Fatigue is a common symptom of long COVID. Fatigue can majorly disrupt daily life and be challenging to treat. Herein, we describe the effect of saikokeishito, a Kampo medicine, on fatigue in patients with long COVID.Between October 2020 and March 2023, we prescribed saikokeishito to 22 patients with long COVID in the general medicine outpatient department of our hospital. Among them, seven patients (age: 15-58 years, two females) had fatigue, a previously confirmed diagnosis of COVID-19, and no concomitant use of other Kampo formulas. We compared their condition at the start of saikokeishito administration to that 3 months later. Five patients had a slight fever, and four had inflammatory findings on blood tests. Within 3 months, all patients had a 20% or greater reduction in fatigue on a visual analogue scale. Six patients had a 20% or greater increase in health-related QOL and were able to return to society. On the other hand, one patient required a transition to an alternative medication, and one patient's follow-up was prematurely discontinued. Fatigue after COVID-19 may be improved by saikokeishito, especially for the treatment of patients with slight fever or inflammatory findings.

A 66-year-old, postmenopausal woman was referred to our hospital because of abnormal breast cancer screening results. A tumor was found in the upper outer part of the left breast. Biopsy revealed papillotubular carcinoma, ER (Allred score total score [TS] 3 = proportion score [PS] 2 + intensity score [IS] 1), PgR (Allred score TS 3 = PS 2 + IS 1), HER2 (2+), fluorescent in situ hybridization 1.1 (negative), and Ki-67 labeling index 15%. In diagnostic imaging, the tumor size was 35 mm. The diagnosis was T2N0M0 Stage IIA, luminal B-like breast cancer. First, letrozole 2.5 mg/day was administered as preoperative hormone therapy. After 2 months of treatment with letrozole, the tumor size had increased to 44 mm and preoperative hormone therapy was discontinued. She was started on preoperative chemotherapy (4 courses of epirubicin plus cyclophsphamide followed by 4 courses of triweekly docetaxel). The tumor size decreased, becoming undetectable. After these preoperative treatments, nipple-sparing mastectomy, sentinel lymph node biopsy, and breast reconstruction with a primary latissimus dorsi flap were performed. As of 3 years and 6 months after the operation, there has been no recurrence. At first, preoperative hormone therapy is performed for Luminal B-like breast cancer as in this case, if the response is insufficient, preoperative chemotherapy after hormone therapy may be a therapeutic option.

Here, we report 3 cases of conservatively treated ischemic colitis with hepatic portal venous gas. In Case 1, an 84-year-old man visited the emergency department because of fatigue, vomiting, and upper abdominal pain. In Case 2, a 72-year-old man was hospitalized for rehabilitation in another hospital following cervical spine trauma. He had diarrhea and mesogastric pain for 2 days and was transferred to our hospital. In Case 3, an 89-year-old woman visited the emergency department because of upper abdominal pain and vomiting. In all cases, we diagnosed the illness as ischemic colitis with hepatic portal venous gas based on computed tomography findings, and the vital signs of all patients were stable. They were treated conservatively. They were able to resume oral intake and were discharged or transferred to another hospital. Hepatic portal venous gas has been considered a poor prognostic sign of severe diseases such as intestinal necrosis. However, recently, reports of cases treated conservatively have been increasing. Conservative treatment may be selected for ischemic colitis associated with hepatic portal venous gas taking into account the patient’s general condition.

A 14-year-old girl (Case 1) with respiratory distress during exercise was referred to our department after a pancreatic mass was detected by computed tomography (CT). Contrastenhanced CT scan showed a low-density mass measuring 2.5 × 2 cm in the body of the pancreas. Low signal intensity was seen on T1-weighted magnetic resonance imaging (MRI) and high signal intensity on T2-weighted MRI. We suspected solid-pseudopapillary neoplasm (SPN) of the pancreas and performed laparoscopy-assisted spleen-preserving distal pancreatectomy. The postoperative course was uneventful, and she was discharged on postoperative day 13. A 15-yearold girl (Case 2) with abdominal pain and fever was referred to our department after an abdominal cystic mass was detected by ultrasound examination. Contrast-enhanced CT showed a 4-cm well-circumscribed mass. Higher signal intensity was seen on T2-weighted MRI. We suspected SPN of the pancreas and performed laparoscopic spleen-preserving distal pancreatectomy. The postoperative course was uneventful, and she was discharged on postoperative day 8. Laparoscopic or laparoscopy-assisted surgery should be considered for SPN of the pancreas.

Primary mesenteric neuroendocrine tumor is extremely rare. Here we describe 2 cases of this disease. Case 1 was a 66-year-old man with a working diagnosis of gastrointestinal stromal tumor or mesenteric tumor who underwent laparoscopic tumor resection. Immunohistochemically, the final diagnosis was primary mesenteric neuroendocrine tumor G1. There has been no recurrence as of 25 months after surgery. Case 2 was an 80-year-old man with a working diagnosis of gastrointestinal stromal tumor or mesenteric tumor who also underwent laparoscopic tumor resection. Immunohistochemically, the final diagnosis was primary mesenteric neuroendocrine tumor G1. This is recurrence-free as of 36 months after surgery. Several cases of primary mesenteric neuroendocrine tumor have been reported, but most have been treated with open surgery. To date, there has been only 1 case of primary mesenteric NET that was resected in a pure laparoscopic procedure. In all 3 cases (including our 2 cases), the largest tumor diameter was 4 cm. It appears that laparoscopic surgery can be used to treat primary mesenteric neuroendocrine tumor of small size (＜ 4 cm) with minimal invasion.

The purpose of this study was to compare the results of open surgery and laparoscopic surgery for acute appendicitis in adults. In 2013, we primarily selected open surgery for acute appendicitis, but in 2017 we opted to select mainly laparoscopic surgery. We compared between 92 patients who had undergone open surgery in 2013 and 88 patients who underwent laparoscopic surgery group in 2017. There was no difference in age, sex, body mass index, white blood cell count, C-reactive protein, or perforation rate on computed tomography between the two groups. The laparoscopic surgery group had significantly longer operation time but significantly lower blood loss and postoperative complication rate. In particular, laparoscopic surgery was advantageous in terms of hemostasis for moderate bleeding. The results suggest that laparoscopic surgery may be more useful in adult appendicitis than open surgery.

The patient was a 52-year-old woman who had undergone laparoscopic colectomy with lymph node dissection and inferior mesenteric artery preservation for cancer of the descending colon. Functional end-to-end anastomosis was performed using a linear stapler. Colonoscopy at the 1-year follow-up revealed a type 2 tumor at the anastomotic site. She was diagnosed with anastomotic recurrence. We performed laparoscopic high anterior resection with inferior mesenteric artery dissection. Rectal resection preceded mobilization of the mesocolon because of severe adhesion around the anastomotic site. Laparoscopic surgery for anastomotic site recurrence is an option under the condition that the initial surgery was laparoscopic.

Background: With the expanding use of social media, medical students have been posting an increasing amount of content that against ethics and professionalism.　Objective: To develop a checklist for social media use within medical education based on our national survey.　Methods: We analyzed and classified unprofessional behaviors that occurred over the past ten years in Japan. Then, we developed an event-based checklist for the use of social media use.　Result: The behaviors violating ethics and professionalism were classified into 3 categories. We have developed a social media checklist consisting of 10 items.　Discussion: Since social networking services are becoming vital information technology, every medical student or professional may risk unprofessional behaviors when they post or exchange any professional information. We propose appropriate education using an event-based checklist for social media usage.

Introduction: To implement effective medical education, it is important to clarify the process of recognizing and comprehending medical terms.　Methods: We conducted a questionnaire survey of 492 first- to fifth-year medical students to evaluate the recognition and comprehension rates of 57 medical terms in each grade. The terms were classified using the hierarchical cluster analysis based on the recognition and comprehension rates.　Results: The response rate was 91.1% (n=448). The 57 terms were classified into the following five clusters: #1, 30 terms that the students recognized and comprehended from Y1; #2, 18 terms that the students recognized from Y1 and comprehended as the grade increased; #3, six terms that the students recognized and comprehended as the grade increased; #4, two terms that the students recognized from Y1 but had not comprehended even in upper grades; #5, one term that the students recognized as the grade increased but had not comprehended even in Y5.　Discussion: Teachers may need to devise educational strategies while considering different patterns of students’ recognition and comprehension of medical terms.