Hosyu Memorial Hospital

A gastric inlet patch (GIP) is an ectopic gastric mucosal lesion usually arising at the cervical esophagus that may rarely cause esophageal adenocarcinoma (EAC). To the best of our knowledge, this is the first case of a GIP-derived EAC that was successfully treated using a multidisciplinary treatment approach. A 64-year-old man was referred to the Department of Gastrointestinal Surgery, Kanazawa University Hospital (Kanazawa, Japan) for surgical treatment of refractory recurrent cervical EAC derived from GIP who had previously been treated with induction chemotherapy, definitive chemoradiotherapy and photodynamic therapy (PDT). Esophagogastroduodenoscopy revealed a stenotic tumor at the GIP site in the cervical esophagus and submucosal tumors with suspected multiple intramural metastases in the anal side of the thoracic esophagus. The patient underwent robot-assisted thoracoscopic esophagectomy with laryngopharyngectomy and cervical lymphadenectomy as radical salvage surgery 4 months after the last PDT procedure. After postoperative adjuvant chemotherapy using oral administration of tegafur/gimeracil/oteracil (oral 5-fluorouracil prodrug) for 1 year; at present, the patient is alive without recurrence 3 years after the operation.

The Scatchard plot of anti-insulin antibodies is curvilinear, indicating heterogeneity in binding sites. However, the relationship between bound insulin (B) and free insulin (F) in patients with anti-insulin antibodies has not yet been elucidated. This study aimed to determine this relationship. We studied two insulin-treated patients with diabetes who had high titers of anti-insulin antibodies. The B and F levels were measured using daily blood samples. Assuming that the law of mass action is applicable to the reactions between insulin and anti-insulin antibody forms, we plotted the bound-to-free ratio (B/F) vs. B using patient data. We also performed an equilibrium binding assay in vitro. Some of the B/F vs. B plots of the daily variation showed an approximately linear relationship, while the Scatchard plots of in vitro data became curvilinear. Our study suggests that the one-site (high-affinity site) of anti-insulin antibodies accounts, for the most part, for insulin pharmacokinetics within physiological insulin concentrations. The online version contains supplementary material available at 10.1007/s13340-023-00641-1.

Background: Metabolic syndrome is a cluster of metabolic disorders including elevated blood pressure, high plasma glucose, excess body fat around the waist, and abnormal cholesterol or triglyceride levels. These conditions cause serious complications such as heart disease, stroke and type 2 diabetes. In Japan, specific health checkups and specific health guidance which focused on metabolic syndrome has been performed since 2008. Those who fall under certain criteria need to receive a medical treatment guidance from doctor, public health nurse or dietitian. Those who received health guidance receives a reassessment of improvement of their life-style 3-6 months later. However, the efficacy of this approach has not been elucidated. In addition, many persons who have metabolic syndrome do not receive this instruction. Recently, the image analysis technology using the artificial intelligence (AI) progresses rapidly. The smart device application “Asken” has an AI-powered photo analysis system which analyzes the photo of the entire meal, and delivers individualized messages and dietary feedbacks. In this study, we utilized the Internet of Things (IoT) device which includes Asken app, body composition analyzer and sphygmomanometer that can connect wirelessly. Objective: Our aim is to assess the efficacy of specific health guidance adding on IoT device. This is a multicenter, unblinded, non-randomized controlled study. Results: At the end of January 2020, we recruited 219 participants including 105 participants with IoT devices. We used 48 participants (32 with IoT and 16 without IoT) who had finished a reassessment 3 to 6 months after initial guidance. Results: Age, body weight (BW), body mass index (BMI), blood pressure (BP), fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), total cholesterol (T-Chol), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), non-HDL cholesterol (n-HDL), and triglyceride (TG), did not differ between IoT-use and control group. 6 months after initial guidance, the quantity of decrease of BW in IoT-use group was significantly larger than control (-2.5 ± 4.1 kg vs. 0.6±4.4, p = 0.03). In addition, the quantities of decrease of both T-Chol and n-HDL in IoT-use group were also significantly larger than control (T-Chol, -5.9 ± 32.0 vs. 14.3 ± 31.6, p = 0.02; n-HDL, -7.6 ± 29.0 vs. 9.4 ± 27.5, p = 0.01). Conclusion: Using IoT device might be useful for body weight loss and the improvement of mild hypercholesterolemia in those with metabolic syndrome.

We present a rare case of a patient who underwent complete microendoscopic excision of an osteoid osteoma, which induced radiculopathy without nerve root compression. A 20-year-old man presented severe right groin pain that was temporarily relieved by nonsteroidal anti-inflammatory drugs. A computed tomography (CT) scan showed typical features of a nidus located in the inferior cortex of the right L3 pedicle. We performed surgery using a posterior microendoscopic approach. We drilled vertically along the line of the cortex of the caudal pedicle using a high-speed drill. After identifying the tumor, en bloc resection of the nidus was achieved. Immediately after surgery, pain in the right groin disappeared. A CT scan showed that most of the right L3 pedicle remained. This minimally invasive technique preserves spinal structures, including the facet and pedicle, and is a viable option for the treatment of spinal osteoid osteomas located close to vital structures.

We herein report the case of a 65-year-old man with pericardial involvement associated with autoimmune pancreatitis. Chest CT imaging showed pericardial thickening. The patient responded to corticosteroid therapy, and the pericardial thickening resolved. Multiple organs are involved in immunoglobulin G4 (IgG4)-related disease (IgG4-RD); however, only a few cases of IgG4-related chronic constrictive pericarditis have been reported. To our knowledge, this is the first reported case of IgG4-RD with pericardial involvement at an early stage. This case indicates that recognizing pericardial complications in autoimmune pancreatitis is important and that CT imaging may be useful for obtaining the diagnosis and providing follow-up of pericardial lesions in cases of IgG4-RD.

ガゴメ昆布フコイダンの高年齢者に対する安全性と免疫機能に対する効果をオープン試験により評価した．高年齢者（69.4 ± 6.9 歳）18 名（男性 7 名，女性 11 名）にガゴメ昆布フコイダン（1 日摂取量 50 mg）と乳酸菌を配合した食品を 8 週間摂取してもらい，摂取前と摂取 4 週間後および摂取 8 週間後に血液検査，尿検査，QOL 調査，免疫機能検査を行った．その結果，いずれの検査においても臨床上問題となる変動は見られなかった．また，試験食品に起因し臨床上問題となる有害事象も認められなかった．免疫機能検査においては，血中の IgE の有意な低下が認められた．以上の結果から，ガゴメ昆布フコイダンは高年齢者に対し安全性の高い機能性食品素材であることが示された．

The incidence of lung disease due to mycobacteria other than Mycobacterium tuberculosis (atypical mycobacteria) in Japan was estimated to be 0.9--1.9 per 10(5) population per year in 1971--1979. Although the incidence of lung tuberculosis is steadily decreasing, the incidence of lung disease due to atypical mycobacteria has remained at almost the same level. The number of patients newly infected per year in recent years was calculated to be approximately 2,000. The ratio of the number of patients with lung disease due to atypical mycobacteria to the number of patients with lung disease due to atypical mycobacteria to the number of patients with lung disease due to all species of mycobacteria was highest in hospitals on the southwest coast of the Pacific. The atypical mycobacteria that caused disease most frequently belonged to the Mycobacterium avium-intracellulare complex. Of the 537 cases of disease due to atypical mycobacteria, 491 (89.6%) were due to these organisms; 43 (8.0%), to Mycobacterium kansasii; and 7 (1.3%), to Mycobacterium fortuitum. The disease due to M. kansasii appeared most frequently in hospitals in the Tokyo and Kanagawa prefectures. Patients with lung tuberculosis had a high risk of lung infection due to M. avium-intracellulare. The incidence of such disease in tuberculous patients was estimated to be 18.7 per 10(5) population per year, a rate that is approximately 10 times that found in the general population.