Background: Long-term steroid users have an increased risk of surgical site infection (SSI), but few studies have focused on emergency surgery. We investigated the incidence of SSI in long-term steroid users after emergency abdominal surgery. Methods: A single-center retrospective study was conducted. Among patients who underwent emergency surgery in the gastroenterology department, we compared the incidence of SSIs in long-term steroid users over the past five years with that in non-steroid users over the past year. Results: Thirty-five steroid-users and 227 non-steroid users were included in the analysis. Six (17.1%) patients in the steroid group and 14 (6.2%) in non-steroid group developed SSI, with a significantly higher incidence in the steroid group (P = 0.035). Four of the six SSI patients in the steroid group showed gastrointestinal perforation. Conclusion: After emergency abdominal surgery, the incidence of SSI was significantly higher in the steroid group.

Objective: To study hypoglycemic attacks in patients admitted to a palliative care unit. Methods: We retrospectively reviewed medical records of hypoglycemic attacks near the end of hospitalization in patients admitted to our palliative care unit from July 1, 2018 to January 31, 2023. Results: Four hypoglycemic attacks were observed in 0.95% of 419 patients: the first patient with carcinoma of the pancreas, liver metastasis, and peritoneal dissemination, whose hypoglycemia was corrected with only one intravenous injection of 50% glucose and subsequently died without hypoglycemia; the second patient with carcinoma of the pancreas and duodenal stenosis, whose hypoglycemic attacks were repeated, but the patient was treated with 50–60 g/day of glucose infusion by PICC (peripherally inserted central venous catheter) without hypoglycemic attack. The third patient had uterine cancer, bone metastasis, and lung metastasis, and had only one hypoglycemic attack on the palliative care ward, after which she was treated with glucose-electrolyte infusion by a peripheral route without hypoglycemic attack. The fourth patient had peritoneal dissemination of a gastrointestinal stromal tumor (GIST), liver metastasis, and tumor-produced insulin-like growth factor (IGF)-II. The patient was admitted to the general ward due to pain and restlessness. On the seventh day of admission, he had a hypoglycemic attack and was treated with 50% glucose solution that was increased to 1680 mL/day, and he was transferred to the palliative care ward on the eighth day. The patient had problems maintaining blood glucose and fluid balance. Conclusion: Hypoglycemic attacks near the end of hospitalization in patients admitted to the palliative care ward were rare (< 1%), and most cases were not difficult to manage. However, it was difficult to achieve glycemic and fluid control in an IGF-II-producing patient, suggesting the importance of balancing glycemic and fluid management while taking the patient’s prognosis into consideration.

Since April 2008, the Act on Securing Medical Care for the Elderly requires insurers to provide specific health checkups and health guidance. The Tenri Yorozu Health Insurance Association also provides specific health checkups and guidance. The characteristics of persons eligible for guidance have been described in previous studies of the specified health checkups; however, there have been few studies comparing them to persons who are ineligible for guidance. In this study, we collected and compared background factors and blood test data to clarify characteristics of patients subject to health guidance (those subject to health guidance) and patients not subject to specific health guidance (those not subject to health guidance). We analyzed the combination pattern of factors associated with each criterion associated with health guidance eligibility, the average rate of specified health checkups, and the implementation rate of specified health guidance. Furthermore, we investigated the characteristics and current status of subjects eligible for health guidance. Comparison of background factors and blood test data showed significant differences in most of the items for judgment of specific health guidance for both men and women. The items other than those for which specific health guidance was given were age, height, total protein, hemoglobin concentration, and eGFR. In the group of subjects receiving health guidance, body weight, ChE, AST, ALT, γ-GTP, and uric acid levels were significantly higher. As these items are associated with metabolic syndrome, they should be closely monitored. The combination pattern of items corresponding to each criterion in the subjects eligible for health guidance showed no major characteristics, and the combination of items was dispersed. Although the average rate of specified health checkups in our association was high (92.0%), the average rate of implementation of specified health guidance was low (6.3%). Thus, the implementation rate of health guidance needs to be improved in the future, and we will monitor its progress as we begin implementing health guidance using e-learning from FY2022. From the viewpoint of preventive medicine, further educational activities are necessary to deepen the understanding of specific health checkups and metabolic syndrome among those who receive specific health checkups.

We herein describe a male patient in his late 70s who presented with stage IV mantle cell lymphoma (MCL) and left-side-predominant pleural effusion (PE). Lymph node (LN) biopsy revealed diffuse proliferation of medium-sized cells that were positive for CD5, CD20, CD79a, BCL2, cyclin D1, and SOX11 and negative for CD3 and CD10. The cells carried t(11;14)(q13;q32)/IGH::CCND1 and the IGHV gene was minimally mutated. Lymphoma involved the systemic LNs, spleen, head of the pancreas, stomach, duodenum, and bone marrow. After one cycle of bendamustine and rituximab and one cycle of cyclophosphamide, doxorubicin, vincristine, and rituximab, surface lymphadenopathy was reduced in size; however, PE unproportionally persisted. Microscopic examination of Ziehl-Neelsen-stained smears prepared from the pleural fluid disclosed very few acid-fast bacilli, and polymerase chain reaction for Mycobacterium tuberculosis was positive. The patient was treated with rifampicin, isoniazid, pyrazinamide, and ethambutol, readily leading to resolution of PE, confirming a tuberculous origin. At five years after the initial presentation, the patient was free from relapse of both MCL and PE. Because patients with lymphoma are at high-risk of developing tuberculosis, we should note that PEs identified in lymphoma patients are not necessarily malignant effusions.

Space-occupying lesions that develop around the bronchial stump after lung cancer surgery are sometimes difficult to distinguish from postoperative recurrence. Herein, we report a patient who developed a progressively growing tumorous lesion at the bronchial stump after lung cancer surgery. The lesion was reduced in size with the administration of tranilast and not regarded as postoperative recurrence. The patient was a 75-year-old woman. She underwent thoracoscopic right lung segmentectomy for right upper lobe lung adenocarcinoma (pT1aN0M0). Computed tomography (CT) performed at 38 months after surgery showed an invasive shadow around the resection stump. Bronchoscopic biopsy was performed, but no diagnosis was made. Tranilast was administered for a suspected foreign-body granuloma at the resection stump for three months until it was discontinued due to liver damage, and the shadow diminished. CT conducted at 70 months after surgery showed that the tumor-like shadow had enlarged again and tranilast was re-administered in combination with a hepatoprotective drug. The lesion was reduced again and remains shrunk. We suggest that tranilast may be effective for differential diagnosis when a lesion around the resection margin of lung cancer is suspected of being a granuloma.

A 40-year-old female developed erythematous patches with small pustules and scales on both cheeks with itching, starting the day after total laparoscopic hysterectomy with bilateral salpingectomy performed under general anesthesia for menorrhagia. Direct microscopic examination of scales from both cheeks revealed five or more Demodex mites per field of view. Treatment with doxycycline 100 mg/day, oral ivermectin 9 mg, and other measures targeting rosacea were administered, but there was no improvement. However, improvement was observed after 20 days of treatment with oral metronidazole.In this case, the skin lesions were consistent with pityriasis folliculorum, a manifestation of skin involvement caused by Demodex mites. While the pathogenicity of Demodex mites on the skin remains a matter of debate, pityriasis folliculorum is considered to be one phenotype reflecting the immunomodulatory effect of Demodex mites. Demodicosis should be considered a differential diagnosis from conditions such as rosacea and acne vulgaris. When a large number of Demodex mites are confirmed by direct microscopic examination, it is advisable to avoid topical corticosteroid treatment in addition to administering rosacea-targeted therapy.Further research standardizing collection and evaluation methods is necessary to further understanding of the pathogenesis, treatment, and epidemiology of Demodex mites as a part of the human skin microbiota.