An 81-year-old man was referred to our hospital with bilateral multiple patchy opacities on chest radiography. His chief complaints were a few months’ history of intermittent mild cough and slightly yellow sputum. Chest computed tomography (CT) showed non-segmental air-space consolidations with ground-glass opacities. Amyloid deposition with organizing pneumonia (OP) was seen in transbronchial lung biopsy (TBLB) specimens from the left S8. Three months later, the infiltration originally seen in the left lower lobe was remarkably diminished, and new infiltrations in the lingual and right lower lobes were detected on chest CT. Amyloid deposition with OP was seen in TBLB specimens from the left S4. Transthyretin was detected following immunohistochemical examination. The presence of wild-type transthyretin (ATTRwt) was proven using genetic analysis. The present report describes a rare case of ATTRwt amyloidosis associated with OP.

Background/Aims: Endoscopic biliary drainage is the gold standard treatment for cholangitis. The two methods of biliary drainage are endoscopic biliary stenting and nasobiliary drainage. A novel integrated outside biliary stent and nasobiliary drainage catheter system (UMIDAS NB stent; Olympus Medical Systems) was recently developed. In this study, we evaluated the efficacy of this stent in the treatment of cholangitis caused by common bile duct stones or distal bile duct strictures. Methods: We conducted a retrospective pilot study by examining the medical records of patients who required endoscopic biliary drainage for cholangitis due to common bile duct stones or distal bile duct strictures, and who were treated with a UMIDAS NB stent, between December 2021 and July 2022. Results: Records of 54 consecutive patients were reviewed. Technical and clinical success rates were 47/54 (87.0%) and 52/54 (96.3%), respectively. Adverse events were observed in 12 patients, with six patients experiencing pancreatitis as an adverse event, following endoscopic retrograde cholangiopancreatography (ERCP). Regarding late adverse events, five cases of biliary stent migration into the bile duct were observed. Disease-related death occurred in one patient. Conclusions The outside-type UMIDAS NB stent is an efficacious new method for biliary drainage and can be applied to many indications.

　　A 56-year-old woman was referred to our hospital because of an abnormal finding in the right pulmonary hilum on chest X-ray. Enhanced chest computed tomography showed hyperplastic bronchial arteries dilating and winding around the trachea and bronchi. A racemose hemangioma of the bronchial artery with multiple bronchial artery aneurysms (diameter <20mm) was seen displacing the trachea and both main bronchi. Bronchoscopy showed submucosal tumor-like lesions at the distal trachea and in both main bronchi, and a dusky-red elevated pulsatile lesion at the orifice of the left B3b＋c. We performed coil embolization of the bronchial artery aneurysm to prevent abrupt rupture of the bronchial aneurysm.

[Introduction] We report our experience with a patient with panic disorder (PD) , which suggests the importance of building a trusting relationship between the patient and the acupuncturist.[Case] A 69-year-old woman with PD presented to our acupuncture clinic with anxiety and difficulty breathing. Her symptoms appeared six months prior, and later, she presented to the emergency department of A Hospital with dyspnea and nausea. Shehad a significant medical history of RLS and rheumatoid arthritis. She was diagnosed with PD at the Department of Oriental Medicine of the same hospital. Her symptoms improved with herbal remedies; however, anxiety and difficulty breathing persisted. Her symptoms at the first acupuncture visit were dyspnea, chest tightness, and anxiety regarding seizures that occurred once or twice a week. She also experienced insomnia and nocturnal hot flashes in her legs. She had no panic attacks or prevailing anxiety, and her neurological and cardiovascular parameters were normal. During the treatment period of 91 days, 14 acupuncture and moxibustion treatments were performed once a week. GV20, PC6, HT7, ST36, SP6, LV3, GB20, BL13, BL15, LI4, BL23, and BL33 were used for mood symptoms, and KI9, BL57, and KI3 were used for toe symptoms. After the second visit, BL10, GB21, and SL14 were performed for neck and shoulder symptoms, and Ex-LE10 and plantar nerve acupuncture were performed for coldness in the lower extremities. Moxibustion was applied to SP6, KI3, and LV3.[Course] After the initiation of acupuncture, anxiety and difficulty breathing were almost resolved by the second treatment session; however, insomnia and hot flashes in the lower extremities worsened in the seventh round of treatment. The patient had also hoped for the resolution of the insomnia-related symptoms using acupuncture. However, since acupuncture was ineffective, we explained the need for specialized treatment and referred her case to a psychiatrist. She was diagnosed with restless leg syndrome, and treatment was initiated using pramipexole, which improved hersymptoms.[Discussion] In this case, acupuncture and moxibustion treatment were effective for the symptoms associated with panic disorder. Additionally, the importance of providing opportunities for appropriate medical consultations as needed was demonstrated.

Background/Aims: Endoscopic biliary drainage using self-expandable metallic stents (SEMSs) for malignant biliary strictures occasionally induces acute cholecystitis (AC). This study evaluated the efficacy of prophylactic gallbladder stents (GBS) during SEMS placement. Methods: Among 158 patients who underwent SEMS placement for malignant biliary strictures between January 2018 and March 2023, 30 patients who attempted to undergo prophylactic GBS placement before SEMS placement were included. Results: Technical success was achieved in 21 cases (70.0%). The mean diameter of the cystic duct was more significant in the successful cases (6.5 mm vs. 3.7 mm, p<0.05). Adverse events occurred for 7 patients (23.3%: acute pancreatitis in 7; non-obstructive cholangitis in 1; perforation of the cystic duct in 1 with an overlap), all of which improved with conservative treatment. No patients developed AC when the GBS placement was successful, whereas 25 of the 128 patients (19.5%) without a prophylactic GBS developed AC during the median follow-up period of 357 days (p=0.043). In the multivariable analysis, GBS placement was a significant factor in preventing AC (hazard ratio, 0.61; 95% confidence interval, 0.37–0.99; p=0.045). Conclusions GBS may contribute to the prevention of AC after SEMS placement for malignant biliary strictures.