Pulmonary arterial hypertension (PAH) is a rare complication of ANCA-associated vasculitis (AAV). We report a 37-year-old man with PAH complicated by both AAV and SSc who presented with dyspnea, cardiac enlargement, positive myeloperoxidase (MPO)-ANCA, anticentromere antibodies, proteinuria, and urinary casts. Elevated pulmonary arterial pressure (58/22/34 mmHg) and low PAWP (2 mmHg) were confirmed by right heart catheterization. Treatment with glucocorticoids (GC) decreased urinary protein and serum MPO-ANCA; however, PAH did not respond to GC. Therefore, a combination of beraprost, bosentan, and tadalafil was needed. The differences in responses to GC suggest that the pathophysiology of nephropathy is different from that of PAH. We considered that nephropathy was associated with AAV but that PAH was associated with SSc in the present case. We discuss the pathophysiology and treatment response of PAH complicated by AAV, referring to nine past cases.

Percutaneous ablation techniques, including microwave ablation (MWA) and radiofrequency ablation (RFA), are important minimally invasive treatment options for liver tumors. MWA is expected to provide a larger ablation zone than RFA in a shorter time. The aim of this study was to investigate the duration of ablation, the number of punctures, and technique efficacy of RFA versus MWA for hepatocellular carcinoma (HCC) and liver metastasis. Methods: Between January 2014 and December 2018, 208 sessions with 274 tumors (263 HCCs and 11 liver metastases) treated by RFA and 32 sessions with 34 tumors (26 HCCs and 8 liver metastases) treated by MWA were enrolled in this retrospective study. We investigated age, sex, Child-Pugh classification, number, and size of tumors. Technical success (TS), local tumor progression (LTP), size and shape of the ablation zone, number of punctures, and duration of ablation were compared.Postoperative follow-up was performed with imaging studies performed between January 2014 and March 2019. Results: The TS rate was 88.2% for MWA and 92.3% for RFA. The LTP rate after 3 months was 6.7% for MWA and 5.4% for RFA. The LTP rate after 6 months was 15.0% for MWA and 10.7% for RFA.There was no significant difference between MWA and RFA. The number of punctures per tumor was 1.42 ± 0.56 for MWA and 2.76 ± 1.27 for RFA. The duration of ablation per tumor was 10.40 ± 4.26 minutes for MWA and 23.20 ± 10.54 minutes for RFA. Compared with RFA, MWA caused spherical ablation in a shorter time with fewer punctures (P < 0.05). Conclusion: MWA had similar short-term outcomes with fewer punctures and duration of ablation than RFA. MWA has potential as a less invasive treatment for liver tumors.

Background and study aims Diaphragm disease (DD) is a rare gastrointestinal disease featuring multiple thin, circumferential strictures in the intestine, related to prolonged intake of nonsteroidal anti-inflammatory drugs (NSAIDs). Here, we report a case of DD associated with cytomegalovirus (CMV) infection in a patient not taking NSAIDs. A 72-year-old man was referred to our hospital due to persistent epigastric pain. Push enteroscopy showed extensive mucosal detachment in the upper jejunum. Immunohistochemistry examination of biopsy specimens revealed CMV positivity. In addition, CMV antigenemia was positive. Antiviral treatment with ganciclovir improved his symptoms and the CMV antigenemia became negative. Wireless capsule enteroscopy performed 1 month after antiviral treatment showed regenerated mucosa and multiple diaphragm-like strictures in the jejunum, resulting in capsule retention. Balloon dilatation using double balloon enteroscopy (DBE) was performed and the capsule was retrieved endoscopically. DBE 6 months after antiviral therapy confirmed no recurrence of stenosis or inflammation. The patient had no history of long-term NSAID use. In a case of DD unassociated with NSAIDs, CMV infection should be considered in the differential diagnosis.