Internal medicine
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Objective Digital evacuation (DE) is an intervention used to address severe constipation. Literature exists on easily administered laxatives; however, reports on mildly invasive DE usage are limited. This study aimed to elucidate the fundamental data regarding constipation management using a comprehensive national database of DE incidence. ⋯ A seasonal analysis revealed a significant increase in DE procedures during winter compared with summer (P<0.0125). A correlation was observed between the DE incidence and certain meteorological variables, particularly the temperature. Conclusion This study highlights the notable demographic patterns and the impact of seasonal and meteorological factors on the DE incidence.
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A woman in her 60s presented with a small pancreatic head tumor. Imaging studies revealed a 13-mm well-defined pancreatic head tumor. A neuroendocrine neoplasm was suspected, and the patient opted for observation at that time. ⋯ Hypoglycemia was induced during fasting test. The tumor exhibited clear features of an insulinoma during follow-up observation. While small neuroendocrine neoplasms are often managed through observation, caution should be exercised regarding their transformation into functional neuroendocrine tumors.
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A 70-year-old man who had undergone treatment for gastroesophageal reflux disease (GERD) by a family doctor presented to our hospital with severe heartburn and dysphagia despite taking vonoprazan (20 mg) for 3 months. A diagnosis of vonoprazan-refractory nonerosive reflux disease was made based on esophagogastroduodenoscopy and esophageal function examinations. ⋯ After endoscopic treatment, his GERD symptoms disappeared and he no longer required GERD-related medications. An examination of his esophageal function revealed the improvement of items related to GERD.
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Case Reports
A Case of Hereditary Coproporphyria in which the Patient's Course Improved after the Discontinuation of Givosiran.
Hereditary coproporphyria (HCP) is caused by a partial deficiency of coproporphyrinogen oxidase during heme biosynthesis. Givosiran is approved for the treatment of acute hepatic porphyria. ⋯ However, givosiran was discontinued after six months due to a decreased renal function. The patient's ALA and PBG levels remained within the normal ranges, and her HCP-related symptoms resolved more than 2 years after the discontinuation of givosiran.