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Gender identity disorder is defined as a condition in which physical and mental sexuality do not match. A female-to-male (FTM)has the mental sexuality of males and the physical sexuality of females. FTM transsexuals generally receive androgen therapy, mastectomy, and sex reassignment surgery to live as their desired sex. The risk of breast cancer in FTM transsexual patients remains unclear. We report a case of breast cancer in an FTM transsexual. A 44-year-old man who underwent mastectomy and sex reassignment surgery and received androgen as hormone therapy developed breast cancer. At first glance, mastectomy and sex reassignment surgery may reduce the risk of breast cancer by suppressing estrogen. However, there are reports of breast cancer in FTM transsexuals. It is important to provide sufficient information that patients may develop breast cancer from residual breast tissue and that they should therefore start hormone therapy even if they have undergone mastectomy and sex reassignment surgery. In order to decide whether to restart androgen therapy after breast surgery, it is necessary to consider not only the risk of recurrence of breast cancer but also their gender identity.

Patient 1 was a 59-year-old woman receiving prednisolone for idiopathic hypereosinophilia. Brain MRI of patient 1 disclosed slight gadolinium enhancement at lesions, indicating inflammation. Patient 2 was a 32-year-old woman with systemic lupus erythematosus under immunosuppressive therapy. Brain biopsy of patient 2 showed balanced infiltration of CD8+ and CD4+ T lymphocytes at the sites of lesions. Both subjects were diagnosed as having progressive multifocal leukoencephalopathy (PML) shortly after the onset of neurological symptoms and were treated with a combination of mefloquine, mirtazapine, and risperidone. Both patients remain alive with improved neurological symptoms even after long-term follow-up (24 months in patient 1 and 45 months in patient 2). Although the prognosis of PML is very poor, our findings suggest that pharmacotherapy may be effective for patients with well-controlled immune reactions against the JC virus.

Objective: We investigated the clinical efficacy and pharmacokinetics of lamotrigine (LTG) as an add-on therapy in childhood-onset intractable epilepsy., Methods: We reviewed the charts of 28 outpatients who had received LTG as an add-on therapy. The data collected included epilepsy type, seizure frequency, concomitant anti-epileptic drugs, dosage of LTG and LTG serum levels. Furthermore, we reviewed the relationship between the LTG serum levels (microg/ml) and dosage of LTG (mg/kg/day), as well as the relationship between the LTG serum levels (microg/ml) and clinical efficacy in the following 2 groups:the valproate sodium (VPA) combination group and the non-VPA combination group., Results: A reduction of 50% or more in seizure frequency was observed in 10 patients. In addition, there was a high correlation between the LTG serum levels and the dosage of LTG in each group. In the VPA combination group, the average of LTG serum levels in patients with adequate therapeutic response (50% reduction in seizure frequency) was higher than that in patients without adequate therapeutic response. In the non-VPA combination group, the average LTG serum level in adequate response patients was lower than that in patients without adequate therapeutic response. However, the epilepsy types of adequate response patients differed in the two groups., Conclusions: The LTG serum level is predictable based on the dosage of LTG. It was judged that the effective blood concentration of LTG differed when used with VPA, although factors other than the combined use of VPA should have been taken into consideration also.

The patient was a 72-year-old woman diagnosed with advanced gastric cancer, hepatic portal lymph node and para-aortic lymph node metastases. After five courses of S-1/CDDP combination therapy, both the primary tumor and lymph node metastases disappeared clinically. She wished to continue chemotherapy instead of having a resection. After three more courses of S-1/CDDP therapy, gastric cancer and lymph node metastases were still completely regressed, but complications of carcinoma of the gallbladder were suspected. Gastrectomy was performed with cholecystectomy, and a histopathological examination revealed cancer cells remaining in the gastric submucosa and xanthogranulomatous cholecystitis. We consider surgical therapy for clinically completely disappearing advanced gastric cancer by chemotherapy, in addition to case report.

Examination of a 58-year-old woman who had developed severe upper back pain showed left peripheral type of facial nerve palsy, sensory disturbance of limbs and body trunk (Th7-9), cerebellar ataxia and generalized hyporeflexia. Upper back pain increased at night and was resistant to NSAIDs, antianxiety agents, opioids, and corticosteroids. Concentrations of serum CK and cerebrospinal fluid total protein were elevated. Electromyography (EMG) of perivertebral muscles (Th7-10) showed reduced recruitment and polyphasic potential. Several days later, our patient developed weakness of limbs and respiratory failure, and required mechanical ventilation. From these findings, we diagnosed her as having Guillain-Barré syndrome (GBS) and began treatment with intravenous immunoglobulin therapy. All symptoms including upper back pain improved gradually, and she had recovered almost completely by the 40th hospitalization day. Pain, especially lower back and leg pain, have attracted attention as common symptoms in GBS. However, only one GBS patient with initial severe upper back pain has been reported. Although the precise mechanism of pain in GBS remains unclear, EMG findings lead us to surmise our patient's pain originated from the nerve roots. Limb and back pain should therefore be taken into account for the diagnosis and treatment of GBS patients.