bluuebunny/crossref_metadata_2025 huggingface dataset:
pak2a
mutations cause cerebral hemorrhage in
redhead
zebrafish
Authors: Buchner David A. , Su Fengyun , Yamaoka Jennifer S. , Kamei Makoto , Shavit Jordan A. , Barthel Linda K. , McGee Beth , Amigo Julio D. , Kim Seongcheol , Hanosh Andrew W. , Jagadeeswaran Pudur , Goldman Daniel , Lawson Nathan D. , Raymond Pamela A. , Weinstein Brant M. , Ginsburg David , Lyons Susan E.
Published: August 2007

The zebrafish is a powerful model for studying vascular development, demonstrating remarkable conservation of this process with mammals. Here, we identify a zebrafish mutant,
redhead
(

rhd
mi149

), that exhibits embryonic CNS hemorrhage with intact gross development of the vasculature and normal hemostatic function. We show that the
rhd
phenotype is caused by a hypomorphic mutation in
p21-activated kinase 2a
(
pak2a
). PAK2 is a kinase that acts downstream of the Rho-family GTPases CDC42 and RAC and has been implicated in angiogenesis, regulation of cytoskeletal structure, and endothelial cell migration and contractility among other functions. Correction of the Pak2a-deficient phenotype by Pak2a overexpression depends on kinase activity, implicating Pak2 signaling in the maintenance of vascular integrity. Rescue by an endothelial-specific transgene further suggests that the hemorrhage seen in Pak2a deficiency is the result of an autonomous endothelial cell defect. Reduced expression of another
PAK2
ortholog,
pak2b
, in Pak2a-deficient embryos results in a more severe hemorrhagic phenotype, consistent with partially overlapping functions for these two orthologs. These data provide
in vivo
evidence for a critical function of Pak2 in vascular integrity and demonstrate a severe disease phenotype resulting from loss of Pak2 function.
Euler’s definition of the derivative
Authors: Edwards Harold
Published: August 2007

Euler’s method of defining the derivative of a function is not a failed effort to describe a limit. Rather, it calls for rewriting the difference quotient in a way that remains meaningful when the denominator is zero.
On the Euler equations of incompressible fluids
Authors: Constantin Peter
Published: August 2007

Euler equations of incompressible fluids use and enrich many branches of mathematics, from integrable systems to geometric analysis. They present important open physical and mathematical problems. Examples include the stable statistical behavior of ill-posed free surface problems such as the Rayleigh-Taylor and Kelvin-Helmholtz instabilities. The paper describes some of the open problems related to the incompressible Euler equations, with emphasis on the blowup problem, the inviscid limit and anomalous dissipation. Some of the recent results on the quasigeostrophic model are also mentioned.
Tracheolaryngeal Complications of Inherited Epidermolysis Bullosa: Cumulative Experience of the National Epidermolysis Bullosa Registry
Authors: Fine Jo‐David , Johnson Lorraine B. , Weiner Madeline , Suchindran Chirayath
Published: August 2007

Objectives/Hypothesis: To accurately determine the frequency with which complications arise in the ears, noses, and throats of patients with inherited epidermolysis bullosa (EB) as well as the cumulative risk of tracheolaryngeal stenosis or stricture.

Study Design: Cross‐sectional study (3,280 patients) with a nested, randomly sampled longitudinal subcohort (n = 450), representing data collection, stratified by major EB subtype, of the National EB Registry, an epidemiologic project focused on enrolling all EB patients within the continental United States from 1986 to 2002, to permit generalization of findings to the entire American EB population.

Methods: Systematic epidemiologic case finding and data collection were performed throughout the continental United States, followed by subclassification of patients by EB subtype. ENT complications were quantified via contingency tables (as frequencies) and lifetable analyses. Frequencies of surgical procedures were also determined.

Results: The most important clinical ENT complication in inherited EB was tracheolaryngeal stenosis or stricture, arising during early childhood and primarily within infants and children with junctional EB (JEB) (cumulative risk of 39.8% and 12.8% in Herlitz and non‐Herlitz JEB, respectively, by ages 6 and 9). Other uncommon complications included chronic otitis media, chronic otitis externa, and hearing loss.

Conclusions: Given the potential risk for sudden airway occlusion and death, meticulous surveillance by a pediatric otolaryngologist is a critical part of the overall management of infants and children with EB, especially those with JEB and two rare subtypes of generalized EB simplex. Elective tracheostomy should be considered in EB infants and children with evidence of airway embarrassment.
Dysregulation of CD47 and the ligands thrombospondin 1 and 2 in multiple myeloma
Authors: Rendtlew Danielsen Jannie M. , Knudsen Lene Meldgaard , Dahl Inger Marie , Lodahl Marianne , Rasmussen Thomas
Published: August 2007

CD47 and thrombospondin 1 and 2 (TSP1 and TSP2) expression were analysed by real‐time reverse transcription polymerase chain reaction in fluorescence‐activated cell sorted plasma cells (PCs) from patients at consecutive stages of multiple myeloma (MM) development. 80% of MM patients, but only 39% of patients with monoclonal gammopathy of undetermined significance (MGUS) expressed CD47; median expression level increased 10‐fold with progression from MGUS to MM. Elevated TSP1/TSP2 levels occurred in bone marrow cultures from MM patients compared with healthy donors. CD47 and TSP1/TSP2 may have a potential role in the pathophysiology of MM, probably in the interaction between MM PCs and the microenvironment.
Outcome of children with nodular lymphocyte predominant Hodgkin lymphoma – a Children's Cancer and Leukaemia Group report
Authors: Hall G. W. , Katzilakis N. , Pinkerton C. R. , Nicolin G. , Ashley S. , McCarthy Keith , Daw S. , Hewitt M. , Wallace W. H. , Shankar A.
Published: August 2007

This report describes the clinical outcomes and follow‐up records of 42 children with nodular lymphocyte predominant Hodgkin lymphoma (LPHL) treated on United Kingdom Children's Cancer Study Group (UKCCSG) HD1 (1982–1992) and HD2 protocols (1992–2000). The clinical records of 42 children with LPHL treated between 1982 and 2000 were reviewed retrospectively. All 42 had histology reviewed centrally and confirmed as LPHL by an expert panel. In both trials, only patients with stage IA disease had the option of being treated with either involved field radiation alone or combination chemotherapy consisting of chlorambucil, vinblastine, procarbazine and prednisolone (ChlVPP). Patients with all other stages were treated with ChlVPP chemotherapy. Thirty‐five patients (83%) presented with early stage disease (Stages I & II). All 42 patients achieved a complete remission (CR). Six children relapsed after primary therapy. The 5‐ and 10‐year relapse‐free survival rates were 87% and 82% respectively. Forty‐one are currently alive in CR. In conclusion, children with low‐stage LPHL treated between 1982 and 2000 according to the UK strategy for classical Hodgkin lymphoma (HL) had an excellent prognosis. There have been no second malignancies or transformations to B‐cell non‐Hodgkin lymphoma.
General surgical patients’ perspectives of the adequacy and appropriateness of discharge planning to facilitate health decision‐making at home
Authors: McMurray Anne , Johnson Patricia , Wallis Marianne , Patterson Elizabeth , Griffiths Susan
Published: August 2007

Aim.  To investigate general surgical patients’ perspectives of the adequacy and appropriateness of their discharge planning.

Objectives.  To identify any aspects of discharge planning that could be strengthened to assist people in managing their posthospital care and maintaining continuity of care.

Background.  Appropriate discharge planning is a priority in today's healthcare environment in which patients are discharged ‘quicker and sicker’, sometimes without home support. Adequate and appropriate discharge planning helps promote health literacy, which has benefits for both patients and their caregivers in helping them manage postsurgical recovery at home.

Design.  A qualitative, interpretive study was designed in which patients were interviewed at least one week after they returned home from hospital.

Methods.  Purposeful sampling was used to interview 13 general surgical patients from one of three hospitals (two public and one private) in New South Wales and Queensland, Australia. Data were collected in unstructured interviews and analysed using thematic analysis. Reflective analysis by individual research team members generated preliminary themes, which were then analysed collectively by all members of the research team to achieve consensus on patients’ perspectives.

Results.  Themes included a ‘one‐size‐fits‐all’ approach to providing discharge information; inconsistent or variable advice from different health professionals; a lack of predischarge assessment of their home and/or work conditions and the need for follow‐up assessment of patient and carer needs.

Conclusions.  The findings of this study illuminate the need for a more individualized approach to discharge planning, taking into account the patient's age, gender, surgical procedure and family and community support for immediate and longer‐term nursing follow‐up.

Relevance to clinical practice.  Patients would be more adequately prepared for their recovery period at home, by encouraging client‐centred, interdisciplinary communication between health practitioners; adopting a flexible, approach to discharge planning which is tailored to individual needs of postsurgical patients, particularly in relation to advice and information related to recovery; and encouraging and supporting adequate health literacy for self‐management.
Newly qualified Irish nurses’ interpretation of their preparation and experiences of registration
Authors: Mooney Mary
Published: August 2007

Aims and objectives.  The aim of this paper is to report on the insights of newly qualified Irish nurses into their preparation for registration as general nurses and to develop insights into the postregistration experience.

Background.  Nurse education in Ireland has undergone much reform over the past decade. These changes include the introduction of supernumerary status for nursing students and the formation of links with institutes of higher education. No Irish literature was found on this subject.

Method.  Individual semi‐structured, in‐depth interviews were held with 12 newly registered nurses, from two cohorts, within 10 months of qualification. A grounded theory approach was adopted and content analysis employed to analyse the data.

Results.  Two categories, entitled Learning the Ropes and The Metamorphosis emerged from the analysis of data. Within each of these categories there were two subcategories. All respondents reported that since qualification, they had become increasingly conscious of their isolation and unmet needs as nursing students. Postregistration, they enjoyed their increased status and widespread recognition by others.

Conclusions.  This study details how improvements can be made at clinical level to assist the preparation of nursing students for registration. The positive aspects of registration are revealed through descriptions of comparisons of pre‐ and postregistration experiences, while the shortcomings of the journey to registration are described.

Relevance to clinical practice.  Pre‐registration nurses have unmet clinical needs which, if fulfilled, would benefit them post‐registration. Good ward morale is elementary for student learning and enhances the post‐registration experience. Registered nurses are highly conscious of their altered status. These findings are pertinent to clinicians and educationalists as they prepare nursing students for practice.
Care for emergency department patients who have experienced domestic violence: a review of the evidence base
Authors: Olive Philippa
Published: August 2007

Aims.  A literature review was conducted to identify and evaluate the research base underpinning care for emergency department patients who have experienced domestic violence.

Background.  The extent of domestic violence in the general population has placed it high on health and social policy agendas. The Department of Health has recognized the role of health care professionals to identify and provide interventions for patients who have experienced domestic violence.

Method.  Systematic review.

Results.  At least 6% of emergency department patients have experienced domestic violence in the previous 12 months although actual prevalence rates are probably higher. Simple direct questioning in a supportive environment is effective in facilitating disclosure and hence detecting cases of abuse. Although routine screening is most effective, index of suspicion screening is the current mode of practice in the UK. Index of suspicion screening is likely to contribute to under‐detection and result in inequitable health care. Patients with supportive networks have reduced adverse mental health outcomes. Women will have negative perceptions of emergency care if their abuse is minimalized or not identified. Women want their needs and the needs of their children to be explored and addressed. Access to community resources is increased if patients receive education and information.

Conclusion.  Domestic violence is an indisputable health issue for many emergency department patients. Practitioners face challenges from ambiguity in practice guidelines and the paucity of research to support interventions. Recommendations for practice based on the current evidence base are presented.

Relevance to clinical practice.  The nursing care for patients in emergency and acute health care settings who have experienced domestic violence should focus on three domains of: (1) Providing physical, psychological and emotional support; (2) Enhancing safety of the patient and their family; (3) Promoting self‐efficacy.
Malaria‐specific antibody responses and parasite persistence after infection of mice with Plasmodium chabaudi chabaudi
Authors: ACHTMAN A. H. , STEPHENS R. , CADMAN E. T. , HARRISON V. , LANGHORNE J.
Published: August 2007

While it is known that antibodies are critical for clearance of malaria infections, it is not clear whether adequate antibody responses are maintained and what effect chronic infection has on this response. Here we show that mice with low‐grade chronic primary infections of Plasmodium chabaudi or infections very recently eliminated have reduced second infections when compared with the second infection of parasite‐free mice. We also show that parasite‐specific antibody responses induced by infection of mice with Plasmodium chabaudi contain both short‐ and long‐lived components as well as memory B cells responsible for a faster antibody response during re‐infection. Furthermore, parasite‐specific antibodies to the C‐terminal fragment of merozoite surface protein‐1 (MSP‐1) undergo avidity maturation. However, antibodies with both low and high avidity persist throughout infection and after re‐infection, suggesting repeated rounds of activation and maturation of memory B cells. Neither the avidity profile of the antibody response, nor its maintenance is affected by persisting live parasites. Therefore, differences in parasitemia in re‐infection cannot be explained solely by higher levels of antibody or greater affinity maturation of malaria‐specific antibodies. These data suggest that there may be an antibody‐independent component to the early control of secondary infections in mice that are chronically infected.
Carbonate deposits on submerged seamounts in the northwestern Pacific Ocean
Authors: Takayanagi Hideko , Iryu Yasufumi , Yamada Tsutomu , Oda Motoyoshi , Yamamoto Kazuyuki , Sato Tokiyuki , Chiyonobu Shun , Nishimura Akira , Nakazawa Tsutomu , Shiokawa Satoshi
Published: August 2007

Abstract The lithology of shallow‐water carbonates collected from 19 sites on 16 seamounts in six areas of the northwestern Pacific Ocean using the Deep‐sea Boring Machine System are described. The areas include the Amami Plateau, Daito Ridge, Oki‐Daito Ridge, Urdaneta Plateau, Kyushu‐Palau Ridge and Ogasawara Plateau. Chronological constraint is provided by calcareous nannofossil biostratigraphy, planktonic foraminiferal biostratigraphy, larger foraminiferal biostratigraphy and strontium (Sr) isotope stratigraphy. Large amounts of shallow‐water carbonates accumulated on the seamounts during the Oligocene, a relatively cool period, whereas limited carbonate deposits formed during the Early Miocene, a relatively warm period. This might indicate that deposition of shallow‐water carbonates on seamounts in the northwestern Pacific Ocean was not necessarily controlled by climatic conditions, but was related to volcanism and tectonics that served as foundations for reef/carbonate‐platform formation. Remarkable differences in biotic composition exist between Cretaceous and Cenozoic shallow‐water carbonates. Late Cretaceous shallow‐water carbonates are distinguished by the occurrence of rudists, solenoporacean algae and microencrusters. Middle Eocene to Early Oligocene shallow‐water carbonates are dominated byHalimedaor nummulitid and discocyclinid larger foraminifers. Scleractinian corals became common from the Oligocene onward. Nongeniculate coralline algae and larger foraminifers were common to abundant throughout the Eocene to the Pleistocene. The replacement of major carbonate producers in the shallow‐water carbonate factory during post‐Cretaceous time is in accordance with previous studies and is considered to reflect a shift in seawater chemistry.
A Colonoscopic Study of Aphthoid Ulcers of the Large Intestine
Authors: SATO Shuichi , NAGASAKO Kou , YASHIRO Kurato , IIZUKA Bun‐ei , OBATA Hiroshi
Published: August 2007

Colonoscopic characteristics of aphthoid ulcers in amebiasis, Crohn's disease, and tuberculosis were evaluated. Multiple aphthoid ulcers were featured in 14 out of 15 cases of amebiasis, 7 out of 74 cases of Crohn's disease, and 5 out of 24 cases of tuberculosis. Aphthoid ulcers of amebiasis were often confined to the rectum and lower sigmoid colon, being characterized by marginal elevation and erythema. Crohn's aphthoid ulcers lacked the red halo in all but one case. No verrucous elevations were observed. The intervening mucosa appeared intact in all cases. Aphthoid ulcers of intestinal tuberculosis were oval or lozenge‐shaped. They were surrounded by a marginal red halo in 4 cases (80%), however, the red halos found in tuberculosis patients were milder than those of patients with amebiasis. Aphthoid ulcers of Crohn's disease and tuberculosis showed a tendency to be arranged in a specific direction. Crohn's ulcers were arranged in a longitudinal fashion, whereas tuberculous ulcers were arranged in a circular fashion. Ulcers of amebiasis were arranged entirely at random. Biopsy from aphthoid ulcers of amebiasis showed parasites in 64%, whereas cytological studies were positive in 93% of cases.
Evaluation of Esophago‐gastric Varices with Endoscopic Ultrasonography
Authors: URABE Takeshi , YONESHIMA Manabu , OIKO Yoshiyasu , INAGAKI Yutaka , KANEKO Shuichi , UNOURA Masashi , KOBAYASHI Ken‐ichi
Published: August 2007

Esophago‐gastric varices of 22 patients were studied using a newly developed method of endoscopic ultrasonography (EUS). During the observation, the esophagus was filled with de‐aerated water, and reflux of the water was prevented using a balloon placed 7 cm proximal to the tip of the endoscope. Thirteen of 22 patients received endoscopic sclerotherapy (EIS) for their esophago‐gastric varices, and sequential changes of the varices were observed mith EUS.

The EUS method demonstrated esophago‐gastric varices as singular, or a bundle of low‐echoic luminal structures, and extramural collateral vessels were also observed. Therefore, it was possible to evaluate the residual blood flow after EIS by the EUS findings. Sequential changes of the treated varices were observed as follows: (1) formation of a thrombus in the varices, (2) thickening of variceal wall, and (3) disappearance of luminal structures. Small luminal structures in the extramural space of the lower esophagus, dilated paraesophageal veins, were detected in 6 of 13 patients with EIS. The recurrence rate was smaller and the remission period was longer in these 6 patients than those in patients without these luminal structures. Our new EUS method has been shown to be useful not only for the morphological evaluation of varices, but also for the assessment of the effect of EIS.
Pancreatic Sphincterotomy and Pure Pancreatic Juice Collection for Treatment of Chronic Pancreatitis
Authors: FUJI Tadasu , OHMURA Ryosuke , SASAKI Toshiyuki , PUA Shirley , AMANO Hideo , OKITA Kiwamu , TAKEMOTO Tadayoshi
Published: August 2007

Abstract: After our introduction of endoscopic pancreatic sphincterotomy for treatment of chronic pancreatitis in 1985, our interest has been focused to the value of pure pancreatic juice collection with or without pancreatic sphincterotomy for management of chronic pancreatitis.

Through pancreatic sphincterotomy, pain relief was obtained in 13 out of 16 cases with moderate and marked chronic pancreatitis. After pancreatic sphincterotomy extraction of pancreatic calculi using basket forceps was done successfully in 2 of these cases, Spontaneous stone passage occured in the other 2. In pure pancreatic juice collection without pancreatic sphincterotomy, pain relief was seen in 6 out of 13 cases with mild and moderate chronic pancreatitis. The protein plug was simultaneously aspirated during the procedure in 3 cases.

Recently, we have indicated in these patients both pancreatic sphincterotomy and pure pancreatic juice collection and noted pain relief was obtained in all of the 8 cases with this approach. With an improvement in the technology of pancreatic drainage, these endoscopic treatment modalities may be possibly useful to stop the progression of chronic pancreatitis.
Endoscopic Treatment of Early Gastric Cancer
Authors: OGURO Yanao
Published: August 2007

Abstract: Successful radical endoscopic treatment of early gastric cancer has recently progressed using chiefly the high frequency electric current method and the laser method. The forms of treatment can be classified into mucosal resection and non mucosal resection. The high frequency electric current method is a typical method for mucosal resection and makes it possible to confirm by pathology the complete curability of the excised and collected lesion, but it has limits in terms of the size of the lesion. Of the high frequency electric current method, there are two chief methods used which are endoscopic polypectomy and strip biopsy or ERHSE. Laser endoscopy is a typical method for non mucosal resection, however it cannot remove the lesion and therefore needs a follow‐up study including biopsy after the treatment, it can treat however much larger lesions than the mucosal resection method. Laser endoscopy includes the three main methods of vaporization, photodynamic therapy and laserthermia. Indications for radical treatment of early gastric cancer by endoscopy should be limited to lesions without lymph node metastasis. Radical endoscopic treatment for early gastric cancer has recently become the treatment of choice for lesions, even in patients without surgical risk, because of the decreased quality of life which may follow after surgery. The ratio of radical endoscopic treatment to surgery for early gastric cancer has been increasing yearly. Recent advances in the area are reviewed, here.
Injection Sclerotherapy for Recurrent Esophageal Varices after Surgical Procedures
Authors: AOYAGI Hiroyuki , TAKASE Yasuhiro , SHIBUYA Susumu , SHARMA Niranjan , CHIKAMORI Fumio , IWASAKI Yoji
Published: August 2007

Abstract: Thirteen patients, who had recurrent esophageal varices after esophageal transection or esophagoproximal gastrectomy were treated by endoscopic injection sclerotherapy. Four patients successfully underwent emergency sclerotherapy to control active variceal hemorrhaging. Three of these patients and the remaining nine patients (including six rebleeding patients who were conservatively treated) underwent elective sclerotherapy. None of the patients had variceal rebleeding in the follow‐up study with sclerotherapies. Only one patient with recurrent varices did not undergo any additional sclerotherapy following emergency treatment. In this study, no deaths occured nor any major complications. Minor complications such as low grade fever and chest pain were observed, but they were transient and disappeared within 2 or 3 days without specific treatments. It is concluded that endoscopic injection sclerotherapy is considered to be the most effective procedure for recurrent varice following surgery.
Diagnosis of Chronic Pancreatitis by Endoscopic Ultrasonography
Authors: NAKASHIO Kazuaki , MATSUMOTO Jun , YOSHIKAWA Junichi , SUEKAWA Kiyoyasu , ARIMURA Fumio , TANAKA Keizo , SHIBUE Tadashi , ARIMA Terukatsu , YAMAGUCHI Atsumasa , OSAME Toshikazu
Published: August 2007

Abstract: This study evaluates the usefulness of endoscopic ultrasonography in the diagnosis of chronic pancreatitis. 52 patients with chronic pancreatitis, which included 15 cases of mild pancreatitis, 19 cases of moderate pancreatitis and 18 cases of advanced pancreatitis, were diagnosed by endoscopic retrograde cholangiopancreatography and further investigated by endoscopic ultrasonography. The 4 main findings of 1) dilatation of the main pancreatic duct, 2) irregularity of the main pancreatic duct, 3) inhomogeneity of the pancreatic parenchyma and, 4) irregular configuration of the pancreas were reviewed. In all of the 18 cases of advanced pancreatitis, irregularity of the main pancreatic duct, inhomogeneity of the pancreatic parenchyma and irregular configuration of the pancreas were seen. 89% of these patients had dilatation of the main pancreatic duct. In the patients with moderate pancreatitis, on the other hand, all 4 findings occurred with a frequency of between 58% to 95%. In the patients with mild pancreatitis, irregularity of the main pancreatic duct, inhomogeneity of the pancreatic parenchyma and irregular configuration of the pancreas occurred at a rate of 40% to 93%, and dilatation of the main pancreatic duct occurred rarely in only 13% of the patients. We were able to detect abnormalties in the pancreatic parenchyma by endoscopic ultrasonography even in the early stages of chronic pancreatitis, and this suggests that this technique may be useful in the diagnosis of mild pancreatitis, which usually causes quite minor abnormal changes in the main pancreatic duct.
Clinicopathological Study on Flat and Depressed Minute Colorecta Carcinomas
Authors: HIRATA Ichiro , TANAKA Masaya , SUGIMOTO Kenji , YOSHIZUMI Munenori , UMEGAKI Eiji , MASAKI Hirohide , OHSHIBA Saburo
Published: August 2007

Abstract: Over the last two years, a total colonoscopy was performed on 3,006 patients and 232 colorectal carcinomas were detected in these patients. Seventy one (30.6%) of the carcinomas were found to be early cancers. Eighteen (25.4%) of these 71 early cancers were minute (>5 mm) colorectal carcinomas of the flat or depressed type and they were resected endoscopically. More than half of them were accompanied by colonic polyps.

Among the characteristic endoscopic features of flat and depressed early colorectal carcinomas are redness, fine granularity and defects of the innominate groove on the lesional surface.

Another important finding is whitish annular mucosa surrounding the lesion. The gross appearance of these lesions was depression (3 lesions), depression with a marginal elevation (11 lesions), or flat (4 lesions).

On histological examination, all the lesions were found to be well–differentiated intramucosal adenocarcinoma. It appears that depressed lesions with or without marginal elevation have a tendency to horizontal and vertical invasion, respectively. Moreover, it is thought that flat lesions are very early cancers that might later develop into depressed lesions with or without marginal elevation, or flat elevated lesions.
A Case of Pneumatosis Cystoides Intestinalis Associated with Trichlor‐oethylene Developing Typical Features during the Follow‐up of Undetermined Sigmoid Lesions
Authors: OWA Osamu , AKAMATSU Taiji , MATSUDA Yoshiaki , MATSUO Keisuke , HASEBE Osamu , USHIMARU Hiroyasu , MUKAWA Kenji , KAMIJO Toshikazu , FUJIMORI Yoshifumi , FURUTA Seiicii , NASU Tamie , SATO Akio , YAMAGUCHI Kotaro
Published: August 2007

Abstract: A 64‐year‐old male lens grinder with a 43‐year history of occupational exposure to trichloroethylene (TCE) visited Shinshu University Hospital in December 1988 complaining of distention of the lower abdomen. A barium enema study and endoscopic examination showed rosary‐like semilunar folds and edematous mucosa of undetermined etiology in the sigmoid colon. Three months later, the patient visited the hospital again complaining of blood in the stool. An endoscopic examination performed at this time revealed numerous broad‐based, smooth‐surfaced, protruding lesions in the sigmoid colon. A diagnosis of pneumatosis cystoides intestinalis (PCI) associated with TCE was made. After 4‐days treatment with 50% oxygen given by inhalation, the patient's symptoms were completely relieved, and a colonoscopy revealed no evidence of PCI. He returned to his job at the factory which involved dealing with TCE and because of adequate ventilation and a shorter work‐day he has been free of recurrence during a year follow‐up period. The finding of rosary‐like semilunar folds, as demonstrated by the initial endoscopic and barium enema studies in our patient, is a peculiar one in the incipient stage of PCI.
Electronic Endoscopy and Biopsy Findings During the Course of Reflux Esophagitis
Authors: TOKI Munetoshi , OHWADA Tsuneo , SEKIGUCHI Toshikazu
Published: August 2007

Abstract: We observed the esophageal mucosa in 90 patients with reflux, esophagitis using a zoom‐type electronic endoscope and clarified the endoscopic characteristics of each stage of the disease as well as the response to treatment. It was possible to differentiate between white slough, erosions and regenerating epithelium from observations of the magnified mucosa.

The white slough appeared uniform and featureless, the erosions appeared irregular and had featureless reddish areas, and regenerating epithelium were noted in the reddish areas in addition to various types of mucosal surface structure.

Biopsies obtained after the disappearance of the white sloughs of reflux esophagitis from the mucosal membrane of the discolored esophagitis generally showed the “accessory findings” of the diagnostic criteria of the Japanese Society of Esophageal Diseases. Even in the early scarring stage (S1), the inflammation persisted under the regenerating mucosa, and it was necessary to continue treatment until the late scarring stage (S2) to prevent recurrence.

Regarding treatment, H2 receptor antagonists were effective, but 19.4% of the patients showed resistance to them. Intractable esophagitis was often seen in stage III and IV of the Savary & Miller classification and in the elderly patients. Intractable esophagitis was associated with a high incidence of hiatus hernia, a reduced lower esophageal sphincter pressure, and a reduction in primary peristalsis in the lower esophagus.
Comparison of Injection Materials for the Elevation of Gastric Mucosa Prior to Endoscopic Mucosal Resection
Authors: UENO Akihiko , KATOH Yoshihisa , HARADA Takashi
Published: August 2007

Endoscopic mucosal resection (EMR), namely strip biopsy, to eradicate gastric mucosal lesions requires certain special techniques, including submucosal injection of appropriate agents. This experimental study using dogs was conducted to compare, with regard to the degree of duration of mucosal elevation and subsequent histologic changes of the gastric wall, three injection materials; physiological saline, hypertonic saline with epinephrine (HSE) and 10% soybean oil. The duration of mucosal elevation which should be sufficient for the EMR procedure did not differ between the three agents. The post‐injection histologic changes included vessel dilatation in the peri‐muscularis mucosae, dilatation of the lymphatic channels and vessel congestion. These changes appeared in all injection material groups, and the vessel congestion was found to be more conspicuous in the HSE group.

All EMRs in this series were performed by single snare cutting, which was also evaluated. The margin of the stripped material was well limited to the submucosal layer in all cases, but the depth of the ulcers formed varied. The healing process of the ulcer for the first 4 weeks was delayed in the soybean oil group. Although there were few cases of perforation in this experiment and some subjects had adhesion between the gastric serosa and adjacent organs, the single snare method could be applicable for clinical use by skilled hands.
An Endoscopically Resected Case of Early Carcinoma of the Duodenal Bulb
Authors: TAKESHITA Kimiya , WATANUKI Shigeo , GOSEKI Narihide , OKABE Satoshi , SAITO Naoya , ENDO Mitsuo , NAKAJIMA Takatoshi , MIYATA Tatsuya
Published: August 2007

We report here on a case of early carcinoma originating in the duodenal bulb. The patient was a 70‐year‐old woman who complained of nausea. A gastrointestinal endoscopy disclosed a lesion protruding from the duodenal bulb and a biopsy revealed adenocarcinoma. According to the results of the endoscopy, the tumor was subpedunculated and probably confined in the mucosal layer.

Based on these findings, we performed an endoscopic tumor resection. A histological examination of the resected specimen revealed a papillotubular adenocarcinoma (1.7 × 1.2 × 0.8 cm) localized in the mucosal layer. No carcinomatous lesion was left in the resected margin. No symptoms of recurrence have been noted during the last 6 months.

When considering clinical pathology of the present case, we assessed 39 cases of primary early carcinoma in the duodenal bulb previously reported in the Japanese literature. We considered that our patient was the 14th in Japan with an early carcinoma of the duodenum which was completely excised via endoscopic resection. We expect that endoscopic resection of early duodenal carcinoma will be widely used in the future.
Difference in the Progression of a Liver Disease in a Pair of Siblings with Wilson's Disease
Authors: MARUYAMA Toshihiro , ISHINODA Yoshihiro , IWAKI Yoshihiro , HAYASHI Tohru Kitamura Katsuhiro , NAKAMURA Haruki , TSUDA Kazunori
Published: August 2007

Wilson's hepatolenticular degeneration is a well defined disease, where copper metabolism is disturbed genetically in the liver, but its exact cause is not known. The development of the clinical symptoms varies in each individual and it is interesting to know the mechanism of the individual differences which occur in this well defined disease. We studied a pair of siblings with Wilson's disease in whom the condition of the liver disease was very much different. The 16‐year‐old man had the full blown liver cirrhosis characteristic of Wilson's disease, with large regenerating nodules and a deposition of copper granules in the hepatocytes. On the other hand, the liver of the 19‐year‐old sister, who was supposed to have the same Wilson's disease gene and who had been exposed to high concentrations of liver copper for a longer period, was fairly well preserved with a smooth liver surface. There is no study that reports in detail the differences in this liver disease in close relatives. According to the findings of our comparison of these 2 cases, we speculated that there are factors, other than the direct effect of Wilson's disease gene, which control the mode of accumulation and toxicity of copper in the liver, or factors that control the response to the accumulated copper in the liver.
Correlation between α1–Adrenoceptors in Biopsy Specimens and Endoscopic Color Changes of Human Gastric Ulcer
Authors: OHIDA Masahito , HAYASHI Hiromi , KIKUCHI Shin , IMAIZUMI Hiroshi , TANABE Satoshi , KOIZUMI Wasaburo , YOKOYAMA Yasushi , SAIGENJI Katsunori
Published: August 2007

α1–Adrenoceptors were measured in the scar tissue (U) and marginal normal mucosa (C) of human gastric ulcers by radio‐binding assay using [3H]‐prazosin as the ligand. The specific radioactivity binding was calculated for the membrane‐rich fractions of the U and C regions along with U/C ratio, and the relationship between the scar color tone and α–adrenoceptor binding levels was studied by conventional endoscopy and pharmacoendoscopy

The U/C ratio for red scars (mean: 92.2%) increased as redness decreased. White scars had a mean U/C ratio of 135.6%. For pharmacoendoscopic classes P1 and P2, which remained red after spraying epinephrine onto the scar, the mean U/C ratio was 86.8%. For the P3 class, which turned pale after the application of epinephrine spray, the mean U/C ratio was 172.0%. The recurrence of peptic ulcers is more frequent when red scars ocAcur, assessed by conventional endoscopy, in the P1 and2 classes, evaluated by pharmacoendoscopy, than in white scars (P3 class). As the α1–adrenoceptor binding of [3H]‐prazosin appears to be proportional to the maturity of vasculature tissue, the present data suggest this latter factor plays a key role in the recurrence of gastric ulcers and that pharmacoendoscopy allows for a more accurate prognosis of ulcer relapse than conventional endoscopy
Usefulness of Mechanical Lithotripters in Endoscopic Sphincterotomy
Authors: AKASHI Ryukichi , KIYOZUMI Takeaki , YAMABE Hiroshi , SAGARA Katsuro , HATTORI Masahiro
Published: August 2007

We have been performing bile duct lithotripsy by EST at Kumamoto Regional Medical Center since January 1982. A balloon catheter is the method of choice for performing lithotripsy. For stone removal, a conventional FG‐22Q basket catheter was used from January 1982 to June 1984 (extraction rate: 88.5%), and a prototype EML BML‐1Q basket catheter was used with a FG‐22Q basket catheter from July 1984 to April 1990 (extraction rate: 91.5%). Since May 1990, lithotripsy has been performed in the following sequence with excellent results (extraction rate: 97.0%): EST‐balloon catheter, slide‐type EML BML‐3Q‐balloon catheter. Although the difference between the extraction rates for BML‐1Q and BML‐3Q basket catheters were only marginally significant, the difference between the conventional basket FG‐22Q and BML‐3Q was clearly significant. Lithotomy using the procedure employed since May 1990 is therefore recommended as a highly effective means of extracting gallstones and is considered to be superior to conventional methods.
Newly Developed Miniature Ultrasonic Probe, Basic and Clinical Study
Authors: YAMAMOTO Hiroshi , YAMANAKA Takeo , YOSHIDA Yukio , MATSUMOTO Hironari , MIYAMA Michio
Published: August 2007

The authors evaluated a new device‐the miniature ultrasonic probe (3.4mm in the outer diameter, radial scan type, 7.5MHz, Olympus XMP‐02) from both its basic and clinical aspects using fresh resected gastric specimens with water immersion

The ultrasonic resolution of this new probe was demonstrated to be best when the probe‐object distance was 1.0–1.5cm and the angle of inclination was0–20*. Practical use of the probe with a smaller diameter is limited in the imaging range of horizontal directions; only 0.7cm right and left from the center receiving ultrasonic beams at a right angle.

Although the ultrasonic resolution of this new device is inferior to that of conventional ultrasonography instruments, it can be applied to stenosed lesions and possibly to the bile duct or pancreatic duct regions in the future. This device, with further improvement, is expected to become much more useful for clinical application.
A Case of Cronkhite–Canada Syndrome—With Special Reference to Magnifying Endoscopic Observation of Polyps and Coeliac Angiographic Findings—
Authors: MAKIYAMA Kazuya , IWANAGA Seima , KATSUMATA Tatsuya , FUKAUMI Atsushi , MUTA Kouki , ITSUNO Minoru , UMENE Yoshihiko , SENJU Masahiro , MURATA Ikuo , HARA Kohei
Published: August 2007

The Cronkhite‐Canada syndrome was diagnosed in a 62 year‐old male in whom the gastrointestinal polyposis and ectodermal change disappeared after treatment with corticosteroids and albumin infusions. The major pathophysiologv of this syndrome is gastrointestinal polyposis. The polyps were examined in detail using a magnifying endoscope and then by spraying methylene blue onto the mucosa. It was shown that the polyps were formed by groups of intestinal glands each dilated by hyperaemia and oedema. Destruction of the dilated glands and opening of a pit at the central region were also observed. These changes were associated with secretion from the pit and it is suggested that this is the mechanism for the protein leakage.

Angiographic studies confirmed our previous finding that the coeliac and mesenteric arteries are dilated in the Cronkhite‐Canada syndrome but a follow‐up study showed that this is reversible once the mucosal lesions have resolved in response to treatment.
Mucin Secreting Cholangiocarcinoma Associated with Clonorchiasis
Authors: Hsu Ronald KK , Lai Chi‐wai , Lo Ki‐kam , Leung Joseph WC
Published: August 2007

Hepatic clonorchiasis is implicated in the pathogenesis of mucin secreting cholangiocarcinoma in the Far East. Obstructive jaundice is often associated with the malignant stricture. We present a case with recurrent cholangitis due to biliary obstruction caused by excessive mucus produced by the tumor. The excess mucus and infected bile led to early stent clogging within a few weeks after stent insertion. Intraductal 5‐fluorouracil treatment resulted in an apparent reduction in mucus production. Apart from frequent admission for stent exchange, the patient has lived a reasonably good quality life for three years.
Factors Influencing the Relapse of Gastric Ulcers During H2‐Receptor Antagonist Maintenance Therapy
Authors: SAIGENJI Katsunori , AZUUMI Yoshiteru , YOKOYAMA Yasusi , ASHIHARA Takeshi , KOIZUMI Wasaburo , MITSUHASHI Toshiharu , OHIDA Masahito
Published: August 2007

Abstract: We performed H2‐receptor antagonist maintenance therapy for 2 years on 146 patients with healed gastric ulcers (including those with concurrent duodenal ulcers), and determined the cumulative endoscopic and symptomatic recurrence rates. We also investigated the factors involved in ulcer recurrence in the first 12 months of maintenance therapy. The cumulative endoscopic non‐recurrence rate was 70.0% at 12 months and 57.2% at 24 months, while the cumulative symptomatic non‐recurrence rate was 84.8% at 12 months and 75.0% at 24 months. The factors contributing to endoscopic recurrence were the presence of a concomitant disease, the presence of duodenal ulcer, the type of ulcer, and the endoscopic stage at healing. The factors related to symptomatic recurrence were smoking and the type of ulcer. Multivariate analysis showed that the type of ulcer, smoking, and the endoscopic stage at healing influenced the risk of recurrence.
Endoscopic Scoring System for Experimental Colitis with Trinitrobenzene Sulfonic Acid in Rats
Authors: SHIBATA Yoshimi , ASHIDA Tomofumi , AYABE Tokiyoshi , TARUISHI Masaki , YOKOTA Kinichi , OKUYAMA Shuji , SAITOH Yusuke , OKAMURA Kiyoshi , NAMIKI Masayoshi
Published: August 2007

Abstract: Experimental colitis models require serial sacrifice of animals to confirm the evolution of the inflammatory process. Endoscopy may possibly enable us to detect sequential changes in the lesions throughout the inflammatory process without killing animals. Using rat colitis induced with trinitrobenzene sulfonic acid (TNBS) after the study by Morris et al. the accuracy of endoscopic examination was investigated by comparing endoscopic findings with histologic findings.

A polyethylene catheter was rectally inserted into rats’(Fischer, 6W male) colon. After intraluminal administration of 25 mg TNBS dissolved in 0.5 ml of 50% ethanol, each animal was kept in the tail‐up position for one minute. Colonic changes were examined weekly with an Olympus BF‐3C20. It took about 3 min to complete the observation per rat.

We offered a novel endoscopic and histologic scoring system. The endoscopic score mainly reflected the size of the ulcers occupying the lumen and the histologic score the sizel depth of the ulcers and the degree of acute inflammation in the colonic mucosa. A highly significant (r = 0.71, p<0.01) linear correlation was observed between the endoscopic and histologic scores. This system may allow us to detect potential therapeutic agents or to investigate the mechanism underlying colitis in the human counterpart, such as Crohn 's disease, without killing laboratory animals.
The Influence of Endoscopic Injection Sclerotherapy on Organs Surrounding the Esophagus
Authors: URITA Yoshihisa , MUTOH Masue , ISHIHARA Manabu , HACHIYA Akihiko , YAMADA Shuichi , KONDOH Eisaku , NAKATANI Naoto , IHARA Fumie , MATSUZAKI Hiroshi , NAKATA Masayuki , OZAKI Motonobu , NARUKI Yukihiko , MACHIDA Keiichi , OHTSUKA Sachio
Published: August 2007

Abstract: Endoscopic injection sclerotherapy (EIS) is widely accepted as a means of treating esophageal varices. However, various complications of EIS have been reported. To investigate the cause of chest complications after EIS, chest CT and bronchofiberscopy (BF) were carried out in patients undergoing EIS. A contrast medium was added to the sclerosant in a 1: 4 ratio, and a chest CT examination was performed 30 minutes after the EIS procedure. BF was performed before and after EIS.

CT findings were classified into four types, i. e., Type I : ring‐enhanced esophageal wall, Type II : ring‐enhanced paraesophageal wall, Type III : locally enhanced esophageal wall, and Type IV : beltlikeenhanced parietal pleura. The CT findings depended on the frequency of EIS rather than the total volume of sclerosant. After injection into the Paravariceal wall, the sclerosant unexpectedly moved beyond the local injection site during the first or second EIS procedures. During the third or subsequent procedures the sclerosant tended to abide locally in the esophageal wall.

Before EIS, bronchial venous dilatation, present mainly in the left main bronchus, was noted and its degree was correlated with the form and location of the esophageal varices. Bronchial venous dilatation decreased in three patients after EIS. The change in venous dilatation seemed to reflect alterations in the esophageal variceal blood flow. After EIS bronchial ulceration was found in the main bronchus in 3 patients. This phenomenon was attributed to both the direct effects of the sclerosant and the physical effects of the endoscopic examination itself: Minor complications such as pleural effusion, chest pain, and fever were not associated with either CT or BF findings.

Patients undergoing EIS should be carefully monitored to facilitate the early detection and management of potential chest complications.
A Study of Reflux Esophagitis in an Apparently Healthy Population
Authors: SEGAWA Kose , ARISAWA Tomiyasu , NIWA Yasumasa , KATO Tadashi , GOTO Hidemi , YOSHIKANE Hiroaki , SHIMODAIRA Masaya , HAMAJIMA Eiji , OHMIYA Naoki , TSUKAMOTO Yoshihisa
Published: August 2007

Abstract: To study reflux esophagitis in the general population, we reviewed the records of 64,171 apparently healthy Japanese adults, 48, 706 men and 15,465 women, who had undergone automated multiphasic health testing and services (AMHTS), a comprehensive routine medical health check, that includes double‐contrast upper gastrointestinal roentgenograms. All subjects suspected of having gastrointestinal disease underwent a flexible fiberscopy as indicated. Reflux esophagitis was thus confirmed in 101 subjects. The prevalence of refla esophugitis was 0.20% among men and 0.04% among women (men vs. women p<0.001) and its frequency increased with age in both men (p<0.001) and women (p<0.05). Endoscopic classification according to the Savary‐Miller criteria yielded 48, 27, 23, and patients in Stage I, II, III and IV, respectively. In this series, 49/101 (48.5%) of the esophagitis patients had concurrent upper gastrointestinal abnormalities. The incidence of heavy smoking and excessive drinking of alcohol was significantly higher in the patients with reflux esophagitis (p<0.001 and p<0.005, respectively) as compared with the normal population.