bluuebunny/crossref_metadata_2025 huggingface dataset:
HYPO‐OSMOTIC STRESS INHIBITS DOXORUBICIN‐INDUCED APOPTOSIS VIA A PROTEIN KINASE A‐DEPENDENT MECHANISM IN CARDIOMYOCYTES
Authors: D'Anglemont De Tassigny Alexandra , Ghaleh Bijan , Souktani Rachid , Henry Patrick , Berdeaux Alain
Published: July 2004

1. The clinical use of doxorubicin is limited by the development of severe cardiomyopathies linked, at least in part, to an abnormal increase in the rate of apoptotic cell death. Because cell shrinkage is considered to be a crucial step at the onset of apoptosis, the aim of the present study was to investigate whether a brief hypo‐osmotic stress, which leads to an increase in cell volume, could interfere with the induction of apoptosis by doxorubicin in adult cardiomyocytes.

2. Cell volume expansion results in intracellular accumulation of cAMP, so we secondarily tested whether the protective effect of hypo‐osmotic stress could be related to the cAMP pathway. Accordingly, apoptosis was induced by doxorubicin (1 µmol/L) in cardiomyocytes freshly isolated from New Zealand adult rabbit hearts.

3. Exposure to doxorubicin in an iso‐osmotic medium (290 mOsmol/kg H2O) induced a rapid decrease in cell volume, as well as increases in annexin V labelling and caspase‐3 activity, two biological markers of apoptosis. These effects of doxorubicin were abolished by 15 min pretreatment with hypo‐osmotic stress at 220 mOsmol/kgH2O (HS 220).

4. This cytoprotective effect of HS 220 was still observed when doxorubicin was added to the medium 60 min later, but it was abolished when the pretreatment by HS 220 was associated with the protein kinase A inhibitor KT 5720 (200 nmol/L).

5. Conversely, 15 min pretreatment with either the cAMP analogue 8‐bromo‐cAMP (0.5 mmol/L) or the adenylate cyclase activator forskolin (10 µmol/L) inhibited apoptosis induced by doxorubicin.

6. In conclusion, these results demonstrate that: (i) apoptosis induced by doxorubicin can be counteracted by a hypo‐osmotic stress in adult cardiomyocytes; and (ii) activation of the protein kinase A‐dependent pathway plays a major role in the mechanism leading to the cytoprotective effect induced by a hypo‐osmotic stress.
CURRENT STATUS OF ENDOSCOPIC TREATMENT FOR UPPER GASTROINTESTINAL STRICTURE: CHAIRPERSON's REVIEW
Authors: Inoue Haruhiro , Yao Kenshi
Published: July 2004

Endoscopic management for upper gastrointestinal stricture has been discussed. First‐line treatment for unresectable esophageal cancer is chemothepary (or chemoradiotheapy). When the first‐line treatment is not effective, intubation of self expandable metallic stent (SEMS) is considered. A poor‐risk patient who has no tolerance to radiochemotherapy is also a candidate for direct SEMS stenting. Prompt recovery from dysphagia is the major advantage to SEMS stenting. Nevertheless, SEMS stenting is a non‐curative treatment to the original disease and it induces a temporary relief only from dysphasia. Bleeding, perforation, and re‐stenosis are often encountered drawbacks after intubation of SEMS. Stricture after widespread EMR may also be successfully controlled by temporarily stenting of covered SEMS. Balloon dilatation or Botox injection is used to control stricture in achalasia, but the effectiveness is limited to short duration of relief from dysphasia. For complete response to stricture of achalasia, laparoscopic surgery is mandatory.

Stenting to gastric outlet obstruction is one of the treatment choices that induces temporary but rapid recovery from dysphasia. However, the patient is still exposed to risks of bleeding, perforation, and re‐stenosis continuously after SEMS intubation. Its efficacy should be clarified by further studies. Chemotherapy is also recognized as a first‐line treatment for unresectable gastric cancer. Chemotherapy has a small chance to cure the disease, but stenting has no chance to cure the cancerous disease.
TREATMENT STRATEGIES FOR ESOPHAGEAL STRICTURE BEFORE OR AFTER CHEMORADIOTHERAPY FOR ADVANCED ESOPHAGEAL CANCER
Authors: Muto Manabu , Ohtsu Atsushi , Yoshida Shigeaki
Published: July 2004

Esophageal stricture due to advanced cancer is one of the serious complications of esophageal cancer as it causes dysphagia. A self‐expandable metallic stent is easily inserted in such patients and provides immediate symptomatic relief of dysphagia. Alternatively, definitive chemoradiotherapy has demonstrated a significant improvement in local control and overall survival, and is now commonly used for not only unresectable esophageal cancer patients but also in resectable cases. However, little is known about its role in relief of dysphagia. Therefore, we reviewed our experience of patients with esophageal stricture who were treated with chemoradiotherapy. We expect that the findings in this article might be useful in future clinical practice.
CURRENT STATE OF SELF‐EXPANDABLE METALLIC STENT PLACEMENT FOR GASTRIC OUTLET OBSTRUCTION
Authors: Maetani Iruru , Ikeda Masaki , Shimura Jun‐Ichi , Ukita Takeo , Sakai Yoshihiro
Published: July 2004

Self‐expandable metallic stents are being used increasingly to maintain luminal patency in patients with unresectable gastric outlet obstruction. Stent technology has facilitated placement of the stent in the pyloric or duodenal obstruction. An example of advances in technology is the innovative through‐the‐scope (TTS) stent, which is not yet commercially available in Japan. Enteral stents provide a high success rate, quick relief from symptoms, and an improvement in the performance score, although some complications remain. This article reviews the current status of stent placement for gastric outlet obstructions. The self‐expandable metallic stent seems to provide a potentially attractive alternative to surgical bypass, since most of these patients are terminally ill with a limited life expectancy. Available data is currently insufficient to clarify the use of stents for gastric outlet obstructions, therefore a prospective randomized comparison is required to compare this procedure with surgical alternatives.
STENT THERAPY FOR MALIGNANT ESOPHAGO‐GASTROINTESTINAL STRICTURE
Authors: Kida Mitsuhiro , Shimao Hitoshi , Saigenji Katsunori
Published: July 2004

After Charles Symonds first reported stent therapy for malignant esophageal stricuture in 1885, several kinds of endoprosthesis, such as latex, silicone has been introduced in the clinical fields and improved feeding problems, etc. After the introduction of self‐expandable metallic stent (SEMS) in the beginning of 1990s, SEMS has changed clinical treatment dramatically. It resolves the feeding problem, prolongs the period of living in ones own house, and improves quality of life. However, SEMS has several complications and problems such as dislocation, perforation, regurgitation. These need to be resolved in the near future.
BALLOON DILATION THERAPY FOR BENIGN PYLORODUODENAL STRICTURES
Authors: Matsui Toshiyuki , Matake Hiroaki , Ikeda Keisuke , Wada Yoko , Yao Tsuneyoshi
Published: July 2004

The efficacy and prognosis of balloon dilation (EBD) therapy for various benign pyloroduodenal strictures was investigated. Subjects were 19 patients; nine with Crohn's disease, six with a duodenal ulcer, and four patients with duodenal second part strictures. Endoscopic EBD was started with through‐the‐scope (TTS) balloon with the primary endpoint being the endoscope passing through the lesions. All except one of the patients attained primary success from the EBD session. Long‐term prognosis was good for 11 of 15 with pyloric channel stenosis (73.3%), and excluded patients with second part stenosis during the observation period (average = 5.3 years). Prognosis for EBD for benign pyloroduodenal stricture is favorable and this procedure is recommended for such patients.
THE STATE‐OF‐THE‐ART OF ENDOSCOPIC TREATMENT OF COLORECTAL STENOSIS IN JAPAN: SURVEY OF PARTICIPATING INSTITUTIONS IN ENDOSCOPY FORUM JAPAN
Authors: Tanaka Shinji , Igarashi Masahiro
Published: July 2004

In order to verify the actual condition of endoscopic treatment of colorectal stenosis in Japan, 16 institutions participating in the Endoscopy Forum Japan participated in a survey with questionnaires concerning the number of stenting cases, the number of ballooning cases, the number of transanal ileus‐tube insertion cases, the technical success rate, and complications, and so on. Treatment with a stent was conducted in 31.2% of the institutions for malignant lesions and in 25.0% of the institutions for benign lesions. Ballooning was conducted in 12.5% of the institutions for malignant lesions and in 62.5% of the institutions for benign lesions. Transanal ileus‐tube insertion was conducted in 81.1% of the institutions for malignant lesions and in 18.7% of the institutions for benign lesions. The therapeutic success rate was excellent with each therapeutic technique and reached 86–100%. Complications included perforation and bleeding.
LONG‐TERM OUTCOME OF ENDOSCOPIC BALLOON DILATION IN OBSTRUCTIVE GASTROINTESTINAL CROHN's DISEASE
Authors: Matsui Toshiyuki , Tsuda Sumio , Matake Hiroaki , Ikeda Keisuke , Yao Tsuneyoshi
Published: July 2004

Background:  Gastrointestinal strictures are the most often and serious complication in Crohn's disease. Because of the frequent postoperative recurrence in Crohn's disease, endoscopic therapy of gastrointestinal stricture is one of the best therapeutic options.

Method:  The present study sets out the results from a prospective study of endoscopic dilation therapy on 48 Crohn's disease patients with severe gastrointestinal stenoses. All patients who could not undergo endoscopic balloon dilation therapy (EBD) were operated on.

Results:  Long‐term success was attained in 32 of the 48 patients; cumulative avoidance of surgery after EBD was 86% at one year and 71% at three. Second, the most hazardous factor was recurrent inflammation causing restenosis. Patients who had strictures with oral luminal dilatation and patients with frequent recurrence had a tendency to be operated on. As a complication, perforation occurred in two cases (3.3%).

Conclusions:  EBD therapy for Crohn's stricture in the gastrointestinal tract is recommended before surgical intervention.
EXPERIENCES OF SELF‐EXPANDABLE METALLIC STENT FOR COLORECTAL OBSTRUCTIONS: 70 CASES
Authors: Saida Yoshihisa , Sumiyama Yoshinobu , Nagao Jiro , Nakamura Yasushi , Nakamura Yoichi
Published: July 2004

Clinical utilization of self‐expandable metallic stent (EMS) endoprosthesis has come later for colorectal diseases than for other lesions. Recently, EMS has been used for palliative insertions for strictures caused by malignant diseases or as a ‘bridge to surgery’ for obstructive colorectal cancers, with good clinical results increasingly reported in many western countries. Its application for benign strictures has been reported, but we believe that the surgical indications require more careful analysis because of the absence of data concerning long‐term prognosis. The advantage of this technique in the treatment of colorectal strictures is that it limits invasiveness, such as in palliative or temporary stoma creation, thereby improving patient quality‐of‐life. Therefore, we believe that EMS endoprosthesis will play a key role in this field. We are awaiting the introduction of the metallic stent for the colon and the associated kit, as well as the Japanese government's approval for reimbursement for this procedure.
PRESENT STATUS and PERSPECTIVES OF SUBMUCOSAL DISSECTING METHOD OF ENDOSCOPIC MUCOSAL RESECTION IN THE COLORECTUM IN JAPAN
Authors: Tsuda Sumio , Matsui Toshiyuki , Kikuchi Yousuke
Published: July 2004

Endoscopic mucosal resection (EMR) is one of the endoscopic procedures for treatment of intramucosal cancer of the gastrointestinal tract. This method enables complete resection of a lesion, however, the size of lesions which can be resected en bloc has a limit. For lesions which can not be resected en bloc, endoscopic piecemeal mucosal resection (EPMR) are employed. However, it is often difficult to determine cancer invasion at holizontal and vertical cut end on pathological examination of resected specimens. Therefore, for the purpose of en bloc resection submucosal dissecting method of endoscopic mucosal resection (SDEMR) that is a method by which mucosa is dissected using some special devices after circumferential mucosal incision around the lesion was proposed. It enables us to resect large lesions which cannot be removed en bloc by EMR. Therefore, it is possible that this procedure is able to prevent residual cancer. Furthermore, sufficient pathological examination of resected specimens is possible, and it helps to determine a therapeutic plan after resection. It is now widely accepted as one of the endoscopic procedures for treatment of early gastric cancer, however, there have been few reports on its experience in the colorectum. Then, in order to consider the perspectives of SDEMR in the colorectum, the present status of it in Japan in August 2003 was analyzed and reviewed in this paper.
ENDOSCOPIC MUCOSAL RESECTION AND SUBMUCOSAL DISSECTION METHOD FOR LARGE COLORECTAL TUMORS
Authors: Sano Yasushi , Machida Hirohisa , Fu Kuang‐I. , Ito Hiroaki , Fujii Takahiro
Published: July 2004

The goal of endoscopic mucosal resection (EMR) is to allow the endoscopist to obtain tissue or resect lesions not previously amenable to standard biopsy or excisional techniques and to remove malignant lesions without open surgery. In this article, we describe the results of conventional EMR and EMR using an insulation‐tipped (IT) electrosurgical knife (submucosal dissection method) for large colorectal mucosal neoplasms and discuss the problems and future prospects of these procedures. At present, conventional EMR is much more feasible than EMR using IT‐knife from the perspectives of time, money, complication, and organ preservation. However, larger lesions tend to be resected in a piecemeal fashion; and it is difficult to confirm whether EMR has been complete. For accurate histopathological assessment of the resected specimen en bloc EMR is desirable although further experience is needed to establish its safety and efficacy. Further improvements of in EMR with special knife techniques are required to simply and safely remove large colorectal neoplasms.
THE TECHNICAL FUNDAMENTALS OF ENDOSCOPIC MUCOSAL RESECTION IN THE COLON: OUR METHOD
Authors: Oda Yasushi , Goto Hideyo , Hasuda Kiwamu , Tanaka Tomofumi , Hattori Masahiro
Published: July 2004

Endoscopic mucosal resection (EMR) is the technique used to resect flat or depressed tumors or larger tumors such as laterally spreading tumors with marginal normal mucosa. Recently, endoscopic mucosal dissection technique has been rapidly accepted, mainly in early gastric cancer in Japan. We need to have firm knowledge of EMR technique in the colon for recovery as we advance this new technique. We describe our conventional EMR method practically.

EMR should be performed to locate the target lesion at down side to perform sure EMR. The ideal shape of upheaval by saline injection is hemisphere. The needle sheath and snare should be taken out a little of the endoscopy to manipulate firmly.

Another technique of secure EMR is the snare manipulation. We prefer that the shape of the snare is circular and the snare is hard. It is important while trapping to press the target lesion with both the whole snare circle and the end of the sheath. With these fundamental procedures we could resect the target lesions at will.
COMPLICATIONS ASSOCIATED WITH ENDOSCOPIC MUCOSAL RESECTION: DEFINITION OF BLEEDING THAT CAN BE VIEWED AS ACCIDENTAL
Authors: Tajiri Hisao , Kitano Seigo
Published: July 2004

The consensus reached during the meeting on complications associated with EMR entitled ‘The definition of bleeding that can be viewed as accidental’ was held at the third EMR Conference, December 20, 2003, in Tokyo is as follows. (1) The definition of complications associated with EMR as intraoperative bleeding is cases requiring special measures such as emergency surgery, intraoperative blood transfusion, or vasopressor therapy and cases where EMR has to be necessarily discontinued because of intraoperative bleeding; and (2) the definition of complications associated with EMR as postoperative bleeding is marked bleeding from the ulcer‐affected area after EMR, requiring special measures for hemostasis. Bleeding during or after EMR may be deemed as accidental if the Hb level falls by 2 g/dL or more in comparison with the last preoperative level, or if any of apparent bleeding or massive melena, etc. is seen. Providing a clear definition for ‘apparent bleeding’ and ‘massive melena’ was left open to debate.
EARLY GASTRIC CANCER: PROPOSAL FOR A NEW DIAGNOSTIC SYSTEM BASED ON MICROVASCULAR ARCHITECTURE AS VISUALIZED BY MAGNIFIED ENDOSCOPY
Authors: Yao Kenshi , Iwashita Akinori , Yao Tsuneyoshi
Published: July 2004

We have developed a magnified endoscopic technique for observing the microvascular architecture within the gastric mucosa in units as small as capillary and we have reported the characteristic findings of the microvascular architecture in both normal gastric mucosa and early gastric cancer. The findings in the normal stomach were different depending on the section of the stomach. The body mucosa demonatrated a regular honeycomb‐like subepithelial capillary network pattern with a collecting venule, while the antral mucosa demonstrated a regular coil‐shaped subepithelial capillary network pattern. The magnified endoscopic findings of early gastric carcinoma were different depending on the types of histological differentiation. The characteristic findings of differentiated carcinoma were (1) the presence of a demarcation line; (2) the disappearance of the regular subepithelial capillary network pattern; and (3) the presence of an irregular microvascular pattern. The findings of undifferentiated carcinoma showed only a reduction in or else the complete disappearance of the regular subepithelial capillary network pattern. In clinical practice, the magnified endoscopic findings of differentiated carcinoma are useful both for determining the margin of early gastric cancer and for making a differential diagnosis between gastritis and gastric cancer in the case of flat reddened lesions. The microvascular architecture as visualized by magnified endoscopy could be a new diagnostic system for the endoscopic diagnosis of early gastric cancer.
CLINICAL USEFULNESS OF COLONOSCOPIC INSERTION OF A DECOMPRESSION TUBE FOR OBSTRUCTIVE COLORECTAL CANCER
Authors: Kobayashi Kiyonori , Igarashi Masahiro , Yoshizawa Shigeru , Katsumata Tomoe , Saigenji Katsunori
Published: July 2004

We evaluated the clinical usefulness of colonoscopic insertion of a decompression tube (decompression method) for the treatment of ileus associated with left‐sided colorectal cancer. Decompression method was done in 48 patients with colorectal cancer (38 primary cancer, 10 metastatic cancer). A decompression tube was successfully inserted in all but 10 patients who had primary cancer with severe strictures. The overall insertion rate was 79%. Decompression method improved obstructive symptoms and decreased intestinal gas as evaluated on plain X‐ray films of the abdomen. Emergency operation was unnecessary in 96% of the patients with primary cancers, in whom the decompression tube was successfully inserted. We conclude that decompression method can improve abdominal symptoms caused by obstructive colorectal cancer and reduce the need for emergency operation.
METAL STENTS FOR PALLIATION OF INOPERABLE CARCINOMA OF THE GASTROINTESTINAL TRACTS
Authors: Shim Chan Sup , Jung In Seop
Published: July 2004

Recently, various self‐expandable metal stents (SEMS) have been developed for palliation of malignant obstruction of gastrointestinal tract. Although they have not been approved for use in benign disease, there are specific clinical indications for which expandable metal stents may be beneficial. This article reviews the use of self‐expandable metal stents for malignant gastrointestinal obstruction and the use of SEMS specially developed for unusual stenting such as antimigration and antireflux mechanism.
ENDOSCOPIC MANAGEMENT OF BILIARY and PANCREATIC DUCTS STRICTURES
Authors: Maguchi Hiroyuki , Takahashi Kuniyuki , Katanuma Akio
Published: July 2004

Endoscopic treatment is applied to a relatively large number of biliary and pancreatic duct strictures, and is a practical matter. It is essential to select the most appropriate treatment for each lesion. For instance, when treating malignant biliary stricture, accurate diagnosis of whether surgical treatment is required or not is vital; and in choosing a stent for an inoperable case, location of the stricture, with or without anticancer treatment, prognosis, and management of possible post‐stenting re‐stricture must be taken into consideration. For benign strictures, not only short‐term results in mobility and motality, but also decades of long‐term results must be cautiously questioned. Bearing these in mind, we need to accumulate the worldwide data of the treatments and establish a proper treatment guideline.
MERITS and DEMERITS OF METALLIC STENT FOR TREATMENT OF PANCREATIC DUCT STRICTURES IN PATIENTS WITH CHRONIC PANCREATITIS
Authors: Inui Kazuo , Yoshino Junji , Okushima Kazumu , Miyoshi Hironao , Nakamura Yuta
Published: July 2004

We inserted a metallic stent into the strictures of the main pancreatic duct in two patients with calcified chronic pancreatitis and severe abdominal pain not to be relieved using narcotics. One patient was a 39‐year‐ old male, and the other was 49‐year‐old male. Their etiology of chronic pancreatitis was alcoholism. We inserted a Strecker stent, 7 mm in diameter and 6 cm in length, for achieving long‐term patency than plastic stent. In one patient, the stent was obstructed half a year after the first treatment and pancreatic calculi recurred with abdominal pain. After endoscopic extraction of pancreatic stone and balloon dilatation of the stent was performed three times, a plastic stent was inserted in the metallic stent twice. Even if he was performed nerve block twice, he was administered narcotics for treatment of continuous abdominal pain. In the other patient, the stent was obstructed 1.5 years after insertion and pancreatic calculi recurred with abdominal pain. He was treated with extracorporeal shock‐wave lithotripsy for pancreatic stone, abdominal pain continued. He underwent pylorus preserving pancreato‐duodenectomy 6 years after the first stenting, because the obstructed metallic stent could not be removed. Metallic stent should not be chosen for treatment of pancreatic duct stricture.
ENDOSCOPIC TREATMENT OF LOWER GASTROINTESTINAL STRICTURES
Authors: Igarashi Masahiro
Published: July 2004

The methods of endoscopic treatment to a stricture of colon and rectum, are balloon dilatation, stenting, and transanal tube decompression. Balloon dilatation is useful for the stricture with benign disease. It is simple and is considered to be the first choice by the postoperative stricture. To the stricture of Crohn's disease, the long‐term prognosis effect equivalent to an operation is shown, and it is the therapy that should be tried before an operation. Stenting should not be performed easily at the present time for benign stenosis because there are problems that must be solved. For malignant stricture, balloon dilatation is contraindication, and transanal tube decompression and stenting are useful to an improvement of decompression and a passage obstacle. Both are useful to postoperative complications, and the improvement of quality‐of‐life of the stenotic condition by carcinoma.
COVERED METALLIC STENTS FOR MANAGEMENT OF DISTAL MALIGNANT BILIARY OBSTRUCTION
Authors: Isayama Hiroyuki , Kawabe Takao , Nakai Yousuke , Komatsu Yutaka , Omata Masao
Published: July 2004

Covered metallic stent (covered MS) is useful to improve quality‐of‐life in patients with unresectable malignant distal biliary obstruction. We have managed 129 patients with three types of covered MS; polyurethane‐covered Wallstent (hand‐craft), polyurethane‐covered Diamond stent (hand‐craft), and silicone‐covered Wallstent (commercially available). They were compared with 115 cases treated with uncovered metallic stent (uncovered MS). There was no significant difference in survival between the two groups. The cumulative stent patency was significantly higher in the covered MS group than uncovered MS group (P = 0.0027). Stent occlusion occurred in 17 patients (13%) in the covered MS group, and in 48 patients (42%) in the uncovered MS group (P < 0.0001). Complications of covered MS were 8 (6%) in acute cholecystitis, 10 (8%) in acute pancreatitis, and 10 (8%) in migration. We evaluated the risk factors for these complications of covered MS.
A CASE WITH PERFORATION AFTER ENDOSCOPIC BALLOON DILATATION FOR STRICTURE OF MALIGNANT LYMPHOMA
Authors: Cho Eisai , Uno Koji , Tanaka Kiyohito , Yasuda Kenjiro , Nakajima Masatsugu
Published: July 2004

We have experienced a case with perforation after endoscopic balloon dilatation. The patient was diagnosed as having malignant lymphoma in the terminal ileum, and treated with eradication of H. Pylori and chemotherapy. The severe stenosis appeared at the same site of the tumor after the medical treatment. The first dilatation with a 15 mm balloon was successful. The lower small bowel obstruction occurred 14 months after the first balloon dilatation. The second dilatation with an 18 mm balloon was performed. The stricture site was remarkably dilated and could be passed by the scope. Perforation was confirmed because of the complaint of severe abdominal pain. The laparotomy finding showed the hole at the stricture site and remarkable fibrosis without tumorous tissue. The fragility of the tissue, the excessive inflation of the balloon and the insertion of the scope might be causes of the perforation. The case with severe stricture having almost no flexibility should be considered carefully in the determination of treatment procedures for the balloon dilatation.
ENDOSCOPIC MUCOSAL RESECTION FOR EARLY GASTRIC CANCER: A NEW TECHNIQUE USING A SLIT‐HOOD and HOOK KNIFE
Authors: Fujisaki Junko , Yamamoto Yorimasa , Takahashi Hiroshi
Published: July 2004

We report a successful application of a new submucosal dissection method for EMR using an endoscope equipped with a slit‐hood and hook knife. The mucosal lesion is separated from the submucosal layer with the aid the hood and the submucosal fibers are cut with the hook knife introduced through the slit, allowing an easy and safe dissection with good visualization of the tissue. Twenty‐seven patients with early gastric cancer underwent EMR using a slit‐hood and hook knife. Tumors were completely resected in 10 cases, and perforation of the stomach occurred in one case. The hook knife cuts as it is pulled back into the hood, helping to prevent perforation.
ENDOSCOPIC PANCREATIC STENTING IN CHRONIC PANCREATITIS WITH DUCTAL DILATION PROXIMAL TO A STRICTURE: A SAFE and EFFECTIVE PROTOCOL
Authors: Mukai Hidekazu , Yoshinaga Hiroshi , Watanabe Akihiko , Fujiwara Hitoshi , Fujita Tsuyoshi
Published: July 2004

After removal of intraductal stones, a 10‐Fr or 7‐Fr pancreatic stent was placed in 16 patients with upstream ductal dilation proximal to a stricture of the main pancreatic duct. Stents were removed after a mean duration of 52.5 days. Nine patients underwent repeated stenting. About one year after removal of the initial stent, when the remaining upstream ductal dilation was found on follow‐up pancreatograms, the next stent was replaced. Repeated stenting improved outflow of pancreatic juice more effectively than one‐time stenting. Correlation between long‐term pain relief without recurrence of intraductal stones and reduction of duct diameter was also shown. Stent occlusion was observed in 14 of 30 stents. Stent occlusion was frequently associated with recurrence of pancreatitis and intraductal stones, and was also associated with morphologic changes in the pancreatic ductal system. Although there were no significant differences between stent patency of the initial stents and that of the next stents, stent patency of 10‐Fr stents was superior to that of 7‐Fr stents. 10‐Fr stents should be removed within 8 weeks and 7‐Fr stents should be removed within 4 weeks for the prevention of stent occlusion. Repeated stenting with short‐term stenting is therefore considered a safe and effective protocol of endoscopic pancreatic stenting.
ENDOSCOPIC SUBMUCOSAL DISSECTION FOR THE RELIABLE EN BLOC RESECTION OF COLORECTAL MUCOSAL TUMORS
Authors: Yahagi Naohisa , Fujishiro Mitsuhiro , Imagawa Atsushi , Kakushima Naomi , Iguchi Mikitaka , Omata Masao
Published: July 2004

Scheduled piecemeal resection has been actively conducted for granular type laterally spreading tumor (LST‐G) in Japan, as long as a definite preoperative diagnosis is made. However, en bloc resection is desirable for depressed lesions (e.g. IIc lesion) as well as non‐granular type laterally spreading tumor (LST‐NG) since they have considerable high risk for submucoasl invasion and require precise histopathological evaluation. Endoscopic submucosal dissection (ESD) has been developed for the en bloc resection of mucosal tumors of gastrointestinal tract and widely applied especially in gastric lesions. Although the large intestine involves structural and technical difficulties, we conducted en bloc resection by ESD while exercising sorts of ingenuity for preparation; endoscopes, instruments, local injections, and others. ESD is a reliable technique that allows en bloc resection of gastrointestinal mucosal lesions, and even has a splendid possibility for the treatment of early stage colorectal cancer.
FACTORS AFFECTING THE PATENCY OF EXPANDABLE METALLIC STENT FOR MALIGNANT BILIARY OBSTRUCTION
Authors: Hasebe Osamu , Arakura Norikazu , Imai Yasuharu , Nagata Atsuo
Published: July 2004

Although placement of expandable metallic stent (EMS) is an established method for palliation of malignant biliary obstruction, it remains unclear which factors affect the patency of the stent. We retrospectively analyzed the patency of EMS according to the following four factors: location of the stenosis (distal vs. hilar bile duct stenosis); uncovered vs. covered EMS; position of the distal end of EMS (intra bile duct vs. intra duodenal placement); and stent design (Diamond stent vs. Wallstent). The median stent patency was comparable in each group, but there was a trend that it was longer in covered EMS and intraduodenal placement group.
MALIGNANT BILIARY OBSTRUCTION: A COMPARISON OF COST FOR A USE OF METAL OR PLASTIC STENT FOR PALLIATION IN JAPANESE HEALTH CARE SYSTEM
Authors: Fukami Norio , Inoue Haruhiro , Kudo Shin‐ei
Published: July 2004

Endoscopic treatment with endoprosthesis for obstructive jaundice is a well‐accepted method for palliation of obstructive jaundice and its associated symptoms. Yet, there is no consensus whether a plastic stent or metal stent to be used. The longer patency period with metal stent is a definite advantage but its high cost limits its routine use. The best use of metal stent is accomplished with consideration of patients’ predicted prognosis and a medical cost in Japan. We used a simulated case scenario to calculate a cost for metal stent and non‐metallic stent. Metal stent use would cost about 437 000 yen per patient at 6 months compared with 276 000–329 000 for non‐metallic stents, and thus metal stent use appears to be more costly in current Japanese medical system. Longer patency rate with covered metal stent would make metal stent more favorable, and less frequent procedure would be beneficial for patients who are at their terminal stage of diseases. Alternatively, many patients would not need stent replacement after first biliary stent placement due to the nature of underlying diseases. In addition to a development of an ideal stent and an appropriate technique, our research should also aim at determining who would benefit most for each stent in our own practice, preferably in prospective randomized trial.
ENDOSCOPIC TREATMENT FOR THE BENIGN BILIARY STRICTURE IN THE PATIENT WITH CHRONIC PANCREATITIS
Authors: Igarashi Yoshinori , Okano Naoki , Miura Tomihiro , Iida Kazunari , Miki Kazumasa
Published: July 2004

In some patients with chronic pancreatitis (CP), strictures are observed in the intrapancreatic bile ducts due to fibrosis and inflammation in the pancreas. Normally, even when biliary strictures exist, obstructive jaundice is rarely observed. It seemed that obstructive jaundice was brought about by temporary pancreatitis due to immoderate alcohol ingestion, followed by the aggravation of the intrapancreatic biliary stricture. When immoderate alcohol ingestion is incriminated for the pancreatic disorder, the patient should be strictly instructed to abstain from alcohol, but failure to observe this instruction seems to render endoscopic biliary stenting ineffective. When CP is complicated with pancreatolithiasis, stone fragmentation using extracorporeal shock wave lithotripsy (ESWL) is effective, and combination with endoscopic lithotomy makes it possible to remove pancreatic stones in the main pancreatic duct (MPD). To treat the beside dilating stricture of the MPD, balloon dilation and pancreatic duct stenting are performed. We obtained good results with 10 Fr pancreatic duct stents, but biliary strictures are better treated with a combination of these methods. When 10 Fr or larger straight biliary stents are used, they may be dislodged or stray if the bile duct is sharply curved. To prevent this accident we have used 10 Fr double layer stents and obtained good results. In patients with benign biliary strictures, stents are temporarily placed and should be removable. Some cases have been reported where Wallstent gave good results in a short period, but the stents were occluded due to hyperplastic proliferation of the biliary epithelium. Metal stents are not considered desirable for benign biliary strictures. Our results seem to support the assumption that benign biliary strictures are improved with 10 Fr or larger biliary stents while exercizing care to keep the patient abstinent from alcohol and performing ESWL and endoscopic treatment for CP.
Politics Within and Without — The Origins and Development of a Rangelands Landcare Group
Authors: Gill Nicholas
Published: July 2004

The 1990s saw a resurgence of interest in land‐use reform in the arid and semi‐arid rangelands of Australia. Scientists and conservationists called for a reassessment of land use in areas now used for extensive grazing of cattle and sheep. Landcare groups formed by pastoralists were criticised for deflecting resources away from questions of land‐use reform. While Landcare groups in agricultural regions of Australia have been subject to considerable assessment, analysis of rangelands Landcare has tended to revolve around questions of land use to the neglect of analysis of the operation of the groups themselves. Based on a case study of a pastoral Landcare group in the rangelands, the research reported in this paper found that pastoral Landcare in the rangelands has comparable outcomes to Landcare elsewhere in terms of the creation of opportunities for improved communication and learning among landholders. In addition, this group has developed from an emphasis on single‐issue projects towards multi‐faceted projects focussed on social as well as ecological sustainability. The analysis also found that political considerations were significant in the forma‐tion of the group and remained important for some pastoralists at the time of fieldwork. Finally, rangelands Landcare in this case study has provided a vehicle for reformist pastoralists and their associates to work actively towards influencing their peers to acknowledge land management problems and to reflect on their management practices.
Kakadu National Park World Heritage Site: Deconstructing the Debate, 1997–2003
Authors: Aplin Graeme
Published: July 2004

The case of Kakadu National Park has had an unusually large amount of time and expense devoted to it in meetings of the World Heritage Bureau and the World Heritage Committee since 1997. Major controversy arose following the announcement that a new uranium mine would be developed at Jabiluka, located in an enclave surrounded by the World Heritage property, but not legally part of it. The explosive juxtaposition of issues concerning the trio of conservation of heritage values, uranium mining, and Aboriginal land rights inevitably led to strong reactions against the Federal Government's decision to allow mining, not least on the part of Australian and international non‐government organisations. It was felt that the mining development would jeopardise the integrity of the key values for which Kakadu had been inscribed on the World Heritage List. This paper attempts to unravel some of the strands of the ensuing debate — to at least begin to deconstruct the debate — that saw Kakadu almost placed on the List of World Heritage in Danger. This is an important task to attempt because there were many undercurrents to the publicly reported debate, and a large degree of ‘reading between the lines’ is needed to interpret official records of meetings adequately. The paper also attempts to throw some light on the forceful opposition to such a move on the part of the Australian Government, based in large part on its underlying developmentalist philosophy, and at a time when it was giving less than wholehearted support to many international agreements to which Australia is a signatory. Finally, it is hoped that an insight into the workings of the World Heritage Convention and its supporting bodies will be gained.
From ‘Problem City’ to ‘Promise City’: Gentrification and the Revitalisation of Newcastle
Authors: Rofe Matthew W.
Published: July 2004

The city of Newcastle is a complex and changing landscape. Once regarded as Australia's ‘problem city’, Newcastle's identity is being significantly transformed. This identity transformation draws significantly upon the emergence of more cosmopolitan landscapes within inner Newcastle associated with the gentrification of these areas. The discourse of gentrification is inherently post‐industrial, providing a cleaner and more positive identity as Newcastle seeks to erase the stigma of its’ industrial heritage. However, as landscapes are the amalgam of multiple identities, Newcastle's industrial heritage periodically re‐emerges to problematise the city's newly adopted cosmopolitan identity.
Gardens and the Bush: Gardeners’ Attitudes, Garden Types and Invasives
Authors: Zagorski T. , Kirkpatrick J.B. , Stratford E.
Published: July 2004

Garden plants that invade native vegetation can be a threat to native ecosystems. The species composition of gardens near the bush in Hobart, Tasmania, Australia is shown to relate to environmental variation and the attitudes of gardeners to their recreation, to native plants and to the bush. Four types of gardens are discriminated: the species‐poor shrub garden; the local native garden; the woodland garden; and the gardenesque. A group of gardeners who valued functional gardens, and the hard work in creating a garden, largely produced gardenesque outcomes. A strongly conservationist group of gardeners had native, woodland or shrub gardens. A group of gardeners who valued romance and privacy largely had woodland gardens. A small group of gardeners who liked gardens to create themselves, and preferred to minimize the act of gardening, tended to the shrub garden outcome. Plant species that invade the bush are least frequent in the more manicured shrub and gardenesque styles of garden than in the more informal local native and woodland gardens, in a dissonance between expressed attitudes and outcomes. Most of the most invasive weeds in the bush are shown to be independent of their occurrence in adjacent gardens, suggesting that integrated control programs involving both all gardeners within dispersal range, and bush managers, are necessary. The existence of a small number of respondents who see benefits in environmental weeds in their gardens, suggests that such programs would be ineffective without regulation, a solution offered by no respondent. However, regulation might be ineffective without community understanding, the raising of which was the main solution suggested by the interviewed gardeners.
A Survey of Soil Erosion in Australia using Caesium‐137
Authors: Loughran R.J. , Elliott G.L. , McFarlane D.J. , Campbell B.L.
Published: July 2004

A survey of soil erosion was conducted in Australia using the fallout radioisotope caesium‐137 as an indicator of topsoil redistribution. Two hundred and six sites were sampled, 100 within rotational cropping and horticultural use, 52 within uncultivated permanent pasture and forest, and 54 in rangelands. Average net soil losses were approximately equal for cultivated cropping lands and rangelands (ca. 5.5 t ha−1 yr−1), and just over 1 t ha−1 yr−1 for pasture and forest. The Mann Whitney U Test revealed that losses under cropping and rangeland conditions were significantly higher (p < 0.05) than under uncultivated pasture and forest. Soil loss was negatively correlated with mean annual rainfall and slope gradient, and positively correlated with slope length (Spearman's rank correlation). There was no correlation between rates of soil loss and a rainfall erosi‐vity index. An assessment of erosional events was provided by landholders for 104 sites, with their ranking being weakly but significantly correlated with soil loss estimates (r =+0.35). Sixty percent of sites had net soil losses greater than 1 t ha−1 yr−1, and 74% of sites had losses of more than 0.5 t ha−1 yr−1. This latter rate may be regarded as a limit for a tolerable level of soil loss. These high rates of soil loss have occurred since the mid‐1950s despite there being significant landholder awareness of the soil erosion hazard.
Counting them in, not out: Surveying Farm Women about Agricultural Leadership
Authors: Pini Barbara
Published: July 2004

This paper examines the efficacy of the survey method to investigate questions relating to women and agricultural leadership. I begin by reviewing the feminist critique of the survey using examples from the literature on farming women. I then describe two particular difficulties I encountered in surveying farm women about agricultural leadership in the Australian sugar industry. The first difficulty is the problem of constructing a sample of farm women using official data sources that is representative of the diversity of women in agriculture. The second difficulty is the impact that gendered agricultural identities may have on survey completion rates. The paper argues that, if we are to count farming women ‘in’, rather than ‘out’ when studying agricultural politics, we need to engage with methods which will be inclusive of the diversity of women in farming and which will also give consideration to the construction of gendered identities in agriculture.
Questioning the Rhetoric of Social Mix: Courteous Community or Hidden Hostility?
Authors: Ruming Kristian J. , Mee Kathleen J. , MGuirk Pauline M.
Published: July 2004

This paper explores the increasingly important role of ‘social mix’ in the management practices of the NSW Department of Housing. Social mix is a policy response to the many perceived social, cultural and economic problems related to the concentration of public tenants within larger housing estates. Social mix involves the integration and assimilation of public housing tenants into areas dominated by private home ownership and private rental. Such policies are based upon the belief that social mix has the ability to alter many of these problems simply through the presence of a ‘community’. However, this paper questions the normative construction of homeowners as possessing a ‘community’ which, by implication, will be passed on to public tenants. Through an in‐depth case‐study, it is shown that ‘community’, as constructed by social mix policy rhetoric, may in fact further disadvantage public tenants through processes of othering, stigmatisation and oppression, which operate outside these traditional understandings of community. In addition, this research shows that, rather than increased community integration, it is the physical function of neighbourhood and its direct role in service provision which is the most advantageous constituent of social mix for public housing tenants.
Fiscal Policy in an Overlapping Generations Model with Bequest‐as‐Consumption
Authors: Michel Philippe , Pestieau Pierre
Published: July 2004

This paper analyzes an overlapping generation (OLG) growth model wherein saving finances second period consumption and bequest‐as‐consumption. First, it looks at the market equilibrium and at the optimal solution; then it turns to the issue of decentralizing the optimal solution with various taxes and transfers. Depending on the available instruments, either a first‐best or a second‐best optimum can be achieved. Throughout the paper, the results are contrasted with those obtained in the standard OLG model without intergenerational transfers.
The Organization of Public Service Provision
Authors: Jack William
Published: July 2004

This paper addresses the question of how the responsibility for the delivery of social services, including health, education, and welfare programs, should be divided between state and central governments. We combine a random voting model and the incomplete contracts paradigm to formalize the trade‐off between central and state responsibility for service delivery, and find that authority should rest with the party for whom the marginal impact of the service on re‐election chances is greater. This in turn means that, other things equal, states with lower than average health, education, or welfare status should be given responsibility for service delivery, while authority in states with above average indicators should reside with the central government. Also, we show that there is no presumption that states that are given authority for service delivery should necessarily be granted expanded tax authority.
International Commodity Taxation under Monopolistic Competition
Authors: Haufler Andreas , Pflüger Michael
Published: July 2004

We analyze non‐cooperative commodity taxation in a two‐country trade model characterized by monopolistic competition and international firm and capital mobility. In this setting, taxes in one country affect foreign welfare through the relocation of mobile firms and through changes in the rents accruing to capital owners. With consumption‐based taxation, these fiscal externalities exactly offset each other and the non‐cooperative tax equilibrium is Pareto efficient. With production‐based taxation, however, there are additional externalities on the foreign tax base and the foreign price level that lead non‐cooperative tax rates to exceed their Pareto efficient levels.
Progressive Taxation, Moral Hazard, and Entrepreneurship
Authors: Keuschnigg Christian , Bo Nielsen Søren
Published: July 2004

This paper considers the general equilibrium and welfare effects of a linear progressive income tax with entrepreneurship and moral hazard. A competitive intermediation sector diversifies risk associated with entrepreneurial activity, but full risk consolidation is prevented by moral hazard. Since effort is not observable, risk bearing of entrepreneurs is required for incentive reasons. The extent of risk consolidation is endogenously explained. We find that a nonredistributive tax is neutral. A progressive tax always impairs entrepreneurship while the effect on welfare can be positive or zero, depending on the specification of moral hazard. Some results may also depend on the concrete formulation of preferences.
What Should Optimal Income Taxes Smooth?
Authors: Andersen Torben M. , Dogonowski Robert R.
Published: July 2004

According to the theory of tax smoothing, income tax rates should be kept constant so as to minimize the distortionary costs of taxation. By explicitly considering how labor supply is distorted by income taxes in a fully specified intertemporal model, we find that the optimal income tax policy should smoothen leisure. In the case of varying income (productivity changes) this is attained by a pro‐cyclical (progressive) tax rate.