Sciatic hernia with an early-stage adenocarcinoma of the appendix: report of a case.

Sciatic hernia and early-stage appendiceal adenocarcinoma are rare disorders. We report herein a case of an early stage of appendiceal adenocarcinoma found incidentally during an operation for sciatic hernia. An 80-year-old woman was admitted to our hospital with abdominal distension. Abdominal computed tomography showed a small bowel obstruction and a small bowel loop through the right sciatic foramen outside the pelvic cavity. During an operation for the repair of the sciatic hernia, a deformed appendix was found incidentally and a simple appendectomy was also performed. Histological examination of the excised appendix showed well-differentiated adenocarcinoma confined to the mucosal layer in a tubulo-villous adenoma. At 13-month follow-up, the patient is doing well without evidence of recurrence or metastasis.

Nonfunctional pituitary macroadenoma manifested as muscular symptoms.

A 75-year-old man with a large pituitary adenoma presented with general muscular weakness, including difficulty in rising in the morning and forceless defecation and urination, and muscular pain, numbness and atrophy in the shoulder, neck and thigh. Testosterone replacement and subsequent resection of the pituitary tumor resulted in resolution of the symptoms. The value of pituitary imaging tests for men with hypogonadotropic hypogonadism is discussed.

A gastric fibrolipoma presenting as acute gastrointestinal hemorrhage.

A 56-year-old woman was admitted to our hospital with upper gastrointestinal hemorrhage from a gastric submucosal tumor that was treated by a laparoscopic technique. Endoscopy and endoscopic ultrasonography (EUS) revealed a 2-cm submucosal tumor located in the posterior wall of the upper gastric body, showing a heterogeneous hyperechoic tumor. A laparoscopic wedge resection of the stomach was performed. Pathological examinations revealed that the tumor was composed of spindle cells like fibroblasts and mature adipocytes. Immunohistochemical examinations revealed that the tumor was negative for desmin and alpha-smooth muscle actin. Based on these findings, a diagnosis of fibrolipoma was made. EUS is useful for differentiating a fibrolipoma from a gastrointestinal stromal tumor or lipoma by the findings of characteristic echogenesity and detection of the tumor origin.

Evaluation of gastric acid secretion in two patients (each aged over 90 years) with Helicobacter pylori-negative nonsteroidal anti-inflammatory drug-caused duodenal ulcers.

We treated two patients (each aged over 90 years) with Helicobacter pylori-negative nonsteroidal anti-inflammatory drug (NSAID)-caused duodenal ulcers, and had the opportunity to determine gastric acidity by means of 24-h pH monitoring. Endoscopic and histological examination showed no remarkable atrophic change in the gastric mucosa. The gastric pH was low throughout the day and night, and the gastric pH > or = 3 holding time ratio during 24 h was 17.1% and 25.8%, respectively in the two patients, so it was considered that they had gastric acid secretion of the same level as that in normal subjects of the same age or that in the young without H. pylori infection. Because of the complication of reflux esophagitis with a hiatal hernia, rabeprazole sodium, one of the proton pump inhibitors (PPIs), was administered and both patients made excellent progress. In conclusion, gastric acid secretion in patients with H. pylori-negative NSAID-caused duodenal ulcers is fully maintained even in the elderly, so PPIs may be the first choice of treatment.