A novel scoring system for the prediction of disease severity in STEC-HUS.

Background: Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS) is a life-threatening condition complicated by acute kidney injury, acute respiratory distress syndrome, and central nervous system disorders. The early identification of high-risk patients is required to facilitate timely and appropriate treatment.

Methods: The medical records of patients with STEC-HUS treated at 11 hospitals in Hokkaido, Japan, were reviewed retrospectively.

Comparison of kidney and hepatic outcomes among sodium-glucose cotransporter-2 inhibitors: a retrospective study using multiple propensity scores.

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been reported to have effects beyond lowering blood glucose levels, with certain SGLT2i expanding their indications to chronic kidney disease and chronic heart failure. We focused on the hepatoprotective and renoprotective effects of six SGLT2i and assessed whether the effects were unique to each drug or common class effects, in addition to whether the renal and hepatoprotective effects vary based on renal and hepatic status.

Methods: Patients with diabetes (ipragliflozin: 837, empagliflozin: 850, canagliflozin: 922, dapagliflozin: 590, tofogliflozin: 288, and luseogliflozin: 193) who initiated SGLT2i treatment and were monitored for one year were included.

Multisystem Inflammatory Syndrome in Adults-Related Unstable Angina With Coronary Aneurysm in a Young Female: A Case Report.

Multisystem inflammatory syndrome in adults (MIS-A) is a systemic inflammatory disease associated with COVID-19 and follows coronary artery aneurysms similar to Kawasaki disease. In many cases, it is improved by treatments such as high-dose steroids or intravenous immunoglobulin (IVIg). However, the role of untreated coronary artery aneurysms leading to future stenosis remains unknown.

[A Case of Pathological Complete Response of Advanced Rectal Cancer with Direct Invasion of the Prostate and Extra-Regional Lymph Node Metastasis after Chemotherapy].

A 62-year-old man was diagnosed as having advanced rectal cancer with an invasive carcinoma of the prostate and the right inguinal lymph node metastasis. He received chemotherapy consisting of combination of 5-FU, oxaliplatin, Leucovorin (mFOLFOX6)and bevacizumab. After 5 courses of the chemotherapy, CT and MRI findings revealed the tumor shrinkage.

Possible Paternal Hepatitis B Virus Infection with Different Clinical Courses between Siblings: A Report of Two Cases.

The incidence of hepatitis B virus (HBV) infection is expected to decrease in the future owing to the preventive measures adopted against mother-to-child transmission of HBV and implementation of universal HBV vaccination for children. However, no countermeasure has been established against horizontal infection in nonvaccinated children. We report the case of two siblings who had different clinical courses of possible paternal HBV infection.

The survival impact of preoperative FOLFOX for resectable locally advanced rectal cancer: the R-NAC-01 study.

Purpose: In this follow-up of the R-NAC-01 study, we assessed the long-term oncological benefit of four courses of modified leucovorin, 5-fluorouracil (FU), and oxaliplatin (mFOLFOX6) chemotherapy before rectal surgery.

Methods: In this prospective, multicenter study (UMIN 000012559) involving 11 hospitals in Japan, patients with lower rectal cancer underwent four cycles of mFOLFOX6 chemotherapy and subsequent surgery within four to six weeks. The 3-year recurrence-free survival and local recurrence rates were then reported.

Granulomonocytapheresis Using the Single-Needle Method for a Girl with Ulcerative Colitis.

Granulomonocytapheresis (GMA) is an effective treatment for inducing remission in patients with refractory ulcerative colitis (UC). Furthermore, GMA has very few side effects and can be performed without using drugs except anticoagulants. However, GMA is sometimes challenging to perform, especially in children, as it usually requires securing two blood vessels.

Small Bowel Obstruction Caused by Ileal Endometriosis with Appendiceal and Lymph Node Involvement Treated with Single-Incision Laparoscopic Surgery: A Case Report and Review of the Literature.

BACKGROUND Endometriosis is an ectopic proliferation of endometrial glands and interstitium outside the uterus. It usually affects the organs surrounding the uterus, and less often, involvement of extrapelvic organs, such as the intestines and urinary tract, is observed. CASE REPORT A 40-year-old woman had been experiencing intermittent right lower abdominal pain for years, which worsened months earlier.

[Effect of Matrix Size on Lesion Detectability in CT Colonography].

Objectives: While computed tomography colonography (CTC) has become a non-invasive alternative to traditional colonoscopy, superficial lesions tend to be harder to detect, with reports of lesions <2 mm in height being missed. Therefore, for the evaluation of lesion detectability using CTC, optimizing scan parameters becomes important. In this study, we investigate the effect of the reconstructed matrix size from CTC on the lesion conspicuity.

Refeeding syndrome in a 12-year-old girl with distal renal tubular acidosis.

Distal renal tubular acidosis is a risk factor for refeeding syndrome. Frequent measurement of serum phosphorus levels at the initiation of nutrition and rapid administration of phosphate preparations are required to prevent organ failure.

A Case of Nonalcoholic Steatohepatitis in Central Precocious Puberty Aggravated by Gonadotropin-releasing Hormone Analog.

We report the case of a girl with central precocious puberty (CPP) and nonalcoholic steatohepatitis (NASH) aggravated by gonadotropin-releasing hormone analog (GnRHa). She was diagnosed with CCP and began treatment with GnRHa at the age of 8 years and 9 months. She already had mild liver dysfunction and was obese at that time; however, liver dysfunction was aggravated during GnRHa initiation.

Eosinophilic gastroenteritis with persistent abdominal pain: a case report.

Two months ago, a 9-year-old boy experienced intermittent abdominal pain regardless of food intake, without diarrhea, bloody stool, or nausea. Blood test results revealed a peripheral blood eosinophil count of 660 cells /µL, which was marginally elevated, without inflammatory reaction, occult blood, or enteric pathogens. The intestinal mucosa from the terminal ileum to the rectum was endoscopically normal, but mucosal biopsy revealed eosinophilic infiltration of the terminal ileum and whole colon with ≥20 eosinophils/high power field (HPF).

Rotavirus Vaccine Effectiveness against the Risk of Hospitalization and the Impact of Using Public Funds for the Vaccine on a Regional Rotavirus Gastroenteritis Epidemic in Japan.

An epidemic of rotavirus (RV) gastroenteritis occurred from April to July 2015 across a wide area of Hokkaido, surrounding the Abashiri-Kosei General Hospital. The RV vaccine for children in Shari and Koshimizu was provided at public funds by their local governments, while children in Abashiri were charged for the vaccine. This study examined the effectiveness of the RV vaccine against the risk of hospitalization based on a retrospective cohort study and the impact of using public funds for RV vaccination on a regional RV gastroenteritis epidemic.

Simultaneous Laparoscopic Cholecystectomy and Combined Endoscopic and Laparoscopic Surgery for an Endoluminal Tumor of the Sigmoid Colon: A Case Report.

BACKGROUND One treatment for colon endoluminal tumors is endoscopic resection, i.e., endoscopic mucosal resection (EMR).

Endoscopic Retrograde Cholangiopancreatography (ERCP) with Laparotomic Small-Intestinal Incision Approach for Extraction of a Common Bile Duct (CBD) Stone Following Total Gastrectomy and Roux-en-Y (R-Y) Anastomosis: A Case Report.

BACKGROUND Endoscopic retrograde cholangiopancreatography for common bile duct stone in patients who underwent gastrectomy and Roux-en-Y anastomosis is challenging. We report a case in which we performed endoscopic retrograde cholangiopancreatography through a small-intestinal incision approach for a common bile duct stone, which had developed after total gastrectomy and Roux-en-Y anastomosis. CASE REPORT An 86-year-old woman with a history of laparoscopic-assisted total gastrectomy and R-Y anastomosis and incision of the common bile duct and cholecystectomy for common bile duct stone by open surgery 3 years ago presented with abdominal pain.

Case of chronic pain after laparoscopic percutaneous extraperitoneal closure in an adolescent girl with inguinal hernia in which open repair was effective.

Chronic pain after laparoscopic percutaneous extraperitoneal closure is very rare. Here, we report a case of chronic pain after laparoscopic percutaneous extraperitoneal closure in an adolescent patient with inguinal hernia who underwent open repair. A 15-year-old girl was diagnosed with a left indirect inguinal hernia, and laparoscopic percutaneous extraperitoneal closure was performed.

Successful treatment of normokalemic periodic paralysis with hydrochlorothiazide.

Background: Periodic paralysis (PP) is an autosomal dominant muscle disorder characterized by periodic muscle weakness attacks associated with serum potassium level variations. It is classified into hypokalemic (hypoKPP), hyperkalemic (hyperKPP), and normokalemic (normoKPP) forms based on the ictal serum potassium level. HyperKPP and normoKPP are caused by mutations of the same gene SCN4A, the gene encoding the skeletal muscle voltage-gated sodium channel.

Laparoscopic abdominoperineal resection with lateral lymph node dissection for advanced rectal and prostate cancer with synchronous lateral lymph node metastases.

Here we report a case of advanced rectal and prostate cancer with synchronous lateral lymph node (LLN) metastases that was treated with laparoscopic surgery. A 71-year-old man presented with fecal occult blood and was diagnosed with rectal cancer. A metastatic right LLN was suspected after CT examination of a 19-mm lymph node (proximal internal iliac artery region) and a 13-mm lymph node (distal internal iliac artery region) in the right lateral region.

Laparoscopic anterior resection for rectal cancer in a patient with a ventriculoperitoneal shunt.

Laparoscopic surgery has been relatively contraindicated in patients with ventriculoperitoneal shunts (VPS) because of concerns about the effect of the pneumoperitoneum on shunt function. However, there have been recent reports of laparoscopic surgery on the gallbladder and cecum. This is the first report of laparoscopic high anterior resection for rectal cancer without manipulation of the VPS catheter in a patient with VPS.

[Effect of Reduced Tube Voltage on Diagnostic Accuracy of CT Colonography].

The normal tube voltage in computed tomography colonography (CTC) is 120 kV. Some reports indicate that the use of a low tube voltage (lower than 120 kV) technique plays a significant role in reduction of radiation dose. However, to determine whether a lower tube voltage can reduce radiation dose without compromising diagnostic accuracy, an evaluation of images that are obtained while maintaining the volume CT dose index (CTDI) is required.

Cytomegalovirus colitis in a patient undergoing postoperative adjuvant chemotherapy for lung adenocarcinoma with uracil-tegafur.

When we examine a patient with symptoms of acute enteritis in the course of chemotherapy with oral fluoropyrimidines such as uracil-tegafur (often referred to as UFT), we usually suspect 5-fluorouracil-induced enterocolitis. In case of persistent clinical symptoms despite discontinuation of chemotherapy, cytomegalovirus colitis should be considered in the differential diagnosis of chemotherapy-induced enterocolitis. We herein report the case of a patient who underwent surgery for lung adenocarcinoma followed by postoperative adjuvant chemotherapy with uracil-tegafur and was diagnosed as having cytomegalovirus colitis during the therapy.

Pharmacokinetics of drugs for pediatric pulmonary hypertension.

Background: Over the past few years, several drugs, each with a different mechanism, have been developed for the treatment of pulmonary hypertension (PH) and are now prescribed in the clinical setting. While the optimal doses of these drugs in adults have been determined, the optimal dose in children, however, is unclear. The aim of this study was therefore, to measure blood drug levels and analyze the pharmacokinetics of two such drugs in children.

Balloon catheter versus basket catheter for endoscopic bile duct stone extraction: a multicenter randomized trial.

Background And Study Aims: Endoscopic bile duct stone (BDS) removal is a well-established treatment; however, the preference for basket or balloon catheters for extraction is operator-dependent. We therefore conducted a multicenter prospective randomized trial to compare catheter performance.

Patients And Methods: We enrolled patients with a BDS diameter ≤ 10 mm and common bile duct diameter ≤ 15 mm.