The treatment of hepatocellular carcinoma (HCC) is based on the tumors’ condition and the liver reserve capacity. This article describes transcatheter arterial embolization (TAE) and systemic therapy, which is mainly used aspalliative therapy. TAE is widely used for conditions that cannot be curatively treated. We mainly used Lipiodol,an anticancer drug (mainly cisplatin and epirubicin) and a gelatin sponge. The procedure was performed on 832patients over the course of 16 years, from 2001 to 2016. The median survival time (MST) was I: 49 months, II:35 months, III: 24 months, and IV: 11 months for each stage. Recently, a permanent embolic material was used totreat a large HCC that measured at least 5 cm, and the survival period was extended. The MST was 24.3 monthsafter using a permanent embolic material 9.3 months before the procedure (P = 0.013). However, the incidenceof HCC is decreasing due to the decrease in HCV infection, so the number of TAE procedures is also decreasing. Molecularly-targeted therapy for HCC have been available since 2009, and several types of drugs have beendiscovered since then. Recent progress is especially remarkable. Systemic therapy was originally used to treatcases in which the efficacy of TAE was diminished or ineffective. Today, new attempts are being made to improvethe effectiveness of combination treatments, such as TAE, radiofrequency ablation and resection. At present, thefirst-line treatment of HCC is atezolizumab + bevacizumab combination therapy. The second-line treatment issorafenib and lenvatinib. Other drugs, such as ramucirumab (AFP ≥ 400 ng/mL), cabozantinib, and regorafenib,can also be used. Systemic therapy has made remarkable progress recently and is expected to improve the survivalof HCC.

The treatment of pharyngeal and laryngeal cancers have special characteristics because the pharynx and larynxare closely related to QOL. The major roles of the pharynx and larynx are breathing, speaking, and swallowing.These three roles are important for performing daily living activities and are also important for humans. It isrequired to find a balance between cancer treatment and QOL. If a total laryngectomy is performed, you will beunable to speak after the operation. If a total or partial pharyngectomy is performed, dysphagia will occur; youwill be unable to eat well or speak clearly after the operation. After a total laryngectomy, you will be unable tosmell. If the tracheostomy is unable to be closed after a pharyngectomy, the cannula will remain, and QOL willdecrease. If chemoradiation therapy is performed, you will be unable to eat well, you will need PEG, and you willbe unable to smell or taste. The treatment of head and neck cancers are required to improve QOL and a cure isneeded. Therefore, reduction surgery should be considered without degrading the treatment results.

Ovarian cancer is a group of malignant tumors of various histological types. In this article, we discuss the mostfrequently occurring epithelial ovarian malignant tumor (ovarian cancer). Ovarian cancer tends to metastasize tothe peritoneum at an early stage, while symptoms do not appear until a progressed stage. Furthermore, an effectivecancer screening method has not been established. Therefore, most cases of ovarian cancer at the time of diagnosisare unresectable and advanced. Even in advanced cases with intra-abdominal metastases, an active mass reductionsurgery is recommended to improve the prognosis. Such aggressive surgical procedures often require a multidisciplinary approach, including gastroenterology and urology. Pharmacotherapy, mainly with cytotoxic agents, isthe mainstay of treatment for advanced ovarian cancer. In addition, angiogenesis inhibitors and molecular targetedagents that utilize double-stranded DNA repair deficiency (homologous recombination repair deficiency) havebeen developed for ovarian cancer and are expected to improve treatment outcomes. Despite remarkable progressin ovarian cancer treatment in recent years, many patients still suffer from unfortunate outcomes. As stated in theJapanese 3rd Basic Plan for the Promotion of Cancer Control, providing holistic support to these patients’ dailylives is also an essential element of ovarian cancer treatment.

Background: Chronic kidney disease (CKD) leads to myocardial tissue alterations that are associated with cardiac events and mortality. Cardiac magnetic resonance imaging (MRI) may be useful for noninvasively detectingmyocardial abnormalities associated with CKD and its relationship with patients’ prognoses.Objectives: The aim of this study was to evaluate the relationship between myocardial T1 and T2 values, cardiacfunction and 1-year outcomes in male patients with CKD.Methods: Thirty-eight patients with CKD were examined using a 1.5T imager. The relationship between thepatients’ native T1 or T2 values and their age, renal function, cardiac functional parameters measured by cardiacMRI, and 1-year outcomes was assessed. The 1-year outcomes was defined as cardiac events including hospitalization or death associated with coronary artery diseases or heart failure that occurred within 1 year after having acardiac MRI.Results: Native T1 and T2 values of the myocardium were significantly higher than those of our institutional reference standard (P < 0.05 for both). The patients’ T1 values were correlated with several cardiac functionalparameters (P < 0.05). There were significant differences in the left ventricular end-diastolic volume (LVEDV) aswell as the LVEDV index (LVEDVI) between patients with and without cardiac events within 1 year after havinga cardiac MRI (P = 0.048 for both). A receiver operating characteristic analysis revealed that a LVEDV of 124 mLand a LVEDVI of 75.05 mL/m2 were appropriate thresholds for identifying patients with CKD with poor 1-yearoutcomes.Conclusions: T1T2 mapping might be a useful tool to quantify myocardial tissue alterations specific for CKD andits cardiac function. LVEDV and LVEDVI are significantly related to 1-year outcomes in male patients with CKD.

当院で切除不能膵癌に対して Gemcitabine (GEM) +nab-paclitaxel (nab-PTX) 療法（GnP 療法）を一次治療で施行した 17 例の治療成績を検討した．治療企画時の病期分類は Stage IIA が 3 例，Stage III が 4 例，Stage IV が10 例であり，切除可能性分類は UR-LA が 7 例，UR-Mが 10 例であった．治療効果は PR 6 例，SD 8 例，PD 3例で，奏効率は 35.3％，病勢制御率は 82.4％であった．GnP 療法後に Conversion Surgery を施行した症例は 4 例あり，UR-LA が 3 例，UR-M が 1 例であった．いずれも非切除例より良好な全生存期間を得ている．集学的治療に奏効した患者で耐術可能な場合，Conversion Surgeryは試みられるべき治療法と考える．

2019 年から 2020 年 の 2 年間に受診した Grade2 とGrade3 の眩暈を伴わない 60 歳以上の突発性難聴の男性5 例に漢方薬の八味地黄丸を投与した．5 例中治癒または回復に至ったのは 3 例であった．2015 年から 2018 年の 4 年間で，同レベルの眩暈を伴わない突発性難聴で受診した 60 歳以上の男性は 4 例であったが，八味地黄丸は投与していない．4 例中治癒または回復に至ったのは1 例であった．八味地黄丸投与群の初診時と最終受診時の 5 分法平均聴力はそれぞれ 58.2 ± 9.7 dB と 36.2 ± 14.2 dB で，有意な改善が認められた．一方，非投与群の初診時と最終受診時の 5 分法の平均聴力はそれぞれ 49.2 ± 12.5 dB と50.2 ± 20.0 dB で，有意な改善は認められなかった．さらに，投与群と非投与群の聴力の改善度を初診時と最終受診時の 5 分法平均聴力閾値において比較したが，投与群の聴力閾値の変化は −22.0 (± 18.2) dB と非投与群は 2.6 (± 13.3) dB で (P = 0.050044)，両者の改善度には有意差は認められなかった．

本研究では酸素 3 L/min 以上の投与下で SpO2 ≦ 93％となった COVID-19 中等症 II に区分される 13 症例に覚醒下腹臥位療法を施行し，11 例で SpO2 値が上昇した．腹臥位療法単独で軽快した群と人工呼吸管理を要した群で年齢・性別・血液検査所見に明らかな差は認められなかったが，胸部 CT では前者は背側中心に病変を認め，後者は背側から腹側まで病変を認めた．胸部 CT で背側中心の病変であれば覚醒下腹臥位療法により人工呼吸管理を回避できる可能性がある．

Background: Giant parathyroid adenoma presenting with a brown tumor is considered to be rare. This conditionrequires special consideration.Case Presentation: A 21-year-old woman presented to the clinic with persistent pain in her right knee. A radiographic examination showed an osteolytic lesion in her right tibia. Blood laboratory tests revealed that serumcalcium and intact parathyroid hormone were increased significantly. Physical examination showed a 3-cm, firm,immovable lump in her neck. Ultrasonography of the patient’s neck revealed a 3.5-cm, well-circumscribed masswith a homogeneous internal texture. Computed tomography also showed a localized tumor with clear margins.The 99mTc-MIBI scintigraphy showed a hot spot in the right inferior gland. Based on these findings we judgedthat she had giant parathyroid adenoma presenting with a brown tumor. These pre-operative findings suggest thatthe possibility of carcinoma was low. We performed a parathyroidectomy via a small incision. The excised parathyroid gland weighed 10.3 g. The patient’s postoperative course was unremarkable.Conclusions: Giant parathyroid adenoma presenting with a brown tumor is rare. Accordingly, the differentiationbetween giant adenoma and parathyroid carcinoma is crucial. However, we determined that the possibility ofcarcinoma was low based on imaging studies, including ultrasonography and computed tomography. As a result,we performed successful parathyroidectomy with a small incision.