Two Cases of Acrodermatitis Continua of Hallopeau Associated with Generalized Arthritis

We report two cases of acrodermatitis continua of Hallopeau with generalized arthritis. Oral cyclosporin together with topical steroid were effective for the skin disorders, but not for the arthritis, whereas infliximab and salazosulfapyridine improved the general arthritis. Although arthritis is usually more refractory to conventional therapies, the arthritis in acrodermatitis continua of Hallopeau is likely to be improved by intravenous infliximab together with methotrexate as well as by oral salazosulfapyridine, similar to psoriatic arthritis

Development of High-Precision Three-Dimensional Images for Colonoscopy

Background: For three-dimensional image analysis, SYNAPSE VINCENT (Fujifilm, Japan) has been applied. Authors have continued various clinical practice and research with image study by computer analysis. Patient and Method: The patient is a 65-year-old female with further evaluation of colon. Method included abdominal computed tomography (CT) scan associated with injecting necessary amount of air from the anus. With maintaining this condition, CT scan was conducted two times of supine position and prone position. Results: The case had sigmoid cancer, which was presented irregular surface texture. Further, she had colon polyp in the sigmoid colon and diverticula in the descending colon. These images were presented in the display associated with i) the position and direction for observation, ii) CT image of the corresponding point, iii) endoscopic image for the corresponding region. Discussion: This image analysis system would be useful for clinical diagnosis, because the images have multiple angles and related situations of colon mucosa, folds, and stiffness and so on. The combined data can provide significant information including coronal, horizontal and sagittal planes. When the surgeon operates colon cancer, he can make the correct imagination of the lesion in advance. It seems to be beneficial for smooth treatment of surgical operation

Clinical Significance of Chest CT Scan for Previous Heavy Smoker

The patient is an 83-year-old male, who smoked 20-40 cigarettes daily during 20-75 years and quit after that. In March 2021, he revealed normal chest X-P and was explained to take chest computed tomography (CT) next year. In April 2022, chest X-P was unremarkable, but CT showed a small solid abnormal shadow in the upper left lung region nearby aortic arch and abdominal aortic aneurysm (AAA) in the upper abdomen. Almost lung cancer cases are found in current smokers or ex-smokers. Using CT, lung cancer screening shows a 20-26% decrease in cancer death. Consequently, Low-Dose CT (LDCT) for smokers would be recommended

Reconstruction Image of Small Bowel Obstruction (SBO) Due To Japanese Rice Cake (Mochi)

Background: Authors have continued clinical practice with reconstruction method of computed tomography (CT). Case presentation: We have experienced 78-year-old male of acute abdomen complaining strong abdominal pain. Result: Laboratory test showed WBC 14800 /μL, and CT showed two high-density lesions in right middle and left upper abdomen, which has 143/214 Hounsfield unit, respectively. They suggest small bowel obstruction (SBO) by traditional Japanese rice cake (mochi). He was treated conservatively with infusion and relieved. Discussion: Rice cake may cause various problems, such as ileus, gastric ulcer, perforation and suffocation. This report becomes hopefully a reference for future practice and research

Augmentation of Articulate Data using 3D Image Analysis

Background: Recently, the development of information and communication technology (ICT) has been remarkable utilizing artificial intelligence (AI) technology with deep learning. Three-dimension (3-D) image analysis technology has developed using computerized tomography (CT), magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). Among them, SYNAPSE VINCENT system (Fujifilm, Japan) is known for its predominance. Patient and Method: The patient is a 52-year-old female with type 2 diabetes mellitus (T2DM), who was suspected to have space occupying lesion (SOL) in the right kidney. Method included the investigation of enhanced abdominal CT with analysis of SYNAPSE VINCENT. Results: The detail analysis showed some findings as follows: i) coronal view of bilateral kidney shows well-enhanced left adrenal tumour, no apparent of right renal tumour, and atrophy of renal cortex, ii) the image rotated 30 degrees showed same findings, iii) the image rotated 180 degrees also showed atrophy of reverse side of right kidney. Discussion: In this case, the background of the atrophy of renal cortex has not been apparent, but it might be from diabetic nephropathy (DN). The application of VINCENT has expanded to various organs, such as liver, pancreas, biliary tract, and others, expecting augmentation of articulate data using 3D image analysis

Clinical Unitlity of Reconstruction Image of Computed Tomography Scan

Computed tomography (CT) has been utilized in the clinical practice across the world. It was introduced in 1972, and has been evolved for indispensable diagnostic examination for long. CT scan exams have been prevalent and increased to 80 million a year in United States

Early improvement of HbA1c, weight and low-density lipoprotein (LDL) for Type 2 diabetes (T2D) patient by Rybelsus (oral semaglutide)

Background: Latest topic for Type 2 diabetes (T2D) would be oral semaglutide (Rybelsus). Case presentation: Patient is 74-year-old female with T2D. She showed 65.5 kg (BMI 28.7 kg/m2) and HbA1c 7.4% in Feb 2022. Results: She started Rybelsus 3-7mg/day, and then she had clinical effects as 58kg and 6.0% in June 2022, respectively. Discussion: Rybelsus is characteristic for its clinical efficacy of improvement for glucose variability and body weight. Various data were from Semaglutide Treatment Effect in People with Obesity (STEP) and Peptide Innovation for Early diabetes treatment (PIONEER) studies. This report becomes hopefully useful reference for diabetic research

Changed Diabetic Treatment from Multiple Daily Injection (MDI), Dulaglutide to Xultophy

The patient is a 56-year old (yo) female with type 2 diabetes mellitus (T2DM). Medical histories include persisting T2DM from 35yo, renal stone at 43yo, hypertension from 45yo, photocoagulation for retinopathy on 54yo. An incidentaloma was found in the left adrenal gland, where endocrinological exams were negative for functional tumor. Her diabetic control situation became worse with HbA1c > 10%, then the treatment has been changed from multiple daily injection (MDI), Dulaglutide to Xultophy which is combined agents of degludec and liraglutide (IDegLira). It was provided 10-18 doses daily, and then glucose variability profile was improved satisfactory, suggesting the dual synergistic effects

Treatment Strategy According to Findings on Pressure-Flow Study for Women with Decreased Urinary Flow Rate

Purpose. In women who reported a weak urinary stream, the efficacy of treatment chosen according to the urodynamic findings on pressure-flow study was prospectively evaluated. Materials and Methods. Twelve female patients with maximum flow rates of 10 mL/sec or lower were analyzed in the present study. At baseline, all underwent pressure-flow study to determine the degree of bladder outlet obstruction (BOO) and status of detrusor contractility on Schäfer's diagram. Distigmine bromide, 10 mg/d, was given to the patients with detrusor underactivity (DUA) defined as weak/very weak contractility, whereas urethral dilatation was performed using a metal sound for those with BOO (linear passive urethral resistance relation 2–6). Treatment efficacy was evaluated using the International Prostate Symptom Score (IPSS), uroflowmetry, and measurement of postvoid residual urine volume. Some patients underwent pressure-flow study after treatment. Results. Urethral dilatation was performed for six patients with BOO, while distigmine bromide was given to the remaining six showing DUA without BOO. IPSS, QOL index, and the urinary flow rate were significantly improved in both groups after treatment. All four of the patients with BOO and one of the three with DUA but no BOO who underwent pressure-flow study after treatment showed decreased degrees of BOO and increased detrusor contractility, respectively. Conclusions. Both BOO and DUA cause a decreased urinary flow rate in women. In the short-term, urethral dilatation and distigmine bromide are efficacious for female patients with BOO and those with DUA, respectively

Clinically Both Effects of Weight and Glucose Variability by Oral Semaglutide (Rybelsus) for Younger Female Patient with Type 2 Diabetes (T2D)

Background: Obesity and Type 2 Diabetes (T2D) are crucial problems worldwide. Oral semaglutide (Rybelsus) was introduced to medical practice for Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA). Case presentation: The patient is 24-year-old female with obesity (BMI 39.3 kg/m2), T2D and fatty liver. Results: She started and increased Rybelsus from 3mg, 7mg to 14mg/day each 4 weeks. She showed significant efficacy for 4 months as HbA1c 6.3% to 5.6% and weight 107kg to 103kg, without Gastrointestinal Adverse Events (GIAEs). Discussion: Rybelsus is provided just after waking up, and kept >30 min fasting period. Longer fasting time may contribute current effect