AIM: To describe the anal cushion lifting(ACL) method with preliminary clinical results. METHODS: Between January to September 2007, 127 patients who received ACL method for hemorrhoid was investigated with informed consent. In this study, three surgeons who specialized in anorectal surgery performed the procedures. Patients with grade two or more severe hemorrhoids according to Goligher’s classification were considered to be indicated for surgery. The patients were given the choice to undergo either the ACL method or theligation and excision method. ACL method is an original technique for managing hemorrhoids without excision. After dissecting the anal cushion from the internal sphincter muscle, the anal cushion was lifted to oral side and ligated at the proper position. Clinical characteristics and outcomes of patients were recorded including complications after surgery. RESULTS: A total of 127 patients were enrolled. Their median age was 42(19-84) years, and 74.8% were female. In addition, more than 99% of the patients had grade 3 or worse hemorrhoids. The median followup period was 26(0-88) mo, and the median operative time was 15(4-30) min. After surgery, analgesics were used for a median period of three days(0-21). Pain control was achieved using extra-oral analgesic drugs, although some patients required intravenous injections of analgesic drugs. The median duration of the patients’ postoperative hospital stay was 7(2-13) d. A total of 10 complications(7.9%) occurred. Bleeding was observed in one patient and was successfully controlled with manual compression. Urinary retention occurred in 6 patients, but it disappeared spontaneously in all cases. Recurrent hemorrhoids developed in 3 patients after 36, 47, and 61 mo, respectively. No anal stenosis or persistent anal pain occurred. CONCLUSION: We consider that the ACL method might be better than all other current methods for managing hemorrhoids.
AIM:To investigate ethanol-induced hepatic steatosis after liver resection and the mechanisms behind it.METHODS:First,the preliminary examination was performed on 6 sham-operated(Sham)and 30 partial hepatectomy(PH)male Wistar rats(8-wk-old)to evaluate the recovery of the liver weight and liver function after liver resection.PH rats were sacrificed at the indicated time points(4,8,and 12 h;1,3,and 7d)after PH.Second,the time point for the beginning of the chronic ethanol exposure(1 wk after sham-or PH-operation)was determined based on the results of the preliminary examination.Finally,pair-feeding was performed with a controlled diet or with a 5-g/d L ethanol liquid diet for 28 d in another 35 age-matched male Wistar rats with a one-week recovery after undergoing a sham-(n=15)or PH-operation(n=20)to evaluate the ethanol-induced liver injury after liver resection.Hepatic steatosis,liver function,fatty acid synthase(Fas)gene expression level,the expression of lipid metabolism-associated enzyme regulator genes[sterol regulatory element binding protein(Srebp)-1and pe roxis ome prol i fe rat or-ac t ivat e d re c e pt or(Ppar)-α],the mediators that alter lipid metabolism[plasminogen activator(Pai)-1 gene expression level and tumor necrosis factor(Tnf)-αproduction],and hepatic class-1 alcohol dehydrogenase(Adh1)-associated ethanol elimination were investigated in the4 groups based on histological,immunohistochemical,biochemical,Western blotting,reverse transcriptase chain reaction,and blood ethanol concentration analyses.The relevant gene expression levels,liver weight,and liver function were assessed before and 1wk after surgery to determine the subject’s recovery from the liver resection using the rats that had been subjected to the preliminary examination.RESULTS:In the PH rats,ethanol induced marked hepatic steatosis with impaired liver functioning,as evidenced by the accumulation of fatty droplets within the hepatocytes,the higher increases in their hepatic triglyceride and blood alanine aminotransferase and bl
We developed an ex vivo model of arterially perfused rat duodenum to examine the motor activity of intestine. In this preparation, spontaneously occurring pressure waves with regular rhythm were observed. The oxygen consumption and motor activity of the intestine were compared at different arterial perfusion rates to determine the degree of oxygenation required to elicit spontaneous motility. Pressure waves with regular rhythm occurred at a frequency of 1 min-1 when the arterial perfusion was 3-5 mL min-1, and stopped when the perfusion rate fell below 2 mL min-1. Atropine and hexamethonium reduced the percentage motor index/10 min of pressure waves in a dose-dependent manner, and tetrodotoxin completely blocked motor activity. Acetylcholine stimulated motor activity, and this effect was not antagonized by TTX. These findings suggest that spontaneous contraction in the ex vivo perfused rat duodenum might be mediated by a cholinergic mechanism via muscarinic receptors on smooth muscle, but that noncholinergic mechanisms may also participate in this response.
We examined the mechanisms of effects of vasoactive intestinal polypeptide (VIP), pituitary adenylate cyclase activating polypeptide (PACAP) 27 and PACAP38 on spontaneously occurring pressure waves in ex vivo perfused rat duodenum. VIP and PACAPs dose‐dependently reduced the percentage motor index of pressure waves; this reduction was not prevented by atropine, hexamethonium or tetrodotoxin (TTX). VIP and PACAPs abolished acetylcholine‐induced stimulation of pressure waves, even in the presence of TTX. These findings suggest that VIP and PACAPs may exert direct inhibitory effects via VIP/PACAP receptors located on smooth muscle rather than via cholinergic receptors. The inhibitory effects of VIP and PACAPs were partially antagonized by the VIP receptor antagonists VIP(10–28), suggesting that VIP and PACAPs share common receptor sites on intestinal smooth muscle. The effects of VIP and PACAPs were completely antagonized by nitric oxide (NO) synthase inhibitor N G ‐nitro‐ L ‐arginine (L‐NA), suggesting that NO mediates the inhibitory effects of VIP and PACAPs on duodenal motility. Furthermore, single injection of L‐NA stimulated spontaneously occurring pressure waves, while VIP(10–28) did not affect them. These findings suggest that VIP/PACAPs and NO strongly interact as an inhibitory mediator on duodenal motility, but that their modes of action in doing so may differ.
The involvement of serotonin (5‐HT) receptor subtypes in motor activity of the ex vivo vascularly perfused rat duodenum was investigated. Clusters of phasic contractions (CPCs), migrating in an oral to anal direction, were obtained without any stimulation. Drug effects were evaluated by changes in different components of the pressure waves, such as motor index (MI), frequency, amplitude and duration of the CPC. The effect of 5‐HT depletion on motor activity was examined in animals treated with p‐chlorophenylalanine (PCPA). The MI, frequency and duration of CPC were decreased by PCPA, but the amplitude was not affected, suggesting that endogenous 5‐HT may play an important role in regulation of the motor activity of the rat intestine. The importance of the 5‐HT receptor subtypes in the regulation of motor activity was examined. Neither the nonselective 5‐HT1 and 5‐HT2 receptor antagonist, methysergide, nor the 5‐HT2 receptor antagonist, ketanserin, affected motor activity. However, the 5‐HT3 receptor antagonists, granisetron and azasetron, decreased percentage MI, frequency, percentage amplitude and percentage duration of CPC. The 5‐HT4 receptor antagonist, SB204070, exerted both excitatory and inhibitory actions, with a higher dose (10 n M ) stimulating percentage MI, frequency, percentage amplitude and percentage duration, and a lower dose (0.1 n M or 1 n M ) decreasing percentage MI and percentage duration of CPC. These results suggest that endogenous 5‐HT regulates the motor activity of the rat duodenum through 5‐HT3 and 5‐HT4 receptors, with the former mediating the stimulatory influence and the latter mediating both stimulatory and inhibitory influences.
