We experienced a case of widely spreading Fournier's gangrene. A 54-year-old man was transferred to the hospital in a state of pre-shock after unsuccessful incisional drainages performed at two another hospitals to where he was admitted because of anal pain. Computed tomography (CT) revealed a widespread low density area, from perineal lesion and right scrotum to right upper leg. The patient was diagnosed as having Fournier's gangrene and immediately further wide drainage operation and colostomy were carried out. After the 3rd drainge operation the patient developed DIC and ARDS, but his life was saved by intensive care. Skin grafting surgical wound dried. The patient was dischaged from the hospitl.
Over 400 cases of Fournier's gangrene have been reported in the European & American literature, but the disease is relatively rare in Japan. In addition, there are few reports that the disease widely spreaded like this case. This case is presented with some notes on the relevant literature.

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We report a case of anaphylactoid purpura induced by recurrence of intussusception because it was thought to be a relatively rare clinical course. A 4-year-old girl was admitted to the hospital because of abdominal pain. She was diagnosed as having an intussusception and was easily by treated by airreduction. Nearly one month later, she experienced recurrence of intussusception. It was though to be also curable by air-reduction, but general examination was carried out since she was older than the age of its frequent occurrence. During the examination, there appeared purpura in her crus followed by articular pain. She was diagnosed as anaphylactoid purpura induced by recurrence of intussusception. Thereafter she made satisfactory progress by conservative therapy. This case in rare in that intussusception associated with anaphylactoid purpura recurred after an interval of more than one month. We should entertain that intussusception appears as a probable initial symptom of anaphylactoid purpura other than some organic disease when it occurs in older children.

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A study of 18cases of mamushi bites experienced at the hospital from 1989 to 1996 is reported. In terms of the severity of the condition, these cases included three Grade I cases, Three Grade II cases, one Grade III cases, eight Grade IV cases and three Grade V cases. Severe cases (Grade IV and Grade V) represented 66% of all cases. Severe cases occurred from cases in which fingers or foot were bitten, or cases in which the mamushi bites were managed by patients themselves. On their arrivals at the hospital, the bitten sites were incised and vacuumed in all cases. Ten cases had been administered cepharanthin and the remaining eight cases had been administered cepharanthin and antivenin.
At the present time when antivenin is the only one established remedy for the mamushi bites, the antivenin should be administered as soon as possible for mild or probable severe cases. In addition the most common fatal cause is acute renal failure, and so the preservation of the renal function starting in an early phase after the mamushi bites is important.

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A 63-year-old man was seen at the department of internal medicine in our hospital because of dysphagia. Endoscopic examination of the upper gastrointestinal tract revealed an esophageal cancer of the lower intrathoracic esophagus, but further exploration with endoscopy was impossible because a stricture at the site of cancer was too narrow to pass through the endoscopy. Upper gastrointestinal series performed on another day revealed two elevated lesions in the stomach. The patient was referred to the department for operation. Intra-thoracic esophagectomy, total gastrectomy, and reconstruction with the small intestine were performed. Pathologically the resected specimens were diagnosed as squamous cell carcinoma of the esophagus, and moderately differentiated tubular adenocarcinoma and poorly differentiated adenocarcinoma of the stomach. Esophageal cancers with gastric cancer have been reported to represent 0.3-2.5% of all esophageal cancers, but synchronous double cancer of esophagus and stomach is rare. For the exploration of gastrointestinal malignant tumor, careful attitude entertaining probable double cancer is of importance. And appropriate selection of operative procedure that can provide a cure with minimal surgical stress may be critical to treat such synchronous double cancer of the esophagus and stomach.

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