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A man in his 70s was observed to have GIST recurrence 19 months after surgery. Chemotherapy was initiated with imatinib 400 mg/day orally. The dose was eventually reduced to 100 mg/day to avoid side effects. Tumor reduction was confirmed 3 months after treatment initiation. Currently, 84 months after the onset of GIST, the patient survives with continuous intake of the same dose of oral imatinib. We were able to observe long-term survival in a patient with recurrent GIST after the administration of a small dose of imatinib.

Pediatric deep neck abscesses are a relatively rare and can lead to critical or life-threatening situations. However, the clinical characteristics of pediatric deep neck abscesses are not fully understood in Japan. We conducted a retrospective study of the clinical characteristics of children presenting with pediatric deep neck abscesses at our hospital. All pediatric patients were diagnosed with deep neck abscesses on the basis of the clinical findings and computed tomography (CT) scanning of the neck between April 2009 and March 2014. The incidence, initial examining department, sex, age, presenting signs and symptoms, physical findings, duration between onset and admission, timing of CT scanning, abscess location, causative organism, and method of treatment were determined from the medical records. 　We identified a total of 20 pediatric patients with deep neck abscesses, with a mean incidence of 4.0±1.9 cases per year. Pediatric deep neck abscesses were more common during winter and spring. Most patients initially presented to the pediatric department before consulting an otolaryngologist. Fourteen (70%) patients were male and six (30%) were female, with no obvious peak age of onset. The mean duration between onset and admission was 7.2±3.9 days. The mean timing of CT scanning was 8.1±3.6 days after onset. The most commonly involved area was the retropharyngeal space in nine (45%) and the retro-cervical space in eight (40%) patients. The most frequent causative organism was Staphylococcus aureus (20%), with no cases of antibiotic-resistant bacteria infection observed. Majority of the children were initially managed with conservative treatment. Five patients who failed to improve within 48 h of treatment subsequently underwent surgical drainage. No significant complications such as descending mediastinitis and septic shock were observed in any of the patients.

A 30-year-old man was admitted with anemia. Colonoscopy showed diffuse small polyps in the colon, 1 cancer in the sigmoid colon, and 2 cancers in the rectum. He was diagnosed with familial adenomatous polyposis (FAP). Total colectomy was conducted laparoscopically through 5 trocars, and a total proctocolectomy (TPC ) was performed. The operating time was 9 hours and 30 minutes, and intraoperative blood loss was 20 g. On the 1st postoperative day, he started oral intake. On the 14th postoperative day, he was discharged from our hospital. We thus consider laparoscopic resection to be a very useful technique for FAP.

An 76-year-old man was referred to our hospital due to right hydrothorax. The diffuse thickening of parietal pleura with increased fluoro-2-deoxy-D-glucose (FDG) uptake was noted by computed tomography (CT) and positron emission tomography (PET). Surgical biopsy was performed and the tumor was diagnosed as mucosal associated lymphoid tissue (MALT) lymphomas of parietal pleura origin by pathology. Complete remission was achieved by postoperative chemotherapy (R-CHOP), and the patient is now alive without recurrence.

Mumps infection is anecdotally believed to occur only once over a lifetime. However, in recent years, it has gradually come to be recognized among pediatricians that mumps reinfection is not a rare condition, and some criteria for the mumps reinfection have been proposed. One of the widely accepted criteria is levels higher than 25.8 IU/dl of serum IgG antibodies against the mumps virus and lower than 2.0 IU/dl of serum IgM antibodies. From July 2010 to June 2011, 45 patients with acute swelling of the major salivary gland(s) were enrolled into our survey of mumps reinfection in Tsuchiura Kyodo General hospital. Serum IgG and IgM antibodies against the mumps virus were measured at the initial visit. Ten cases were diagnosed as having primary infection with the mumps virus, while the other 10 cases were diagnosed as having reinfection with the mumps virus according to the criteria. The present study suggests that mumps reinfection is a common condition in patients with acute swelling of the major salivary glands in adulthood.

A 77-year-old woman was admitted to our hospital with abnormal chest shadow detected on a medical checkup. Chest computed tomography(CT)showed a well-defined tumor in the upper lobe of the right lung. On positron emission tomography by fluorodeoxyglucose(FDG),the tumor revealed to be positive. We performed right upper lobectomy with hilar and mediastinal lymph node dissection. The histopathological diagnosis was lymphoepithelioma-like carcinoma (LELC). In the past 25-years, 41 cases have been reported in Japan. The average age is 64 years old, including 25 male cases and 16 female cases. Among these cases, more than half were in the early resectable stage.

60-year-old woman was admitted with an abnormal shadow on the chest roentgenogram. Computed tomography showed atelectasis of the right middle lobe and hilar and mediastinal lymphadenopathy. Bronchoscopic examination revealed an obstruction at the orifice of the right middle lobe bronchus and biopsy was performed. The biopsy suggested malignant lymphoma. A diagnosis of methotrexate-associated lymphoproliferative disorders was suspected because the patient was administered methotrexate to treat the rheumatoid arthritis. The video-assisted thoracoscopic surgery was performed. Histological examination showed no malignancy and sarcoidosis in the peribronchial lymph nodes. The compressed middle lobe bronchus by enlarged lymph nodes was consider to be the cause of the middle lobe atelectasis.

The patient was a 60's-year-old man, who was incidentally pointed out a coin lesion in the right lung by chest radiogram. Chest computed tomography showed a round-shaped, well defined nodule of 2.5 cm in size in the right S1. Positron emission tomography did not show the accumulation of fluorodeoxyglucose in the nodule. We considered the tumor to be benign, but the patient chose surgical treatment. Partial resection of the lung was performed by thoracoscopic surgery. Histopathological diagnosis was human pulmonary dirofilariasis.

A 71-year-old man, who had been given a diagnosis of Bochdalek hernia in infancy, was referred to our hospital for dyspnea The chest X-ray and computed tomography (CT) showed left pneumothorax with bullas and intestines in his left thoracic cavity. He was admitted to our hospital and a chest tube was inserted into the left pleural cavity. The left lung expanded immediately and air leakage was stopped. He became asymptomatic and he was discharged from the hospital on the 8th day. Most Bochdalek hernias are observed in infancy, and adult cases combined with pneumothorax and bullas are very rare.

An 84-year-old woman visited a local clinic with the complaint of upper abdominal pain and was referred to our hospital because of a suspected mediastinal tumor. Chest and abdominal computed tomography (CT) scanning were performed and Morgagni's hernia that contained omentum was identified on multiplanar reconstruction (MPR) images. Repair surgery was performed via mini-thoracotomy with thoracoscopy. The omentum witch was adherent to the hernial sac in the thorax was carefully dissected and was replaced in the abdomen. The diaphragmatic defect was closed and was reinforced with an expanded proline mesh patch. The thoracoscopic surgery with mini-thoracotomy can be a safe and effective method for repairing a Morgagni's hernia of which contents are thought to be omentum and when intrathoracic adhesions in the hernial sac are suspected.

A 40-year-old female had right-sided pneumothorax. She was treated with a chest tube. On the 2nd day, her menstruation started. Because of a persistent air leak, she underwent a thoracoscopic operation on the 15th day. During the operation, we noted a pulmonary bulla at the apex and multiple blue berry spots both on the visceral pleura and the tendinous part of the diaphragm. We performed a resection of the pulmonary bulla, partial diaphragmatic excision plus suture. Section of visceral pleura and diaphragm shows ductal structures, which is insistent with endometriosis. The serum CA125 level decreased to 39 U/ml. Following surgery, oral contraceptives was started and no recurrence was encountered thereafter.

A 66-year-old woman felt dysphagia gradually seven years after an operation of breast cancer. We diagnosed her with esophageal metastasis of the breast cancer, and carried out irradiation and outpatient chemotherapy. Because her general condition became worse after the treatment for about four years, we performed an operation of gastric fistula and tracheotomy to manage her nutrition and of an accidental swallowing. Although the patient and her family resisted a discharge from hospital due to the progressive nature of her illness and change in physical surroundings, she was eventually switched to take a homecare medical treatment with the support of a team care approach. The main purposes of the homecare treatment were to manage gastric fistula including the administration of anti-cancer drugs, cervicobrachial pain control and tracheal cannula exchange. Though she was mentally stable and got along well with the family during the home stay, she was hospitalized again two months after the homecare treatment because of aggravated symptoms and the family's fatigue. We respected the value of her quality of life and gave careful considerations to support her during the entire period of re-hospitalization. She gently died two months after re-hospitalization. We considered that this palliative home care could be realized with the palliative team care, nursing intervention visit and family support.

Purpose: Local application of vascular endothelial growth factor (VEGF) was examined to determine whether it is effective in promoting bone regeneration., Methods: We operated on live 6-week male SD rat mandibular bone tissue to prepare bone defects in order to attempt the guided bone regeneration (GBR) method. Laboratory animals were divided into 3 groups: the control group, the fibrin group, and the VEGF group. Both radiological observation using soft x-ray and histological observation were performed respectively on the 10th, 20th and 30th days after the operations., Results: After 10 days, there was no apparent radio-photographic changes in the bone defects. However, after 20 days there were quite apparent changes, and after 30 days there were even more remarkable changes. The fibrin and VEGF groups changed more than the control group. In our histological observation, we observed rich capillary formation most notably in the VEGF group. This VEGF group also exhibited regeneration in the bone tissue., Conclusions: Histological and soft x-ray radiological observations indicated that VEGF was effective for blood vessel formation, and VEGF offers potential for bone regeneration.