Osteoporosis represents one of the major causes leading to immobilization. Owing to the progress in bone cell biology and molecular biology, understanding of normal bone remodeling and pathogenesis of osteoporosis has been advanced. In this review recent progress in etiology, diagnosis, prevention, and treatment of osteoporosis is summarized.

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Pre-emptive analgesia is an antinociceptive pretreatment that prevents postoperative pain result from the establishment of sensitization of neurons. This concept is derived from basic animal pain research.
Sensitization of the peripheral and central neurons triggered by input from tissue injured area, decreases thresholds of dorsal horn neurons, and enhances the response to stimuli and expand the receptive area in the dorsal horn. These sensitization induce the clinical pain.
The effects of pre-emptive analgesia obtained in experimental studies are evident, but the results of clinical studies on the value of pre-emptive analgesia for postoperative pain are not clear.
Pretreatment before operation alone can't prevent the nociceptive input from the injured tissue during and after surgery. Pre-emptive analgesia should start and continue from before surgical operation until wound healing is well established after operation.
More clinical studies, which correctly designed and controlled are need to clarify the effect of pre-emptive analgesia on postoperative pain.

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To evaluate the intellectual function of Duchenne muscular dystrophy (DMD) with event related potentials (ERP), P300 and mismatch negativity (MMN) were recorded in 15 patients with DMD (aged 15-31). Cortical potentials were recorded with surface electrodes from Fz, Cz and Pz with A1+A2 reference. P300 was recorded using oddball two-tone discrimination paradigm (target: 2 kHz, non-target: 1kHz) counting the number of target tones, and the probability of the target tones was 15%. MMN was obtained by subtructing the potentials to the frequent tones (1kHz, 85%) from the potentials to the rare tones (2 kHz, 15%). Patients were required to ignore the auditory stimuli.
P300 was abnormal in 5 of 15 patients examined, but early components of this ERP, N1 and N2, were normal, and MMN was normal in all patients. There was no significant difference in MMN between the patients who showed normal P300 and the patients who showed abnormal P300. These results suggest that the later process (controlled process) of cognitive function presented by P300 is impaired, but early and automatic process of cognitive function is hardly affected in DMD.

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The treatment of multiple drug resistant tuberculosis is difficult even today. We report here a case of multiple drug resistant pulmonary tuberculosis in whom cavernostomies were effective. The patient is a 34 year-old female with a cavitary pulmonary tuberculosis in the right lobe who was admitted because of persistent fever of more than two months duration. Because the bacilli isolated were multiple drug resistant, the patient was still young, and the lesion was located close to the chest wall, we performed cavernostomy which is less invasive than the other surgical approaches such as thracoplasties or lobectomies. In two months after the initial surgery the fever subsided and the sputum became negative. However, about a year and a half later the patient developed another cavities in the middle lobe and then in the left upper lobe. Both were treated successfully by cavernostomies and chemotherapies. Cavernostomy is still a treatment of choice in some patients with multiple drug resistant pulmonary tuberculosis if the lesion is limited and located close to the chest wall because it is relatively easy to perform, safer, and less invasive.

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We report a 20-day-old boy with Cornelia de Lange syndrome. He had high urinary β2-microglobulin from the neonatal period. At six months of age, he was affected with urinary tract infection again, and vesico-ureteral reflux was discovered. Combined treatment with cefaclor and sulf amethoxazole/trimethoprim had been used in repeated urinary tract infection. Repeated urinalysis and measurement of urinary β2-microglobulin were useful for diagnosis and assessment of the disease.

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A case report of normal delivery more than 6 years after the surgery for gastric carcinoma is presented. The patient was a 22 years-old woman who came to our hospital in 1982 because of abdominal fullness. Gastroscopy disclosed a Borrmann type II gastric carcinoma in the antrum. Subtotal gastrectomy with second level lymphnode resection and partial resection of the transverse colon were performed. Pathological study of the resected specimen revealed poorly differentiated, scirrhous type adenocarcinoma invading the transverse colon, without lymphnode metastasis. After a series of adjuvant chemotherapy with 5 FU, adriacin, and mitomycin C, she was discharged from the hospital. Six years after the operation, she became pregnant and delivered a normal female baby in July 1989. In November 1990, ie., eight years after the operation, she died of carcinomatous peritonitis. To our knowledge, there have been 9 case reports of pregnancy and delivery after surgery for gastric carcinoma in Japanese literature, ; and these data may suggest that pregnancy be acceptable only if gastric cancer is in early stage, absolute curative resection is performed and if estrogen receptor of the tumor is negative.

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