A 28-year-old woman presented with persistent diarrhea, lower abdominal pain, low-grade fever and general fatigue in 1994. She was admitted to a hospital with suspected inflammatory colitis. Aphthoid mucosal changes were founded on colonoscopy, but the etiology was unknown. Salazosulfapyridine was administered for 3 months, but it was not effective for the abdominal symptoms. In November 1995, pyrexia, lymph node swelling and polyarthralgia appeared, and the patient was admitted to our hospital. Malar rash, photosensitivity, leukopenia, antinuclear antibody and anti-DNA antibody were found. She was diagnosed as having systemic lupus erythematosus and lupus colitis. Prednisolone (30mg/day) was administered, and pyrexia, polyarthralgia and leukopenia were improved, but the abdominal symptoms persisted for 5 weeks. Keisi-ka-syakuyaku-to was administered, and it was markedly effective for relieving persistent diarrhea and abdominal pain. Keisi-ka-syakuyaku-to was continued until February 1999 and the patient's clinical course was satisfactory.

Introduction：Hyponatremia, which is frequently present in patients with end-stage cancer, causes delirium and disturbance of consciousness and is considered a poor prognostic factor. We report a case of hyponatremia with hypopituitarism in association with leptomeningeal metastasis, resulting in reversible disturbance of consciousness. Case report：A 77 year-old female received chemotherapy at our hospital for postoperative recurrence of lung cancer, and best supportive care due to a side effect. After transfer to another hospital, she experienced a sudden disturbance of consciousness and was returned to our hospital. A detailed examination resulted in a diagnosis of hyponatremia from hypopituitarism following leptomeningeal metastasis involving the cerebral ventricles. Hyponatremia was improved by NaCl supplement and hormone replacement, followed by recovery from disturbance of consciousness. Discussion：QOL of patients with end-stage cancer can be improved through the active treatment of reversible causes of disturbance of consciousness. Conclusion：When severe hyponatremia is detected in cancer patients, it is important to consider the possibility of hypopituitarism with brain metastasis or meninges dissemination in the differential diagnosis.

Background/Aims: Three-dimensional (3D) flexible endoscopy, a new imaging modality that provides a stereoscopic view, can facilitate endoscopic hand suturing (EHS), a novel intraluminal suturing technique. This ex-vivo pilot study evaluated the usefulness of 3D endoscopy in EHS. Methods: Four endoscopists (two certified, two non-certified) performed EHS in six sessions on a soft resin pad. Each session involved five stitches, under alternating 3D and two-dimensional (2D) conditions. Suturing time (sec/session), changes in suturing time, and accuracy of suturing were compared between 2D and 3D conditions. Results: The mean suturing time was shorter in 3D than in 2D (9.8±3.4 min/session vs. 11.2±5.1 min/session) conditions and EHS was completed faster in 3D conditions, particularly by non-certified endoscopists. The suturing speed increased as the 3D sessions progressed. Error rates (failure to grasp the needle, failure to thread the needle, and puncture retrial) in the 3D condition were lower than those in the 2D condition, whereas there was no apparent difference in deviation distance. Conclusions 3D endoscopy may contribute to increasing the speed and accuracy of EHS in a short time period. Stereoscopic viewing during 3D endoscopy may help in efficient skill acquisition for EHS, particularly among novice endoscopists.