Notes

[Effect involving triple-induction program including all-trans retinoic acid solution, arsenic trioxide in addition anthracyclines for older people along with non-high-risk serious promyelocytic leukemia].
Achalasia is a rare motor disorder of the oesophagus that typically characterized by the absence of oesophagus peristalsis and failure of swallow induced relaxation of oesophagus sphincter (LOS). The prevalence of achalasia is eight cases per million population.

A 35-year-old woman presented with progressive dysphagia for 6 years. Her symptoms worsened in the last 14 days followed by vomiting undigested and retained food. She was previously diagnosed with a variant respiratory problem but her symptoms did not improve with medication. Clinical evaluation and investigation revealed features of multiple depigmented patches with sharply defined borders and leucotrichia on the neck, abdomen, hand, knee, and lateral malleolus. The patient had vitiligo for 18 years. The upper gastrointestinal endoscopy showed the dilatation from distal oesophagus (38 cm from incisors) with retained food. The diagnosis of achalasia was given. After laparoscopic Heller's myotomy was performed and the opening of the oesophagus was repaired with Dor's fundoplication, her symptoms were much improved.

We hereby report on a rare case of achalasia in a woman presenting with vitiligo which may suggest an autoimmune disorder in the onset of achalasia. Achalasia must be considered in vitiligo or any autoimmune disease presenting with the oesophagus-related problem.
We hereby report on a rare case of achalasia in a woman presenting with vitiligo which may suggest an autoimmune disorder in the onset of achalasia. Achalasia must be considered in vitiligo or any autoimmune disease presenting with the oesophagus-related problem.
Several complications of intravenous administration of Methylprednisolone in spine surgery have been reported previously. However, perioperative Addisonian crisis resulting from postoperative routine cessation of intravenous Methylprednisolone has been rarely reported. We here report a case of perioperative Addisonian crisis induced by postoperative routine cessation of intravenous Methylprednisolone.

To report a 56-year-old lady was diagnosed with Addisonian crisis on postoperative duration of lumbar spine surgery after routine cessation of intravenous Methylprednisolone on postoperative day 5.

There are potential risk and medical complexity of the intravenous administration of Methylprednisolone perioperatively when patients underwent spine surgery, especially the patients with a history of adrenal insufficiency or hypothyroidism, and other endocrine diseases. The early diagnosis and effective replacement therapy after cessation of intravenous glucocorticoid to keep normal serum hormone levels can reduce risk and complication of Addisonian crisis.

Addisonian crisis may be triggered by the discontinuation of exogenous glucocorticoid. Physicians need to be immediately aware of this potentially lethal complication in patients with endocrine system diseases.
Addisonian crisis may be triggered by the discontinuation of exogenous glucocorticoid. Physicians need to be immediately aware of this potentially lethal complication in patients with endocrine system diseases.
Solitary adrenal metastasis derived from colorectal cancer is rare. Adrenal metastasis is usually associated with systemic spread of the disease and is considered to be unsuitable for surgical resection. However, it has been reported that an aggressive surgical resection of adrenal metastasis results in improved overall survival in selected patients. We herein report an extremely rare case of complete resection of rectal cancer with a synchronous solitary adrenal metastasis.

A 70-year-old woman who presented with bloody stool was diagnosed with rectal cancer with a synchronous solitary adrenal metastasis and was suspected of having liver invasion. After a total of 2 cycles of chemotherapy with capecitabine and oxaliplatin, an abdominoperineal resection with D2 (proxD3) lymph node dissection and right adrenalectomy was performed and complete resection was possible. According to the TNM classification, the diagnosis was stage IVA (fT3N1bM1a[ADR]). At 18 months after surgery, the patient is alive with no evidence of recurrence and distant metastasis.

Complete resection of adrenal metastasis may have a possibility of leading to a good prognosis in patients with a synchronous solitary adrenal metastasis.

Adrenalectomy should be considered in patients who can undergo complete resection, as it may offer a good long-term prognosis.
Adrenalectomy should be considered in patients who can undergo complete resection, as it may offer a good long-term prognosis.Deficits in the accommodative and/or vergence responses have been linked with inattentive behavioral symptoms. While using automated systems (e.g., self-driving cars, autopilot), operators (e.g., drivers, pilots, soldiers) visually monitor displays for critical changes, making deficits in the accommodative and/or vergence responses potentially hazardous for individuals remaining actively engaged in the task at hand. The purpose of this study was to determine if symptoms of accommodative-vergence deficits predict an individual's level of task engagement and cognitive fatigue while performing a flight simulation task with or without automation. Eighty-four participants performed a flight simulation task with or without automation. Prior to task completion, self-report accommodative-convergence deficit symptoms were assessed with the Convergence Insufficiency Symptom Survey (CISS). Before and after the flight simulation task participants rated their task engagement and cognitive fatigue. iJMJD6 concentration Electroencephalographic activity (EEG) was recorded concurrently during task performance. Results showed that higher scores on the CISS were related to increased feelings of fatigue and decreased ratings of task engagement. The CISS was also positively related to parietal-occipital fast alpha power during the last 10 min of the task for participants using automation, suggesting increased cortical idling. CISS scores did not predict performance. Results have implications for optimizing operator cognitive states over extended task performance.
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