bluuebunny/crossref_metadata_2025 huggingface dataset:
A study of the indications and changing trends of evisceration in north India
Authors: Dada Tanuj , Ray Manotosh , Tandon Radhika , Vajpayee Rasik B
Published: March 2003

Aim: To study the demographic pattern and indications for evisceration in north India and to evaluate the changing trends over the last decade.

Methods: In a retrospective hospital‐based study, case records of all patients who underwent evisceration at Rajendra Prasad Centre for Ophthalmic Sciences from January 1990 to December 1999 were reviewed. The parameters evaluated were the age and sex distribution, the place of residence (urban/rural) and the indications for evisceration. The aetiology responsible for evisceration was determined on the basis of history, clinical examination and investigations as determined from previous records.

Results: One hundred and sixty‐four patients had one eye eviscerated
during the study period. The mean age of the patients was 51 ± 13.84 years
(range 6 months to 90 years). Panophthalmitis
was the most common indication for evisceration (78.6%, n = 129),
followed by irreparable globe injury (21.3%, n = 35). There was a significant decrease in the eviscerations performed due to pano‐phthalmitis from 104 cases during the period 1990−1994, to 25 cases in the period 1995−1999.

Conclusion: Panophthalmitis and severe ocular injury are the major indications of evisceration in north India. There has been a significant decrease in the number of eviscerations related to panophthalmitis over the last decade.
Ku‐ring‐gai Flying‐fox Reserve
Authors: Pallin By Nancy
Published: March 2003

Strong community support led to government protection of a bat colony in northern Sydney in 1985. Restoration of the roosting habitat of the Grey‐headed Flying‐fox (Pteropus poliocephalus) was implemented by a non‐government organization in cooperation with the local government. The aims, methods, results and challenges of the project so far are outlined.
Acacia species and rhizobial interactions: Implications for restoration of native vegetation
Authors: Murray By Brad R. , Thrall Peter H. , Woods Matthew J.
Published: March 2003

Summary For successful restoration of native vegetation on nitrogen‐depauperate soils, an understanding of nitrogen‐fixing relationships between plant host species and their bacterial symbionts is critical. Each of three geographically restricted Acacia species (A. fulva, A. nano‐dealbata, and A. trachyphloia) and three widely distributed species (A. dealbata, A. implexa, and A. melanoxylon) were inoculated with 20 different rhizobial (Bradyrhizobium spp.) strains. The strains comprised two obtained from each of 10 different host species, including the six Acacia species listed above plus a further four species, A. cangaiensis, A. cincinnata, A. deanei, A. mearnsii. Neither restricted nor widely distributed species grew more effectively with their own strains than with strains isolated from other species. Thus, host species with restricted geographical ranges did not demonstrate greater specialization in their symbiotic associations with rhizobia than widespread species. Highly significant variation was observed between the strains obtained from each host species with respect to their ability to promote effective plant growth across all host species. In many cases, strains that were highly effective at promoting growth for one host species, were comparatively ineffective in combination with other host species. Strains thus exhibited host specificity in their ability to fix nitrogen. These findings indicate that choosing appropriate rhizobial strains for inoculation prior to revegetation is critical and should be made carefully for both restricted and widespread species.

Key words distribution, nitrogen fixation, revegetation, symbiotic interactions.
The value of ‘bat boxes’ for attracting hollow‐dependent fauna to farm forestry plantations in southeast Queensland
Authors: Smith Geoffrey C. , Agnew Gordon
Published: March 2003

Summary Small artificial nest/roost boxes, originally designed for microbats,
were deployed in three farm forest plantations and at one native forest site in southeast
Queensland in order to assess their use by vertebrates and their contribution toward
enhancing biodiversity in plantation forests through the provision of habitat. Two
sites were located in a relatively ‘intact’ forest landscape (SF 351
and Strano) and two sites in a more ‘fragmented’ or ‘variegated’
landscape (Askham and Thomas). Twenty‐four boxes were placed at each site over an
area covering approximately 1.2–1.8 ha. Each site was checked from five (SF
351) to nine (Askham) times between April 1996 and November 2000. The artificial
nest/roost boxes were attractive to a range of small fauna that included Feathertail
Gliders (Acrobates pygmaeus), Sugar Gliders (Petaurus breviceps), Squirrel
Gliders (Petaurus norfolcensis) and the Yellow‐footed Marsupial Mouse (Antechinus
flavipes), all of which constructed nests inside boxes. Gould’s Long‐eared
Bats (Nyctophilus gouldi) used boxes primarily as roosts and maternity sites. In general, fewer animals were recorded in boxes at the two sites located within a relatively ‘intact’ landscape, while the highest numbers of animals were recorded in boxes in two farm forest plantations within ‘variegated’ landscapes. The availability of alternative natural hollows and landscape factors appear to be important determinants of the extent to which boxes are occupied. The present study indicates that the biodiversity of farm forests can be enhanced through simple habitat manipulation utilizing artificial roosting or nesting boxes.

Key words Antechinus, biodiversity, farm forestry, glider, marsupial, microbat,
nest box, roost.
Assessing the quality of native vegetation: The ‘habitat hectares’ approach
Authors: Parkes David , Newell Graeme , Cheal David
Published: March 2003

Summary Assessments of the ‘quality’, condition or status of stands of native vegetation or habitat are now commonplace and are often an essential component of ecological studies and planning processes. Even when soundly based upon ecological principles, these assessments are usually highly subjective and involve implicit value judgements. The present paper describes a novel approach to vegetation or habitat quality assessment (habitat hectares approach) that can be used in almost all types of terrestrial vegetation. It is based on explicit comparisons between existing vegetation features and those of ‘benchmarks’ representing the average characteristics of mature stands of native vegetation of the same community type in a ‘natural’ or ‘undisturbed’ condition. Components of the index incorporate vegetation physiognomy and critical aspects of viability (e.g. degree of regeneration, impact of weeds) and spatial considerations (e.g. area, distribution and connectivity of remnant vegetation in the broader landscape). The approach has been developed to assist in making more objective and explicit decisions about where scarce conservation resources are allocated. Although the approach does not require an intimate botanical knowledge, it is believed to be ecologically valid and useful in many contexts. Importantly, the index does not provide a definitive statement on conservation status nor habitat suitability for individual species. It purposefully takes a ‘broad‐brush’ approach and is primarily intended for use by people involved with making environmentally sensitive planning and management decisions, but may be useful within environmental research programmes. The ‘habitat hectares’ approach is subject to further research and ongoing refinement and constructive feedback is sought from practitioners.
Triage: How do we prioritize health care for landscapes?
Authors: Hobbs Richard J. , Kristjanson Linda J.
Published: March 2003

SummaryWe explore the potential use of health care as a metaphor for landscape‐scale conservation. In human health‐care provision, a range of care options is generally available to cover the various levels of treatment required and the degree of urgency of that treatment. The concept of triage is frequently used in emergency situations where many people may be injured and decisions have to be made on the relative urgency of treatment for different individuals versus the relative likelihood of the success of that treatment. Indeed, the need to decide on level and type of care extends throughout health‐care provision, and the array of health‐care options available can be displayed on a grid that considers relative level of need or threat and the probability of recovery. A similar grid can be constructed for landscape management, which considers level of threat and the probability of system persistence or recovery. The grid differentiates between a variety of scenarios ranging from the need for prompt management action to protect or restore important habitat through to preventative threat minimization. We suggest that the broad concept of triage goes beyond the simple allocation of patients, landscapes or species into urgent, not urgent, and terminal categories and, instead, offers a rational basis for considering allocation of appropriate levels of management to different situations. We also suggest that the practice of restoration has much to learn from health care, where decisions are made daily on the allocation of appropriate levels of care.
Ocular decompression retinopathy after resolution of acute primary angle closure glaucoma
Authors: Nah Gerard , Aung Tin , Yip Chee Chew
Published: March 2003

A patient presented with acute primary angle closure glaucoma with markedly elevated intraocular pressure. Two weeks after laser peripheral iridotomy and resolution of the acute attack, the patient was noted to have developed scattered retinal haemorrhages. The haemorrhages resolved over time with no visual sequelae. This is the first reported case of ocular decompression retinopathy after resolution of acute primary angle closure glaucoma.
Cyanoacrylate glue for corneal perforations: a description of a surgical technique and a review of the literature
Authors: Vote Brendan Jt , Elder Mark J
Published: March 2003

The effective early application of a cyanoacrylate glue corneal patch can aid in the management of small corneal perforations, corneal melts and wound leaks. Their use gives improved visual outcomes with reduced enucleation rates (6%vs 19%). It may also avoid the need for tectonic penetrating keratoplasty.

Cyanoacrylate glue prevents re‐epithelialization into the zone of damaged and naked stroma and prevents the development of the critical setting for collagenase production that leads to stromal melting. Cyanoacrylates also have significant bacteriostatic activity against Gram‐positive organisms.

We describe a simple and easily reproducible method of cyanoacrylate corneal patch application, with neglible risk of inadvertent glue complications. It has the further advantage of a smooth corneal surface rather than an irregular surface as often occurs with direct application methods.

With corneal application, the major concern is toxicity of cyanoacrylates through direct contact with the corneal endothelium and lens. Fibrin glues may be less toxic; however, they are not as readily available. The longer alkyl chains of currently available cyanoacrylate glues (e.g. Histoacryl) slows degradation significantly, limiting accumulation of histotoxic by‐products to amounts that can be effectively eliminated by tissues. Vigilance in monitoring for infection/corneal infiltrate is necessary at all times, especially when the glue has been present for more than 6 weeks.

Corneal patching with cyanoacrylate glue is a temporizing procedure only, buying time to allow healing secondary to medical treatment of the underlying condition, or allowing surgery to be elective and under more optimal conditions once inflammation has been reduced and the integrity of the globe restored.
Coexistent adenoviral keratoconjunctivitis and Acanthamoeba keratitis
Authors: Gajdatsy Adam D , Kosmin Alan , Barrett Graham D
Published: March 2003

A 17‐year‐old youth presented with bilateral follicular conjunctivitis and nummular subepithelial corneal infiltrates. Failure of this to settle in an outpatient setting led to corneal scraping with microscopy and culturing for bacteria, fungi, Herpes simplex, adenovirus and Acanthamoeba as an inpatient. Polymerase chain reaction analysis of corneal cells was positive for adenovirus, and culture on live Escherichia coli‐ coated agar plates was positive for Acanthamoeba by phase contrast microscopy on day two.

We conclude that Acanthamoeba infection can complicate adenoviral keratoconjunctivitis. This observation is in keeping with previously reported modes of infection by Acanthamoeba, whereby any epithelial breach seems to allow inoculation of the eye by this opportunistic organism.
Trichiasis in Aboriginal people of the Kimberley region of Western Australia
Authors: Mak Donna B , Plant Aileen J
Published: March 2003

Background: Trachoma is a significant public health problem in the Kimberley region of Western Australia. The prevalence of follicular trachoma in the region has been well documented and control of active trachoma is well established. In contrast, trichiasis prevalence in recent years is less well documented. This study aimed to determine trichiasis prevalence in the Kimberley population and to document an appropriate intervention.

Methods: A collaborative programme was established involving the Kimberley Public Health Unit, Kimberley Aged Care Services and the visiting ophthalmology service. After training, medical students screened the aged‐care population for trichiasis and the aged‐care services staff were educated about identification and referral procedures for patients with trichiasis. The Kimberley Public Health Unit was responsible for ensuring specialist assessment, and correction, of trichiasis and appropriate post‐treatment follow up.

Results: A total of 597 Kimberley Aboriginal people aged 50 years or more were screened for trichiasis, representing 42% of that age group. Trichiasis was suspected in 40 people. Of the 28 people with suspected trichiasis who underwent ophthalmological assessment, 17 were found to have trachomatous trichiasis. The observed prevalence of trachomatous trichiasis was 2.8%. The trichiasis screening programme has been adopted by most aged‐care organizations in the Kimberley.

Conclusions: The results show that trichiasis continues to affect elderly Aboriginal people, especially those from Halls Creek Shire. Health professionals and aged‐care workers should be alert to the possibility of this preventable cause of blindness and work collaboratively to ensure that patients receive timely and appropriate treatment.
Gene expression of pro‐inflammatory cytokines and chemokines in mouse eye infected with Pseudomonas aeruginosa
Authors: Xue Mei‐Lang , Thakur Archana , Willcox Mark
Published: March 2003

Ocular infection with Pseudomonas aeruginosa triggers
extensive host inflammatory response and corneal damage. The purpose
of present study was to investigate the gene expression of pro‐inflammatory
mediators interleukin (IL)‐1β, IL‐6, tumour necrosis factor‐α (TNF‐α),
macrophage inflammatory protein (MIP)‐2 and cytokine‐induced neutrophil
chemo­attractant (KC) in the mouse eye challenged with P. aeruginosa. Scratched
mouse corneas were infected with three phenotypes of P. aeruginosa individually.
Total RNA was extracted from mouse eyes at 4 h, 8 h,
16 h and 24 h post‐challenge. Single stranded
cDNA was synthesized from total RNA by reverse transcription and
then subjected to poly­merase chain reaction (PCR) using
specific primers for IL‐1β, IL‐6, TNF‐α, MIP‐2
and KC. Results revealed three patterns of cytokines and chemokines
expression in response to ocular infection with three phenotypes
of P. aeruginosa. Ocular infection with the invasive
strain induced the highest levels of IL‐1β, IL‐6, MIP‐2
and KC mRNA, followed by the infection with the cytotoxic strain.
Ocular infection with the CLARE strain induced the lowest levels
of IL‐1β, IL‐6, MIP‐2 and KC mRNA. The expression of TNF‐α mRNA
was very low and irregular following P. aeruginosa challenge.
These data indicate that over‐expression of pro‐inflammatory cytokines
and chemo­k­ines may represent a vigorous immune
response and therefore may contribute to corneal damage during P. aeruginosa infection.
Vitreous surgery in highly myopic retinal detachment resulting from a macular hole
Authors: Lu Lin , Li Yonghao , Cai Shengshi , Yang Jiu
Published: March 2003

Purpose: This study aimed to assess the therapeutic effect of vitreous surgery in conjunction with photocoagulation for highly myopic retinal detachment resulting from a macular hole.

Methods: Sixty‐two consecutive highly myopic patients (65 eyes) with retinal detachment from macular holes underwent vitreous surgery. Gas tamponade in conjunction with laser photocoagulation was performed in 46 eyes (44 cases, group 1); gas tamponade only was performed in 12 eyes (11 cases, group 2); and silicone oil tamponade only was performed in seven eyes (seven cases, group 3). Additional laser photocoagulation was given in group 1 if necessary. The anatomical and functional success rates were compared between the groups.

Results: Primary retinal reattachment was achieved in 43 eyes (93.5%) in group 1, seven eyes (58.3%) in group 2 and four eyes (57.1%) in group 3. Final visual acuity was 6/60 or more in 24 eyes (52.2%) in group 1, in six eyes (50.0%) in group 2 and in three eyes (42.9%) in group 3. The initial retinal reattachment rate was significantly higher in group 1 than in group 2 (P = 0.0075) and group 3 (P = 0.0248). The macular hole was completely closed in 18 eyes in group 1 and one eye in group 2 after 2 months or longer. A thin fibrous membrane and scar could be easily noticed beneath the macula in 15 eyes.

Conclusion: Vitreous surgery in conjunction with laser photo­coagulation can improve the surgical success rate for highly myopic retinal detachment resulting from a macular hole.
Orbital and adnexal cysticercosis
Authors: Pushker Neelam , Bajaj Mandeep S , Betharia Subhash M
Published: March 2003

Orbital and adnexal cysticercosis is emerging as a far commoner disease than previously considered, both in endemic and nonendemic areas of cysticercosis. A review of the literature on orbital and adnexal cysticercosis found that it has a predilection for children and young adults with no definite sex predilection. The extraocular muscle form is the commonest type of orbital and adnexal cysticercosis. Lodgement of cysts in the subconjunctival space is another common site, followed by the eyelid, optic nerve, retro‐orbital space and lacrimal gland. Association of orbital cysticercosis with systemic cysticercosis is quite rare. The clinical manifestations of orbital or adnexal cysticercosis are entirely different and depend on the location, size, relation to adjacent structures and stage of evolution of the cyst. Diagnosis of cysticercosis is based mainly on orbital imaging because of its highly specific appearance. Tissue diagnosis is not essential for initiating treatment. Medical therapy is the recommended treatment for the extraocular muscle form and retro‐orbital cysticer‐cosis. Surgical removal is advocated for subconjunctival and eyelid cysticercosis. Because of the limited number of cases of optic nerve and lacrimal gland cysticercosis, their treatment is controversial.
Methotrexate‐induced optic neuropathy
Authors: Balachandran Chandra , McCluskey Peter J , Champion G David , Halmagyi G Michael
Published: March 2003

A 53‐year‐old Caucasian woman with long‐standing, well controlled, severe rheumatoid arthritis, treated with metho­trexate, salazopyrin, naprosyn, prednisone and plaquenil, presented with progressive visual loss in each eye. She had a past history of non‐necrotizing anterior scleritis that was treated with increased doses of prednisone. She developed left then right central scotomas, reduced vision and optic atrophy. Eventually a diagnosis of methotrexate‐induced optic atrophy was made.
Prevalence of diabetic retinopathy in an Aboriginal Australian population: results from the Katherine Region Diabetic Retinopathy Study (KRDRS). Report no. 1
Authors: Jaross Nandor , Ryan Philip , Newland Henry
Published: March 2003

Background: The Katherine Region Diabetic Retinopathy Study (KRDRS) was carried out in the Lower Top End of the Northern Territory of Australia between 1993 and 1996 as part of the Northern Territory Eye Health Program. It investigated diabetic eye conditions and its determinants in the Aboriginal Australian population of the region.

Methods: The study provided cross‐sectional data about diabetic retinopathy in the Aboriginal diabetic population of the Katherine region in 1993 and in 1996. A total of 234 people with diabetes were examined in 1993 and 243 in 1996.

Results: The prevalence of retinopathy was 18% in 1993 and 21% in 1996. The respective findings for maculopathy were 13% and 10%, for clinically significant macula oedema 8% and 6%, for proliferative stage subject retinopathy 0.9 and 1.3% and for vision‐threatening retinopathy 8.5% and 6.7%. In 1993 the prevalence of diabetic retinopathy was 18% in the four major centres compared with 16% in the smaller communities. The findings for 1996 were 25% and 13%, respectively. In 1993 the prevalence of vision‐threatening retinopathy was 8% in major centres compared with 7% in other communities. The findings for 1996 were 7% and 8%, respectively. Sex was not significantly related to the prevalence of retinopathy.

Conclusion: Diabetic retinopathy is as much a problem in Aboriginal communities as in the wider Australian population but presents a unique set of challenges for health services and for clinicians.
Pathogenesis of orbital cholesterol granuloma
Authors: Selva Dinesh , Phipps Simon E , O'Connell John X , White Valerie A , Rootman Jack
Published: March 2003

Two cases are presented of orbital cholesterol granuloma associated with gradual proptosis arising in men aged 35 and 41 years. Computed tomography demonstrated osteo­lytic masses in the frontal bone at the lacrimal fossa. Curettage revealed a characteristic histology of foreign body reactions surrounding cholesterol clefts. In both cases abnormal bone, more consistent with fibrous dysplasia than reactive change, was found at the periphery. The finding of abnormal bone associated with orbital cholesterol granulomas suggests that a pre‐existing bone anomaly may be present in a subset of these cases.
MAGNIFYING ENDOSCOPY OF THE GASTRIC BODY: A COMPARISON OF THE FINDINGS BEFORE and AFTER ERADICATION OF HELICOBACTER PYLORI
Authors: Yagi Kazuyoshi , Nakamura Atsuo , Sekine Atsuo
Published: March 2003

Gastric mucosal changes observed by magnifying endoscopy before and after eradication of Helicobacter pylori have not been investigated, although histological changes have been reported. In a previous paper, we described the principal features of the gastric body of the H. pylori‐negative normal stomach observed by magnifying endoscopy. In this report, we describe the magnified features of the gastric body before and after successful eradication of H. pylori. On the basis of these magnified features, we tried to determine whether eradication had been successful in 54 patients by examining their magnified views. We also observed the lesser curvatures of patients over 1 year after successful eradication and evaluated the correlations between the magnified features and histological grade of atrophy.

1. The following three features of magnified views after successful eradication were observed: (i) erythema and/or swelling of the areas between the gastric pits disappeared; (ii) white pits became pinhole‐like; and (iii) collecting venules became visible.

2. Successful eradication was diagnosed in 50 patients according to their magnified features and culture and histological examination proved that eradication had been successful in them all. Unsuccessful eradication was diagnosed in four patients, because they either had white, not pinhole‐like, pits or erythema of the areas between the pits. Culture and histological studies revealed that eradication had been unsuccessful in three of them, but culture, histological examination and the urea breath test proved it had been successful in the other.

3. Magnified views of the lesser curvature of the lower body of patients over 1 year after successful eradication were classified into two types; one comprised pinhole‐like pits and a network of capillaries and the other comprised tubular structures. The atrophic grade of biopsy specimens from patients with the former type was significantly lower than that of patients with the latter features.

Magnifying endoscopy was developed in order to observe the gastric mucosa in more detail than is possible with standard endoscopy, in the hope that the views obtained would enable diagnosis of certain conditions to be made without the need for biopsy. Examination of the magnified views produced by this technique enables H. pylori eradication to be diagnosed and the grade of histological atrophy to be estimated.
DEVELOPMENT OF REAL‐TIME ENDOSCOPIC IMAGE PROCESSING TECHNOLOGY: ADAPTIVE INDEX OF HEMOGLOBIN COLOR ENHANCEMENT PROCESSING
Authors: Nakamura Kazunari
Published: March 2003

A depressing type of early cancer has recently been focused on. From the endoscopy point of view, it is said that this type of cancer can be identified with change in color tone such as reddening or discoloration. With the structural enhancement processing incorporated into EVIP‐230 and CV‐240, mucosal minute patterns can be made clear by the enhancement processing; however, in theory, this is not regarded as being suitable to enhance slight difference of color tone itself. In addition, even if the number of pixels of the CCD is increased and resolution is improved, it is not likely that slight color tone change is made clear. However, with the index of hemoglobin (IHb) color enhancement processing incorporated into EVIP‐230 the following improvements have been made.

1. Red component of the image is easily saturated.

2. Because of the enhancement processing, noise becomes noticeable at dark part, and halation is likely to be seen at light part.

In order to solve the above problems and realize the best enhancement processing for endoscopic images, we developed the adaptive IHb color enhancement processing system which performs the most suitable enhancement processing adaptively according to condition of each image and each pixel.
OBSTACLES TO WIDESPREAD USE OF ENDOSCOPIC ULTRASONOGRAPHY IN THE DIAGNOSIS OF BILIOPANCREATIC DISEASES
Authors: Fujita Naotaka
Published: March 2003

The population of endoscopists who can perform biliopancreatic endoscopic ultrasonography (EUS) has not been increasing as expected. To encourage young endoscopists to become more involved in biliopancreatic EUS, re‐assessment and establishment of a typology of typical EUS images obtained by transduodenal scanning is necessary. Standardization of the maneuver and interpretation of EUS images would help increase the number of skilled echoendoscopists.
VALUE OF ADAPTED TYPE INDEX OF HEMOGLOBIN COLOR ENHANCEMENT FOR THE DIAGNOSIS OF COLORECTAL DISEASE
Authors: Igarashi Masahiro , Kobayashi Kiyonori , Sada Miwa , Yoshizawa Shigeru , Katsumata Tomoe
Published: March 2003

Currently available video‐endoscopes provide improved, more distinct images, permitting to some degree detailed assessment of the surface structure of lesions. The recent introduction of adapted type IHb color enhancement is expected to increase the detection rate of pathological changes that were previously difficult to detect, such as type IIc lesions, when used with conventional functions. Index of hemoglobin color enhancement also enables visualization of minute vascular changes associated with inflammatory diseases. This capability is therefore expected to contribute to further progress in clinical diagnosis and endoscopic research.
CLINICAL SIGNIFICANCE OF ADAPTIVE INDEX OF HEMOGLOBIN COLOR ENHANCEMENT FOR ENDOSCOPIC DIAGNOSIS OF SUPERFICIAL TYPE COLORECTAL TUMORS
Authors: Kobayashi Kiyonori , Igarashi Masahiro , Sada Miwa , Katsumata Tomoe , Saigenji Katsunori
Published: March 2003

We examined the clinical significance of adaptive index of hemoglobin (IHb) color enhancement (color enhancement) for the detection of superficial type colorectal tumors. In this prospective study, the detection rate of superficial type tumors with colonoscopic examination was significantly higher in the color enhancement group than in the control group. The colonoscopic findings made more distinct by color enhancement, leading to tumor detection, were tumor redness and interrupted vascular networks around the tumor. These results demonstrate that color enhancement is effective for the detection and diagnosis of superficial type colorectal tumors.
INFLUENCE OF TOPICAL EPINEPHRINE APPLICATION ON MICROCIRCULATORY DISTURBANCE IN SUBJECTS WITH ULCERATIVE COLITIS EVALUATED BY LASER DOPPLER FLOWMETRY AND TRANSMISSION ELECTRON MICROSCOPY
Authors: Igawa Morihito , Miyaoka Masaaki , Saitoh Toshihiko
Published: March 2003

Background: The aim of this study was to evaluate the state of local microcirculation in ulcerative colitis.

Methods: Rectal blood flow was measured in 26 subjects with ulcerative colitis and in 10 normal subjects by laser Doppler flowmetry before and after topical spray of epinephrine during colonoscopy. Of those subjects, mucosal capillaries were observed by transmission electron microscopy in eight subjects with ulcerative colitis and in four normal subjects.

Results: The blood flow was significantly higher in subjects with active ulcerative colitis than in normal subjects or in subjects with inactive ulcerative colitis, with the difference being significantly different in subjects with ulcerative colitis and in normal subjects following topical epinephrine spray. The capillaries were almost devoid of erythrocytes in subjects with active ulcerative colitis and the frequency of capillaries with erythrocytes in subjects with active ulcerative colitis before and after epinephrine application did not differ.

Conclusions: These results indicate that the mucosal microcirculation in subjects with active ulcerative colitis showed ischemia and functional disorder. Further, continuous measurement of blood flow in subjects with active ulcerative colitis may be a useful method for evaluating the changes in microcirculation.
PREDICTION OF RECURRENCE AFTER ENDOSCOPIC TREATMENT FOR ESOPHAGEAL VARICES: WITH SPECIAL REFERENCE TO ESOPHAGEAL VARICEAL PRESSURE
Authors: Ohira Masaichi , Yoshikawa Kazuhiko , Hori Takeshi , Shimizu Sadatoshi , Yamashita Yoshito , Yamada Nobuya , Sawada Tetsuji , Nishino Hiroji , Sowa Michio , Hirakawa Kosei
Published: March 2003

Background: We investigated the factors influencing esophageal variceal recurrence after endoscopic treatment on the basis of 25 variceal patients who were measured for esophageal variceal pressure, which had been reported to have a close relationship to variceal rupture.

Method: Six patients (24.0%) showed variceal recurrence during follow‐up periods of up to 60 months. Clinical, biochemical, endoscopic and portal hemodynamic parameters were analyzed by univariate analysis in order to determine variceal recurrence.

Results: The cumulative risk of variceal recurrence was greater in patients with F3 varices (P = 0.027), and esophageal variceal pressure (EVP) ≥ 15 mmHg (P = 0.021). It was not significantly related to any clinical, biochemical parameter. Large portosystemic collaterals, which were not concerned with esophageal varices, were demonstrated in five patients who had never showed variceal recurrence; all of their EVP were under 15 mmHg.

Conclusion: It is suggested that the form of varices and EVP, which may reflect a part of portal hemodynamics, are the most reliable factors for predicting variceal recurrence.
A CASE WITH DIFFUSE NARROWING OF THE MAIN PANCREATIC DUCT SUCCESSFULLY TREATED BY STEROID THERAPY
Authors: Takizawa Hideaki , Suzuki Yasufumi , Aoyagi Yutaka , Asakura Hitoshi
Published: March 2003

We report a case of chronic pancreatitis with diffuse narrowing of the main pancreatic duct. A 66‐year‐old man complained of an abdominal mass at the upper abdominal region. Increased serum levels of γ‐globulin, immunoglobulin G and elastase‐1, and disturbed pancreatic function with low urinary excretion of bentiromide were demonstrated. The abdominal ultrasonography and computed tomography of the abdomen revealed diffuse enlargement of the entire pancreas without a localized mass. Endoscopic retrograde pancreatography showed diffuse and irregular narrowing of the main pancreatic duct from the head to the tail of the pancreas. Based on these characteristic findings, the patient was strongly suggestive of having so‐called ‘autoimmune pancreatitis’, and was treated with steroids. Administration of prednisolone had reduced the size of the pancreas. Moreover, follow‐up endoscopic retrograde pancreatography demonstrated an improvement of the narrowing of the main pancreatic duct. Dramatic improvement by steroid therapy suggested that the etiology of this disease seemed to be related to autoimmunity.
Large mucosa‐associated lymphoid tissue lymphoma simulating multiple polypoid lesions at the cecum and rectum
Authors: Onishi Yutaka , Fujisawa Takashi , Maeda Mitsuo , Sakamoto Norikazu , Sakaguchi Kazuhiko , Kuroda Shoji , Toyoda Masanori , Teranishi Tetsuya , Miyamoto Katsufumi , Kusumoto Chosei , Nishigami Takayuki
Published: March 2003

Herein we describe a case of mucosa‐associated lymphoid tissue (MALT) lymphoma of the cecum and rectum with the Leser–Trélat sign. A 76‐year‐old Japanese woman was admitted to the Harima Hospital of Ishikawajima‐harima Heavy Industries, Health Insurance Society for hematochezia. Colonoscopy showed two large elevated tumors, one in the cecum and the other in the rectum. Biopsy was not diagnostic. Endoscopic snare loop biopsy specimens from both tumors were diagnosed as MALT lymphoma. After staging to IIE, the patient underwent surgery. Macroscopically, the cecal tumor was elevated with a large and deep depressed region, measuring 40 × 35 mm. The rectal lesion was a large elevated tumor, measuring 80 × 70 mm. Histologically, both tumors were diagnosed as MALT lymphoma and there was no lymph node metastasis. The patient received chemotherapy and there is no evidence of recurrence 1 year after surgery. We present this case to show that colorectal MALT lymphoma can present as a large tumor, even in early clinical stages, that multiple lesions should be anticipated and that surgical treatment is needed in these cases.
Superficial neuroendocrine carcinoma of the esophagus
Authors: Iwamura Takeshi , Shibata Naoya , Termuhlen Paula , Nagano Motoaki , Yamada Hiromi , Hatakeyama Kinta , Hayashi Toru , Toyoda Kiyokazu
Published: March 2003

A 50‐year‐old man underwent subtotal esophagectomy for a superficial ulcerated tumor, 1.8 cm in length, located in the middle third of the esophagus. Histological examination of the resected specimen showed a stage I infiltrating neuroendocrine carcinoma. Tumor cells were immunohistochemically positive for chromogranin A, neuron‐specific enolase, synaptophysin, protein gene product 9.5 and carcinoembryonic antigen. Postoperative cisplatin‐based chemoradiation therapy was administered. Fourteen months after surgery, widely metastatic disease was noted and the patient died 3 months later.
Surveillance interval of endoscopic examinations for colorectal cancer screening
Authors: NOZAKI RYOICHI , SASAKI TOSHIHARU , MORITA NORIKAZU , YAMADA KAZUTAKA , TAKANO MASAHIRO , HIDAKA HISAMITSU
Published: March 2003

Background: There have been a few evidence‐based studies concerning the relationship between the length of the surveillance interval of colonoscopic examinations and the risk of colorectal cancer (CRC). The aim of the present study was to assess the appropriate interval between endoscopic examinations for CRC screening in a retrospective cohort study.

Methods: The cohort included subjects in whom cancer was not detected at the initial endoscopic examination and in whom endoscopic examination(s) was subsequently performed one or more times. The results of the endoscopic examinations performed in the mass screening for CRC between November 1983 and March 1999 were analyzed. The study end point was the detection of CRC and the detection rates of cancer were assessed among those who underwent examinations at various intervals between successive endoscopic examinations.

Results: Among the 117 636 cohort subjects, 63 invasive cancer cases and 112 mucosal cancer cases were found. The odds ratio (OR) for invasive cancer was not significantly elevated even when the interval between successive examinations was over 5 years. The OR for mucosal or invasive cancer was significantly elevated among the subjects in whom the interval between successive examinations was over 5 years (OR, 1.71; 95% confidence interval (CI), 1.07–2.73), than among those in whom the interval was 1 year.

Conclusions: Since prolongation of the interval between endoscopic examinations of up to 5 years did not result in any change in the cancer risk among persons who are at average risk for CRC, 5 years may be an adequate interval between endoscopic examinations in the mass screening for CRC.
Argon plasma coagulation for treatment of hemorrhagic radiation gastroduodenitis
Authors: MAEKAWA SHU‐JI , AOYAMA NOBUO , SHIRASAKA DAISUKE , INOUE TAKASHI , KURODA KOHEI , EBARA SHIGEYUKI , TAMURA TAKAO , MIYAMOTO MASAKI , KASUGA MASATO
Published: March 2003

A 79‐year‐old man who had received radiotherapy for portal vein thrombosis due to hepatocellular carcinoma (HCC) 5 months earlier, showed progressive anemia and melena. Endoscopy on admission revealed diffuse bleeding from multiple telangiectasias on the anterior wall of the antrum and bulbus. We treated this patient with a new non‐contact hemostatic method: the argon plasma coagulator (APC). The melena stopped after the first session and the hemoglobin level remained stable for 7 months. No delayed complications have been observed. Gastrointestinal bleeding from chronic radiation gastroduodenitis is rarely reported compared with radiation proctitis. This case demonstrates that APC is effective for hemostasis of diffuse bleeding from radiation gastroduodenitis, just as for radiation proctitis.
Laparoscopic treatment of colonic stenosis due to perforation in crohn’s disease
Authors: MIYAJIMA NOBUYOSHI , YAMAKAWA TATSUO
Published: March 2003

A 23‐year‐old woman was admitted to the Teikyo University Hospital with symptoms of watery diarrhea and left lower abdominal pain. A painful mass was palpated in the left lower abdomen. Abdominal computed tomography demonstrated an inflammatory mass associated with gas accumulation. Abscess formation and perforation of the intestine was strongly suspected. Considering her general condition, antibiotic therapy was adopted first. The size of the mass decreased markedly with antibiotic administration. Upper gastrointestinal series showed no abnormalities in the small intestine. Barium enema showed complete obstruction of the descending colon. Colonoscopy revealed the granular change of the mucosa and stenosis at the descending colon. Non‐caseous granuloma was histopathologically noted. The condition of the patient was diagnosed as colonic stenosis due to the perforation at the descending colon as a complication of Crohn’s disease and laparoscopic resection of the colon was performed. Although marked adhesion was noted around the lesion, surgery was successfully completed. Crohn’s disease is a chronic, potentially panintestinal, incurable affliction. Colonic perforation in Crohn’s disease is a relatively rare complication. Surgical management should be as minimal as possible. Laparoscopic surgery for this particular patient was considered to be an adequate choice of treatment.
Primary malignant melanoma of the esophagus
Authors: ÖZER B , SERIN E , GÜMÜRDÜLÜ Y , NURSAL TZ , NOYAN T , KAYASELÇUK F , BOYACIOGLU S
Published: March 2003

Primary malignant melanoma of the esophagus is a rare neoplasm that accounts for approximately 0.1–0.2% of all esophageal tumors. Many cases are advanced at the time of diagnosis, and survival time is very short. The literature lists only four long‐term (> 5 years) survivors after optimal surgical excision. We present the case of a geriatric woman with a malignant melanoma of the esophagus that showed no pigment on gross inspection.
Marked atrophy of the right lobe seen in idiopathic portal hypertension confirmed by laparoscopy
Authors: NAKANO MICHIKO , YANAGISAWA NOBUYOSHI , KUNIYOSHI TOHRU , MITSUHASHI TAKAHIRO , MUROHISA TOSHIMITSU , IIJIMA MAKOTO , SUGAYA HITOSHI , TERANO AKIRA , HISAUCHI TOHRU
Published: March 2003

A 70‐year‐old‐male was hospitalized for the treatment of esophageal varices and close examination of the liver. Blood chemistry tests revealed mild liver dysfunction. Abdominal ultrasound and computed tomography scan revealed marked atrophy of the right and quadrate lobes of the liver without abnormalities of the biliary system. Abdominal angiography revealed marked atrophy of the right lobe of the liver, without obliteration in the portal venous system, but it could not be determined whether the atrophy was congenital or secondary. Subsequently performed laparoscopy revealed marked atrophy of the anterior segment of the right lobe and quadrate lobe with the whitish scarred edge demarcating the border between the edge and neighboring liver parenchyma. The liver surface appeared to be undulant, but non‐cirrhotic. These findings suggest secondary lobar atrophy of the liver, without cirrhosis. Liver biopsy of the left lobe showed the findings to be compatible with idiopathic portal hypertension (IPH), and we diagnosed IPH based on these findings and hepatic lobar atrophy was attributable to IPH. There have been few reports of cases with hepatic lobar atrophy associated with IPH, and the mechanism of atrophy is unclear. We report a case of IPH with marked liver atrophy in which laparoscopy is a decisive means whether liver atrophy is congenital or secondary.
Endoscopic classification of chronic gastritis based on a pilot study by the research society for gastritis
Authors: Kaminishi Michio , Yamaguchi Hirokazu , Nomura Sachiyo , Oohara Takeshi , Sakai Shigeru , Fukutomi Hisayuki , Nakahara Akira , Kashimura Hiromasa , Oda Masaya , Kitahora Tetsuji , Ichikawa Hideyuki , Yabana Tsuyosi , Yagawa Yuichi , Sugiyama Toshiro , Itabashi Masayuki , Unakami Masamitsu , Oguro Yanao , Sakita Takao
Published: March 2003

Background: Various types of classification of gastritis have been proposed, but no plausible classification has been available until now. The Research Society for Gastritis performed a pilot study to establish an endoscopic classification, taking into consideration the following: (i) ease of use; (ii) permitting everyone the common image; and (iii) presence of histopathological evidence.

Methods: One hundred and fifty‐five patients were enrolled and underwent gastroscopy. Eight basic endoscopic and histological types of gastritis (superficial, hemorrhagic, erosive, verrucous, atrophic, metaplastic, hyperplastic and special types) were defined. Gastritis was endoscopically diagnosed according to the definition of the endoscopic types of gastritis. Four or more biopsy specimens were obtained from the lesser and the greater curvatures of the antrum and the corpus of each patient, and the histological findings of gastritis and Helicobacter pylori infection were assessed. The histological diagnosis of gastritis was made according to the definition of histology types of gastritis. The endoscopic and the histological diagnoses were then compared in a blinded fashion.

Results: Endoscopic diagnosis was 62% as sensitive as histological diagnosis for erosive gastritis, 67% for verrucous gastritis and 84% for atrophic gastritis in the antrum. In superficial gastritis, sensitivity was approximately 25% in the corpus, but only 8% in the antrum. Metaplastic and hyperplastic gastritis were correctly diagnosed only in severe cases.

Conclusion: Five basic types of gastritis (superficial, erosive, verrucous, atrophic and special types) should be employed for the new endoscopic gastritis classification. Metaplastic and hyperplastic gastritis are considered to be subtypes of atrophic gastritis and they should be excluded from the basic endoscopic classification. A new definition of gastritis in the antrum accompanied by redness still remains to be investigated.
PEUTZ–JEGHERS POLYPOSIS WITH BLEEDING FROM POLYPS OF THE SIGMOID COLON SUCCESSFULLY TREATED BY LAPAROSCOPIC SURGERY
Authors: Yada Kazuhiro , Inomata Masafumi , Adachi Yosuke , Kitano Seigo , Kashima Kenji , Sakai Masahiro , Sakai Iwami
Published: March 2003

We report a case of colonic bleeding complicating congestive heart failure in a patient with Peutz–Jeghers (P–J) polyposis successfully treated by laparoscopic surgery. A 49‐year‐old woman was admitted for severe cough and edema of the extremities. Chest X‐ray revealed bilateral pleural effusion and cardiomegaly. Her cardiac function was within normal limits, but anemia and severe hypoproteinemia were observed. During the treatment, anal bleeding was observed. Endoscopic and radiographic examinations revealed hundreds of polyps from the duodenum to the rectum. 99mTc‐diethylene triamine penta‐acetic acid human serum albumin scintigraphy showed radiotracer collected in the sigmoid colon, the area having the most polyps. After some intestinal polypoid lesions were resected endoscopically, laparoscopy‐assisted sigmoid colectomy and cecectomy were performed. In the postoperative course, she complained less about abdominal pain and her first flatus occurred on the third postoperative day. She recovered uneventfully. The anemia, hypoproteinemia, and congestive heart failure resolved and gastrointestinal bleeding has not been seen. It was thought that protein loss and hemorrhage due to the P–J polyposis caused congestive heart failure. When congestive heart failure is accompanied by gastrointestinal hemorrhage, it is important to consider hypoproteinemia due to gastrointestinal polyposis, such as that characterizing P–J syndrome. Laparoscopic surgery was very useful for the treatment of colonic bleeding.
MODIFIED ENDOSCOPIC CONGO RED TEST: A RAPID METHOD TO VISUALIZE GASTRIC ACID SECRETION
Authors: Tóth Ervin , Sjölund Kristina , Thorlacius Henrik
Published: March 2003

Background:  The conventional endoscopic Congo red test (CRT) permits visualization of acid‐producing mucosa. However, the CRT has not been disseminated into clinical endoscopy, which is partly due to the substantial prolongation of the gastroscopic examination.

Methods:  Five healthy volunteers and 551 patients were included in a study designed to develop a more rapid approach based on the CRT. In this modified endoscopic Congo red test (MCRT), 0.2 µg/kg of pentagastrin was given intravenously to stimulate gastric acid production. The technical feasibility, tolerability, reproducibility, and inter‐ and intra‐observer reliability of the MCRT were evaluated.

Results:  The MCRT was as effective as the CRT (i.e. 6 µg/kg of pentagastrin was administered intramuscularly) in visualizing the extent of acid‐producing gastric mucosa. Moreover, the MCRT significantly reduced the duration of examination by 63% (almost 8 min), compared to the CRT.

Conclusions:  This MCRT is a simple, inexpensive, well‐tolerated and reproducible method with low inter‐ and intra‐observer variability and is well suited for endoscopy units with high workloads.