Zenker's diverticulum is a pulsion diverticulum that occurs at a weak site in the posterior wall of the pharyngoesophagus between the inferior constictor of the pharynx and the cricopharygeus muscle, i.e. Killian's triangle. Zenker's diverticulum is rare in Japan. We performed diverticulectomy with cricopharyngeal myotomy for Zenker's diverticulum via the external cervical approach with the patient under general anesthesia. The huge diverticulum was resected with the use of a large-diameter (45Fr) esophageal bougie. Patients with a large diverticulum are at risk for postoperative surgical complications, such as pneumonia and reccurent laryngeal nerve paralysis.

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Liposarcoma is a malignant mesenchymal tumor that tends to develop in the retroperitoneal trunk and extremities. A 59-year-old woman came to our hospital with a chief complaint of abdominal pain. Computed tomography revealed an ovoid mass, 150mm in diameter, in the middle of the peritoneal cavity. Endoscopy showed an ulcerative tumor in the rectosigmoid. Anterior resection of the rectum and resection of the tumor were performed. Histological examination showed a well-differentiated liposarcoma that had developed in the ligamentum teres hepatis and an adenocarcinoma of the rectosigmoid. The present case of liposarcoma developing in the ligamentum teres hepatis is, to our knowledge, the first to be reported.

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We report a case of intrauterine intestinal volvulus without malrotation in a fetus. A 31-year-old woman was admitted at 33 weeks 3 days' gestation because of decreased fetal movement and a nonreassuring fetal heart rate pattern on cardiotocography. A 1,948-g boy was delivered via emergency cesarean section. After birth, a small-bowel volvulus without malrotation was noted at laparotomy. In this case, the abnormal fetal heart rate pattern might have been caused by the decreased cardiac output associated with intestinal bleeding and distension due to small bowel volvulus.

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I review several theoretical and computational approaches for calculating the conformational change of biomolecules, which is a key biomolecular event in cells. After discussing the motivation for the study of conformational change, I describe the path search algorithms in simple terms and discuss the application of the string method, a powerful path search method, to the calculation of minimum free energy pathways in an enzyme, adenylate kinase, which plays a role in converting ADP to AMP and ATP in cells. Finally I briefly mention a more advanced topic of path sampling for biomolecules.

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Our internal defense system is composed of two distinct elements; local innate immunity principally arranged on the surface area to establish barriers against various pathogens and systemic acquired immunity mainly seen in systemic compartments to survey and control internal damage and disorders. The former innate surface barrier is chiefly regulated via species-restricted CD1 antigen-presenting molecules through lipid/glycolipid antigens presented mainly by dendritic cells (DCs), while the latter internal acquired immune system is controlled by individually restricted MHC molecules and gained antigen-specific memories through gene-rearrangements. Such specific memories are also instructed mainly by DCs that can capture the antigenic information from foreign bodies whose lipids or nucleic acids fragments stimulate the DCs. Therefore, our innate immunity seems to be controlled by various lipids and their relatives. On reconsidering the Traditional Chinese medicine, boiled water-extract of various herbs has been used. In that water-extract, there are various saponin detergents, essential oils, alkaloids, and other lipid-related substances that may clean and erase the old sticky lipids or protect and activate the innate immune system. In this review, based on our recent immunological progress on lipids, the possible relationship between Traditional Chinese Herbal medicine and innate immunity will be discussed.

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