Recently, prognosis of patients with esophageal carcinoma has greatly improved in Japan. It may largely owe to the early detection of tumor by an advanced endoscopic technique and to the enlarged surgical field. Correct tumor staging by CT scanning, endoscopical and percutaneous ultrasonographies did a lot for accurate selection of the treatment, which consequently have contributed to improve overall patient prognosis. According to the report of national registration in Japan, percentage of superficial carcinoma in total esophageal tumors has increased by more than double time in the last ten years resulting in 28%. This increased number of early stage tumor gives impetus to the evolution of endoscopic mucosal resection (EMR). Using Lugol-staining method, EMR has a definite role today in the treatment system of esophageal carcinoma. While, a study to examine whether chemo-radiation therapy can be a treatment with curative intent or not for patients with early stage tumor has started. The standard treatment for esophageal carcinoma has been surgery, and nearly 80% of patients have undergone it in the last ten years. Around 18 years ago, a technique of 3-field lymph node dissection was introduced to an esophagectomy, which has become a part of the standard technique of esophagectomy in many leading institutions in Japan, By these advances, postoperative survival rate for patients with esophageal carcinoma in our institute has reached to 50%. Reduction of the surgical burden and development of new treatment strategies in the place of surgery are assignments for us in the future.

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Vpr, an accessory gene of human immunodeficiency virus, encodes a virion-associated nuclear protein of 15 KDa in size. Vpr is supposed to have an important role for the AIDS development. It induces cell cycle abnormality and enhances virus production. We have established a stable transfectant (MIT-23) in which Vpr expression is highly regulated. Using MIT-23 cells, we found that quercetin, a f lavonoid, inhibited Vpr function, and that Vpr expression induced genomic instability. We discuss the feasibility of using Vpr as a target molecule for the development of a novel anti-HIV therapy.

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To detect the site of origin of premature ventricular contractions (PVCs), echocardiography were recorded in forty-two patients with frequent PVCs but without organic heart disease. In All patients, wall motion during PVC were evaluated. In ten of these patients, the time intervals f romonset of QRS complex of PVC to beginning of contraction on M-mode echocardiography were measured. PVCs were classified into left bundle branch block (LBBB) type, right bundle branch block (RBBB) type and unclassified type, according to electrocardiographic patterns. Each type was subdivided into inferior and leftward axis subtypes. M-mode echocardiography showed abnormal early contractions and late abnormal wall motions during PVC. Abnormal wall motions at PVC were recognized on anterior wall of the right ventricle (RV), interventricular septum (IVS) and lateral wall of left ventricle (LV) in type of LBBB with inferior axis; on posterior wall of RV and IVS in type of LBBB with leftward axis; on posterior wall and lateral wall of LV and anterior IVS in type RBBB with inferior axis; on inferior wall of LV and IVS in type of RBBB with leftward axis; on anterior IVS lateral wall and posterior wall of LV in type of unclassified pattern with inferior axis; on posterior wall of RV, inferior wall of LV and IVS in type of unclassified pattern with leftward axis respectively. National Sanatorium Kanagawa Hospital When the time intervals from onset of QRS complex to beginning of contraction were measured during PVC, the site of earlist contraction was near the anterior IVS in type of LBBB with inferior axis; near the inferior IVS in type LBBB with leftward axis; from the anterior IVS to lateral wall of LV in type of RBBB with inferior axis; near the inferior IVS in type of RBBB with leftward axis; near the anterior IVS in type of unclassified pattern with inferior axis; and near the inferior IVS in type of unclassified pattern with leftward axis, it seems to be usefull to estimate the origin of PVC by echocardiography.

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We evaluated the concentration of soluble E-selectin (sE-selectin), which is a marker of endo-thelial damage, in patients with non-insulin-dependent diabetes mellitus (NIDDM). SE-selectin was measured in 40 diabetic patients and 32 healthy subjects. Increased sE-selectin concentrations were found in the patients with NIDDM compared to the control subjects (p<0.01). The concentration of plasma sE-selectin was positively correlated with the level of plasma glycated haemoglobin (r=0.46, p<0.01).
These results suggest that the concentration of sE-selectin may be related to blood glucose control, and that the grade of DM control is closely related with vascular endothelial damage in patients with DM.

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A seventy five-year-old woman visited our hospital with chief complain, subcutaneous tumor at the left wrist joint. She had left hemiplegia due to old stem infarction. Because of continuous swelling and pain at the wrist, tumor was resected. The first histological finding was metastatic tumor like small cell lung cancer (SCLC), so whole body examination of the cancer origin was done. But no abnormal changes was found.
A few months later, subcutaneous swelling appeared again. So re-operation was performed. Pathological final diagnosis was Merkel cell carcinoma with electron microscopical findings. No reccurent evidence occured.
Merkel cell carcinoma was rarely found as a neoplasma in the soft tissue of the wrist. It is difficult to diagnose between Merkel cell carcinoma and small cell lung cancer.
We suggest that it is important to exercise the patient having the tumor reccurence short time after operation and tumor like small cell carcinoma at the subcutaneous lesions.

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This report is a case of esophageal perforation and mediastinitis by an ordinary uppe gastrointestinal endscopic study.
A 61 year-old woman was pointed out abnormality of the body of stomach by group examination. She was examined by gastrointestinal endoscopic study on June 31th 1997. Since 1 hour after the study, she had pain at epigastric region, neck and back. By examination of computed tomography (CT), we diagnosed mediastinitis caused by perforation of esophagus. We treated by non-operative theaapy. She was inhibited from oral intake and movement under treatment of IVH and was taken antibiotics. So 1 week later, she had no symptom and diagnosed to have no infection of mediastinum and neck by CT. According to the literature, this is a very rare case of mediastinitis and perforation by ordinary gastrointestinal endoscopic study. Even if an ordinary gastrointestinal study happens to occur mediastinitis, conservative therapy is probably useful.

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In order to evaluate the response to diabetic education in our hospital, information was collected from patients with diabetes mellitus who had been admitted for diabetic education from 1991 to 1996. We used questionnaires focusing on dietary and exercise compliance on outpatient basis. The results indicated that only fifteen and twenty eight percent of patients followed the doctor's instructions on dietary and exercise therapy, respectively. Nearly sixty percent of patients who could not bear dietary and exercise therapy gave up following the doctor's instructions within half year after discharge.
The results of questionnaires and the data of medical records were investigated to clarify the cause of discontinuation of the dietary and exercise therapy. The results showed up the need for more motivation and guidance for diabetic education.

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