Recent studies have demonstrated that the rupture of the atherosclerotic plaque with superimposed thrombosis triggers the acute coronary syndrome. In addition to the disruption of plaque, disturbances of the fibrinolytic system may contribute to the occurrence and persistence of coronary thrombosis. The dynamics of fibrinolysis is mainly governed by the released amounts of tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PA-1) from vascular endothelial cells. PAI-1, which inhibits the fibrinolytic activity through blocking t-PA effect, has been al-ready proved to be inceased in the acute coronary syndrome. Recently, it was reported that t-PA, C-reactive protein (CRP) and PAI-1 might be the predictors of subsequent cardiovasular events in patients with ischemic heart desease (IHD). However, there are few studies of the association between these risk factors and cardiovascular events in the Japanese population. In this review, we show our recent studies focused on the changes of fibrinolytic factors in the acute coronary syn-drome and the factors predicting the risk of cardiovasular events in patients with IHD and discuss the fibrinolytic system as a risk factor of IHD.

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Based on monitoring CD 4⁺ and CD 8⁺ T cell counts, previous studies have indicated that orthopedic surgery does not influence on clinical status of HIV-1 infected patients. However, there are no reports of influence of such surgery on HIV-1 RNA (viral load) in plasma. Here, we measured plasma viral load CD 4⁺ nad CD 8⁺ T cell counts in four HIV-1 infected hemophiliacs (five operations) be-fore and after orthopedic surgery, Which included four total knee arthroplasties and one total hip arthroplasty operation performed under general anesthesia between 1997 and 1999. Compared with baseline values (pre-surgery), CD 4⁺ and CD 8⁺ T cell counts did not change significantly at one and three months after orthopedic surgery. None of the patients developed fever or inflammatory reaction that delayed postoperative recovery. Furthermore, viral load did not increase at one and three months after operation. Our data suggest that orthopedic surgery does not influence on clinical course of HIV-1 infection judging from changes of viral load, CD 4⁺ and CD 8⁺ T cell counts. However, to con-firm our conclusion, further studies with long-term follow-up and a larger number of patients are necessary.

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We investigated the difference of methods for drugs or poisons determination system in acute intoxication patients, using HPLC, GCMS and atomic absorption spectropohotometers (AAS) system.
We determined 88% kinds of expected drugs in HPLC, GCMS and AAS system, while 59% kinds of expected drugs in only HPLC. Particularly in unknown samples, the rate of identification of drugs was increased. We suggest that HPLC, GCMS and AAS are useful for drug concentration determination in acute intoxication case.

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The type 2 gastric cancer was pointed out by the endoscopic examination in a 68-years-old woman who had history of lung resection because of lung cancer. Left pleural effusion and nodular shadow in lung field were recognized simultaneously. The result of the cytological examination from the effusion was Class V. Because of advanced stage of the recurrent lung cancer, the second cancer was considered to be out of gastric operation. After administrating Pirarubicin and OK432 into the pleural cavity and the low dose FP (CDDP+5Fu) therapy combined with Cyclophosphamide (CPA), Partial Response (PR) to the gastric cancer and effectiveness to the pleural effusion were seen. Because of the growth of gastric cancer, subtotal gastrectomy was done successfully to this patient. After the operation, we could not administrate enough chemotherapy. But she is still alive without increasing in the pleural effusion, 8 months after the gastrectomy.
From the clinical course, we consider that CPA has been useful in this case. One of the factors of usefulness was administration of 5'-DFUR instead of 5FU. CPA is an activator of pyrimidine nucleoside phosphorylase (PyNPase). Although anti tumor effect of 5'-DFUR might be increased by CPA.

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A 72-year-old male with chronic atrial fibrillation admitted to our hospital. He was treated with warfarin scince pulmonary infarction occured when he was operated on for descending colon cancer in April 1999. He had discontinued warfarin to pull out his rotten tooth for one week and had anterior chest pain in December 6, 1999. Electrocardiogram suggested acute inferior infarction and emergent coronary angiography revealed obstruction of right coronary artery at segment 3. But the thrombus of coronary artery migrated to the distal site of segment 4 PD after inserting PTCA baloon before inflation. There was no residual stenosis at the occluded site. PTCR with rt-PA was performed only to fail. Coronary angiogram showed no organic stenosis of right coronary artery after 19 days. Echocardiogram could not detect the organic change of mitral valve and left atrial thrombus. But there was smoke like echo pattern in left atrium and flow velocity of left atrial appendage decreased moderately. These findings suggested that the cause of myocardial infarction was coronary thromboembolism and we may need anticoaglants in non valvular atrial fibllilation.

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In 21st century, the pediatricians in the national medical institutions are expected to take charge in the develomental medicine. An evaluation was made on the future role of the pediatricians in this field. Among the national medical institutions in Japan, there are 50 institutions, which are in charge of developmental medicine. This covers various fields of medicine including: (1) genesial medicine; (2) perinatal medicine; (3) pediatric medicine; (4) puberal medicine; (5) maternity and adult medicine; and (6) emergency medicine for infants and mothers. It seeme to be difficult to cover all of these fields from the viewpoint of personal resources as well as the quality of the care for infants and children. Positive promotion of interpersonal relationship and information exchange between the institutions is essential in order to effectively utilize limited personal resources in each individual institution and to attain the highest effects. National policy based on deregulation is indispensable so that all pediatricians would be able to participate in the childcare as one of the measures to cope with the society with rapid increase of younger population.

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The management guideline of amyotrophic lateral sclerosis (ALS) in national hospitals was made in the fiscal year of 1999 by the executive committee and several other members belonging to the Council of Neurology, The National Hospitals and The National Center of Neurology and Psychiatry.
The guideline includes the necessity of giving information and explanation to the patients themselves on the disease ALS, mechanical ventilation, palliative care, home care assistance, linking with other institutions, welfare and ALS patients' association.

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