Crowned dens syndrome is a type of pseudogout that occurs in the elderly. It is associated with calcification around the dens of the atlas and can cause recurrent pain. We report successful treatment for crowned dens syndrome by using Kampo medicine. An 85-year-old woman was seen in our clinic after 3 days of neck pain and active exercise pain without trigger. Physical examination revealed tenderness in the bilateral upper cervical spine. Computed tomography (CT) revealed calcifications around the dens of the atlas and blood test data showed inflammatory reaction. Thus, she was diagnosed with crowned dens syndrome. In view of her medical history of gastric ulcer treatment, we prescribed Kampo medicine eppikajutsuto and daiobotampito, instead of nonsteroidal antiinflammatory drugs. The cervical pain and tenderness in her bilateral upper cervical spine disappeared, and her laboratory data also improved 6 days after treatment without side effects. Thus, her medications were discontinued.

Background/Aims: Magnifying endoscopic classification systems, such as the Japan narrow-band imaging (NBI) Expert Team (JNET) classification, have been widely used for predicting the histologic diagnosis and invasion depth of colorectal epithelial tumors. However, disagreement exists among observers regarding magnifying endoscopic diagnosis, because these classification systems are subjective. We herein investigated the utility of endoscopic microvascular density (eMVD) calculated from magnifying NBI endoscopic images in colorectal tumors. Methods: We reviewed magnifying NBI endoscopic images from 169 colorectal epithelial tumors (97 adenomas, 72 carcinomas/high-grade dysplasias) resected endoscopically or surgically. The eMVD on magnifying NBI endoscopic images was evaluated using image-editing software, and relationships between eMVD and clinical, endoscopic, and pathological findings were retrospectively analyzed. Results: The eMVD in carcinomas (0.152 ± 0.079) was significantly higher than that in adenomas (0.119 ± 0.059, P< 0.05). The best cutoff value for distinguishing carcinoma from adenoma was 0.133. Sensitivity, specificity, and accuracy were 56.9%, 67.0%, and 62.7%, respectively. In addition, JNET type 2B tumors showed significantly higher eMVD (0.162 ± 0.079) compared to type 2A tumors (0.111 ± 0.050, P< 0.05). Conclusions The eMVD as determined by magnifying NBI endoscopy is considered to be a possible objective indicator for differentiating colorectal carcinomas from adenomas.

We report three patients with acute lumbago who did not respond to nonsteroidal anti-inflammatory drugs (NSAIDs), but were treated successfully with daiobotampito and shimotsuto. Case 1 (86-year-old man) and Case 2 (56-year-old woman) were diagnosed with acute lumbago. Case 3 (69-year-old man) was diagnosed with acute lumbago and mild left sciatica. All three patients were initially administered orally NSAIDs, but this treatment was ineffective. Therefore, daiobotampito and shimotsuto were administered after choeikatsurakuto according to “Manbyokaishun.” Following this treatment, the patients' acute lumbago and sciatica resolved within 1-2 weeks. In conclusion, daiobotampito in combination with shimotsuto seems to be a useful Kampo medicine for treatment of lumbago.

Urinary tract infection (UTI) is a common disease, and administration of antibiotics should be the first choice for UTI. However, it often recurs, and recurrent UTI is generally treated with antibiotics. Many reports describe the use of choreito for the treatment of lower urinary tract symptoms and ureteral stones, but only a few reports are dedicated to the treatment of recurrent UTI with choreito. An 84-year-old woman had a UTI that recurred 4 times, and every time she was hospitalized. Although we treated her condition with an antibiotic and α 1-blocker for neurogenic bladder, and provided her home-care advice, her UTI recurred 4 times. Thus, we gave her choreito, which successfully treated her recurrent UTI. Before the treatment, she was hospitalized 4 times within 2 months. However, in the recent 7 months after the treatment with choreito, she did not need to be hospitalized. She is currently visiting a hospital once every 2 months. The present case indicates that choreito is beneficial in terms of health economics.

Background/Aims: Recently, a three-plane symmetric nee-dle with Franseen geometry was developed for endoscopic ultrasound-guided fine needle biopsy (EUS-FNB). In this ret-rospective study, tissue acquisition per pass was compared between 22-gauge Franseen FNB and standard fine needle aspiration (FNA) needles in patients with solid pancreatic le-sions. Methods: Consecutive patients who underwent EUSFNA or EUS-FNB for solid pancreatic lesions between Octo-ber 2014 and March 2018 were retrospectively studied. The tissue acquisition rate and the diagnostic performance per session, per pass, and at first pass were compared. Results: A total of 663 passes (300 by the FNB needle and 363 by the standard FNA needle) were performed in 154 patients (71 FNB and 83 FNA). The tissue acquisition rate per session and at first pass in the FNB and FNA groups was 100% and 95% (p=0.13) and 87% and 69% (p=0.007), respectively. The multivariate analysis revealed that among the patients, EUS-FNB (odds ratio, 3.07; p=0.01) was associated with a higher first-pass tissue acquisition rate. While the tissue ac-quisition rate reached a plateau after the 4th pass with FNA, it reached a plateau after the 2nd pass with FNB. Among the 129 malignant cases, the histological tissue acquisition rate per session was similar (100% and 94%), but the sensitivity by histology alone per session was higher for FNB than for FNA (93% and 73%, p<0.01). Conclusions The results of our retrospective analysis indicated that compared with a standard FNA needle, a 22-gauge Franseen FNB needle was associated with a higher first-pass tissue acquisition rate.