Using the event-triggered recorder, SpiderFlash-t AFIB, which allows us to detect asymptomatic or symptomatic arrhythmia, we examined the prevalence of hidden atrial fibrillation (AF) in patients with type 2 diabetes admitted to our hospital. In total, we enrolled 69 patients with type 2 diabetes mellitus admitted to the hospital due to hyperglycemia. Averages of HbA1c, age, duration of the disease, and BMI were 8.9％, 64.8 years old, 14.8 years, and 26.0kg/m², respectively. Neuropathy, retinopathy, and nephropathy were found in 37 (53.6％), 27 (39.1％), and 27 (39.1％), respectively. Macroangiopathy was found in 13 (18.9％). In the first series of surveys where we attached the recorder for 7 days no sustained AF events were found, and only 2 transient events. We attached the recorder for 14 days with 39 subjects in the second series of the survey, and fail to find any AF rhythm. This study is the first attempt to reveal the frequency of hidden AF in diabetes. This finding suggests that screening of atrial fibrillation with SpiderFlash-t AFIB for patients with type 2 diabetic patients hospitalized for glycemic control may not be useful in assessing the prevalence of atrial fibrillation.

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Hepatoblastoma usually requires multimodality treatment including chemotherapy and operation such as extended hepatectomy and liver transplantation. In our medical area, the public pediatric hospital is available to perform chemotherapy for a pediatric patient with hepatoblastoma, while major hepatectomy is able to be performed in our hospital. A 3-year-old girl was referred to the public pediatric hospital with a chief complaint of fever and abdominal distention, and received a diagnosis of hepatoblastoma (PRETEXT II) by abdominal CT scan and liver biopsy. Six courses of chemotherapy were performed at the pediatric hospital and the tumor size reduced to one twentieth. She was transferred to our hospital to undergo an extended right lobectomy. Her postoperative course was uneventful and she returned to the pediatric hospital for chemotherapy. There was no recurrence thereafter. We have experienced a total of 4 cases of hepatoblastoma including the above between 2016 and 2019. Although 1 out of 4 cases (25％) had a postoperative complication, all were alive without recurrence for 4 years. Thus, when both chemotherapy and surgery for hepatoblastoma could not readily be performed in the same facility, it seems necessary to cooperate between two facilities to perform multimodality treatment.

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