Background: Recent technical innovation enhances progresses in liver surgery. Now, for example, a preoperative 3D-simulation of the liver is indispensable for liver surgery. Detailed 3D-image revealed that portal perfusion area in cranial side of anterior segment sometimes surrounded superior right hepatic vein (SRHV). In such patients with HCC, SRHV should be resected for systematic resection. The aim of this presentation is to introduce various kinds of progresses in preoperative simulation and propose a new hepatectomy based on a hybrid concept of portal perfusion of anterior segment and hepatic venous drainage area of SRHV. A next generation simulation: 1) One-stop shopping of 3D-simulation of the liver: We newly developed 3D-simulation using a software of SYNAPSE VINCENT Ver. 3.1 (Fujifilm Medical, Tokyo, Japan), in which biliary system and hepatic vasculature are simultaneously reconstructed in one dynamic MD-CT. This technique can avoid incorrect positional relationship when separately depicted DIC–CT or MRCP is fused on 3D-image by MD-CT, as well as unnecessary radiation exposure. Recently, we applied 3D-printer to a preoperative simulation of hepatic resection to better understand the 3D-anatomy 2) Assessment of partial functional reserve: We have reported new methods to estimate regional hepatic functional reserve using hepatocyte-phase of EOB-MRI (J Gastroenterol 2012), (and fusion image of 3D-CT and asialoscintigraphy using 99m-Tc galactosyl human albumin). The method of EOB-MRI utilized character of hepatocyte-uptake of EOB through membrane transporters on hepatocytes. Fusion of both acialoscintigram of hepatic functional reserve and 3D-simulation by the above-mentioned software also well determines regional liver functional reserve. Those techniques provided accurate estimation of partial functional volume, and help surgeons’ decision making for resection volume of the liver. A new anatomical resection: SRHV-involvement was observed in 17 out of 66 patients (26%). The large IRHV (more than 5 mm in diameter) was found in 16 out of 66 patients (24%). In patients with SRHV-involvement, the incidence of a large IRHV (8 of 17: 48%) was significantly higher, compared to that in those without SRHV-involvement (8 of 49: 16%). The procedures are as follows: 1) encircling of anterior Glissonian pedicle, SRHV and inferior right hepatic vein (IRHV), 2) confirmation of demarcation line of anterior segment by occluding Glissonian pedicle and demarcation (congested) line by clamping proper hepatic artery and SRHV, and 3) IRHV-preserved complete resection of portal perfusion area plus drainage area of SRHV, combined with SRHV resection. Two patients having a large IRHV and HCC near the root of SRHV underwent a IRHV-preserved hepatectomy combined with SRHV resection (S8 + SRHVdrainage area in 1 and anterior segment + SRHV-drainage area in 1). Postoperative CT scan revealed complete resection of drainage area of SRHV and no congestion in the remnant posterior segment after hepatectomy due to excellent drainage through a large IR. Conclusions: Various advancements, such as preoperative 3D-simulation including partial functional reserve estimation and 3D-printer, enabled surgeons to perform hepatic resection easily and safely. In such HCC patients having a large IRHV, our new hepatectomy based on a hybrid concept of portal perfusion of anterior segment and venous drainage area of SRHV, combined with SRHV resection, is a promising option from the viewpoint of systematic resection (curability) and functional reserve of the future remnant liver in selected patients.

Objective: To report that screw-in type pacing leads can be removed by screw retraction even after a significant anchoring period. Patient: A 78-year-old woman who visited our hospital for skin erosion over a pacemaker that had been implanted 3 years previously and had migrated from the subclavicular area to the axilla. Methods: Culture revealed a local staphylococcus infection. We placed a new pacemaker system in the contralateral (right) side, removed the old one, inserted a straight type stylet into the leads, and turned the rotator counterclockwise. Results: An image monitor confirmed complete retraction of the ventricular lead screw and partial retraction of the atrial lead screw, and we were able to pull out both leads without any resistance. The patient was given antibiotics and discharged 2 days after the surgery. No wound infection was evident at a 3-month follow-up examination. Conclusion: When a screw-in type pacemaker with a retractor must be removed long after its implantation, screw retraction should be tried before resorting to a removal kit or open heart surgery.

With a view to learning the status, on a wide scale, of the new-infection of hookworms in a rural district, the author examined the pupils of lower secondary schools in Ichiharagun, Chiba Prefecture, and obtained the following results: 1. The ratio of hookworm-ova positive cases was as high as 29.7%of all the pupils examined. By sex, it was higher in the male group than in the female group; and farmers'children showed a higher percentage than non-farmers'.
2. The percentage of new-infection was 2.2%at the minimum, 28.0%at the maximum, 12.4%on an average.In the 20 schools of all the 21 examined, percentages were not higher than 20%.And a significant correlation was found between the total infection rate and the rate of new-infection.
3. The rate of new-infection was also higher among the male than among the female examinees. By their family occupation, it was higher among farmers' children.
4. Distribution of different species among the group of people newly infected with hookworms was closely correlated with such distribution picture in the corresponding area.

In Ichihara-gun, Chiba Prefecture, a rural district, two villages where no anti-hookworm measure had hitherto been taken were selected for the study. The inhabitants of these two villages were first given mass anthelmintic treatment twice, but after that no more anti-hookworm measure was taken. In such natural conditions, theconditions of newand re-infection were observed for more than one year's time byway of stool examination.
1. The hookworm egg-positive rates: 82.4% for Itohisa, Miwa-machi, and 41.2% for Nakano, Shitsu-mura. Both species were present, but Necator americanus predominated in either of the two areas.
2. The cumulative rates of new-and re-infection for the whole year: It was higher in Itohisa (36.9%) than in Nakano (8.4%). But, in the two other villages where antihookworm measures had been executed over a long period of time, such rate was extremely low.
3. The seasonal fluctuations of the rates of new-and re-infection: In both of these subject villages it was higher in the warmer season including the wet season, i. e. mid-April to mid-July.
4. Analysis of the rates of new-and re-infection by modesof living: In Itohisa, school children showed a higher rate of new-infection, and the adults of the same area presented the higher rates of both new-infection andre-infection.In Nakano, no significant difference was seen between school children and adults, but one thing to be noted is that the cases of conversion to positive among school children were all of them new-infection cases.
5. New-and re-infection rates by sex: No particular difference was recognized in either of the two areas.
6. Classification of new-and re-infection cases by species: In bothof the villages, majority of the cases carried Necator americanus only.

We report a case of massive, life-threatening from a varicose lesion of the right lower extremity. An 81-year-old lady was brought to the emergency room at our hospital because of massive bleeding from her right leg. She had had high ligation of the right saphenous vein at another hospital 2 years ago. After hemostat and transfusion, she recovered from hemorrhagic shock. Three-dimensional enhanced computed tomography angiography revealed a residual right great saphenous vein and recurrent varicose lesion. We performed high ligation of the great saphenous vein and closed all of the residual perforators. The patient was discharged hospital 10 days after the surgery and experienced no bleeding episodes within 8 months after the surgery. Certain high ligation and elimination of perforators of the great saphenous vein in surgery for varicose vein of leg is necessary to prevent lethal bleeding.

[Objective]The skin is the biggest organ in the body. The human epidermis functions as a defence against various antigens in addition to physical and bio-chemical protection. The dermis consists of dense connective tissue which contains the circulatory system and sensory nerve endings. In this paper, regional differences in the structures of human skin are described.
[Materials and Methods]The skin of different regions in the human body was examined by optical and electron microscopy and by utilizing various morphological techniques.
[Results and Discussion]Epidermis:The cornified layer in the finger pulp and heel, which receives strong mechanical stimuli, is considerably thicker than other regions. The germinal layer consisting of spinous and basal layers becomes thinner with aging. Langerhans cells that produce antigens are scattered in the germinal layer. Furthermore, Merkel cells situated at the basal layer are found in the finger pulp, bottom of the foot and the hair disks of limbs. These cells are involved in the sense of touch or pressure. Dermis:The dermis is divided into the papillary and reticular layers, which consist of loose and dense connective tissue, respectively. In the papillary layer, fibrocytes and mast cells are distributed. Large-sized dermal papillae are found the in finger pulp and bottom of the foot, but there are also a few small papillae in other regions. In large papillae, loops of blood capillaries and Meissner's tactile corpuscles were observed. In addition, large-sized lymphatic capillaries are present in the papillary layer.A dense network of free endings, which are situated beneath the epidermis and are responsible for thermal nociception, are abundant in the face, palm, forearm and sacrum. Corpuscles of Vater-Pacini situated in the deep dermis or subcutaneous tissue are found in the finger pulp, and bottom of the foot.
[Conclusion]In conclusion, it is likely that acupuncture and moxibustion may directly or indirectly stimulate Langerhans cells, Merkel cells, fibrocytes, mast cells or various nerve endings.