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Aims To study the possibility of constructing a remote interpretation system for retinal images. Methods An ultra-widefield (UWF) retinal imaging device was installed in the internal medicine department specializing in diabetes to obtain fundus images of patients with diabetes. Remote interpretation was conducted at Nagoya City University using a cloud server. The medical data, severity of retinopathy, and frequency of ophthalmologic visits were analyzed. Results Four hundred ninety-nine patients (mean age, 62.5 ± 13.4 years) were included. The duration of diabetes in 240 (48.1%) patients was less than 10 years and 433 (86.7%) patients had a hemoglobin (Hb) A1c below 8%. Regarding the retinopathy severity, 360 (72.1%) patients had no diabetic retinopathy (NDR), 63 (12.6%) mild nonproliferative retinopathy (NPDR), 38 (7.64%) moderate NPDR, 13 (2.6%) severe NPDR, and 25 (5.0%) PDR. Two hundred forty-one (48.3%) patients had an ophthalmologic consultation within 1 year, 104 (20.8%) had no history of an ophthalmologic consultation. DR was not present in 86 (82.7%) patients who had never had an ophthalmologic examination, 30 (78.9%) patients with severe NPDR or PDR had had an ophthalmologic visit within 1 year. The frequency of ophthalmic visits was correlated negatively with age, diabetes duration, HbA1c, and severity of retinopathy. Conclusion Remote interpretation of DR using UWF retinal imaging was useful for retinopathy screening. During the COVID-19 pandemic, a remote screening system that can ensure compulsory social distancing and reduce the number of ophthalmic visits can be a safe system for patients and clinicians.

Nestin is an intermediate filament protein expressed in undifferentiated cells during central nervous system development, and glioma is known to be a highly infiltrative tumor. We determined whether nestin was expressed in astrocytic tumors and could identify infiltrating tumor cells. We screened 65 archival, paraffin-embedded adult astrocytic tumors using immunohistochemical staining and computerized overlaid photographs. Normal biopsied brains and metastatic brain tumors were also examined. The intensity of nestin expression corresponded to the tumor grade. All 33 glioblastoma cases showed positive and extensive staining, which was less positive in diffuse astrocytoma. Overlaid images showed that nestin immunostaining delineated tumor invasion into adjacent gray and white matter. Nestin is a useful marker for examining the infiltration of malignant cells into surrounding tissue.

下大静脈内腫瘍栓は肝細胞癌や腎細胞癌では報告例が散見されるが，大腸癌が下大静脈に腫瘍栓を来すことはまれである．今回，大腸癌肝転移切除後に発症した下大静脈内腫瘍栓の1例を経験したので報告する．症例は38歳の女性で，S状結腸癌同時性多発肝転移の診断でS状結腸切除術，肝右三区域切除術，S3部分切除術を施行した．術後15か月のCTで左肺S8の結節影と傍大動脈リンパ節の腫大，肝部下大静脈内の陰影欠損が出現した．肺転移の疑いで胸腔鏡下肺部分切除術を施行したが病理組織学的検査では肺梗塞であった．初回手術から2年の腹部CTで傍大動脈リンパ節の腫大，下大静脈内の陰影欠損域に変化はなかった．傍大動脈リンパ節転移，下大静脈内血栓もしくは腫瘍栓の診断でリンパ節摘出術，下大静脈人工血管置換術を施行した．下大静脈内腫瘤とリンパ節は病理組織学的に大腸癌の転移と判明した．現在明らかな再発の所見を認めていない．

透析患者に発症した特発性腸間膜血腫の1例を経験したので報告する．症例は40歳代の女性．30歳頃から慢性腎不全で血液透析を受けている．突然の下腹部痛で当院救急外来を受診した．腹部CTでS状結腸間膜内に血腫を疑う低吸収域を認めた．3時間後の腹部造影CTでは血腫と思われる低吸収域の増大，内部に造影剤の漏出を認め出血性腸間膜血腫を疑った．血管造影検査で明らかな血管外漏出像を認めなかったが貧血の進行を認めたため緊急手術を行った．術中所見でS状結腸間膜内に血腫を認め，血腫を形成している腸間膜，S状結腸を切除した．病理組織学的検査では栄養血管に明らかな動脈瘤，動静脈瘻等認めず，出血の原因は不明で特発性腸間膜血腫と診断した．術後経過良好で第28病日に退院，現在再発の徴候を認めていない．特発性腸間膜血腫の本邦報告例は自験例を含め44例と稀であり，若干の文献的考察を加え報告する．

We report a case of well differentiated mucinous carcinoma of the gallbladder. An 80-year-old man was admitted to our hospital because of fever and CT showed a mass in the fundus of the gallbladder and choledocholithiasis. Endoscopic removal of the common bile duct stones was done. Abdominal ultrasonography and CT showed a 4 cm mass in the fundus of the gallbladder. Based on a diagnosis of adenomyomatosis or mucinous carcinoma of the gallbladder, a laparotomy revealed a white mass in the fundus of gallbladder. Intra-operative pathological diagnosis of lymph node of cystic duct was mucinous carcinoma. Therefore, we conducted partial resection of the liver with D1 lymph node dissection. Pathological diagnosis confirmed well differentiated mucinous carcinoma of the gallbladder. His postoperative course was uneventful, and he is doing well without recurrence.