Laparoscopic-assisted partial ileectomy for crohn's disease associated with chronic anemia due to frequent hemorrhage.

Crohn's disease can involve any part of the gastrointestinal tract. Although good conservative treatment is given as soon as possible, most patients with this disease will eventually require surgery. We encountered a case of Crohn's disease associated with anemia which we treated with laparoscopic-assisted ileectomy. The postoperative course was satisfactory. The most important characteristic of Crohn's disease, fat wrapping and extending over the serosal surface toward the antimesenteric border, was observed in the ileum, distinguishing the disease and pinpointing the lesion accurately. This surgical method has an advantage over open surgery in that the recovery time is shorter and incisions are smaller, allowing easier surgery in the future, shortening the patient's hospital stay, and improving the patient's quality of life.

Beneficial effect of complementary alternative medicine on lymphedema with rheumatoid arthritis.

Lymphedema of the limbs can be an added complication in a small number of rheumatoid arthritis cases, becoming a long-standing problem even when there is good control of inflammatory joint disease. In the present article, we describe a patient with RA who developed lymph-edema of the forearms successfully treated with TJ-48 (Juzentaihoto) as a complementary alternative medicine (CAM). This kind of edema does not seem to show any consistent relationship with the severity of arthritis in the literature surveyed. In contrast, lymphedema in this case improved in parallel with RA disease activity. We discuss the utility of CAM treatments and review the literature.

Production of endothelin-1 and big endothelin-1 by human cardiac myxoma cells--implications of the origin of myxomas--.

BACKGROUND: Although the origin of cardiac myxomas is still controversial, the 2 main hypotheses are that the tumor cells originate either from multipotential mesenchymal cells or from endocardial neural tissue. METHODS AND RESULTS: The production of various cytokines in 2 human cardiac myxoma cell lines was examined by enzyme-linked immunosorbent assay. After 7 days of culture, extremely high concentrations of interleukin-6 were detected in the culture media from both myxoma cell lines. Increased production of CXC chemokines, interleukin-8 and growth-related oncogene-alpha, were observed in both myxoma cell lines. Endothelin (ET)-1 and its precursor, big ET-1, were detected in the culture media from both myxoma cell lines. The production of both ET-1 and big ET-1 by myxoma cells was higher than by human umbilical vein endothelial cells. Similar to endothelial cells, myxoma cells did not produce stem cell factor, granulocyte colony-stimulating factor, hepatocyte growth factor, or ET-3. CONCLUSIONS: The similarity of the cytokine production pattern between cardiac myxoma cells and endothelial cells supports the hypothesis that the tumor cells originate from mesenchymal cells capable of endothelial differentiation. Overproduction of CXC chemokines may explain, in part, the malignant potential of histologically benign myxomas.

Is carbon dioxide as an insufflation agent for double contrast barium enema still worthwhile after a same-day flexible sigmoidoscopy?

PURPOSE: The aim of the study was to evaluate the efficacy of a double-contrast barium enema (DCBE) with CO(2) as a distending gas after a screening flexible sigmoidoscopy for reducing abdominal distension after an examination. PATIENTS AND METHODS: A total of 165 DCBEs for patients with positive faecal occult blood tests were randomly allocated to a CO(2) group (n = 83) and a control group (n = 82) using air. Abdominal radiograph were taken before the DCBE, immediately following it, and 30 minutes later to determine residual bowel gas. The degree of abdominal discomfort was recorded using a scoring system. RESULTS: The patients in the CO(2) group had significantly smaller amounts of residual gas 30 minutes after the DCBE than did the control group, both in the colon (P < 0.02) and in the small intestine (P < 0.001). There was significantly less abdominal distension after the DCBE in the CO(2) group compared to the control group (P < 0.001). The abdominal discomfort score at 30 minutes after CO(2) correlated with the residual gas in the small intestine (r = 0.390,P = 0.003) but not in the colon (r = 0.155, P = 0.15). The quality of the images and the number of polyps detected did not differ between two groups. CONCLUSIONS: We concluded that using CO(2) when administering a DCBE after a screening sigmoidoscopy was useful for relieving abdominal discomfort following the examination; furthermore, it did not impair the diagnostic ability of the DCBE.

Use of a mattress suture to eliminate dog ears in double-stapled and triple-stapled anastomoses.

Double-stapling techniques for restorative rectal resection have been effective in minimizing local contamination compared with open circular stapling techniques. Inclusion of the transverse staple line closure of the distal rectal stump in the circular stapled anastomosis may minimize the risk of suture line recurrence. A technique for formation of such an anastomosis is described that avoids use of a distal purse string.