[A Case of Intracranial Epidural Abscess Secondary to Medication-Related Osteonecrosis of the Jaw].

Recently, bisphosphonate and denosumab have been widely used for the treatment of bone metastasis of breast cancer. However, medication-related osteonecrosis of the jaw(MRONJ)has often been reported as a side effect of these drugs. We experienced a rare case of intracranial epidural abscess secondary to MRONJ. The patient died of the condition, although chemotherapy was effective. The mechanism of and therapy for MRONJ have not been clarified; therefore, its prevention should be emphasized.

Difficulty Achieving a Preoperative Diagnosis of IgG4-Related Sclerosing Cholangitis.

A 75-year-old male was admitted to our hospital because of bile duct stenosis. He had no medical history of autoimmune disease. The level of tumor markers, serum IgG, and IgG4 were within normal ranges. Computed tomography showed perihilar and distal bile duct stenosis and wall thickening without swelling or abnormal enhancement of the pancreas. Endoscopic retrograde cholangiopancreatography showed perihilar and distal bile duct stenosis. A biopsy and cytology from the distal bile duct stenosis suggested adenocarcinoma, and cytology from the perihilar bile duct also suggested adenocarcinoma. A preoperative diagnosis of perihilar and distal bile duct cancer was made, and the patient underwent left hepatectomy and pancreaticoduodenectomy. Resected specimens showed wall thickening in the perihilar and distal bile duct; however, tumors were unclear. A histopathological examination revealed lymphoplasmacytic infiltration, storiform fibrosis, and obliterative phlebitis in the perihilar and distal bile ducts. Immunohistochemistry revealed diffuse infiltration of IgG4-positive plasma cells in the perihilar and distal bile ducts. Lymphoplasmacytic infiltration, inflammatory change, storiform fibrosis, and obliterative phlebitis were shown in the pancreas. A final diagnosis of IgG4-related sclerosing cholangitis (IgG4-SC) with autoimmune pancreatitis was made. We herein report a case in which a preoperative diagnosis of IgG4-SC was difficult due to normal serum IgG4 levels and no obvious pancreatic lesion.

[Catamenial pneumothrax treated in portable pneumothorax drainage kit; report of a case].

A 37-year-old woman visited our hospital for right pneumothorax and was treated using a portable thoracic drainage kit(Thoracic Egg). A month later, she had relapse of right pneumothorax with onset of a menestration. Catamenial pneumothorax was diagnosed clinically and the surgical treatment and a hormone therapy were recommended. But she refused our proposal and desired a treatment using Thoracic Egg again. Thereafter, she relapsed pneumothorax 3 times, and was treated by rest or using Thoracic Egg. A Thoracic Egg was useful for management of spontaneous pneumothorax, but there is no report concerning the catamenial pneumothorax. Thoracic Egg may be a choice of treatment for catamenial pneumothorax of minor or moderate grade.