Objective: The aim of this study was to investigate the healthcare workers’ awareness and support regarding the sexuality of cancer patients, their families. Methods: A self-reported questionnaire survey was conducted on the healthcare workers in Shikoku Cancer Center on May 2014. Results: Four hundred and fifty-seven (84.9%) workers responded to the questionnaire. It was 29.8% who have communicated about sexual issues with patients and their families, 67.0% acknowledged the necessity of supporting them. In the group which had experience in communicating about sexual issues and participating in study meetings of sexuality, there were more healthcare workers who acknowledged the necessity of support significantly (aware group). In the aware group, the reasons why they hesitated and felt difficulty in communicating about sexual issues were that they had no chances to communicate with patients about sexual issues (93.5%), they didn’t know whether the patients needed intervention of healthcare workers (89.2%), they felt lack of their knowledge of support regarding sexuality (89.2%), and they felt lack of their skill of support regarding sexuality (88.9%). In the aware group, in order to get knowledge and information about sexuality, books and brochures which could be introduced to the patients and their families (96.4%) were considered to be most wanted. Conclusion: We have to make an effort so that all healthcare workers recognize the importance of the necessity of communicating about sexual issues with the patients, their families and their partners.

We report a case of a 16-year-old boy with Marfan's syndrome who underwent Bentall's procedure on a diagnosis of acute aortic dissection (DeBakey type II). He was readmitted with pyrexia 5 months after the initial operation. Methicillin-resistant Staphylococcus epidermidis (MRSE) was detected by blood culture and transesophageal echocardiography revealed a vegetation adherent to the entry of a remaining false lumen just distal to the distal anastomosis. Although antimicrobial therapy was employed, an arterial embolism developed in the right popliteal artery. CT scan revealed dilatation of the false lumen, and consequently, emergency surgery was performed. The intima of the distal aortic end was partially out of the suture line and the vegetation adhered at that point. Re-replacement of the ascending aorta, omental transposition, and embolectomy of the right femoral artery were performed and resulted in a satisfactory course.

Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) using a 19-gauge needle is an efficient sampling method for the diagnosis of lymphadenopathy. This study compared 19-gauge conventional and Franseen needles for the diagnosis of lymphadenopathy and classification of malignant lymphoma (ML). Methods: Patient characteristics, number of needle passes, puncture route, sensitivity, specificity, and accuracy of cytology/histology for lymphadenopathy were analyzed in patients diagnosed with lymphadenopathy by EUS-FNA using conventional or Franseen needles. Results: Between 2012 and 2022, 146 patients met the inclusion criteria (conventional [n=70] and Franseen [n=76]). The median number of needle passes was significantly lower in the conventional group than in the Franseen group (3 [1–6] vs. 4 [1–6], p=0.023). There were no significant differences in cytological/histological diagnoses between the two groups. For ML, the immunohistochemical evaluation rate, sensitivity of flow cytometry, and cytogenetic assessment were not significantly different in either group. Bleeding as adverse events (AEs) were observed in three patients in the Franseen group. Conclusions Both the 19-gauge conventional and Franseen needles showed high accuracy in lymphadenopathy and ML classification. Considering sufficient tissue collection and the avoidance of AEs, the use of 19-gauge conventional needles seems to be a good option for the diagnosis of lymphadenopathy.

Objective: Colonoscopy is useful in diagnosing intestinal tuberculosis. However, the terminal ileum is generally not examined during routine colonoscopy. Therefore, even with colonoscopy, the diagnosis can be missed in patients with lesions confined to the terminal ileum. Herein, we report the case of an asymptomatic patient with intestinal tuberculosis, in whom a colonoscope insertion into the terminal ileum led to the diagnosis.Patient: An asymptomatic 71-year-old man visited our hospital for a colonoscopy after a positive fecal occult blood test.Results: Colonoscopy revealed diffuse edematous and erosive mucosa in the terminal ileum. Mycobacterium tuberculosis was detected by polymerase chain reaction and culture of biopsy specimens from the erosions, leading to the diagnosis of intestinal tuberculosis. The patient was treated with antitubercular agents for 6 months, and a follow-up colonoscopy revealed healing of the lesions.Conclusion: Asymptomatic intestinal tuberculosis may occasionally be detected on colonoscopy following a positive fecal occult blood test and is sometimes confined to the terminal ileum. Therefore, clinicians should consider intestinal tuberculosis in the differential diagnosis of the causes of positive fecal occult blood test results and perform colonoscopies, including observation of the terminal ileum.

Liposarcoma is one of the most common types of soft tissue sarcomas and can develop at any site, although omental liposarcoma is extremely rare. Omental liposarcoma has a poor prognosis because the diagnosis is difficult, until it presents as a large tumor causing severe noticeable clinical symptoms. A 51-year-old male with lower abdominal pain was referred to our clinic. Abdominal ultrasonography revealed an ill-defined, solid, heterogeneous, and hypoechoic tumor deep in the lower abdomen. Generally, liposarcomas are hyperechoic, though 20% of liposarcomas present as hypoechoic tumors. This variation might occur depending on the pathological classification. We should consider the possibility of a dedifferentiated component if ultrasonography reveals typical features of soft tissue sarcoma with hypoechoic lesion.

Objective: Lenvatinib is an oral multitarget tyrosine kinase inhibitor (mTKI) and is recommended for patients with advanced hepatocellular carcinoma (HCC) with Child-Pugh A liver function, who are not amenable to surgical resection, locoregional treatment, or transcatheter arterial chemoembolization. Hepatogastric fistula is a rare complication with a poor prognosis in patients with HCC. Previous reports on fistula formation during mTKI therapy for HCC were all associated with sorafenib. Here, we report the first case of recurrent hepatogastric fistula during lenvatinib therapy for advanced HCC managed using an over-the-scope clip (OTSC).Patient: We present the case of a 73-year-old man with alcoholic liver cirrhosis who was treated for multiple HCC for 7 years. HCC was treated using repetitive transcatheter arterial chemoembolization, radiofrequency ablation, and sorafenib. Owing to disease progression, lenvatinib treatment was started. During lenvatinib treatment, recurrent hepatogastric fistulas developed. An OTSC was useful for fistula closure and prevention of recurrence.Results: The major cause of fistula formation is considered to be the direct invasion of HCC; however, HCC treatment might also be a contributing factor in our case. In addition, OTSC was useful for fistula closure.Conclusion: Clinicians should be aware of the fatal complications during HCC treatment.