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Malignant neoplasm preferentially occurs in the elderly. Common cancers in the elderly are gastric, colorectal, lung and prostate cancers in men whereas colorectal, lung, gastric and pancreatic cancers in women. There are several characteristic features such as tumor location, histology, biological behavior and pathway of carcinogenesis in malignant neoplasms occurring in the elderly. Multiple cancers increase with aging. Although it is generally believed that carcinoma in the elderly shows well differentiation, slow growth, low incidence of metastasis and favorable prognosis, the tumor does not always show such features. Regarding biological behavior of malignant tumor in the elderly, age-related alterations of the host such as stromal weakness and decreased immune response against cancer cell invasion should be considered as well as characteristics of tumor cell itself. Thus, we need a specific strategy for treatment for malignant neoplasms in the elderly.

A 62-year-old woman presented at our hospital with a headache, cognitive decline, and fever that had persisted for 3 months. On admission, fever, headache, and mild cognitive dysfunction were all clearly evident, suggesting chronic meningoencephalitis. Laboratory examination showed mild neutrophilia as well as an increase in her erythrocyte sedimentation rate and serum C-reactive protein levels. MRI showed multiple small hyperintense lesions on T2 weighted image and diffusion weighted image (DWI) in the cerebral cortex and white matter. Contrast-enhanced T1 weighted image showed the abnormal pial enhancement along the cerebral sulci. Systemic evaluations for infectious organisms, autoantibodies, and malignant tumors were all negative. Her fever and neurological symptoms continued. As a result of worsening MRI findings, a brain biopsy was carried out. Neuropathological analysis revealed neutrophilic infiltration in the subarachnoid space and multinucleated giant cells. However, there was no vasculitis on the histological sections. This pathological finding was reminiscent of rheumatoid meningitis despite articular findings of rheumatoid arthritis, as well as rheumatoid factor (RF) and anti-CCP antibody tests being negative. After oral steroid therapy, her fever and inflammatory reactions by laboratory test diminished and her cognitive function improved remarkably.

Increasing evidences suggest an association between estrogens and colorectal cancer (CRC), especially in postmenopausal women. Inhibitory role has been suggested by CRC risk reduction among women treated with exogeneous hormones or by decrease of estrogen receptor (ER)-beta expression in CRC compared with normal epithelium. Controversial results have been reported in epidemiological studies on endogeneous hormones or CRC cell line assays. Progressive role has been suggested by studies directly examining estrogenic conditions in CRC surgical materials. To further understand the role of estrogens in the pathobiology of colorectal cancer, where wide variety exists, a large, systematic, and comprehensive study considering sex, age, locus, stage, grade, clinical outcome, microsatellite instability, ER-beta status, and estrogen related gene polymorphism is needed.

Malignant neoplasms usually occur in the elderly. Common cancers in elderly men are gastric, lung, colorectal and prostate, whereas they are colorectal, gastric, lung and biliary in elderly women. Compared with malignant neoplasms in younger patients, several characteristic features exist in the neoplasms of the elderly, such as tumor location, histology, biological behavior, and the pathway of tumor carcinogenesis. The incidence of multiple cancers increases with aging. Although it is generally recognized that carcinoma in the elderly is well -differentiated and shows slow growth, a low incidence of metastases and favorable prognoses, tumors do not always evidence such features. Regarding biological behavior of malignant tumors in the elderly, age-related alterations of the host, such as stromal weakness and decreased immune response against cancer cell invasion should be considered, as well as the characteristics of the tumor cell itself.

An 84-year-old man was admitted with paresis of the right lower limb. Hemorrhagic lesions were demonstrated in the left frontoparietal lobe and cerebellum by cranial computed tomography (CT) and magnetic resonance imaging (MRI). Chest CT revealed an ill-defined mass measuring 4 x 6 cm in the left lower lobe of the lung, although bronchoscopic examination failed to obtain pathological diagnosis. Clinical diagnosis of primary lung cancer with multiple brain metastases was made, and he underwent whole brain radiotherapy. The pulmonary and cerebral lesions mimicked abscesses during his clinical course, and he died of respiratory failure due to bilateral pneumonia three months after admission. Autopsy revealed that both the pulmonary and brain lesions were malignant melanomas, but no other melanoma lesions could be identified despite meticulous investigation. Although malignant melanoma with an unknown primary site is rare in Japan, careful evaluation of the CT and MRI findings might be the key to correct diagnosis in this case.

In Japan, elderly gastric cancer(GC)patients have been rapidly increasing, and in 2020 when the babyboomers' GC incidence reaches its peak, the number of deaths due to GC will reach seventy thousand per year. Few clinical trials have been done for surgery and chemotherapy for GC so far, and little information is available on the risk benefit for elderly patients. Reports from single institutes described comparable efficacy and safety, while a large national database indicates age as an independent risk factor. Similarly, little study and information are available on chemotherapy for elderly with GC. In future, standardization of comprehensive geriatric assessment(CGA)and preoperative risk assessment in clinical trials with risk-stratified protocol treatment, and a large surgical database with similar standard risk assessment are warranted.

To investigate the actual situation of multiple cancers including hematological malignancies, 266 autopsy cases with one or more hematological malignancies were compiled from autopsy case files between January 1995 and October 2006 in our hospital. The median age at death was 75 years (range 48 to 102 yr). Of 266 cases, 72 (27.1%) had multiple cancers. Of these 72 cases, 62 cases were complicated with non-hematological malignancy, and 10 cases showed duplication of other hematological malignancies. Prostate and colon cancers were frequent as complicating cancers. Seventeen of 256 cases without duplication of other hematological malignancies demonstrated 3 or 4 cancers (6.6%). Of 10 cases showing duplication of other hematological malignancies, 9 cases had NHL. The rate of multiple cancers in elderly patients with hematological malignancy was higher than that of non-hematological cancers.

We reviewed the definition of the esophagogastric junction and the biopsy sites and histologic findings of biopsy specimens from Barrett's esophagus. The borderline between the esophagus and stomach has been defined as the distal limit of the longitudinal vessels by the Japan Esophageal Society, because the longitudinal vessels are always located within the esophagus. As squamous islands in Barrett's mucosa are usually the orifices of esophageal glands proper, biopsy specimens from the squamous islands show esophageal glands proper or their ducts. The identification of esophageal glands proper is a definite histological indicator that a piece of biopsy tissue is of esophageal origin. Therefore, a diagnosis of Barrett's esophagus can be made purely on the basis of the histologic findings in these biopsy specimens of squamous islands. Since columnar mucosa is usually recognizable at endoscopy, a diagnosis of Barrett's esophagus can be made solely on the basis of endoscopic examination, without any need for histologic confirmation, if squamous islands are recognized in columnar-lined mucosa.

Objectives: The present study was conducted to examine the effects of acute administration of prostacyclin derivatives on plasma levels of adhesion molecules, endothelial function, and pulse wave velocity in patients with coronary heart disease., Methods: In 20 patients with coronary heart disease, plasma levels of vascular cell adhesion molecule-1, P-selectin, and beta-thromboglobulin, endothelial function, and pulse wave velocity were assessed before and after the cold pressor test. These assessments were performed again 2 hr after the oral administration of prostacyclin derivatives (beraprost sodium 40 micrograms) or placebo. Endothelial function was assessed by changes in forearm blood flow before and after reactive hyperemia. Pulse wave velocity was determined by the volume rendering method., Results: Prostacyclin derivatives significantly improved endothelial function and decreased plasma beta-thromboglobulin level, but did not affect blood pressure and pulse wave velocity. Prostacyclin derivatives did not prevent the elevations of blood pressure and pulse wave velocity induced by the cold pressor test, but did prevent the elevations of P-selectin and beta-thromboglobulin induced by the cold pressor test., Conclusions: Prostacyclin derivatives improved endothelial function and prevented platelet activation induced by the cold pressor test. Prostacyclin apparently has an anti-atherogenic effect.

It has been reported recently that %PSA, the ratio of free-PSA(F-PSA) and total-PSA(T-PSA), remains significantly lower in sera of patients with prostatic cancer(PCA) than there in cases with benign prostate hypertrophy(BPH). We examined %PSA can be used for differential diagnosis of PCA from BPH. Forty-seven non-treated Japanese patients with prostate problem were examined for PSA assays and biopsy. On biopsy, 25 cases were diagnosed as PCA, and 22 cases as BPH. On T-PSA value, there were 18 cases of PCA and 8 cases of BPH whose T-PSA values were over 10 ng/ml. When %PSA was studied, cases with less than 15% of %PSA were found to be PCA exclusively(16/16), while cases with less than 20 of %PSA included 19 PCAs and 4 BPHs. In 17 PCA patients with stage B to stage D, the %PSA was less than 20 except one case. T-PSA was examined in 88 cases at the checkup in our old age home. Four samples of which T-PAS levels were in gray zone, were assayed for %PSA. Two of them, with %PSA values less than 20 ng/ml, were found to be PCA, while the remaining two, with %PSA over 20 ng/ml, were BPH.

We conducted comparative studies on intracranial atherosclerosis and coronary artery stenosis over the past 28 years. Two-year consecutive autopsy case studies from an urban geriatric hospital between 1974-1975 (Group I. 484 cases). 1986-1987 (Group II, 504 cases) and 2000-2001 (Group III, 273 cases) were employed. Atherosclerotic changes of the bilateral middle cerebral arteries and basilar artery were semiquantitatively evaluated as none (0), mild (1), moderate (2) and severe (3) and values of the 3 arteries were totalled to give a value of 0-9 which was taken as the intracranial atherosclerotic index (ICAI). The coronary stenotic index was calculated as previously reported (Sugiura et al 1969). ICAI and CSI were directly compared with each other, together with risk factors for each, including mean blood pressure (BP), serum level of total cholesterol (Tch) and the history of diabetes mellitus (DM+). Chronologically ICAI decreased dramatically but CSI did not change at all. There was continuous lowering of BP, elevation of Tch and increased incidence of DM+. There was a significant positive correlation in BP in relation to both ICAI and CSI (p < 0.01). DM+ vs. CSI (p < 0.01) and ICAI (p < 0.05), and Tch vs. CSI (p < 0.01) but not ICAI. Regression analysis highlighted age and BP as major risk factors for ICAI. Our study provides the first morphological confirmation of marked decrease of the intracranial atherosclerosis in the recent 28 years, in contrast with unchanged coronary stenosis in Japanese elderly subjects.

Objectives: First derivative electrocardiography (FDECG) records the slope of the wave of the standard 12-lead electrocardiography (ECG) and enables quantification of ECG-T wave symmetry. This study investigated the usefulness of FDECG to diagnose effort angina pectoris in patients with chest pain., Methods: All 62 patients who visited our hospital with exertional chest pain underwent FDECG at rest, and exercise electrocardiography or stress thallium scintigraphy. Patients with possible ischemic change underwent coronary angiography, and those with significant coronary artery stenosis (> or = 75% reduction) were classified as the angina pectoris group (23 subjects). The other patients (without ischemic change or without significant coronary artery stenosis) formed the non-angina pectoris group (39 subjects). The FDECG is a simple differential wave with two peaks. The first peak of the FDECG-T wave designated as the T1 wave and the second peak as the T2 wave. The heights (the T1 and T2 wave amplitude) and the T2/T1 ratio (T2 wave heights/T1 wave heights) were calculated in the two groups., Results: The T2/T1 ratios in leads I, V3, V4, V5 and V6 were significantly (I, V3, V4: p < 0.01, V5: p < 0.0001, V6: p < 0.001) decreased in the angina pectoris group. Using the criterion of a T2/T1 ratio at the V5 lead of less than 1.30, FDECG could detect effort angina pectoris patients with 65% in sensitivity, 74% specificity and 71% accuracy., Conclusions: ECG-T waves in the angina pectoris group were symmetrical. T2/T1 ratio of the FDECG-T wave is a useful index to diagnose effort angina pectoris at rest.