The patient was a 36-year-old woman who had undergone modified radical mastectomy for right breast cancer in November 2005. An LH-RH agonist and tamoxifen were administered, but metastasis was found in the right femoral bone, so six cycles of EC therapy were administered. A partial response was achieved, but the bone metastasis worsened in June 2007, so administration of docetaxel and trastuzumab was added. This treatment was continued because a partial response was achieved, but metastatic tumors appeared in the lateral region of the left lobe of the liver in April 2008, and they had grown bigger by July 2008, so we changed docetaxel to vinorelbine administered for 2 weeks, followed by a week of rest. Serum LDH and CA15-3 levels began to increase in August 2008, and the metastatic tumors showed marked enlargement, so we performed hepatectomy and inserted an indwelling catheter in the hepatic artery in October 2008. After the operation, a combination of hepatic intra-arterial epirubicin every week and systemic irinotecan every 2 weeks with trastuzumab every week was begun and is ongoing. As of January 2009, 3 months after the operation, the outcome has been good, with no recurrence or metastatic lesions seen on PET-CT.

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A 72-year old female was urgently admitted to our hospital with the chief complaints of abdominal pain and nausea. Abdominal CT scan revealed expanded small intestine and a mass of some ingested material. After conservative treatment with long-tube drainage, laparotomy was performed on the eleventh day because her condition was not getting better. Minimally invasive surgery via a 5cm mini laparotomy was performed and during the operation, small amount of rice wrapped by plastic wrap was found causing obstruction 60cm proximal to Bauhin's valve, and was removed. Food induced small bowel obstruction must always be kept in mind when we encounter patients presenting bowel obstruction, and it is important to interview patients about food ingested and to detect the foreign body on imaging methods including CT scan for successful preoperative diagnosis to perform minimally invasive surgery

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A 23 year-old female developed anorexia nervosa, with weight loss and anorexia. CBC revealed leucopenia, and bone marrow biopsy specimen revealed hypocellular and deposition of gelatinous material. These hematological abnormalities are primarily caused by malnutrition, however, the precise mechanism remains unknown. Endocrinological study revealed decreased plasma levels of insulin-like growth factor 1 (IGF-1) and leptin, and increased levels of growth hormone (GH), and cortisol. Since these hormones of IGF-1 and leptin are reported to have the receptors for the hematopoietic stem cells, the suppression of hematopoiesis in anorexia nervosa might be related in a part to decreased levels of these hormones. The pharmaco and psycotherapy brought the increases in the body weight and leukocyte count after 3 months.

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A 31-year-old man was given a diagnosis of Crohn's disease at age 20, and was complicated with anorectal fistula from age 22. At age 28, seton drainage was performed because of deterioration of anorectal fistula. He underwent treatment of digestive therapy after drainage, but second surgery was performed by seton drainage because of perianal abscess. From age 29, treatmet with Infliximab was started, but he had third surgery for recurrence of anorectal fistula at age 30. His symptom was improved after seton drainage, and perianal inflammation was also improved by Infliximab. Seton drainage for anorectal fistula in Crohn's disease is efficacious both in treating inflammation and preserving anal sphincter function.

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We report a case of intussusception caused by a colon lipoma, diagnosed based on the findings of abdominal computed tomography (CT). An 80-year-old man presented with abdominal pain and abdominal ultrasonography showed intussusception. Abdominal CT showed a "coil spring" appearance of the transverse colon with a low-density area in the center, suggestive of a tumor. Intussusception caused by transverse colon lipoma was suspected and the patient underwent emergency surgery the same day. After successful reduction of the intussusception with Hutchinson's maneuver via laparotomy, we performed a transeverse colectomy. Histological examination confirmed a diagnosis of benign lipoma. The postoperative course was uneventful. We report this case to show that colon lipoma should be included in the differential diagnosis of adult intussusception.

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