Twenty years have passed since the first case of living donor liver transplantation (LDLT) in Japan. The recipients of LDLT have rapidly changed from children to adults through the use of right lobe grafts. The number of LDLTs in Japan has increased since January 2004 because of indication for LDLT changed widely in an insurance application. (UNCLEAR) A total of 4,292 LDLTs have been performed as of December 31, 2006, and 2,621 (61.1%) of these have been adult-to-adult LDLTs. Patients who have hepatocellular disease or hepatocellular carcinoma or both account for more than 50% of all recipients in Japan. The overall 3-, 5- and 10-year survival rates were 73.8%, 70.4%, and 66.3%, respectively. There were no significant differences in survival rates between LDLT in Japan and cadaveric transplantation in America or Europe. The survival rates will improve to clarify the timing and indications for LDLT and the optimal operative procedures. However, because of the number of patients requiring transplant will increase, it is important that cadaveric donor liver transplant is promoted in addition to LDLT in Japan.

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In Japan, since the number of patients with osteoporosis totals more than 10 million, we have numerous chances to examine such patients.
In this review, I would like to describe the diagnosis and treatment of osteoporosis based on up-to-date knowledge.
Patients with osteoporosis usually complain of chronic back or lower back pain.
Pain in patients with osteoporosis is brought about by fractures due to osteoporotic (fragile) bone. Common fractures seen in osteoporosis are those of the proximal femur, proximal humerus, vertebral body, and distal end of the radius.
Diagnosis should be established based on the findings of X-ray images of the lumbar spine or proximal femur and bone mineral density (BMD) in accordance with the diagnostic criteria proposed in 2000 by the Japanese Society for Bone and Mineral Research.
The aim of osteoporosis treatment is to prevent fractures complicated with compromised bone strength. Preventing the loss of activities in daily life, the quality of life of patients with osteoporosis must be maintained.
Now, we are able to prescribe two kinds of drug to increase the BMD and prevent fractures: bisphosphonates and SERM (selective estrogen receptor modulator). Sufficient evidence for the efficacy of both drugs has been accumulated, and they are strongly recommended.

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We describe cell transplantation for experimental brain infarction. Pluripotent embryonic stem (ES) cells, fetal and adult neural stem cells, and bone marrow cells are considered to be possible donor cells for transplantation. In addition, recently established inducible pluripotent stem (iPS) cells are also candidate donor cells. Because an embryo or fetus is required to obtain ES and fetal neural stem cells, obtaining such cells is ethically problematic. Adult neural stem cells are difficult to obtain, because these cells are present in the subventricular zone and the hippocampus. Although iPS cells can be used for autologous transplantation, gene transfection is necessary to produce these cells. Bone marrow cell transplantation has been established as a hematologic treatment. Bone marrow contains pluripotent bone marrow stromal cells (BMSCs) that can be used for autologous transplantation. BMSC transplantation reportedly results in good functional recovery and infarct volume reduction in an experimental stroke model. BMSCs produce various trophic factors, such as vascular endothelial growth factor, hepatocyte growth factor, and nerve growth factor, which decrease apoptosis in the ischemic boundary zone. BMSCs require a period of cell culture before transplantation, whereas bone marrow mononuclear cells (BMMCs) can be collected autologously just before administration. This ease of collection may provide a clinical advantage, although BMSCs may have a greater protective potential than do BMMCs. We examined the effects of BMMC transplantation in an experimental stroke model. Autologous BMMCs were obtained from each rat, and animals were subjected to 90 minutes of focal ischemia followed by BMMC administration via the ipsilateral carotid artery or the femoral vein immediately after reperfusion. Infarct volume and motor function were assessed at 24 hours and at 7 days after reperfusion. Infarct volume reduction and good motor function were observed in animals that had undergone intra-arterial BMMC transplantation. BMMCs were labeled with PKH26 before administration, and many PKH26-positive cells were observed within the ischemic hemispheres of rats that had undergone intra-arterial BMMC transplantation. The larger number of transplanted BMMCs in the brain during the early stage of reperfusion may be important for the protective effect. Further investigations are necessary to establish cell transplantation therapy for ischemic stroke.

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A 65-year-old man visited our hospital because of hematemesis. Endoscopic examination revealed a hemorrhagic gastric ulcer in the upper body of the stomach and also type IIc and type II a early gastric cancer. We performed total gastrectomy with a Roux-en-Y reconstruction. Thus, in cases of hematemesis originating from a stomach lesion, it is extremely important to closely examine not only the lesion itself, but also regions other than the lesion, especially in the anal aspect of the stomach, during endoscopy¹⁾.

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Torsion of the gallbladder is a rare condition that most commonly affects the elderly. This condition is rarely diagnosed preoperatively despite advances in diagnostic imaging. We report a case of torsion of the gall bladder diagnosed preoperatively. An 81-year-old woman presented with right upper quadrant pain. Initial laboratory tests revealed elevation of the white blood cell count to 15,900/μL(normal, 4,000 to 8,000/μL) and mild liver dysfunction. Ultrasonography and computed tomography revealed swelling of the gall bladder with increased wall thickness, but neither examination showed any gallstones. Percutaneous transhepatic gall bladder drainage was performed, and bloody bile juice was obtained. Cholangiography via the drainage catheter of the gall bladder and endoscopic retrograde cholangiography revealed smooth tapering of the neck of the gall bladder. We diagnosed acute torsion of gallbladder and brought the patient to the operating theatre for laparoscopic cholecystectomy. Intraoperatively, we observed that the gallbladder had undergone complete torsion and appeared gangrenous. Routine cholecystectomy was then performed, and the patient recovered without incident.

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