Takashi Kinoshita

Histochemical localization of nitric oxide synthase in rat enteric nervous system

The localization of nitric oxide synthase, the enzyme responsible for producing the short-acting messenger nitric oxide, has been determined in the digestive tract of the rat using histochemistry for reduced nicotinamide adenine dinucleotide phosphate-diaphorase activity, a specific marker for neuronal nitric oxide synthase. Positively stained neurons were found throughout the entire digestive tract from the esophagus to the rectum. Positive neuronal somata were very common in the myenteric ganglia. Dense positive fibers were distributed in internodal strands, the secondary plexus, the tertiary plexus, and were particularly abundant in the deep muscular plexus, while very few were observed in the submucosal ganglia. The density of these positive structures was higher in the small and large intestine than in the esophagus and stomach. The pattern of distribution suggested that some of these positive cells innervate gut muscles. Double-staining revealed that in these enteric neurons, nitric oxide synthase does not co-localize with acetylcholinesterase. Instead, vasoactive intestinal polypeptide almost always coexists with nitric oxide synthase in the myenteric plexus. Thus, nitric oxide and vasoactive intestinal polypeptide may be co-transmitters in a population of non-adrenergic, non-cholinergic neurons in the enteric nervous system.

Mandibular bone metastasis of rectal cancer: Report of a case

A 56-year-old man was referred with lower rectal cancer showing anal canal invasion and liver metastasis. He underwent an abdominoperineal resection and a partial hepatectomy. Adjuvant therapy with tegafur-uracil and leucovorin was administered postoperatively. Lung metastasis was detected 2 years later and was resected. Right mandibular metastasis was diagnosed 2 months after the resection of the lung metastasis. A partial mandibular resection was performed after chemoradiotherapy, followed by reconstruction with a titanium frame and oral cavity reconstruction with a greater pectoral musculocutaneous flap. The pathological diagnosis was metastatic rectal cancer, and the therapeutic effect chemoradiotherapy was Grade 2. He is presently alive without any evidence of cancer, and has maintained a good quality of life 3 years after the mandibular resection and more than 5 years after his first operation. Mandibular metastasis from rectal cancer is very rare and the prognosis is poor according to the literature, so this case is considered to be very unusual.

Endoscopic Surgery for Facial Lipoma Excision

Minimally invasive endoscopic surgery in the neck, first reported by Gagner in 1996, has been adopted by a number of other surgical specialties. We have developed new techniques for performing endoscopic enucleation lipoma. Using our new techniques, various complications, such as injury to nerves and vessels, are prevented. The technique generates cosmetically satisfying results. Expansion of minimally invasive surgery into the facial area will be enhanced by the future development of instruments for this area, and decrease operating time and hospital stay.

Endoscopic Resection of Zenker's Diverticulum.

We report an endoscopically assisted total diverticulectomy for Zenkers diverticulum. Skin incisions were made at the anterior axillary line, the center of the sternum, and the neck as portals for endoscopical instruments. The skin was retracted with hooks which provided an excellent view of the working space. The diverticulum was fully exposed and resected by using a multifire endoscopic stapler. This approach is minimally invasive in comparison with the conventional open cervical approach.

Endoscopic Neck Surgery for Thyroid Carcinoma

In the past 5 years, endoscopic neck surgery has been performed by various surgeons in Japan. However, many problems remain to be solved, including indications for this related in malignant thyroid tumors. For small thyroid cancers and legions suspected of malignancy, we found that we could obtain radicality in endoscopic neck surgery that was comparable to that attainable by conventional methods. Here, we describe our recent endoscopic surgical experience in five patients with preoperative diagnoses of definite or suspected thyroid carcinoma.

Invagination induced by a long intestinal tube: Report of a case

Invagination induced by a long intestinal tube is rarely encountered. We report herein one such case of a 62-year-old man who was successfully treated by laparoscopically reducing the invagination, then performing partial resection of the small intestine.