Introduction: We report a case of sudden loss of consciousness due to hypoglycemia in the terminal stage of cancer. Case: A 73-year-old man underwent craniotomy in 2016 and was diagnosed with solitary fibrous tumor. In 2022, his brain tumor recurred and he was admitted to our hospice. On the morning of the 120th day after transfer, the patient suddenly developed impaired consciousness. Blood tests showed hypoglycemia (33 mg/dL), and intravenous glucose injection improved his loss of consciousness, leading to a diagnosis of impaired consciousness due to hypoglycemia. After various examinations, hypoglycemia due to extrapancreatic tumor (non-islet cell tumor hypoglycemia: NICTH) was strongly suspected. Discussion: NICTH is considered to be caused by excessive secretion of an insulin-like substance (high molecular weight insulin-like growth factor (IGF-)II) from the tumor. In patients who are exposed to hypoglycemia for a long period of time, central nervous system symptoms such as impaired consciousness may suddenly develop without sympathetic symptoms. NICTH should be considered as a differential diagnosis in patients with delirium, impaired consciousness, or convulsive seizures and a large tumor, although it is not easy to prove the excessive secretion of high-molecular-weight IGF-II, especially in the terminal stage of cancer.

Ryokeijutsukanto consists of four crude drugs, Hoelen, Cinnamonmi Cortex, Atractylodis Rhizoma, and Glycyrrhizae Radix. In Kampo medicine, it is used for the yang stage, fluid disturbances, and qi counterflow. It is also used for orthostatic disturbance, which does not change smoothly from parasympathetic nerve dominance to sympathetic nerve dominance. This time, we report that ryokeijutsukanto is also effective for disturbance with function regulation of autonomic nervous system. Case 1: a patient who had headache after exercise and working. Case 2: a patient who had dizziness and cold sweat that appeared in the evening. Case 3: a patient who had headache after working or on holidays. In these cases, ryokeijutsukanto was effective for symptoms that appeared when the patient could not change smoothly from sympathetic nerve dominance to parasympathetic nerve dominance. Furthermore, we found that ryokeijutsukanto was effective, even if there was no sign of fluid disturbance in conjunction with the yang stage and qi counterflow. We identified a new category of patients for whom ryokeijutsukanto is effective.

Objective: This report presents a case of supracondylar femur fracture with finite element analysis and discusses its causes and prevention.Patient and Methods: A 53-year-old man presented with right talar osteonecrosis after osteosynthesis for a talus fracture. A medial femoral condyle-free vascularized bone graft (size, 20 × 12 × 17 mm) from the contralateral femur was performed, including the posteromedial cortical corner. The patient suffered a donor-site supracondylar femoral fracture while standing up from a cross-legged sitting position on the bed on postoperative day 6. The fracture was treated with intramedullary nailing. We analyzed the effects of the location of the bone graft harvest in an intact model using the three-dimensional finite element method (FEM).Results: The talar necrosis and the femur fracture healed. The FEM result revealed that the longitudinal axial pressure had minimal effect on the femur; however, the stress around the bone defect increased with rotation, especially in the posteromedial bone defect model.Conclusion: Harvesting the bone graft should not include the posteromedial corner of the supracondylar femur. The patient should strictly limit the motion of torsional stress, such as standing from a cross-legged sitting position or pivoting turn.