We performed thoracic endovascular aortic repair（TEVAR）for 33 type B aortic dissection at our institution from April 2011 to August 2019. The average age was 71 years old, and there were 21 men and 12 women. The average interval of aortic dissection onset to TEVAR was 1,500 days（0-7,944 days） . We divided them into two groups of the E group within six months（17 cases）and the L group more than six months（16 cases）as for an interval of aortic dissection onset to TEVAR. There were two hospital death, three cerebral infarction and one paraparesis. There was no aorta-related death of the E group at remote period, and aorta-related death free rate of the L group was good with 94% at five years. Reintervention free rate at ﬁve years was 68% in the E group and 31% in the L group. The pre- and postoperative aortic maximum diameter（average）reduced from 49.7mm to 42.6mm in the E group, but enlarged it from 58.9mm to 61.7mm in the L group. The shrinkage and disappearance of false lumen was signiﬁcantly provided in the E group than in the L group. The strict follow-up and various kinds of additional procedures were necessary in the cases that false lumen was not thrombosed completely and dilated after the closure of primary entry with TEVAR for double barrel type of chronic aortic dissection.
Lynch syndrome is the most common hereditary colorectal cancer, accounting for 1-4% of all colorectal cancers. It has clinical features such as colon cancer accumulation in the family, early onset, and multiple cancers. The cause is a mutation in the DNA mismatch repair gene, whose cancer tissue shows high frequency microsatellite instability （MSI-H）. On the other hand, BRAF V600E mutation is rarely found in Lynch syndrome. For colon cancer suspected of having Lynch syndrome, it is possible to narrow down cases by excluding sporadic colorectal cancer by conﬁrming the negative BRAF gene mutation （V600E） . We experienced a case of primary hepatocellular carcinoma during follow-up of a young BRAF V600E mutation-negative MSI-H colorectal cancer.
A 62-year-old man with advanced lung cancer developed watery diarrhea and hematochezia 26 weeks after the ﬁrst administration of pembrolizumab. Colonoscopy showed colitis mimicking ulcerative colitis; however, unlike previous reports about immune checkpoint inhibitor-related colitis, our patient had discontinuous lesions. The pathologic ﬁndings showed crypt abscesses and advanced inﬂammatory cell inﬁltration. We diagnosed the patient with an immune-related adverse event induced by pembrolizumab. After steroid therapy, the clinical manifestations and endoscopic ﬁndings were markedly improved. There are few reports involving the endoscopic features of immune checkpoint inhibitor-related colitis, and we believe that this may be a valuable case for further discussion of the endoscopic features.
Urinary tract infection is clinically one of the most common infections. In particular, early diagnosis and initiation of treatment are needed because pyelonephritis sometimes may follow a serious course. Usually, urinary tract infections are diagnosed by clinical symptoms and urinalysis. We experienced multiple pyelonephritis cases with bacteremia which detected the same bacteria from urinary culture and blood culture although did not detected the white blood cell in the urine, clinical diagnosed pyelonephritis by CT images and symptoms. These cases had a blockage site such as stones in the urinary tract, so needed the consideration of the drainage treatment. We report the clinical features of pyelonephritis that are negative for pyuria.