Splenic pseudoaneurysm rupture is a serious condition that sometimes leads to death. Pseudoaneurysm rupture is often treated with transcatheter arterial embolization (TAE), after which the re-rupture rate is 18%–37%. A 59-year-old man presented with back pain, and contrast-enhanced computed tomography (CECT) revealed pancreatic tail cancer with multiple liver metastases. After three courses of chemotherapy, CECT revealed good response with shrinkage of the tumors. However, the patient had back pain and CECT revealed pancreatic pseudocyst with pseudoaneurysm rupture. He underwent angiography, wherein the splenic artery pseudoaneurysm was embolized using TAE. Subsequently, pseudocyst drainage was performed using lumen-apposing metal stent (LAMS) to prevent pseudoaneurysm re-rupture. Thereafter, the pseudocyst shrieked with decreased serum levels of C-reactive protein, allowing the patient to re-institute chemotherapy. Pseudocyst drainage using LAMS was safe and effective when the pancreatic pseudoaneurysm had a high-risk rebleeding due to exposure to pancreatic juice.

Background/Aims: Serum leucine-rich alpha-2 glycoprotein (LRG) is a potential biomarker of Crohn’s disease (CD). This study aimed to evaluate the usefulness of LRG in predicting clinical relapse in patients in remission with CD. Methods: This retrospective observational study assessed the relationships among patient-reported outcome (PRO2), LRG, and other blood markers. The influence of LRG on clinical relapse was assessed in patients in remission with CD. Results: Data of 94 patients tested for LRG between January 2021 and May 2023 were collected. LRG level did not correlate with PRO2 score (ρ = 0.06); however, it strongly correlated with C-reactive protein (CRP) level (r=0.79) and serum albumin level (r=–0.70). Among 69 patients in clinical remission, relapse occurred in 22 patients (31.9%). In the context of predicting relapse, LRG showed the highest area under the curve, followed by CRP level, platelet count, and albumin level. Multivariate analysis revealed that only LRG (P= 0.02) was an independent factor for predicting clinical remission. The cumulative non-relapse rate was significantly higher in patients with LRG < 13.8 μg/mL than in patients in remission with LRG ≥ 13.8 μg/mL and normal CRP level (P= 0.002) or normal albumin level (P= 0.001). Cumulative non-relapse rate was also higher in patients with LRG < 13.8 μg/mL compared to those with LRG ≥ 13.8 μg/mL in patients with L3 or B2+B3 of Montreal calcification. Conclusions LRG is useful in predicting clinical relapse in patients with CD during biological remission. LRG is a useful biomarker for predicting prognosis, even in patients with intestinal stenosis, or previous/present fistulas.

Splenic pseudoaneurysm rupture is a serious condition that sometimes leads to death. Pseudoaneurysm rupture is often treated with transcatheter arterial embolization (TAE), after which the re-rupture rate is 18%–37%. A 59-year-old man presented with back pain, and contrast-enhanced computed tomography (CECT) revealed pancreatic tail cancer with multiple liver metastases. After three courses of chemotherapy, CECT revealed good response with shrinkage of the tumors. However, the patient had back pain and CECT revealed pancreatic pseudocyst with pseudoaneurysm rupture. He underwent angiography, wherein the splenic artery pseudoaneurysm was embolized using TAE. Subsequently, pseudocyst drainage was performed using lumen-apposing metal stent (LAMS) to prevent pseudoaneurysm re-rupture. Thereafter, the pseudocyst shrieked with decreased serum levels of C-reactive protein, allowing the patient to re-institute chemotherapy. Pseudocyst drainage using LAMS was safe and effective when the pancreatic pseudoaneurysm had a high-risk rebleeding due to exposure to pancreatic juice.

Background/Aims: Serum leucine-rich alpha-2 glycoprotein (LRG) is a potential biomarker of Crohn’s disease (CD). This study aimed to evaluate the usefulness of LRG in predicting clinical relapse in patients in remission with CD. Methods: This retrospective observational study assessed the relationships among patient-reported outcome (PRO2), LRG, and other blood markers. The influence of LRG on clinical relapse was assessed in patients in remission with CD. Results: Data of 94 patients tested for LRG between January 2021 and May 2023 were collected. LRG level did not correlate with PRO2 score (ρ = 0.06); however, it strongly correlated with C-reactive protein (CRP) level (r=0.79) and serum albumin level (r=–0.70). Among 69 patients in clinical remission, relapse occurred in 22 patients (31.9%). In the context of predicting relapse, LRG showed the highest area under the curve, followed by CRP level, platelet count, and albumin level. Multivariate analysis revealed that only LRG (P= 0.02) was an independent factor for predicting clinical remission. The cumulative non-relapse rate was significantly higher in patients with LRG < 13.8 μg/mL than in patients in remission with LRG ≥ 13.8 μg/mL and normal CRP level (P= 0.002) or normal albumin level (P= 0.001). Cumulative non-relapse rate was also higher in patients with LRG < 13.8 μg/mL compared to those with LRG ≥ 13.8 μg/mL in patients with L3 or B2+B3 of Montreal calcification. Conclusions LRG is useful in predicting clinical relapse in patients with CD during biological remission. LRG is a useful biomarker for predicting prognosis, even in patients with intestinal stenosis, or previous/present fistulas.

Splenic pseudoaneurysm rupture is a serious condition that sometimes leads to death. Pseudoaneurysm rupture is often treated with transcatheter arterial embolization (TAE), after which the re-rupture rate is 18%–37%. A 59-year-old man presented with back pain, and contrast-enhanced computed tomography (CECT) revealed pancreatic tail cancer with multiple liver metastases. After three courses of chemotherapy, CECT revealed good response with shrinkage of the tumors. However, the patient had back pain and CECT revealed pancreatic pseudocyst with pseudoaneurysm rupture. He underwent angiography, wherein the splenic artery pseudoaneurysm was embolized using TAE. Subsequently, pseudocyst drainage was performed using lumen-apposing metal stent (LAMS) to prevent pseudoaneurysm re-rupture. Thereafter, the pseudocyst shrieked with decreased serum levels of C-reactive protein, allowing the patient to re-institute chemotherapy. Pseudocyst drainage using LAMS was safe and effective when the pancreatic pseudoaneurysm had a high-risk rebleeding due to exposure to pancreatic juice.

Background/Aims: Serum leucine-rich alpha-2 glycoprotein (LRG) is a potential biomarker of Crohn’s disease (CD). This study aimed to evaluate the usefulness of LRG in predicting clinical relapse in patients in remission with CD. Methods: This retrospective observational study assessed the relationships among patient-reported outcome (PRO2), LRG, and other blood markers. The influence of LRG on clinical relapse was assessed in patients in remission with CD. Results: Data of 94 patients tested for LRG between January 2021 and May 2023 were collected. LRG level did not correlate with PRO2 score (ρ = 0.06); however, it strongly correlated with C-reactive protein (CRP) level (r=0.79) and serum albumin level (r=–0.70). Among 69 patients in clinical remission, relapse occurred in 22 patients (31.9%). In the context of predicting relapse, LRG showed the highest area under the curve, followed by CRP level, platelet count, and albumin level. Multivariate analysis revealed that only LRG (P= 0.02) was an independent factor for predicting clinical remission. The cumulative non-relapse rate was significantly higher in patients with LRG < 13.8 μg/mL than in patients in remission with LRG ≥ 13.8 μg/mL and normal CRP level (P= 0.002) or normal albumin level (P= 0.001). Cumulative non-relapse rate was also higher in patients with LRG < 13.8 μg/mL compared to those with LRG ≥ 13.8 μg/mL in patients with L3 or B2+B3 of Montreal calcification. Conclusions LRG is useful in predicting clinical relapse in patients with CD during biological remission. LRG is a useful biomarker for predicting prognosis, even in patients with intestinal stenosis, or previous/present fistulas.

To date, there have been limited reports on the efficacy of Kampo medicine in treating obsessive compulsive behaviors. To the best of our knowledge, there have been no previous reports on the efficacy of ryokeijutsukanto for obsessive compulsive behaviors. Here, we describe 2 cases of obsessive-compulsive behavior successfully treated with ryokeijutsukanto. Case 1 involved a 30-year-old female patient who presented with vague anxiety. As a result, she spent significant time engaging in compulsive behavior related to checking and was frequently tardy to work. She met the diagnostic criteria for obsessive compulsive disorder. We prescribed ryokeijutsukanto. Her compulsive behavior then improved from 40 minutes to 5 minutes in 56 days. Case 2 involved 57-year-old female patient who complained of not feeling refreshed in the morning. In addition, she had a feeling of gloom, daytime sleepiness and compulsive behavior of checking about 5 times whether windows were locked. We prescribed ryokeijutsukanto. In 14 days, her checking behavior then improved from 5 times to once. Other troublesome symptoms also improved. Ryokeijutsukanto is usually utilized for patients with fluid retention, dizziness, and qi counterflow. However, these 2 cases have qi stagnation rather than qi counterflow. These results suggested that ryokeijutsukanto could also be utilized to treat compulsive behaviors when patients had fluid retention, dizziness and qi stagnation.

The case is a 6-year-0-month-old girl. She was referred to our department at the age of 5 years and 10 months due to persistent fever over 38.0 ℃. Since blood tests and contrast-enhanced computed tomography showed no abnormalities and there was no response to antipyretics, psychogenic fever was suspected, but psychological factors were unclear. She had lived in father’s home country until the age of 4 years and 11 months (father is foreign national/mother is Japanese), had plans to return to father’s home country. Her height was 117.5 cm, weight 18.7 kg, body temperature 37.4 ℃, and her cardiopulmonary findings were normal. She tried five types of Kampo preparations sequentially. Her body temperature less frequently exceeded 38.0 ℃ with kamishoyosan and yokukansan, and never exceeded 38.0 ℃ with kamikihito. Suspecting that family relationships and vague insecurities were behind her symptoms, it was found that she was stressed about plans to return to father’s home country, leading to the diagnosis of psychogenic fever. When investigating the etiology behind the symptoms, it is useful to refer to the responsiveness to Kampo medicines.

Background/Aims: We aimed to investigate (1) promising clinical findings for the recognition of focal type autoimmune pancreatitis (FAIP) and (2) the impact of endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-TA) on the diagnosis of FAIP. Methods: Twenty-three patients with FAIP were involved in this study, and 44 patients with resected pancreatic ductal adenocarcinoma (PDAC) were included in the control group. Results: (1) Multivariate analysis revealed that homogeneous delayed enhancement on contrast-enhanced computed tomography was a significant factor indicative of FAIP compared to PDAC (90% vs. 7%, p=0.015). (2) For 13 of 17 FAIP patients (76.5%) who underwent EUS-TA, EUS-TA aided the diagnostic confirmation of AIPs, and only one patient (5.9%) was found to have AIP after surgery. On the other hand, of the six patients who did not undergo EUS-TA, three (50.0%) underwent surgery for pancreatic lesions. Conclusions Homogeneous delayed enhancement on contrast-enhanced computed tomography was the most useful clinical factor for discriminating FAIPs from PDACs. EUS-TA is mandatory for diagnostic confirmation of FAIP lesions and can contribute to a reduction in the rate of unnecessary surgery for patients with FAIP.