We report an 88-year-old man suffering from repetitive non-occlusive mesenteric ischemia (NOMI) accompanied with bradycardia and portal venous gas. He was admitted to hospital with acute onset epigastralgia and vomiting. Consciousness was clear, but he was pale and had a cold sweat. Vital signs were normal except for sinus bradycardia (HR 42). Abdominal CT revealed portal venous gas. Over 14 months, he had three recurrences of symptoms. We administered a muscarinic antagonist that improved the symptoms at the first and the second recurrence; however, at the third recurrence, the antagonist was ineffective, and the patient had increased portal venous gas, intestinal intramural gas, and hyperlacticacidemia. We performed emergent operation because of the possibility of bowel necrosis. Intraoperative laparoscopy revealed no obvious necrosis, and indocyanine green fluorography revealed no vascular insufficiency. These findings suggested the involvement of NOMI in acute mesenteric ischemia. After surgery, isosorbide dinitrate transdermal patch was administered to prevent NOMI by inhibiting mesenteric artery spasm. A 4-year follow-up revealed no recurrence of NOMI. We report the first case of repetitive NOMI accompanied with bradycardia and portal venous gas and its successful treatment.

Symmetrical lipomatosis is characterized by symmetrical infiltration of adipose tissue into the head, neck, or upper trunk. By contrast, oral involvement is extremely rare. The present report describes a case of symmetrical lipomatosis of the tongue (SLT) presenting as macroglossia. The patient was a 63-year-old Japanese male who developed progressive dysarthria secondary to enlargement of the tongue. The patient's medical history was notable for alcoholic hepatitis and hyperlipidemia. Marginal glossectomy was performed on both sides of the tongue to achieve volume reduction and restore normal speech. Histopathologic examination of the resected tissue revealed diffuse infiltration with adipose tissue lacking a fibrous capsule. The patient's postoperative course was uneventful, and he remained free of recurrence or regrowth and functional deficits at the 6-year follow-up time point.

Background: and PurposeNeurogenic orthostatic hypotension (nOH) is one of the most important nonmotor symptoms in patients with α-synucleinopathies. Atomoxetine is a selective norepinephrine transporter blocker that is a treatment option for nOH. This systematic review and expert focus-group study was designed to obtain evidence from published data and clinical experiences of Korean movement-disorder specialists about the efficacy and safety of atomoxetine for the pharmacological treatment of nOH in patients with α-synucleinopathies. Methods: The study comprised a systematic review and a focus-group discussion with clinicians. For the systematic review, multiple comprehensive databases including MEDLINE, Embase, Cochrane Library, CINAHL, PsycInfo, and KoreaMed were searched to retrieve articles that assessed the outcomes of atomoxetine therapy. A focus-group discussion was additionally performed to solicit opinions from experts with experience in managing nOH. Results: The literature review process yielded only four randomized controlled trials on atomoxetine matching the inclusion criteria. Atomoxetine effectively increased systolic blood pressure and improved OH-related symptoms as monotherapy or in combination with other drugs. Its effects were pronounced in cases with central autonomic failure, including multiple-system atrophy (MSA). Atomoxetine might be a safe monotherapy regarding the risk of supine hypertension. Conclusions Atomoxetine is an effective and safe option for short-term nOH management, which could be more evident in patients with central autonomic dysfunction such as MSA. However, there is a paucity of evidence in the literature, and data from the focus-group discussion were inadequate, and so further investigation is warranted.

Background: Two randomized phase III trials (EORTC55971 and CHORUS) showed similar progression-free and overall survival in primary or interval debulking surgery in ovarian cancer, however both studies had limitations with lower rate of complete resection and lack of surgical qualifications for participating centers. There is no consensus on whether neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) could be a preferred approach in the management of advanced epithelial ovarian cancer (EOC) in the clinical practice. Methods The Asian SUNNY study is an open-label, multicenter, randomized controlled, phase III trial to compare the effect of primary debulking surgery (PDS) to NACT-IDS in stages IIIC and IV EOC, fallopian tube cancer (FTC) or primary peritoneal carcinoma (PPC).The hypothesis is that PDS enhances the survivorship when compared with NACT-IDS in advanced ovarian cancer. The primary objective is to clarify the role of PDS and NACT-IDS in the treatment of advanced ovarian cancer. Surgical quality assures include at least 50% of no gross residual (NGR) in PDS group in all centers and participating centers should be national cancer centers or designed ovarian cancer section or those with the experience participating surgical trials of ovarian cancer. Any participating center should be monitored evaluating the proportions of NGR by a training set. The aim of the surgery in both arms is maximal cytoreduction. Tumor burden of the disease is evaluated by diagnostic laparoscopy or positron emission tomography/computed tomography scan. Patients assigned to PDS group will undergo upfront maximal cytoreductive surgery within 3 weeks after biopsy, followed by 6 cycles of standard adjuvant chemotherapy. Patients assigned to NACT group will undergo 3 cycles of NACT-IDS, and subsequently 3 cycles of adjuvant chemotherapy. The maximal time interval between IDS and the initiation of adjuvant chemotherapy is 8 weeks. Major inclusion criteria are pathologic confirmed stage IIIC and IV EOC, FTC or PPC; ECOG performance status of 0 to 2; ASA score of 1 to 2. Major exclusion criteria are non-epithelial tumors as well as borderline tumors; low-grade carcinoma; mucinous ovarian cancer. The sample size is 456 subjects. Primary endpoint is overall survival.