Role of anorectal myectomy in the treatment of short segment Hirschsprung's disease in young adults.

Basic pathological disorder in Hirschsprung's disease (HD) comes into being by the abnormal innervations of the aganglionic distal intestine. The nonserious forms of this congenital disease may reach the young by proceeding with chronic, obstinate constipation that does not respond to diet. Myectomy of the short segment of aganglionic part may provide diagnostic and therapeutic value. Between 1993 and 2003, anorectal posterior myectomy was performed in 19 patients diagnosed with HD. The mean age of patients was 23 years. Previous or concomitant anterior resection was added to the procedure in seven cases due to dolicomegacolon. In addition to the deficiency of anorectal inhibitor reflex (ARIR) among all patients, the frequency of defecation was 12.5 days (range, 6-30 days) before operation. Anorectal length before widening was an average of 5.5 cm (range, 2-8 cm). All pathologic specimens were found to be aganglionic. Postoperatively, the mean of first regular defecation interval was 1.5 days (range, 1-3 days). Involution of rectum was evaluated with a rectal examination and barium enema X-rays during follow-up. ARIR of patients also returned to normal. In conclusion, anorectal posterior myectomy is an effective operation in diagnosis and treatment of short-segment HD. Furthermore, colon resection annexed to this operation, in the condition of dolicomegacolon, is also used to remove obstinate constipation.

Robotic-assisted minimally invasive central pancreatectomy: technique and outcomes.

BACKGROUND: Central pancreatectomy is a definitive treatment for low-grade tumors of the pancreatic neck that preserves pancreatic and splenic function at the potential expense of postoperative pancreatic fistula. We analyzed outcomes after robot-assisted central pancreatectomy (RACP) to reexamine the risk-benefit profile in the era of minimally invasive surgery. METHODS: Retrospective analysis of nine RACP performed between August 2009 through June 2010 at a single institution. RESULTS: The average age of the cohort was 64 (range 18-75 years) with six women (67 %). Indications for surgery included: five benign cystic neoplasm and four pancreatic neuroendocrine tumor. Median operative time was 425 min (range 305-506 min) with 190 ml median blood loss (range 50-350 ml) and one conversion to open due to poor visualization. Median tumor size was 3.0 cm (range 1.9-6.0 cm); all patients achieved R0 status. Pancreaticogastrostomy was performed in seven cases and pancreaticojejunostomy in two. The median length of hospital stay was 10 days (range 7-19). Two clinically significant pancreatic fistulae occurred with one requiring percutaneous drainage. No patients exhibited worsening diabetes or exocrine insufficiency at the 30-day postoperative visit. CONCLUSIONS: RACP can be performed with safety and oncologic outcomes equivalent to published open series. Although the rate of pancreatic fistula was high, only 22 % had clinically significant events, and none developed worsening pancreatic endocrine or exocrine dysfunction.

Element concentrations in the swimbladder parasite Anguillicola crassus (nematoda) and its host the European eel, Anguilla anguilla from Asi River (Hatay-Turkey).

The European eel's swimbladder nematode, Anguillicola crassus, sampled from the Asi River (Orontes River) in Antakya (Hatay, Turkey) in May 2006 were analysed by Inductively Coupled Plasma-Atomic Emission Spectrometry (ICP-AES) for their some heavy metal (Cd, Cr, Cu, Fe, Hg, Mn, Pb and Zn) levels. The metal concentrations of the parasites were compared to different organs (swimbladder, liver, muscle and skin) of the fish hosts. The parasite contained statistically highly significantly amounts of Fe (P < 0.05). The iron level of nematode was up to 25.52 times than the muscle of its host, Anguilla anguilla. However, bioconcentration of Cd, Cr, Cu, Hg, Mn, Pb, Zn were detected in the A. crassus and it contained no statistically differences with the other tissues of its host, the eel (P > 0.05). Furthermore, no significant differences were detected in the heavy metal accumulations between the parasitized and un-parasitized fish tissues. The analysed metals (Cd, Cr, Cu, Fe, Mn, Pb and Zn) were found in fish muscle at mean concentrations under the permissible limits proposed by FAO.