Current treatment of hepatocellular carcinoma (HCC) was reported. Small HCC can be detected by the close follow-up of the patients with chronic liver disease using diagnostic modalities, such as US, CT and serum tumor marker (AFP, PIVKA-II) measurements. Recent improvements in surgical techniques and preoperative and postoperative managements have increased the safety of hepatic resection. Consequently, the long-term survival following hepatectomy in patients with HCC have remarkably improved as well. While the development of non-surgical therapeutic procedures, such as transcatheter arterial embolization (TAE), percutaneous ethanol injection therapy (PEIT), microwave coagulation therapy (MCT) and radiofrequency ablation (RFA) have changed the indication for hepatic resection of HCC, early diagnosis and aggressive treatments for postoperative recurrence and second primary HCC still remains the most important strategy in prolonging the survival.

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The term of primary or secondary pulmonary hypertension was analogously used as the classification of systemic hypertension. In secondary pulmonary hypertension, the exogenous stimulation induces the injury to endothelial cell, which responds in natural function, leading to persistent pulmonary vascular remodeling and pulmonary hypertension by the repetitive stimulation. With time, pulmonary hypertension induces the progressive increase in pulmonary vascular impedance, which ultimately produces right ventricular overload and/or hypertrophy. In fact, pulmonary vascular impedance was changed with an elevation of pulmonary arterial pressure in chronic obstructive pulmonary disease, in which the peripheral resistance increased and the compliance of the proximal pulmonary artery decreased. This means that the proximal and distal pulmonary vessels become stiffer.
In 1996, it was reported that the continuous intravenous infusion of epoprostenol (prostacyclin) produced hemodynamic and symptomatic improvement. Prostacyclin decreases pulmonary arterial pressure, and increases cardiac output and oxygen supply, improving pulmonary vascular remodeling. The inhalation of nitric oxide (NO) decreases pulmonary arterial pressure in a short-term manner. However, a long-term effect of NO on pulmonary hypertension is investigated in progress.

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It was mentioned that characteristic of interstitial pneumonia during exercise is high respiratory frequency and high ratio of tidal volume to inspiratory capacity (VTsuneo/IC). We investigated the change in respiratory frequence and tidal volume in patients with interstitial pneumonia during exercise compared to those of pulmonary emphysema.
The results showed that respiratory frequency and V_T/IC increased in patients with interstitial pneumonia compared to pulmonary emphysema, but thera were no significant difference in V_T/IC between interstitial pneumonia and pulmonary emphysema.
Frequency/tidal volume (f/V_T) ratio, rapid shallow index, was elevated in interstitial pneumonia compared to that in pulmonary emphysema (p=0.0041). We thought that high value was due to low pulmonary compliance and the accelation of sympathetic nerve by intestitial edema.
We thought characteristic finding of interstitial pneumonia during exercise was high value of f/V_T and high respiratory frequency.

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We measured the plasma and bronchoalveolar lavage fluid (BALF) levels of human neutrophil peptides (HNP), which is antimicrobial cytotoxic peptides in azurophil granules of neutrophils, in patients with active pulmonary tuberculosis, Plasma HNP levels in 32 patients before treatment were higher than those in 25 normal healthy volunteers, but the levels were significantly decreased after the treatment of tuberculosis. High levels of HNP in BALF were also observed in patients with pulmonary tuberculosis and there was a correlation between levels of HNP and Interleukin-8 in BALF. A negative correlation was found between plasma HNP levels before treatment and Δ%vital capacity (VC) (%VC after treatment-%VC before treatment). These findings suggest that deterioration of pulmonary function in active pulmonary tuberculosis may be caused by HNP released by neutrophils that accumulated in the lung.

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Stroke in Japan is the 3rd in death, 2nd in medical expense, and 1st in disability. The situation will become worse because of rapid increase in aged population. Stroke management, however, has made a great progress, that includes thrombolytic therapy in hyperacute ischemic stroke, carotid endarterectomy against severe carotid stenosis, etc. There is good evidence that specialized care in Stroke Unit can reduce mortality and morbidity, and improve outcome in stroke patients as compared with management in a general ward. Reconstruction of the stroke care system is def finitely required.
In the 54th Annual Scientific Meeting held in Osaka, November, 1999, we had an opportunity to chair the symposium (S-II) regarding medical care for stroke patients. The symposium consisted of 6 lectures and a designated discussion. There were fruitful arguments about many problems awaiting solution, such as hospital-clinic relationship, acute stroke nursing and rehabilitation, seamless care home nursing. In addition, we obtained information about current and future status of stroke care in Japan and Western countries. We hope this proceedings of the symposium will help resolve many problems surrounding medical service for stroke patients.

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