Nagano ranks third in Japan in terms of the percentage of HIV-positive people in its population.
We analysed the number of CD4+ T cells, the ratio of AIDS in HIV-positive people, diagnostic clues and the past histories in 125 patients who visited the AIDS base hospitals in Nagano from January 2001 to August 2005.
58.4% of patients had developed to AIDS when they were diagnosed as HIV positive. CD4+ T cells were below 200/μl in 64.8% and severe immunosupression (CD4+ T cells below 50/μl) was observed in 40.8%. The median number of CD4+ T cells at diagnosis was 70.5/μl. Frequent clues to the diagnosis of HIV infection were found to be pneumocystis pneumonia, oral candidasis and body weight loss. Herpes zoster infection, sexually transmitted infections (STIs), and refractory eruptions were observed in past histories.
In Nagano Prefecture, many of the patients were diagnosed as HIV positive when they had already developed to AIDS. Past histories such as herpes zoster infection, STIs, and refractory eruptions seemed to be clues for making an early diagnosis by general clinicians, which will be essential to improve the prognosis and prevent the spread of the disease.

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Neurally mediated syncope (NMS) is an important cause of recurrent syncopal episodes. We performed head-up tilt testing (HUT) with isoproterenol provocation in 27 patients (10 males and 17 females) who were suspected of having NMS between 2001 and 2006 at Joetsu General Hospital. Of the 27 patients, 20 (5 males and 15 females ; mean age, 57.7 years) had syncope ; five of these (25%) had syncope due to bradycardia or cardiac arrest (cardioinhibitory type), 9 (45%) due to hypotension (vasodepressor type), and 6 (30%) due to bradycardia with hypotension (mixed type).
We selected treatment methods based on the type of syncope. DDD pacemakers with a rate drop response algorithm were implanted in the patients with the cardioinhibitory type. β-blocking agents and disopyramide were administered to patients with the vasodepressor and mixed types, respectively.
During the follow-up period, 17 patients (85%) were syncope-free and two (cardioinhibitory type) had one episode of syncope. However, after adjustment of the pacemaker algorithm, they were syncope-free. One patient (cardioinhibitory type) died from an accidental fall.
Careful documentation of history and HUT are necessary for the diagnosis and treatment of NMS. We believe that the prognosis of NMS is good if treatment is selected based on the type of syncope.

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We report a case of intractable chylothorax with chyloma after esophagectomy that demonstrated respiratory dysfunction. A 55-year-old man underwent thoracoscopically esophagectomy for esophageal cancer. After surgery, effusion from the chest drain increased to over 1000ml/day. We diagnosed chylothorax with laceration of the thoracic duct, and operated for thoracoscopic ligation of the thoracic duct on the 11th postoperative day (POD). After the second operation, although the patient took food without permission and fluid from the chest drain increased remarkably. We performed treatment by pleurodesis on the 35th POD, but fluid volume from the thoracic drain failed to decrease. Chest CT on the 34th POD showed a chyloma in the mediastinum. We performed conservative management for the chylothorax because fluid volume from the thoracic drain decreased to 70ml/day. On the 82th POD, his temperature rose, and WBC and CRP increased. We removed the central venous catheter. On the 89th POD chest X-ray showed that the chyloma had rapidly increased in size, and the patient had severe dyspnea. Respiratory tract obstruction by the large chyloma with bacterial infection was strongly suspected. We opened the wall of the chyloma and ligated the thoracic duct. We found an accessory duct or thick lateral branch of the main thoracic duct, and also ligated this duct. On the 15th POD after the third operation food intake began, and the patient was discharged from our hospital on the 35th POD after the third operation. It is suspected that the chylothrax was caused by injury to the accessory duct or the lateral branch of the main thoracic duct.

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●加齢黄斑変性は高齢者の失明原因として大きな問題となっている。加齢黄斑変性に対する治療法の中で，光線力学的療法は現在選択できる最も有効かつ安全な治療法と考えられる。さらに有効な治療法の研究も進んでいる。

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