Malaria is one of the most devastating diseases in the context of emerging and re-emerging infectious diseases. We have to be fully prepared for the introduction of the disease into Japan under recently enforced“the new law for the prevention of infectious diseases”as it is called. However, prompt diagnosis and proper treatment are not always to be provided in Japan, because of our relatively poor awareness of its importance and inappropriate supply of effective anti-malaria drugs. Travel medicine is rarely practiced though it is indispensable as internationalization or globalization of our society progresses. It is also quite important for us to contribute to the control of malaria in the tropical countries. The former prime minister Hashimoto pointed out its importance in the G8 summit in Denver, 1997, and then Japanese Government started to promote Global Parasite Control Strategy for the 21 century or“Hashimoto Initiative”. Another initiative suggested by WHO as “Roll Back Malaria” is also a global malaria control program, to which Japanese Government should contribute. Now requirement for the investment into the basic and applied research of malaria is recognized, and the budget will be increasing in the area of Grant-in-aid for scientific research of the Ministry of Education, Science, Sports and Culture, and the Ministry of Health and Welfare of Japan.

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Survival of advanced epithelial ovarian cancer has not apparently increased in spite of various efforts. In this paper, recent circumstances are summerized and several problems are disscussed with operation and chemotherapy.
Standard treatment is initial debulking of intra-abdominal tumor followed by chemotherapy. If it is impossible to achieve optimal debulking, intervention cytoreduction following several courses of chemotherapy shoud be considered. First-line chemotherapy has been cisplatin-based combination therapy last 30 years, but, these regimen (CAP or CP) are, usually, not effective for clear cell adenocarcinoma and mucinous cystadenocarcinoma. Recently, In the latter two types of histology, CPT-11-based regimen are reported to be effective. Further, in stead of cisplatin-based regimen, paclitaxel-based regimen has been watched based on several randomized studies.

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We examed soluble interleukin-2 receptor (sIL-2R) and soluble intercellular adhesion molecule-1 (sICAM-1) in venous blood from healthy subjects, sIL-2R and sICAM-1 are correlated with age (r=0.207, n=174, p=0.0064 and r=0.248, n=126, p=0.0065, respectively). Both factors had significantly higher levels in males than in females (p<0.007). There was statistically significant correlation between sIL-2R and sICAM-1. Changes in serum sIL-2R and sICAM-1 levels with aging and increased levels in men may be related to the developement of atherosclerosis.

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The feasibility of using the plasma brain and atrial natriuretic peptide (BNP, ANP) level as an index of pulmonary hypertension (PH) with chronic respiratory failure was evaluated. We examined PH by echocardiography with continuous wave Doppler method in 21 patients with chronic respiratory failure (>Hugh-Jones grade II, pulmonary emphysema/old pulmonary tuberculosis) and classified PH into three groups according to normal, moderately or severe impairment. In the severe PH group, plasma BNP and ANP levels were significantly increased, whereas moderately PH group, the increase in plasma BNP and ANP levels were not significant. The results suggests the increase in the plasma BNP and ANP levels at rest failure may be a non-invasive index of severe pulmonary hypertension with chronic respiratory.

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A family with MEN2 A was reported. This family included nine cases of the thyroid cancer, in which five cases of the medullary thyroid carcinoma were diagnosed. Among five one case had the pheochromocytoma. The propositus was operated for Hirschsprung's disease in infancy and was operated for the medullary thyroid carcinoma at the age of 23. A DNA analysis of the propositus revealed a mutation at codon 618 of exon 10. Periodic biochemical tests and DNA analyses might be nesessary for this family.

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Acute tumor lysis syndrome consists of combinations of hyperuricemia, lactic acidosis, hyperkalemia, hyperphosphatemia, and hypocalcemia, occurrs generally in patient with a high LDH level or renal insufficiency. We reported a 77 year old female with relapsed Non-Hodgkin's lymphoma who developed acute tumor lysis syndrome. Before chemotherapy, multiple lymph nodes were swollew on physical examination and atypical cells were present in peripheral blood. Laboratory data showed normal renal function and LDH level. After starting chemotherapy (ABEP therapy), urine volume was decreased, twenty-four hours later, ECG showed tall T-wave and laboratory data showed hyperkalemia (K 8.1 mEq/l), hyperuricemia (UA18.9 mg/dl) and renal dysfunction (Cr1.9 mg/dl). Acute tumor lysis syndrome is seen less frequently after routine use of allopurinol and hydration. All patients receiving chemotherapy should be closely monitored.

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We report a case of acute heart failure showing unusual changes of electrocardiogram. Patient was a 75-year-old woman who was admitted because of palpitation and dyspnea. On admission, physical examination revealed severe hypertension, and chest X-ray demonstrated pulmonary congestion. Sinus tachycardia, left atrial overloading, and ST elevation in V₁-V₃ were found on the electrocardiogram. the findings suggesting hyperthyroidism were also found on laboratory data. Her blood pressure and symptoms due to heart failure were controlled with load reduction and antihypertension therapy, while negative T waves concomitant with prolongation of QT interval appeared and persisted in almost all leads of the electrocardiogram. Echocardiogram revealed hypokinesis of the apical wall on admission, which was improved thereafter, ¹²³Iodine-metaiodobenzylguanidine (¹²³I-MIBG) myocardial imaging demonstrated a decreased accumulation in the lateral, posterior, and apical wall in sub-acute phase, and the decreased accumulation in the posterior wall persisted in chronic phase. Angiogram showed normal coronary arteries, and there was no adrenal mass on abdominal computed tomography. In this case, both hyperthyroidism and hypertension might trigger the acceleration of sympathetic cardiac nervous system, which might induce myocardial injury with unusual changes of the electrocardiogram.

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