Sendai City Hospital

症例は73歳の男性で，30代の時に胃癌に対する幽門側胃切除術，Billroth II法再建の既往があった．かかりつけ医で貧血の指摘があり，上部消化管内視鏡検査を行ったところ，残胃の不整粘膜を認め，生検で高分化腺癌の診断となった．残胃癌の診断で当院紹介となり残胃全摘術を施行したが，術後のレントゲンで十二指腸憩室の存在が明らかとなった．術後3日目に腹腔内ドレーンの排液が腸液様となり，消化管穿孔の診断で再手術を行ったところ，結石を内包して穿孔した十二指腸憩室を認めた．穿孔部は単純閉鎖し，十二指腸内腔の減圧処置を追加して手術を終了した．術後敗血症を呈したため長期入院加療を要したが，初回手術から95日後に無事自宅退院となった．残胃癌の術前精査では十二指腸憩室の診断が難しいことも多いが，残胃癌の根治術が誘発した憩室穿孔と考えられ，教訓的症例として報告する．

A venous aneurysm (VA) is characterized by localized venous dilatation. We report a case of a left external jugular VA in a child with recurrent thrombophlebitis. The patient was diagnosed at 1 year of age, and the VA temporarily regressed after thrombophlebitis at 3 years of age, but it recanalized and recurred at 7 years of age, necessitating surgical resection. Five years after surgery, no recurrence of VA was observed. Although surgical resection of a VA associated with thrombophlebitis may be an effective treatment option, with a favorable post treatment course, early excision should also be considered.

ABSTRACTExosomal microRNAs (miRNAs) are candidates for liquid biopsies. Organoid culture systems enable long‐term expansion of the colon epithelium. This study evaluated exosomal miRNAs from colorectal cancer organoids for liquid biopsy. Organoids were established from normal colon and colorectal cancer tissues. Exosomes were isolated from conditioned media. miRNAs were extracted from exosomes and compared using microarray analysis. Exosomal miRNAs expression levels in the sera of healthy patients and patients with colorectal cancer were compared at a single institution. The multicenter study was validated using miRNAs upregulated in the serum of colorectal cancer patients, along with exosomal miRNAs reported to be upregulated in colorectal adenoma organoids and sera. A total of 44 exosomal miRNAs were commonly expressed in both normal colorectal epithelial cells and colorectal cancer organoids, whereas 59 were exclusively expressed in colorectal cancer organoids. In a single‐center cohort study, two exosomal miRNAs (miR‐4284 and miR‐5100) were upregulated in the serum of colorectal cancer patients. In a multicenter study, four exosomal miRNAs (miR‐4284, miR‐5100, miR‐1246, and miR‐1290) were upregulated in the serum of patients with colorectal cancer. The combination of these four exosomal miRNAs had comparable diagnostic performance to carcinoembryonic antigen, with an area under the curve of 0.75 (95% confidence interval: 0.65–0.83) versus 0.79 (95% confidence interval: 0.70–0.87). Combining the four miRNAs with carcinoembryonic antigen improved diagnostic accuracy, with an area under the curve of 0.82 (95% confidence interval: 0.74–0.89). Exosomal miRNAs derived from colorectal cancer organoids can serve as diagnostic biomarkers for colorectal cancer.

Nowadays, computed tomography urography and multiparametric magnetic resonance are the most often used imaging techniques in patients with bladder cancer; however, dual-energy computed tomography is making its way into the oncological field. This narrative review article aimed to show the fundamentals of dual-energy computed tomography by outlining its physical principles, techniques, protocols, and postprocessing images to help those who used this cutting-edge technology as the first approach to fully understand its emerging applications in the evaluation of bladder cancer, a field yet to be explored. In particular, we discuss the usefulness of dual-energy computed tomography by focusing on the main images obtained, such as the iodine map, comparing them to the images obtained with conventional computed tomography scans. Dual-energy computed tomography applications may be beneficial for bladder cancer diagnosis, staging, and treatment planning. Nevertheless, its application is limited to its availability in healthcare structures and the training of healthcare personnel who can perform and interpret the scans correctly.

A questionnaire survey on severe hypoglycemia (SH) in pediatric patients with diabetes was distributed to pediatric diabetes specialists and members of the Committee of Pediatric Diabetes in the Japan Diabetes Society. Thirty-three hospitals answered the questionnaire survey, and 17 had treated the eligible patients under 15years of age, including 506 with type 1 diabetes and 302 with type 2 diabetes. Of these patients, 25 experienced SH from January 2017 to December 2021. SH occurred in 3 patients at 0-5years, 5 at 5-10years, and 15 at 10-15years, and it most frequently occurred between the times of 0:00 and 08:00 a.m. The majority of the patients had SH at home during the nighttime. Only 4 patients experienced SH during school time. Eleven patients took glucose orally, while 5 used glucagon nasal powder. Fifteen patients were transferred to hospital emergency units for the management of SH. From these results, the frequency of SH was estimated to be 0.01/patient/year, and the treatment for SH seemed insufficient.

BackgroundPancreaticoduodenal artery aneurysm (PDAA) is a rare, but fatal disease. However, the association between aneurysm size and the risk of rupture remains unclear. There are many options for therapeutic strategies that should be discussed well because the treatment options are often complicated and highly invasive. However, it remains unclear whether additional endovascular therapy is essential for all patients undergoing bypass surgery. Here, we present a case of triple PDAAs with celiac axis occlusion and spontaneous complete regression of inferior PDAAs (IPDAA) after aneurysmectomy of superior PDAA (SPDAA) and aorto-splenic bypass.Case presentationA 68-year-old woman presented with one SPDAA and two IPDAAs caused by celiac axis occlusion. Aneurysmectomy for IPDAAs was difficult because of their anatomical location and shape. Therefore, we planned a two-stage hybrid therapy. The patient underwent aorto-splenic bypass and resection of the SPDAA. Follow-up CT was performed to evaluate the IPDAAs before planned endovascular embolization. Spontaneous regression of the IPDAAs and normalized PDA arcade decreased the blood flow in the PDA arcade. The patient is doing well without graft occlusion, and the IPDAAs have completely regressed 7 years after surgery.ConclusionNormalization of hyperinflow to the PDA arcade can lead to the regression of PDAA. Potentially, additional endovascular therapy may not be required in all cases when dilation of the PDA improves. However, more cases must be accumulated to establish criteria for predicting the risks of short- and long-term PDAA ruptures.