Four hundred and sixty-three cases, who visited medical center for annual check-up, were enrolled in this study. All subjects were required to answer three symptoms in the ten upper abdominal symptoms and the frequency of these symptoms by which they might visit hospital to take medical care. Upper abdominal pain, nausea and chest pain were best three symptoms, which might cause hospital visit and only a few subjects thought that they make a hospital visit by heartburn, acid regurgitation and early satiety. More than 30% of subjects think that they might visit medical center for medical care when these symptoms occur over three times per week. In contrast, upper abdominal pain, nausea, vomiting, heartburn and early satiety were frequently observed in 100 patients, who visited medical center to take medical care. In addition, about half of patients visited medical center when these symptoms occurred every day.
A 29-year old woman with Crohn's disease was performed colostomy due to severe perianal abscess. Her disease had been easy to recur and she was admitted to hospital for intestinal bleeding caused by acute exacerbation in Crohn's disease on October 2006. The bleeding was stopped rapidly and clinical remission was maintained with bimonthly administration of infliximab. Finally, her colostomy was closed after 5 years 8 months. Periodical treatment of infliximab not only prevented recurrence but also enabled closure of colostomy in fistulating perianal Crohn's disease.
A 60-year-old man, with a high risk GIST of the rectum, suspected of the infiltration to the prostate and measuring 10cm in diameter, underwent resection after neoadjuvant therapy of imatinib mesylate. Perineal approach was added because intraperitoneal dissection was not enough, however, the infiltration to the prostate was denied completely due to a reduction in the tumor size, thus total peritoneal resection was avoided. It seems that neoadjuvant therapy with imatinib mesylate is useful for resectability and for the preservation of the functions of ambient organs.
We report three cases of gastrointestinal stromal tumor (GIST) with delayed bone metastasis at least four years after initial surgery. One small intestinal and two rectal GISTs were all considered as high-risk according to the classification based on tumor size and mitotic count. GIST usually metastasizes to the liver and peritoneum, however bone metastasis should be considered in the patients with long prognosis.
A 52-year-old man was admitted to our hospital for fever, jaundice, and general malaise. Laboratory data revealed elevated serum liver enzyme levels (AST 2377IU/L, ALT 2756IU/L) and bilirubin (T-Bil 3.7mg/dl). Blood count showed a marked decrease of platelets (2.0×104/μl). Serological and virological analysis showed positive results for HEV IgM and HEV RNA, indicating a diagnosis of acute hepatitis E. The serum ferritin level was also markedly elevated (23200ng/ml). A diagnosis of virus associated hemophagocytic syndrome (VAHS) was strongly suggested. This is the first report of hepatitis E most likely accompanied by VAHS.
A tumor, which was 10cm in diameter, was found in the lateral segment of the liver of a 42-year-old man in October, 2004. The lesion was clinically diagnosed as focal nodular hyperplasia (FNH). In March, 2006, the patient admitted our hospital complaining epigastralgia, back pain, and fever. Hemorrhage and necrotic region was revealed within the tumor, hence lateral segmentectomy was carried out. The lesion was pathologically diagnosed as a telangiectatic FNH (T-FNH). A possibility that hemorrhage or necrosis may be induced within a T-FNH during its progress should be taken into consideration.
We recently experienced a case of lymphoepithelial cyst of the pancreas, which is a rare benign pancreatic cystic tumor. A 59-year-old-man was pointed out as having a pancreatic tumor based on abdominal ultrasonography findings obtained during a medical check-up. Thereafter, abdominal ultrasonography, CT, and MRI studies revealed the presence of a multi-cystic tumor in the pancreas body to tail measuring 45mm in size which had no infiltrating tendency. The operative findings showed a yellowish-white colored cystic tumor covered with a thin capsule, which could be easily extirpated from the pancreas. The dissected tumor, which contained a curd-like material and a condensed milky liquid, was diagnosed to be a lymphoepithelial cyst of the pancreas based on the pathological findings. Similar reports of lymphoepithelial cysts arising in the pancreas have recently been increasing.