bluuebunny/crossref_metadata_2025 huggingface dataset:
Whole blood donor deferral rate and characteristics of the Turkish population
Authors: Arslan Ö.
Published: August 2007

summary Whole blood (WB) donors are deferred for several reasons, either permanently or temporarily. In this retrospective study, we quantified the rate of and reasons for donor deferral among Turkish donors.

Computer records of the last 5 years were analysed to quantify the deferral rate and reasons. Deferrals were categorized as temporary short‐term (1–56 days), long‐term (57–365 days) and multiple years or permanent (more than 365 days). Deferred donors were also analysed according to gender, age and education level.

A total of 95 317 persons were admitted for WB donation: 89·1% of them were male donors and 59·9% were in the 30 to 49‐year old age category. Rates of deferral for temporary short‐term, long‐term, permanent or for unknown reasons were 66, 22·5, 10 and 1·5% respectively. Female donors were deferred more frequently than male donors (25·8 vs. 13·3%, P≤ 0·0001). The deferral rates were significantly different among the different age groups (P < 0·0001). Donor education level had no effect on the deferral rates (P > 0·05). The main reason for deferral was common cold and/or sore throat or elevated temperature (20·4%) in male donors and low haemoglobin (51·6%) in female donors. Although the three uppermost reasons for deferral in women were identical for all age categories, these varied in the male group (high‐risk sex partner for the younger group vs. hypertension and low haemoglobin for the older group).

Although permanent and temporary deferral rates are similar between the Turkish population and western countries, leading causes vary widely.
BK virus‐associated hemorrhagic cystitis in a pediatric lung transplant recipient
Authors: Elidemir Okan , Chang I‐Fen , Schecter Marc G. , Mallory George B.
Published: August 2007

Abstract:  BKV was first postulated to be a potential pathogen in 1971 when it was isolated in the urine of a renal transplant recipient. The pathology of BKV is generally confined to the urinary tract. In renal transplant recipients, BKV has been associated with hemorrhagic cystitis, urethral stenosis, and interstitial nephritis. Reports of BKV infection in lung transplant recipients are limited to a few case reports in adult patients. A recent report revealed that up to 32% of adult lung transplant recipients may shed BKV in their urine without symptoms or renal dysfunction. To our knowledge, there are no published reports of pediatric lung transplant recipients with BKV‐associated hematuria. We hereby report a case of BKV‐induced hemorrhagic cystitis in a pediatric lung transplant recipient.
Complications of chronic kidney disease in children post‐renal transplantation – A single center experience
Authors: Feber Janusz , Wong Hubert , Geier Pavel , Chaudry Bushra , Filler Guido
Published: August 2007

Abstract:  Similar to adults, CKD may persist after pediatric RTx. Clinical and laboratory parameters were analyzed retrospectively in 23 RTx recipients (13 males, age 11.9 ± 5.2 yr), initially treated with prednisone, calcineurin inhibitor (TAC = 18, cyclosporine neoral = 5), and MMF at four months post‐RTx (T1) and at 3.4 ± 2.8 yr post‐RTx (T2). Mean (±s.d.) cystatin C GFR (mL/min/1.73 m2) was 72 ± 19 at T1 and 70 ± 22 at T2 (NS). At T2, CKD stage I was present in five patients (22%), stage II in eight patients (35%), and stage III in 10 patients (43%). At T2, calcineurin inhibitors were utilized in 19, MMF in 13, and SIR in 13 patients. The prevalence of hypertension was 69% at T1 and 87% at T2 (p = NS). Anemia was diagnosed in 61% at T1 and 69% at T2 with average therapeutic MMF (2.78 ± 1.3 mg/mL) and SIR (7.62 ± 2.3 mg/mL) trough levels. Hypercholesterolemia was detected in 44.0% at T1 and 47% at T2. Bone disease was diagnosed in 26.0% at T1 and 21.7% at T2. Mean height Z‐scores were −1.0 ± 1.2 (T1) and −1.0 ± 1.59 (T2, NS), with 21% at T1 and 30% at T2 below two SDS. We observed suboptimal growth, hypertension, hypercholesterolemia, bone disease, and anemia in a significant proportion of transplanted children.
Geological age of the Yokawa Formation of the Kobe Group (Japan) on the basis of terrestrial mammalian fossils
Authors: Tsubamoto Takehisa , Matsubara Takashi , Tanaka Satoshi , Saegusa Haruo
Published: August 2007

Abstract  The age of the Yokawa Formation of the Cenozoic Kobe Group distributed in Hyogo Prefecture of western Japan based on mammalian fossils is discussed. Two fossil dental specimens of terrestrial mammals discovered from the lowest part of the Yokawa Formation in the Sanda area are described. These two fossils described here are: (i) a right mandibular fragment with p2–m3 of Bothriodon sandaensis sp. nov. (selenodont anthracotheriid artiodactyl), which appears to be the most primitive among the species of the genus; and (ii) right m1–m3 of cf. Hyrachyus sp. (primitive rhinocerotoid perissodactyl). In the lower part of the Yokawa Formation, Zaisanamynodon (amynodontid perissodactyl) was previously reported. The morphology (‘evolutionary stage’) of B. sandaensis is indicative of the latest Middle to Late Eocene, that of cf. Hyrachyus sp. is indicative of the Early to Middle Eocene, and Zaisanamynodon is indicative of the Late Middle to Late Eocene. Therefore, the fossil mammals of the Yokawa Formation indicate an latest Middle Eocene (ca. 38 Ma) correlation for the lower part of the formation, as a working hypothesis. Although the resolution of the geological age based on these mammalian fossils is relatively low compared to that based on marine index fossils, this result is concordant with the recent radiometric correlation of the lower part of the Yokawa Formation in the Sanda area.
Oceanic crust and Moho of the Pacific Plate in the eastern Ogasawara Plateau region
Authors: Tsuji Takeshi , Nakamura Yasuyuki , Tokuyama Hidekazu , Coffin Millard F. , Koda Keita
Published: August 2007

Abstract  To show the structure of oceanic crust and Moho around the eastern Ogasawara Plateau, we have analyzed industry‐standard two‐dimensional multichannel seismic reflection data. To obtain improved velocity models, phase information of seismic signals was used for velocity analysis and velocity models for oceanic crust above Moho were determined. We apply this velocity analysis technique to seismic reflection data around the eastern Ogasawara Plateau, with the result of clear images of structures within oceanic crust and Moho. South of the Ogasawara Plateau, Moho deepens proximal to the Plateau. Moho distal to the Plateau is ca 7 km below sea floor (bsf), whereas it is ca 10 km bsf near the Plateau. The characters of oceanic crust and Moho differ significantly north and south of the Plateau. To the north, the structure of oceanic crust is ambiguous, the sea floor is shallower and less smooth, and Moho is discontinuous. To the south, structures within oceanic crust and Moho are imaged clearly, and the sea floor is deeper. A strong Moho reflection south of the Plateau might represent a sharp boundary between layered gabbro and peridotite. However, discontinuous Moho reflections north of the Plateau might represent rough topography because of intensive magmatism or a gradual downward increase in velocity within a thick Moho transition zone. A fracture zone north of the Plateau also appears to separate oceanic crust and Moho of different characters, suggesting vigorous magmatism between the Plateau and the fracture zone, and that the Ogasawara Plateau and the fracture zone influenced the genesis of oceanic crust and upper mantle. Differences in acoustic characteristics to the north and south of the Plateau are apparent in profiles illuminated by seismic attributes.
A Case Report of Borrmann 2 Type Gastric Cancer Complicated with Lung Cancer and Treated with Laserthermia
Authors: MUTO Nobuyoshi , SHIBATA Harumichi , SHIINA Yasubumi , TAKAYASU Hiroyuki , KONAGAYA Minoru , AOKI Jun , SUZUKI Sohtaro , MIWA Takeshi
Published: August 2007

Abstract: A 52 year‐old female was admitted to our hospital for lung cancer. We performed upper gastrointestinal endoscopy for her complaint of epigastralgia, and diagnosed Borrmann 2 type gastric cancer on the posterior wall of the angle.

Chemotherapy with CDDP and VDS was commenced for lung cancer, and endoscopic Nd‐ YAG laser local hyperthermia (Laserthermia) was carried out for gastric cancer. Nd‐ YAG laser provided computer‐controlled thermo‐monitering system was irradiated in 3W, intermittently. Laserthermia could be applied safely to the clinical endoscopy.

Conclusions were as follows;

1) Borrmann 2 type gastric cancer complicated with lung cancer was treated with laserthermia without severe complication.

2) This is the first report that the Laserthermia controlled by computer thermo‐system was put in to clinical use.

3) Laserthermia with chemotherapy was more effective than laserthermia alone.
Acute Gastric Lesions Induced by Transcatheter Arterial Embolization and Intra‐arterial Infusion Chemotherapy for Hepatocellular Carcinoma
Authors: OKUHIRA Masaru , NAKANO Toshiaki , KUNIEDA Kouji , KITAJIMA Tomoko , AMOU Yasuo , NONAKA Tsuneyuki , HIRAMATSU Arata , MIZUNO Takako , SAMESHIMA Yoshiko
Published: August 2007

We performed an endoscopic study of the acute gastric lesions induced by transcatheter arterial embolization (TAE) and infusion chemotherapy (one shot infusion: OSI). Forty‐eight patients with primary hepatocellular carcinoma were investigated, and of them, 25 received TAE and 23 were treated with OSI. Endoscopy was performed within 1 week both before and after therapy and any gastric mucosal changes were noted. Before treatment, all patients had gastric lesions such as redness, erosion, hemorrhage and ulcer. These lesions were exacerbated or new lesions appeared after both TAE and OSI in about 50% of the subjects, and no significant difference in the incidence of lesions was observed between these two treatments. Moreover, there was no significant correlation between the exacerbation or new appearance of gastric lesions and the Child's classification, the catheter position, or the presence or absence of A‐P shunt or portal thrombus.

The appearance and/or exacerbation of these gastric lesions was not prevented by the administration of common antiulcer drugs before treatment. Thus the possibility that these gastric effects of TAE and OSI may occur should always be kept in mind and appropriate preventive or therapeutic measures should be adopted.
Clinical and Endoscopic Study of Ischemic Colitis
Authors: IGARASHI Masahiro , KATSUMATA Tomoe , YAMAMOTO Yoshimasa , MITOMI Hiroyuki , KOBAYASHI Kiyonori , HONMA Jiro , SAIGENJI Katsunori , OKABE Haruya , SEGAWA Kenichi , ATARI Hideo
Published: August 2007

The clinical signs and symptoms of ischemic colitis have been analyzed. Eighty‐one cases were investigated; there were 62 cases of the transient type, 15 of the stricturing type, and 4 cases of the gangrenous type. All cases were diagnosed by colonoscopy.

In addition, the healing process of the transient type, observed by colonoscopy, was analyzed. The results were noted as follows.

1. Sudden onset of abdominal pain was the initial complaint in most of the cases. The onset time of this pain was morning (8.7%), afternoon (23.2%), and night (68.1 %).

2. The average amount of time from the onset of abdominal pain to hemorrhage was 6.6 +/‐ 4.1 hours. Abdominal pain persisted for 1.6 +/‐ 0.7 days and hemorrhage continued for an average of 1.5 +/‐ 0.8 days.

3. The transient type was common in the young age group (under 40), and the stricturing type was common in the advanced age group (over 70).

4. In cases of the transient type, the lesions healed within 7 days in 68% of all cases, and within 14 days in 82% of them. On the other hand, in cases of the stricturing type, during these same time spans, the lesions healed in 33% and 50% of affected patients, respectively.

5. The change in the findings of longitudinal ulcers in cases of the transient type, which were typical findings of ischemic colitis, disappeared within about 6 days in most cases.

It is concluded that an emergency colonoscopy is essential in the diagnosis of ischemic colitis of the transient type.
Flow Cytometric Measurement of DNA Index and BrdUrd Labeling Index in Endoscopic Biopsy Specimens of Colorectal Carcinoma
Authors: KOSAKA Takeo , MATSUMOTO Hisashi , ISHIDA Tetsuya , TAKEGAWA Shigeru , OOYAMA Shigekazu , KAMATA Toru , KANNO Masahiro , YAMAGUCHI Akio , YONEMURA Yutaka , MIWA Koichi , MIYAZAKI Itsuo , II Toru
Published: August 2007

We compared values of the DNA Index (DI) and bromodeoxyuridine (BrdUrd) labeling index (BULI) of biopsy specimens with those of resected specimens from 12 patients with colorectal cancer, to evaluate the cell cycle by flow cytometry (FCM). From each patient, 4 biopsy specimens were endoscopically removed. Also, small pieces of tissue, 0.5 cm in diameter, were taken from 4 different sites of the resected tumor. Both kinds of specimens were labeled in vitro with BrdUrd. Their DI and BULI values were evaluated from the DNA/BrdUrd bivariate scatter diagram by FCM. It was found that the coefficients of variation (CVs) for endoscopic biopsy specimens were siginificantly lower than those for resected specimens, 4.2 ± 1.3 (Mean ± S. D.) and 5.4 ± 1. 7, respectively. In 8 cases without intratumoral DI heterogeneity, there was a good correlation in the values of DI between the biopsy and resected specimens (r = 0.99, p < 0.01). A significant correlation was also found in the BULI values between the two types of specimens (r = 0.73, p < 0.01). These results suggested that 4 biopsy specimens were enough to estimate DI and BULI by FCM and that DI and BULI values determined by flow cytometry could be useful for decision‐making about the therapeutic modality for preoperative patients.
Hepatocellular Carcinoma with Invasion of the Right Intrahepatic Bile Duct Observed by Peroral Cholangioscopy: a Case Report
Authors: PUA Shirley C. , FUJI Tadasu , AIBE Tsuyoshi , AKIYAMA Tetsuji , NOGUCHI Takayoshi , TANAKA Shinya , HARIMA Kenzo , SASAKI Toshiyuki , KONDO Satoshi , ADACHI Kayoko , TANAKA Hiroko , OKITA Kiwamu
Published: August 2007

A 48‐year‐old chronic alcoholic with previous hepatitis B virus infection presented with recurrent episodes of obstructive jaundice secondary to hepatocellular carcinoma. The obstructive nature of the jaundice was confirmed by the peroral cholangioscopic findings of a friable nodular mass partially obstructing the right hepatic duct, and by relief of obstructive signs and symptoms after endoscopic sphincterotomy freed the common bile duct of “dark greenish formed materials”.
Peroral Micro‐Pancreatoscopy (PMPS) for the Diagnosis of Pancreatic Diseases
Authors: SUGA Toshihiro , MIYAKAWA Hiroyuki , MURASHIMA Yoshio , YAOSAKA Toru , KOITO Kazumitsu , NATSUI Kiyoto , SATO Takahiro , WATANABE Masao , OIKAWA Yumiko , NAGAKAWA Tatsuya , NOBUTA Aichiro
Published: August 2007

In order to observe the inside of the main pancreatic duct endoscopically, we have performed pancreatoscopy using a microfiberscope with an external diameter of 0.75 mm which was inserted even into the undilated duct via a canula for ERCP without papillotomy. The peroral micro‐pancreatoscopy (PMPS) was carried out on 38 patients (16 cases of tumor, 21 of chronic pancreatitis and 1 of a cyst) and was successful in 33 patients (87%). In patients with cancer, rough elevation, redness, bleeding, or ulceration were recognized on the mucosa of the stenotic and the obstructed duct. In chronic pancreatitis, protein plugs were most frequently observed floating in the juice or attached to the ductal wall; some stones were also found in two patients.

PMPS is one of the most useful techniques for the diagnosis of the earlier stages of pancreatic diseases.
Studies on the Phenomenon of Locational Variation in the Speed of Discoloration During the Endoscopic Congo Red Test. The First Report: Quantitative Study of Parietal Cell Populations by Cell Isolation Method
Authors: TANI Norio , KIMURA Norio , KARASAWA Hiroyuki , HARA Masafumi , MUTOU Nobuyoshi , KONDOU Hitoshi , MIWA Takeshi
Published: August 2007

A quantitative study of parietal cell populations was done using the cell isolation method designed by the authors in order to investigate the cause of the phenomenon of locational variation in the speed of discoloration during the endoscopic Congo red test. The endoscopic Congo red test was performed in three mongrel dogs and five patients with peptic ulcers. In each case, at the time when spotty discoloration was observed, three biopsy specimens were obtained from both the quickly discolored portion (Q) and the slowly discolored portion (S) of the greater curvature of the middle body. After determination of wet weight, the biopsy specimens, having been separated into two groups (the Q‐group and the S‐group), were digested simultaneously with collagenase and dispose in the same way in each case. The number of parietal cells per microlitre in the obtained cell suspensions were counted using Neubauer's hemocytometer, staining with tetranitroblue tetrazolium. The number of parietal cells per milligram tissue wet weight was calculated for each sample from both groups. The number of parietal cells per milligram wet weight of the quickly discolored portion was 2.0 times (on average) as large as that of the slowly discolored portion in the case of the dogs. In the case of patients, the former was 1.7 times (on average) as large as the latter, with a statistically significant difference. We concluded that the locational variation of the speed of discoloration during the endoscopic Congo red test may be mainly due to the unequal distribution of parietal cells.
Duodenal Lipoma ‐A Report of Two Cases Resected by Endoscopic Polypectomy‐
Authors: CHANG Shih‐Yong , LIN Jaw‐Town , WANG Teh‐Hong , WANG Jin‐Town , CHEN Chi‐Long
Published: August 2007

Duodenal lipomas are rarely reported. We reported two asymptomatic pedunculated duodenal lipomas successfully resected by endoscopic polypectomy. Case 1 was a 48‐year‐old Chinese female who came for a physical check‐up. Upper gastrointestinal series and endoscopic examination revealed a 2.0 × 1.0 cm pedunculated polyp in the posterior wall of the bulb. Case 2 was a 67‐year‐old female. A 1.7 times 1.0 cm olive‐shaped pedunculated polyp was found by endoscopic examination during a health check‐up. Both tumors were polypectomised by endoscopy and proven to be duodenal lipomas pathologically. The diagnosis of duodenal lipoma has largely been made by surgery and autopsy in the past. It may be made nowadays with abdominal computed tomography and repeated deep biopsies. Duodenal lipomas may be treated by endoscopic polypectomy if the tumor is small and pedunculated.>
Injection Sclerotherapy for Esophageal Varices Associated with Hepatocellular Carcinoma and Liver Cirrhosis
Authors: SHARMA Niranjan , TAKASE Yasuhiro , SHIBUYA Susumu , IWASAKI Yoji
Published: August 2007

Survival period, causes of death and variceal rebleeding in 20 patients with esophageal varices associated with hepatocellular carcinoma and liver cirrhosis were analyzed to evaluate the effectiveness of injection sclerotherapy. The first injection sclerotherapy successfully stopped active variceal bleeding in all seven emergency cases. These were followed up as elective cases later on. The remaining 13 patients, who had a history of variceal bleeding, were treated as elective cases from the beginning. Endoscopic evaluation of the varices was performed at intervals of six months to one year, after the first sclerotherapy, and recurrence was treated by elective sclerotherapy. 85% of the patients died within one year. Three out of 20 cases were still alive until this study was performed. But, whereas 17 patients died mainly due to hepatic failure and hepatocellular carcinoma, only one patient died due to variceal rebleeding. No deaths were observed to have been directly due to sclerotherapy or its complications. Hence we think that injection sclerotherapy should be considered one of the treatments for esophageal varices in patients with hepatocellular carcinoma and liver cirrhosis.
Endoscopic and Radiological Observations of the Growth of an Esophageal Diverticulum
Authors: MIWA Masahiko , KOHDA Shizuo , KOHZUMA Kazunori , TADOKORO Masao , SHINOURA Asahi , OGASAWARA Michio , ISHIKOH Toshitake , MIWA Takeshi
Published: August 2007

A 60‐year‐old female was admitted to the hospital because of acute mediastinitis caused by the perforation of a diverticulum of the esophagus. The patient was successfully treated with antibiotics and on the endoscopic examination the diverticulum was completely cured.

Approximately two years after the first admission, the patient was admitted twice because of acute gastritis. Barium‐meal upper gastrointestinal examination and upper G. I. endoscopy were performed on each occasion. These examinations clearly suggested that the diverticulum had chronic inflammation, with polypoid hyperplasia, and documented the growth of the diverticulum between the 2nd and 3rd admission. As far as we know, this is a very rare report, describing the course and enlargement of an esophageal diverticulum.
Pedunculated Submucosal Ectopic Mucosa of the Stomach Treated by Endoscopic Polypectomy: Report of Two Cases
Authors: FUKUMOTO Shiro , ADACHI Kyoichi , OHTSU Keiichi , ARIMA Noriyuki , WATANABE Makoto , SHIMADA Yoshihiro , UNO Koji , MIKAMI Masayuki , KOBAYASHI Hiroo , HATTORI Shuzo
Published: August 2007

We report here two cases of submucosal ectopic gastric mucosa which grew with pedunculation. A lesion 23 mm in size was located in the posterior wall of the upper gastric body in a 61‐year‐old female. A 58‐year‐old female had a lesion 12 mm in size in the anterior wall of the upper gastric body. Both were elevated lesions expressed as Yamada's type IV and were endoscopically diagnosed as submucosal tumors. For the purpose of total biopsy, endoscopic polypectomy was performed in both cases. Histological examination of the polypectomized specimens showed gastric mucosa in the submucosal layer.

These two cases were unique in that ectopic gastric mucosa was pedunculated and diagnosed after endoscopic polypectomy, not by postoperative pathological examination.
Reasons for False Negatives in the Endoscopic Screening for Cancer in the Upper Gastrointestinal Tract
Authors: O'CALLAGHAN Elena , TAKAHASHI Hiroshi , FUJITA Rikiya
Published: August 2007

Abstract: The following paper is a study of 119 gastric cancer lesions that were not diagnosed as malignant in the first gastroscopic examination. These cases were classified according to their endoscopic appearance, and the frequency with which they appeared was compared with the frequency of that type of lesion in the population that receives endoscopy.

Gastric ulceration, adenomas, polyps, submucosal tumors, acute gastric mucosal lesions, and gastric redness appeared more frequently in the false negative group than in the population that receives endoscopy.

Atrophic gastritis, duodenal ulceration, gastric ulcer scar and gastric erosion appeared less frequently in this group titan in the population that receives endoscopy.

To evaluate whether malignancy should really have been suspected in the lesions, the gastroscopic pictures were reviewed by an expert endoscopist. In only 15% of the lesions was cancer not suspected by the expert endoscopist.

Chromoscopy as an auxiliary method for the endoscopist was used in only about half of the cases. Depending on the experience of the endoscopist, some endoscopic findings appeared more often than others:

i‐ INTERMEDIATE and BEGINNING endoscopists mainly mistook cancer for gastric ulceration.

ii‐EXPERT endoscopists confused many more adenomas and polips.

We conclude that some gastric lesions are more easily confused in regard to malignancy than others, and that the experience level of the endoscopist stakes hint or her more prone to confusing certain kinds of lesions.
A Histologic Study of Endoscopic Biopsies of the Gastric Remnant Mucosa Following Subtotal Gastrectomy, with Special Reference to Changes of the Stomal Mucosa
Authors: SOWA Michio , CHUNG Yong‐Suk , JIMOTO Yasuhisa FU , NISHIMURA Masanori , KUBO Toshiaki , MAEKAWA Hitoshi , KATO Yasuyuki , NISHIWAKI Hideki , YOSHIKAWA Kazuhiko , UMEYAMA Kaoru , KOBAYASHI Kenzo
Published: August 2007

Abstract: Endoscopic biopsy specimens of the remnant gastric mucosa (and of the stomal mucosa in particular) were investigated in 219 patients who had received subtotal gastrectomy for gastric cancer. Dilated glandular lumina (glandular dilatation) and curved ducts (irregular glandular structure) were detected significantly more freguently in the group gastrectomized long before, or by Billroth II resection, than in those treated recently, or by Billroth I resection. DNA histograms showed a distribution of epithelial cells from the remnant gastric mucosa which was somewhat different from the normal histogram. The occurrence rates of polyploid cells were significantly higher than normal, and tended to increase in the same individuals with advancing time after gastrectomy. These observations suggested that the pavticulav environments of the gastric remnant might have nonphvsiologic influences upon the gastric mucosa, although further studies are essential for the clarification of the possible relationship of these environments to oncogenesis in the remnant stomach.
Peptic Ulcer in Infants: Three Case Reports and a Review of the Japanese Literature
Authors: HAYAKAWA Makoto , MORISE Kimitomo , SUGITO Tetsuaki , UMEDA Takashi , UCHIDA Kiyoshi , OKA Youji , KUROKAWA Susumu , KUSAKABE Atsuhiko , TACHINO Fumio , ANDO Takahumi , SAKAI Toru , HATTORI Tatsuo , KANAYAMA Kazuhiro , KUSUGAMI Kazuo , CHIN Kenshou , ITO Shingo , KONAGAYA Toshihiro , KOJIMA Kunihiko , HIKI Yoishiki
Published: August 2007

Abstract: Three cases of peptic ulcer in children under two years of age are reported, and 33 cases of infants with peptic ulcer reported in Japan between 1955 and March, 1989 are reviewed.

Case 1 was an 8‐month‐old male complaining of melena, and endoscopic examination showed a gastric ulcer on the lesser curvature of the antrum. Cases 2 and 3 were a 15‐month‐old mule and an 18‐month‐old male, respectively, with complaints of melena and hematemesis. Endoscopic examination revealed an active duodenal ulcer in both cases. All 3 infants were successfully treated with H2 blocker and/or antacid. In these 3 cases, infection or drugs were speculated to be predisposing factors, and the fathers of these three infants all had histories of duodenal ulcer.

Among 33 cases of infants under 2 years old with peptic ulcer in Japan, 9 had a gastric ulcer and 24 had a duodenal ulcer. Seventeen were treated with conservative therapy and 16 were operated on because of perforation or bleeding.

We should always keep in mind that peptic ulcer does occur in infancy, and that endoscopic examination should be promptly performed when peptic ulcer is suspected.
Primary Leiomyosarcoma of the Liver: Diagnostic Efficacy of Endoscopic Retrograde Cholangiopancreatography
Authors: AKIMOTO Kimihiko , MINE Tetsuya , OHARA Tsuyoshi , MURAKAMI Toshikazu , OGATA Etsuro
Published: August 2007

Abstract: A small primary leiomyosarcoma of the liver detected in a 58‐year‐old man is presented in this paper. In addition to the findings obtained by gray scale ultrasonogruphy and computed tomography, the possible diagnosis of this very rare tumor was suggested by endoscopic retrograde cholangiopancreatography (ERCP). The characteristic findings of leiomyosarcoma of the liver obtained by ERCP were skipping strictures at the intrahepatic bile ducts. The ERCP findings and diagnosis were verified bv pathological studies of the resected material. This appears to be the first report discussing the usefulness of ERCP in vnaking a diagnosis of primary leiomyosarcoma of the liver.
Jejunojejunal Intussusception in a Patient with von Recklinghausen's Disease
Authors: SATO Tadashi , FUJINO Masayuki A. , IKEDA Masahiro , TAKEKAWA Masazumi , NAKAMURA Toshiya , TACHIKAWA Hirokuni , KINOSE Tadashi , AINOTA Takao , MIYAZAKI Yoshiki , YAMAMOTO Yasuyuki , AKAHANE Yoshihiro , SUZUKI Hiroshi , SUGAHARA Katsuhiko , KAWAOI Akira
Published: August 2007

Abstract: A 63‐year‐old female with von Recklinghausen's disease was referred to us because of intermittent periumbilical pain and vomiting. Abdominal ultrasonography showed a segment of the bowel with intussusception in the left ripper quadrant. After intestinal decompression, small‐intestinal endoscopy was performed. Endoscopy revealed multiple protruding lesions in the esophagus, stomach, and jejunum, the largest one markedly stenosing the proximal jejunum. We were able to identify a tumor as the lead point preoperatively. Segmental jejunectomy was performed for the resection of the tumor. Pathological studies revealed that the tumor was leiomyosarcoma.

Gastrointestinal involvement is well documented in von Recklinghausen 's disease. Thus attention should be paid to gastrointestinal involvement in the management of these patients. The present case had intussusception, a rare complication of von Recklinghausen 's disease. Svnall‐intestinal Endoscopy played an essential vole in the diagnosis of gastrointestinal involvement in our patient.
Elevation of the Ulcer Base in Cases Treated with an H2‐Blocker —Difference between an Elevated Type of Gastric Ulcer Scar and a White Elevated Lesion—
Authors: ITO Susumu , TAKAOKA Tsukasa , KAJIMOTO Yoshifumi , WADA Satoru , SYUNDOU Jyoji , SHIMIZU Ichiro , KISHI Seiichiro , SANO Toshiaki , II Kunio
Published: August 2007

Abstract: A white elevated lesion (WEL) was noted in 7 out of 227 ulcer patients treated with an H2‐blocker. These were compared with eight patients with an elevated type of gastric ulcer scars

The elevated type of gastric ulcer scar (ES) is an elevated lesion covered with regenerating epithelium, showing no whitish exudate, and is foveolar hyperplasia in the histological picture of biopsy. The period prior to the formation of an elevated lesion was as short as 4 weeks on average, and the formed elevated lesion retained the elevated from for as long as several months to several years.

The WEL is an elevated lesion covered with whitish exudate, and shows granulation in the histological picture of biopsy. The period prior to the formation of an elevated lesion was as short as 3 weeks on average, and the formed elevated lesion became flattened in a relatively short period of several weeks to several months.

From the above results the ES and the WEL are different in the clinical course, morphology and the histological picture, and considered to be of a different quality.
Clinical Evaluation of Brushing Cytology and Biopsy of the Pancreatic Duct in Patients with Mucin Producing Tumor of the Pancreas
Authors: TADA Hideki , TAKEDA Yoshinobu , SHINDO Hiroaki , NISHIHARA Tokufumi , HASHIMURA Naotaka , TAKASHIMA Tetuya , NAKAJIMA Shuzo , HIGASHINO Takeshi , HONGO Yasushi , ADACHI Gakuji , OSHIBA Saburo , KUROKAWA Akio
Published: August 2007

Abstract: A cytological study of pure pancreatic juice obtained endoscopically after brushing the lesion of the pancreatic duct urns performed in 10 patients with mucin producing tumors of the pancreas. In 6 of these 10 patients, biopsies from the lesion in the pancreatic duct were also carried out endoscopically.

The brushing cytology in all 6 patients with mucin producing carcinoma of the pancreas, except for the sidebranch type, showed cellular atypism and the cytological diagnoses were Class IV or Class V. The results of the brushing cytology in the patients assumed clinically benign were Class I ˜ Class III.

Biopsy results in 4 patients with mucin producing carcinoma of the pancreas indicated that one of them had adenocarcinoma, and the other 3 had atypical hyperplasia which suggests the existence of malignancy. In the patient with adenoma, diagnosis of the biopsy specimen revealed hyperplasia only.

It was concluded that cytology and biopsy of lesions in the pancreatic duct are a valuable way of assessing mucin producing tumors of the pancreas before surgery.
A Case of Early Gallbladder Carcinoma Associated with the Anomalous Union of the Pancreaticobiliary Ductal System
Authors: TAKIUCHI Hiroya , TADA Hideki , TAKEDA Yoshinobu , TEI Hogen , HASHIMURA Naotaka , ASHIDA Kiyoshi , ASADA Syuji , HIRATA Ichirou , OHSHIBA Saburo , NABESHIMA Toshiya , MASAKI Keiko , NAITOH Kazuma
Published: August 2007

Abstract: A 68 year‐old woman was admitted to our hospital with a high fever. Ultrasonography revealed the presence of two protruded mass lesions in the fundus of the gallbladder. Endoscopic retrograde choledochopancreatography (ERCP) indicated an anomalous union of the pancreaticobiliary ductal system (AUPD), with an anomalous junction heated at the site 30 mm proximal to the ampulla of Vater. ERCP also showed the presence of three flat elevated lesions at the fundus of the gallbladder. Amylase activity in the bile obtained from the common bile duct during ERCP was high. From these findings, gallbladder carcinoma associated with AUPD was suspected. Cholecystectomy, choledochectomy followed by hepaticojejunostomy were performed on this patient. A microscopic study of the resected gallbladder demonstrated adenocarcinoma with epithelia like intestinal metaplasia in those elevated lesions surrounded by mucosa associated with atypical hyperplasia without intestinal metaplasia. The authors believe that intestinal metaplasia is the main change accompanied by the cancer, but atypical hyperplasia was an important pre‐cancerous lesion in this case.
Development of a Submucosal Tumor‐like Protrusion at the Site of a Gastric Ulcer during H2‐Blocker Treatment—Report of a Case—
Authors: YUKAWA Masahiko , FUJIMORI Takahiro , SUEHIRO Itsuro , TAMADA Fumihiko , HIRAYAMA Daisuke , SATONAKA Kazuhiro , KITAZAWA Souhei , MAEDA Sakan
Published: August 2007

Abstract: We studied a patient with a gastric ulcer in which the entire ulcer protruded like a submucosal tumor. Candida albicans was observed in the biopsy specimen taken during treatment with cimetidine; the tumor disappeared after treatment with an antifungal agent, both topically and orally. The patient was a 68‐year‐old male who had undergone periodical endoscopic examinations of his upper digestive tract although he did not complain of any subjective symptoms. He was admitted to Suma Red Cross Hospital because examination revealed an active ulcer on the greater curvature of the fornix of the stomach. The patient was treated with 800mg/day of cimetidine. After ten days of treatment, endoscopic studies revealed the elevation of the entire ulcer, which grew into a mass resembling a submucosal tumor associated with a bridging fold. A biopsy of the periphery of the ulcer revealed the presence of Candida albicans in the tissue specimen. Endoscopic ultrasonography revealed a tear in the submucosa and an inflammatory picture that extended into the tunica muscularis. The patient was diagnosed as having a Candida‐infected gastric ulcer. Concomitant use of topical and oral fungizon resulted in the protuberance settling; it was confirmed that the tumor mass completely disappeared and the ulcer healed after 58 days of treatment.
Study on Small Colorectal Polyps and Early Cancers
Authors: IGARASHI Masahiro , KATSUMATA Tomoe , KOBAYASHI Kiyonori , SAIGENJI Katunori , MITOMI Hiroyuki , SEGAWA Kenichi , ATARI Hideo
Published: August 2007

Abstract: We investigated the histopathological features of polyps with a diameter of less than 5 mm that had been resected by a snare or hot‐biopsy (1, 357 lesions in 712 patients), and considered the problems associated with these techniques. 67.7% of the polyps were adenomas, 15.5% were metaplastic polyps, 0.6% were colon cancers, and 0.1% were carcinoids. Eighty percent of the polyps situated on the oral side of the descending colon were adenomas. Although adenomas occurred somewhat more frequently in the sigmoid colon, they tended to be distributed evenly throughout the entire colon. The reddened color of the surface of the polyps tended to accompany adenomas, while a whitish surface color was frequently associated with metaplastic polyps. Multiple polyps occurred in 57% of the patients and 33.7% of the patients had a large polyp with a diameter of more than 6 mm. In six out of eight cases of cancer the cancers were limited to the mucosa (m), the other 2 were submucosal invaded carcinomas. One of these cases was a depressd type of cancer and the other lesions were classified as being elevated type polyps. The elevated type of diminutive early colorectal carcinoma with a diameter of less than 5 mm was difficult to distinguish endoscopically from benign polyps, so we recommended that small colonic polyps should be removed when encountered during a colonoscopy.
Evaluation of Laparoscopic Findings in Chronic Hepatitis C
Authors: HINO Keisuke , KONISHI Tomomi , OKUDA Michiari , FURUKAWA Tetsuya , YAMASHITA Satoyoshi , SHIRASAWA Hiroyuki , ANDO Masaya , YASUNAGA Mitsuru , FUKUMOTO Yohei , OKITA Kiwamu
Published: August 2007

Abstract: To elucidate the differences in the progression of liver cirrhosis of chronic hepatitis B and C, the laparoscopic appearance of the liver surface and the histological findings were carefully assessed in 65 patients with chronic hepatitis B and 58 patients with chronic hepatitis C.

There was a difference noted in the distribution of periportal reddish markings between the two types of chronic hepatitis. Localized and irregular markings were found to be common in hepatitis C. While the markings were seen to be diffusely distributed over the liver surface in hepatitis B. In addition, localized and longitudinal depressions on the liver surface were observbed more frequently in the hepatitis C patients than in those with hepatitis B. Biopsy specimens obtained from the hepatitis C patients with the above‐mentioned laparoscopic findings showed more advanced histological activity. These laparoscopic changes developed in accordance with the progression of histological activity in chronic hepatitis C. Lymphoid follicles or aggregates within the portal areas were observed more frequently in the patients with chronic hepatitis C than in the chronic hepatitis B patients.

Although it is not yet clear how the laparoscopic and histological differences between these two types of chronic hepatitis come about, it appears that the progression of hepatocellular necrosis in chronic hepatitis C is different from that of chronic hepatitis B.
The Endoscopy‐Guided Plan of Radiotherapy for Detecting Esophageal Cancer Using Lugol Staining
Authors: KOBAYASHI Hisataka , ITOH Tsuyoshi , MURATA Rumi , NAOKI Masao , MAEKAWA Takama , SATAKE Hiroshi , KAJITANI Yukio , TANABE Masaya , KOGAWA Kochu
Published: August 2007

Abstract: The Lugol staining method has recently come to play an important role in the detection of superficial esophageal cancers which are extremely difficult to detect using only a barium double‐contrasted esophagogram and/or a conventional esophagoscopy. We have therefore tested the endoscopy‐guided treatment by radiotherapy using Lugol stainings as a technique for detecting 8 lesions of esophageal cancers in 5 patients.

This method was found to be useful for the detection of small intraepithelial lesions, such as intramural metastasis or multiple origin cancers. It is also useful in projecting the lesions accurately on the surface of the body of the patient and planning the radiotherapeutic treatment of the lesions. Additionally, it has been found useful in determining the definite shape of superficial malignant lesions in the evaluation of biopsy specimens taken from the border of the non‐stained regions.
Increased Deoxyribonucleic Acid Synthesis in Primary Biliary Cirrhosis with the Laparoscopical Hallmark of “Reddish patch”
Authors: TARAO Kazuo , SHIMIZU Akio , HARADA Masaoki , KUNI Yukifusa , OHKAWA Shinichi , ITO Yoshihiko , TAMAI Setsuo , HOSHINO Hiroshi , KAMEDA Yoichi , YAMAGUCHI Masanao , IIDA Manichi , UNAYAMA Shiro
Published: August 2007

Abstract: The deoxyribonucleic acid (DNA) synthetic potency of hepatocytes in liver biopsy specimens was investgated in: 6 patients with primary biliary cirrhosis (PBC) with a laparoscopical finding of a “reddish patch”, 5 patients with PBC without a “reddish patch”, 10 patients with chronic aggressive hepatitis with a typical “patchy liver” as seen on laparoscopy, 14 patients with cirrhosis of a viral origin with a laparoscopic “nodular liver”, and in 6 patients with gastric cancer without liver involvement (control subjects). The bromodeoxyuridine (BrdU, a thymidine analogue) ‐anti‐BrdU method was used. The mean BrdU L. I. (±SE) of the PBC patients with a “reddish patch”, PBC patients without a “reddish patch”, patients with a “patchy liver”, patients with a “nodular liver” and of the control subjects was 3.5±0.6%, 0.5±0.1%, 1.3±0.3%, 1.1±0.3%, and 0.2±0.1% respectively. The BrdU L.I. of the PBC patients with a “reddish patch” was significantly greater than that of the PBC patients without a “reddish patch” (p>0.001) and greater than that of patients with a “patchy liver” or a “nodular liver” (p>0.001, respectively). It was the greatest in all of the benign liver diseases examined. Thus, the so‐called laparoscopical finding of a “reddish patch” in PBC may represent a marked regeneration of hepatocytes.
Laparoscopic Observation of Hepatocellular Carcinoma with an Unusual Growth Pattern —Four Case Reports—
Authors: MATSURA Tatsuya , WATANABE Makoto , FUKUMOTO Shiro , YAMAMOTO Shyun , NAGAOKA Saburo
Published: August 2007

Abstract: Usually a laparoscopy is performed for many cases of hepatocellular carcinoma (HCC), but HCC with an unusual growth pattern is not encountered frequently. In this study we report on four cases of HCC which show an unusual growth pattern, who were found out of 96 cases of HCC examined by laparoscopy at our clinic. The first case of HCC considered occurred in a 72–year–old male with intraperitoneal dissemination; the second case, was discovered in a 71–year–old female, and had extrahepatic growth; the third case, in a 56–year–old male, ruptured spontaneously and produced an encapsulated hematoma; the fourth case, present in a 64–year–old male, also ruptured spontaneously. The clinico–pathological and laparoscopic features of HCC with an unusual growth pattern are discussed, placing emphasis on the value of laparoscopy in the diagnosis of HCC with an unusual growth pattern.
Endoscopic Therapy of Early Gastric Cancer —Comparison of Endoscopic Mucosal Coagulation and Resection—
Authors: TAKAHASHI Hiroshi , FUJITA Rikiya , SUGIYAMA Keiichi , SUZUKI Satoshi , KOHSEN Kenzo , SEKI Morihito , SATAKE Yoshiharu , SUGATA Fumio , NAMATAME Kimio
Published: August 2007

Abstract: The clinical efficacy of various methods of endoscopic treatment was evaluated in 70 patients with early gastric cancer. The treatments included using an Nd‐ YAG laser on 22 patients (2 IIa cases, 3 IIa + IIc cases and 17 IIc cases), a heater probe on 2 patients (IIc) and endoscopic mucosal resection (EMR) on 46 patients (13 I cases, 15 IIa cases, 2 IIa + IIc cases and 16 IIc cases). Laser irradiation and the heater probe method (endscopic mucosal coagulation; EMC), which cause coagulation and necrosis to lesions using heat energy, were found to be successful for well differentiated adenocarcinoma confined to the mucosa even if the size of the lesions was 20 mm and over. Poorly differentiated adenocarcinoma with lesions 20 mm or smaller reoccurred, and only well differentiated adenocarcinoma with infiltration limited to the mucosa seemed to be treatable endoscopically by EMR. Whether or not total resection was possible was determined with respect to the size and site of lesions in patients treated by EMR. Great therapeutic efficacy was achieved when the lesions were 10 mm or smaller and located in the anterior wall or the greater curvature. Piecemeal resection had to be made in a majority of cases when the lesions measured 10 mm or more or were located in the lesser curvature or the posterior wall. Therefore, endoscopic EMR is recommended if the size of the lesions is 10 mm or less, while EMC must also be considered if the lesions are larger or piecemeal resection is required.
Characteristic Laparoscopic Findings of Chronic Hepatitis C: A Comparison with Hepatitis B.
Authors: KAJINO Kazunori , OGAWA Yasushi , MICHITAKA Kojiro , NADANO Seijin , ONJI Morikazu , HORIIKE Norio , KIKUCHI Takashi , NONAKA Takashi , KANDA Kimitoshi , MASUMOTO Toshikazu , NAKANISHI Kimio , MATSUURA Bunzou , DOI Kazuaki , OHTA Yasuyuki
Published: August 2007

Abstract: We performed laparoscopy on 72 patients with chronic hepatitis C (CH‐C) to elucidate its morphological features and characteristics relating to its progressive clinical course. We then compared these findings with those of 188 patients with chronic hepatitis B (CH‐B).

The frequency of reddish hepatic markings was almost the same in the patients with CH‐B (21%) and the patients with CH‐C (24%). In the patients with CH‐B, reddish markings were present more frequently in the subjects with sublobular hepatic necrosis (34%) than in those without it (5%, p<0.01), but in CH‐C the difference was not significant. Reddish markings were more even in the patients with CH‐B with respect to form, size and distribution, whereas those in the patients with CH‐C were more uneven. Prenodular patchy markings were present more frequently in the patients with CH‐B (14%) than in the patients with CH‐C (6%, p<0. 05).

These findings suggested that the progression of hepatic necrosis was more variable in different parts of the liver, and that the regeneration of hepatocytes was less active in the patients with CH‐C, compared with the patients with CH‐B.
Upper GI Bleeding in an Emergency Hospital: Etiology, Prognosis and Improved Survival by Endoscopic Hemostasis
Authors: THOMAS Gregory A. , SUGAWA Choichi , JOSEPH Anthony L. , NAKAMURA Ryuji , SAIHARA Tetsushi , INOUE Yoshihiro
Published: August 2007

Acute upper gastrointestinal bleeding (UGIB) is a frequent diagnosis prompting hospital admission or complicating another preexisting condition. This report examines the experience of an urban medical center in the utilization of endoscopy and endoscopic hemostasis in the diagnosis and management of UGIB over a four‐year period.

The first portion of this study examines 562 admissions to a single institution with UGIB. The most common causes of bleeding were acute gastric mucosal lesions (AGML), 24%; esophageal varices (EV), 22%; gastric ulcers, 19%; duodenal ulcers, 14%; Mallory‐Weiss tears, 11%; and esophagitis, 3%. Nonoperative treatment was sufficient in the majority of patients (89.5%). Endoscopic therapy was utilized in 144 patients (26%), of whom 12 required a subsequent operation. Fifty‐eight patients (10.5%) underwent surgery; however, emergent operations were required in only 2.5% of the patients. Factors correlating with mortality included shock at the time of admission (SBP < 80), transfusion requirements of > 5 U PRBC, and presence of EV (each p < 0.001).

The second part of this study examines the effect of thrombogenic sclerotherapy on both short and long‐term survival in 101 patients referred with bleeding esophageal varices. Alcoholic cirrhosis was responsible for the majority (88%) of EV, and most patient were Child's C classification (84%). In long‐term follow‐up, rebleeding was significantly reduced (p = 0.03) in patients compliant with follow‐up sclerotherapy. A trend toward decreased mortality was noted in patients compliant with sclerotherapy and in those who avoided further alcohol usage.