The usefulness of Avitene for the control of oozing in laparoscopic cholecystectomy.

An efficient method for the laparoscopic application of Avitene is presented herein. During laparoscopic operation, we cannot staunch bleeding points directly. Given such circumstances, the spray application of Avitene is a very effective method of hemostasis that should make laparoscopic operations even safer.

[Clinical effect of combined chemotherapy with UFT, MMC and OK-432 in recurring or advanced cancer of the digestive organs].

The usefulness of UFTMO therapy (combined chemotherapy with UFT, MMC and OK-432) performed in 40 cases of recurring or advanced cancer of the digestive organs was investigated. According the response criteria by Koyama et al., of 40 eligible cases, the treatment was judged effective in 13, 2 CR and 11 PR cases with a response rate of 32.5%, while of the 35 complete cases, 2 CR and 9 PR cases made for 11 effective cases and a response rate of 31.4%. Side effects were observed in 58.3% of the 36 evaluated cases; of the subjective and objective side effects, however, none were serious enough to require cessation of administration, while stopping administration in the cases of abnormal laboratory findings resulted in rapid recovery. UFTMO therapy, therefore, is considered to be one of the beneficial treatments for recurring or advanced cancer of the digestive organs.

[Pathophysiology of defecatory disturbance in the patient with Hirschsprung's disease and chronically constipated patients with simple megarectum].

The disturbance of defecation in the patient with Hirschsprung's disease and the pathophysiology of constipation in the constipated patient with simple megarectum were investigated. In Hirschsprung's disease, an existence of aganglionosis and the sphincter achalasia are two main factors which cause clinical symptoms such as chronic constipation and megacolon. As a surgical treatment, we have routinely performed our modified Duhamel's operation. Postoperative followup study indicated that the most cases in our series have gained a satisfactory defecatory function 1 to 3 years after operation. In chronically constipated patient with simple megarectum, on the other hand, it was found manometrically that the most of them had significantly high anal canal pressure and incomplete anal relaxation after rectal stimulation. These findings indicate that those patients have hypertonic and achalasic sphincter. Therefore, the authors propose "high anal pressure syndrome (HAPS)" for such constipated patient with simple megarectum. As to the surgical treatment, 6 patients with simple megarectum had a complete posterior internal sphincterotomy and the postoperative results were excellent or good in our series.

Endoscopic extraction of foreign bodies from the duodenum: four cases in infancy.

Four cases of foreign bodies in the duodenum were treated using a flexible fibre-optic panendoscope. All the patients were boys and eight months to four years of age. The ingested foreign materials were an injection needle, a marking pin, a hairpin and a curtain hook. Endoscopic extraction was attempted, because the ingested objects might cause perforation or obstruction of the gastrointestinal tract. Until recently, they had to be carefully watched or prophylactic operation suggested. Under general anaesthesia, duodenal endoscopy was easily performed and extraction of foreign bodies was not found to be difficult during infancy. This is considered to be a safer and less hazardous way than careful watching or prophylactic operation.