Z-shaped anastomosis for the treatment of a benign rectosigmoid stricture.

A girl with malrotation underwent a Ladd's operation at 35 days of age and later had an adhesiotomy at 115 days of age. After the adhesiotomy, she suffered from sepsis and subsequent disseminated intravascular coagulation (DIC). At 178 days of age, she developed an intestinal obstruction because of a rectosigmoid stricture probably caused by DIC-associated ischemia. As a result, an ileostomy was performed. At one year, 4 months of age, she underwent a resection of the proximal part of the rectosigmoid stricture and a reconstruction by means of a Z-shaped anastomosis. Based on our experience, Z-shaped anastomosis appears to be an excellent treatment not only for Hirschsprung's disease but also for benign rectosigmoid stricture.

Video-assisted neck surgery for thyroid and parathyroid diseases.

BACKGROUND: Endoscopic surgery has now become a well-established modality for the treatment of various organ diseases. In the present study, we analyzed the surgical results achieved by video-assisted neck surgery (VANS) in thyroid and parathyroid diseases. METHODS: From January 2000 to April 2002, 87 patients (eight males and 79 females) with a mean age of 49 years underwent VANS. The preoperative diagnoses of these patients included 37 benign thyroid tumors, 30 Graves' diseases, 17 parathyroid adenomas and three thyroid cancers. RESULTS: The mean operative time of VANS was 165 min for a hemithyroidectomy, 287 min for a subtotal thyroidectomy, and 157 min for a parathyroidectomy. The mean intraoperative blood loss was 60, 183 and 23 g for a hemithyroidectomy, subtotal thyroidectomy and parathyroidectomy, respectively. No conversion from VANS to conventional surgery was experienced. Three patients (3.4%) had temporary palsy of the recurrent laryngeal nerve. Otherwise, the postoperative courses were uneventful. CONCLUSIONS: VANS for thyroid and parathyroid diseases was found to be safe and effective. From a cosmetic point of view, a high degree of patient satisfaction was obtained. VANS is thus considered to be an excellent option for selected patients with thyroid and parathyroid diseases.

In vivo assessment of acceleration of motor activity associated with acetylcholine release via 5-hydroxytryptamine4 receptor in dog intestine.

Effect of mosapride, a benzamide, on the motor activity associated with the release of endogenous acetylcholine (ACh) from enteric neurons was examined in the ileum of anesthetized dogs using an in vivo microdialysis method and compared with the effect of 5-hydroxytryptamine (5-HT). Intraarterial administration of 5-HT accelerated intestinal motor activity and increased the concentration of dialysate ACh, and the responses were inhibited by SB204070, a specific 5-HT4-receptor antagonist, but were apparently not affected by methiothepin, ketanserin and granisetron. Intraarterial administration of mosapride, a prokinetic benzamide, accelerated intestinal motor activity and the concentration of dialysate ACh increased. The effects of mosapride were antagonized by SB204070. Specific [125I]SB207710 binding was observed in the myenteric and submucosal plexuses and muscle layers of dog ileum by in vitro receptor autoradiography. High densities of [125I]SB207710 binding sites were detected in the myenteric and submucosal plexuses. Mosapride as well as SB204070 inhibited [125I]SB207710 binding. Thus, in the whole body of dogs, 5-HT and mosapride accelerated the intestinal motor activity due to the increases in ACh release mediated by stimulation of the 5-HT4 receptor.