Facing an increasingly aged society, prostate cancer screening, mainly by prostate-specific antigen (PSA), is increasing all over the world, even in Japan. Newly diagnosed prostate cancer has been dramatically increasing and the number of affected patients is estimated to be 78000 in 2020 in Japan. Three-quarters of patients with prostate cancer are older than 65 years old, which makes the cancer suitable for chemoprevention. Herein, we introduce a typical clinical procedure in the diagnosis and treatment of this disease, and report the basic, clinical aspects and prospects of chemoprevention. Within the report, the results in four of phase 3 trials, including the Physicians Health Study II (PHS II), Selenium and Vitamin E Chemoprevention Trial (SELECT), Prostate Cancer Prevention Trial (PCPT) and Reduction by Dutasteride of Prostate Cancer Events Trial (REDUCE) are presented and discussed.

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It is considered difficult to perform direct percutaneous endoscopic jejunostomy (DPEJ) in patients with total gastrectomy or with peritoneal dissemination. In the present report, four gastric cancer patients with intestinal obstruction due to peritoneal dissemination after gastrectomy underwent DPEJ for decompression of the intestines, and we attempted to evaluate the palliation of symptoms by DPEJ. As a result, the discomfort due to insertion of the ileus tube disappeared in all four of the patients, and the frequency of vomiting per day was reduced in three out of the four patients. No severe complications were observed. Furthermore, as the technique of DPEJ is almost the same as the method of percutaneous endoscopic gastrostomy, which is performed routinely, we think that DPEJ is a safe and useful method as palliative care for the patients with terminal cancer stage who have intestinal obstruction when the surgeons have sufficient experience.

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A 64-year-old woman visited our medical center due to skin itching and visual disturbance. She was diagnosed with uveitis based upon inter-sterno-costoclavicular osteoarthropathy (ISCCO). Hematological and serological examination showed an increased erythrocyte sedimentation rate, and serum levels of enzymes, such as alkaline phosphatase, leucine aminopeptidase and gamma glutamyl transpeptidase. Autoantibodies, such as anti-nuclear antibody and anti-mitochondria M2 antibody were also positive. Chest X-ray examination and computed-tomography of the chest showed an abnormal hyperostosis of both the clavicular and upper part of the sternum. Together with these findings and symptoms, she was diagnosed as having a primary biliary cirrhosis (PBC) with an ISCCO. Arthropathies complicated with PBC usually depend on the complications of other autoimmune diseases, such as Sjogren’s syndrome, rheumatoid arthritis and scleroderma. Some reports have shown that arthropathies complicate chronic liver diseases, including PBC, and most of such arthropathies showed hyperplastic changes of the bones and joints. The ISCCO presented here is one of the typical hyperplastic arthropathies, however, the overlapping of PBC and ISCCO has not been reported. PBC of this patient is now well controlled with ursodeoxycholic acid treatment.

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An 86 year-old male with two drug-eluting stent implantations was admitted to our hospital because of congestive heart failure. Paclitaxel-eluting stents (PES) were implanted in his left anterior descending artery (LAD) and right coronary artery (RCA) 4 months before admission. Emergent coronary angiography was performed, which revealed stent restenosis in both the LAD and RCA. Although early-phase restenosis of drug-eluting stent (DES) is considered to be very rare, and while its exact mechanism remains unknown, angioscopy for DES-implanted segment in RCA was possible in this case. We observed red thrombi, incomplete neointimal coverage and a yellow plaque behind the stent struts by angioscopy. We thought that the reason for the restenosis in this case was stent thrombosis caused by increased thrombogenicity associated with uncovered vulnerable plaque behind the stent struts. Therefore, in addition to excessive neointimal proliferation, stent thrombosis should also be considered as one of the mechanisms of early-phase DES restenosis.

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