We retrospectively evaluated the effect of follow-up for chronic liver disease in 91 patients with primary hepatocellular carcinoma. Of these patients, 38 (41.8%) were followed-up for chronic liver disease, while 53 patients (58.2%) were not followed-up. Regarding the baseline status of the liver, the proportion of patients with non-viral hepatitis was significantly higher among patients who were not followed-up (p<0.001). Furthermore, the cumulative survival rate was significantly lower among patients who were not followed-up (p=0.013). Among the 53 patients who were not followed-up, 20 (37.7%) patients did not undergo abdominal imaging for hepatic evaluation despite recorded hepatic issues, and 31 patients (58.5%) were treated by a primary care doctor. Our study suggests that the identification of patients with non-viral hepatitis and confirmation that they are followed-up are vital for improving the prognosis of patients with chronic liver disease.

Background:Marginal ulcer after pancreatoduodenectomy (PD) is a relatively common complication, but if massive bleeding or ulcer perforation occurs together with the marginal ulcer, this condition may be fatal. Objective:To identify the risk factors and management of marginal ulcer after PD. Methods:In all, 438 patients who underwent PD from 2003 to 2017 were retrospectively reviewed and analyzed. After surgery, all patients were administered a histamine H2 receptor antagonist (H2RA) or a proton pump inhibitor (PPI), which was continued after discharge. Marginal ulcer was diagnosed by endoscopy or surgery. The risk factors for marginal ulcer were then investigated using univariate and multivariate analyses. Results:After a median follow-up time of 2.7 years, 29 patients (6.6%) developed marginal ulcer. Seventeen patients developed marginal ulcer within 1 year after PD, and 7 patients developed marginal ulcer more than 3 years after PD. All 8 patients who underwent surgery for the treatment of marginal ulcer developed acute peritonitis. Two patients with acute peritonitis died within 1 month after surgery. A multivariate analysis found that discontinuation of PPI treatment was the only independent risk factor for marginal ulcer development (P<0.001). In contrast, sex, age, primary disease, procedure, operation time, volume of blood loss, pancreatic texture, development of postoperative pancreatic fistula, postoperative complications, poor glycemic control after PD, and discontinuation of H2RA therapy after PD were not significantly different between the patient group that developed marginal ulcer and the patient group that did not. Sixteen patients were not treated with antacids at the time of marginal ulcer development. The reason for discontinuation of antacids was the decision of the family physician in 8 cases and the decision of the patient in 3 cases. Conclusion:Marginal ulcer can still develop a long time after PD, and sometimes, it may be fatal. PPI administration should be continued even after a long time has passed, although this therapy is often discontinued for various reasons. It is therefore important for family physicians and patients to recognize the danger of marginal ulcer after PD.

A 22-year-old woman who was diagnosed with Crohn's disease experienced diarrhea and bloody stool. She was suspected of have aggravated Crohn's disease and was transferred to our hospital. Upper gastrointestinal endoscopy revealed multiple esophageal ulcers and erosive gastritis, while colonoscopy revealed multiple ulcers in the rectum to the sigmoid colon. Initially, the evidence suggested that the Crohn's disease had worsened, and consequently, prednisolone (PSL) therapy was initiated. However, the patient's condition was determined to be atypical inflammatory bowel disease, which was indicated by endoscopic findings and skin symptoms and because various test results did not meet the diagnostic criteria for Crohn's disease. As a result, her diagnosis was changed to granulomatosis with polyangiitis. Here, we report a case of granulomatosis with polyangiitis with gastrointestinal symptoms similar to Crohn's disease, both of which have been suggested to involve Th1/Th17 cells.

A woman in her 70s with systemic sclerosis experienced dyspnea, and consequently, she was diagnosed with an esophago-pleural fistula, which was caused by a perforated esophageal ulcer. We administered conservative treatments including continuous pleural drainage and total parenteral nutrition. The fistula was closed but recurred, at which point we attempted to close the fistula by filling and shielding using polyglycolic acid (PGA) sheets and fibrin glue (FG). We were able to safely and smoothly fill and shield the fistula using the PGA sheets with a guidewire. We show that endoscopic closure of an esophago-pleural fistula using this technique is an effective, low-invasive treatment for gastrointestinal perforation and refractory fistulas.

A 76-year-old woman was admitted to our hospital due to diabetes and was diagnosed with advanced pancreatic cancer for which she received gemcitabine plus nab-paclitaxel. Fourteen days later, eruptions were observed in the first division of the right trigeminal nerve;she was then diagnosed with herpes zoster and was successfully treated with antiviral therapy. Seven days after the herpes zoster infection, right ophthalmoplegia appeared. Oculomotor nerve palsy secondary to herpes zoster ophthalmicus was suspected and she was treated with steroid pulse therapy. Her symptoms improved, and chemotherapy was able to be continued. Her ophthalmoplegia had almost fully resolved 41 days after the onset of herpes zoster infection.

Traditionally, abstinence has been regarded as the only appropriate goal in the treatment of alcohol dependence in Japan. Recently, harm reduction by reducing alcohol consumption, which has been used as a treatment approach in Europe, has gained recognition in Japan. The 2018 guideline for the treatment of alcohol dependence in Japan recommends abstinence as the primary goal, but reduction of alcohol consumption is described as an appropriate treatment goal in some patients. Nalmefene is an opioid modulator that is used to reduce alcohol consumption in patients with alcohol dependence. Here, we report the clinical course of alcoholic liver cirrhosis in alcohol-dependent patients who were treated with nalmefene for three months. Their alcohol consumption was reduced, which led to an improvement in liver function. Nalmefene provides a clinical benefit, constitutes a potential pharmacological treatment paradigm in terms of the treatment goal and dosing regimen, and addresses an unmet medical need in patients with alcohol dependence who need to reduce their alcohol consumption.