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Purpose Infantile acute subdural hematoma (IASDH) has a limited age distribution and mostly benign clinical features. Mild-type IASDH has a stereotypical clinical course which, however, has been described in only a few studies.Methods Four male infants (aged 6–10 months; mean age: 7.5 months) were diagnosed as mild-type IASDH associated with retinal hemorrhage (RH) after suffering from occipital impact in a fall. The present case series reviews their clinical features and neuroimaging findings, including CT and MRI findings.Results All the infants fell backwards from a standing or sitting position onto a soft surface, striking the occipital region. They began crying on impact, then soon afterwards exhibited seizure-like activity or recurrent vomiting. CT and MRI revealed a thin, unclotted subdural hematoma (SDH) without mass effect or brain parenchymal abnormality. Various degrees of bilateral retinal hemorrhage (RH) were observed. On the day of symptom onset, all infants returned to baseline, and follow-up more than 5 years revealed normal development with no deficits.Conclusions Mild-type IASDH with retinal hemorrhage presents with seizure-like activity or recurrent vomiting preceded by crying after an occipital impact on a soft surface. The clinical course of IASDH is followed by rapid recovery on the day of symptom onset. CT and MRI findings reveal a small, unclotted subdural hematoma (SDH) without a mass effect or cerebral parenchymal abnormality.

Purpose Infantile acute subdural hematoma (IASDH) has a limited age distribution and mostly benign clinical features. Mild-type IASDH has a stereotypical clinical course that, however, has been described in only a few studies. Methods Four male infants (aged 6–10 months; mean age: 7.5 months) were diagnosed with mild-type IASDH associated with retinal hemorrhage (RH) after suffering from occipital impact in a fall. The present case series reviews their clinical features and neuroimaging findings, including CT and MRI findings. Results All infants fell backwards from a standing or sitting position onto a soft surface, striking the occipital region. They began crying on impact and then soon afterwards exhibited seizure-like activity or recurrent vomiting. CT and MRI revealed a thin, unclotted subdural hematoma (SDH) without mass effect or brain parenchymal abnormality. Various degrees of bilateral retinal hemorrhage (RH) were observed. On the day of symptom onset, all infants returned to baseline, and follow-up for more than 5 years revealed normal development with no deficits. Conclusions Mild-type IASDH with retinal hemorrhage presents with seizure-like activity or recurrent vomiting preceded by crying after an occipital impact on a soft surface. The clinical course of IASDH is followed by rapid recovery on the day of symptom onset. CT and MRI findings reveal a small, unclotted subdural hematoma (SDH) without a mass effect or cerebral parenchymal abnormality.

We herein report 2 cases of gastric cancer treated by S-1 and oxaliplatin combination therapy before later undergoing gastrectomy. The pathological results of both cases demonstrated complete response. Case 1 had a giant tumor which was suspected to have invaded the pancreas. Case 2 was associated with extensive lymph node metastasis. Based on the findings of these 2 cases, preoperative chemotherapy with S-1 and oxaliplatin for advanced gastric cancer shows sufficient efficacy.

An acute subdural hematoma (ASDH) in infants without external signs of trauma is differently recognized as shaken baby syndrome (SBS) or abusive head trauma (AHT) in the United States or as infantile acute subdural hematoma (i-ASDH) due to minor head trauma in Japan. The aim of the present case report is to document the existence of i-ASDH as a discrete clinical entity differing from SBS and AHT.

We reviewed 21 patients with locally advanced breast cancer with distant metastasis.The median age was 61 years.The median time to presentation at hospital was 13 months, and the median neoplasm diameter on the first visit was 10 cm.The main histological type was scirrhous carcinoma.Sixteen cases tested positive for hormone receptor(76%), 4 tested positive for HER2(19%), and 3 were triple negative(14%).Four patients underwent surgery.The techniques performed included mastectomy and axillary lymph node dissection.Three patients experienced local recurrence.The first-line treatment was surgery for 1 patient, chemotherapy for 12 patients, hormonal therapy for 7 patients, and trastuzumab for the HER2 positive patients.The median follow-up period was 49 months.The patients for where an operation was performed were 49 months and the operation not- enforcement patients were 54 months.If treatment is possible for patients with locally advanced breast cancer with distant metastasis, multidisciplinary treatment according to individual patient characteristics is recommended. In the case of surgical treatment, careful consideration must also be given to these characteristics.

We report a case of resection of a paraaortic lymph node recurrence, wherein complete response to bevacizumab was observed. Our patient was a 50-year-old woman who had a paraaortic lymph node recurrence during adjuvant chemotherapy with FOLFOX 6 months after surgery for sigmoid colon cancer. She was treated with chemotherapy consisting of FOLFOX plus bevacizumab/FOLFIRI plus bevacizumab, which suppressed progression of the periaortic lymph node recurrence. She underwent surgery for the paraaortic lymph node recurrence, and the pathologic result was complete response. We report that bevacizumab was effective for her paraaortic lymph node recurrence.

A 13-year-old boy with medically intractable sinusitis-related intracranial epidural abscess in the frontal region was treated using percutaneous tapping. Drainage of pus measuring 7 ml yielded excellent postoperative course without cosmetic disadvantage on the forehead. Percutaneous tapping is considered to be the ideal treatment because of minimal invasiveness and cosmetic aspects of the wound.

71歳，男性．平成6年6月に直腸癌のため腹会陰式直腸切断術を受けている．術後再発徴候は無く，定期検診を続けていた．平成17年7月頃より人工肛門部からの出血が度々認められ，平成18年4月には，同部位に顆粒状の粘膜異常を伴う1.5cm大の粘膜下腫瘤を認めるようになったため，平成18年5月に腫瘍摘出術を施行した．病理組織学的診断では粘膜下に高度の炎症細胞浸潤を認め，結節状の腫瘤を形成していた．腫瘍性変化は認めず，炎症性偽腫瘍と診断した．直腸癌術後から隔日で洗腸を続けていたことが，炎症性偽腫瘍の原因になったと推察された．大腸原発の炎症性偽腫瘍では稀であり，人工肛門部での発症例はこれまでに報告がない．

A 61-year-old man was diagnosed with rectal cancer with multiple liver metastases in December 2009, and low anterior resection of the rectum was performed. Postoperative adjuvant chemotherapy with 6 courses of oxaliplatin, Leucovorin, and 5-FU (FOLFOX4) and bevacizumab was initiated, followed by 5 courses of fluorouracil, Leucovorin, and irinotecan (FOLFIRI) and bevacizumab. Right posterior segment (S6, S7) hepatectomy with enucleation of S2, S3 and S5 was performed, and chemotherapy with FOLFOX4 (11 courses) was administered. New metastases in the S5 segment were observed in August 2011 and right hepatic lobectomy was performed. The patient then underwent 8 courses of adjuvant chemotherapy with FOLFOX4. However, left hepatic lobe lateral segment and caudate lobe metastases then appeared. Subsequent repeated chemotherapy with FOLFIRI plus cetuximab (3 courses) and irinotecan plus cetuximab was interrupted in August 2013 owing to adverse events resulting in rapid growth of hepatic metastases. The patient underwent hepatic left lateral segmentectomy and left caudate lobectomy. The postoperative course was uneventful and the patient has currently survived 4 years and 7 months after the initial surgery.

We report a case of gastric cancer accompanied by disseminated carcinomatosis of the bone marrow treated with S-1 and cisplatin( CDDP) combination chemotherapy. The patient was a 68-year-old woman who was detected as having disseminated intravascular coagulation( DIC) during an examination for gastric cancer and she was diagnosed as having disseminated carcinomatosis of the bone marrow by lumbar puncture. She was immediately treated with S-1 and CDDP combination chemotherapy( S-1, 80 mg/body orally administered[ po] on days 1-21 and CDDP, 60 mg/body intravenously [iv] administered on day 8) and her DIC improved on the fourth day. Subsequently, the patient was treated with 3 courses of combination chemotherapy and she survived for 184 days from the initiation of the treatment. Although disseminated carcinomatosis of the bone marrow is associated with a poor prognosis, we believe that the duration of survival of our patient was extended due to initiation of chemotherapy at an early stage.

特発性大腸穿孔は明らかな原因を認めずに大腸に穿孔をきたす比較的まれな疾患で, 予後不良といわれている. 今回, 82歳と84歳で2度にわたり特発性大腸穿孔を発症し, 救命しえた症例を経験したので報告する. 症例は84歳の女性で, 82歳時に特発性大腸穿孔にてHartmann手術を施行されている. 腹痛を主訴に近医より汎発性腹膜炎の診断にて当院に搬送された. 入院時78/48mmHgと血圧の低下を認めた. 腹部単純X線, CT検査にて腹腔内遊離ガス像を認め, 消化管穿孔の診断にて緊急手術となった. 人工肛門の口側8cmの部位に長径3cmの穿孔を認めたため, 穿孔部を含めて結腸を切除し, 新たに人工肛門を増設した. 病理組織検査より特発性大腸穿孔と診断した. 術後43日目に軽快退院した. 高齢者の突然の腹痛では, 本症を念頭において, 早期診断と適切な早期治療を心がけることが重要である.

To elucidate the mechanism of excessive size of the head in Sotos syndrome, serial neuroimaging features from birth were reviewed in two patients. Macrocephaly shortly after birth was attributed to increased volume of the cerebral parenchyma itself (megalencephaIon). Subsequent excessive size of the head was related to retention of cerebrospinal fluid in the ventricles and the subarachnoid spaces. Thus, macrocephaly in Sotos syndrome reflects two different mechanisms. The value of serial evaluation of intracranial structures is emphasized. [Neural Res 1998; 20: 149–152]

A 55-year-old man with traumatic acute subdural hematoma (SDH) was managed nonsurgically because of having isolated mild headache that resolved within a week. However, the patient developed an acute onset of amnestic aphasia 12 days post-trauma. Although the SDH itself did not increase in volume, remarkable swelling of the ipsilateral cerebral hemisphere was observed on CT scanning. Craniotomy was required since the main component of the SDH was solid and partially organized. Post-operative recovery from his speech disturbance was delayed, necessitating speech therapy for more than two months. Additionally, decreased cerebral blood flow on the affected side was observed even 3 months after injury. Symptomatic subacute SDH exclusively presenting as focal neurological deficits, though very rare,is worthwhile to be kept in mind as a pitfall in nonsurgical management of acute SDH.

The incidence of hemangioma is the highest of all benign tumors of the liver, but subjective symptoms are few and surgical tretment is performed only in symptomatic cases of giant tumor. We experienced two interesting patients with giant cavernous hemangioma of the liver showing subjective symptoms. Case 1 was a 45-year-old woman complaining of general fatigue and an abdominal mass. A giant hemangioma in the lateral and posterior segments of the liver associated with coagulopathy (reduced platelet counts and fibrinogen, and elevated total serum FDP) was diagnosed and hepatectomy was performed. Case 2 was a 34-year-old woman diagnosed as to have a giant hemangioma in the posterior segment of the liver. After a 7-year observation period the tumor suddenly start to enlarge, and subsequently a right upper abdominal pain and slight fever developed. Hepatectomy was performed in order to avoid the risk of rupture. Good results were obtained in both cases with disappearance of subjective and objective symptoms.

Case report: An 8-year-old boy who was treated for hydrocephalus with lumboperitoneal shunting presented with extreme night bradycardia. Results and conclusion: The night bradycardia disappeared after shunt revision, suggesting that the probable cause was secondary to long-lasting increased intracranial pressure (ICP). Long-lasting increased ICP is known to be associated with papilledema, but it has rarely been reported to induce night bradycardia in clinical practice. Extreme night bradycardia in this setting is not only a clinical sign of increased ICP but also a possible cause of cardiogenic sudden death, which must be borne in mind in the management of patients with shunted hydrocephalus.

While the efficacy of cerebrovascular bypass surgery for Moyamoya disease with ischemic events has been substantiated, the surgical indication for the patients presenting with intracranial hemorrhage is as yet undetermined. In an effort to prevent rebleeding from rupture of Moyamoya vessels, seven patients with intracranial hemorrhage underwent indirect bypass surgery. During the follow-up period between 2 and 11 years (mean 4.9 years), one patient suffered rebleeding 5 years after bypass surgery. Follow-up cerebral angiography failed to show revascularization and reduction of moyamoya vessels in all but one of seven patients. Thus, the author's experience suggests that bypass surgery for Moyamoya disease with hemorrhage is angiographically far less successful compared to that with ischemia. A review of the series including patients with angiographically successful revascularization and reduction of Moyamoya vessels failed to demonstrate the definitive effectiveness in eliminating the risk of further intracranial hemorrhage.

In order to investigate the duodenal motor activity after subtotal gastrectomy (Billroth-I, R2 lymph node dissection) for gastric cancer, migrating motor complex (MMC) of the duodenum was recorded using a micro-tip force transducer in 19 patients. At the same time serum levels of gastrointestinal hormone were measured. The following results were obtained. 1) MMC were observed in 12 patients, but not in the other 7 patients in whom only phase II was sustained. 2) It was suggested that the vagus nerve might not contribute to occurrence of MMC. 3) Possible participation of motilin and somatostatin as well as the necessity of their cooperation action in occurrence of MMC were also indicated.

Obturator foramen hernia is a relatively rare disease and is likely to occur in aged, thin females. Herein we report a case of obturator foramen hernia associated by incarcerated femoral hernia. A 95-year-old woman was seen at the hospital because of nausea and vomiting. At admission, she was diagnosed with incarcerated femoral hernia due to swelling at the right lower area of the groin. Because an abdominal simple X ray demonstrated intestinal obstruction as well as Howship-Romberg sign was obtained, a pelvic CT was performed. The pelvic CT demonstrated right obturator hernia. At laparotomy, a large omentum was incarcerated at the right femoral ring while the small intestine 130cm proximal from the terminalileum showed Richter type hernia at the right obturator foramen. Operative procedures included: reposition of the large omentum and the ileum; resection of a part of the large omentum; and closure of the hilus of the hernia. With a recent progression in imaging procedures, clinical cases diagnosed as obturator foramen hernia preoperatively have been increasing. Aggrssive examination sincluding CT scan are useful in making preoperative diagnosis of the disease, especially not to overlook associated hernia which is difficult to be detected by palpation like in this case.

A case is presented in which recurrence of acute subdural hematoma developed 29 days after head trauma. An emergency craniotomy was complicated by intraoperative profuse bleeding, which was caused by the rupture of a large false aneurysm of the middle meningeal artery. A pitfall in the surgical treatment of this rare lesion is discussed.

Preoperative evaluation using serial magnetic resonance imaging was performed on an infant with lumbosacral lipoma. Syrinx formation arising just above the lipoma was observed in conjunction with rapid growth of the lipoma. Definite shrinkage of syringomyelia was obtained after radical excision of the lipoma. The syrinx formation was possibly caused by compression from the extramedullary lipoma.

We describe two patients with rebleeding from intracranial vertebral artery dissecting aneurysms during the acute stage. One patient had excellent results after emergency surgery. A review of recent reports including 60 patients with this disorder revealed a rebleeding rate of 30%, mostly during the acute stage. This suggests that a ruptured dissecting aneurysm in the vertebral artery is at risk for rebleeding during the acute stage, similar to a saccular aneurysm in the same location.

✓ The cases of 30 infants with chronic subdural hematoma treated surgically between 1978 and 1987 (after the introduction of computerized tomography) were reviewed. This series was limited to infants presenting with increased intracranial pressure, neurological deficits, or developmental retardation. Nineteen patients were male and 11 were female, ranging in age from 1 to 14 months (average 6.1 months). The surgical treatment was initiated with percutaneous subdural tapping which was repeated periodically, if indicated, for 2 weeks. If the patients failed to respond to subdural tapping, subdural-peritoneal shunting was installed. The follow-up periods were from 3 months to 9 years 8 months (average 4 years 10 months). Computerized tomography at that time disclosed disappearance or minimal collection of subdural fluid in 28 cases (93%) and a significant collection (> 5 mm) in two (7%). Neurological examination revealed that the patients were “normal” in 17 cases (57%), “mildly or moderately disabled” in nine (30%), and “severely disabled” in four (13%). The majority of disabled patients had lesions secondary to infantile acute subdural hematoma, child abuse, or hemorrhagic diathesis. These results indicate that the treatment protocol in the present series is acceptable for the elimination of subdural hematoma. Together, early diagnosis and treatment of the etiological conditions causing the lesion are indispensable for obtaining a satisfactory neurological outcome.

Two cases of TS associated with brain tumors had severe psychomotor retardation and early onset of long-term intractable convulsions, compared with cases without tumors. In one case, the tumor was partially cystic and progressed rapidly. Immunohistochemical studies of neuron specific enolase, glial fibrillary acidic protein and myelin basic protein revealed differences in positivity between cell types and between cases. These results suggested that the origin of the tumor cells could be variably differentiated cells.

Embryonal urachus exists as a cord-like structure between the urinary bladder and the umbilicus. In some cases of urachal cysts at the level of the navel, no special symptoms are detected during childhood, but spontaneous drainage at the navel may occur after adolescence, which is called an infected urachal cyst. Especially in cases accompanied by infected omphalitis, no constant opinion has been established to choose either initially curative resection or staged incision. In this study, we evaluated the characteristics of patients with urachal cysts who underwent the staged approach. Twenty patients (14 men and 6 women) with urachal cysts complicated by infected omphalitis were treated in our hospital. Staged surgery was performed for 18 patients. Neither recurrent omphalitis nor subsequent urachal carcinoma was observed. It is desirable that urachal cyst accompanied by intractable omphalitis should be treated by conservative therapy, conducted image diagnosis, and chosen staged surgery.

A 70-year-old male presented with rapid neurological deterioration and fever 3 months after suffering a closed head trauma. He underwent craniotomy for possible subdural empyema based on computed tomography and clinical findings. Dural incision revealed an outer membrane typical of chronic subdural hematoma which covered a clear, yellowish fluid containing Campylobacter fetus. Histological examination confirmed the capsule of the hematoma, with a necrotic focus infiltrated by neutrophils. Administration of intravenous imipenem and topical tobramycin and cefalothin achieved total resolution of his neurological deficits. Development of the infected subdural effusion was probably secondary to bacterial infection in the pre-existing chronic subdural hematoma in the resolving stage. The presence of the hematoma capsule always carries the risk of development of an infectious focus.

We report a 64-year-old woman who underwent mastectomy for stage II (T2N1M0) advanced breast cancer, in whom multiple spine metastases developed 18 months postoperatively. She received 6 cycles of CA (cyclophosphamide 500 mg/m2, ADM 50 mg/m2 3 wq) therapy and oral tamoxifen (20 mg/body) administration for adjuvant therapy. The multiple bone metastases of the spine were revealed by technetium bone scan. The level of serum tumor marker CA15-3 increased two times over the normal range 18 months after surgery. She also developed osteoporosis a few years later, so we selected high-dose toremifene administration (120 mg/body) as a second-line therapy. No adverse effects have occurred and bone metastases disappeared. Moreover, the tumor marker was also normalized 6 months after toremifene therapy started. It was shown that high-dose treatment of toremifene was useful for recurrent breast cancer with bone metastasis.

The patient was a 50-year-old female with peritoneal metastasis of Type 4 gastric cancer. She underwent a relative curative resection with total gastrectomy and peritonectomy. Postoperative chemotherapy with 5'-DFUR following 5-FU and CDDP was performed. Thirteen months after surgery, cancer recurrence was suspected due to elevated levels of the serum tumor markers carcinoembryonic antigen (8.9 ng/ml) and alpha fetoprotein (85.8 ng/ml). She was additionally treated with UFT 300 mg/day and Lentinan 2 mg/week. The serum tumor markers decreased gradually returned to normal levels. At 5 years and 8 months after surgery, she is alive without any sign of recurrence.

A 57-year-old male developed subdural effusion after head trauma, which remained asymptomatic and unchanged in volume during a follow-up period of 3 months. A typical chronic subdural hematoma (CSDH) developed 6 weeks after burr-hole exploration in spite of the absence of hematoma capsule or blood components in the effusion. The CSDH was successfully treated by irrigation and drainage. This case suggests that the presence of blood in subdural effusion may be the trigger for evolution of CSDH. We recommend that asymptomatic subdural effusion should be followed up without surgical intervention.

Ulcerative colitis (UC) associated with Takayasu's disease (TD) is not common in Japan. Here, we report two patients with both diseases who received a total proctocolectomy. Patient 1, a 41-year-old woman with chronic continuous type UC, was first diagnosed with TD at the age of 10 years. Subsequently, she was diagnosed with UC and rectal cancer. HLA typing showed A2, A31(19), B52(5), and DR2(DRB1*1502). Coronary angiography showed 90% narrowing of the right coronary artery (RCA). After alleviating the RCA narrowing by percutaneous transluminal coronary angioplasty (PTCA), we performed a total proctocolectomy and ileostomy. Patient 2, a 20-year-old woman, was first diagnosed with TD at the age of 13 years. Severe symptoms, indicating fulminant UC, started 1 month prior to hospitalization. She was judged as needing surgery because the symptoms were not alleviated even with high doses of prednisolone. HLA typing showed A2, A31(19), B52, B61(40), DR2(DRB1*1502), and DR4 (DRB1*0405). Aortography showed a narrowing of the right renal artery; however, her renal function was normal. Based on these findings, we performed a three-stage operation for total proctocolectomy. Previously, we have reported that the DRB1*1502 and DRw11 genes were closely related to the intractability of UC. To date, we have not determined whether or how the DRB1*1502 gene might be related to TD. As the number of cases of UC associated with TD increases, it will be necessary to examine their DR2 subtypes.

In an effort to maximize the effectiveness of subdural-peritoneal shunting for the treatment of chronic subdural hematoma in infants, the author developed a new shunt system. The characteristics of this shunt include a large-caliber catheter, a very low pressure slit valve, and a one-piece design with a large flushing device. This shunt is particularly useful for patients without increased intracranial pressure, who are usually refractory to treatment using a conventional ventriculoperitoneal shunt system.

A patient who suffered rapid deterioration due to cerebral vasospasm 18 days after aneurysmal subarachnoid haemorrhage is reported. Unusually delayed onset of ischaemic neurological deficits and its preventative management is discussed.

An eight-month-old boy with clinical features of acute encephalopathy with symmetrical low-density areas in the thalami and the putamen on computed tomography is presented. These particular computed tomography features suggest potential aetiology common to acute encephalopathy with low-density areas in the thalami and infantile bilateral striatal necrosis with an acute onset The therapeutic consideration of these conditions is also discussed.

BACKGROUND This case illustrates that although percutaneous subdural tapping for patients with chronic subdural hematoma (CSDH) is successful and minimally invasive, it can be complicated by acute epidural hematoma. CASE PRESENTATION A 62-year-old woman presented with headache two months after minor head trauma. Computed tomography (CT) scanning revealed CSDH with mixed density on the right side. Prior to percutaneous subdural tapping, twist-drill craniostomy was performed at the parietal tuber. When the drill-needle reached the dura mater, the patient began to complain of headache, which was followed by altered consciousness. CT scanning disclosed acute epidural hematoma abutting the CSDH; both hematomas were evacuated by emergency craniotomy. At surgery, no definite bleeding source was identified apart from oozing on the dura mater. CONCLUSION Hemorrhagic complications after percutaneous subdural tapping are rare. The formation of acute epidural hematoma during twist-drill craniostomy has not been reported in the literature. This complication can occur when the blunt tip of the drill-needle remains on the dura mater without penetrating into the subdural hematoma cavity.

A 57-year-old, previously healthy man who developed acute onset of hemiplegia is presented. Neuro-imaging studies on admission suggested dissection of the middle cerebral artery producing infarction in the frontotemporal region. In contrast to his stable clinical course, serial neuro-imaging studies disclosed rapid growth of malignant glioma, which was confirmed at surgery. Microscopic examination of the surgical specimen demonstrated invasion of glioma cells into the arterial wall associated with intramural haematoma formation of the middle cerebral artery. This case is the first to document dissection of an intracranial artery caused by invasion of tumour cells.

The authors report a case of postoperative middle meningeal arteriovenous fistula found after craniotomy for aneurysmal surgery using the pterional approach. It was no longer demonstrable at the follow-up examination 3 months later.