Introduction: Pancreatic cancer often recurs as local recurrence or peritoneal dissemination, causing severe abdominal and back pain. We report a case of postoperative skull metastasis of pancreatic cancer that caused headache and was treated effectively with radiotherapy. Case: A 67-year-old woman underwent surgery for pancreatic cancer. She had epigastric pain due to local recurrence and peritoneal dissemination, which was controlled with loxoprofen and fentanyl transdermal patch. She had right-sided headache, which gradually increased in intensity, but lacked intracranial hypertension and focal neurological symptoms. Acetaminophen and Goreisan did not provide adequate pain relief. Although CT showed no brain or bone metastasis, MRI showed metastasis in the right frontal bone. Palliative radiotherapy was administered. Subsequently, headache decreased from 7–8/10 to 2–3/10 on the Numerical Rating Scale. Conclusion: Skull metastases in cancer patients may be diagnosed using MRI, even when they remain undetectable by CT.

Background/Aims: The frequency and details of nonalcoholic fatty liver disease (NAFLD) complications in patients with inflammatory bowel disease (IBD) remain unclear. This study aimed to clarify characteristics of NAFLD in patients with IBD. Methods: We retrospectively identified and enrolled patients with IBD diagnosed with or without NAFLD by undergoing abdominal computed tomography (CT) at our institution between 2005 and 2020. The primary endpoint was the complication rate of NAFLD in patients with IBD. Secondary endpoints were the clinical characteristics of nonobese patients with IBD and comorbid NAFLD and their association with nutritional and inflammatory parameters. Results: Twenty-one (21.9%) of 96 eligible patients with IBD also had NAFLD. In nonobese patients (defined as patients with a body mass index <25 kg/m2), C-reactive protein (CRP; P<0.001) and alanine aminotransferase (P=0.018) levels were higher and the albumin level (P=0.005) and prognostic nutritional index (PNI; P=0.002) values were lower in patients with NAFLD than in those without NAFLD. The PNI value was positively correlated (P<0.001) and the CRP level was negatively correlated (P=0.001) with the hepatosplenic ratio. However, in the NAFLD combined group, PNI (P<0.05) and CRP values (P<0.001) were improved over time after CT imaging by continuing IBD treatment. Conclusions Worsening nutritional and inflammatory status in IBD patients is associated with complications of NAFLD. Diagnosis of NAFLD in IBD patients using CT imaging might be useful not only for early detection of NAFLD but also in assessing the need for therapeutic intervention for IBD.

Background: Individuals with axillary osmidrosis suffer detrimental effects to their psychosocial functioning. In Asian nations, major operations for axillary osmidrosis include subdermal excision (open surgery) and suction-curettage (closed surgery). Objective: The aim of this meta-analysis was to determine which of these two procedures is most favorable in terms of safety and efficacy. Methods: According to the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guideline, we searched electronic databases for articles published in English, Japanese, Korean, and Chinese languages. Fixed-effects model meta-analyses of odds ratios (OR) and 95% confidence intervals (CI) were conducted, and the I2 was used to assess heterogeneity. Complication rates, recurrence/ineffectiveness rates, and patient satisfaction data were extracted and compared between open and closed surgeries. Results: Our search yielded 8 articles that include 1,179 patients; 560 underwent open surgery, and 619 underwent closed surgery. Our meta-analysis revealed that suction-curettage had a significantly lower risk of acute adverse events than open excision (OR, 0.15; 95% CI, 0.07~0.32), whereas open excision was significantly superior to suction-curettage for recurrence/ineffectiveness rate (OR, 2.90; 95% CI, 1.37~6.15). Patient satisfaction was equally high with both treatments (OR, 1.58; 95% CI, 0.69~3.60). Conclusion Since surgical treatments for axillary osmidrosis have been performed mostly in East Asian nations, it was meaningful to review articles published in four languages. This meta-analysis revealed that closed surgery was safer but less effective than open surgery. However, both patient groups expressed high satisfaction with the outcomes. Our results may be helpful for deciding surgical treatment options.

BACKGROUND: Placenta previa and placenta accreta associate with high morbidity and mortality for both mothers and fetus. Metal exposure may have relationships with placenta previa and placenta accreta. This study analyzed the associations between maternal metal (cadmium [Cd], lead [Pb], mercury [Hg], selenium [Se], and manganese [Mn]) concentrations and placenta previa and placenta accreta. METHODS: We recruited 17,414 women with singleton pregnancies. Data from a self-administered questionnaire regarding the first trimester and medical records after delivery were analyzed. Maternal blood samples were collected to measure metal concentrations. The subjects were classified into four quartiles (Q1, Q2, Q3, and Q4) according to metal concentrations. RESULTS: The odds ratio for placenta previa was significantly higher among subjects with Q4 Cd than those with Q1 Cd. The odds ratio for placenta previa was significantly higher for subjects with Q2 Pb than those with Q1 Pb. CONCLUSION Participants with placenta previa had higher Cd concentrations. However, this study was cross-sectional and lacked important information related to Cd concentration, such as detailed smoking habits and sources of Cd intake. In addition, the subjects in this study comprised ordinary pregnant Japanese women, and it was impossible to observe the relationship between a wide range of Cd exposure and placenta previa. Therefore, epidemiological and experimental studies are warranted to verify the relationship between Cd exposure and pregnancy abnormalities.
Adult ; Cross-Sectional Studies ; Female ; Humans ; Japan ; Metals, Heavy ; blood ; metabolism ; Placenta Accreta ; metabolism ; Placenta Previa ; metabolism ; Pregnancy ; Selenium ; blood ; metabolism

BACKGROUND: Few studies have examined the association of workhours and shift work (referred to here as "time-related work factors") with dietary behaviors. We aimed to investigate this association, as well as the dietary behaviors among individuals with occupations characterized by time-related work factors. METHODS: A cross-sectional study was performed using data from the Japan Environment and Children's Study. The study included 39,315 working men. Dietary behaviors (i.e., skipping breakfast, eating out, eating instant food, overeating, and eating fast) were assessed with a self-reported information from the Food Frequency Questionnaire. Logistic regression analysis was conducted to examine the associations of time-related work factors with dietary behaviors and dietary behavior tendencies among those in occupations characterized by long workhours and/or shift work. RESULTS: Long workhours were associated with high frequencies of skipping breakfast, eating out, eating instant food, overeating, and eating fast. The frequency of having shift work was associated with high frequencies of skipping breakfast, eating out, and eating instant food. Several occupations involving long workhours and/or shift work showed specific dietary behaviors; in some occupations, the level of significance changed after adjusting for time-related work factors in addition to other potential confounding factors. CONCLUSIONS Time-related work factors may help explain workers' dietary behaviors. Long workhours and shift work may lead to poor dietary behaviors. Other factors influenced by occupation itself, such as food environment, may also influence workers' dietary behaviors. Workhours and/or shift work, and these other work factors, should be given attention in workplace health promotion.
Adult ; Cross-Sectional Studies ; Eating ; Feeding Behavior ; Humans ; Japan ; Life Style ; Male ; Occupations ; classification ; Shift Work Schedule

The durability of the Starr-Edwards (SE) mitral caged-disk valve, model 6520, is not clearly known. We reported that SE mitral caged-disk valves implanted ＞20 years previously should be carefully followed up, and that SE caged-disk valves implanted ＞30 years previously should be electively replaced with modern prosthetic valves in our experience. We found the removed valve 39 years after implantation, which seemed minimal structural deterioration. The patient was discharged on the 10th postoperative day without any complications.

The patient was a 74-year-old woman who had undergone mitral valve replacement with a mechanical valve for rheumatic mitral valve stenosis at age 60. She was scheduled for aortic valve replacement for severe aortic stenosis. However, she had significantly worsening anemia before the operation. Capsule endoscopy showed angiodysplasia with bleeding in her small intestine, which was considered the cause of the anemia. Because of progressive anemia, we tried embolization under angiography. However, there was no evidence of extravasation. Neither melena nor exacerbation of anemia was observed, and she underwent aortic valve replacement. She was discharged on postoperative day 22 without gastrointestinal bleeding. Heyde syndrome is aortic valve stenosis associated with gastrointestinal bleeding induced by von Willebrand disease and angiodysplasia in small intestine. Molecular multimeric analysis of von Willebrand factor and the existence of angiodysplasia with hemorrhage of the digestive tract are important for definitive diagnosis. Capsule endoscopy, which is a general examination, is more useful for diagnosis than molecular multimeric analysis of von Willebrand factor. Aortic valve replacement is the only therapeutic option for Heyde syndrome. It is important to decide the appropriate timing of AVR with cardiopulmonary bypass.