Gastrointestinal stromal tumor (GIST) is generally defined as a mesenchymal tumor that consisits of spindle-shaped or epitheloid cells, originates in the gastrointestinal tract, and immunohistochemically expresses c-kit and/or CD34, regardless of myogenic and neurogenic markers. Gastrointestinal mesenchymal tumors are generally diagnosed as the submucosal tumors. Most of these tumors were histologically diagnosed as myogenic or neurogenic tumors. However, with the development of immunohistochemistry in the 1980s, we were able to clearly distinguish between myogenic tumors and neurogenic tumors. This new ability also resulted in the development of a new concept of the tumor that could not be classified into either of them. The tumor is, in fact, GIST. However, a quarter of a century was required for the concept and the treatment of GIST to be established. Because of four breakthroughs (1. the development of immunohistochemistry, 2. the classification in Ackerman's Surgical Pathology, 3. the derivation from interstitial cells of Cajal and 4. the high efficacy of imatinib mesylate) during this time, the concept of GIST has changed greatly. On the other hand, the resistance to imatinib in GIST has gradually increased, and new problems have arisen. The further development of drugs (five kinds of drugs such as SU 11248 are undergoing clinical trials) is awaited.

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Idiopathic pulmonary fibrosis (IPF) is a devastating and fatal disease of unknown etiology. Survival of IPF is estimated at 3 to 4 years from first medical assessment for idiopathic interstitial pneumonias (IIPs). Currently, available therapies for IPF include corticosteroid and immunosuppressant for anti-inflammatory actions unfortunately no improvements were noted for the survival of IPF. Recently, several clinical studies report on the antifibrotic outcomes for new agents of IPF. Pirfendione, Interferon (IFN)-γ, and N-acetylcysteine (NAC) are promising agents for IPF. We confirmed the efficacy of pirfenidone as a significant inhibitor for the deterioration of pulmonary functions and for decreasing the number of patients with acute exacerbations during a well designed, double blind placebo controlled randomized clinical trial in Japan. Furthermore, we adopted new methods for assessing dynamic pulmonary function by measuring minimum values of desaturation during 6 minutes walking at constant speed. Interstitial pneumonia in patients with Hermansky-Pudlak syndrome has been treated with pirfenidone in US. Pirfenidone successfully prevents worsening of %FVC for patients with %FVC>60%, but not for the group %FVC≤60%. Treatment with IFN-γ for IPF has been conducted in North America, but IFN-γ could not improve progression-free survival for the intent-to-treat group. However, IFN-γ significantly decreased the mortality ratio in patients with %FVC>60%. Recently, the evaluation of effective drugs for IPF has focused on dynamic pulmonary functions such as 6 minutes walk test, as pathological evaluation of IIPs is not recognized as a gold standard for estimating survival of patients with IPF. In this review, we introduce new strategies for the evaluation, and compounds for the treatment of IPF.

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We report a case of anorexia nervosa with familial idiopathic basal ganglia calcification (IBGC, Fahr's disease). A 30-year-old woman with anorexia nervosa was brought to the Department of Critical Care Medicine because of severe weight loss and dehydration. Imaging studies revealed bilaterally symmetrical calcifications in the caudate nucleus, putamen, globus pallidus, and thalamus, and Fahr's disease was diagnosed. Fahr's disease sometimes has comorbid psychiatric conditions, such as schizophrenia and personality changes, but this is the first case of Fahr's disease with anorexia nervosa. This case illustrates the importance of comprehensive medical assessment for psychiatric patients admitted for the first time.

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A 75-year-old woman was admitted to our hospital with a chief complaint of distinct abdominal pain. At first we suspected rupture of an abdominal aortic aneurysm because of the presence of a pulsatile abdominal mass. However, the computed tomography with contrast enhancement revealed an infrarenal abdominal aortic aneurysm with marked thickening of the aneurysmal wall (mantle core sign) and left hydronephrosis. Left hydronephrosis was caused by rigid adherence of the adjacent left ureter to the aneurysmal wall. We diagnosed an unruptured inflammatory abdominal aortic aneurysm and performed elective surgical replacement of the abdominal aorta using a Y-shaped woven Dacron graft. We avoided urological intervention for the hydronephrosis to prevent injury to the ureter because marked thickening of the aneurysmal wall and rigid adherence of adjacent structures decrease after surgery. Recognition of abdominal aortic aneurysm with careful diagnostic management before surgery can help determine the operative strategy.

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We present here a case of ovarian bleeding in a patient with cervical carcinoma treated by radical hysterectomy and ovarian transposition.

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A 70-year-old woman visited our hospital for evaluation of epigastric pain. She had been treated for a gastric ulcer by her home doctor with H2-receptor antagonist or PPI for 30 years. An upper GI series revealed a gastroduodenal fistula from the lesser curvature to the prepyloric region and the duodenal bulb. Eighteen months later, endoscopic examination revealed a double pylorus without additional changes.

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