A 14-year-old boy who underwent aortic valve-sparing operation for annuloaortic ectasia at the age of 9 was referred to our service with a diagnosis of acute type A aortic dissection. Emergency total arch replacement with the elephant trunk technique was done successfully and the postoperative course was uneventful. However, computed tomography (CT) 2 weeks after the operation showed a new dissection and enlargement in left subclavian artery and folded elephant trunk. Dilatation in coronary buttons were also seen since the time of surgery. No residual dissection was found in the aorta. Careful follow up is necessary for this case due to multiple aneurysmal changes and a new dissection lesion in a short period. Loeys-Dietz syndrome (LDS) is characterized by vascular findings (aortic aneurysm and dissection) and skeletal manifestations. Due to aortic dissection occurring in smaller diameter aortas in LDS patients than in Marfan syndrome, early and aggressive surgery is recommended for patients with LDS.

The liver mitochondrial redox state (the liver mitochondrial free NAD+/NADH ratio), which indicates hepatic energy charge, is known to parallel the ketone body ratio (acetoacetate/3-hydroxybutyrate) in liver tissue. Since the ketone body ratio in arterial blood was reported to correlate with that in liver tissue; the arterial ketone body ratio (AKBR) has been widely accepted as a useful measure of the liver function reserve. The liver mitochondrial redox state is known to decrease with the oxidation of ethanol in alcohol abusers. To evaluate whether AKBR reflected the effect of alcohol intake on the liver, AKBR was measured in normal controls (n=8), and patients with alcoholic liver injuries (n=14) and chronic active hepatitis (n=15). The mean AKBRs in the normal control subjects, in patients with chronic active viral hepatitis, and in those with alcoholic liver disease were 1.68±0.77, 2.22±1.02, and 1.55±0.79, respectively. Though the AKBR in patients with alcoholic liver disease tended to be lower than the other groups, there was no significant difference in AKBR among those three groups. In conclusion, this study demonstrated that AKBR was doubtful as an accurate parameter to estimate the changes in the liver mitochondrial redox state by alcoholic intake.

Cardiac tumors are rare, and multiple myxomas are even rarer. The latter phenomenon is mostly associated with the Carney complex, a dominantly inherited disease characterized by multiple primary cardiac myxomas, endocrinopathy, and spotty pigmentation of the skin. We report the rare case of a patient who did not have the Carney complex but had multiple primary cardiac tumors. A 78-year-old woman with a past history of breast cancer was referred to our hospital for further examination of multiple cardiac tumors. Echocardiography showed 4 tumors in the left atrium and left ventricle. We could not diagnose them preoperatively and decided to resect them surgically because they were mobile and could have caused embolism and obstruction. The postoperative pathological findings of all 4 tumors were myxomas, although the patient did not meet the diagnostic criteria of the Carney complex. Therefore, a rare case of multiple primary cardiac myxomas was diagnosed.
Aged ; Breast Neoplasms ; Carney Complex* ; Echocardiography ; Embolism ; Female ; Heart Atria ; Heart Neoplasms ; Heart Ventricles ; Humans ; Myxoma* ; Pigmentation ; Skin

Purpose: This study was performed to determine the prognostic value of lymphocyte-to-CRP ratio after curative resection for hepatocellular carcinoma. Methods: Between July 2010 and October 2021, 173 consecutive patients (144 male, 29 female) who underwent surgical resection for pathologically confirmed hepatocellular carcinoma were included in this retrospective study. Cox regression analysis was used to evaluate the relationship between clinicopathological characteristics and recurrence-free survival (RFS) and overall survival (OS). A P-value of <0.05 was considered statistically significant. Results: The patients (mean age, 71 years) were stratified into high (≥9,500, n = 108) and low (<9,500, n = 65) lymphocyteto-CRP ratio groups. The low lymphocyte-to-CRP ratio group had significantly worse RFS and OS. Low lymphocyte-toCRP ratio (hazard ratio [HR], 1.865; 95% confidence interval [CI], 1.176–2.960; P = 0.008), multiple tumors (HR, 3.333; 95% CI, 2.042–5.343; P < 0.001), and microvascular invasion (HR, 1.934; 95% CI, 1.178–3.184; P = 0.009) were independently associated with RFS, whereas low albumin-to-globulin ratio (HR, 2.270; 95% CI, 1.074–4.868; P = 0.032), α-FP of ≥25 ng/mL (HR, 2.187; 95% CI, 1.115–4.259; P = 0.023), and poor tumor differentiation (HR, 2.781; 95% CI, 1.041–6.692; P = 0.042) were independently associated with OS. Lymphocyte-to-CRP ratio had a higher area under the curve (0.635) than other inflammation-based markers (0.51–0.63). Conclusion Lymphocyte-to-CRP ratio is superior to other inflammation-based markers as a predictor of RFS in patients with surgically resected hepatocellular carcinoma.

Ryokeijutsukanto is an herbal medicinal product that is often used for dizziness when standing up, that is, orthostatic dysregulation. This time, we encountered 2 patients with orthostatic dysregulation successfully treated with ryokeijutsukanto, and objectively evaluated the therapeutic effect of ryokeijutsukanto by using Visual Analog Scale (VAS), Vertigo Symptom Scale-short form (VSS-sf) Japanese version and Dizziness Handicap Inventory (DHI) Japanese version. Case 1 is a 17-year-old woman. Dizziness when standing up appeared from 2 month ago. Before treatment, VAS scored 71/100, VSS-sf scored 7 points, and DHI scored 42 points. After 4 weeks of administration of Ryokeijutsukanto, VAS improved to 22/100, VSS-sf improved to 6 points, and DHI improved to 26 points. Case 2 is a 38-year-old woman. Dizziness when standing up appeared from 3 month ago. Before treatment, VAS scored 48/100, VSS-sf scored 18 points, and DHI scored 32 points. After 4 weeks of administration of Ryokeijutsukanto, VAS improved to 9/100, VSS-sf improved to 3 points, and DHI improved to 20 points. In both cases, all the evaluation scales showed sharp improvement after 4 weeks, indicating that ryokeijutsukanto was certainly effective.

Tonsillectomy is an operation generally carried out in otolaryngology. Postoperatively, the pain is very strong and it is often difficult to eat for several days. This time, we experienced a case after tonsillectomy in which rikkosan was effective for pain management. The patient was a 23-year-old woman. With a diagnosis of habitual tonsillitis, we performed her tonsillectomy. Postoperative pain was strong, however, it was difficult to use both non-steroidal anti-inflammatory drug and acetaminophen due to the history of drug eruption. Pain was alleviated immediately after taking rikkosan Subsequently we managed pain by using rikkosan as needed. Following a good postoperative course, she was discharged 6 days after surgery.

Treatment for malignancy bowel obstruction (MBO) includes surgery, gastrointestinal stenting, nasogastric tube, percutaneous endoscopic gastrostomy, and drug therapy. Drug therapy such as octreotide acetate significantly reduces the quality of life of patients because oral intake is no longer possible and continuous intravenous infusion is required. After a multidisciplinary conference including the department of gastrointestinal surgery and the department of palliative medicine, we could perform staging laparoscopy on a nutritionally-depleted patient with MBO and laparoscopic jejunostomy as a palliative surgery. As a result, she could discontinue from administration of octreotide acetate and resume oral intake.