Although laparoscopic pancreatic resection of selected patients is a feasible and safe procedure in the hands of experienced laparoscopic surgeons, patients must be carefully observed after surgery to avoid serious conditions by pancreatic fistula.

In bariatric surgery, LRYGBP is the most effective treatment for morbid obesity, while LAGB has a low risk of postoperative complications. LSG is also a safe procedure for supermorbidly obese patients. We expect that bariatric surgery will be a common procedure for patients with morbid obesity in Japan.

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We measured plasma atrial natriuretic polypeptide concentrations in the umbilical artery and vein, and peripheral veins of healthy children from birth to adolescence to establish the normal range. The plasma atrial natriuretic polypeptide concentration in the umbilical artery (mean +/- SD, 51.0 +/- 21.4 fmol/ml) was significantly higher than that in the umbilical vein (18.1 +/- 13.5 fmol/ml) in neonates after vaginal delivery. Also neonates aged 5 days or less had a significantly high concentration in the peripheral vein (60.7 +/- 29.4 fmol/ml). There was no significant difference in atrial natriuretic polypeptide concentrations in the peripheral veins between older children and adults. The concentrations in children aged more than 5 days and adults aged 20-34 years were 14.4 +/- 7.4 fmol/ml and 10.0 +/- 4.8 fmol/ml, respectively. However, the atrial natriuretic polypeptide concentration in the umbilical artery was not increased in three neonates delivered by caesarean section although they had a high concentration in the peripheral vein 24 hours after birth.

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Patients with spontaneous pneumothorax require immediate insertion of a chest drain to evacuate the intrathoracic air. During video-assisted bullectomy, we made use of an existing chest drain hole to insert a thoracoscope or an endoscopic linear stapler. Video-assisted bullectomy was performed through three ports-two 2-mm ports and the existing chest drain hole. Therefore, no new skin incisions were required for the insertion of the 2-mm ports. A chest drain was again inserted via the existing chest drain hole after bullectomy. This procedure was used on 8 of 10 patients with spontaneous pneumothorax. There were no postoperative complications or recurrences. Thoracoscopic bullectomy using needlescopic instruments is technically feasible, safe, and effective. Currently, the procedure is indicated only for simple cases and not for the lysis of adhesions.

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