Technique of transanal endoscopic microsurgery

Summary Sessile adenomas are predominantly localized in the rectum and lower sigma. Surgical removal is indicated but often implies an invasive surgical procedure. Using conventional transanal surgical techniques, only the lower rectum can be reached and there are high rates of recurrence. The new technique combines an endoscopic view of the rectum under gas insufflation via a stereoscopic telescope with conventional surgical preparation and suturing. Adenomas can be excised using the mucosectomy technique or full-thickness-excision, whereas carcinomas should be excised using full-thickness excision with a sufficient border of healthy mucosa. In carcinomas of the sacral cavity, we remove the retrorectal fat up to the fascia of Waldeyer, including the regional lymph nodes. Transanal endoscopic microsurgery is the most economical and tissue-saving surgical technique for the removal of rectal adenomas and early rectal carcinomas.     

A Swiss Manufacturer Sees the Industrial Revolution in England

I have recently come across the diaries of Johann Conrad Fischer. These diaries span six decades and cover the years of social, economic, and technological upheaval which marked the industrial revolution in England. The reader is given a picture of these years through the eyes of a Swiss manufacturer with a good perception of history, and his notes are of some value to historians.     

202. Probleme der Indikation und Beatmung bei der Segmentresektion der Trachea

Zusammenfassung Aufgrund klinischer Erfahrungen und experimentell gewonnener Daten mit vorgeschalteten Stenosen fordern wir: Bestimmung des Bronchialwiderstandes und der inspiratorischen und exspiratorischen Sekundenkapazität. Die Indikation zur Operation sollte bei einem Bronchialwiderstand von über 5 cm/l/s gestellt werden. Dies entspricht einem Stenosedurchmesser von unter 8 mm. Bei der Segmentresektion kann zeitweise nur eine Lunge beatmet werden. Die von uns intraoperativ ermittelten Daten bestätigen die alte Forderung nach Abklemmung der A. pulmonalis der Gegenseite.     

The esophageal tube inserted under endoscopic radiologic control

During the past 2 years we have treated 30 patients with an endotubus positioned by endoscopical and radiological control. In contrast to many other authors we have also used this method in proximal stenosing tumors. Our mortality rate lies at 16% with a mean post-operative survival time of 9 weeks. There were no deaths due to this procedure in patients (n = 18) with distally situated tumors. The hospital stay of patients treated using this method is much shorter than when surgery is employed, and the complication rate is much lower. If no problems are encountered, patients can be discharged after 2 days.     

A high-pressure injector for sclerotherapy of oesophageal varices

In the intravascular sclerotherapy of oesophageal varices, the success of the procedure depends upon the precision and rapidity of injection of the sclerosant. With the aid of a high-pressure injector, which has been tested in a total of 174 sclerotherapeutic procedures, 10 ml of the sclerosant can be injected within 7 seconds, without any particular manual effort being required.     

Role of the signal peptide in the synthesis and processing of the glucagon-like peptide-1 receptor

Background and purpose:

The glucagon-like peptide-1 receptor (GLP-1R) belongs to Family B of the G protein-coupled receptor superfamily and is a target for treatment of type 2 diabetes. Family B G protein-coupled receptors contain a putative N-terminal signal peptide, but its role in receptor synthesis and trafficking are unclear. Further, the signal peptide is not cleaved in at least one family member.

Experimental approach:

We examined receptor glycosylation and the role of the signal peptide in GLP-1R synthesis and trafficking using constructs containing epitope tags at the N- and/or C-terminus and in which the signal peptide sequence was either present or absent.

Key results:

The signal peptide was absolutely required for GLP-1R synthesis but could be substituted to some extent by increasing positive charge in the N-terminal region of the receptor flanking the signal peptide. The signal peptide is cleaved during synthesis and processing of the receptor. An enhanced GFP-epitope tag at the N-terminus of the receptor permitted synthesis of the receptor but blocked signal peptide cleavage and prevented trafficking to the plasma membrane. Cleavage site mutation allowed synthesis of a full-length receptor, blocked signal peptide cleavage and caused retention within the endoplasmic reticulum.

Conclusions and implications:

Signal peptide cleavage was not essential for receptor synthesis but was obligatory for processing and trafficking of receptors to the plasma membrane. Further, the GLP-1R is subject to N-linked glycosylation and only the mature, fully glycosylated form of the receptor is present in the plasma membrane. Inhibition of glycosylation prevents processing and cell surface expression of the GLP-1R.