We examined apolipoprotein E (Apo E) polymorphism and methylenetetrahydrofolate reductase (MTHFR) 677 C to T mutation by using the polymerase chain reaction (PCR) method in 100 elderly Japanese aged 60 or more, and assessed whether these genetic factors are associated with an increased risk for the clinical phenotypes of senile dementia, Alzheimer's disease (AD) and vascular dementia (VD) by cross-sectional survey. It was found that the Apo E * 4 allele were associated with an increased prevalence of AD as previously reported. Although, it was not strongly related to the severity of senile dementia, a weak associaton between the ApoE genotype and the severity of dementia was suggested. The proportion of patients with senile dementia was higher in the group of carriers of MTHFR mutation than in the group of noncarriers. Furthermore, the proportion of male patients with senile dementia was higher in the group of homozygous for the mutation (+/+) than the group without the mutation (-/-).Notably in VD patients, 5 of 7 males had the +/+ genotype. The results suggest that the ApoE * 4 genotype and the MTHFR mutation are associated with the clinical phenotype and the clinical onset of senile dementia.

Coler-Reilly et al.: Nationwide epidemiological study in Japan on HTLV-1 associated myelopathy/tropical spastic paraparesis using HAM-net, a novel patient registration system. Retrovirology 2014 11(Suppl 1):P17.

A 20-year-old man was scheduled for sagittal mandiblosteotomy. Prior to admission, he had undergone pharyngeal flap surgery for his persistent cleft palate. Avoiding injury of the pharyngeal flap during anesthetic procedures was therefore necessary. To avoid damaging the pharyngeal flap, nasoendotracheal intubation was performed fiberoptically with the patient awake, and anesthesia was completed uneventfully.

BackgroundPatients with chronic occlusion of the celiac artery and superior mesenteric artery (SMA) are often asymptomatic, and occlusion may be caused by arteriosclerosis or median arcuate ligament compression. Pancreaticoduodenectomy (PD) is occasionally performed for patients with celiac artery occlusion; however, reports on patients with SMA occlusion are rare. We report a patient with cholangiocarcinoma and total atherosclerotic occlusion of the SMA without preoperative stenting or bypass.Case presentationA 73-year-old man suspected to have lower bile duct carcinoma was admitted to our hospital for further treatment. Three-dimensional computed tomography (3DCT) showed a common bile duct tumor and total occlusion of the SMA with collateral circulation of the gastroduodenal artery (GDA) and inferior mesenteric artery (IMA). We performed a PD. During the operation, we used test clamping of the GDA, which revealed no bowel ischemia. The postoperative course was uneventful, and the patient was discharged on postoperative day (POD) 30. 3DCT on POD 98 and POD 307 showed development of collateral circulation between the IMA and SMA.ConclusionHere, we report the case of a patient with total occlusion of the SMA who subsequently underwent PD. 3DCT was instrumental in gathering vascular collateral information and thus we conclude that the assessment of collateral circulation before surgery is important.