Ultrasound assisted percutaneous endoscopic jejunostomy.

The percutaneous endoscopic gastrostomy (PEG) cannot be performed for the patient after total gastrectomy. We design the new procedure to make jejunostomy with using an ultrasonography and a regular PEG kit. We name the procedure Ultrasound assisted Percutaneous Endoscopic Jejunostomy (USPEJ). Three cases has been performed USPEJ. Operating time is 30 minutes, 45 minutes and 10 minutes respectively. All cases were performed without any troubles. We conclude that the USPEJ is a useful method for the patient with dysphagia who has the past-history of total gastrectomy.

Different effects of simvastatin and losartan on cytokine levels in coronary artery disease.

BACKGROUND AND OBJECTIVE: Use of HMG-CoA reductase inhibitors (statins) and angiotensin II type 1 (AT(1)) receptor antagonists reduces the incidence of cardiovascular events. The cytokines macrophage colony-stimulating factor (M-CSF) and transforming growth factor (TGF)-beta may exert proatherogenic and antiatherogenic effects, respectively. In this study, we examined whether treatment with a statin or an AT(1) receptor antagonist alters M-CSF and TGF-beta levels in patients with coronary artery disease. METHODS: Twenty-seven consecutive patients with coronary artery disease were randomly assigned to the following three treatment groups for 8 weeks: simvastatin 5 mg/day (n = 10); losartan 50 mg/day (n = 9); or control (usual treatment; n = 8). Blood samples were collected before and after treatment. RESULTS: Clinical characteristics and baseline cytokine levels were comparable among the three groups. Serum levels of M-CSF were significantly decreased only in the simvastatin group (from 403 +/- 71 to 303 +/- 116 pg/mL; p = 0.009). Plasma levels of TGF-beta were significantly increased only in the losartan group (from 5.01 +/- 1.13 to 7.50 +/- 3.83 ng/mL; p = 0.021). Simvastatin decreased serum M-CSF levels independently of changes in total cholesterol or low-density lipoprotein-cholesterol. CONCLUSIONS: The results of this study indicate that simvastatin decreases serum levels of M-CSF while losartan increases plasma levels of TGF-beta, suggesting that the two drugs may have different anti-atherosclerotic properties.

Personal experience of laparoscopic cholecystectomy.

BACKGROUND/AIMS: We performed laparoscopic cholecystectomy with a surgical team consisting of the same operator and the same first assistant to evaluate a personal learning curve of laparoscopic cholecystectomy. METHODOLOGY: In the 135 patients who underwent the laparoscopic cholecystectomy, operative complications, postoperative complications and operative time were evaluated on the basis of using different camera assistants and the chronological advancement of the same operator and the same first assistant. RESULTS: The average operative time was 120 +/- 54 minutes. The operative time was statistically longer in the first ten cases. The major complication during operation, which was ligation of the common bile duct, occurred in the 7th case. The other operative complications, such as minor bile duct injury or mild bleeding, occurred occasionally in spite of experience or inexperience; the operative complications, however, tended to occur under the same camera assistant. On the other hand, the operative time was not related to the use of different camera assistants. CONCLUSIONS: From the personal learning curve of laparoscopic cholecystectomy, operative time is relatively longer in the early 10 cases. Complications tend to occur under the same camera assistant.