In this paper, we introduced current intravascular surgery. Safer and more appropriate intravascular treatments have been performed by development of superselective microcatheter, microguide wire, various embolic materials, DSA equipment and so on. Indications are embolization for surgically difficult aneurysms, arteriovenous malformation and dural arteriovenous fistulas, percutaneous transluminal angioplasty for post-subarachnoid hemorrhage vasospasms, stenoocclusive diseases. Inravascular surgery combined with surgery can make neurosurgical treatments more effective and safer.

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A study was performed to evaluate the combined effect of hormone replacement therapy (HRT) and an HMG-CoA reductase inhibitor simvastatin on lipid profile in postmenopausal women with hypercholesterolemia. 13 (46.4%) of 28 surgical menopausal women (A) and 48 (46.2%) of 104 natural menopausal women (B) had hypercholesterolemia (cholesterol>220 mg/dl).
After our protocol with three months of HRT, the number of women with hypercholesterolemia decreasd to 9 (32.1%) of 28 in group A and 35 (33.7%) of 104 in group B. After 3 months of combination treatment with HRT and Simvastatin, the number of women with hypercholesterolemia decreased to 4 (14.3%) of 28 in group A and 18 (17.3%) of 104 in group B.
It is concluded that we can expect to improve the quality of life of postmenopausal women by doing the active examination of lipid, education of life style and treatment.

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Japan has to develop a new elderly medicare system in 21st century as a nation with the longest life expectancy. Toward a healthy and active longevity society, a new medicare system should take the following basic principles into consideration; the improvement of QOL as its target, comprehensive team care system, integrative system of medicare, prevention and welfare and the application of high technology.
In this symposium, according to their own idea each speaker reported what should be done in each field to establish a new medicare system in 21st century longevity society.

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A case of hypothyroidism associated with increased serum creatine kinase due to immunoglobulin-linked macro-creatine kinase is reported. A 50 year-old woman who had been followed at our outpatient clinic because of hypertension, and treated with nilvadipine at a dose of 8 mg/day, complained of muscle weakness in her upper extremities which had persisted for a month. Laboratory examination revealed high serum creatine kinase (CK) and she was admitted for further evaluation. Physical examination showed muscle weakness in her upper and lower extremities, rough dry skin, thin hair, and non-pitting edema in her lower extremities. Isozyme analysis showed 98.5% of CK activity to be of MM type and an extra band was detected on electrophoresis of CK. Thin-layer geifiltration disclosed a normal spot and a high molecular spot. Finally, the enzyme immunofixation method revealed immunoglobulin linked CK with heavy chain; A and light chain; κ and λ . Based on physical examination findings, hypothyroidism was suspected and thyroid hormones were measured. Both free T³ and T⁴ were below the detection limit of the assay, whereas TSH was extremely high. Supplementation with levothyroxine sodium was started and her muscle weakness improved, serum CK normalized and immunoglobulin-linked CK disappeared during the course of treatment. Cases of hypothyroidism associated with immunoglobulin-linked CK are rare, only 2 cases have been reported to date in Japan.

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A 47 years old female with familial adenomatous polyposis, who underwent extended left side hemicolectomy for carcinoma of rectosigmoid colon in 1980 and residual total colectomy and rectal mucosectomy in 1985, was found to have a ampullary carcinoma of duodenum. Subsequently pancreatoduodenectomy was performed in 1994. The resected specimens showed an ulcerating carcinoma on the ampulla of Vater, which was a moderately differentiated adenocarcinoma with adenomatous component histologically. Multiple adenomas were present in duodenum and one of them was revealed to be a cancer in adenoma. These observations support the existence of the adenoma-carcinoma sequence in the duodenal lesion of the familial adenomatous polyposis.

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Treatment for patients with femoral neck fracture who have Parkinsonism is difficult. And there is still controversy as to the best treatment for a fracture of the femoral neck in patients who have Parkinsonism. We performed a retrospective study of ten patients (twelve fractures of the femoral neck) who had Parkinsonism. The average age of the patients was 73.3 years (range, fifty-four to eighy-three years). We evaluated the factors which influenced ambulation after the operation. All patients had been able to walk without assistance before the fracture. However, only two patients who had been able to walk without assistance after the operation. Three patients had died. Three patients continued to walk with an aid, although at a decreased level. The remaining two patients could not walk. The prognosis of younger patients was comparatively good than older patients. The older patients had post operative complications as pneumonia were bad. To sustain the activity of patients. early operation must be done after the fracture and begun the rehabilitation program as soon as possible to protect the post operative complications.

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The patient was a four-year-old girl, diagnosed as posthepatitic severe aplastic anemia. Medication was littie effective and she needed granulocyte-colony stimulating factor (G-CSF) which made peripheral granulocytes count more than 500/μl, red blood cell transfusion once a month, platelet transfusion once a week. There were no human leukocyte antigen (HLA)-identical donors in the Bone Marrow Bank. When her mother delivered a sibling whose HLA was completely identical to that of the patient, the total 44 ml of the cord blood was collected and stored. After preconditioning of antithymocyte globulin, cyclophosphamide and total lymphoid irradiation, the cord blood (38.5 ml) and the bone marrow (30 ml) were transfused. The absolute neutrophil count reached 500/μl on day 17 and the platelet count reached 50, 000/μl on day 22. There was no evidence of acute graft-versus-host disease (GVHD) or chronic GVHD.

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