A 79-year-old woman with a history of pyothorax was admitted with a 4-day history of abdominal distension. Physical examination revealed marked abdominal distention, absent bowel sounds, and a vesicular rash over the left Th8-10 dermatome. Abdominal radiography showed gaseous distension of the colon and ileum. Colonoscopy excluded any obstructive process of the colon. Laboratory findings yielded positive results for serum IgM and IgG against the varicella zoster virus (VZV) . Paralytic ileus associated with the VZV was therefore diagnosed. The ileus improved after conservative treatment with intravenous acyclovir. Although shingles is frequently encountered, it is a rare cause of paralytic ileus. In the future, the VZV should be considered as one of the causes of paralytic ileus, and complete resolution can be achieved with conservative management.

Of the 1635 patients with hepatocellular carcinoma receiving initial treatment at our hospital, 297 received local ablation therapy and 592 underwent hepatectomy. The prognosis and background factors of these patients were compared in this study. No significant difference was noted in the cumulative survival rate between the local ablation therapy and hepatectomy groups. However, with regard to background factors, the local ablation therapy group had significantly poorer hepatic functional reserve, smaller tumor size, and a lower proportion of patients with progressive stage disease. Accordingly, further investigation was conducted in a similar manner to correct for these differences in background factors. We limited the target hepatocellular carcinoma patients to those with liver damage grade A and a single tumor of ≤2 cm. Although no difference was found in the cumulative survival rate between the local ablation therapy and hepatectomy groups, the cumulative non-recurrence survival rate was significantly more favorable in the latter. However, serum albumin levels were significantly lower and tumor size was smaller in patients who received local ablation therapy than in those who underwent hepatectomy, despite the inclusion of only those patients who met the aforementioned conditions of liver damage grade and tumor size. Similarly, the results of specific local ablation therapies, including percutaneous ethanol injection therapy, percutaneous microwave coagulation therapy, and percutaneous radiofrequency ablation, were compared with those of hepatectomy in patients with liver damage grade A and a single tumor of ≤2 cm in size. However, the results indicated no difference in the cumulative survival rate. In conclusion, the cumulative survival rate did not differ between patients who received local ablation therapy and those who underwent hepatectomy, even on limiting the subjects to patients with liver damage grade A and a single tumor of ≤2 cm.

We present a case of a 73-year-old man with multifocal autoimmune pancreatitis (AIP) in the pancreatic head and tail, and who had undergone sigmoidectomy and rectectomy 28 months before presenting to our department. Upon presentation, his serum IgG4 level was elevated at 267mg/dl, but tumor marker levels were within normal ranges. CT and MRI showed two localized pancreatic masses with delayed enhancement, but endoscopic retrograde pancreatography revealed neither stenosis nor dilatation of the main pancreatic duct. FDG-PET examination showed intense uptake in regions concordant with both tumors. The possibility of atypical AIP was a concern, but malignant tumor could not be clinically or radiologically excluded. Endoscopic ultrasonographic fine-needle aspiration biopsy was performed, but no malignant cells were detected. The patient underwent subsequent distal pancreatectomy. Histological evaluation of the tumors showed the presence of many IgG4-positive plasma cells without any evidence of malignancy.

A 40's woman was hospitalized with cervical lymph node enlargement. Laboratory examinations showed elevated serum bile duct enzymes and the presence of anti-mitochondrial antibody. Abdominal ultrasonography and computed tomography showed enlargement of not only perihepatic lymph nodes, but also axillary and cervical lymph nodes. FDG-PET showed intense uptake concordant with these lymph nodes. We performed endoscopic ultrasonographic fine-needle aspiration biopsy of a perihepatic lymph node, but detected no malignant cells. We then performed liver biopsy, and obtained a histological diagnosed primary biliary cirrhosis. Systemic lymph nodes decreased together with serum bile duct enzyme levels during treatment with ursodeoxycholic acid.