bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple Microhamartomas of the Biliary Tract System (Von Meyenburg Complexes) with Multiple Liver Cysts — Diagnostic Imaging and Laparoscopic Findings —
Authors: TAMEDA Yukihiko , KOSAKA Yoshitane , SHIRAKI Katsuya , KIHIRA Takayuki , OHASHI Yohei , FUJIOKA Hiromichi , HAMADA Minoru , MIYAZAKI Mitsukazu , ITO Nobuyasu , TAKASE Kojiro , NAKANO Takeshi
Published: August 2007

Abstract: We present two patients with multiple microhamartomas of the biliary tract (von Meyenburg complexes) with multiple liver cysts with special reference to their diagnostic imaging and laparoscopic findings. Case 1 was a 76‐year‐old male and case 2 was 51‐year‐old male, who was later found to have adenocarcinoma of the common bile duct as a complication. The characteristic findings of ultrasonography (US) were markedly heterogeneous and there was a severe hyperechoic pattern in the liver with small cystic lesions. Computed tomography (CT) demonstrated multiple low attenuation focal defects scattered throughout both lobes which showed no enhancement following the application of intravenous contrast medium.

Laparoscopically, multiple whitish nodular or stellate‐shaped lesions, which were slightly depressed, and multiple small dark greenish cystic lesions of various sizes were scattered on the smooth surface of both lobes. Some dark greenish cystic lesions and whitish lesions were adjoining. A histological study of the whitish nodular lesions revealed a collection of proliferated and irregularly dilated bile ducts and ductules in a dense fibrous stroma. These findings are compatible with microhamartomas.

These features are characteristic of this disease, and support the close association between liver cysts and microhamartomas. Our hypothesis is that a polycystic liver may result from cystic dilatation of microhamartomas.
A Case of Crohn's Disease which Initially Presented with Diffuse Inflammation in the Rectum and Sigmoid Colon
Authors: HIBI Toshifumi , SERIZAWA Hiroshi , TOMITA Masako , SUEMATSU Makoto , KANAI Takanori , WATANABE Noriaki , TASHIRO Yukio , SUGINO Yoshinori , TSUCHIYA Masaharu
Published: August 2007

Abstract: This case report describes a female patient with Crohn 's disease who had diffuse proctosigmoiditis without a longitudinal ulcer or cobblestone appearance at the initial attack. She was treated with sulfasalazine on the presumptive diagnosis of ulcerative colitis. Two and a half months later, painful ulcers in the oral cavity and a deep longitudinal ulcer in the sigmoid colon were found, and a non‐caseous granuloma was revealed in the biopsy specimens taken from the sigmoid colon. A definitive diagnosis of Crohn's disease was established from these findings and treatment with a corticosteroid was effective.
Intussusception Caused by Subserosal Lipoma of the Ileum
Authors: SHIROEDA Osamu , INOKUCHI Hideto , MATSUSHITA Masanori , KIYOTA Keisuke , HIROTA Makoto , YOKOTA Takashi , HIRAI Kiyoshi , YAMADA Yoshihiro , KAWAI Keiichi
Published: August 2007

Abstract: In this study a case of ileal subserosal lipoma with ileocolic intussusception is reported, together with a review of the literature. The patient, a 37‐year‐old female, was admitted with melena and abdominal pain. A complete blood cell count revealed microcytic anemia. An ultrasonography and CT scan revealed ileocolic intussusception. On colonoscopy, a tumor was seen at the site of the ileocecal valve. Subsequently, the tumor was retracted mechanically using an endoscope. An ileogram taken after retraction revealed the tumor to have been about 50 cm proximal to the ileocecal valve. In addition to the tumor, 6 cm of the ileum was resected. The tumor was 2.5 cm in diameter; the histological diagnosis was subserosal lipoma of the ileum. This is a rare case of intussusception due to an intestinal lipoma diagnosed by various visual examinations before surgery.
Endoscopic US and Dynamic CT in Preoperative TN Staging of Esophageal Squamous Cell Carcinoma
Authors: FUJISHIMA Hiroshi , CHIJIIWA Yoshiharu , MARUOKA Akira , MISAWA Tadashi , NAWATA Hajime
Published: August 2007

Abstract: 〈Objective〉 The aim of this study was to assess the accuracy and limitations of endoscopic ultrasonography (US) and dynamic computed tomography (CT) in the preoperative evaluation of esophageal carcinoma.

〈Methods〉 Endoscopic US and dynamic CT were performed preoperatively in 96 patients with an esophageal squamous cell carcinoma. The results were correlated with the histology of specimens resected from patients who had undergone subtotal esophagectomy with lymph node dissection.

〈Results〉 According to the TN staging classification, endoscopic US was superior to dynamic CT for evaluating the depth of tumor infiltration (overall accuracy: EUS 75%, CT 35%) and in assessing regional lymph node metastases (overall accuracy: EUS 77%, CT 67%). However, the T4 stage was not accurately evaluated using endoscopic US in this study. Its specificity was high (97%) but its sensitivity was low (45%).

〈Conclusions〉 We believe endoscopic US is the most accurate method for local tumor staging in esophageal carcinoma. A limitation to endoscopic US staging performed with current instruments was severe stenosis, as it would not permit passage of the instrument (25% of all cases in this study).
Acute Ulcers Induced in Canine Stomachs by Endoscopic Compressed Air Delivery of 25 mg NaCl
Authors: HOSHINO Teruo , KISHI Tadahiro
Published: August 2007

Abstract: Endoscopic administration of 25 mg NaCl powder to target sites on the gastric mucosa of five dogs, using a compressed air delivery system developed by the author, was followed by observation of changes in the gastric mucosa. After 30 seconds, 1 minute, 2 minutes, 5 minutes and 10 minutes, the sprayed NaCl was washed away by endoscopic water spray, and the presence of submucosal bleeding was observed at the target sites. After 24 hours, ulcers in the gastric mucosa were recognized at sites at which the NaCl had been in contact for 2 minutes or more before being washed away. With one minute or less contact time between NaCl and the mucosa, erosion and redness were observed at the target sites. In a control study, however, no mucosal lesions occurred following identical spray of 25 mg lactose powder which was left in contact for 30 seconds, 1 minute, 2 minutes, 5 minutes and 10 minutes, and also 24 hours.

Experimental gastric ulcers can be induced by endoscopic administration of a small amount of NaCl powder. The time of contact of NaCl on the gastric mucosa affected the induction of gastric mucosal damage. This method will be useful in the investigation of the direct effects of various drugs on the gastric mucosa.
A Case of Hemochromatosis in which Laparoscopy was Useful for Differentiation from a Hepatocellular Tumor
Authors: SHIOMI Susumu , KUROKI Tetsuo , UEDA Tadashi , SAKAGUCHI Hiroki , NISHIGUCHI Shuhei , SEKI Shuichi , KOBAYASHI Kenzo , SAITO Shinobu , HARIHARA Shigeyoshi
Published: August 2007

Abstract: The case of a 54‐year‐old man with hemochromatosis who developed cirrhosis of the liver and hepatocellular tumor is discussed. Before laparoscopy, the possibility of hepatocellular carcinoma was not ruled out by imaging tests only. Laparoscopy revealed a tumor, 60 mm in diameter, protruding from the lower portion of the left lobe of the liver. The tumor was biopsied during laparoscopy, and tentatively identified as a regeneration nodule. Laparoscopy is useful for the definite diagnosis of hepatocellular tumors.
Endoscopic Injection of Absolute Ethanol Achieves Ultimate Hemostasis in Bleeding Caused by Peptic Ulcers
Authors: KOYAMA Takanori , FUJIMOTO Kazuma , IWAKIRI Ryuichi , HIRANO Masahiro , OONO Akihiro , KLSU Tatsuro , YAMAOKA Kotaro , YAMAGUCHI Masaya , HISATSUGU Takeharu
Published: August 2007

Abstract: This study was performed to assess the efficacy of endoscopic injection therapy with absolute ethanol to prevent emergency surgery and recurrent bleeding in patients with peptic ulcers. We compared two different treatment protocols of peptic ulcers with active bleeding or with visible vessels on the ulcer bed. In group I (1981–1984, control group), 45 patients underwent emergency endoscopy with spraying 0.1% epinephrine and thrombin, but no other endoscopic hemostatic procedure. In group II (1989–1992, experimental group), we performed endoscopic injection therapy with absolute ethanol for peptic ulcers in 46 patients. The background characteristics of the patients were not different in the two groups. The rate of successful initial hemostasis tended to be greater in the ethanol injection group compared with the control group without significance. The ultimate hemostatic rate in the ethanol injection group was markedly and significantly greater compared to the control group (P<0.05). Ultimate hemostasis by ethanol injection was performed effectively in peptic ulcers with spurting and oozing hemorrhage and in the non‐bleeding peptic ulcers with visible vessels at the initial endoscopy (P<0.05 for each). These results indicate that ethanol injection therapy by endoscopy achieves ultimate hemostasis and prevents emergency surgery due to hemorrhage from peptic ulcers. (Dig Endoc 1994; 6 : 34–38)
The Cosmetic Benefit of Three‐Port Laparoscopic Cholecystectomy and Umbilical Trocar Insertion
Authors: INOUE Haruhiro , ITOH Kin‐ichi , HORI Hikaru , MURAOKA Yukihiko , GOSEJSI Narihide , TAKESHITA Kimiya , ENDO Mitsuo
Published: August 2007

Abstract: From April 1991, we performed successful laparoscopic cholecystectomy (LC) on 221 patients. Among them, 198 patients were treated using the standard procedure based on four‐trocar insertion. We developed a new three‐port LC, which might have several cosmetic advantages, and used it with 23 selective patients with non‐inflammatory cholecystolithiasis. LC was conducted in all of the patients without any technical difficulties using the three ports method. The mean operating time was 52 minutes and was 10 minutes longer than for four‐port LC. As regards the cosmetic benefits, a 10‐mm port for the laparoscope was inserted through the inside of the umbilicus. This wound scar cannot be distinguished from the normal umbilical configuration after complete wound healing and there are only two small recognizable surgery scars. We believe this three‐port method has more cosmetic advantages, and its application could be gradually extended. (Dig Endosc 1994; 6 : 49–51)
Peritoneoscopic Findings of Autoimmune Hepatitis
Authors: TANIMIZU Masahito , UKIDA Minoru , ITO Toshio , YAMAMOTO Kazuhide , KOBASHI Haruhiko , KAKIO Takeshi , SAKAI Nobuyuki , OMORI Nobuhiko , OMOTO Masaki , MIKAMI Masayuki , NAKANISHI Sosuke , HASUI Toshimi , TSUJI Hideyuki , SHIMOMURA Hiroyuki , SAKAGUCHI Kosaku , TSUJI Takao
Published: August 2007

Abstract: To clarify the morphologic differences between hepatitis C virus (HCVI‐negative autoimmune hepatitis (AIH) and HCV‐positive AIH, peritoneoscopic findings were studied. Among twenty three patients with AIH according to the Japanese criteria (1992), 15 were HCV‐negative and 8 were HCV‐positive. The terms grooved depression, coarse depression, coarse elevation, coarse undulation, and round‐shaped reddish marking (RM) were used in this study to evaluate the peritoneoscopic findings. Grooved depressions, coarse depressions, coarse elevations, coarse undulations and round‐shaped RMs were all common findings (53%, 87%, 73%, 80%, and 80%, respectively) in HCV‐negative AIH patients, but they were less common (13%, 25%, 13%, 13%, and 0%, respectively) in HCV‐positive AIH patients. This study revealed that HCV‐negative AIH patients had different peritoneoscopic findings from HCV‐positive AIH patients. Thus HCV‐negative AIH may be typical AIH, and HCV‐positive AIH may essentially be a subset of type C chronic hepatitis.
Relationship of Helicobacter pylori‐associated Gastritis and Polymorphonuclear Leukocyte Elastase
Authors: NAKATA Hiroya , YOKOYA Yukihiro , KAWAI Jun , KAWAGUCHI Shinya , HARA Takeshi , NAKATA Hidenori , ITOH Hidekazu , NISHIOKA Shingo
Published: August 2007

Abstract: Background: Much remains to be clarified about the mechanisms of Helicobacter pylori (H. pylori)‐associated gastritis. We considered the possibility of neutrophil involvement and investigated the role of polymorphonuclear leukocyte elastase (PMN‐E) in the etiology of H. pylori‐associated gastritis. Methods: In 60 patients with gastritis, infection by H. pylori was diagnosed by a combination of the ELISA method and conventional culture method. The hexosamine contents of the mucosal tissues and plasma polymorphonucler leukocyte elastase complexes (PMN‐EC) were determined. Results: PMN‐EC was found to be elevated in H. pylori‐positive gastritis patients, and the degree of elevation was proportionately related to the grade of gastritis inflammation. The hexosamine concentration of the gastric antral mucosa was significantly lower in H. pylori‐positive patients than in the H. pylori‐negative patients. The ratio of PMN‐EC/gastric mucosal hexosamine concentration was significantly higher in the H. pylori‐positive group than in the negative group. Conclusion: These data suggest that one of the mechanisms of the H. pylori‐associated gastritis may be the infiltration of neutrophils into the gastric mucosa followed by the release of PMN‐E which is responsible for the degradation of gastric mucosal proteins and resultant tissue damages.
Diagnostic System for Helicobacter pylori Urease Based on a pHsensitive Field Effect Transistor
Authors: KOHLI Yoshihiro , KATO Takuji , ITO Shigeji , MIYAZI Hideo , AZUMA Takeshi , NAGATA Kumiko , TSURUTA Hitoshi , MATSUI Satomi , OKA Keiko , NAKAMURA Michihiro
Published: August 2007

A rapid diagnostic system for Helicobacter pylori (H. pylori) was developed based on an urease analyser using a pH‐sensitive field effect transistor (pH‐FET). The system is composed of a solid‐phase capillary‐tube and a pH‐measuring cell. The solid‐phase tube, with an inner diameter 0.55 mm and coated with a monoclonal antibody against H. pylori's urease, was used to selectively capture the urease in endoscopically collected gastric mucus. The urease activity on the inner surface of the solid‐phase tube was measured by coupling it with ph‐FET in a pH measuring cell containing urea solution. Before immuno reaction in the solid‐phase, gastric mucus was diluted with a phosphate buffered saline containing 1% n‐octylglucoside, which was effective for accelerating the release of active urease from H. pylori's cells suspended in the sample solution. As a result of preliminary evaluations, it was found that the clinical sensitivity and specificity were 100 and 86%, respectively, using a bacteriological test as a reference.
Cystic Duct Stones Detected During Intraoperative Cholangiography in Laparoscopic Cholecystectomy
Authors: IDO Kenichi , KIMURA Ken , TANIGUCHI Yushi , KAWAMOTO Chiaki , ISODA Norio , SUZUKI Takanori , NAGAMINE Nobuhiko , IOKA Tatsuya , KUMAGAI Machio
Published: August 2007

During intraoperative cholangiography, cystic duct stones were diagnosed in 79 of 898 consecutive patients (8.8%) who underwent laparoscopic cholecystectomy over a 45‐month period. The stones were successfully removed laparoscopically. In addition, it should be mentioned that the stones were identified and retrieved before the cholangiography was started in all but 8 of the 79 cases. Of these 79, only 27 cases (34.2%) had been diagnosed as having cystic duct stones preoperatively by intravenous cholangiography and/or endoscopic retrograde cholangiography. From the results obtained, it can be concluded that intraoperative cholangiography is mandatory to detect unsuspected retained stones not only in the common duct but also in the cystic duct during laparoscopic cholecystectomy, and also provides vital information as to biliary anatomic variations, the proximity of the cystic duct to the common duct, and the confirmation of inadvertent bile duct injury.
A Case of Massive Hepatic Necrosis (Scarred Liver) with Elevated α‐Fetoprotein and Seroconversion from HBe Ag to HBe Ab
Authors: WATANABE Makoto , SAKAI Shino , SATO Shuichi , FUKUDA Ryo , AKAGI Shuji , KOHGE Naruaki , KUSHIYAMA Yoshinori , FUKUMOTO Shiro
Published: August 2007

A 39‐year‐old male with general malaise visited our clinic with high levels of aminotransferases (AST 776 IU/1, ALT 1,069 IU/I) and a prolonged prothrombin time. Serum‐fetoprotein (AFP) level was markedly elevated (2,214 ng/ml) and human hepatocyte growth factor (hHGF)was also high (0.81 ng/ml). Hepatocellular carcinoma was found to be negative from imaging techniques. AFP bands separated by lectin affinity electrophoresis had a benign pattern. Laparoscopic diagnosis was scarred liver and histologically massive hepatic necrosis with a strongly positive AFP stain. Levels of hHGF and AFP fell into a normal range after treatments with glucagon‐insulin and prostaglandin Ei. At second laparoscopy, regenerated nodules were confirmed by improved staining with Indocyanine Green. Hepatocyte regeneration was also histologically proven with a weakly positive AFP stain. The proliferating cell nuclear antigen (PCNA) was stained, and hepatocytes with PCNA positive nuclei were not seen at the time of the first laparoscopy, whereas hepatocytes with PCNA positive nuclei were found to be many at the time of the second laparoscopy. Seroconversion from HBe Ag to HBe Ab was observed 4 months after the maximum rise of AFP (6,341 ng/ml), when levels of ALT and DNA polymerase were within normal ranges.

This is a patient with a marked rise in his serum level of AFP in association with seroconversion from HBe Ag to HBe Ab, and the elevation of AFP in the present case was thought to reflect severe liver injury with concomitant regenerative activities of injured hepatocytes rather than simple hepatocyte regeneration after hepatic necrosis was resolved.
Laparoscopic Findings of Metastatic Laryngeal Carcinoma of the Liver Histologically Simulating Hepatocellular Carcinoma
Authors: SATO Shuichi , WATANABE Makoto , AKAGI Shuji , KOHGE Naruaki , SAKAI Shino , FUKUMOTO Shiro
Published: August 2007

A 77‐year‐old male was admitted to the department of Oto‐rhino‐laryngology of our hospital in 1989 with hoarseness due to laryngeal cancer. It was well treated with X‐ray irradiation and could not be detected by computed tomography (CT) and Gallium (87Ga) scintigraphy at the time of his discharge from hospital, and his hoarseness also subsided.

In November 1992, he noticed the hoarseness again with a gradual worsening. On admission to the same department, multiple space occupying lesions were detected in right lobe of the liver by abdominal ultrasonography (US) and CT. When he was transferred to our department, a US‐guided aspiration biopsy showed a pathohistology mimicking hepatocellular‐carcinoma with a multiple restiformation. Laparoscopy revealed multiple yellowish white flat lesions with an irregular margin, and aimed biopsy was performed to one of these lesions. Histology mimicked hepatocellular carcinoma with a few keratinocytes and a coiled structure and these were consistent with a diagnosis of metastatic epidermoid carcinoma.

This is the first case report regarding laparoscopic observation of metastatic epidermoid carcinoma originating in the larynx.
Experience with Percutaneous Electronic Choledochoscopy
Authors: SHINOHARA Yasushi , FUKUDA Sadao , TAKEDA Kazuya , TAKEI Kazuo , HORIBE Toshiya , KAKUTANI Hiroshi , KAWAI Takashi , NIIDO Teitetsu , IKEDA Hajimu , SAITOH Toshihiko
Published: August 2007

Experience with percutaneous choledochoscopy using a prototype electronic choledochoscope (Pentax ECN‐1530) is presented herein. This electronic endoscope is 5.3 mm in outside diameter at the tip and has a forceps channel 2.0 mm in diameter. The outside diameter is 0.4 mm larger, while the forceps channel diameter is 0.2 mm smaller, than that of the conventional fiberoptic choledochoscope (FCN‐15X) produced by the same company. Although the new electronic choledochoscope could be inserted through a 16 Fr in size fistula, we considered an 18 Fr fistula to be preferable for insertion without resistance. Various types of accessory equipment for endoscopic treatment, such as an electrohydraulic Shockwave lithotriptor (EHL) and an Nd‐YAG laser, could be used without difficulty. The electronic choledochoscope was useful for examining bile duct carcinoma invasion to the hepatic side and evaluating the efficacy of various multi‐modal treatments, as it provided observation of the bile duct mucosa in great detail due to a very clear dynamic image. Moreover, endoscopic treatment was also greatly facilitated because it provided a clear view on a large, bright monitor screen for the surgeons. We therefore believe that this new electronic choledochoscope is very useful for the accurate diagnosis and treatment of biliary diseases.
Diagnosis of the Depth of Advanced Gastric Cancer Invasion by Endoscopic Ultrasonography
Authors: CHONAN Akimichi , FUJITA Naotaka , MOCHIZUKI Fukuji , YUKI Toyohiko , ISHIDA Kazuhiko , INOUE Shigeru , NODA Yutaka , KOBAYASHI Go , KMURA Katsumi , MATSUNAGA Atsuo , ANDO Masao , TOMINAGA Gen , NOMURA Mikiko , YAGO Akira , CHIBA Masaki , KISARA Norihiro
Published: August 2007

Preoperative endoscopic ultrasonography (EUS) was performed in 272 patients with advanced gastric cancer who underwent gastrectomy between December 1986 and December 1993. We divided the subjects into two groups: group A consisted of patients whose stomachs were filled with water for the EUS examination (water‐filling method: 1986.12–1992. 10) and group B of patients in whom EUS was performed with the water‐filled balloon compression method (balloon‐compression method) in addition to the water‐filling method (1992.11–1993. 12). A comparative study of EUS diagnostic efficacy, as regards the depth of invasion, was made between group A and group B. The following results were obtained:

1) In group A, the depth of invasion of mass‐forming type carcinoma was accurately diagnosed by EUS in 59.3% of patients with mp cancer, in 28.8% of those with ss cancer, in 78.8% of those with se cancer, and in 83.3% of those with si cancer. The accuracy rate in diagnosing the depth of invasion of wall‐thickening type carcinoma was 46.2% in patients with mp cancer, 68.0% in those with ss cancer, 59.1% in those with se cancer, and 66.7% in those with si cancer.

2) In group B, the depth of invasion of mass‐forming type carcinoma was accurately diagnosed by EUS in 70.6% of patients with mp cancer, in 68.4% of those with ss cancer, in 92.3% of those with se cancer, and in 100% of those with si cancer. The accuracy rate in diagnosing the depth of invasion of wall‐thickening type carcinoma was 75.0% in patients with mp cancer, 72.7% in those with ss cancer, 76.5% in those with se cancer, and 100% in those with si cancer.

3) These results suggest that the diagnostic efficacy of EUS utilizing both the balloon‐compression method and the water‐filling method is greater, as regards the depth of advanced gastric cancer invasion, than EUS utilizing only the water‐filling method.
A Case of Duodenal Duplication
Authors: NOZAKI Hiroshi , MIZOBUCHI Noboru , HABA Takanori , SAKAKIBARA Noburu
Published: August 2007

Abstract: Duplication of the duodenum is extremely rare. Including the present case, duodenal duplication in adults has been reported in only 20 cases in Japan. All previously reported cases underwent open surgery, and endoscopic resection has not previously been reported. In this report, we describe a patient in whom a duodenal duplication was endoscopically resectable, demonstrating the usefulness of endoscopic resection for the treatment of this malformation.
Ball Measure for Quantitative Analysis of Minute Morphological Changes in Mucosal and Submucosal Cancer
Authors: INOUE Haruhiro , IZUMI Yosuke , KAWANO Tatsuyuki , TAKESHITA Kimiya , ENDO Mitsuo
Published: August 2007

Abstract: We introduce the “ball measure” concept, which is utilized for quantitatively evaluating minute morphological changes in the mucosal surface of superficial cancer. The ball measure device is a completely spherical, white‐colored, plastic ball with a 1‐mm outer diameter. An applicator is also available, which can settle the ball accurately on any mucosal surface target. The ball measure device is attached around the lesion, allowing precise assessment of the height of a marginal elevation or depression. The actual sizes of granules in the ulcer bed can also be described with this method. We believe that the ball measure technique is an indispensable means of objectively assessing morphology, and thereby of providing an accurate diagnosis of the infiltrative depth of an early cancer.
Laparoscopic Cholecystectomy in Patients with Previous Gastrectomy
Authors: HAKEEM Rachit , KANO Nobuyasu , YAMAKAWA Tatsuo , ISHIKAWA Yauro , ISHIYAMA Junji , KASUGAI Hisashi , REY Sammuel , MIYAJIMA Nobuyoshi , OTAKI Shuji
Published: August 2007

Abstract: This study was designed to assess outcome, morbidity and mortality in patients with a previous history of gastrectomy who underwent laparoscopic cholecystectomy at Teikyo University Hospital at Mizonokuchi.

From May 1990 through April 1995, 18 patients who had an upper midline incision from previous gastric surgery underwent attempted or successful laparoscopic cholecystectomy. Previous gastric operations included subtotal gastrectomy with Billroth l/ll anastomosis for ulcer diseases and total gastrectomy with jejunal interposition for gastric cancer. Preoperative ultrasound was done in all cases, ERCP in nine cases and drip infusion cholangiography in three cases to assess and evaluate the biliary system. Intraoperative cholangiography was done in the latter eight cases. Laparoscopic cholecystectomy was successful in all but one patient who had severe adhesions necessitating conversion to an open cholecystectomy. Overall results were very similar in patients with and without a previous history of gastric surgery who underwent laparoscopic cholecystectomy at this institution. It was also found that intraoperative difficulties and a prolonged operative time did not correlate with the nature of the previous operation, but rather with the severity of adhesions identified during surgery.

Although the number of cases in this study was very small, the results indicate that if the surgeon is experienced and well prepared patients with a previous history of gastrectomy can also undergo laparoscopic cholecystectomy safely and with maximum benefit. We conclude that these patients should not be denied the advantages of laparoscopic cholecystectomy. A trial laparoscopic procedure is warranted although the conversion rate to open cholecystectomy may be high.
Experimental and numerical studies on dynamic crack growth in layered slate rock under wedge impact loads: part II – non‐plane strain problem
Authors: ALAM M. R. , MUNASWAMY K. , SWAMIDAS A. S. J.
Published: August 2007

Dynamic crack propagation in non‐plane strain (or 3D) slate blocks under wedge impact loads was investigated numerically in this part of the paper. A parabolic‐shaped crack trajectory was taken into consideration to model the crack propagation in slate blocks for analyzing the impact splitting of layered slate rock. Major and minor axes of the parabola were determined from the condition of equal mode I stress intensity factors (SIFs) along the crack front. Mode I SIFs were determined for experimental breaking loads for each increment of crack growth in a manner similar to that mentioned in part I of this paper. These values were compared with the plane strain material fracture toughness value obtained from experimental studies and very good agreement was obtained between them, for the case of actual load applied on the specimen. Numerical analysis of a field problem, i.e., separation of a large‐sized slate slab from the rock strata in a slate quarry using wedge impacting, was also carried out in this paper. It can be observed that a large magnitude of load is required to break large‐sized slate blocks; but this load is applied through a number of smaller load‐capacity actuators‐in‐parallel, requiring large power capacity for the hydraulic pumps. However, this required power could be reduced considerably if the load applied on the line of hydraulic actuators is cascaded across the (line of) actuators (starting from centrally placed actuators) with a small time delay (equal to the initial crushing time in slate rock).
Repeat retroperitoneal lymph‐node dissection after chemotherapy for metastatic testicular germ cell tumour
Authors: Willis Susan F. , Winkler Mathias , Savage Philip , Seckl Michael J. , Christmas Timothy J.
Published: August 2007

OBJECTIVES

To examine the operative findings, histopathology and clinical outcome of patients undergoing repeat retroperitoneal lymph node dissection (RPLND) after initial chemotherapy and RPLND (PC‐RPLND) for metastatic testicular germ cell tumour (GCT), as a small proportion relapse or have residual disease after incomplete resection in the lung, retrocrural or pelvic nodes, and retroperitoneum.

PATIENTS AND METHODS

Between September 1992 and May 2006, 359 patients had PC‐RPLND under the care of one surgeon, 54 of which were repeat procedures. We compared the long‐term outcome between those having primary and those having repeat PC‐RPLND.

RESULTS

The median (range) time from original to repeat surgery was 2.4 (0.25–26.5) years, and the median follow‐up after the repeat procedure was 5.8 (0.08–12.9) years. There was no difference in survival between patients requiring only one PC‐RPLND and those having a repeat procedure (P = 0.592). The most frequent sites of recurrent disease were: behind the great vessels/para‐aortic areas (38, 46%), in the suprahilar region (18, 18%), in the retrocrural area (16, 19%), in the pelvic nodes (10, 12%) and in the lung (one, 1%). The most common pathological findings in the repeat PC‐RPLNDs were differentiated teratoma (19, 35%), malignant teratoma undifferentiated (nine, 17%), adenocarcinoma (eight, 15%) and necrotic tissue (five, 9.2%).

CONCLUSION

Although a small proportion of patients with metastatic GCT might require repeat PC‐RPLND, there is no difference in survival between this group and those having one PC‐RPLND. However, to avoid cancer recurrence and reoperation, it is crucial that the first PC‐RPLND is careful and complete, preferably done in a centre with expertise in this procedure.
Role of Rho‐kinase in contractions of ureters from rabbits with unilateral ureteric obstruction
Authors: Turna Burak , Cinar Mehtap G. , Canda Abdullah E. , Orhan Elif C. , Tiftik Nalan R. , Nazli Oktay , Buyukafsar Kansu
Published: August 2007

OBJECTIVE

To investigate the expression of two isoforms of Rho‐kinase (ROCK) and its functional role in the pathophysiological control of smooth muscle contraction in rabbits with unilateral ureteric obstruction (UUO).

MATERIAL AND METHODS

Left UUO was created in 14 rabbits and eight other rabbits (controls) had sham operations. After 2 weeks all the rabbits were killed. Ureteric strips suspended in an organ bath were used for functional studies and the effects of Y‐27632, a specific inhibitor of Rho‐kinase, on spontaneous contractions and electrical field stimulation (EFS; 50 V, 1 ms, 16 Hz, for 20 s), carbachol‐ (10−7–10−4m), phenylephrine‐ (10−7–10−4m) and KCl‐ (50 mm) induced contractions were analysed. Western blotting was used to determine expression levels of Rho‐kinase protein in the ureters of UUO and control rabbits.

RESULTS

In the functional analysis, the contractions induced by EFS, KCl, phenylephrine and carbachol in the ureteric strips from rabbits with UUO were significantly greater than those from the control rabbits. Y‐27632 considerably suppressed the ureter contractile responses in both UUO and control rabbits. Western blot analysis showed that both ROCK‐1 and ROCK‐2 proteins were expressed in the rabbit ureter. In accordance with the functional studies, the expression levels of both ROCK‐1 and ROCK‐2 were significantly greater in the ureters of UUO rabbits than in the controls.

CONCLUSIONS

Y‐27632 suppressed ureteric contractions in the rabbits with UUO. Western blot analysis also confirmed greater expression levels of ROCK‐1 and ROCK‐2 in the ureters of UUO rabbits. It is important to elucidate by which mechanisms the Rho‐kinase pathway affects ureteric function after obstruction.
Quo Vadis Doctoral Education? New European Approaches in the Context of Global Changes
Authors: KEHM BARBARA M.
Published: August 2007

The first part of the article provides an overview of the changing policy contexts in Europe and North America in which doctoral education and training are embedded and points out the similarities and differences of the ongoing debates and concerns about doctoral education in the two world regions. The second part provides some insight into the differentiation of motives and purposes of doctoral education which has led to a differentiation of the models for doctoral education based on a clearer distinction between a research and a professional doctorate. In the third part, a number of networks, projects and initiatives concerned with reforming doctoral education are introduced to serve as an illustration of the direction current changes are taking. The last part draws some conclusions, emphasising in particular the fact that knowledge production has become a strategic resource in the emerging knowledge economies and thus an object of policy‐making and institutional management. This development tends to lead to a concentration of research and research training in fewer institutions.
Supervision and Schizophrenia: the professional identity of Ph.D supervisors and the mission of students' professionalisation
Authors: DAHAN AUBÉPINE
Published: August 2007

Professionalisation, defined as the transmission of competences adapted to the job‐market, is one of the new missions of Doctoral Schools in France. Interviews with supervisors reveal a number of ambivalent attitudes towards this new policy. Supervisors do support the rhetoric of professionalisation, but are powerless to push their students towards other careers than the academic one. We interpret this as a challenge to the academic identity through the modification of what a Ph.D is, which, in turn, impacts on the content, output and meaning of supervision. We show that academics do professionalise their students, but only for the profession they know: academia. They only train the students whom they believe they can acknowledge as future peers, and the on‐the‐job training provided by Ph.D supervisors is implicitly directed towards academia. The absence of an explicit academic professional identity is discussed, as well as the fact that ‘professionalising’ must relate to a specific professional identity. We argue that only ‘specific’ professional identity can be transmitted, leading to questions about the implementation of the related policy.
University Positioning and Changing Patterns of Doctoral Study: the case of the University of Bath
Authors: JAMIESON IAN , NAIDOO RAJANI
Published: August 2007

The study examines the changing nature of doctoral study in higher education in the context of significant global changes in higher education. From its origins with Humboldt, the trajectory of doctoral study is traced through the traditional Ph.D, the extended 'American model', to the professional doctorate. A university case study charts how these global changes impacted on a specific UK university as it attempted to position itself in the changing market for doctoral study.
The European Education Quality Benchmark System: helping teachers to work with information to sustain change
Authors: SNYDER KRISTEN M.
Published: August 2007

Applying the concept of ‘quality’ to education has been controversial, making it difficult for educators to develop systems for sustainable quality development in schools that meet the needs of governmental accountability and pedagogical practice. The varying perspectives reflect conflicting views about what is quality and, morevoer, how quality can and should be measured. Over the last several decades, numerous programmes and strategies have been developed at the European level to assist schools in developing quality in education, as well as giving perspective to the underlying questions. In 2003, the European Education Quality Benchmark System (2EQBS) was designed with the intent to bridge the paradigmatic camps regarding quality in education, providing educators with a holistic framework to examine their practices in relation to the needs of their community, national curricula, pedagogical principles, and European partners. A formal content validation and usability study were conducted of the quality development tool to examine the degree to which the 2EQBS provides educators with a framework to facilitate school development through cross‐cultural partnerships in an age of accountability. Findings from this study are presented in this article and contribute insight into the possibilities for creating a framework that facilitates school development through cross‐cultural partnerships and provides teachers with a system for helping to sustain change.
The Implementation of Bachelor and Master Programmes in Hungary
Authors: ALESI BETTINA , ROSZNYAI CHRISTINA , SZÁNTÓ TIBOR
Published: August 2007

Hungary's higher education system is being transformed fundamentally for a second time after the regime change in 1989–90. The first Higher Education Act was passed in 1993. An entirely new law issued in December 2005 involved fundamental changes in the entire higher education system. The most sweeping change was the introduction of the two‐cycle programme structure which, with a few exceptions, began in September 2006. National qualification requirements were replaced by education and outcome requirements, focusing on set competences defined for each study programme.

This article provides a background, with facts and figures, of the Hungarian higher education system and an overview of the process and problems encountered that led up to the implementation of the Bachelor/Master structure. The reception of the system, based on interviews with various actors affected by higher education, reveals mixed responses, with respondents stressing the opportunity and their hope for a fundamental reform. The article also elaborates the goals and consequences of the ‘Bologna structure’. The traditional binary institutional structure of colleges and universities remains in place, but with both permitted to launch Bachelor and Master programmes. How colleges will be able to compete with more theoretically oriented universities in preparing for Master studies and, vice versa, how universities will be able to offer education at the Bachelor level that will be competitive in the job market remain to be seen. The final sections of the article deal with other aspects of the Bologna Process, such as ECTS, and the Diploma Supplement.

One of the main concerns is that the quality of higher education, which was perceived to be at a high level in Hungary, even in the 15 years since mass education overtook what was previously an elite sector, should not deteriorate. The reciprocal effects of the new degrees and the job market are challenges Hungarian higher education will face a few years down the road.
Molecular evidence for cosmopolitan distribution of platyhelminth parasites of tunas (Thunnus spp.)
Authors: Aiken Hamish M , Bott Nathan J , Mladineo Ivona , Montero Francisco E , Nowak Barbara F , Hayward Craig J
Published: August 2007

Global distribution of platyhelminth parasites and their host specificities are not well known. Our hypothesis was that platyhelminth parasites of large pelagic fishes are common around the world. We analysed molecular variation in three different taxa of platyhelminth parasites infecting four species of tunas: yellowfin tuna (Thunnus albacares, Scombridae) from Western Australia, southern bluefin tuna (Thunnus maccoyii, Scombridae) from South Australia, Pacific bluefin tuna (Thunnus orientalis, Scombridae) from Pacific Mexico and northern bluefin tuna (T. thynnus, Scombridae) from two localities in the Mediterranean (Spain and Croatia). Comparisons of ITS2 and partial 28S rDNA demonstrated two congeneric species of blood flukes (Digenea: Sanguinicolidae) from multiple hosts and localities: Cardicola forsteri from southern bluefin and northern bluefin tunas, and Cardicola sp. from Pacific bluefin and northern bluefin tunas; and a gill fluke, Hexostoma thynni (Polyopisthocotylea: Hexostomatidae), from yellowfin, southern bluefin and northern bluefin tunas. Partial 28S rDNA indicates that a second type of fluke on the gills, Capsala sp. (Monopisthocotylea: Capsalidae), occurs on both southern bluefin and Pacific bluefin tunas. This appears to be the first report of conspecific platyhelminth parasites of teleosts with a wide‐ranging geographical distribution that has been confirmed through molecular approaches. Given the brevity of the free‐living larval stage of both taxa of flukes on the gills (H. thynni and Capsala sp.), we conclude that the only feasible hypothesis for the cosmopolitan distribution of these flatworms is migrations of host tunas. Host migration also seems likely to be responsible for the widespread occurrence of the two species of blood flukes (Cardicola spp.), although it is also possible that these were translocated recently by the spread of infected intermediate hosts.
Diagnosis and management of small‐scale fisheries in developing countries
Authors: Andrew Neil L , Béné Christophe , Hall Stephen J , Allison Edward H , Heck Simon , Ratner Blake D
Published: August 2007

Small‐scale fisheries (SSF) make important but undervalued contributions to the economies of some of the world’s poorest countries. They also provide much of the animal protein needed by societies in which food security remains a pressing issue. Assessment and management of these fisheries is usually inadequate or absent and they continue to fall short of their potential as engines for development and social change. In this study, we bring together existing theory and methods to suggest a general scheme for diagnosing and managing SSF. This approach can be adapted to accommodate the diversity of these fisheries in the developing world. Many threats and solutions to the problems that beset SSF come from outside the domain of the fishery. Significant improvements in prospects for fisheries will require major changes in societal priorities and values, with consequent improvements in policy and governance. Changes in development policy and science reflect these imperatives but there remains a need for intra‐sectoral management that builds resilience and reduces vulnerability to those forces beyond the influence of small‐scale fishers.
The guild approach to categorizing estuarine fish assemblages: a global review
Authors: Elliott Michael , Whitfield Alan K , Potter Ian C , Blaber Stephen J M , Cyrus Digby P , Nordlie Frank G , Harrison Trevor D
Published: August 2007

Many studies have recently described and interpreted the community structure and function of fishes inhabiting estuaries and other transitional waters in terms of categories or guilds. The latter describe the main features of the fishes’ biology and the way in which they use an estuary. However, the approach has been developed by different workers in different geographical areas and with differing emphasis such that there is now a need to review the guilds proposed and used worldwide. The previous wide use of the guild approach has involved increasing overlap and/or confusion between different studies, which therefore increases the need for standardization while at the same time providing the opportunity to reconsider the types and their use worldwide. Against a conceptual model of the importance of the main features of fish use in estuaries and other transitional waters, this review further develops the guild approach to community classification of fish communities inhabiting those areas. The approach increases the understanding of the use of estuaries by fishes, their interactions and connectivity with adjacent areas (the open sea, coastal zone and freshwater catchments) and the estuarine resources required by fishes. This paper gives a global perspective on this categorization by presenting new or refined definitions for the categories, lists the synonyms from the literature and illustrates the concepts using examples from geographical areas covering north and central America, north and southern Europe, central and southern Africa, Australia and the Indo‐Pacific.
Management Strategies and Improvement of Performance of Sewer Networks
Authors: Breysse Denys , Vasconcelos Elisio , Schoefs Franck
Published: August 2007

Abstract:  Managers of sewer systems are faced with their infrastructure system ageing. Even when they are conscious about the needs of maintenance to keep the system in a good condition, they lack efficient methods and tools that may help them in taking appropriate decisions. One can say that no really satisfactory and efficient tool exists, enabling the optimization of Inspection, Maintenance, or Rehabilitation (IMR) strategies on such systems. Sewer managers and researchers have been involved for many years in the French National Research Project for Renewal of Non Man Entry Sewer System (RERAU—Réhabilitation des Réseaux d'Assainissement Urbains, in French) to improve their knowledge of these systems and the management policies. During the RERAU project, a specific action has been dedicated to the modeling of asset ageing and maintenance. A special attention has been dedicated to the description of defects and dysfunctions, to the evaluation of performances and its modeling, accounting for its various dimensions (from the point of view of the manager, of the user, of the environment…). After having defined an Index of Technical Performance (ITp), we will introduce the Index of Technical and Economic Performance (ITEp) that is a combined measure of performance (including social costs) and technical costs. This index provides an objective standard tool for managers to compare different alternatives. It is used in the article to compare some simple IMR strategies. It sets the basis of a new method for no‐man entry sewer system management, enabling us to analyze the profitableness of investment in terms of both technical and economic performance.
A Multicriteria Decision Support Methodology for Annual Rehabilitation Programs of Water Networks
Authors: Le Gauffre Pascal , Haidar Hatem , Poinard David , Laffréchine Katia , Baur Rolf , Schiatti Marcello
Published: August 2007

Abstract: This article provides an overview of a multicriteria decision support methodology for annual rehabilitation programs of water networks. A first set of criteria is formulated for the purpose of comparing and ranking rehabilitation projects. Each proposed criterion is a measure of a particular impact of the condition of a pipe. The ELECTRE TRI method is implemented for defining rehabilitation priorities.Two reference profiles are used to define the limits of three categories associated with three increasing priority levels. With these two reference profiles, applying the ELECTRE TRI method to an asset stock(a set of pipes that are candidates for rehabilitation)means assigning each pipe to one of six possible priority groups. A second set of criteria, based on the concept of efficiency, is proposed for comparing alternative rehabilitation programs(subsets of the asset stock).