This study suggested that the addition of IVCF to anticoagulants does not provide a substantial risk reduction for perioperative patients with VTE prior to surgery.

Inferior vena cava filter (IVCF) is a recent treatment of choice for prophylaxis against pulmonary embolism (PE). Although a temporary and a permanent type of IVCF are available, it remains lack of evidence for prophylactic effect on PE for perioperative patients with venous thromboembolism (VTE). This study reviewed 51 patients with active VTE at perioperative period, who underwent placement of an IVCF in our department from January in 1999 to March in 2008. There were 14 men and 37 women with an average age of 56.2 years old.Underlying diseases for surgery included gynecologic (n = 18) and orthopedics (n = 13), diseases treated by general surgery (n = 12), neurosurgery (n = 6), urologic diseases (n = 1) and plastic surgery (n = 1). Thirty five patients underwent a temporary IVCF insertion (Group T, Antheor TM n = 28, Neuhaus Protect TM n = 7) and 16 patients underwent permanent filtration of IVC (Group P). Both groups had neither fatal nor anticoagulant-related complications. However, PE occurred in one patient of the each group at a perioperative period. The patient in Group T developed PE after withdrawal of a temporary IVCF, whereas placement of a permanent IVCF caused symptomatic PE in the other patient in Group P. On the other hand, filter-related complications occurred in Group T included filter migration (more than 3 cm, n = 11), filter connection trouble (n = 1) and infection of catheter (n = 1) during the hospitalized period. Two patients out of 11 had a migrated temporary filter in the atrium.Moreover, nine patients in Group T had attached thrombi at a filter and needed additional thrombolytic therapy to remove a filter. Unfortunately, one patient underwent venotomy and ligation of the IVC to withdraw a filter attached with thrombi. Long-term follow-up showed that Group P experienced one IVC occlusion. The present study indicated that a temporary IVC filter, for prophylactic use against PE for the patients with VTE at a perioperative period, supports the needs for innovative design.

Objective: We aimed to investigate the relationship between the use of intermittently scanned continuous glucose monitoring (isCGM) and quality of life (QoL) in overweight individuals with impaired glucose tolerance (IGT) or mild type 2 diabetes mellitus (T2DM). Methods: Forty overweight individuals (BMI ≥25kg/m2) having IGT or mild T2DM (without taking antidiabetic drugs and with HbA1c ≤7.0%) were recruited. We randomly divided the subjects into two groups: those using isCGM in addition to diet and exercise therapy (isCGM group) and those treated with diet and exercise therapy alone (control group). We conducted a 6-month intervention and assessed QoL using SF36 before and after the intervention. Results: One participant in the isCGM group withdrew the consent. We thus analyzed 19 participants in the isCGM group (53.8±11.5 years old, BMI 35.2±5.7 kg/m2, HbA1c 6.2±0.3%) and 20 participants in the control group (54.3±14.0 years old, BMI 31.6±6.8 kg/m2, HbA1c 6.2±0.3%). There were no differences in changes in each subscale of the SF36 and component summary scores between the isCGM and control groups. In the isCGM group, Mental Component Summary (MCS) improved significantly after the intervention (43.6/48.2, p<0.05). Changes in SD and Time Above Range (TAR) were negatively correlated with changes in general health perception (GH) (r= -0.50, p<0.05; r= -0.53, p<0.05). The number of scans positively correlated with vitality, mental health, and MCS before and after the intervention. Conclusions: The use of isCGM improved MCS in overweight individuals with IGT or drug-naïve T2DM. The improvement in SD and TAR with the use of isCGM likely contributed to the improvement in GH. In addition, the number of scans correlated with MCS, suggesting that vitality and mental health are essential for the effective use of isCGM. Disclosure S. Nishikage: None. Y. Nakagawa: None. Y. Hirota: Other Relationship; Lilly, Sanofi K.K., Terumo Corporation, Sumitomo Dainippon Pharma Co., Ltd. Research Support; Sumitomo Dainippon Pharma Co., Ltd. K. Yoshimura: None. M. Ueda: None. A. Yamamoto: None. T. Takayoshi: None. A. Matsuoka: None. M. Takahashi: None. K. Yokota: None. T. Nakamura: None. K. Sakaguchi: Research Support; Sumitomo Dainippon Pharma Co., Ltd. W. Ogawa: Advisory Panel; Abbott Japan Co., Ltd. Research Support; Boehringer Ingelheim Japan, Inc., Eli Lilly Japan K.K., Novo Nordisk, Teijin Pharma Limited, Kowa Company, Ltd., Sumitomo Dainippon Pharma Co., Ltd., Abbott Japan Co., Ltd. Speaker's Bureau; Sumitomo Dainippon Pharma Co., Ltd.

Cases in which bilateral adrenal 123I-Metaiodobenzylguanidine (123I-MIBG) scintigraphy accumulation is sometimes shown, with mildly elevated catecholamine (CA) or metanephrine (MN) levels (within 3 times the upper reference limit) are diagnostic dilemmas. We experienced 3 cases of adrenal incidentalomas with this dilemma in the differential diagnosis. The clinical diagnosis was subclinical Cushing's syndrome in 2 cases, and primary aldosteronism in 1. Despite suspected CA excess in clinical symptoms and imaging findings, the pathological findings of all these tumors were revealed to be cytochrome P450 family 11 subfamily B member 1 (CYP11B1) positive adrenocortical adenomas. Interestingly, adrenal medullary hyperplasia (AMH) was detected in the adrenal parenchyma of all those backgrounds. To clarify the clinical features of such cases, a cross-sectional study was conducted at the Kobe University Hospital from 2014 to 2020. One-hundred sixty-four patients who had undergone 123I-MIBG scintigraphy were recruited. Among them, 10 patients (6.1%) met the above criteria, including the presented 3 cases. Plasma adrenaline, noradrenaline, urinary metanephrine, and normetanephrine had values of 0.05 ± 0.05 ng/mL, 0.63 ± 0.32 ng/mL, 0.22 ± 0.05 mg/day, and 0.35 ± 0.16 mg/day, respectively. Nine cases were complicated with hypertension, and symptoms related to CA excess were observed. Half of them (5 cases) including presented 3 cases had unilateral adrenal tumors. These suggest that in cases of bilateral adrenal uptake on 123I-MIBG, AMH needs to be considered. Adrenocortical adenomas may be associated with AMH and further larger investigation is needed for this pathology.

Pheochromocytoma is a rare but life-threatening condition due to catecholamine release induced by drug treatments such as β-blockers or glucocorticoids. We present a case of hypertensive crisis due to pheochromocytoma, induced after the initiation of dexamethasone and landiolol during intensive care for severe coronavirus disease 2019 (COVID-19). Based on a detailed medical history review, the patient was previously diagnosed with primary aldosteronism by confirmatory tests, moreover, an abdominal computed tomography scan identified an adrenal tumor 2 years before current admission. We tentatively diagnosed the patient with pheochromocytoma and initiated α-blockers without conducting a catecholamine report, leading to stable hemodynamics. We present a successfully managed case of pheochromocytoma concomitant with COVID-19, which has become a global crisis.