Fontan procedure is a surgical procedure used for congenital heart disease with a single ventricular physiology. Lymphatic disorders, including chylothorax, protein-losing enteropathy, and cast bronchiolitis are well-recognized complications of the Fontan procedure. Development of these complications is associated with anatomic abnormalities of the lymphatic system. Noncontrast magnetic resonance lymphangiography （MRL）, a less-invasive imaging approach for the anatomic evaluation of the lymphatic system, has been used in our institution since August 2020. However, obtaining sufficient image quality has been difficult because of the fine structure of the lymphatic vessels, especially in young children. In complex magnetic resonance imaging, including MRL, imaging conditions are typically adjusted during the examination to provide optimal images for clinical purposes. On performing noncontrast MRL in 15 cases up to July 2022, we observed that the imaging quality of the lymphatic vessels compared with the surrounding tissues changed depending on echo time, a key imaging parameter. Analysis of this clinical experience in this study concludes that echo time adjustment constitutes an appropriate imaging approach for MRL. Improving the quality of lymphatic vessel imaging will greatly assist in the evaluation of lymphatic disorders.

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Deep vein thrombosis （DVT） is a frequent complication of total knee arthroplasty （TKA）, which may cause pulmonary embolism （PE） among other serious conditions. Therefore, the prevention of DVT is crucial. Recent reports indicate that the risk of DVT can be reduced by introducing early physical therapy following surgery; however, in Japanese medical literature, such reports are limited. Since 2017, Showa University Fujigaoka Hospital has implemented early physical therapy starting from the day of surgery to prevent DVT and PE. This study aimed to examine the effectiveness of initiating physical therapy on the day of TKA for DVT prevention. The study included 319 patients who underwent TKA at Showa University Fujigaoka Hospital from 2017 to 2019. We extracted data, including patient background, surgery details, presence or absence of physiotherapy on the day of surgery, and postoperative presence or absence of lower extremity DVT via ultrasound imaging, from the patients’ charts. The incidence of DVT was compared between the physiotherapy intervention and nonintervention groups. Furthermore, factors contributing to DVT development were investigated. The incidence of DVT following unilateral and bilateral TKA was significantly lower in the intervention group than in the nonintervention group. Logistic regression analysis revealed that the presence or absence of physiotherapy on the day of surgery and sex were associated with DVT development. DVT commonly occurs either immediately postsurgery or on the subsequent day. Thus, it is conceivable that physiotherapy during this period of immobility could improve blood flow and prevent thrombus formation.

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Patients with cleft lip and palate require multiple surgeries and dental treatments for a long period. In this study, we used an impression material for conventional impressions and the intraoral scanner TRIOS®3 （3Shape, Denmark） for optical impressions of the patients’ oral cavity. We created gypsum and digital models from impressions generated using alginate impression and optical impression data, respectively. Next, we measured each model’s distance, evaluated the difference in the measured values, and investigated the accuracy of optical impressions compared with that of conventional impressions. Forty patients scheduled for primary cleft lip and palate surgery at Showa University Fujigaoka Hospital between October 2019 and February 2021 were included in the study. Next, measurements the following three sites: the distance between the left and right alveolar tips, the distance between the posterior arytenoid points, and the distance from the maximal alveolar swelling point to the maximal alveolar recession point were noted. We observed no difference in the first two distances. However, the distance from the maximum alveolar swelling point to the maximum alveolar recession point was significantly higher with the optical impression than with the conventional impression. In conclusion, the optical impression of areas without depth and vertical components, such as the regions between the left and right alveolar tips and between the posterior arytenoid points, taken using an intraoral scanner is similar to the conventional impression taken using an impression material, and it can be used to measure distances. Conversely, optical impression is unsuitable for measuring areas with depth and vertical components, such as the distance from the maximum alveolar swelling point to the maximum alveolar recession point.

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Owing to the rapid progress of head IVR, various types of intracranial stents have been used in recent years. Furthermore, the number of FD treatments is expected to increase in the future. During FD treatment, pressing the implanted stent against the vessel wall is important. Further, the selection of the stent size based on an accurate measurement of the vessel diameter is crucial for successful FD treatment. The vascular structure of the stent placement site can be accurately grasped using three-dimensional rotational angiography （3DRA） images and is measured using 3D reconstructed and 2D digital subtraction angiography （2DDSA） images. The diameter and length of the device are selected based on the vessel diameter of the indwelling site and assumed indwelling length. In this study, we compared the effect of changing the reconstruction function, such as filters, in 3DRA images with 2DDSA on the measurement of cerebral aneurysm and vessel diameters. During 2DDSA, measurement error was reduced by placing and shooting the measured object at the isocenter. Because of the tendency of 3DRA measurement to overestimate, measurement error was reduced using a reconstruction function that emphasized high-frequency components and by changing the threshold value to sharpen the images.

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A 16-year-old male adolescent with a history of atopic dermatitis and food allergy since infancy was referred to our department to receive continued medical care for food allergy. The patient denied experiencing any subjective symptoms or other issues; however, laboratory findings indicated hepatotoxicity with serum aspartate aminotransferase and alanine aminotransferase levels of 36 and 77 IU/L, respectively. Abdominal ultrasonography and plain abdominal computed tomography did not show any relevant abnormalities. A detailed interview revealed that for over a year before presentation the patient had been consuming a daily over-the-counter supplement, which claimed to “promote growth.” A prick test performed using the supplement showed negative results. However, a lymphocyte stimulation test performed using spirulina, a reportedly hepatotoxic ingredient in the supplement, showed a high stimulation index value （27.5） and maximum response value （3,409cpm）. The patient scored 7 points on a scoring system based on the diagnostic criteria for drug-induced liver injury. Consequently, the patient was diagnosed with spirulina-induced allergic liver injury. The patient was instructed to discontinue the supplement and avoid products with similar ingredients. Subsequently, the patient’s liver disorder rapidly resolved. To our knowledge, this is the first case report to describe allergic liver injury in Japan. The online descriptions and packaging materials of dietary supplements and health foods often provide incomplete information regarding possible health hazards associated with their use. Therefore, consumers should be aware of the risks when purchasing such products.

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