While transvaginal NOTES is argued to be a promising access for scarless surgery, gynecologists mention postoperative infection, visceral lesions, infertility, and adhesions as conceivable complications. Since long-term experience has not yet been achieved, potential problems such as dyspareunia, infertility, and the spread of pre-existing endometriosis remain definitely conceivable complications.

Chronic graft rejection mediated by cellular immune responses still poses a serious clinical problem in transplant surgery. Chemokines coordinate the recruitment of leukocytes in inflammatory and immune responses. Their precise functions in the rejection of allografts are still ill defined. This study investigates the role of chemokine receptor 4 (CCR4) in acute and chronic cardiac allograft rejection in mice. Allogeneic hearts were transplanted into CCR4 deficient (CCR4 -/-) and control recipients. Reverse transcription-PCR showed transcription of macrophage-derived chemokine and thymus and activation-regulated chemokine, the cognate chemokine ligands of CCR4, within the graft. Compared to wild-type controls, acute allograft rejection in CCR4 -/-recipients was only slightly prolonged. In contrast, in a gallium nitrate chronic cardiac allograft rejection model, cardiac graft survival was significantly prolonged in CCR4 -/-recipients. A relative increase in the percentage of graft infiltrating CD8 + T cells in CCR4 -/-recipients was observed 30 days after transplantation and was accompanied by a decrease in CD4 + T cells. Moreover, the percentage of NK1.1 + CD3 + graft-infiltrating cells was significantly reduced on day 5 and day 30 post transplantation. These findings indicate that CCR4 is involved in the recruitment of NK1.1 + CD3 + cells into cardiac allografts and clearly establish an important and novel role for CCR4 in chronic graft rejection.

Bronchogenic cysts of the esophagus are rare in comparison with the relatively common bronchogenic cyst of the lung. Only a few cases have been reported in literature since 1930. We report on a case of a 43-old-male with a bronchogenic cyst in the distal esophagus, which was misdiagnosed as a malignant esophageal tumor based on preoperative imaging and high levels of the tumor markers CA 19-9 and CA 125.