[Transdiaphragmatic pericardial fenestration: laparoscopic modification of the procedure].

We present a modification of the laparoscopic pericardial fenestration, an already accepted method for the treatment of the pericardial effusion caused by intrathoracic malignancies. We used this new technique in 5 patients. Laparoscopy was performed with three ports standard technique and dissection with Ultrascision was used for the fenestration of the pericardium.

[Results of ventral hernia repair: comparison of suture repair with mesh implantation (onlay vs sublay) using open and laparoscopic approach--prospective, randomized, multicenter study].

Incisional hernias is a frequent complication following abdominal surgery, it develops in 11-20% of patients who had laparotomies. Different operative techniques are used for repair but results are often poor. In the absence of valid scientific data, there is no general agreement on the best surgical treatment.

Transvaginal extraction of the laparoscopically removed spleen.

Laparoscopic removal of normal and moderately enlarged spleens has become the gold standard operation in recent years because its short operative time, technical safety, and quick patient recovery time. The best method for extraction of the removed spleen, however, has not yet been determined. The authors present a new method for the extraction of the laparoscopically removed spleen.

A new technique for laparoscopic left adrenalectomy.

After the first description of laparoscopic adrenalectomy was published in 1992, this method rapidly attracted widespread interest. Similar to conventional open techniques two main approaches have ben established for the minimally invasive adrenalectomy: the transabdominal and the retroperitoneal. With the transabdominal technique several different routes for exploration of the glands are possible as the patient can be operated on in a lateral, semi-lateral, or even in a supine position for both glands.

Nitric oxide is involved in the relaxant effect of capsaicin in the human sigmoid colon circular muscle.

The relaxant effect of capsaicin (300 nM) has been studied on mucosa-free circular strips of the human sigmoid colon in vitro. The response of precontracted preparations to capsaicin (sub-maximal relaxation) was reduced by over 50% by the nitric oxide synthase inhibitor N(G)-nitro- L-arginine (L-NOARG; 20 microM or 100 microM) or by the guanylate cyclase inhibitor 1 H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ; 1 microM), but not by tetrodotoxin (1 microM) or the P(2) purinoceptor antagonist pyridoxal phosphate 6-azophenyl-2',4'-disulfonic acid (PPADS; 50 microM). L-NOARG or ODQ caused moderate contraction of the circular muscle, indicating a tonic "nitrergic" control.

Aboral pouch with preserved duodenal passage--new reconstruction method after total gastrectomy.

A new reconstruction method--the aboral pouch with preserved duodenal passage--has been introduced after total gastrectomy. After removal of the stomach, preparation of the Roux loop and construction of the esophago-jejunostomy, a jejuno-duodenostomy is performed approximately 50 cm away from the esophageal anastomosis between the Roux limb and the duodenal stump. Right below this second anastomosis, the Roux limb is closed with a stapling device to provide a unidirectional food passage through the duodenum.

Pericardioperitoneal shunt: further development of the procedure using VATS technique.

We report a modification of the previously described VATS (video-assisted thoracic surgical) method of pericardioperitoneal shunt. Our method was used in 5 patients with pericardial tamponade requiring permanent drainage.

The hourglass appearance of the neurofibroma on rectal ultrasound. A case report.

Colorectal manifestation of von Recklinghausen's disease is a rare entity. The typical dumbbell shape of the lesion has been described previously, but only from a resected cecal specimen. The authors present the endosonographic appearance of a rectal neurofibroma, which shows a similar hourglass shape, thus facilitating the diagnosis.

[High-pressure air-blast injury of the esophagus].

Blast injuries causing pneumatic damage to the oesophagus are very rare. Patients usually present with respiratory distress, subcutaneous and mediastinal emphysema, and may also have pneumothorax. Ruptures need early repair to avoid serious morbidity and potential lethal complications.

Pericardial drainage using the transdiaphragmatic route: refinement of the laparoscopic technique.

Four patients with malignant pericardial fluid requiring permanent drainage are reported. A three-port video-assisted thoracoscopic surgery modification of the pericardioperitoneal shunt procedure is described, in which the Ultracision Harmonic Scalpel is used. The supraumbilically introduced camera secures direct vision for the trocars in the left and the right hypochondrium of the patient in a modified lithotomy position.

Clinical experience with different techniques of pancreatic head resection for chronic pancreatitis.

Background/aims: Recently organ-saving procedures have become popular in the treatment of chronic pancreatitis with head enlargement. The purpose of this study is to compare the results of three different procedures.

Methods: Between 1991 and 1998, 32 Beger operations, 13 Frey procedures and 21 pylorus-preserving pancreatoduodenectomies (PPPDs) were performed.

Larynx-preserving pharyngo-esophagectomy after chemoradiation in the treatment of cancer of the pharyngo-esophageal junction.

Pharyngo-laryngo-esophagectomy in the treatment of advanced tumors of the pharyngo-esophageal junction is associated with a high morbidity and poor quality of life due to loss of the larynx. Neoadjuvant chemoradiotherapy resulted in a considerable tumor reduction in 6 patients allowing radical tumor resection by larynx-preserving pharyngo-esophagectomy. The operation consisted of total esophagectomy and resection of the posterior pharyngeal wall and reconstruction by a pharyngogastrostomy in 5 patients, and ileocolon interposition in 1 patient.

[Partial replacement of the trachea with jejunal autograft in the dog].

Extensive lesions of the cervical trachea can occur as a result of malformation, inflammation, tumor disease or trauma. If a short segment of the trachea is resected primary anastomosis may be possible. The problem of how to treat lesions longer than 50% of total tracheal length is still unresolved.

Failure of capsaicin-containing red pepper sauce suspension to induce esophageal motility response in patients with Barrett's esophagus.

Unlabelled: The physiologic importance of afferent sensory pathways in the esophageal motor functions has been recently recognised. Capsaicin-sensitive sensory afferents were shown to play a role in the maintenance of mucosal integrity of the GI tract, and regulation of human esophageal motility. The aim of this study was to investigate the effect of topical application of capsaicin-containing red pepper sauce (Tabasco, 25%v/v, pH:7.

Comparison of quality of life and nutritional parameters after total gastrectomy and a new type of pouch construction with simple Roux-en-Y reconstruction: preliminary results of a prospective, randomized, controlled study.

The aim of the study was to introduce a new type of gastric substitute, the aboral pouch, after total gastrectomy and to compare nutritional, motility, and quality of life parameters of patients with an aboral pouch to those undergoing simple Roux-en-Y reconstruction in a prospective, randomized, and controlled trial. To date 40 patients have entered the study. In 22 of them the aboral pouch was created; the remaining 18 patients with simple Roux-en-Y reconstruction served as the control group.

[Current treatment of anal fissure].

More and more authors believe, that the cause of the chronic anal fissure is the increased anal resting pressure. It maintains a vicious circle causing ischaemia and ulcer on the anoderm. There are many traditional surgical methods treating fissures apart from the conservative ways.

[Esophago-pericardial fistula caused by recurrent esophageal tumor].

The esophago-pericardial fistula is a rare disease that causes a rather high mortality. Up to now less than 70 cases were published in the literature. The authors report an esophago-pericardial fistula caused by recurrent esophageal tumor one year after resection in the lower third esophagus for esophageal cancer.

[Granular cell tumor of the esophagus].

Granular cell tumor is a relatively rare, mostly benign lesion, that can be found in almost every organ, however, only 2% of the cases is oesophageal. It is named after the eosinophilic S-100 protein positive granula in the cytoplasm of the tumor cells. Since patients with oesophageal granular cell tumor are mostly symptomless, the tumor is usually found accidentally.

[Monitoring of oxidative stress after experimental small bowel autotransplantation].

The difficulty at transplanting the small bowel mainly is caused by the biology of the intestine. It is highly immunogenic, is one of the most sensitive tissues to ischemia-reperfusion injury. Our aims were to investigate changes of oxygen free radical mediated reactions after autotransplantation at different preservation times and perfusion fluids.

[Gastric pouch with preserved duodenal passage: attempt to optimize reconstruction after total gastrectomy].

A new method--aboral pouch with preserved duodenal passage--has been introduced for reconstruction after total gastrectomy. After excising the stomach, preparation of the Roux loop and construction of an end-to-side esophago-jejunostomy, the Roux loop is anastomosed to the duodenal stump side-to-end approximately 40-50 cm distal from the esophago-jejunostomy. Right beneath this second anastomosis the Roux limb is closed with a stapler to provide unidirectional passage through the duodenum.

[Larynx-preserving pharyngoesophagectomy in the treatment of cancer of the pharyngoesophageal junction].

Unlabelled: Pharyngo-laryngo-esophagectomy has been the sole surgical option in the management of advanced tumors arising from the pharyngoesophageal junction. This operation is associated with high morbidity, mortality and poor quality of life due to loss of larynx. The aim of the author was to achieve a reduction in tumor size by means of neoadjuvant chemoradiotherapy and so to make the tumor amenable to a larynx preserving operation avoiding pharyngo-laryngo-esophagectomy.