bluuebunny/crossref_metadata_2025 huggingface dataset:
Efforts to restore habitat connectivity for an upland tropical rainforest fauna: A trial of underpasses below roads
Authors: Goosem Miriam , Izumi Yoshimi , Turton Stephen
Published: March 2003

Summary Four large underpasses, specifically designed for movements by fauna, form part of a major road upgrade project on the Atherton Tablelands in northeast Queensland, Australia. We describe the design and rationale of a project to test their effectiveness in restoring habitat continuity for tropical rainforest fauna. The large blocks of upland rainforest divided by the road are recognized for their high faunal conservation significance, forming habitat for many rare or threatened species. Ecologists, road engineers and the Atherton Tablelands conservation community have united with a common conservation goal: to design the ‘furniture’ within the underpasses and accomplish rainforest revegetation to provide protective cover and attract fauna to underpass entrances. Prior to construction, small mammals were trapped weekly for several months in habitats close to the road upgrade. The small mammal community comprised grassland species in abandoned pasture and differed significantly from the rainforest specialists found in three closed canopy habitats: rainforest edge, rainforest interior and Lantana shrubland. Rainforest restoration works designed to restore connectivity for rainforest fauna across this abandoned pastureland (via the underpasses to major rainforest blocks to the north and south of the road) are currently in progress. Monitoring of the effectiveness of the underpasses in allowing faunal movements will involve the use of infra‐red‐triggered cameras within the underpasses and near underpass entrances, and a survey of road‐killed fauna both prior to and postconstruction. Further examination of small mammal community structure and movements, with respect to both the new road and the underpasses, will be undertaken once rainforest plantings have become established. This evaluation should provide insights for further road‐associated restoration projects in rainforest regions.
The potential impact of dryland salinity on the threatened flora and fauna of New South Wales
Authors: Zeppel Melanie J. B. , Murray Brad R. , Eamus Derek
Published: March 2003

Summary We used digital map overlays in a geographical information system (GIS) to quantify the potential impact of dryland salinity on the threatened flora and fauna of New South Wales (NSW). Geographical areas of conservation priority were identified based on richness of threatened species with distribution records overlapping dryland salinity. Two alternative schemes – Interim Biogeographical Regionalization for Australia (regions) and catchment boundaries (catchments) – were used to subdivide NSW. Sydney Basin, North Coast and South‐western Slopes regions – and Hunter, Sydney, Macquarie, Murrumbidgee and Lachlan catchments – were identified as priority areas with more than 10 salinity‐overlap species present. Five threatened plant species were identified as priority species due to more than half of their known distributions overlapping areas of dryland salinity. Threatened animal species of most concern had 10–50% of their records overlapping areas of dryland salinity. Our findings demonstrate that landscape exposure to dryland salinity should be used in conjunction with total richness of threatened species for prioritizing conservation of geographical areas with respect to the potential impact of dryland salinity on threatened species.
Reversal of floppy eyelid syndrome with treatment of obstructive sleep apnoea
Authors: McNab Alan A
Published: March 2003

Purpose: To describe the beneficial effects of treatment of obstructive sleep apnoea on the symptoms and signs of floppy eyelid syndrome.

Method: A case of sleep apnoea with associated floppy eyelid syndrome is reported.

Results: A 32‐year‐old man presented with left floppy eyelid syndrome and a known diagnosis of obstructive sleep apnoea. He underwent treatment for 4 years with continuous positive airways pressure by mask during sleep and the symptoms and signs of his floppy eyelid syndrome disappeared.

Conclusion: Treatment of obstructive sleep apnoea may reverse the changes of floppy eyelid syndrome.
Low molecular weight analysis of tears using matrix assisted laser desorption ionization‐time of flight mass spectrometry
Authors: Mulvenna Irene , Stapleton Fiona , Hains Peter G , Cengiz Arzu , Tan Maxine , Walsh Bradley , Holden Brien
Published: March 2003

Many low molecular weight substances in human tears, including protein and lipid species, have yet to be characterized. Some of these uncharacterized substances may well be important in the pathogenesis of ocular surface disease or in ocular discomfort. The aim of this study was to build a biochemical profile of low molecular weight species in tears, and to determine its repeatability. A total of 80 tear samples were collected from 11 subjects. Tear samples were dialysed to remove salts, added to a matrix of α‐cyano‐4‐ hydroxycinnamic acid, and analysed using matrix‐assisted laser desorption ionization‐time of flight (MALDI‐TOF) mass spectrometry. Species were separated based on their mass to charge ratio (m : z). The repeatability of the appearance of the different species was analysed using logistic regression and diurnal and day‐to‐day repeatability were ascertained. Peptides were identified in the range of 848–3897 Da. Of these, 39 peptides were found to be present in more than 10 / 80 samples. There was no diurnal variation in the peptides. All species were found to occur repeatably, with the exception of peptide 1653 Da. This study has demonstrated that the majority of low molecular weight species in tears are repeatably present and do not exhibit diurnal variation. Further study aims to characterize these species and to identify changes in tear profiles between subject groups.
A comparison of short wavelength automated perimetry with frequency doubling perimetry for the early detection of visual field loss in ocular hypertension
Authors: Landers John , Goldberg Ivan , Graham Stuart
Published: March 2003

Background: Achromatic automated perimetry (AAP) is limited in its ability to detect very early visual field loss in ocular hypertensive patients. Tests targeting axons that are selectively damaged, or have low redundancy, may detect visual field losses before they are seen on AAP. It has been claimed that short wavelength automated perimetry (SWAP) and frequency doubling perimetry (FDP) are two tests that provide early detection.

Methods: Patients (n = 62) were selected on the basis that they had raised intraocular pressure but normal visual fields detected by AAP. A SWAP and an FDP was performed on each of the patients and the results compared. Fields were scored as either normal or abnormal based on criteria used in previous studies.

Results: On comparing FDP with SWAP as the ‘gold standard’, a sensitivity of 88.9% and a specificity of 96.2% was found, showing a high concordance between the two tests.

Conclusion: These results suggest that as SWAP may be predictive of AAP visual field loss, FDP may be similarly predictive.
Post‐traumatic Scedosporium inflatum endophthalmitis
Authors: Taylor Alexandra , Wiffen Steven J , Kennedy Christopher J
Published: March 2003

This is the first documented case of post‐traumatic Scedosporium
inflatum endophthalmitis and only the second of S. inflatum endophthalmitis
occurring in a non‐immuno­compromised individual, to the
authors’ knowledge. A case is reported of a 57‐year‐old
woman who, while chopping wood, had a wood chip hit her in the right
eye. This caused a penetrating corneal injury with uveal prolapse
and damage to the crystalline lens. There were also vitreous and
suprachoroidal haemorrhages. No detectable intraocular foreign material
was retained. The clinical manifestation of infection was delayed,
but once established, it was very destructive. The initially indolent
endophthalmitis eventually led to loss of all light perception and
panophthalmitis which required enucleation. The responsible strain
of S. inflatum was found to be resistant to all
antifungal medication in vitro.
Comparison of the Frequency Doubling Technology screening algorithm and the Humphrey 24‐2 SITA‐FAST in a large eye screening
Authors: Allen Christopher S , Sponsel William E , Trigo Yolanda , Dirks Monte S , Flynn William J
Published: March 2003

Purpose: To compare the Frequency Doubling Technology (FDT) C20‐1 screening algorithm and the Humphrey Field Analyser II (HFA) 24−2 SITA‐FAST in a large eye screening.

Methods: In a non‐randomized, prospective, free eye screening, the FDT Screening Protocol (C20‐1 Screening Algorithm) was administered to 574 attendees (422 men and 152 women, average age 64, range 17−89 years) of the 1998 Veterans of Foreign Wars (VFW) Convention in San Antonio, Texas. Individuals who failed the FDT (two or more misses out of 17 locations) immediately underwent white‐on‐white threshold visual field perimetry (HFA 24‐2, SITA‐FAST). Humphrey visual field analysis included STATPAC and masked evaluations by three glaucoma specialists.

Results: Approximately one‐tenth of the VFW conference attendees
voluntarily presented themselves for screening. Among these 574
volunteers, 69 (12%) failed the FDT and underwent HFA analysis.
Eighty‐one per cent (56/69) of these FDT failures had abnormal
HFA Glaucoma Hemifield Tests. Eighty‐eight per cent (61/69)
were judged to have nerve fibre type visual field loss on HFA by
at least two of three masked examiners. A positive correlation existed between
the number of FDT locations missed and the HFA mean deviation (r = 0.5, P = 0.0001).
A similar association was observed when FDT and HFA results were
analysed by quadrant (r = 0.5, P < 0.0001).

Conclusion: There was a low false positive rate and a good positive predictive value comparing the FDT screening algorithm to the HFA 24−2 SITA‐FAST in this study. This supports the potential use of FDT as an economical screening device.
Orbital lipomatous haemangiopericytoma: an unusual variant
Authors: Davies Peter EJ , Davis Garry J , Dodd Tom , Selva Dinesh
Published: March 2003

Haemangiopericytoma (HPC) of the orbit is a rare tumour occurring in all age groups and presenting with slowly progressive proptosis, ocular motility impairment and visual loss. Although most are benign tumours that are resectable at diagnosis, one‐third of these tumours demonstrate malignant features and recur locally or metastasize, usually with a fatal outcome. In 1995, a morphologically unique variant, termed lipomatous haemangiopericytoma (L‐HPC), was described. Only one case has been reported previously arising in the orbit. In this paper, a case is reported of L‐HPC occurring in the orbit and consider the prognostic implications of this HPC variant.
MAGNIFYING ENDOSCOPY FOR THE DIAGNOSIS OF EARLY GASTRIC CANCER
Authors: Niwa Yasumasa , Goto Hidemi , Ohmiya Naoki , Ohtsuka Yasurou , Ando Nobuhiro
Published: March 2003

Magnifying endoscopy of stomach cancer requires observation of minute structure and minute vessel patterns of the mucosal surface. The small pits, various‐sized pits, irregularly branched pits and irregular vessels were found to be characteristics as the surface structure of early gastric cancer. Small pits were commonly observed on the differentiated type of early gastric cancer (88%) compared with the undifferentiated type (50%). We found it important to analyze not only the minute vessel patterns, but also the minute surface structure to ensure magnifying endoscopic observation using 0.1% indigo‐carmine and the binarized images would be effective in determining the margin of the lesion. The relationship between the findings of magnifying endoscopy in cancer and the histology should now be investigated. Applying the techniques mentioned above, more delicate observation in the regular endoscopy and prudent photographing to obtain clear images might be promoted. Thus, this would contribute to endoscopy with a concept similar to optical biopsy, and which can depend on the usual biopsy methods.
ENDOSONOGRAPHIC CLASSIFICATIONS OF GASTROINTESTINAL SUBMUCOSAL TUMORS
Authors: Hizawa Kazuoki , Kawasaki Masumi , Kouzuki Toshio , Suekane Hiroshi , Matsumoto Takayuki , Fujishima Masatoshi
Published: March 2003

Aim: The aim of this study was to classify the endosonographic features of gastrointestinal submucosal tumors.

Methods: The endosonographic and clinicopathologic findings of 302 submucosal elevated lesions from 295 patients were compared.

Results: Endoscopic ultrasound was able to clearly demonstrate the anatomical layer origin of the lesions. The internal echo patterns of the submucosal tumors could be categorized into seven types consisting of simple cystic (I), multicystic (II), solid cystic (III), hyperechoic (IV), isoechoic (V), hypoechoic (VI), and mixed solid (VII). Cysts, lymphangioma, and lipoma were characterized as type I, II, and IV images, respectively. Brunner’s gland hamartoma and heterotopic gastric mucosa showed various patterns of cystic and solid echoes (I–VII). Inflammatory fibroid polyps, granular cell tumors, and carcinoid tumors often manifested type VI images. Malignant tumors, particularly leiomyosarcoma, tended to show VII images.

Conclusions: The endosonographic classification is considered to be important in the diagnosis of gastrointestinal submucosal elevated lesions.
CASE OF A SEVERE AND LONG BENIGN STRICTURE OF THE ESOPHAGUS
Authors: Yoshida Tatsuya , Nagahama Takeshi , Takizawa Toichiro
Published: March 2003

A unique case of a severe and long benign stricture of the esophagus was experienced by the authors. A 50‐year‐old alcoholic man was admitted to our hospital complaining of dysphagia as well as severe and continuous retrosternal burning pain of acute onset after abrupt vomiting. His previous medical history included alcoholic liver dysfunction, renal dysfunction, Klinefelter’s syndrome and a surgically treated duodenal ulcer. Ingestion of foreign body or acid/alkali substances was excluded. Although histopathologic examination of the endoscopic biopsy specimen was reported to be an esophageal squamous cell carcinoma, endoscopic findings and a barium esophagogram were not typical for a malignant disease. Since this study demonstrated a smooth surface of the lumen in spite of it being approximately 10 cm long, severe stricture of the esophagus was diagnosed. Because the stricture was very long and severe, and was not conservatively treatable, it was decided, after obtaining informed consent, that surgical resection of the esophagus would be performed. Subtotal esophagectomy with lymph node dissection and colonic interposition was carried out. During surgery, the patient was diagnosed as having liver cirrhosis. Histopathologic examination of the surgically resected specimen revealed a 10 cm‐long narrowing of the middle and lower thoracic esophagus with thick walls, particularly in the inner circular muscle layer, without malignancy. Unfortunately, the patient’s postoperative course was followed by cervical leakage. He subsequently died of multiple organ failure on the sixteenth postoperative day. It is worth keeping in mind that esophageal benign stricture with longitudinal ulceration can be induced by esophageal submucosal dissection, as seen in the present case.
Case of Gastric Lymphoma Diagnosed by Laparoscopic Excision Biopsy
Authors: Abe Sadanori , Otani Yoshihide , Ohgami Masahiro , Furukawa Toshiharu , Kubota Tetsuro , Kumai Koichiro , Iwao Yasushi , Mukai Makio , Kitajima Masaki
Published: March 2003

Primary gastric lymphoma is a relatively uncommon disease and sometimes forms submucosal growth causing difficulty of diagnosis. We have reported a case of primary gastric lymphoma successfully diagnosed by laparoscopic wedge resection, after repeatedly performing endoscopic forcep biopsies. Diagnostic laparoscopy for obtaining definite histological diagnosis can be regarded as minimally invasive, accurate and safe.
Endoscopic Variceal Ligation of Bleeding Rectal Varices: A Case Report
Authors: Shudo Ryushi , Yazaki Yasuyuki , Sakurai Shinobu , Uenishi Hiroshi , Yamada Hiroto , Sugawara Kenji
Published: March 2003

The incidence of ectopic varices in the rectum is likely to increase with improvements in the treatment and survival of patients with portal hypertension. If a patient with portal hypertension suffers massive lower gastrointestinal hemorrhage, it is important to perform a detailed endoscopic examination, as there is a possibility of rectal varices. Although a standard therapy for rectal varices has not been established, we encountered a case of rectal varices that was successfully treated with endoscopic variceal ligation alone. Endoscopic variceal ligation is minimally invasive, safe, effective, simple and reliable. Endoscopic variceal ligation is promising as a possible first line of therapy for rectal varices.
ENDOSCOPIC IMAGE OF SECONDARY AORTOENTERIC FISTULA
Authors: Ikeno Tatsuo , Sugiyama Atsushi , Nishimaki Keiji , Arai Masayuki , Urayama Hiroaki , Kawasaki Seiji
Published: March 2003

Surgical treatment of abdominal aortic aneurysms by resection of the aneurysm and graft replacement is now an accepted procedure, but this has led to various postoperative complications. One example of this is secondary aortoenteric fistula. The diagnosis of aortoenteric fistula is often difficult to establish. We report a case of aortoenteric fistula that occurred 1 year after resection of the aneurysm and graft replacement. A 69‐year‐old man was admitted to our hospital following a sudden episode of melena. He had undergone aorto‐bifemoral bypass surgery with a prosthetic graft 1 year previously for abdominal aortic aneurysm. Upper gastrointestinal endoscopy and computed tomography scan were performed and aortoenteric fistula as a result of aortic anastomotic pseudoaneurysm, was diagnosed. In the first stage operation, an extra‐anatomic bypass was implanted from the right axillary artery to both femoral arteries. Removal of the graft and aortic stump closure were carried out in the second stage. The patient recovered uneventfully. This case shows the use of endoscopy for early diagnosis of secondary aortoenteric fistula.
Size, location and patency of the minor duodenal papilla as determined by dye‐injection endoscopic retrograde pancreatography
Authors: Kamisawa Terumi , Tu Yuyang , Egawa Naoto , Sakaki Nobuhiro , Ishiwata Jun‐ichi , Okamoto Atsutake
Published: March 2003

Background: The accessory pancreatic duct (APD) sometimes is developmentally obliterated near the duodenum. We evaluated patency of the minor duodenal papilla by dye‐injection endoscopic retrograde pancreatography to determine whether patency was related to papillary size and location.

Methods: We injected 2–3 mL of contrast material containing indigocarmine into the main pancreatic duct via an endoscopic catheter in 104 patients. It was endoscopically observed whether dye was extruded from the minor papilla. Size of the minor papilla and distance from the orifice of the major duodenal papilla to the apex of the minor papilla were measured endoscopically with measuring forceps.

Results: The APD was patent in 56 of 104 cases (54%). Size of the minor papilla varied considerably from 3 to 6 mm, but showed no correlation with patency. Half of the patients with chronic pancreatitis (6/13) had the minor papilla larger than 6 mm. In cases where the terminal APD had a cudgel or tapering‐off configuration, the minor papilla was larger than in cases where the duct had a stick shape. The minor papilla was patent in 9 out of 10 cases (90%) when it was near the major papilla (≤ 1.5 cm). Frequency of a patent minor papilla was 16 out of 33 (48%) when it existed 1.5 to 2.0 cm from the major papilla, and 31 out of 61 (51%) when the distance was more than 2.0 cm.

Conclusions: The minor papilla was more frequently patent when it was close to the major papilla (P < 0.05).
Non‐alcoholic sclerosing pancreatitis with Sjögren's syndrome and tubulointerstitial nephritis
Authors: Yamada Masahiko , Ichikawa Masafumi , Tamai Hirofumi , Fu Kyo , Ishikawa Shigeto , Ozeki Masayasu , Suzuki Satoshi , Ishiguro Yoshihiro , Matsunaga Kazuya , Yokoi Syunpei
Published: March 2003

We recently encountered a 56‐year‐old Japanese man with pancreatitis who had hyperglobulinemia, was autoantibody‐positive and responded to steroid therapy. The patient had been found to have asymptomatic proteinuria at an annual medical check‐up and had experienced a dry mouth for several years. He was diagnosed as having Sjögren's syndrome indicated by the dry mouth and positive findings from a lip biopsy and a Schirmer's test. Tubulointerstitial nephritis, causing proteinuria, was verified by percutaneous renal biopsy. Antinuclear antibody was positive at the 1 : 160 titer. Serum γ‐globulin and IgG values were markedly increased, whereas complement components C3 and C4 were lowered. Abdominal computed tomography and ultrasonography demonstrated a diffusely enlarged pancreas without localized pancreatic mass or para‐aortic lymphadenopathy. Neither calcification nor cysts were detected in the pancreas. Endoscopic retrograde cholangiopancreatography revealed a diffuse narrowing of the main pancreatic duct with an irregular wall. Wedged biopsy specimens of the pancreas by an exploration of the abdomen showed prominent lymphocytic infiltrates including some plasmacytes, as well as decreased exocrine parenchyma and inter‐ and intralobular fibrosis. These findings suggested a diagnosis of autoimmune‐related pancreatitis. Steroid therapy was carried out with a marked improvement of his clinical symptoms and laboratory data.
Factors affecting the yield of percutaneous cholangioscopic biopsy in patients with bile duct cancer
Authors: Park Ju Sang , Seo Dong Wan , Lee Sung Koo , Joo Yeon‐Ho , Kim Myung Hwan , Min Young Il
Published: March 2003

Background: This study analyzed the factors associated with the yield of percutaneous transhepatic cholangioscopic biopsies in patients with bile duct cancer.

Methods: One‐hundred‐and‐sixteen patients who had received percutaneous transhepatic cholangioscopy and who had been confirmed as having bile duct cancer were enrolled in this study. Multiple targeted biopsies were taken under direct cholangioscopic view.

Results: When the location of the tumor was divided into intrahepatic duct (IHD), hilar duct and common bile duct (CBD), the biopsy yield was significantly higher in IHD cancer (93.7%) than in cases of hilar cancer (69.6%) (P < 0.05). After a bile duct cancer had been classified as a nodular type (n = 31), papillary type (n = 27) or infiltrative type (n = 58) cancer upon cholangioscopic findings, the biopsy yields from nodular (96.8%) or papillary types (96.3%) were significantly higher than from infiltrative types (58.6%; P < 0.01). The positive rate for malignant cells was not influenced by the presence of tumor vessels or the number of biopsy samples taken. However, the sensitivity of the combination of cholangioscopic biopsy and tumor vessel in overall bile duct cancer, especially in the infiltrative type, was significantly increased when it was compared with that of cholangioscopic biopsies (P < 0.01) or tumor vessels alone (P < 0.01).

Conclusions: Cholangioscopic biopsy provides a high positive yield of malignant cells in those patients with IHD, nodular‐type and papillary‐type cancers. The cholangioscopic classification of bile duct tumors might thus provide important clues to predict biopsy yield.
Gastric vascular ectasia treated by endoscopic mucosal resection
Authors: OKAMOTO TETSU , OKAYAMA YASUTAKA , HIRAI MASAAKI , KITAJIMA YASUHIRO , HAYASHI KAZUKI , IMAI HIDETO , AKITA SHINJI , GOTOH KAZUO , OHARA HIROTAKA , NOMURA TOMOYUKI , JOH TAKASHI , YOKOYAMA YOSHIFUMI , ITOH MAKOTO
Published: March 2003

An 80‐year‐old woman consulted our hospital complaining of general weakness. She had iron deficiency anemia, and upper gastrointestinal endoscopy revealed a small lesion accompanying a small amount of fresh bleeding in the stomach. Close observation of the lesion revealed that it was composed of a local assembly of dilated microvessels. The diagnosis of this patient was gastric vascular ectasia causing anemia. Endoscopic ultrasonography demonstrated that the lesion involved the mucosal and submucosal layers of the stomach, and that there were no large vessels inflowing to or outflowing from the lesion. In the present case, we attempted endoscopic mucosal resection (EMR). The lesion was completely resected by only one procedure of EMR without complications such as bleeding. After the endoscopic treatment, iron deficiency anemia improved. Follow‐up endoscopy performed 1 year later revealed that there was no residual or recurrent lesion. Although there have not been any published reports describing the use of EMR for gastric vascular ectasia, EMR may be a useful endoscopic treatment for this condition.
Successful treatment with topical mesalazine for a patient with intractable crohn’s colitis
Authors: KONO MIZUKI , OSHITANI NOBUHIDE , SAWA YOSHINORI , HIGUCHI KAZUHIDE , MATSUMOTO TAKAYUKI , ARAKAWA TETSUO
Published: March 2003

A 32‐year‐old woman was admitted to our hospital for intractable Crohn’s disease. Crohn’s colitis was diagnosed at another hospital in August 1999. She had been successfully treated with oral mesalazine and an elemental diet. In March 2000, she had been admitted to the previous hospital for her third flare up of symptoms. She responded to oral mesalazine administration and total parenteral nutrition, but bowel symptoms were exacerbated and C‐reactive protein level was elevated after a polymeric diet was started. Prednisolone 30 mg/day was started in addition to total parenteral nutrition, but hematochezia and elevated serum C‐reactive protein level persisted, and she was referred to our hospital. She had about four bowel movements per day with fresh bleeding at the time of admission. Total parenteral nutrition and oral mesalazine were continued. The dose of oral prednisolone was increased from 15 mg/day to 40 mg/day. However, the frequency of bowel movements did not decrease and C‐reactive protein level continued to exceed 1.5 mg/day. Mesalazine enemas were begun on 23 January 2001, and were effective in improving hematochezia and serum C‐reactive protein. Both radiologic and endoscopic examinations revealed remarkable improvement.
Acute Gastric Mucosal Injury Caused by Ingestion of Chlorinated Fungicide
Authors: Kasamaki Shinji , Kobayashi Shigeru , Hayashida Yasuo , Hirai Shu , Ochiai Takumi , Motoyama Hironobu , Yokota Hiroo
Published: March 2003

We encountered a patient with acute gastric mucosal injury caused by ingestion of a chlorinated fungicide. Approximately 15 h after the episode of ingestion, endoscopic views were compatible with the acute gastric mucosal lesion of severe degree throughout the stomach. At that time, endoscopic biopsy showed congestion in the epithelial layer of the mucosa, along with lymphocytic infiltration that had likely existed from the onset of the condition. On the third day, the mucosal lesion looked more serious with peculiar hemorrhagic folds, and biopsy revealed exfoliation of the epithelial surface and neutrophilic infiltration in the stroma of the epithelial layer. On the seventh day, endoscopic images showed persistence of the lesion, but biopsy demonstrated the development of regenerating epithelium along with a marked reduction in infiltration of neutrophils and edema in the stroma.
Endoscopic Injection Sclerotherapy for the Treatment of Recurrent Esophageal Varices after Esophageal Transection
Authors: Yoshida Hiroshi , Onda Masahiko , Tajiri Takashi , Toba Masahito , Umehara Matsuomi , Mamada Yasuhiro , Taniai Nobuhiko , Yamashita Kiyohiko
Published: March 2003

Background:  We examined the hemodynamic changes associated with recurrent esophageal varices after esophageal transection (ET) and evaluated the effectiveness of endoscopic injection sclerotherapy (EIS) as the treatment for these varices.

Methods:  Nineteen patients with recurrent esophageal varices after ET were treated by EIS. Endoscopic varicealography during injection sclerotherapy, following oral blockage of flow by a balloon, identified three patterns: (i) type 1: common type, continuous filling by the feeder vessel of the varix; (ii) type 2: retrograde‐disappearing type, confirmed hepatofugal flow; and (iii) type 3: immediate washout type, immediate washout of contrast medium.

Results:  Angiography revealed that the hepatofugal feeder vessel was the right gastric vein in all cases. Fourteen patients (73.7%) were classified as type 1, 4 patients (21.1%) as type 2, and 1 patient (5.3%) as type 3. Fewer treatment sessions were required in type 1 than in type 2 (P < 0.005). Recurrent varices were completely eradicated in all patients except the patient with type 3 disease. Cumulative re‐recurrence rates at 5 and 10 years were similar for types 1 and 2 (28.6 and 71.4%vs 25 and 25%, respectively). The cumulative survival rates after EIS at 5 and 10 years were also similar for types 1 and 2 (77.1 and 66.1%vs 66.7 and 66.7%).

Conclusion:  Endoscopic injection sclerotherapy is an effective treatment for recurrent esophageal varices after ET, except in type 3 disease. Our classification based on endoscopic varicealography during injection sclerotherapy provides knowledge of blood flow within the varices that helps to inform the treatment strategy.
EVALUATION OF ENDOSCOPIC HEMORRHOIDAL LIGATION IN 119 PATIENTS
Authors: Tomiki Yuichi , Higashiyama Akinori , Okada Tsuyoshi , Watanabe Tomoo , Sengoku Hironobu , Kamano Toshiki , Tsurumaru Masahiko , Hayashida Yasuo , Seki Eichiro , Sakurai Hideki , Fujii Yuji , Gonda Hirofumi
Published: March 2003

Background:  Rubber‐band ligation of internal hemorrhoids is a well‐established office procedure. In addition, endoscopic rubber‐band ligation of esophageal varices has become widely accepted. Combining and modifying these techniques, we have conducted endoscopic hemorrhoidal ligation (EHL) since 1993, and we feel that it is appropriate now to evaluate the procedure.

Methods:  One hundred and nineteen patients who were subjected to EHL were followed and evaluated.

Results:  Endoscopic hemorrhoidal ligation was markedly effective in 67 cases (56.3%), effective in 41 cases (34.5%), and ineffective in 11 cases (9.2%). Out of the 11 ineffective cases, three of them received surgical hemorrhoidectomy and eight were treated by conservative measures with frequent or continuous use of suppositories. The most common complications after EHL were postoperative anal pain and slight bleeding. Out of 92 patients followed long‐term, the 5‐year non‐recurrence rate was 90.4%. Persistent therapeutic effects were observed in 62 patients (67.4%), whereas 22 patients (23.9%) had to be treated by suppositories and/or ointments as necessary, and eight patients (8.7%) had a relapse. Out of the eight relapsed cases, four received repeated EHL with symptomatic remission, two received hemorrhoidectomy, and two were treated conservatively.

Conclusion:  Endoscopic hemorrhoidal ligation is an effective method for treating internal hemorrhoids. However, indications for this treatment should be properly decided in each patient, using their history, and general and local conditions.
CHANGES IN MUCOSAL PHOSPHOLIPID‐RELATED PROTECTION IN SOME GASTRIC DISEASES
Authors: MATSUDA MIMIAN GRACIELA , MISUMI ATSUNOBU , MURAKAMI AKITOSHI , NAKAMURA CHIZUKO , SEMBA UMEKO , SHIBUYA YOKO , MIYAZAKI SEBASTIÃO MITSUJI , OKABE HIROAKI
Published: March 2003

Background:  Phospholipids play an important role in gastric mucosal protection. The purpose of the present study was to investigate changes in various phospholipids in the fundic and pyloric gland mucosae of patients with gastric mucosal disease.

Methods:  One hundred and five patients with superficial gastritis, duodenal ulcer, gastric ulcer or gastric cancer were studied. Patients underwent endoscopy to obtain biopsy specimens from both the fundic and pyloric gland mucosae. The phospholipid contents were measured by high performance liquid chromatography.

Results:  Total phospholipid level was significantly greater in the fundic gland mucosa than in the pyloric gland mucosa (P = 0.037), and the level in the fundic gland mucosa was high in all four gastric diseases studied. The difference was significant in patients with gastric ulcers (P = 0.0156). Total phospholipid levels were the highest in superficial gastritis, followed by duodenal ulcer, gastric ulcer and gastric cancer. In all four gastric diseases, phosphatidylserine (PS), phosphatidylethanolamine (PE), and phosphatidylcholine (PC) levels were high, while phosphatidylinositol, lysophosphatidylcholine, and sphingomyelin levels were low. The PE and PC levels were higher in the fundic gland mucosa than in the pyloric glandular mucosa, whereas the PS level was higher in the pyloric gland mucosa than in the fundic gland mucosa.

Conclusions:  The fundic gland mucosa has stronger phospholipid‐related protection than the pyloric gland mucosa, based on the levels of mucosal phospholipids. The main phospholipids for gastric mucosal protection are PC and PE (in the fundic gland mucosa) and PS (in the pyloric gland mucosa). Phospholipid‐related protection is strong in superficial gastritis and duodenal ulcer, but is reduced in the pyloric gland mucosa in patients with gastric ulcers, and in both gastric gland mucosae in patients with gastric cancer.
ADENOCARCINOMA IN SITU ARISING FROM THE ECTOPIC SUBMUCOSAL CARDIAC GLANDS OF SHORT‐SEGMENT BARRETT's EPITHELIUM
Authors: Abe Sadanori , Kojima Masao , Kurihara Hiroaki , Tamura Hikaru , Kitago Minoru , Sasanuma Hideyuki , Wada Masahiro , Ogihara Tomonobu , Sato Yukihiro , Saito Ken
Published: March 2003

Adenocarcinoma of the esophagocardiac junction is a condition difficult to define. It is often necessary to differentiate between esophagocardiac junctional adenocarcinoma and carcinoma in Barrett's esophagus. We herein report a case of an 83‐year‐old Japanese man with adenocarcinoma in situ arising from ectopic submucosal cardiac glands in short‐segment Barrett's epithelium, associated with squamous cell carcinoma. Despite the visualization of a nodule in short‐segment Barrett's epithelium, we diagnosed the present case as one of esophagocardiac junctional cancer arising from ectopic submucosal cardiac glands, using Alcian‐blue staining.
Inhibitory effect of sulindac on the proliferation of HT‐29 colon adenocarcinoma cells: Effects on cell cycle and apoptosis
Authors: Zhengbing Yang , Qin Ouyang , Yuquan Wei , Xiaoqin Liu , Song Lei
Published: March 2003

OBJECTIVE: To investigate: (i) the effect of sulindac on the proliferation of HT‐29 cells; and (ii) the antineoplastic mechanisms of sulindac.

METHODS: The MTT colorimetric assay was used to examine the effect of sulindac on the proliferation of HT‐29 cells. Flow cytometry was used for examining the cell cycle distribution. Flow cytometry, transmission electron microscopy and DNA electrophoresis were used to determine whether sulindac induces cell apoptosis.

RESULTS: Sulindac inhibited cell proliferation in a time‐ and dose‐dependent manner. After treatment with 0.3, 0.6, 0.9 and 1.2 mmol/L sulindac for 72 h, the inhibition rates reached 16, 38, 62.3 and 92.2%, respectively. After treatment with 1.2 mmol/L sulindac for 24, 48 and 72 h, the inhibition rates reached 32.4, 71.3 and 92.2%, respectively (P < 0.05). Sulindac increased the proportion of cells in the G0/G1 phase and decreased the proportion of cells in the S phase of the cell cycle. After treatment with 1.2 mmol/L sulindac for 48 h, the proportion of cells in the G0/G1 phase increased from 32.5 to 70.5% and the S phase decreased from 43.1 to 11.3% compared with the control cells (P < 0.01). Flow cytometry, DNA electrophoresis and transmission electron microscopy all demonstrated that sulindac could induce apoptosis of the HT‐29 cell line. After treatment with 0.3, 0.6 and 1.2 mmol/L sulindac for 48 h, the proportion of apoptotic cells reached 5.8, 7.6 and 11.7%, compared with 2.9% in the control group; after treatment for 72 h, the proportion of apoptotic cells increased to 12.5, 15.4% and 24.2%, respectively (P < 0.05). All effects were time and dose dependent.

CONCLUSIONS: The colon adenocarcinoma HT‐29 cell line can be inhibited by sulindac and the antitumor mechanism may be related to changing cell cycle distribution and inducing cell apoptosis.
Role of signal transduction pathway of mitogen‐activated protein kinase on metastasis of hepatocellular carcinoma induced by VEGF
Authors: Hua Mao , Aili Yuan , Minfang Zhao , Zuosheng Lai
Published: March 2003

OBJECTIVE: Vascular endothelial growth factor (VEGF) plays an important role in angiogenesis, infiltration and metastasis in cancer. However, the associated signal transduction pathway remains unclear. The present study aimed to observe the effect of signal transduction induced by VEGF on p38 mitogen‐activated protein kinase (MAPK) during metastasis in hepatocellular carcinoma.

METHODS: The membrane invasion culture system (MICS) and SB203580, a blocker of p38 MAPK were used to observe the inhibitory effect of VEGF on metastasis in hepatocellular carcinoma.

RESULTS: The numbers of cells in the lower compartment of the Boden chamber with or without SB203580 were 16 × 104 and 0.75 × 104/mL, respectively, after being cultured for 5 h with 5 ng/mL VEGF. These values were markedly higher than the number of cells (1.25 × 104/mL) in the control group (P < 0.01). Pretreatment with 5 μmol/L SB203580 was able to block metastatic potential by 95% in hepatic cancer, the hepatocarcinoma cell number cultured for 5 h with 1 ng/mL VEGF, 5 ng/mL VEGF, 10 ng/mL VEGF in amnia was 15, 42 and 28, respectively, as compared with the control (4 cells), these were highly significant (P < 0.05, P < 0.01). When compared with group of 1 ng/mL VEGF, and group 10 ng/mL VEGF, the carcinoma cell number of group of 5 ng/mL VEGF was also highly significant (P < 0.05).

CONCLUSIONS: Via the p38 MAPK signal transduction pathway, VEGF is able to induce metastasis in hepatic carcinoma. However, when this particular pathway was blocked with SB203580, then metastasis was inhibited.
Histomorphological characteristics of liver tissue in patients with chronic viral hepatitis
Authors: ZENG Wen Jiao , ZHANG Nong , LIU Chen , XU Jie , ZHAO Zhong Hua , GUO Mu Yi
Published: March 2003

OBJECTIVE: Chronic viral hepatitis and cirrhosis caused by hepatitis B virus (HBV), hepatitis C virus (HBC) or both constitute the majority of cases of liver diseases in China. Pathologists often need to differentiate between the morphological features of HBV and HCV. The aim of this study was to explore the differences in inflammatory activity, fibrosis and morphological characteristics in various types of chronic viral hepatitis.

METHODS: Inflammatory activity and degree of fibrosis in liver biopsies
taken from 224 patients with chronic hepatitis were determined according to the Diagnostic
Criteria of Chronic Hepatitis, China, 1995. Each of hepatitis B surface antigen
(HBsAg), hepatitis B core antigen (HBcAg) and the hepatitis C virus nuclear core
protein (CP10) were detected on paraffin sections of the biopsies by using immunohistochemical methods. Patients were divided into HBV, HCV and HBV + HCV infection groups and the differences among these groups were assessed on the basis of histopathological characteristics including inflammatory activity, fibrosis, steatosis, intrahepatic cholestasis, Councilman bodies and ground‐glass hepatocytes.

RESULTS: The HCV infection group had more severe inflammatory activity, fibrosis and intrahepatic cholestasis than did the HBV infection group. The degree of inflammatory activity and fibrosis in the HBV + HCV infection group was moderate, but the degree of intrahepatic cholestasis was the most severe of the three study groups. Ground‐glass hepatocytes were only noted in HBV‐infected specimens. There was no difference in the occurrences of steatosis and Councilman bodies among the three study groups.

CONCLUSIONS: The degree of inflammatory activity and fibrosis induced by HCV in hepatocytes is more severe than that induced by HBV. The histological changes observed in liver infected by both HBV and HCV are no more severe than those observed in liver infected with either HBV or HCV. Intrahepatic cholestasis may play an important role in aggravating damage to hepatocytes.
Long‐term infection with Helicobacter pylori in Mongolian gerbils
Authors: YAO Yong Li , ZHANG Wan Dai , XU Bo , SONG Yu Gang , ZHANG Ya Li , ZHANG Zhen Shu
Published: March 2003

Objective:  To investigate pathological changes occurring in the stomach of the Mongolian gerbil during long‐term Helicobacter pylori infection.

Methods:  Four‐week‐old male Mongolian gerbils were used, which were free from specific pathogens. Eighty Mongolian gerbils were inoculated orally with a suspension of H. pylori NCTC 11637 (0.5 mL, 2 × 1010 CFU/L) in a Brucella broth. To act as controls, a further 30 gerbils were fed with a Brucella broth only. Infected gerbils were killed 10, 25, 45, 55 and 65 weeks after infection. Control gerbils were killed at 10, 45 and 65 weeks. The stomach of each gerbil was removed and opened. Stomach samples for histological examination were fixed in neutral buffered formalin, embedded in paraffin, sectioned and stained with hematoxylin and eosin for analyzing histological changes, Giemsa stain for detecting H. pylori and Alcian blue (AB)/periodic acid−Schiff stain for examining intestinal metaplasia.

Results:  The Mongolian gerbil model for studying long‐term H. pylori infection was successfully established. Helicobacter pylori induced a progression from normal gastric mucosa to chronic gastritis, glandular atrophy, intestinal metaplasia and dysplasia, although no adenocarcinomas were found in the experimental animals.

Conclusions:  Helicobacter pylori
NCTC 11637 is able to easily colonize the glandular stomach mucosa of the Mongolian gerbil. This model is stable, and the histological changes observed in the stomach are similar to those that occur in humans with
H. pylori infection.
Clinical significance of liver biopsy in chronic hepatitis B patients with persistently normal transaminase
Authors: YANG Liu Ming , XU Ke Cheng , ZHAO Yan Long , WU Zhi Rong , CHEN Tu Fang , QIN Zhuo Ying , ZUO Jian Sheng , WEI Bei Hai
Published: March 2003

OBJECTIVE:  The aim of this study was to study the clinical significance of liver biopsy for individuals who had chronic hepatitis B virus infection and persistently normal serum transaminases for more than 6 months.

METHODS:  A total of 452 patients with positive hepatitis B surface antigen for over 6 months underwent percutaneous liver biopsy. All liver biopsy specimens were assessed by experienced liver pathologists blinded to the liver biochemistry, and were scored according to the modified criteria of grade and stage of chronic hepatitis. Patients were divided into four groups: group A and group C patients had normal transaminases, and were hepatitis B e antigen (HBeAg) positive and HBeAg negative, respectively; group B and group D patients had elevated transaminases, and were HBeAg positive and HBeAg negative, respectively.

RESULTS:  All patients had necrosis and inflammation in the liver. Patients with increased serum transaminases had a significantly higher grade (G) of hepatic necrosis and inflammation and more severe (S) fibrosis compared with patients with normal transaminases (P < 0.05). However, in the latter patients, G3 was seen in 10 (5.5%) and 13 cases (9.1%), S3 in seven (3.8%) and 16 cases (11.1%), and S4 in three (1.6%) and seven cases (4.9%) in Group A and Group C, respectively. Moreover, in patients with normal transaminases, the HBeAg‐negative group had more severe fibrosis than the HBeAg‐positive group (P < 0.05).

CONCLUSION:  Although more severe pathological changes were more frequent in patients with elevated transaminases, significant hepatic pathology could still be found in cases with persistently normal transaminases. Liver biopsy in cases of chronic hepatitis B virus infection is helpful to accurately assess both the activity of the disease and the degree of fibrosis, and to estimate if antiviral therapy is justifiable. Patients with normal transaminases and serious hepatic necrosis, inflammation and fibrosis need proper management.
Multicenter randomized controlled trial of heat‐killed Lactobacillus acidophilus LB in patients with chronic diarrhea
Authors: XIAO Shu Dong , ZHANG De Zhong , LU Hong , JIANG Shi Hu , LIU Hou Yu , WANG Geng Sheng , XU Guo Ming , ZHANG Zhong Bing , LIN Geng Jin , WANG Guo Liang
Published: March 2003

OBJECTIVE:  Chronic diarrhea is a common bowel disorder, and disturbance of intestinal microorganisms may play a role in its pathogenesis. The aim of this study was to assess the clinical efficacy of lyophilized heat‐killed Lactobacillus acidophilus LB compared with living lactobacilli in the treatment of chronic diarrhea.

METHODS:  One hundred and thirty‐seven patients with chronic diarrhea were randomly allocated to receive either a 4‐week course of two capsules of Lacteol Fort twice a day as the Lacteol group (69 patients completed the course) or a 4‐week course of five chewable tablets of Lacidophilin three times a day as the Lacidophilin group (64 patients completed the course). The frequency of stools was recorded quantitatively and the semiquantitative parameters such as stool consistency, abdominal pain, distension and feeling of incomplete evacuation were evaluated.

RESULTS:  At the second and fourth week of the treatment, the mean bowel frequency was significantly lower in the Lacteol group than in the Lacidophilin group (1.88 ± 1.24 vs 2.64 ± 1.12, 1.39 ± 0.92 vs 2.19 ± 1.05, respectively; P < 0.05). At the end of the treatment, the clinical symptoms were markedly improved in the Lacteol group.

CONCLUSIONS:  Lactobacillus acidophilus LB is more effective than living lactobacilli in the treatment of chronic diarrhea.
Study on functional constipation and constipation‐predominant irritable bowel syndrome by using the colonic transit test and anorectal manometry
Authors: ZHAN Li Xing , ZHOU Duo Wu , XU Guo Ming , LI Zhao Shen , YIN Nin , ZHANG Mei Qin
Published: March 2003

OBJECTIVE:  To investigate the visceral perception, anorectal pressure and colonic transit time (CTT) in patients with functional constipation and constipation‐predominant irritable bowel syndrome (C‐IBS), and to study the manometric abnormalities of these two conditions.

METHODS:  The CTT in patients with functional constipation and C‐IBS was studied by using radiopaque markers. Rectal visceral perception thresholds, rectal compliance and anorectal pressure were examined by electric barostat.

RESULTS:  The CTT in both groups of constipated patients was abnormal. A lot of radiopaque markers remained in the right colon in C‐IBS patients, whereas in patients with functional constipation, the radiopaque markers remained in each segment of the colon. The anorectal resting pressure, squeezing pressure and relaxation pressure were normal in both groups. Rectal compliance and defecation thresholds were much higher compared with controls, and the rectal visceral perception of functional constipation was also abnormal.

CONCLUSIONS:  The motility abnormalities of functional constipation and C‐IBS occurred in different colonic segments. Results suggest that CTT measure­ment and anorectal manometry could be helpful in the differential diagnosis of these two conditions.