The patient was a 66-year-old man who presented to our hospital with intermittent abdominal pain. Abdominal ultrasound showed a mass presenting as a target sign in the right abdomen, suggesting intussusception. Subsequent computed tomography (CT) and lower gastrointestinal endoscopy revealed a 5 cm lipoma in the ascending colon. The intussusception had resolved spontaneously, so the patient was followed up on an outpatient basis. Although endoscopic treatment was considered for the lipoma, due to its large size, the patient was referred to our department for surgery 1 month later. A follow-up CT scan revealed a recurrence of the intussusception. Because the patient tolerated oral intake, had normal bowel movements without symptoms of bowel obstruction, and experienced only mild abdominal pain, conservative outpatient observation was continued until laparoscopic-assisted ileocecal resection was performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 8 without any complications. Colonic lipoma causing intussusception is relatively rare. Since lipoma is a benign disease, it is a good candidate for laparoscopic surgery, which offers excellent cosmetic outcomes and rapid postoperative recovery. Even in cases with intussusception, when there is no bowel obstruction and the abdominal pain is mild, elective surgery within 1-3 months can be considered a viable option.

Metronidazole is an effective antibacterial agent against anaerobic bacteria, and its use in the gastrointestinal field, particularly in patients with intra-abdominal infections, has increased with the availability of injectable formulations. However, a known side effect of metronidazole is central nervous system impairment, namely, metronidazole-induced encephalopathy. Here, we present a case of a 68-year-old man who underwent laparoscopic abdominoperineal resection for rectal cancer in March of year X. Postoperatively, metronidazole was administered for pelvic dead space infection and perineal wound infection, and the patient continued the oral medication after discharge. In May of year X, the patient was referred to our institution near his home for postoperative adjuvant chemotherapy. In February of year X+1, the patient developed dysarthria, and a FLAIR (fluid-attenuated inversion recovery) image on head magnetic resonance imaging revealed bilaterally symmetric hyperintense lesions in the dentate nuclei of the cerebellum. Suspecting metronidazole-induced encephalopathy based on the medication history, metronidazole was discontinued, leading to symptom improvement within approximately 3 days. We diagnosed metronidazole-induced encephalopathy based on the imaging findings and clinical observations. When using metronidazole, we should pay attention to the dosage and duration of administration and make efforts to detect side effects early.

Splenic rupture can be divided into traumatic and atraumatic forms. Causes of atraumatic splenic rupture include hematologic disease, malignancy, and infection, all of which are extremely rare. An 80-year-old man complaining of left upper abdominal pain was referred to our hospital for further examination and treatment. On arrival, his vital signs were stable, but contrastenhanced computed tomography showed a discontinuity of the splenic membrane and fluid accumulation in the perisplenic area and pelvic floor, suggestive of a hematoma. There was no history of trauma, and suspecting atraumatic splenic rupture, we performed an emergency splenectomy. The patient had a good postoperative course and was discharged on postoperative day 11. He had no previous hematologic disease, and there were no clinical findings suspicious of viral infection. Pathological diagnosis was also negative for malignancy, and idiopathic splenic rupture was diagnosed. We describe here this case of splenectomy for spontaneous splenic rupture.

The patient was a 75-year-old man with advanced rectal cancer underwent abdominoperineal resection and lymph node dissection as conversion surgery after chemotherapy. Intraoperatively, lateral lymph node metastasis was evident in internal iliac vasculature and was deemed unresectable, so chemotherapy was continued after the operation. Due to an elevation in tumor markers and the appearance of lung metastasis, S-1 + irinotecan + bevacizumab therapy was performed as third-line therapy. On day 22 of the third course, he was transported to our hospital with abdominal pain and nausea. Contrast-enhanced computed tomography revealed adhesive bowel obstruction, and chemotherapy was discontinued. Restlessness and diplopia appeared after admission, and magnetic resonance imaging showed a high-intensity area on T2-fluid attenuated inversion recovery images, mainly in the occipital lobe. Because neurological symptoms and imaging findings improved with symptomatic treatment, we diagnosed him with posterior reversible encephalopathy syndrome. Although this disease can develop in association with chemotherapy and, for example, eclampsia, sepsis, renal failure, and autoimmune disease, it is rare and we report this case together with a review of the literature.

An 85-year-old woman was transported to our hospital because of nausea and abdominal pain. Contrast-enhanced computed tomography revealed type IV hiatal hernia with incarcerated necrotic transverse colon. Emergency laparotomy was performed. When the incarcerated stomach and transverse colon were returned to the abdominal cavity, the transverse colon was resected and anastomosed due to necrosis. After the hiatal defect was closed, the Toupet method was also performed. No regurgitation or obstruction was observed after the operation, and the patient was discharged 63 days postoperatively. Here we report this rare case of intestinal necrosis due to type IV hiatal hernia and review the literature.

Acute encephalopathy is classified into multiple syndromes, such as acute encephalopathy with biphasic seizures and late reduced diffusion (AESD), clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) and acute necrotizing encephalopathy (ANE), characterized radiologically by lesions in the cerebral subcortical white matter, splenium of the corpus callosum and bilateral thalami, respectively. We described a previously healthy 8-year-old boy who had febrile and biphasic seizures, and encephalopathy. MRI showed abnormal signal intensity in the corpus callosum on day 2 and cerebral subcortical white matter and bilateral thalamic lesions on day 8. This is the first case of acute encephalopathy in which callosal, subcortical and thalamic lesions co-existed. The clinical course of this case was typical for AESD, atypical for MERS, and different from that of ANE.
Brain Diseases

Recently, significant progress has been made in medical techniques for regenerating bone. However, bone evaluation techniques generally assess bone quantity as opposed to bone quality. The use of c-axis crystallite orientation of biological apatite (BAp) as a bone quality index has recently generated great interest. BAp demonstrates strong crystallographic anisotropy, and preferential alignment of BAp in each bone varies depending on the shape and stress conditions in vivo. In the mandible, complicated bone shape and stress conditions in vivo might be associated with both bone quantity and quality. In this study, we aimed to elucidate changes in the bone microstructure in the mandible using crystallographic orientation of BAp as a bone quality index. Using Crj: CD (SD) IGS female rats, we observed changes in the dentulous mandible during bone growth. Measuring points on the mandible were determined based on its positional relationship with the teeth. For analysis of bone quantity, the area and bone mineral density of cortical bone were evaluated using peripheral quantitative computed tomography (pQCT), while the orientation of the BAp c-axis, as analyzed by a micro-beam X-ray diffraction system, was used to assess bone quality. The results of both bone quantity and quality assessments indicated that changes during bone growth varied depending on the presence of teeth. We concluded that the microstructure (especially the texture) of BAp crystallite changes in correlation with variations in stress distribution in vivo resulting from changes in chewing conditions designed to optimize the dynamic chewing function.

Recently, significant progress has been made in medical techniques for regenerating bone. However, bone evaluation techniques generally assess bone quantity as opposed to bone quality. The use of c-axis crystallite orientation of biological apatite (BAp) as a bone quality index has recently generated great interest. BAp demonstrates strong crystallographic anisotropy, and preferential alignment of BAp in each bone varies depending on the shape and stress conditions in vivo. In the mandible, complicated bone shape and stress conditions in vivo might be associated with both bone quantity and quality. In this study, we aimed to elucidate changes in the bone microstructure in the mandible using crystallographic orientation of BAp as a bone quality index. Using Crj: CD (SD) IGS female rats, we observed changes in the dentulous mandible during bone growth. Measuring points on the mandible were determined based on its positional relationship with the teeth. For analysis of bone quantity, the area and bone mineral density of cortical bone were evaluated using peripheral quantitative computed tomography (pQCT), while the orientation of the BAp c-axis, as analyzed by a micro-beam X-ray diffraction system, was used to assess bone quality. The results of both bone quantity and quality assessments indicated that changes during bone growth varied depending on the presence of teeth. We concluded that the microstructure (especially the texture) of BAp crystallite changes in correlation with variations in stress distribution in vivo resulting from changes in chewing conditions designed to optimize the dynamic chewing function.

Teaching evaluations have been performed since 2002 in the Faculty of Medicine, Tottori University. The effects of evaluations over a 3-year period were assessed, and free comments obtained from students were analyzed with the textmining method to identify factors affecting students' satisfaction. A total of 566 lectures given in undergraduate courses were evaluated, and 33, 751 questionnaires were collected for a recovery rate of 74%. The collected questionnaires included 2495 free comments. Each free comment was parsed word by word, and the nouns, adjectives, adverbs, and verbs were selected as key words. The scores for almost all questions on the questionnaire for the 2003 school year were significantly higher than those for the 2002 school year. However, no difference was found between the scores of the 2003 and 2004 school years. Analysis of the free comments suggested that a well-understood lecture improves student satisfaction and that teaching materials, such as handouts and slides, play an important role in the positive evaluation of lectures. The percentage of lectures receiving poor evaluations (scores less than 3) decreased yearly. This finding suggests that teaching evaluations are effective in helping faculty members with low scores to improve their lectures.