[Background] Videoendoscopic evaluation reveals age- and disease-related decline in swallowing function. We assessed the relation of neck circumference and platysma bands to laryngeal penetration, observed during videoendoscopy, among older Japanese patients with suspected dysphagia. [Methods] Sixty-seven patients with suspected dysphagia were evaluated. Platysma bands were scored (0 to 3 points) according to their thickness and length. The relations between mean neck circumference and platysma bands to laryngeal penetration were analyzed using Student’s t-test and Cochran‒Armitage test, respectively. [Results] Groups with and without laryngeal penetration showed no significant intergroup differences in terms of age or body mass index (BMI). However, the group with low platysma band scores included more patients with laryngeal penetration（p< 0.001). A between group comparison of platysma bands, categorized by a BMI threshold of 21.5 kg/m2, suggested that the difference, after adjustment, was significant for patients with BMI < 21.5 kg/m2（p<0.001). [Conclusions] The neck sail sign refers to the appearance of platysma bands. Subsequent thinning or loss of platysma bands in older individuals with suspected dysphagia is associated with laryngeal penetration and may indicate the risk of dysphagia.

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[Objectives] To determine the frequency and types of clinically significant complications associated with nasopharyngeal swab specimen collection for SARS-CoV-2 testing. [Methods] In this single-center retrospective observational study conducted in Japan from April 2020 to July 2022 included individuals who had a nasopharyngeal swab or saliva specimen tested for SARS-CoV-2 infection. The primary endpoint was the incidence of complications associated with nasopharyngeal swab sampling that occurred within 1 week of collection. The secondary endpoint was the incidence of complications according to swab type. [Results] Overall, 76,264 nasopharyngeal swab samples were obtained from 37,269 individuals (median age 49 years, 50.3% male). Only two cases of clinically significant complications were recorded: a broken swab tip that remained in the nasal cavity of one patient and one in the upper gastrointestinal tract of another. In both cases, the swab tips were endoscopically removed without any further complications. Swabs constructed with a breakpoint had a significantly higher complication rate than those without. [Conclusions] Clinically significant complications associated with nasopharyngeal swab specimen collection are rare. Clinicians should be aware of possible complications and the characteristics of the swabs used for testing and should take extra care when using swabs constructed with a breakpoint.

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Emergency surgery for patients with Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection should be avoided if possible because of increased risks of postoperative complications in patients and infection of medical staff members. We experienced a case of duodenal ulcer perforation that developed after SARS-CoV-2 infection. A 63-year-old man visited our hospital because of tiredness, and SARS-CoV-2 infection was confirmed. His general condition was good and followed up. The next day, he returned to the hospital because of abdominal pain and vomiting. Although his SARS-CoV-2 infection symptoms were mild, he was admitted to the hospital with a diagnosis of acute renal failure due to dehydration. An upper gastrointestinal perforation was revealed by computed tomography performed at the time of admission. Conservative therapy was selected because the abdominal symptoms were localized and inflammatory reaction was mild. However, laparotomy lavage drainage and gastrojejunos- tomy were needed because it worsened to generalized peritonitis. Despite adequate drainage and concomitant use of antibiotic therapy, multiple intra-abdominal abscesses formed. Additional drainage was required, and a long time was required for improvement of the inflammation. For patients with SARS-CoV-2 infection, the appropriate timing of emergency surgery, surgical procedures, and perioperative management is important to reduce complications.

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Campylobacter enteritis presents prodromal symptoms such as fever, headache, and myalgia that develope 12-24 h before gastrointestinal symptoms. In this report, we describe a case of a 21-year-old Japanese man with a fever and headache who underwent lumbar puncture. The cerebrospinal fluid test revealed no hypercellularity and its culture was negative. After admission, he developed watery diarrhea and mild pain in the right lower abdomen. An additional medical interview revealed a history of eating at a Yakitori restaurant 4 days before the hospital visit, and Campylobacter jejuni was identified in blood and stool cultures. Campylobacter enteritis can mimic meningitis during the early clinical course. This report provides a natural history of Campylobacter enteritis from its earliest onset and shows a didactic pitfall of Campylobacter enteritis for clinicians.

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