We report a 79-year-old woman with ANCA-related vasculitis. Rapid lung and renal damage were observed. Myeloperoxidase ANCA (MPO-ANCA) was as high as 640 times normal, and the patient died. ANCA-related disease should be considered when severe lung/renal damage with sudden onset is observed. This was a case in which the autopsy results confirmed our diagnosis of ANCA-related vasculitis.

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A 76-year-old Japanese man with probable hereditary hemorrhagic telangiectasia (HHT) presented with hepatic arteriovenous malformation (AVM) and hyperintense T1 signal of the bilateral basal ganglia on magnetic resonance imaging. He was diagnosed with shunt encephalopathy because of depressed consciousness and drooling. Fast Fourier transform analysis and contrast-enhanced sonography showed a marked increase in blood flow with decreased arterial resistance in the hepatic artery and a delay in the transition to the Kupffer phase. This is the first report of an assessment of hepatic shunt blood flow in an HHT case with shunt encephalopathy caused by hepatic AVM.

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The number of patients with colorectal cancer on maintenance hemodialysis has been increasing. Chemotherapy schedules commonly used in colorectal cancer necessitate dose adjustment and appropriate timing relative to the hemodialysis sessions. Herein, we report the case of a 77-year-old man with RAS wild-type metastatic colonic cancer who was undergoing hemodialysis. Although this patient received the FOLFOX regimen for prevention of recurrence after resection of a hepatic metastasis, he developed multiple lung metastases. Panitumumab, a fully human IgG2 monoclonal anti-EGFR antibody, was administered in combination with the FOLFIRI regimen. Although the doses of cytotoxic chemotherapeutic agents were adequately reduced to avoid side effects, panitumumab was used without dose adjustment throughout the course. Computed tomography showed a partial response of the lung metastases to the EGFR- targeting chemotherapy. This case report demonstrates the feasibility, efficacy, and acceptable toxicity of biweekly panitumumab-based chemotherapy in patients undergoing hemodialysis.

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Recently, the role of general practice in hospitals has become as important as that of specialty practices in Japan. Some societies that are fostering a new field of hospitalists in Japan have discussed the ideal hospitalist, however, they have not yet come to agreement in determining the specific competencies of the profession. Therefore, between September 2019 and February 2020, six expert hospitalists proposed ten newly advocated skills characteristic of the Japanese hospitalist. We designed this statement based on a systematic narrative literature review. Further, we referred to the publications of the Society of Hospital Medicine, the Japan Primary Care Association, and the Japanese Society of Hospital General Medicine. Our statement on the ten characteristic skills contains leadership, management skills, up-to-date medical knowledge, community-based comprehensive care, medical education, clinical research, and academic hospitalists as important keywords of the Japanese hospitalist. Therefore, this statement aims to guide young physicians to contribute to community health care stability and development in Japan. The highlighting of the characteristic skills of a hospitalist will result in an explicit role model for young physicians and set the framework for developing competency for people who are leaders in educating future physicians planning to become hospitalists.

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