[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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An aged female patient with chronic myeloid leukemia in chronic phase was treated with imatinib after failure of interferon-αtreatment. Because of various adverse effects an initial daily dose 400 mg was reduced to 300 mg, which allowed for the coutinuation of imatinib therapy. A coplete cytogenetic response (CCyR) was achieved after 6 months. After 36 months of the treatment the major bcr-abl m RNA level was 172 copy / 0.5 μg RNA in peripheral blood leukocytes, measured by Amp-CML which became available on that time.　The European LenkemiaNet defines the response less than major molecular response (MMR) at 18 months as suboptimal.The suboptimal response is thought to be a heterogeneous category, and patients with a suboptimal response at 18 months are reported to have outcomes that are similar to those patients with an optimal response.　The bcr-abl m RNA levels in this patient in fact remained at the same order for the next 4 years and she is well responding at present. However the imatinib concentration might not be enough to get an optimal response, and there is a possibility of cytogenetic response loss or appearance of mutations in the future.So increase to standard dose (400 mg) may be considered. But the informed consent has not been obtained. The long-term outcome of such a patient is not yet well known. A careful follow up with molecular monitoring every 3 months is required.

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In emergency case with severe pain, spontaneous spinal hematoma is an uncommon but very important entity.　We report two cases of acute cervicothoracic epidural hematomas and a case of lumbosacral subdural hematoma.Three patients were attacked by severe pain without paralysis or vesicorectal dysfunction. They were treated conservatively and left on their feet.　CT is a useful tool to detect spinal hematomas, but MRI is more helpful in recognizing whether the hematoma is localized in the epidural space or the subdural space.

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[in Japanese]

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A 42-year-old female patient visited our hospital with the complaint of acute lower abdominal pain and vomiting after meal. Plain abdominal X-ray and abdominal CT scanning seemed to show the coffee-bean sign in the mid-lower abdomen. She tried to undergo emergent colonoscopy reduction in the diagnosis of sigmoid colon volvulus. Although colonoscope was inserted to the ascending colon, mid-lower intestinal gas was not disappeared completely. MRI imaging afterward showed increased coffee-bean shaped giant gas and increased ascites. Then she underwent emergent laparotomy in the diagnosis of strangulation ileus. A small amount of serous ascites was found. The fixation of the cecum to the retroperitoneum was poor and the ileocecum was twisted 360degree counterclockwise but was not found to be necrotic. An ileocecal resection was performed to avoid the recurrence of the cecal volvulus. The postoperative course was uneventful.　Although most of the cases with coffee-bean sign are volvulus of sigmoid colon, volvulus of cecum should be remembered when large intestinal gas does not disappear after colonoscopy reduction.

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　A 53-year-old woman presented at a local doctor’s practice with an epigastric pain from which she had been suffering since mid-April 2010. In June, upper gastrointestinal endoscopy revealed a small protuberant lesion with redness in the greater curvature of the angular incisures, upon which she was introduced to the department of medical gastroenterology in our hospital for further examination. We observed reddish irregular concentrated folds in the greater curvature of the lower part of gastric body. However, the mucosal color tone seemed unusual, although its micro structure didn’t. Consequently, we suspected that the main part of the lesions was hidden under the mucosa. We performed a boring biopsy of the lesion in 8 places, but didn’t observe anything malignant. The endoscopic ultrasonography revealed a lesion resembling a submucosal tumor with first and second layer preserved and third layer interrupted. As former endoscopic examination didn’t reveal anything abnormal, we suspected that the lesion might be malignant. Upon obtaining informed consent, laparoscopic partial gastrectomy was performed.Histopathologically, we observed worm-like structure surrounded by an eosinophilic abscess and granulomatous reaction in the submusosa. Although this structure could not be defined because it was already degenerating and necrotizing, we suspected Anisakis. The worm-like structure and granuloma were localized in the submucosa.Chronic anisakiasis with eosinophilic granuloma is rare, and worm-like structure cannot be readily observed on the gastrointestinal endoscope as they tend to crawl under the mucosa, which calls for a careful diagnosis.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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We report two cases of trigeminal neuralgia generated by torsion or kinking of the nerve, demonstrated on CISS images. Both of them were treated by straightening of the nerve via key-hole surgery successfully. Common intraoperative findings were deformity of the neural axis due to tethering by thickened arachnoid around the trigeminal nerve. As the operative effect was developed soon after the surgery, ephatic conduction made by transform was corrected by surgery.

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