Skin patch based makeup finish assessment technique by deep neural network.

BACKGROUND: Skin color and texture play a significant role in influencing impressions. To understand the influence of skin appearance and to develop better makeup products, objective evaluation methods for makeup finish have been explored. This study aims to apply machine learning technology, specifically deep neural network (DNN), to accurately analyze and evaluate delicate and complex cosmetic skin textures. METHODS: "Skin patch datasets" were extracted from facial images and used to train a DNN model. The advantages of using skin patches include retaining fine texture, eliminating false correlations from non-skin features, and enabling visualization of the inferred results for the entire face. The DNN was trained in two ways: a classification task to classify skin attributes and a regression task to predict the visual assessment of experts. The trained DNNs were applied for the evaluation of actual makeup conditions. RESULTS: In the classification task training, skin patch-based classifiers for age range, presence or absence of base makeup, formulation type (powder/liquid) of the applied base makeup, and immediate/while after makeup application were developed. The trained DNNs on regression task showed high prediction accuracy for the experts' visual assessment. Application of DNN to the evaluation of actual makeup conditions clearly showed appropriate evaluation results in line with the appearance of the makeup finish. CONCLUSION: The proposed method of using DNNs trained on skin patches effectively evaluates makeup finish. This approach has potential applications in visual science research and cosmetics development. Further studies can explore the analysis of different skin conditions and the development of personalized cosmetics.

A Case of Idiopathic Peptic Ulcer Disease Treated Effectively with Trimebutine Maleat.

A 30-year-old man with idiopathic peptic ulcer disease (IPUD) experienced repeated recurrence of ulcerative bleeding despite treatment with lansoprazole and then vonoprazan. Further evaluation suggested that the cause of the ulcer was strong contractile movements of the antrum. This prompted the co-administration of trimebutine maleate (TM) and vonoprazan to relieve the stomach contractions. TM was effective in preventing the recurrence of ulcerative bleeding, and the patient has remained in remission for 4 years. This case highlights the potential efficacy of TM in treating IPUD and the importance of considering hypercontractility as the underlying cause in cases of IPUD.

Soluble CD163 is a predictor of fibrosis and hepatocellular carcinoma development in nonalcoholic steatohepatitis.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease. The serum level of soluble CD163 (sCD163), a macrophage activation marker, is associated with liver tissue changes; however, its prognostic value is unknown. Here, we determined the utility of sCD163 as a marker for hepatocellular carcinoma (HCC) and prognostic marker for NAFLD. METHODS: This retrospective study obtained data regarding serum sCD163 levels, liver histology, and background factors associated with NAFLD in 287 patients (men/women, 140/147; average age, 53 ± 14 years) with NAFLD who underwent liver biopsy. Repeated liver biopsies of 287 patients with NAFLD (5.0 ± 2.7 years) were compared regarding serum sCD163 levels and liver tissue changes (stage, grade, steatosis, and NAFLD activity score). RESULTS: Serum sCD163 levels increased with the progression of liver fibrosis and inflammation (both P < 0.05) and were particularly helpful in distinguishing cases of Grade 4 fibrosis (P < 0.001). Levels of sCD163 significantly decreased in patients with NAFLD exhibiting alleviated fibrosis and inflammation (P < 0.05). We could also predict the development of HCC and associated mortality based on serum sCD163 levels at the time of NAFLD diagnosis. Serum sCD163 levels were higher in patients with HCC than in patients without HCC (1074 ± 379 ng/ml vs. 669 ± 261 ng/ml; P < 0.0001), and the same trend was observed for mortality. CONCLUSIONS: The serum sCD163 level reflects the progression of fibrosis and inflammation in liver tissues, showing much promise as a noninvasive biomarker for nonalcoholic steatohepatitis and NAFLD as well as a possible predictor of HCC development and patient prognosis.

Lean nonalcoholic fatty liver disease: Age-dependent differences in pathology, prognosis, and liver-related events.

AIM: This study aimed to evaluate the age-specific characteristics, prognosis, and complications of patients with lean nonalcoholic fatty liver disease (NAFLD). METHODS: Background factors (age, sex, diabetes, dyslipidemia, hypertension, and PNPLA3 gene polymorphism), blood test results, liver histology findings, muscle mass, and grip strength were investigated in 782 patients with NAFLD who underwent liver biopsy. Prognosis and complications were compared among 549 patients with nonlean or lean NAFLD who were followed up for 6.5 years. Additionally, background factors, blood test results, liver histology findings, prognosis, and complications were compared according to age (≥60 years vs. <60 years) in patients with lean NAFLD. RESULTS: Lean NAFLD patients showed lower aspartate aminotransferase, alanine aminotransferase, homeostasis model assessment-insulin resistance, high-sensitivity C-reactive protein, ferritin, and leptin but higher adiponectin and hemoglobin A1c (HbA1c) levels than patients with nonlean NAFLD. Furthermore, lean NAFLD patients showed less liver fibrosis, inflammation, steatosis, and ballooning. Among lean NAFLD patients, those aged 60 years and older were more frequently female, showed higher rates of hypertension, diabetes, and dyslipidemia, had higher HbA1c and type IV collagen 7S levels, lower platelet count, higher liver fibrosis and inflammation grades, and lower muscle mass and grip strength. Lean NAFLD was associated with a worse prognosis in patients aged 60 years and over than in those younger than 60 years of age and with a higher incidence of liver-related disease, cerebrocardiovascular events, and nonliver cancer. CONCLUSIONS: Age is an important consideration in patients with lean NAFLD. Compared with nonlean NAFLD, lean NAFLD was associated with a worse prognosis and higher risk of complications in patients aged 60 years and older.

[Evacuation of tissue and blood biomarkers of progression to NASH cirrhosis by six liver biopsies: a case report].

We present a 56-year-old female patient diagnosed with stage 2/grade 3 non-alcoholic steatohepatitis (NASH) via liver biopsy. Over the next 14 years, six liver biopsies were performed, and the patient was followed up clinically. This was a valuable case wherein we were able to investigate the histology of the liver and the timing of changes in the AST/ALT ratio, platelets, albumin, FIB4-Index, and liver fibrosis markers.

Development of the multispectral UV polarization reflectance imaging system (MUPRIS) for in situ monitoring of the UV protection efficacy of sunscreen on human skin.

BACKGROUND: Protection of the human skin from ultraviolet (UV) damage is one of the main issues in dermatology and cosmetology. The UV protection efficacy (UVPE) of the sunscreen film is decreased by sweat, sebum, and friction during the day. However, the technical relationship between the UVPE evaluated in a laboratory and the actual protection in daily use has not been clarified, because the UVPE measurement method in real-life setting has not been established. This study aimed to develop a novel UVPE evaluation system that allows in situ monitoring of the UVPE in real-life activities. METHODS: The multispectral UV polarization reflectance imaging system (MUPRIS) and a UVPE estimation algorithm were developed. The diffuse reflectance spectra were measured for a total of 48 sunscreen materials that were applied on 59 subjects. The UVPEs estimated from the diffuse reflectance spectra were compared with the in vivo SPFs. Finally, the UVPE before and after a marine leisure activity was evaluated using the MUPRIS as the practical use test. RESULTS: Compared with the conventional UV camera, the MUPRIS could visualize the applied sunscreen more clearly and showed good UVPE estimation accuracy (correlation coefficient for in vivo SPF, 0.82). In the practical use test, the degradation of the UVPE during a marine leisure activity was quantitatively monitored and was validated by the actual occurrence of sunburn. CONCLUSIONS: A novel in situ UVPE monitoring tool had been successfully developed. It can strongly support the development of innovative sunscreen products that can perfectly protect customers against UV irradiation in real-life situation.

Prevalence of pruritus in patients with chronic liver disease: A multicenter study.

AIM: Pruritus is a common comorbidity in chronic liver disease. The aim of this study was to clarify the prevalence of pruritus and its characteristics in patients with chronic liver disease. METHODS: A total of 1631 patients with chronic liver disease who attended one of nine joint-research facilities from January to June 2016 were enrolled. We investigated the prevalence of pruritus, itch location, itch duration, daily itch fluctuation, seasonal itch exacerbation, treatment drugs, and therapeutic effects using a medical interview questionnaire. RESULTS: The median age was 66 years and 890 (54.6%) patients were women. The prevalence of pruritus was 40.3% (658/1631), and it differed according to the underlying liver disease. The most frequent body location for pruritus was on the back (63.1%). Pruritus duration was more than 6 months in 252 (38.3%) patients. The severity of pruritus, assessed using a visual analog scale, was higher during the day than at night (median, 4 vs. 3, P < 0.001). Seasonal exacerbation was observed in 296 (45.0%) patients. Although 301 (45.7%) patients were treated with antipruritic agents, 57.8% (174/301) patients reported an insufficient effect. Active hepatitis B virus infection (odds ratio [OR], 2.51; P = 0.043), primary biliary cholangitis (OR, 3.69; P = 0.018), diabetes (OR, 1.57; P = 0.010), and aspartate aminotransferase ≥60 U/L (OR, 2.06; P = 0.011) were independent factors associated with pruritus. CONCLUSION: The prevalence of pruritus varies according to the chronic liver disease etiology. Underlying liver disease, aspartate aminotransferase ≥60 U/L, and comorbid diabetes are factors associated with pruritus in patients with chronic liver disease.

Wisteria floribunda agglutinin-positive Mac-2 binding protein predicts the development of hepatocellular carcinoma in patients with non-alcoholic fatty liver disease.

AIM: As it is not practical to perform regular screening for hepatocellular carcinoma (HCC) in all patients with non-alcoholic fatty liver disease (NAFLD), there is a need to identify NAFLD patients who are at high risk for HCC. Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA+ -M2BP) has been shown to be a surrogate marker for predicting HCC as well as a liver fibrosis marker in patients with chronic hepatitis B and C. The aim of this study was to investigate whether WFA+ -M2BP predicts HCC development in NAFLD patients. METHODS: Serum WFA+ -M2BP was retrospectively measured in 331 patients with histologically proven NAFLD, 51 of whom developed HCC. The association of WFA+ -M2BP and HCC development in NAFLD patients was investigated. RESULTS: The WFA+ -M2BP values were significantly greater in NAFLD patients with HCC than in those without HCC among patients with liver fibrosis ≥stage 3. Multivariate analysis identified WFA+ -M2BP as one of the predictive factors for HCC development (odds ratio, 1.57; 95% confidence interval, 1.083-2.265; P = 0.017). The optimal cut-off index of WFA+ -M2BP for predicting HCC was 1.255 with specificity of 78.4% and sensitivity of 70.4%. The area under the receiver operating characteristic curve value for the prediction of HCC development was 0.806. The cumulative incidence rate of HCC was significantly greater in patients with WFA+ -M2BP ≥ 1.255 (n = 61) than in those with WFA+ -M2BP < 1.255 (n = 137) among patients who were followed up for more than 2 years after the diagnosis of NAFLD. CONCLUSIONS: Wisteria floribunda agglutinin-positive Mac-2 binding protein predicts HCC development and is a useful surrogate marker for identifying NAFLD patients who are at a high risk for HCC.

Case report of diet-related improvements of non-alcoholic steatohepatitis evaluated by four consecutive liver biopsies.

We report the case of a 46-year-old man who achieved remarkable improvement of characteristic non-alcoholic steatohepatitis by dieting. Initially, his body mass index was 40.7 kg/m2 . He proactively commenced a low calorie diet and his body mass index decreased to 28 kg/m2 after 4 years. During the same period, we carried out liver biopsy four times. Liver fibrosis as well as inflammation, steatosis and ballooning improved, and the non-alcoholic fatty liver disease activity score decreased from 4 to 0. The fat deposits of liver tissue changed from macrovesicular droplets to microvesicular, and finally disappeared. Along with improved histology, alanine aminotransferase, homeostasis model assessment-insulin resistance, ferritin, leptin, high-sensitivity C-reactive protein and cytokeratin 18 decreased, and adiponectin increased linearly. However, no clear changes were observed in markers for Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA+ M2BP), type IV collagen 7S, procollage III peptide and fibrosis-4 index along with dieting. This is the first study to report gradual improvement of liver histology during four liver biopsies and fibrosis markers in a patient with non-alcoholic steatohepatitis who achieved complete recovery solely by dieting.

Correlation between serum cytokeratin-18 and the progression or regression of non-alcoholic fatty liver disease.

BACKGROUND: Diagnosis of non-alcoholic fatty liver disease (NAFLD) is limited by the need for liver biopsies. Serum cytokeratin 18 (CK-18) levels have been investigated as potential biomarkers for the presence of NAFLD and non-alcoholic steatohepatitis (NASH). Herein, we assessed the correlation between CK-18 levels and NAFLD progression. MATERIAL AND METHODS: Serum CK-18 levels were estimated using the M30 antibody enzyme-linked immunosorbent assay in 147 patients diagnosed with NAFLD. In 72 patients, disease progression was evaluated by repeated liver biopsy, which was conducted after 4.3 ± 2.6 years. The relationship between the CK-18 levels and liver histological findings was assessed. RESULTS: The CK-18 levels were useful for identifying NAFLD patients with NAFLD activity scores (NAS) ≥ 5 (NAS ≥ 5 vs. ≤ 4: 675.1 U/L vs. 348.7 U/L; p < 0.0001). A cut-off value of 375 U/L was calculated using the receiver operating characteristic curve approach, with a specificity and sensitivity of 81.5 and 65%, respectively, for the diagnosis of NASH. Among the 72 patients who underwent repeated liver biopsy, 11 patients with a progressed NAS also had significantly increased serum CK-18 levels (p < 0.01); in 30 patients with an improved NAS, there was a significant improvement in the mean CK-18 levels (p < 0.0001). The 31 patients with static NAS had static CK-18 levels. CONCLUSIONS: In conclusion, serum CK-18 levels can predict NAS ≥ 5 in NAFLD patients. In NAFLD patients, serum CK-18 levels reflect NAS values and correlate with histological changes, and they appear to be useful indicators of progression and improvement.

Different Food Preferences in Patients with Gastrointestinal Disorders.

Objective Gastrointestinal (GI) disorders such as functional dyspepsia (FD), irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and inflammatory bowel disease (IBD) can exhibit overlapping GI symptoms, including abdominal pain and alterations in bowel habits. The symptoms of GI disorders are commonly considered to be triggered and exacerbated by fatty food intake. Therefore, this study aimed to compare the food preferences of patients with GI disorders. Methods Forty food images (including fatty and light foods) and 20 animal images were selected to evaluate food preferences. The preference score was assessed using a visual analog scale ranging from 1 to 100. GI symptoms were evaluated using the GI Symptom Rating Scale (GSRS), and correlations between the GSRS and preference scores were investigated. Results Overall, 22 healthy controls and 23, 29, 27, and 20 patients with FD, IBS, GERD, and IBD, respectively, were enrolled. The preference score for all foods in patients with FD was significantly lower than that in healthy controls and those with IBS, GERD, and IBD (52.9 vs. 66.5 vs. 68.5 vs. 69.1 vs. 70.7, p<0.01). The score of fatty foods was lower in patients with FD than in healthy controls and those with IBS, GERD, and IBD (43.8 vs. 72.3 vs. 77.5 vs. 77.4 vs. 80.7, p<0.01), whereas that of light foods and animal images was not different among the groups. No significant correlation was found between the preference score and symptom severity. Conclusions Patients with FD had a negative preference for foods, particularly fatty foods, independent of the severity of GI symptoms.

Optimization of excitation-emission band-pass filter for visualization of viable bacteria distribution on the surface of pork meat.

A novel method of optically reducing the dimensionality of an excitation-emission matrix (EEM) by optimizing the excitation and emission band-pass filters was proposed and applied to the visualization of viable bacteria on pork. Filters were designed theoretically using an EEM data set for evaluating colony-forming units on pork samples assuming signal-to-noise ratios of 100, 316, or 1000. These filters were evaluated using newly measured EEM images. The filters designed for S/N = 100 performed the best and allowed the visualization of viable bacteria distributions. The proposed method is expected to be a breakthrough in the application of EEM imaging.

Detection and visualization of intracutaneous allergic type-specific elements using long-wavelength near-infrared hyperspectral imaging.

BACKGROUND/PURPOSE: This study aimed to develop a method for the assessment of allergic dermatitis by using the long-wavelength near-infrared spectrum (more than 1000 nm) to detect intracutaneous allergic type-specific elements. Such a method was realized by establishing a spectral classifier for the spectra of type I and type IV allergic dermatitis reactions. METHODS: Near-infrared spectral images of histamine-induced cutaneous reaction (type I) and contact hypersensitivity erythema elicited by squaric acid dibutylester (SADBE; type IV) were obtained, and the absorption spectra of normal and inflamed skin were extracted from these spectral images. A spectral classifier was established from these training datasets, and it was then applied to two test cases, red flare by methyl nicotinate (normal) and metal allergy (type IV). RESULTS: The spectral classifier established by canonical discriminant analysis (CDA) achieved very accurate detection (normal: 87.67%, type I: 87.00%, type IV: 98.5%). Furthermore, the test cases were also correctly classified: the red flare induced by methyl nicotinate was categorized as normal skin and the metal allergy was categorized as a type IV allergic reaction. CONCLUSIONS: These results suggest a possible application of near-infrared spectral imaging to the assessment of allergic dermatitis.

Efficacy of endoscopic ultrasound-guided abscess drainage for non-pancreatic abscesses: A retrospective study.

Background and Aim: Percutaneous drainage of intra-abdominal abscesses is often uncomfortable for the patient and may result in prolonged hospital stays. Recent studies have shown that endoscopic ultrasound-guided abscess drainage (EUS-AD) could effectively treat various abscesses and fluid collections. However, no indications or procedures have been established for EUS-AD treatments, and studies on its usefulness and safety are insufficient. The present study aimed to evaluate the efficacy and safety of EUS-AD for treating non-pancreatic abscesses. Methods: This retrospective study included 20 patients, aged ≥20 years, who underwent EUS-AD for an abscess or fluid accumulation in the abdomen or mediastinum, but not the pancreas. Patients were treated at the Kawasaki University General Medical Center between March 2013 and June 2021. All EUS-AD procedures were performed prior to a percutaneous drainage or surgical drainage. Results: Among the 20 patients who underwent an EUS-AD for abscess, 8 (40%) had liver abscesses, 6 (30%) had intraperitoneal abscesses, 3 had (15%) splenic abscesses, 1 (5%) had a mediastinal abscess, 1 (5%) had an iliopsoas abscess (n = 1, 5%), and 1 (5%) had an abdominal wall abscess. The technical success rate was 95% (n = 19/20). We inserted nasobiliary catheters in 4/20 patients (20%). The clinical success rate was 90% (n = 18/20). Two clinical failures required reintervention, and both were treated with percutaneous drainage. Adverse events were observed in 2/20 patients (10%). One patient experienced fever after the procedure, and the other experienced localized peritonitis. Conclusion: EUS-AD was effective and safe for abscess removal, particularly when approached from the upper gastrointestinal tract.

Brain activity in response to food images in patients with irritable bowel syndrome and functional dyspepsia.

BACKGROUND: Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are caused and exacerbated by consumption of fatty foods. However, no study has evaluated brain activity in response to food images in patients with disorders of gut-brain interaction (DGBI). This study aimed to compare food preference and brain activity when viewing food images between patients with DGBI and healthy controls. METHODS: FD and IBS were diagnosed using the ROME IV criteria. Food preference was assessed using a visual analog scale (VAS). Brain activity in the prefrontal cortex (PFC) in response to food images was investigated using functional near-infrared spectroscopy (fNIRS). RESULTS: Forty-one patients were enrolled, including 25 with DGBI. The mean VAS scores for all foods (controls vs. FD vs. IBS: 69.1 ± 3.3 vs. 54.8 ± 3.8 vs. 62.8 ± 3.7, p = 0.02), including fatty foods (78.1 ± 5.4 vs. 43.4 ± 6.3 vs. 64.7 ± 6.1, p < 0.01), were the lowest in patients with FD among all groups. Patients with FD had significantly higher brain activity in the left PFC than those with IBS and healthy controls (mean z-scores in controls vs. FD vs. IBS: - 0.077 ± 0.03 vs. 0.125 ± 0.04 vs. - 0.002 ± 0.03, p < 0.001). CONCLUSIONS: Patients with DGBI, particularly those with FD, disliked fatty foods. The brain activity in patients with DGBI differed from that in healthy controls. Increased activity in the PFC of patients with FD was confirmed.

Selection of optimal combinations of band-pass filters for ice detection by hyperspectral imaging.

Hyperspectral imaging captures rich information in spatial and spectral domains but involves high costs and complex data processing. The use of a set of optical band-pass filters (BPFs) in the acquisition of spectral images is proposed for reducing dimensionality of spectral data while maintaining target detection and/or categorization performance. A set of BPFs that could distinguish ice from surrounding water on various materials (e.g., asphalt), was designed as an example. Relatively high accuracy (90.28%) was achieved with only two BPFs, showing the potential of this approach for accurate target detection with lesser complexity than conventional methods.

Impact of local luminance contrast on facial skin lightness perception: A psychophysical reverse correlation study using sub-band contrast modulation noise.

In conventional psychophysical reverse correlation methods using white or pink noise, the luminance noise is added to every pixel. Thus, the image features correlated with perception are often biased toward local mean luminance. Furthermore, spatial frequencies and orientations are represented in the primary visual cortex, which forms the basis of various visual perception. In this study, we proposed a new reverse correlation method using noise that modulated the spatial frequency sub-band contrast and examined its properties in psychophysical experiments on facial skin lightness perception. In the experiment, we asked the observers to compare the perceived skin lightness in a paired comparison manner on face stimuli with increased or decreased spatial frequency sub-band contrasts at random spatial locations. The results showed that the contrasts in the eyes or irises were strongly and positively correlated with the perceived skin lightness in most sub-bands, demonstrating that the proposed method reiterated the findings of previous studies that the sparkle of the irises makes the skin appear lighter. Contrarily, the conventional reverse correlation method using pink noise images was applied to the skin lightness perception. The results indicated that only the local mean luminance in some skin regions, such as the forehead, was correlated with skin lightness perception. In summary, with the proposed method, we found some image features in the facial parts other than the skin mean luminance relevant to skin lightness perception, which are difficult to detect using the conventional method. They are considered complementary given that the proposed method and the conventional method extracted considerably different image features. It depends on the psychophysical tasks and stimuli which one is more appropriate.

Portal Hypertensive Gastropathy in Liver Cirrhosis: Prevalence, Natural History, and Risk Factors.

Objective Portal hypertensive gastropathy (PHG) is a common finding in patients with liver cirrhosis (LC) and may cause both acute and chronic bleeding. A number of risk factors for PHG have been identified. The present study explored the characteristics of Japanese patients with LC who develop PHG. Methods Clinical findings (age, sex, etiology, the presence of esophageal varices, splenomegaly and severity of LC), laboratory data, and whether or not atrophic gastritis was found on endoscopy were retrospectively reviewed in patients with LC who had undergone esophagogastroduodenoscopy. PHG was endoscopically graded as absent, mild, or severe. Results Of 262 patients with LC (mean age, 69 years old; 145 men), 158 had no PHG, 41 had mild PHG, and 63 had severe PHG. In a univariate analysis, a younger age, male sex, non-viral etiology, absence of atrophic gastritis, presence of esophageal varices, splenomegaly, severe LC, low platelet count, and low hemoglobin concentration were associated with PHG. A multivariate analysis showed a significant association of PHG with the absence of atrophic gastritis (p<0.048), presence of esophageal varices (p<0.001), non-viral etiology (p<0.033), splenomegaly (p<0.048), and severe LC (p<0.005). There were no cases of massive bleeding from PHG during follow-up. Conclusion Esophageal varices, splenomegaly, severe liver cirrhosis, the absence of atrophic gastritis, and etiology were found to be risk factors for PHG in Japanese patients.

Edematous wall thickening of the gallbladder induced by hyperthyroidism: A case report.

RATIONALE: Hyperthyroidism, such as Basedow disease, causes fluid retention, although the common cause is volume overload due to congestive heart failure. In addition, hyperthyroidism and Basedow disease are known to cause pulmonary hypertension. Edematous thickening of the gallbladder wall is caused by venous blood congestion. The feature of edematous wall thickening of the gallbladder on abdominal computed tomography (CT) is subserosal edema and is often accompanied by a periportal collar sign. PATIENT CONCERNS: A 30-year-old woman was referred to our hospital because of liver dysfunction, edematous gallbladder wall thickening, and fluid retention. In addition, the patient developed hyperthyroidism and heart failure. Enhanced abdominal CT revealed edematous wall thickening of the gallbladder and a periportal collar sign. DIAGNOSIS: We suspected that fluid retention and congestion were caused by hyperthyroidism and Basedow disease. INTERVENTIONS: On admission, we started thiamazole therapy for Basedow disease, and her thyroid hormone levels normalized. OUTCOMES: Abdominal CT revealed disappearance of edematous wall thickening of the gallbladder, which was likely associated with an improvement in thyroid function. The patient was discharged 10 days after admission. LESSONS: We encountered a case of hyperthyroidism and Basedow disease accompanied by edematous wall thickening of the gallbladder and various fluid retentions as the first symptoms. Such edematous wall thickening of the gallbladder and various fluid retentions were reduced, together with the improvement of hyperthyroidism.

Treatment of ectopic variceal bleeding at choledochojejunostomy by endoscopic glue injection therapy with cyanoacrylate: Report of three cases including long-term outcomes.

Ectopic varices around the choledochojejunostomy site after pancreatoduodenectomy are rare. Diagnosing ectopic varices is difficult but, if untreated or misdiagnosed, the resulting mortality is high. This report describes three cases of ectopic variceal bleeding at the choledochojejunostomy site that were improved by endoscopic glue injection therapy (EGIT) with cyanoacrylate (CA). Case 1 was a 68-year-old man admitted to the hospital with hematemesis and melena. Six years prior, the patient underwent a total pancreatectomy for intraductal papillary mucinous adenocarcinoma. We diagnosed ectopic variceal rupture at the choledochojejunostomy site and controlled bleeding by EGIT with alpha-CA (αCA). Two recurrences of bleeding were improved by EGIT. Case 2 was a 71-year-old man admitted to the hospital with melena. Two and a half years prior, the patient underwent pancreatoduodenectomy for pancreatic head adenocarcinoma. We found the red plug on the ectopic varices at the choledochojejunostomy site through endoscopic observation and performed EGIT with αCA. He had no recurrence. Case 3 was a 77-year-old woman admitted to the hospital with melena. Eleven years prior, the patient underwent pancreatoduodenectomy for chronic pancreatitis at the pancreatic head. We controlled ectopic variceal bleeding at the choledochojejunostomy site by EGIT with αCA. Seven years after EGIT, ectopic varices could not be identified with an endoscope and there was no recurrence of ectopic bleeding.