Introduction: We evaluated the risk of shortness of inhalation when using laninamivir without inhalation practices.

Method: We counted the number of attempts required by each patient to sound the whistle. We classified the patients into the following categories: ①Sound rang in the first attempt; ②Sound rang within 3 attempts; ③Sound rang with in 5 attempts; ④Sound rang within 10 attempts; ⑤The whistle did not sound. We assessed the following: 1. the rate of patients younger than 10 years of age assessed category ② or less,; 2. the rate of patients of teen-age, and 3. the rate of patients of 20 years of age or older, assessed category ③ or less.

Results: We examined 56 patients, and we found that the rate for 1. was 7/11= 63.6%, for 2. was 4/33= 12.1%, and for 3. was 2/12= 16.7%.

Conclusion: We found that more than 60% of patients younger than 10 years of age and more than 10% of patients of 10 years of age or older were at risk of shortness of inhalation when using laninamivir without inhalation practices. And we propose other medication if patients cannot sound the whistle within about 5 attempts.

The patient, a 71-year-old man, was admitted to our department with fever from unknown causes. Ultrasonic examination of the abdominal regions revealed abnormal multiple low-density echo legions (that could be) associated with splenomegaly. For diagnostic purposes, splenic puncture was performed with the aid of an ultra-sound imaging device. Pale yellow-green pus was obtained from the lesions. Based on this finding, we made a diagnosis on the case as multiple abscess of the splean. The patient underwent intensive chemotherapy. However, he dontinued to have a high fever. On the ninth day from hospitalization, splenectomy was performed. Since then, his fever has subsided. Abscess of the spleen is a rare disease. It is generally classified into two types: one is a multiple type, and the other, a solitary type. Multiple splenic abscess mostly occurs as one of the abnormal conditions during the course of a primary disease, which is often severe. Our case, however, did not exhibit any sign of a primary disease.

A 56- year-old woman visited our hospital complaining of right hypochondralgia. X-ray and endoscopic examinations revealed Borrmann 2 type gastric cancer in the anterior wall of an upper part of the stomach. Ultrasonography showed an echogenic mass in the suprarenal area. The mass which had septal formation within it, was about the same in density as fat on computerized tomography, and was hypovascular fed by the right inferior adrenal artery on angiography. These findings suggested that the mass might be adrenal myelolipoma. After total gastrectomy and right adrenectomy were done, histopathological study confirmed that the case is adrenal myelolipoma associated with Borrmann 2 type gastric cancer. In Japanese literature, only 54 cases of surgically resected adrenal myelolipoma have been reported, and this is the second case of adrenal myelolipoma associated with gastric cancer.