Rigid endoscopic LASER diverticulotomy for lateral pharyngoesophageal diverticuli: cases presentation and discussion.

Killian-Jamieson diverticulum (KJD) is a rare cervical esophageal abnormality. Transcervical approach has been the main treatment modality to prevent recurrent laryngeal nerve (RLN) injury. We presented two cases of patients confirmed with KJD and were managed successfully under rigid endoscope. The new technique and idea were described in detail. Under rigid laryngoscope, the septum between the true esophagus lumen and diverticulum can be exposed clearly. A microscope equipped with CO2 LASER system offered precise and focused point cutting energy to the septum. Several efforts were applied to prevent RLN injury in the cases descriptions. We use transnasal esophagoscope and eating assessment tool (EAT-10) for anatomic and functional result evaluation. Much improved symptoms of dysphagia and intact RLN function were observed. Under the assist of rigid laryngoscope and point-cutting CO2 LASER, KJD diverticulotomy could be performed safely with little complication for patients refusing transcervical route.

Peripheral neuropathology of the upper airway in obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder that leads to significant morbidity and mortality without adequate treatment. Though much emphasis on the pathogenesis of OSAS has been placed on a narrow upper airway space and associated muscular factors, possible neuropathy of the upper airway has not been fully elucidated. Increasing peer reviewed evidence suggests involvement of neurologic lesions of the upper airway in OSAS patients. In this article, we review the etiology and pathophysiology of OSAS, the evidence and possible mechanisms leading to upper airway neuropathy, and the relationship between upper airway neuropathy and OSAS. Further studies should focus on the long term effects of the upper airway neuropathy as related to the duration and severity of snoring and or apnea, and also on the potential methods of prevention and management of the neuropathy in sleep disordered breathing.

Rare concurrent ileoileal and ileocolic intussusceptions in a child presenting with painless hematochezia.

Double-site intussusceptions are very rare in children, and only a few have been reported. Here, we report a 17-month-old boy with double intussusceptions, whose clinical manifestations were painless hematochezia and anemia. Ultrasonography demonstrated an edematous, dilated bowel and two target lesions, suggesting multiple sites of intussusception. At surgery, intussusceptions were found in the ileoileal and ileocolic segments of the intestine. The cecum and proximal ascending colon were resected because of a gangrenous ileocolic intussusception. The ileoileal intussusception was reduced manually. Postoperatively, the patient was stable with no subsequent intestinal obstruction or hemorrhage.