It is important to learn the pathogenesis herpes simplex virus (HSV) and the difference between bacterial and viral infection in order to understand the biology of HSV and the need of suppressive therapy. HSV infection in the skin and mucosa results in the retrograde axonal transport of the virus to the sensory ganglia and spread of infection in the ganglia. Then the HSV causes lesions in the region innervated by the ganglia and the virus in ganglia becomes latent and supplier for the reactivation in future. Recent study shows the possibility of reduction of reaction frequency by the reduction of the number of latent HSV genomes by the acyclovir treatment of the primary HSV infection. Reactivation of HSV from the ganglia is inevitable and the suppressive therapy alone is the standard way to suppress reactivation in patients with frequent reactivation. Suppressive therapy does not cause acyclovir-resistant HSV as suspected from the apprearence of drugresistant microbes in infection with bacterial and human immunodeficiency virus. The mode of HSV infection and the fidelity of HSV DNA polymerase render HSV infection exceptional to generate acyclovirresistance during suppressive therapy. Thus the suppressive therapy should be included as the standard therapy for frequent genital herpes in the repertoire of the chemotherapy in Japan.

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Hematological malignancies are presently classified into leukemia, malignant lymphoma and multiple myeloma, and leukemia or malignant lymphoma are furtherly subtyped. Among recent development of treatment strategies against these diseases, treatments for chronic myelogenous leukemia (CML), acute promyelocytic leukemia (APL), diffuse large B-cell lymphoma (DLBCL) or multiple myeloma (MM) need to be highlighted. In the treatment of CML, use of inhibitor for tyrosine kinase, which deeply relates the cause of disease, drastically improved the response rate including genetic alterations and long-term survival, even potentially affecting the indication of allogeneic stem cell transplantation for CML. In APL, strong impact in therapeutic outcome have been achieved by the combination with all-trans retinoic acid, the agent targeting fusion-gene caused by specific chromosome translocation of the disease and anthracycline. In DLBCL, CHOP (cyclophosphamide, adriamycin, vincristine, and prednisolone) had been long evaluated as the standard therapy for DLBCL. However, when CHOP is combined with rituximab, a human/mouse chimera antibodies against human CD20 which is expressed more than 95% of human B-cell lymphoma, have shown statically superior therapeutic effects to CHOP alone in CR rate, disease-free survival rate and survival rate. As for MM, in addition to high dose chemotherapy with autologous stem cell transplantation, recent development in use of thalidomide or proteasome inhibitor, each possesses the novel actions of mechanisms, had brought this field to a new era.

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I reviewed the role of chemotherapy in treating non-small-cell lung cancer (NSCLC). For stage I/II NSCLC patients, adjuvant chemotherapy is currently considered to be the standard treatment. Induction chemotherapy followed by surgery is often conducted in patients with stage IIIA NSCLC. However, since sufficient evidence to recommend this modality has not been obtained, further investigation including the need for surgery is warranted. Concurrent chemoradiotherapy is the standard treatment for stage IIIB NSCLC patients. For stage IV NSCLC patients, a two-drug combination consisting of platinum and one of new agents developed in the 1990s is the standard treatment, and docetaxel monotherapy is recommended for previously treated patients. Although molecular targeting agents such as gefitinib and erlotinib are considered to be hopeful, their effectiveness has not been confirmed.

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Many dramatic advances have been made recently in the treatment of gastrointestinal cancer. For advanced colorectal cancer, fluorouracil (5-FU), long the only mainstay of chemotherapy, has been joined by new, effective anticancer agents such as irinotecan (CPT-11) and oxaliplatin (L-OHP). First-line chemotherapy has been refined continuously and updated annually. The latest regimens in order of survival benefits are 5-FU/LV=irinotecan<IFL<FOLFOX=FOLFIRI. FOLFIRI and FOLFOX, which consist of 5-FU/LV combined with irinotecan and oxaliplatin, are considered the latest first-line chemotherapy for advanced colorectal cancer. In the course of their development, aspects of their metabolism and pharmacology, and the relative advantages of 5-FU administration by continuous infusion or bolus administration, have been clarified.
The introduction of orally administered drugs such as UFTTM, TS-1TM, and capecitabine are likely to further improve the results of 5-FU therapy. Their potential role, impact, and convenience as replacements for intravenously administered drugs, which include FOLFIRI and FOLFOX, are attracting attention. Bevacizumab and cetuximab, which inhibit the effect of VEGF or EGFR, have also become available. Their use for combination treatment is expected to increase median survival time to as much as two years.
Median survival time for advanced colorectal cancer patients not treated with chemotherapy is somewhere between three and six months. This makes the value of chemotherapy for colorectal cancer beyond dispute.

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The standard chemotherapy for gynecologic malignancy consists of topoisomerase I inhibitor and anthracycline using the platinum and taxane as key drugs. The standard therapies for major gynecologic malignancies including ovarian cancer, uterine cervix cancer and uterine corpus cancer in 2005 are briefly mentioned below.
1. Ovarian cancer: The initial therapy is a surgery including a standard surgery and staging laparotomy. Additionally, cytoreductive surgery is performed for advanced cancer. The postoperative chemotherapy is performed with paclitaxel 175mg/m²/3h+carboplatin AUC 5-6 (TC therapy). Three to six courses and six courses are performed for the stage I cancer and advanced cancer, respectively. Docetaxel and irinotecan can be also used depending on the toxicity and histological subtypes. At the time of recurrence, a regimen that is the same as or similar to the initial regimen is performed for chemosensitive tumor with a longer treatment-free interval (TFI>six months), and novel drugs which are not cross-resistant to the initial therapeutic agents are used for patients with chemoresistant tumor (TFI<six months).
2. Uterine corpus cancer: Radiation therapy is the standard for high-risk cases after the primary surgery in Europe and the U.S. Meanwhile, in Japan, chemotherapies are performed in many facilities for high-risk cases. The standard agents include cisplatin, doxorubicin and paclitaxel. The standard regimen is AP (cisplatin/doxorubicin) therapy. Recently, TAP (cisplatin/doxorubicin/paclitaxel)+G-CSF and TC (paclitaxel/carboplatin) are frequently discussed.
3. Uterine cervix cancer. Chemoradiation is the standard for the stage Ib₂ or later in Europe and the U. S. Meanwhile, in Japan, basically, a surgery is performed for up to the stage IIb, neoadjuvant chemotherapy+radical hysterectomy is performed for the stage Ib₂ to IIb with bulky mass, and chemoradiation using cisplatin is widely performed for the stage III/IV based on the evidence of Europe and the US.

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We investigated the antimicrobial susceptibilities of Gardnerella vaginalis by using 607 strains of clinical isolates at Toho University Omori Medical Center from 2002 to 2004. Minimum Inhibitory Concentrations (MICs) of 17 antimicrobial agents were determined with micro broth dilution methods based on the guidelines of NCCLS. Penicillins, carbapenems, macrolides and glycopeptides antimicrobial agents showed potent activities of which the MIC90 levels were 1 μg/mL or less. We could not find any major differences in the antimicrobial susceptibilities between our results and the results in some previous reports. We therefore insist that we can choose adequate antibiotic regimens for patients with G. vaginalis according to these results. Although we could not find any resistant strains against all antibiotics tested in this study, we think that further investigations should be needed to follow up the antimicrobial susceptibilities of clinical isolates of G. vaginalis.

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The efficacy of micafungin (MCFG) and voriconazole (VRCZ) was evaluated in guinea pig models of disseminated candidiasis and pulmonary aspergillosis. MCFG and VRCZ were administered twice daily for 9 days starting at 2-4 hour after infection by subcutaneous injection and oral administration, respectively. MCFG and VRCZ significantly prolonged the survival of guinea pigs infected intravenously with Candida albicans at doses of 0.32 and 1mg/kg, respectively (p<0.05). MCFG and VRCZ significantly prolonged the survival of guinea pigs infected intratracheally with Aspergillus fumigatus at doses of 1.00 and 3.2mg/kg, respectively (p<0.01).
These results supported the efficacy of clinical doses of MCFG and VRCZ in treating disseminated candidiasis and pulmonary aspergillosis.

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An in vitro study comparing the virucidal activity of povidone-iodine (PVP-I) products and other antiseptics, such as ethanol, benzethonium chloride and chlorhexidine gluconate, against feline as well as canine caliciviruses was performed. All PVP-I products (PVP-I solution, PVP-I gargle, PVP-I scrub, PVP-I palm and PVP-I throat spray) reduced the viral infectious titers below or near the detection limit within a reaction time of only10seconds. The potency of PVP-I against caliciviruses clearly exceeded that of any other of the tested antiseptics. These results suggest that PVP-I may be effective against noroviruses, which are classified in the family Calicivirdae.

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Using broth micro-dilution, we studied the susceptibility of 144 clinical isolates of Escherichia coli, Klebsiella spp., Enterobacter spp., Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis to meropenem (MEPM) and reference agents. All strains were isolated from the blood of patients admitted to Keio University Hospital between January 2004 and October 2004. The results were as follows:
1. MEPM and other carbapenems showed excellent antibacterial activity against most blood culture isolates, except for drug-resistant staphylococci (MRSA and some S. epidermidis). A comparison of the antibacterial activity of MEPM with that in previous studies showed no marked increase in MEPM-resistant clinical isolates.
2. MEPM differed microbiologically from imipenem, panipenem, and biapenem in its greater potency in vitro against most Gram-negative pathogens, including P. aeruginosa, and similar potency against many Grampositive pathogens. Resistance to MEPM in clinical isolates of P. aeruginosa was not shown.
In conclusion, the results suggest that MEPM retains its potency as the agent of choice in treating serious infections.

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