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Objective Intragastric balloon (IGB) therapy is a low-invasion treatment for obesity. Recently, a lowcarbohydrate diet has shown effectiveness for encouraging weight loss, but whether or not a low-carbohydrate diet improves the efficacy of IGB therapy remains unclear. Therefore, we examined the effectiveness of a low-carbohydrate diet compared with a calorie-restricted diet in combination with IGB therapy. Methods A prospective study was conducted on 51 patients who had undergone IGB therapy from October 2012 to December 2017. Overall, 31 of the 51 patients were included in this study (12-month assessment after IGB placement). These 31 cases consisted of 18 IGB plus low-carbohydrate diet and 13 IGB plus calorierestricted diet. We compared the two groups with respect to body weight loss as outcomes. Results At 12 months after IGB placement, the body weight was significantly lower than that observed at baseline in both the IGB plus low-carbohydrate diet group (baseline 101.9±25.8 kg, 12 months 88.2±21.9 kg) (p<0.0001) and the IGB plus calorie-restricted diet group (baseline 103.5±17.0 kg, 12 months 89.1±6.2 kg) (p<0.005). The percentage of excess weight loss in the IGB plus low-carbohydrate diet group was slightly higher than that in the IGB plus calorie-restricted diet group, but there was no significant difference between the 2 groups at 12 months after IGB placement (IGB plus low-carbohydrate 49.9±60.0%, IGB plus calorierestricted diet 33.1±27.0%). ConclusionOur study demonstrated that both a low-carbohydrate diet and a calorie-restricted diet were effective interventions for weight reduction in combination with IGB therapy.

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The case of a 10-week-old boy with a solitary mastocytoma is reported. The lesion, noticed at birth, was located in an area extending from the dorsum of the left hand to the proximal phalanx of the ring and little fingers. It appeared as a coin-sized, flattened dome-shaped, round tumor with occasional blistering. The web between the two fingers was free of cutaneous changes. The diagnosis was confirmed by the histological characteristics: a densely mastocytic infiltration into the dermis. The present case of solitary mastocytoma, referred to as "mast cell nevus", is unique because of its previously undescribed divided form.

Liver ISSN 0106-9543Portal-systemic encephalopathy from a spontaneous gastrorenal shunt diagnosed by three-dimensional computed tomography and treated effectively by percutaneous vascular embolization Kuramitsu T, Komatsu M, Matsudaira N, Naganuma T, Niizawa M, Zeniya A, Yoshida T, Toyoshima I, Chiba M, Masamune 0. Portal-systemic encephalopathy from a spontaneous gastrorenal shunt diagnosed by three-dimensional computed tomography and treated effectively by percutaneous vascular embolization.Abstract: A 67-year-old man with a portal-systemic shunt confirmed by three-dimensional computed tomography (3D-CT) was successfully treated by percutaneous vascular embolization. The patient had aggravated loss of memory, disorientation, and hyperammonemia. A gastrorenal shunt 16 mm in diameter was found by 3D-CT reconstructed by helical computed tomography (CT). Embolization was performed only in the shunt percutaneously through the inferior vena cava. One year after the embolization, no recurrence of portal-systemic encephalopathy and no portal hypertension have appeared, and the clinical course has been good.

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Portal hypertension is a relatively uncommon pathologic condition in children and young adults in contrast with older adults. The aim of this study is to evaluate the utility of sonography and color Doppler sonography in the diagnosis of portal hypertension in children and young patients and to evaluate the sonographic pattern of each disease. We reviewed 25 such patients who were younger than 30 years old and obtained the following sonographic findings: (1) liver cirrhosis: (a) multiple intrahepatic venovenous shunts in patients with primary Budd-Chiari syndrome and (b) intrahepatic vascular narrowing and nodular coarse parenchymal texture, with multiple very-high-echo spots along the portal vein in patients with Wilson disease; (2) congenital hepatic fibrosis: marked and developed collaterals, wide periportal echogenic band, and a heterogeneous parenchymal texture comprised of multiple high echoes but without portal thrombus; and (3) extrahepatic portal thrombosis: invisible portal lumen except as an echogenic band. Sonography and color Doppler sonography are very useful in diagnosing these portal hypertensive diseases. However, there are no specific sonographic findings, and the role of sonography is limited to follow-up observation of associated secondary hepatobiliary changes in patients with congenital biliary atresia.