In conclusion, we have tried to partially answer the questions about “What is on the other side of the 21st century doorway?” The answers were discussed in the light of a “third-wave” framework. Five major factors of 1) information management, 2) demographic changes, 3) global environment, 4) world economics and political forces, and 5) health and wellness lifestyles, were introduced to help us prepare for effective health care practice in the next century. Also, it was mentioned that successful health care delivery was incumbent upon professional care giver skills of 1) critical thinking, 2) care management, 3) primary care, 4) community focused, and 5) relationship-centered care. Finally, I believe that collegiality and sharing of better ways of health care delivery such as those demonstrated between our two Universities for more than 16 years is one of the most significant demonstrations of “forecasting a healthier future” for all of us.

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The clinical significance of serum beta-2 microglobulin (Sβ₂M) levels in hematological malignancies and of the ratio of measured β₂M value to calculated β₂M (β₂M M/CTD ratio) from the serum creatinine level for assessing renal function were examined. The levels of Sβ₂M in patients with multiple myeloma (MM), polycythemia vera (PV), and renal failure were markedly increased. The β₂M M/CTD ratio was increased in MM and PV patients, but was not increased in renal failure patients, suggesting that the β₂M M/CTD ratio is useful for distinguishing between MM and renal failure.
In the MM group, the mean Sβ₂M level did not significantly differ between the patients who received chemotherapy with/without interferon and those who were not treated. However, the mean β₂M M/CTD ratio of the chemotherapy plus interferon-alpha group was significantly higher than that of the non-treated group (p <0.01) and that of the chemotherapy-only group (p < 0.02). In the group with chronic myelogenous leukemia, both the mean Sβ₂M level and the mean β₂M M/CTD ratio were significantly different in the non-treated patients compared with the interferon therapy patients (p <0.02, p <0.05).We speculate that the evaluation of prognosis and tumor mass by the level of Sβ₂M should be performed at the time of diagnosis, before the administration of chemotherapy with interferon.

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Two-color analysis of lymphocyte subsets, natural killer cell activity and antibody-dependent cellular cytotoxicity during a 2-month period of conventional physical therapy were evaluated in 11 patients with hemiplegia 2-4 weeks after the onset of cerebrovascular diseases who were classified into stage II-III by the criteria of Brunnstrom on admission. Compared with the patients who discontinued the physical therapy 3-4 weeks after the onset of stroke because of their own will, the suppressor/inducer T cells (CD4⁺×CD45R⁺), helper/inducer T cells (CD4⁺× CD29⁺), and antibody-dependent cellular cytotoxicity activity were increased significantly, though suppressor T cells (CD8⁺×CD11⁺), cytotoxic T cells (CD8⁺×CD11^-), activated T cells (Ia-1⁺×CD3⁺) and natural killer cell activity were not changed. It may be suggested that physical therapy in stroke patients has an effect of increasing the immune function.

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The prognostic factors and the correlation between local control and total dose were investigated for the patients with invasive thymoma treated by a combination of radiation therapy and surgery or radiation therapy alone. Eighteen patients were retrospectively analyzed. Our treatment strategy was to give the target volume a total dose of at least 50 Gy for patients with microscopic residual and 60 Gy or more for macroscopic residual. The actuarial survival rates were 61 % at 5 years and 54 % at 10 years in all patients. All patients having a complete resection survived disease-free for more than 6 years while the survival rates of patients with macroscopic residual or unresected tumors were 38 % at 5 years and 25 % at 10 years (p<0.005). For macroscopic residual local recurrence rate within a radiation field was 0 % at a dose of 60 Gy or more, 67 % from 50 to 58 Gy and 100 % under 40 Gy, respectively. Invasive thymoma may be preferable to be treated at the dose of 50 Gy or more for microscopic residual and 60 Gy or more for macroscopic residual. Good prognosis may be expected in the patients undergoing complete resection and radiation therapy.

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Between 1972 and 1995, three patients with testicular tumor were diagnosed with multiple primary cancer at Gunma Cancer Center. The second cancer in these three cases was renal cancer, hepatic cancer, and bladder cancer respectively.
Some reports have indicated that patients with testicular tumor have a two-fold increased risk for the development of second cancer, and it has been reported that treatment for the first cancer appeared to be responsible for the development of the subsequent tumors.
In our cases, there seemed to be no relationship between the development of the second cancer and radiation therapy to the testicular tumor.

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A 66-year-old male patient complained of swelling of the contents of the left scrotum, a mass in the left abdomen, and appetite loss. Abdominal CT and MR revealed a large mass in the left side of the abdominal aorta extending from the left renal hilus to the pelvis, accompanied by hydronephrosis and hydroureter on the left. A diagnosis of left testicular tumor was made, and left radical orchiectomy was performed. The pathological diagnosis was B-cell-type diffuse lymphoma, large cell type. The patient transferred to the department of hematology and was treated with six courses of multi-drug chemotherapy (MCNU-CHOP). The abdominal mass markedly decreased in size, but it relapsed, and the patient was treated with a course of another regimen (MACOP-B). Pneumonia developed as a complication, the patient's general condition worsened, and he died.

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