An 82-year-old man with fever and back pain was referred to our hospital and was thus found to be thrombocytopenic. A bone marrow biopsy revealed the diffuse infiltration of poorly differentiated neuroendocrine carcinoma (NEC). Computed tomography revealed a large hepatic mass. Considering the risk of bleeding due to thrombocytopenia, a needle biopsy was not performed. The patient rapidly deteriorated and died 10 days after presentation. An autopsy confirmed the diagnosis of primary hepatic NEC, with diffuse metastasis to the spleen, bone marrow, and systemic lymph nodes. This is an extremely rare case of NEC presenting with thrombocytopenia due to extensive bone marrow and splenic infiltration.

Barium magnesium silicate, BaMgSiO 4 , sintered together with H 3 BO 3 in a reducing atmosphere is known to show photochromism, with the generation of a pink color following UV irradiation. It is thought that this photochromism originates from oxygen vacancies in the silicate. In this work, we investigated the nominal Ba-deficient composition Ba 1-x MgSiO 4-x (0 < x < 0.05) in an attempt to effectively generate oxygen vacancies in the silicate. BaMgSiO 4 phases were obtained from a combination of BaCO 3 , MgO and SiO 2 , without the addition of H 3 BO 3 , by sintering in a reducing atmosphere. All samples were pink-colored after UV irradiation and this photochromism was confirmed to be an intrinsic property of BaMgSiO 4 . The color densities of our samples were inferior to that of a previously reported sample sintered with the addition of H 3 BO 3 , and the addition of H 3 BO 3 is believed to improve the photochromism color density. A tendency for the color density to decrease with increasing Ba-deficiency was found among our samples. The observed degradation of the photochromism is discussed based on nonstoichiometry in the BaMgSiO 4 phase.

Objectives Endoscopic submucosal dissection (ESD) is effective for the resection of colorectal intramucosal lesions. This study was performed to examine the safety and effectiveness of using dexmedetomidine (DEX) in the anesthesia regimen of patients with colorectal lesions undergoing ESD. Methods We retrospectively examined 287 consecutive patients who underwent ESD for colorectal lesions in our institution from January 2015 to December 2021. Outcomes including the frequency of intraprocedural pain and adverse events were compared between the DEX and no DEX groups. Moreover, univariate and multivariate analyses were conducted for each clinical factor of intraprocedural pain. Intraprocedural pain was defined as patient‐reported abdominal pain or body movement during the procedure. Results The incidence of intraprocedural pain was significantly lower in the DEX than in the no DEX group (7% vs. 17%, p = 0.02). The incidence of hypotension was also significantly higher in the DEX group (7% vs. 0%, p = 0.01), but no cerebrovascular or cardiac ischemic events occurred. In the univariate analyses, the diameter of the resected specimen, procedure time, no use of DEX, and total midazolam dose was associated with intraprocedural pain. The midazolam dose and DEX administration were significantly negatively correlated and the diameter of resected specimen and procedure time were significantly positively correlated. Multivariate logistic regression showed that no use of DEX was independently associated with intraprocedural pain ( p = 0.02). Conclusions Adding DEX to the anesthesia regimen in patients undergoing colorectal ESD appears to be safe and effective for reducing intraprocedural pain.

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