A 66-year-old man who suffered from intermittent abdominal and back pain underwent medical examinations at our hospital. A high value of leukocyte, inflammatory reaction and IgG4 was detected, and computed tomography demonstrated that there was thickened soft tissue around the abdominal aorta which extended to the superior mesenteric artery and the renal arteries. He was given a diagnosis of retroperitoneal fibrosis, and prednisolone (PSL) was administered. Although the decrease in thickness of the soft tissue around the aorta was seen, the enlargement of the aorta mainly near the orifice of the celiac artery was shown. We were consulted on this thoracoabdominal aortic aneurysm (Crawford type IV) at this time, and considered that this aneurismal change had occurred secondary to chronic periaortitis. In a few weeks, the rapid expansion of this aneurysm was occurred, so we planned early surgical treatment after tapering of PSL. He underwent graft replacement of thoracoabdominal aorta with rifampicin-bonded graft, because the infection could not be denied as a cause of this aneurysmal change. Although Streptococcus pneumoniae was detected in the specimens from the periaortic tissue, false lumen and aortic wall in the culture test, he had a good post operative course with prolonged antibiotic therapy.

Kanehiro Takaki, the founder of The Jikei University School of Medicine suggested that a nutritional factor was important for preventing beri-beri, which was a common disease in the Meiji era in Japan and Southeast Asia. He improved the rations fed to crews of the Imperial Japanese Navy to include wheat and meat. The rations he devised effectively prevented beri-beri. Some 30 years later, vitamin B₁ was discovered, and a deficiency of vitamin B₁ was found to be the cause of beri-beri. Takaki believed that nutrition and exercise were important for keeping our bodies fit. He often gave lectures on how people could keep fit to prevent diseases. Thus, his activities are considered to be the beginning of preventive medicine in Japan. The contributions of Takaki to the physical fitness of the Japanese people have been continued by the graduates of The Jikei University School of Medicine. Some of the graduates became professors of The Jikei University School of Medicine and Tokyo University of Education (now, Tsukuba University). Thus, both universities have the common basis and tradition for research and education in the fields of physical fitness and sports medicine, and have collaborated with each other in these fields. In this article, we provide a brief overview of the history of the development of research regarding physical fitness and sports medicine in Japan. We discuss the contribution of various persons including our graduates, to the health and physical fitness of the Japanese people.

　　We investigated the detection situation of the HER-2 examination that was performed to investigate the adaptation of the molecular targeted medicine trastuzumab for mammary and gastric cancers. The HER-2 positive rate was higher in biopsy specimens than in surgical specimen. In gastric cancer, the positive rate was significantly high when it was of the papillary type, histologically. In comparison with mammary cancer, the percentage of FISH positive was high in 2＋ cases. In addition, as the results of trial investigation showed, HER-2 positive cases ware few in colon cancer.

　　Epidermal growth factor receptor (EGFR) gene mutation examination is now performed in most medical institutions in order to select the molecular targeted medicine for lung cancer. It became clear that the positive rate of the biopsy material was lower than that of the surgical sample in this hospital. The cause was attributed to false negatives due to low tumor cell content in biopsy specimens. We investigated the presence of the mutation using surgical samples and preoperative biopsy specimens from the same patients in 13 cases. Furthermore, we investigated the tumor cell content of the biopsy specimens by cell counting. Results showed that 3 of 6 biopsy specimens that were associated with positive surgical samples were judged to be negative. The tumor cell content was less than 5% in all negative cases. Regarding EGFR gene mutation examination, we should carefully determine tumor cell content when using biopsy specimens.

Congenital anomaly of the coronary artery is rare. We have to care about the injury of the aberrant coronary artery and ischemic complication during and after the heart valve surgery. We experienced a good clinical course of aortic valve replacement (AVR) with concomitant coronary artery bypass grafting (CABG) for aortic stenosis coexisting with anomalous aortic origin of the right coronary artery. A 72-year-old woman had suffered from dyspnea and palpitation on effort, and we diagnosed severe aortic stenosis. Preoperative examination revealed the right coronary artery arising from the left coronary sinus with a stenotic lesion in the interarterial course between the aorta and main pulmonary artery. She underwent AVR and CABG using a saphenous vein graft. The peripheral anastomosis of the bypass grafting was performed before starting cardiopulmonary bypass and the blood cardioplegia was infused into right coronary artery through the bypass graft during cardiac arrest. The postoperative course was uneventful and the patent bypass graft was confirmed by computed tomographic angiography.

　　In breast cancer cases, intra-operative diagnosis of sentinel lymph node metastasis has been performed widely. It is diagnosed at present by HE staining, but more objective methods are needed. In this study using 166 examples, we compared the methods using rapid immunostaining with the genetic examination. In rapid immunostaining, we recognized metastasis using cytokeratin which was an epithelial cell marker used in the serial sections for frozen histological diagnosis. In conclusion, because metastasis could be diagnosed accurately and pathologist&rsqup;s stress would be reduced, rapid immunostaining is useful for intraoperative diagnosis.

We report a case in which an undernourished female patient underwent drainage for gingivitis, and subsequently suffered S. intermedius-induced subdural abscess, meningitis and transverse sinus thrombosis. A few days after drainage, she had a fever of 39°C and became lethargic with non-fluent aphasia. Cerebrospinal fluid revealed pleocytosis of 1269/μl, protein 222 mg/dl (normal 15-45mg/dl), glucose 33 mg/dl (ratio to blood glucose: 0.37). The diffusion-weighted MRI brain showed an area of abnormally high signal along the left brain surface. In the magnetic resonance venography, the left transverse sinus was not well delineated. After treatment with antibiotics (meropenem, vancomycin) and heparin, craniotomy was performed to remove the abscess. Culture of the abscess tissue detected S. intermedius. After surgery she gradually improved. To our knowledge, this is the first report of subdural abscess and transverse sinus thrombosis caused by S. intermedius occurring as a result of drainage treatment for gingivitis.

　　It is known that uterine cervical cancer is caused by persistent infection with high-risk type of HPV (human papilloma virus). We have run HPV genotyping tests on patients since November, 2011. In 111 cases so far examined, HPV types 16, 52 and 58 were detected with high frequency, but type 18 was with low frequency. This trend was comparable to nationwide tendency. Type 52, 56 and 58 were detected from the patients of advanced age frequently. There weredifferences in HPV infection rate between cytology-negative cases and positive cases, but there was not the difference in HPV typing by cytology-negative and positive patients. Furthermore, it was made clear that the superinfection of HPV who significantly related to the development of tumor. In the cytology negative patients who were followed up because of dysplasia, there are many who are negative for high risk HPV. Therefore, HPV genotyping examination may help physicians determine the relative priority for treatment.

　　We report a case of spindle cell type medullary carcinoma of the thyroid in a 77-year-old man. Fine needle aspiration cytology showed numerous spindle cells without inflammation and hemorrhage. The spindle cells were uniform and exhibited no malignant features. Immunocytochemistry was positive for carcinoembryonic antigen and calcitonin, and the tumor was diagnosed as spindle cell type medullary carcinoma. There are various histological subtypes of medullary carcinoma, and diagnosis by cytomorphology alone is difficult. Preservation with LBC fixative was helpful for diagnosis by immunocytochemistry in this case.

The effect of a treadmill running program on the metabolism of cholesterol in liver was studied in male Wistar rats, aged 7 weeks and weighing about 200 g. Rats were exercised on 6 days a week for 8 weeks, running 1, 000 m a day at 15 m/min. The trained rats gave following evidence, as compared with the sedentary control animals:
1. Remarkable lower weight of body and liver
2. Significantly lower level of total and free cholesterol in liver
3. Elevated in vivo incorporation of¹⁴C-acetate and of¹⁴C-mevalonate into liver cholesterol
4. Enhanced incorporation of¹⁴C-mevalonate into cholesterol by liver slice
5. Increased activity of hydroxymethylglutaryl-coenzyme A reductase in liver
6. Increase in cholesterol 7 a-hydroxylase activity in liver
The results indicate that the exercise promotes the turnover of cholesterol in liver.