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The prevalence of dementia is rapidly increasing worldwide, and its treatment and prevention are a health concern. The prevention of dementia requires the identification of risk factors through longitudinal studies of lifestyle. In this study, we aimed to identify the risk factors for the development of dementia in Japan and to clarify their primary care strategies. We analyzed the relationship between the cognitive ability level determined by the survey of long-term care certification and the past questionnaire results of a specific health examination in Japan 10 years ago. To analyze the risk factors for developing dementia, multivariate analysis was used, which showed that residents who gained more than 10 kg since reaching 20 years of age had a significantly lower risk of developing dementia. Regarding the “start of lifestyle modifications” question, those who answered “already started” had a significantly lower risk than those who answered “no plan to improve”. Conversely, residents receiving insulin injections or oral hypoglycemic agents were at a significantly higher risk of developing dementia based on the results of the questionnaire of the health checkups surveyed 10 years prior.

In Japan, national health expenditure is increasing each year. In particular, medical care costs for the elderly is growing at the rate of about 9% annually alongside the rapid increase of the aging population. In Japan, the specific health checkup and specific health guidance were implemented in 2008 to reduce medical costs in the medium to long term by preventing metabolic syndrome. To evaluate the influence of Specific Health Guidance on medical costs for metabolic-related or other diseases, we conducted propensity score matching and compared between those who received the Health Guidance and those who did not. The two groups were extracted from those with zero outpatient medical expenses for the five months prior to the checkup. The following were selected as variables for matching: gender, age, BMI, abdominal circumference, systolic blood pressure, HbA1c, total cholesterol, urinary protein, smoking/nonsmoking, hoping/not hoping for Health Guidance, and willing/not willing to improve one’s lifestyle habits. Finally, 50 one-to-one matches were performed between the intervention and control groups. The results of the Tobit regression analysis showed that Health Guidance significantly lowered metabolic-related medical expenses for the 26 months. However, for other diseases, no significant difference for medical expenses was evident between the two groups. The consultation rate of the intervention group after 12 months was 28% and 46% for the control group. The results suggest that the Specific Health Guidance in Japan reduced outpatient consultation for metabolic-related diseases.

Dementia is a common disease in elderly people, with its prevalence expanding rapidly worldwide. Longitudinal and cohort studies on lifestyle and health conditions are needed to identify the risk of dementia. This study aimed to identify the risk factors for dementia incidence in Japan and to clarify the strategy for its primary care. In this study, an analysis was performed to investigate the association between the cognitive faculty level of the long-term care certification survey and the previous results of the specific health checkups in Japan. To investigate the risk factor for dementia incidence, a multivariable logistic regression analysis was performed, which showed a significant odds ratio for the incidence of dementia for two items, including abdominal circumference and insulin injections or oral hypoglycemic medications. The findings of our study suggested that a lower abdominal circumference had a higher risk for dementia incidence, and individuals who received insulin injections or oral hypoglycemic medications had a higher risk for dementia incidence based on the results of the health checkups conducted 10 years previously. Further, longer duration study with a larger sample is needed to identify the items from the specific health checkups that are associated with the risk of dementia.

Background: The Japanese government has recently promoted a communitybased integrated care system, and the new reform of the system implemented in 2012 will reinforce this integration of care. In Japan, social security expenditures are increasing along with the increasing elderly population ratio; therefore, it is important to promote the utilization of existing regional resources to reduce longterm care provision costs. In each regional community, a variety of organizations and groups provide a range of functions in the lives of local residents, from providing small bits of information such as health promotion to great undertakings such as the reconstruction of the local community. Regional centers and the local social welfare councils are representative organizations that offer seamless support services in cities, towns, and villages throughout the country in the country as representative organizations by integrating regional resource information into these support services. Regional resources are not necessarily limited to information concerning social care activities for the elderly, and this means care is provided in the broadest sense. Purpose: The purpose of this study is to gain an understanding of the actual conditions and the intensity of integration between regional centers and regional resources for nationwide social care provision. Methods: A selfcompleted survey was administered at 4,557 Community-based integrated Centres [CBICs] regional centers and 1,741 social welfare councils [SWCs] in Japan. The purpose of this survey was to gain an understanding of the actual conditions of these centers and how they collect, manage, and use their regional resources for the benefit of all. We used 5 degrees of the “functional clinical integration scale” developed by Ahgren (2005) to evaluate integration intensity. Results: 1. The recovery rates for the CBICs and SWCs were 31.5% (1,437/4,557) and 43.4% (808/1,741), respectively. 2. Regarding the intensity of integration, the top three regional resources of the CBICs were Case worker/children’s social workers’ council, 3.41; Communal organizations, 2.41; and Fundamental organizations for regional welfare promotion, 2.38. Those of the SWCs were Case worker/children’s social workers’ council, 3.92; Volunteer group, 3.32; and Communal organizations, 2.95. 3. The scores for the different categories of regional resources used by the CBICs in providing social care were: Watching over, 3.03; Salon and intercommunication, 2.71; and Fitness, 2.54. Those of the resources used by the SWCs and the regional resources were Urban renovation, 4.38; Salon and intercommunication4.21; and Watching over, 3.65. Conclusions and Discussion: This study is the first to reveal on a national scale the main uses of regional resources for social care provision at two types of regional centers in Japan. In order to structure the CommunityBased Integrated Care System and improve the quality of seamless care in the communities, it is critical to strategically use the regional resources existing in each local community to provide social care for the people who need it. Therefore, it is necessary to continually update information concerning regional resources and build a system to effectively use this information. This research is supported by the Japan Agency for Medical Research and Development (AMED), # 15dk0107014h0002.

Purpose : Aging is progressing in Japan at a speed unparalleled in other countries. According to the national census of 2015, the population aged 65 years or over is about 33.4 million people (about 26.7% of the Japanese population), and it is forecast to reach a peak of about 39 million people in 2042. Furthermore, the ratio of the population aged 75 years or over is expected to continue to increase thereafter. In the super-aged society, a new problem such as frailty that is not covered by the insurance systems will occur in super-aged society. A new system solving such a problem is necessary for sustainability of the integrated community-based care system. Method : All of the articles and reports from the following journals were examined: Chiiki fukushi kenkyu (Study on Community Welfare], published from 1973 ) and Shakai fukushi kenkyu (Study on Social Welfare], published from 1967 ). Furthermore, the precedent studies to be related to the integrated community-based care system were examined. We considered a new system for sustainability of the integrated community-based care system. Result : The Japanese government has been continuing its efforts to integrate care so as to meet the needs of a super-Aged society and to strengthen primary care and community medicine, enacting the Re-arrangement of Relevant Acts for Promoting the Comprehensive Provision of Medical and Nursing Care in Communities in 2014. This act is promoting the building of community-level comprehensive support and service setups, which is to say the integrated community-based care system so that as far as possible people can continue to live in their own way and in familiar surroundings to the end of their lives. This system is comprised of five constituent elements: three specialized service (professional services of prevention, medical treatment, and nursing care) and two non-specialized service (preconditions for these services, that is, housing and living support/welfare services). We developed social and community prescription model, in which social and community prescription is a strategic management tool which links the non-specialized service to the specialized service of the integrated community-based care system. Conclusion : Social and Community Prescription is a strategic management tool which links the non-specialized service to the specialized service of the integrated community-based care system. In order to structure the integrated community-based care system, and for improving its quality, it is critical to strategically use the social and community prescription. On the other hand, the non-specialized service are based on social common capital in the community, which are regional activities that presently exist in each local region as well as new regional resources that might be created out of changes in the social environment in the future. We have developed the social and community prescription model which is useful to avoid “ The tragedy of the commons ”.

Background : Since Japan introduced long-term care insurance in 2000, the government has been continuing its efforts to integrate community-based care so as to meet the needs of a super-aged society, enacting the Act Concerning the Establishment of Related Acts, Etc. to Promote the Comprehensive Ensuring of Medical and Long-term care in Communities in 2014. This act seeks to establish a sustainable social security system by, among other things, (1) strengthening links between medicine and care, (2) building an integrated community-based health care system and (3) building efficient and high-quality systems for providing medical care in communities. Specifically, this integrated community-based health care system aims to support living at home by skillfully combining five constituent elements: the professional services of prevention, medical care, and nursing care and the preconditions for these services, that is, housing and living support/welfare services. Literature review : In order to build the integrated community-based health care system and improve the quality of such care services, it is important to strategically utilize existing regional resources and new ones that will be created out of changes in the coming years in the social environment. To make this happen, the following areas need to be strengthened: collecting and updating information regarding regional resources; processing and sharing information for its effective utilization; and a coordinating system that will link information on regional resources with specific care services. A variety of organizations and groups have been playing an active role for their local residents in each regional community in Japan. We try to clarify the wide variety of regional activities that may contribute to improving the quality of comprehensive care of the regions by bibliographic consideration. Discussion : The regional activities that will contribute to the improvement in quality of comprehensive care of the regions are broken down into twelve items as shown below: 1 Salon and intercommunication, 2 Fitness, 3 Livelihood support, 4 Watching over, 5 Consultation and support, 6 Tentative place to stay, 7 Residence, 8 Rental space, 9 Education and learning, 10 Employment support, 11 Advocacy, 12 Urban renovation. Also it became apparent that as for the use of regional activities, establishing a coordinating functional capability that links regional activities to specific care services remains a future task. Conclusion : In order to structure the integrated community-based care system, and for improving the quality of comprehensive care in the regions, it is critical to strategically use the regional activities that presently exist in each local region as well as new regional resources that might be created out of changes in the social environment in the future. Therefore, it is necessary to continually update the information on regional activities, which is broken down into certain types, and to build a system to effectively use such information. At the same time, it is likewise necessary to strengthen the coordinating functional capability to link information-based support to the specific care services. Social and Community prescription is a strategic tool which a healthcare professional and a patient can identify together the type of activities that will be of benefit. We can really strengthen the coordinating function by building up the system of Social and Community prescription. This research is supported by Japan Agency for Medical Research and Development (AMED), # 15dk0107014h0002.

The system is defined as a network of mutually dependent separate components that cooperate with each other to achieve an objective. Systems can be categorized into the mechanical system having the mechanical nature and the adaptive system adjusting itself depending on the situation. Systems can also be categorized into the mechanical system having the mechanical nature and the adaptive system adjusting itself depending on the situation. For the mechanical system, it is obvious how its components react to a stimulus and the reaction can be accurately predicted. This allows a statistical management approach to effectively work. In contrast, the adaptive system has components that initiate very diverse and basically unpredictable reactions to a stimulus. Systems containing human components are considered as a typical adaptive system. For the adaptive system, the concepts of normalization and standardization are not effective and it is important to orient complicated system behaviors toward a certain objective with a comparatively simple principle. The health care system is intrinsically an adaptive system comprised of patients and health care providers who have the ability to learn from experiences and change themselves. The behaviors of patients and health care providers cannot always be predicted and may transform their imminent environment or a broader environment.In the health care fields, many unpredictable behaviors specific to the complexity adaptive system can be observed. A feature of the health care system that other industries do not have is that the zones of the mechanical system and complexity adaptive system must be concurrently managed. Although most businesses provide within the zone of the mechanical system at present, when businesses will explore opportunities in the zone of the complexity adaptive system, the industries will learn a great deal from the health care system management.

A 75-year-old woman was referred to us because of cough, high fever and skin erythema in April 1999. Malignant lymphoma (diffuse mixed cell type) was previously diagnosed in 1990 and she achieved complete remission after treatment with a series of CHOP regimen treatments. In 1998, multiple myeloma (IgG lambda type) was diagnosed and she was treated with a combination of melphalan and prednisolone. On physical examination, superficial lymphadenopathy and skin erythema were noted. Biclonal gammopathy (IgG kappa/lambda) was shown in serum, and Bence Jones protein in urine. Computed tomography showed pleural effusion and swelling of paraaortic lymph nodes. The bone marrow examination showed an increased number of abnormal plasma cells (19.2%) and no evidence of lymphoma. Left axillary lymph node biopsy revealed that she had non-Hodgkin's lymphoma (immunoblastic lymphadenopathy-like T cell lymphoma). She was treated with the CHOP regimen at reduced doses for both diseases. The lymphoadenopathy reduced after 6 courses of CHOP and 4 courses of CHOPE (CHOP + VP16), however, she had bone pain on November 1999 and received treatment with MCNU-VMP (MCNU + VDS + L-PAM + PSL). Her rib pain improved, but she died of systemic infection of herpes zoster virus. We report here a rare case of malignant lymphoma concomitant with multiple myeloma.

Of 43 elderly patients who were suspected to have polycythemia between October 1990 and July 1998, 12 patients showed an increased red cell volume measured by 51Cr-labeled red blood cells. We analyzed the clinical characteristics of the 12 patients consisted of 7 men and 5 women, with a median age of 71 (range: 57-92). Chief complaints were headaches and dizziness (3 cases), symptoms of other conditions than polycythemia (4 cases). Five patients had no symptoms. Five of 6 patients over 70 years old had no symptoms due to polycythemia. Seven cases (58%) showed splenomegaly and three cases (25%) showed hepatomegaly. Laboratory findings were as follows: WBC 9.7 +/- 3.9 x 10(3)/microliter (mean +/- SD, p < 0.02 vs normal control), Hb 17.9 +/- 4.2 g/dl (p < 0.001), Plt 39.7 +/- 26.0 x 10(4)/microliter, EPO 13.8 +/- 5.2 mU/ml (p < 0.0001), NAP score 258 +/- 114, Vit. B12 1,686 +/- 2,156 pg/ml, arterial O2 saturation more than 92% in all cases. The diagnosis of all cases was polycythemia vera according to the diagnostic criteria of Polycythemia Vera Study Group. Associated conditions included 8 cases of thrombosis (cerebral thrombosis 4, thrombophrebitis 2, myocardial infarction 1, ischemic colitis 1) and 3 cases of malignancy (esophageal cancer 1, breast cancer 1, renal cancer 1), none of which was therapy-related cancer. Six patients (50%) had only phlebotomy, three (25%) only chemotherapy, and three (25%) both phlebotomy and chemotherapy. Patients over 80 years old needed neither intensive nor continuous treatment. Only one patient died due to esophageal cancer at age 89.

Fifty patients, aged 60 years or more, who had been admitted to a hematology ward for more than 1 month, were studied in regard to their understanding of informed consent. The doctors informed 74% of their patients about the disease for which they were being treated. The rate of informing patients remained low in those with advanced age or with malignant tumors. However, only 42% of the patients realized that they had been informed of their diagnosis and clinical condition. The comprehension rate remained low at 43.2% even in patients who were informed by their doctors. While 60% of patients declared that they understood what the doctors described, only 36% could write something about the name or the state of their disease. Even among the patients who could understand the doctor's explanation, the comprehension rate was 43.3%. Sixty-six percent of patients demonstrated their wish to have a correct explanation of their diagnosis, 36% of patients wanted to be treated according to their own wishes, and 48% of patients left the decisions regarding their treatment to the doctors.

A 60-year-old female was hospitalized because of anemia, edema, and diarrhea. She was diagnosed as having short bowel syndrome. The patient developed acrodermatitis enteropathica and taste impairment. Laboratory data showed that the serum zinc level was 21 μ g/dl and erythrocyte CAI specific activity was 0 units/mg isozyme (normal range 0.37 ± 0.08 units/mg isozyme) and CAII specific activity was 2.99 units/mg isozyme (normal range 3.02 ± 0.05 units/mg isozyme). The patient was diagnosed as being in a zinc deficient status. Zinc supplementation resulted in the disappearance of these complications. The serum zinc level reached 50 μ g/dl and erythrocyte CAI specific activity was recovered to 0.26 units/mg isozyme and CAII specific activity was 1.60 units/mg isozyme. CAI is found in gastrointestinal epithelial cells, in vascular epithelium, corneal, lens, ciliary body epithelium, and in sweat glands. CAII is found in virtually all tissues and is especially abundant in secretory and absorbing epithelia. The tissue distribution of CAI corresponds to clinical and physiologic indicators of zinc deficiency. Thus, the erythrocyte CAI specific activity may reflect the actual tissue zinc deficiency status.

PIXE, Particle Induced X-ray Emission, is a Powerful, multi-elemental analysis method which has many distinguishing features and has been used in varies research fields. Recently the method of applying baby cyclotrons for nuclear medicine to PIXE has been developed. This enables us to study biomedical phenomena from the physical point of view. Mouse bone marrow stromal cells were transferred bacterial β -galactosidase gene (LacZ gene) by murine retroviral vectors. Analysis of the bone marrow stromal cells with the LacZ gene by PIXE revealed remarkable changes of intracellular trace elements compared with the normal control cells. These results indicate that gene transfer by retroviral vectors may bring about a dynamic change of intracellular circumstances of the target cell.

Febrile episodes occurring in 29 elderly patients (mean age 75 years) with leukemia, from 1988 to 1993, were reviewed. A febrile episode was defined as a temperature of 38 degrees C or greater for at least 6 hours. The number of febrile episodes was 64. The average was 2.2 febrile episodes per patient. Seventy-two percent of febrile episodes occurred when the patients had neutropenia below 100/microliters, while 16% occurred with neutropenia of 101/microliters to 500/microliters. Causative microorganisms were identified in 48% of total febrile episodes. The most common infectious site was the urinary tract which accounted for 25% of total episodes. Pneumonia and septicemia accounted for 22% of total episodes, respectively. Gram-positive cocci were responsible for 66% of microbiologically documented febrile episodes, while 21% were caused by gram-negative bacilli. Gram-positive cocci, particularly staphylococcus aureus, coagulae-negative staphylococcus and enterococci increased compared with a decade ago in our department. Granulocyte colony-stimulating factor (G-CSF) was used 12 times for infection. No significant difference in fever amelioration was seen between G-CSF and non-G-CFS cases.

It is considered that many people are struggling with diseases that are difficult to cure. In general, it takes a long time to diagnose and to cure such diseases. In Japan, methods for curing 56 incurable diseases have been studied. However, methods for early diagnosis of incurable diseases have not been studied. To make early diagnoses for incurable diseases improves the quality of life of patients. This paper proposes a new service system that supports latent patients of incurable diseases by early diagnosis. For using this system, users have to prepare a text in which episodes about patients' experiences that have been caused because of their diseases are written. The system takes such a text as input, and then the system extracts common factors among episodes, i.e., keywords appearing in several episodes. The system output the extracted keywords as keywords relating to symptoms of an incurable disease. We experimented the system and extracted keywords relating to the symptoms of retinitis pigmentosa which was one of the incurable eye diseases. Most of the symptoms relating to the extracted keywords were not known even by medical doctors. Some of them indicated symptoms in the early stage of the disease. The experiment brought us one step closer to the early diagnosis of incurable disease as one of the service systems.

There are many people who are struggling againstintractable diseases in the world. In general, it takes a long time to cure the intractable diseases because it is difficult to make diagnoses and to cure such diseases. There may be also people who are struggling against unclassified diseases that we have not discovered yet. Though, in Japan, methods for curing 56 intractable diseases have been studied, methods for discovering the unclassified diseases have not been studied. This paper proposes a new system that supports users for thinking new criteria for the unclassified diseases. We propose this system as one of the new diagnosis approach for early detection of intractable diseases. A user of the system inputs names of classified diseases to use the system. The system chooses 20 names from the inputs and show them to the user on its visualizing interface. The user chooses some names of disease whose diagnostics are similar to each other, and makes a group of the diseases. After making groups of diseases, if the user vacillates which group is appropriate for names of disease, the user writes the names and the reasons why the user has vacillated. The system outputs the reasons as candidates of new criteria for classifying unclassified diseases. We experimented the proposed system. Though six doctors majoring eye, hematology, and psychiatry used the proposed system, we obtained new criteria for unclassified diseases only from eye doctors. We validated the efficiency of the system for specific doctors.

It is considered that many people are struggling with diseases that are difficult to diagnose. In general, it takes a long time to diagnose and to cure such diseases. There may be also people who are struggling with diseases that we have not classified yet. In Japan, methods for curing 56 incurable diseases have been studied. However, methods for discovering unclassified diseases have not been studied. This paper proposes a new system that supports doctors in thinking of new criteria for classifying diseases.

We have already reported significant elevation of serum granulocyte colony-stimulating factor (G-CSF) in the acute phase of infection. In this study, we compared the responses to infection between patients with frequently repeated infection (repeaters) and others (non-repeaters). We examined the clinical data and serum G-CSF levels in 48 patients with acute infections. Serum G-CSF levels were significantly lower in repeaters than in non-repeaters (197.7 +/- 370.0 vs. 1014.1 +/- 924.4 pg/ml. P less than 0.001). There were no significant differences in age, serum total protein, or cholinesterase between the groups, but serum albumin was significantly lower in repeaters than in non-repeaters (2.87 +/- 0.5 vs. 3.31 +/- 0.4 g/dl. P less than 0.005). It is suggested that administration of recombinant G-CSF may be useful for patients with repeated infections.

A 22-year-old male was hospitalized with mild fever, diarrhea, abdominal pain, and weight loss and was diagnosed as having Crohn’s disease. Total parenteral nutrition was administered to reduce bowel inflammation and correct nutritional disturbances. During long term intravenous hyperalimentation, the serum zinc level fell to 27 μg/dl and the patient developed acrodermatitis enteropathica and pancreatitis. Zinc supplementation resulted in the disappearance of these complications. Erythrocyte CA I-specific activity was 0.35 units/mg before zinc replacement, and recovered to 0.62 units/mg when the serum zinc level reached 124 μg/dl. CA I is present not only in erythrocytes but also in gastrointestinal epithelia, vascular endothelium, and sweat glands. To date there are no specific laboratory tests that reliably document tissue zinc deficiency. However, erythrocyte CA I activity may reflect the actual zinc status.

5'-Methylthioadenosine (MTA) produced during the synthesis of polyamines is degraded to adenine by MTA phosphorylase. This pathway is considered to be the main source of endogenous adenine. We determined the concentrations of MTA and adenine in control subjects and in those with a pathological disorder. In patients with active leukemias, as well as with other types of malignancies, the concentrations of MTA and adenine in the urine were elevated. These changes seemed to be the result of an accelerated production of MTA due to an accelerated biosynthesis of polyamine. In patients with adenine phosphoribosyltransferase (APRT) deficiency, the concentrations of adenine in the urine were elevated, presumably due to a disturbance in the catabolism of adenine. Although adenine is a potent inhibitor of MTA phosphorylase, APRT-deficient patients did not excrete MTA into urine in concentrations significantly larger than noted for control subjects. However, the amount of MTA excreted positively correlated with that of adenine in these patients, hence that accumulated adenine probably had a slight, but positive, inhibitory effect on the degradation of MTA.

We retrospectively analyzed 126 acute myelogenous leukemia (AML) patients agedor =60 years who had all been referred to the same hematological department between 1989 and 1999. In 76 de novo AML cases, 53 patients (median age, 72 years) were treated with combination chemotherapy (CT) for remission induction. Complete remission (CR) rate was 57.1%. The median overall survival (OS) was 16 months, and the rate of 3-year OS was 28%. The favorable prognostic factors were performance statusor =2, cholinesteraseor =100 IU, and intermediate or favorable karyotype (P.01). Seventeen patients (median age, 78 years) with hypocellular bone marrow or poor general condition were treated with low-dose cytosine arabinoside (LDAraC). In these patients, the CR rate was 50% and the median OS was 11 months, with an OS estimate at 3 years of 14%. All patients with hypocellular bone marrow who received LDAraC for 21 days achieved CR. In 50 patients who developed AML following a myelodysplastic syndrome (MDS/AML), 22 patients (median age, 74 years) were treated with CT, and 14 (median age, 74 years) patients were treated with LDAraC. The CR rates were 22.7% and 21.4%, respectively, and the median OS durations were 8 months and 11 months, respectively. There were no significant factors that would indicate a good prognosis in MDS/AML patients.

To clarify the physiologic roles of granulocyte colony-stimulating factor (G-CSF) in infectious states in vivo, we examined the serum levels of G-CSF in patients with infection. Serum samples from 24 patients in the acute stage of infection (14 men and 10 women, age 65 to 101, without hematologic disorders), as well as samples from 32 age- matched normal elderly volunteers were investigated. Sixteen of the initial 24 patients were reexamined after the recovery phase. G-CSF levels were examined by quantitative enzyme immunoassay. The G-CSF level in normal elderly controls, 25.3 +/- 19.7 pg/mL, was not different from that reported in other findings. There was no statistically significant relationship between their G-CSF level and peripheral white blood cell count or neutrophilic granulocyte count. The G-CSF level in the acute stage of infection was 731.8 +/- 895.0 pg/mL, with a range of 30 to 3,199 pg/mL. There was no significant difference in G-CSF levels between patients with respiratory tract infection and those with urinary tract infection. In all 16 cases examined, the serum G-CSF level in the acute stage of infection was significantly higher than that after recovery phase, the latter being the same as the level in normal elderly controls. G-CSF must therefore play a significant role in human infectious states in vivo.

Plasma concentration of cytosine arabinoside (Ara-C) was determined in elderly patients with myelodysplastic syndromes or acute myelocytic leukemia who were treated with subcutaneous injection of Ara-C (Ara-C s.c.; 10 mg/m2/12 hr, 14-21 days), continuous drip infusion of Ara-C (Ara-C d.i.v.; 20 mg/m2/day, 24 hr 14 days) and/or oral administration of cytarabine ocfosfate (SPAC) (SPAC p.o.; 100 mg-300 mg/body/day, 14 days) by radioimmunoassay. In the Ara-C s.c. patients, the peak plasma level (Cmax) of Ara-C was 103 ng/ml and the time to reach Cmax was 15 min. The elimination half-like (t1/2) was 25 min and no accumulation was detected after 14 days of consecutive Ara-C s.c. administrations. In the SPAC p.o. patients, Cmax of Ara-C was 3-8 ng/ml and it took 3-5 days to reach Cmax. The plasma concentration level of Ara-C remains almost at the Cmax level during the SPAC p.o. administration and it remained higher than 0.32 ng/ml for as long as 15 days after the end of administration. In a Ara-C d.i.v. patient, plasma level of Ara-C was detected 4-7 ng/ml during the administration (day 7 through day 14). In all patients bone marrow suppression was observed after chemotherapy regardless of regimen, and there was no significant difference between nadir peripheral cell blood counts of Ara-C s.c. patients and SPAC p.o. patients.

The amount of polyamines in urine from patients with various neoplasms is larger than in normal subjects. We have determined the concentration of 5'-methylthioadenosine (MTA), a by-product of the polyamine biosynthesis, in patients with malignancies as well as normal subjects. Our studies indicate that the amount of MTA in urine from patients with leukemias and malignant lymphomas was higher than in normal subjects (p less than 0.005). Urine samples from patients with other malignancies contained normal amounts of MTA. The levels of blood MTA in patients with leukemias before treatment or in relapse was higher than in control subjects (p less than 0.005), while in patients with other malignancies and leukemia in remission, the levels were not different from control subjects. Peripheral blood MTA levels clearly decreased after effective chemotherapy. The measurement of MTA levels in urine and blood may not be as useful as polyamine assays for the detection of malignancies, but blood levels of MTA may be useful as an indicator of the efficacy of chemotherapy in leukemic patients.

Body-cavity-based lymphoma (BCBL) is a recently described subtype of human non-Hodgkin's lymphoma characterized by the localization of neoplastic cells exclusively in the body cavities. BCBL is found most commonly in AIDS patients, and is known to be highly associated with Kaposi's sarcoma-associated herpes virus (KSHV). We describe here a case of BCBL that occurred in a 101-year-old man. He was successively treated with etoposide, but died 8 months after the diagnosis of BCBL. No lymphoma masses were noted at pre- and postmortem examinations. KSHV was demonstrated in large numbers in the neoplastic cells using semiquantitative PCR analysis. Although there have been four brief reports of HIV negative BCBL, the present case is the first for which the detailed clinical course and response to chemotherapy have been recorded.