SUMMARY Middle Triassic (Anisian) red bedded cherts were collected from the Ajiro area in Kyushu Island, southwest Japan, for a palaeomagnetic study. Thermal demagnetization showed five distinct remanent magnetization components from the cherts. The lowest temperature component below 200 °C (component A) is a present‐day viscous overprint. The second‐ (up to 420 °C, component B) and third‐demagnetized (up to 580 °C, component C) components are secondary magnetizations of thermoviscous and chemical origin, respectively, both of which reside in magnetite. The fourth‐removed component (component D) was demagnetized at 630 °C and is a secondary magnetization carried by haematite. Components B and C are considered to be a result of widespread remagnetization in southwest Japan during the Cretaceous; the basis of this consideration is that red chert remagnetizations from an area about 600 km away from the present study area, are of the same origins with unblocking spectra similar to those observed in this study. The last‐removed component during thermal demagnetization (up to 695 °C, component E) is a primary magnetization carried by haematite. The directions of this component, after correction for the inclination flattening, yielded a mean palaeolatitude of 2°S at the time of deposition in the Middle Triassic. The Ajiro cherts accreted as part of an accretionary complex to the eastern margin of the South China Block during the Middle Jurassic and were then translated northwards from the continental margin to their present position through a margin‐parallel translation process owing to the oblique convergence of the oceanic plate.

Verruciform xanthoma is a rare benign verrucopapillary lesion that develops in the oral mucosa and genital skin. Its development in the esophagus is extremely rare, with only 5 reported cases. We present 2 cases of verruciform xanthoma of the esophagus. Case 1 involved a 91-year-old woman, who had hypertension and chronic gastritis with Helicobacter pylori infection, with a 12-year history of a 10-mm white-yellow elevated lesion on the esophagus, 35 cm from the incisor teeth. Case 2 involved a 70-year-old man with fundic gland polyp, hyperlipidemia, and lung cancer, who had a 10-mm whitish granular/verrucoid lesion on the esophagus, 28 cm from the incisor teeth. Microscopically, these lesions show verrucous and papillomatous epithelial hyperplasia with neutrophilic intraepithelial exocytosis. The histological hallmark is the presence of numerous foamy histiocytes infiltrating the elongated squamous epithelial papillae. Although its etiology is unknown, irritation or trauma caused by radiotherapy has been suggested.

Rationale: Refeeding syndrome (RS) is a fatal condition caused by rapid calorie intake during starvation. Self-neglected fasting in psychiatric disorders is associated with RS. However, overeating resulting from circumventing the clinician's instructions does not have a reportedly high risk of RS.Patient concerns: A 47-year-old undernourished woman with borderline personality disorder was hospitalized for nausea, vomiting, and diarrhea.Clinical findings: She had not eaten much for 10 days and had lost weight (56.5-51.1 kg) over 3 weeks. No abnormalities were indicated on physical examination and imaging examinations.Diagnoses, interventions, and outcomes: Infectious diseases and malignancies were excluded from the differential diagnosis. On the third day of admission, the patient's serum phosphorus level significantly decreased to 0.7 mg/dL, and additional sodium phosphate was administered intravenously. On the fourth day, despite our instructions, the patient was found to be eating nonhospital food from the first day of admission. In conjunction with her history, a final diagnosis of RS was made. After appropriate treatments, the patient was discharged on the 15th day of hospitalization. The patient's nausea, vomiting, and diarrhea were improved.Lessons: When undernourished patients have psychiatric disorders, including borderline personality disorder or schizophrenia, the occurrence of RS should be considered based on the patients' poor adherence to physicians' instructions.Abbreviations: BMI = body mass index, BPD = borderline personality disorder, RS = refeeding syndrome.

Rationale: Idiopathic achalasia is an esophageal peristaltic dysfunction of the lower esophageal sphincter (LES). The initial symptom is progressive dysphagia. However, due to its rarity, it is often misdiagnosed as an esophageal disorder. High LES pressure on esophageal manometry is an essential finding for the diagnosis. Patient concerns: A 55-year-old man was hospitalized with saliva-like vomitus, stuck-in-throat feeling of dysphagia, and weight loss. Clinical findings: On initial admission, gastrointestinal endoscopy, esophageal manometry, laboratory tests, and physical examination results were within normal limits. Diagnoses, interventions, and outcomes: Initially, the patient was diagnosed with globus sensation and recovered with medication. However, the symptoms recurred. He requested another examination on the second admission and was diagnosed with achalasia based on repeat esophageal manometry. The patient recovered after surgical treatment. Lessons: When patients still suffer from these symptoms, there is a need to reconsider achalasia, even if it is initially excluded from the differential diagnosis. Medication is not a radical treatment; however, it sometimes ameliorates symptoms. Moreover, the psychosomatic approach can be useful in such cases.