[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 a case of hemostatic treatment by transcatheter arterial embolization (TAE) of the left gastric artery and a branch of the left bronchial artery for oozing hemorrhage in the lower esophagus, because of incomplete endoscopic hemostasis.
A 52-year-old woman with systemic lupus erythematosus was previously admitted three times to our hospital for endoscopic treatment of hemorrhage in the lower esophageal lesions.
The procedure of TAE for esophageal hemorrhage seems to be a useful treatment for cases of incomplete endoscopic hemostasis.

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A 55-year-old man was given a diagnosis of grade 0IIc type gastric cancer of the midgastric posterior wall following endoscopy of the upper digestive tract, and subsequently underwent distal gastrectomy. Tumor cells resembling Paneth cells were occasionally observed in differentiated adenocarcinoma that had invaded the submucosal layer, the tumor was CD10-positive, and showed differentiation to complete intestinal metaplasia. In addition, p53-positive cells were also occasionally observed. Although complete intestinal metaplasia is associated with a low incidence of malignant transformation, this case was considered to be different from complete intestinal metaplasia, on which a mutation of the gene of p53 is involved in the early period of carcinogenesis.

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A 60-year-old woman presented in February 2003 with an ulcer on the lesser curvature of the anglus. The endoscopic biopsy specimens showed epithelial signet-ring cell associated with lymphoid infiltration, suggesting a diagnosis of gastric cancer. Histopathological examination confirmed the diagnosis of low-grade B-cell lymphoma of MALT with epithelial signet-ring cell lymphoepithelial lesion, which was negative for H. pylori and t (11;18) (q21;q21) translocation (API2-MALT1 gene) D This case was treated with H. pylori eradication and additional radiation therapy, and the tumor was disappeared.

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A 45-year-old man presented with intermittent abdominal pain for a month. Intestinal intussusception was diagnosed by the findings of abdominal ultrasonography and computed tomography. Intussusception was reduced by barium enema. Based on magnetic resonance imaging, we diagnosed intestinal intussusception due to multiple lipoma. At laparotomy, after successful reduction of the intussusception with Hutchinson's maneuver, an ileoceal resection was performed. Intussusception in adults is relatively rare and may be difficult to diagnose preoperatively. In the diagnosis of this disease, abdominal echo, CT, and MRI are useful.

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A 23-year-old woman had lower abdominal pain, diarrhea and bloody stool was admitted and given a diagnosis of influenza B. Her home doctor had started treatment by neuraminidase inhibitor (oseltamivir) the previous day. Colonoscopic examination revealed an area of hemorrhage and erosion in the left transverse colon. After halting oseltamivir treatment these symptoms disappeared and her colonoscopic findings improved. A drug-induced lymphocyte stimulation test was positive for oseltamivir. This case is the first reported case of acute hemorrhagic colitis induced by oseltamivir.

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A 58-year-old man was admitted because of perforation of the small intestine by a gastrointestinal stromal tumor (GIST)D FirstC the small intestine including a GIST was resected;and then 2 month laterC a part of the liver (S5) conforming to metastatic lesion was surgically removed. Twelve months laterC another liver metastases was foundC and surgical treatment was recommended;but the patient requested non-surgical therapyC so a radiofrequency ablation (RFA) was successfully performed. After thatC recurrence of liver metastasis was not observedC but another metastasis was observed on the fifth lumbar vertebra;so administration of imatinib mesylate was started. 28 months after the initial administration the metastatic liver lesion was still invisibleC and the bone metastatic lesion had not grown. The patient is alive with good performance status. This report shows that multi-modality therapy by surgeryC RFA and imatinib mesylate was effective for liver and bone metastases of GIST.

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We encountered 2 patients (No. 1 and 2) with pseudocyst hemorrhage of the pancreas. Patient No. 1C who presented with hemorrhagic shock due to rupture of a splenic aneurysmC was evaluated as a responder based on the response to the initial transfusionC and emergency TAE (transcatheter arterial embolization) was performedC which proved to be a successful life-saving measure. In Patient No. 2C also judged to be a responderC angiography was conducted and the course could be observedC because the hemorrhage was localized in the cyst. These results indicate that it is important to promptly select treatment policies based on the hemodynamic responses to the initial transfusion in cases with cystic hemorrhage of the pancreas.

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We encountered a solid pseudopapillary tumor (SPT) without any cyst component in an elderly man. A literature survey of SPT without cystic component suggested that the size and vascularity of a tumor were related to lack of cystic component. The prognosis of this disease was comparatively goodC but elderly or middle aged case and cases without capsule seem to have high malignant potential.

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