There have been few reports concerning the influences of cardiac hypertrophy on the clinical features and prognosis of acute myocardial infarction (AMI) . Therefore, the left ventricular myocardial mass index (LVMI) was calculated using echocardiogram obtained on the first hospital day in 202 patients with initial AMI (148 males and 54 females with a mean age of 66.3 years) . The patients were divided into Groups A and B with high (LVMI: M≥130, F≥120) and low (LVMI: M<130, F<120) myocardial masses, respectively, consisting of 110 and 92 patients, and the hemodynamics, echocardiographic findings, clinical features and prognosis in the acute and chronic stages were compared. Group A was further divided into an improved group in which the myocardial mass was decreased on the 28th hospital day compared to the 1st day (Group A1), and an unimproved group distinguished by myocardial mass remained unchanged or increased (Group A2) . The mean duration of follow-up was 4.7 years. The appearance rate of left ventricular wall thinning increased with time in both groups but the incidence was higher and the appearance after onset was also earlier in Group A. Regarding the prognosis, the incidences of congestive heart failure (CHF) and cardiac events (CE) in the acute stage and CHF, angina pectoris (AP) and CE in the chronic stage were significantly higher in Group A. With respect to the odds ratios of coronary risk factors, such as hypertension, diabetes, smoking, hyperlipidemia, obesity, and myocardial mass in the acute stage of CHF. AP and CE, the myocardial mass ratios in CHF and CE were 2.77 and 2.07, respectively, showing significant differences. As for the chronic stage, the odds ratios of myocardial mass in CHF, AP and CE were 3.51, 3.30 and 4.29, respectively, showing significant differences. On comparison of groups AI and A2, the appearance rate of left ventricular wall thinning increased with time, and the thinning was noted more frequently and earlier in Group A2. Regarding the prognosis, the incidences of CHF and CE were significantly higher in Group A2 in the acute stage. Based on the above findings, when cardiac hypertrophy is complicated by AMI, the prognosis is significantly poor in both the acute and chronic stages. Aggressive treatment to minimize the infarct area, to inhibit cardiac remodeling and to reduce the myocardial mass should be initiated from the onset of MI.

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A retrospective review of patients with prostate cancer was performed to evaluate the efficacy of primary hormonal therapy and predict long-term prognosis in these patients. Between 1988 and 2005, a total of 692 patients who were diagnosed with prostate cancer in clinical stages A to D were treated with primary hormonal therapy at Showa University Hospital and National Disaster Medical Center. The clinical outcome of the patients was analyzed in relation to clinical stage, biopsy Gleason score, pretreatment PSA, and % positive core. The median age of patients was 76 years (range 50-97), and the median follow-up period was 886 days (range 10-5812 days) and median pretreatment PSA level was 31 ng/ml (range 0.7218000) . The 5 and 10-year overall survival rates of all 692 patients were 70.7% and 51.6%, respectively, with 5 and 10-year cause-specific survival rates of 82.9% and 68.3% respectively. The 5 and 10-year PSA failure-free survival rates of all patients were 61.9% and 38.8% respectively. In the Kaplan-Meire method, between all or some categories investigated showed significant difference in prognosis. In multivariate analysis, the factors that significantly affected prognosis were the clinical stage, Gleason score, % positive core. It is possible to show nomograms to patients to predict the 5-year causespecific survival rate. In conclusion, our results show that hormonal therapy had a good long-term outcome in early stage cancer, and the % positive core was an independent prognostic factor. These results are useful in explaining the status or future prospective of the disease to patients and families.

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Cyclooxygenases (COX) are key enzymes in the conversion of arachidonic acid to prostaglandins. Cyclooxygenase 2 (COX-2) is an inflammation-associated enzyme involved in the pathogenesis of many solid tumors. In multiple myeloma (MM), recent studies have demonstrated that COX-2 overexpression is associated with reduced survival. Moreover, several studies have shown a relation between angiogenesis and COX-2 expression. Bone marrow angiogenesis plays an important role in the pathogenesis and progression of MM. The aim of this study was to determine the relationship between COX-2 and tumor angiogenesis in multiple myeloma. Eighty newly diagnosed patients with MM were included in the study. Immunohistochemical stain was used for detecting the expression of COX-2 in paraffin-embedded bone marrow biopsy specimens. The monoclonal antibody against Von Willebrand Factor was used for displaying vascular endothelial cells, and microvascular density (MVD) was detected by counting of Von Willebrand Factor factor -positive vascular endothelial cells. There were 4, 33, and 43 bone marrow biopsy specimens with negative, weak-moderate, and strong COX-2 immunostaining, respectively. Kaplan-Meier overall survival estimate of those patients with negative or weakmoderate COX-2 immunoreactivity in myeloma cells was significantly better than that of patients with strong COX-2 immunoreactivity (P=0.02) . COX-2 overexpression was associated with reduced survival. Kaplan-Meier overall survival estimate of those patients with low MVD (≤24) was significantly better than that of patients with high MVD (24<) . Moreover, both COX-2 and MVD correlated with the stage (Dune salmon), serum β-2 microglobulin, bone marrow plasma cells, and bone lesion. The expression of COX-2 in myeloma cells correlated significantly with tumor angiogenesis and may become a new therapeutic target for anti-COX-2 in multiple myeloma.

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To improve the performance of enzyme immunoassay (ETA), as a novel solid phase, magnetic micro-particles made of gelatin and gum arabic were prepared. Due to the hydrophilic characteristics of the particles, protein adsorption on the particle surface was restricted, resulting in high specificity when used as a solid phase of ETA. Magnetic gelatin particle-based ETA for detection of hepatitis B virus surface antigen showed similar sensitivity to and higher specificity than a commercially available fully automated enzyme immunoassay system. Therefore, magnetic gelatin particles would be especially useful in the immunoassay requiring higher sensitivity and specificity.

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Clinical data of 1956 anesthetic cases older than 40 years in 2001 were analized retrospectively on preoperative complications, anesthetic methods and intraoperative complications in order to examine the influence of age on anesthetic management. The cases undergoing cardiac surgery and obstetric anesthesia and those which used an artificial heart-lung were excluded from this study. The patients were divided into 5 groups according to age: Group 1 (40-49 years), Group 2 (50-59 years), Group 3 (60-69 years), Group 4 (70-79 years), and Group 5 (80 or older) . These 5 groups were subsequently divided into 3 groups according to method of anesthesia: general anesthesia (GA), combined epidural-general anesthesia (CEGA), and spinal anesthesia (SA) . The results were as follows: The preoperative complications were significantly increased in elderly patients, especially those with hypertension, ECG change and cardiac disease. The incidence rate of intraoperative hypertension above 180 mmHg was higher in the GA group than in the CEGA group. Intraoperative hypertension had a slight correlation with preoperative hypertension. The incidence rate of intraoperative hypotension under 80 mmHg was the highest in the CEGA group. Intraoperative hypotension showed a slight correlation with preoperative ECG change. The cases treated with vasopressor were most frequently observed in the CEGA group. In particular, a majority of over 60's needed treatments with vasopressor. The incidence rate of intraoperative blood transfusion was high in the GA and the CEGA groups. This clinical study revealed that preoperative complications and incidences of intraoperative hemodynamic disorder significantly increase in elderly patients. Geriatric anesthesia requires very skillful management of the vasopressor and anesthetic agents.

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Osteomyelitis is a generally severe infection characterized by inflammatory destruction of the bone. This disease is often refractory and subject to recurrence.Staphylococcus aureus, the Gram-positive organism, is the most common causative agent of osteomyelitis. In bone marrow inflammation caused by the infection withS. aureus, the production of various cytokines is induced. Inflammatory cytokines such as IL-1, IL-6, and TNF-a and receptor activator of NF-κ B ligand (RANKL) are candidate cytokines which are produced by osteoblasts and promote bone resorption. Epigallocatechin gallate (EGCg), the main constituent of tea catechins, exhibits antibacterial, antioxidative, and anti-inflammatory activities. Here, we examined the inhibitory effect of EGCg on production of IL-1α, IL-1β, IL-6, TNF-α, and RANKL in mouse osteoblst infected withS. aureus. Normal osteoblastes produced IL-1α, IL-6, and RANKL but not IL-1β and TNF-α after exposure toS. aureus. In contrast, pretreatment with EGCg to osteoblasts significantly inhibited the production of IL-1α, IL-6, and RANKL. These results indicate that the reduction of IL-1α, IL-6 and RANKL in osteoblasts by EGCg may result in the prevention and therapy for inflammatory bone diseases.

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We report a 57-years-old woman with endometrial cancer and bullous pemphigoid who underwent transabdominal hysterectomy. Steroid application and preoperative internal use helped to reduce the blister. The cutis symptoms of chromatosis in the extremities soma improved. Intubation of the trachea may be hazardous because of the possibility of airway obstruction resulting from oropharyngeal and laryngeal bullae. Careful attention must be given to the formation of bullae on any part of the body caused by mechanical stimuli during anesthetic management. The patient was successfully anesthetized with Combined Spinal-Epidural anesthesia without any untoward event. The surgery proceeded uneventfully and the postoperative period was uncomplicated. The patient did not have any cutis symptoms such as new blister formation and a recurrence. The patient was discharged from the hospital.

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