4 weeks. There was no significant improvement in eosinophil counts, IgE antibody levels, thymus and activation-regulated chemokine levels. Byakkokaninjinto added gypsum powder was found to be effective for the “sho” of “sensitive to heat” and “excessive sweating.” Thus, it can be one of the options in oral medicine for treating patients with intractable AD including steroid repellents because the rash improved in a short period of 4 weeks in our patients.

Background/Aims: The frequency and details of nonalcoholic fatty liver disease (NAFLD) complications in patients with inflammatory bowel disease (IBD) remain unclear. This study aimed to clarify characteristics of NAFLD in patients with IBD. Methods: We retrospectively identified and enrolled patients with IBD diagnosed with or without NAFLD by undergoing abdominal computed tomography (CT) at our institution between 2005 and 2020. The primary endpoint was the complication rate of NAFLD in patients with IBD. Secondary endpoints were the clinical characteristics of nonobese patients with IBD and comorbid NAFLD and their association with nutritional and inflammatory parameters. Results: Twenty-one (21.9%) of 96 eligible patients with IBD also had NAFLD. In nonobese patients (defined as patients with a body mass index <25 kg/m2), C-reactive protein (CRP; P<0.001) and alanine aminotransferase (P=0.018) levels were higher and the albumin level (P=0.005) and prognostic nutritional index (PNI; P=0.002) values were lower in patients with NAFLD than in those without NAFLD. The PNI value was positively correlated (P<0.001) and the CRP level was negatively correlated (P=0.001) with the hepatosplenic ratio. However, in the NAFLD combined group, PNI (P<0.05) and CRP values (P<0.001) were improved over time after CT imaging by continuing IBD treatment. Conclusions Worsening nutritional and inflammatory status in IBD patients is associated with complications of NAFLD. Diagnosis of NAFLD in IBD patients using CT imaging might be useful not only for early detection of NAFLD but also in assessing the need for therapeutic intervention for IBD.