The rs17822931 SNP of the human ABCC11 gene determines earwax types, and is also associated with some functions of apocrine glands, including the mammary gland. Nevertheless, whether the ABCC11 polymorphism is correlated with estrogen receptor (ER)α status of breast cancer (BC) remains unclear. To investigate the correlation between rs17822931 and BC, we screened the genotypes in a total of 276 and 295 histological BC samples collected from Japanese and Ukrainian BC patients, and 269 and 264 ethnically-matched healthy individuals, respectively, using TaqMan^TM PCR. Genotype frequencies at rs178229131 in Japanese and Ukrainian BC patients were not significantly different from those in their respective control populations. Consistently, no correlation between rs178229131 and the susceptibility to BC was found. The AA genotype, which corresponds to dry earwax, occurred less frequently in ERα -negative BC in Japanese [odds ratio, 0.48; 95% confidential interval, 0.29-0.80] but not in Ukrainian patients although a similar correlation was weakly observed. Our results indicate that the rs178229131-A allele may be important in reducing the risk of ERα -negative BC development.

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Objectives: "Practice Guidelines for Acute Cholecystitis and Acute Cholangitis (in Japanese)," issued in 2005 in Japan, recommends early cholecystectomy in patients with acute cholecystitis. We evaluated the feasibility and problems in management of this condition. Method: We analyzed the clinical and laboratory data of 120 consecutive patients in whom cholecystectomy was performed for treatment of acute cholecystitis between April 2003 and March 2010 in our hospital. Results: After the Guidelines were issued, the rate of urgent operations increased (from 2.4% to 35.4%; p < 0.001) and the length of preoperative hospital stay decreased (form 12.5 days to 7.6 days; p <0.05). Urgent operation, however, was chosen in only 35.4% of the patients even after the Guidelines were issued, mainly because of the shortage of surgeons and anesthesiologists. In these patients with moderate to severe acute cholecystitis, percutaneous cholecystostomy (PC) was performed without severe complications, followed by cholecystectomy. Conclusion: Urgent operation for acute cholecystitis has the advantages of earlier alleviation of symptoms and shorter hospital stays than PC followed by surgery or elective operation. PC followed by surgery may be a suboptimal option for patients with moderate to severe acute cholecystitis who might be able to tolerate an urgent operation, given that appropriate human resources are not available.

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Among the countries in the developed world, Japan has the longest mean lifespan for women; however, the nation has encountered serious problems in policy and economics, as well as in managing medical care for its aging population. Aging is inevitable, but it also constitutes a major challenge in modern biology and medicine. In the treatment of geriatric patients, an understanding of the fundamental biological mechanisms of aging and longevity is crucial for the effective treatment and prevention of diseases and disorders, including dementia, osteoporosis, and sarcopenia. To address the most basic questions about aging, including determinants of lifespan and the identity of critical genes and anti-aging factors, we discuss paradoxical phenomena in the biology of longevity, with a particular focus on "time" and "size" of organisms. We also discuss essential factors and/or activities associated with anti-aging mechanisms in connection with brain function in adults and the elderly. Finally, we discuss unique features of the Shc gene family, which is involved in longevity determination, brain size restriction, cognitive functions, and evolution. The aim of this paper is to offer some insight into various problems in gerontology and geriatrics for future research.

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In the conservative management of adnexal torsion, cystectomy is indicated after detorsion when a neoplasm is involved. Cystectomy is technically very difficult in case of an ischemic edematous adnexa. We report a case of adnexal torsion in a young woman, in whom a 2-stage laparoscopic operation was adopted for successful cystectomy.

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Myelodysplastic syndromes (MDS) are a myeloid neoplasm characterized by abnormal differentiation, ineffective hematopoiesis, and genetic instability with enhanced risk of transforming to acute myeloid leukemia (AML). The diagnosis of MDS is principally made based on the percentage of blasts in the bone marrow and peripheral blood, type and degree of dysplasia and the presence of ring sideroblasts. Recently, for making an accurate diagnosis of MDS, the aberrant antigen expression detection of hematopoietic cells by flow cytometry has been reported to be a useful. However, the diagnostic systems utilized in those studies are rather complicated. We modified an existing flow cytometric scoring system (FCMSS) based on aberrancies in the myeloid lineage and evaluated its usefulness in diagnosing various anemic disorders, including myelodysplastic syndromes (MDS). The flow cytometric score was significantly higher in MDS patients than in those with other anemic disorders, the exception being megaloblastic anemia (i.e., Vitamin B12 deficiency, folate deficiency). The data suggest that our FCMSS may provide useful information for making the diagnosis of MDS and other anemic disorders.

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Laparoscopic surgery is a less invasive treatment option for tumors in the intraabdominal organs; however, the safety and indication of laparoscopic or laparoscopy assisted pancreaticoduodenectomy (LPD) is still controversial. We attempted LPD in four cases for intraductal papillary mucinous neoplasm (IPMN) located in the pancreatic head and we report the surgical records and short-term outcome. LPD was carried out in four patients including three patients with the combined type IPMN and one with the branch type, based on the International Consensus Guidelines. None of the patients had invasive carcinoma based on preoperative imaging diagnosis. Laparoscopic procedures were performed until isolation of the pancreas head and duodenum, and final resection of PD and intestinal reconstruction were performed using small incision laparotomy (7-8cm). The mean total operating time was 882 minutes (820-932 minutes), mean blood loss was 925ml (610-1550ml) and red cell transfusion was not required in any patients. One patient underwent reoperation for bleeding at the pancreaticojejunostomy site at day 1. Mean duration until patients were able to walk was 3.5 days (2-6 days) and duration of use of analgesia was limited to within 7 days. Grade B pancreatic fistula was observed in one patient and jejunal ileus was observed in one patient. There were no deaths. LPD was safely performed and blood loss was limited, although the operating time was long. Postoperative recovery in patients without complications might be better than the conventional PD under laparotomy. Future study is necessary.

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Excision and hepaticojejunostomy are well-established treatments for choledochal cysts. However, the formation of intrahepatic bile duct stones has been reported as one of the most serious long-term complications on follow-up of choledochal cyst excision. The reported incidence of this complication varies from a small percentage of patients to 10% or more. Various procedures have been reported as treatments for postoperative bile duct stone formation. We report a case in which percutaneous transhepatic electrohydraulic lithotripsy (EHL) was used in the treatment of bile duct stones that developed after choledochal cyst excision. A 17-year-old boy, who had undergone choledochal cyst excision and hepaticojejunostomy when he was 27 days old, presented with colic abdominal pain in the right hypochondriac region and liver dysfunction. CT performed in our emergency department revealed intrahepatic bile duct stones in minimally dilated intrahepatic bile ducts in both lobes. Percutaneous transhepatic cholangiography showed packed stones distal to the right hepatic duct and stenosis of the right hepatic duct; there was no evidence of stenosis at the hepaticojejunostomy anastomosis. He underwent extracorporeal shockwave lithotripsy under general anesthesia. Although the large stone was fragmented into smaller stones, they were not small enough to be eliminated due to stenosis of the hepatic duct. After balloon dilatation of the stenosis, the patient underwent percutaneous transhepatic EHL. The fragmented stones were then thoroughly washed out from the intrahepatic bile duct. EHL is an effective and less invasive treatment for intrahepatic bile duct stones after choledochal cyst excision.

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