A 31-year-old Japanese female came to our outpatient clinic because of a 15-year history of recurrent episodic chest pain accompanied by fever, each lasting for three days. The patient was diagnosed with familial Mediterranean fever (FMF) because of the following: 1) short attacks of fever recurring at varying intervals; 2) pleuritic chest pain accompanied by fever; 3) the patient's sisters had similar episodes of fever accompanied by abdominal or chest pain; and 4) absence of any other causative factors responsible for her symptoms or pathologic findings. Although FMF has been described primarily in several limited ethnic groups, only a few cases have been reported in Japan. No diagnostic tests are commercially available for FMF so identifying the characteristic clinical picture of FMF is important.

We report a childhood case of localization-related epilepsy manifesting frequent gelastic seizures, which were successfully treated with topiramate (TPM) monotherapy. The seizures were not associated with feelings of mirth. High-resolution three-tesla magnetic resonance imaging revealed no structural abnormality. Interictal 18F-fluorodeoxyglucose positron emission tomography showed hypometabolism over the entire right hemisphere. Single-photon emission computed tomography imaging, both ictal and interictal, demonstrated no significant findings. Interictal electroencephalography (EEG) showed paroxysms in the right frontal region. Ictal video EEG demonstrated diffuse attenuation, followed by fast activities and spike-wave complexes predominantly over the right hemisphere. At the ictal EEG onset, low amplitude paroxysmal fast activity was recorded over the F8-T4 region. The seizures were considered to have originated from the right frontal lobe. TPM monotherapy resulted in complete cessation of the seizure. We suggest that TPM should be considered as a valuable tool for treating childhood intractable gelastic seizures, which are not due to hypothalamic hamartoma.

　　Pancreatic neuroendocrine tumors, relatively rare cancers, mostly arise in the pancreatic parenchyma with infrequent involvement of the main pancreatic duct. Now and then, however, case reports have been published on pancreatic neuroendocrine carcinoma in which the main pancreatic duct is obstructed by tumor cells with severely fibrous stromal cells. Here, in this paper, we report a case of pancreatic neuroendocrine carcinoma with obstruction of the main pancreatic duct. A 59-year-old man complained of right upper abdominal pain. Magnetic resonance cholangiopancreatography and fat-suppressed T1-weighted magnetic resonance imaging showed gallbladder stones, a low-intensity-area measuring 8 mm in diameter in the pancreatic body, and club-shaped dilatation at the distal end of the pancreatic duct. The patient was thus diagnosed with a tumor in the pancreatic body and cholecystolithiasis, and underwent distal pancreatectomy and cholecystectomy. HE-staining showed tumor cells with eosinophilic cytoplasm and nuclear atypia. The infiltrative growth of the cells with severe fibrosis caused stenosis of the pancreatic duct. Based on the positive results of immunohistochemical staining for chromogranin A and synaptophysin and the Ki-67 index, the tumor was finally identified as pancreatic neuroendocrine carcinoma. The patient has been under follow-up with no additional treatment for >3 years since the surgery, without evidence of tumor recurrence.

Purpose: To clarify the family-perceived usefulness of a pamphlet for families of imminently dying patients. Methods: Physicians and/or nurses provided medical and practical information about the dying process using a pamphlet for families of imminently dying patients. We surveyed family members 6 months after the death of the patient about the perceived usefulness. Results: We sent out a questionnaire to 325 bereaved, and obtained an answer from 260 (response rate: 85%). Overall, 81% reported the pamphlet to be “very useful” or “useful”. The experience reported by the bereaved included: “Helped me to understand the dying process” (84%); “Helped me to understand how symptoms and changes occur” (76%), “Useful in preparation for patient's death“ (75%), “Helped me to understand the physical conditions of the patient” (75%), “Helped me to know what I can do for the patient” (74%). Conclusion: “A pamphlet for families of imminently dying patients” may be useful for members of an imminently dying patient's family.

The purpose of the present study was to evaluate the prokinetic effects of mosapride with non-invasive assessment of myoelectrical activity in the small intestine and caecum of healthy horses after jejunocaecostomy. Six horses underwent celiotomy and jejunocaecostomy, and were treated with mosapride (treated group) at 1.5 mg/kg per osos once daily for 5 days after surgery. The other six horses did not receive treatment and were used as controls (non-treated group). The electrointestinography (EIG) maximum amplitude was used to measure intestinal motility. Motility significantly decreased following surgery. In the treated group, the EIG maximum amplitude of the small intestine was significantly higher than in the controls from day 6~31 after treatment. These findings clearly indicate that mosapride could overcome the decline of intestinal motility after jejunocaecostomy in normal horses.
Anastomosis, Surgical/veterinary ; Animals ; Benzamides/*pharmacology ; Cecum/*drug effects/physiology ; Electrophysiology ; Female ; Gastrointestinal Agents/*pharmacology ; Gastrointestinal Motility/*drug effects ; Horses/*physiology/surgery ; Intestine, Small/*drug effects/physiology/surgery ; Jejunostomy/veterinary ; Male ; Morpholines/*pharmacology