A 68-year-old female complained of muscle pain and weakness of both thighs resulting in gait and squatting disturbance, pain in the shoulders and knees, and these persisted for 2 months. The patient also complained of ptosis and easy fatigability of extremities. Anti-nuclear factor was positive and anti-acetylcholine receptor antibody was highly elevated, while anti Jo-1 antibody was negative. Ptosis improved on edrophonium test, while muscle power of extremities and gait disturbance did not improve. Muscle biopsy of the thigh demonstrated the irregular degeneration of the muscle fibers, infiltration by inflammatory lymphocytes and neutrophils. Electromyograpy measured in median nerve demonstrated a neuromuscular unit (NMU) of low amplitude and short duration, and waning. These findings were compatible with the simultaneous occurrence of polymyositis and myasthenia gravis. Musle pain, weakness of extremities and gait disturbance were improved by administration of prednisolone, although the complaints of easy fatigability of the extremities and ptosis remained to some extent after gradually tapering the dose of prednisolone. Those complaints were later ameliorated by administration of ambenonium chloride.

View full abstract

A 56-year-old woman was admitted for upper abdominal pain of 2 days'duration. After admission, she developed a high-grade fever, and her white blood cell count and C-reactive protein level were elevated. Abdominal computed tomography and magnetic resonance images revealed a homogenous thick-walled cystic lesion measuring 21 cm in diameter in the left lobe of the liver. The lesion was diagnosed as an infected liver cyst. Because antibiotic treatment for inflammation and percutaneous transhepatic drainage were unsuccessful, we performed surgical fenestration of the liver cyst. Liver plasty with suturing was performed to restore the shape of the liver, which was deformed by the fenestration procedure, and prevent adhesion of intraperitoneal organs. The postoperative course was uneventful. Four months after surgery, the shape of the liver was almost fully restored. In case of infected liver cyst, surgical treatment must be performed as soon as possible if antibiotic treatment and percutaneous transhepatic drainage are unsuccessful. Liver plasty is effective if the organ is deformed after fenestration.

View full abstract

Proton pump inhibitors (PPIs) are known to be the most potent anti-ulcer agents, because of stronger inhibitory action of gastric acid secretion in comparison with H₂-receptor antagonists (H₂-RAs). PPIs have been used in the treatment of H₂-RA-resistant ulcers. However, in accordance of accumulation of these cases, it is also known that some peptic ulcers are resistant even to PPIs as well as H₂-RAs. Two patients who suffered from hemorrhagic gastric ulcers were admitted to our institution. The hemostasis was verified by endoscopy after intravenous administrations of H₂-RAs. Rebleeding from ulcers occurred after change of intravenous injection of H₂-RAs to oral administrations of PPIs. H₂-RAs was given again instead of PPIs, and gastric ulcers were healed. It is not clear why some gastric ulcers are resistant to PPIs. We considered that disturbance of gastric emptying was one of the important factors to develop PPI-resistant ulcers.

View full abstract