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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片麻痺レベルII-III (Brunnstrom 法) の脳血管障害患者11例 (理学療法群;脳出血4例, 脳梗塞7例, 68.9±9.3歳) について理学療法による二重染色解析リンパ球サブセット, NK細胞活性及び抗体依存性細胞作動性細胞障害 (ADCC) 活性の変化を測定し, 理学療法を中断した同疾患患者5例 (対照群;脳出血2例, 脳梗塞3例, 72.2±9.3歳) と比較検討した.理学療法群では対照群に比しサプレッサー・インデューサーT細胞 (CD4⁺×CD45R⁺), ヘルパー・インデューサーT細胞 (CD4⁺×CD29⁺) は有意に増加したが, サプレッサーT細胞 (CD8⁺×CD11⁺), 細胞障害性T細胞 (CD8⁺×CD11^-) 及び活性化T細胞 (HLA-DR⁺×CD3⁺) は両群間に有意差はなかった.また, 理学療法群ではADCC活性は有意に増加したが, NK細胞活性は両群問で有意差はなかった.脳血管障害患者では理学療法の継続は免疫機能を亢進させるが, 理学療法中断は免疫機能の低下をもたらす可能性が示唆された.

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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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今回我々は1972年から1995年までの24年間に精巣腫瘍を第1癌とする重複癌を3例経験した.3例の第2癌はそれぞれ腎癌, 肝癌, 膀胱癌であった.精巣腫瘍の患者では2次癌発生の危険性が約2倍になるとの報告もあり, 第1癌に対する治療がその要因のひとつとされている.今回我々が報告した3例中2例は, 術後予防的に放射線治療を行っているが, 2次癌発生を誘発した可能性は低いと思われた.

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患者は66歳, 男性.主訴は左陰嚢内容無痛性腫大, 左腹部腫瘤, 食欲不振腹部CTおよびMRで, 腹部大動脈左側に左腎門部から骨盤内に達する巨大な腫瘤がみられ, 左水腎, 水尿管をともなっていた.左精巣腫瘍の診断にて高位精巣摘除術を施行.病理診断はB細胞由来のDiffuse lymphoma, large cell typeであった.血液内科に転科し, 多剤併用化学療法 (MCNU-CHOP) を計6クール施行.一時腹部腫瘤は著明に縮小したが, その後再燃したために別のレジメン(MACOP-B)を開始.施行途中に肺炎を併発し, 徐々に一般状態は悪化して死亡した.

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