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BACKGROUND/PURPOSE The purpose of the present study was to investigate the possibility of reducing clinical impacts of acute necrotic collection (ANC) on patients with acute pancreatitis (AP) using recombinant human soluble thrombomodulin (rTM). METHODS In this retrospective multicenter study, 233 consecutive AP patients with ANC and acute peripancreatic fluid collection (APFC) from 2012 to 2016 were enrolled. To assess clinical impacts of ANC, severity on admission (JPN score, JPN CT grade, and Modified CT severity index), development of walled-off necrosis (WON), imaging costs for follow-up, and mortality were recorded. Finally, we investigated whether rTM could reduce the clinical impacts, adjusting the severity using propensity analysis with Inverse probability of treatment weighting. RESULTS Patients with ANC developed WON with higher ratio than APFC (58/98 [59.2%] vs 20/135 [14.8%], OR = 8.3, P

We describe the case of a 60-year-old man who presented at our hospital with abdominal pain and elevated hepatobiliary enzymes. Computed tomography showed portal thrombosis and cavernous transformation as well as increased wall thickness and a stricture in the biliary tract. At that time, the cause of the portal thrombosis was unknown. During follow-up, the blood cell counts (WBCs and platelets) were remarkably increased, and a test performed for the JAK2V617F mutation was positive. We diagnosed the patient with polycythemia vera. Our findings demonstrate that a patient presenting with portal thrombosis, portal biliopathy, and underlying myeloproliferative neoplasms should be carefully examined, even in the absence of the typical blood alterations.

A Japanese male in his 70s with chronic hepatitis C was diagnosed with diffuse large B-cell lymphoma and achieved and maintained complete remission following treatment with eight cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisolone). Seven years later, he received the direct-acting antivirals (DAAs) sofosbuvir/ledipasvir for hepatitis C virus (HCV) genotype 1b. Although the patient achieved sustained virological response immediately after the initial treatment period, laboratory data showed elevation of LD and soluble IL-2R. Computer tomography showed diffuse intraabdominal lymph node swelling and splenomegaly. Lymph node biopsy revealed the relapse of lymphoma. The lymphoma cells were resistant to chemotherapy, and the patient died five months later. Several studies reported early recurrence of hepatocellular carcinoma after HCV treatment using DAAs. However, the relationship between DAAs and hepatocellular carcinoma recurrence remains unclear. Nonetheless, possible cancer recurrence should be considered in patients with a history of lymphoma who are prescribed DAAs to treat HCV.