bluuebunny/crossref_metadata_2025 huggingface dataset:
Hydronephrosis in the early stage of pregnancy after renal transplantation
Authors: SAITO KAZUO , SUZUKI KOTARO , YAMAGISHI TAKUYA , TERANISHI JUNICHI , OKUDA MIKA , MAKIYAMA KAZUHIDE , KUBOTA YOSHINOBU
Published: July 2006

Abstract  A 28‐year‐old woman with end‐stage renal disease due to congenital hypoplasia and vesicoureteric reflux in the bilateral kidneys received a renal transplant from her 52‐year‐old mother. She became pregnant 3 years later. The serum creatinine level was 1.6 mg/dL with a creatinine clearance of 27.3 mL/min/1.48 m2 just prior to pregnancy. Her graft showed hydronephrosis at 12 weeks of pregnancy. At 25 weeks a double J‐type stent catheter was placed, without exposure to radiation, because of progressive deterioration of the graft hydronephrosis. Hydronephrosis partially improved, but her serum creatinine level further increased to 2.3 mg/dL. She delivered a healthy boy by routine caesarean section at 34 weeks of pregnancy. Computed tomography demonstrated the ureter wedged between the gravid uterus and the graft. The catheter was removed 10 days postpartum. Six months later, ultrasonographic study did not show hydronephrosis and the serum creatinine level was 2.0 mg/dL.
Superimposition of nutcracker syndrome in a hematuric child with idiopathic hypercalciuria and urolithiasis
Authors: SHIN JAE IL , PARK JEE MIN , LEE JAE SEUNG , HAN SANG WON , KIM MYUNG JOON
Published: July 2006

Abstract  We report a 5‐year‐old girl with idiopathic hypercalciuria who developed gross hematuria and left flank pain despite normalization of calciuria, a renal stone, and microscopic hematuria. She was found to have nutcracker syndrome by renal Doppler ultrasound, which revealed the significant differences of the peak blood flow velocities in the two portions of the left renal vein.
Mycotic aneurysm of the renal transplant artery
Authors: FUJIKATA SHIRO , TANJI NOZOMU , ISEDA TOKUHIRO , OHOKA HIROJI , YOKOYAMA MASAYOSHI
Published: July 2006

Abstract  A case of mycotic aneurysm secondary to septicemia is reported. A 59‐year‐old man with end‐stage renal failure underwent renal transplantation from a living donor. On the fifteenth postoperative day, he was febrile and his arm around an entry wound of the drip infusion had infectious signs. Cultures of the blood and pus discharge grew Methicillin‐resistant Staphylococcus aureus. Vancomycin was administered intravenously for 30 days. Then the existence of a mycotic aneurysm on the transplant artery was not suspected by computed tomography. After his infectious signs disappeared, examinations revealed a pseudoaneurysm measuring 4 cm in diameter at the site of anastomosis between the renal transplant and external iliac arteries by computed tomography. He has been carefully followed up with a conservative management. This is the first case of a mycotic aneurysm treated conservatively and displaying an uneventful course without rupture.
Ureteral carcinoid tumor
Authors: LEE TE‐AN , CHANG HUANG‐KUANG , YANG STONE , FANG SHAOU‐MING , CHANG KUO‐MING
Published: July 2006

Abstract  Most ureteral tumors are transitional cell neoplasms. Neuroendocrine tumors of the genitourinary tract are extremely rare. To our knowledge, only one ureteral carcinoid tumor has been reported before. We report a second case of ureteral carcinoid tumor found in a 70‐year‐old female.
11C‐choline positron emission tomography in bladder cancer: Report of four cases
Authors: YOSHIDA SOICHIRO , NAKAGOMI KAZUAKI , GOTO SHUICHI , FUTATSUBASHI MASAMI , TORIZUKA TATSUO
Published: July 2006

Abstract  Little work has been done with positive emission tomography (PET) in bladder tumors because high urinary excretion of 18F‐FDG makes visualization of the bladder tumor difficult. 11C‐choline has recently been reported as a new tracer which lacks urinary radioactivity. We report the result of 11C‐choline PET in four patients with invasive bladder tumors. In one case, 11C‐choline PET could detect bladder tumor effectively without urinary activity and bone metastasis despite negative bone scintigraphy. On the other hand, an intense accumulation of the tracer in the bladder hampered the interpretation on PET scanning in three patients. The mechanisms of the 11C‐choline accumulation in the bladder were reported to be due to inflammatory and proliferative changes in the mucosa of the bladder from previous catheterization or other factors. Further study is necessary to prove the value of 11C‐choline PET for detecting primary bladder cancer and bone metastasis.
Churg–Strauss syndrome presenting with eosinophilic prostatitis
Authors: KIYOKAWA HIDEO , KOYAMA MASAMICHI , KATO HARUAKI
Published: July 2006

Abstract  We report a patient with eosinophilic prostatitis associated with Churg–Strauss syndrome. A 74‐year‐old man, who had been treated for asthma, underwent transurethral resection of the prostate. After the operation he had a high temperature of approximately 40°C. The differential blood count revealed marked eosinophilia of 77.5%. The patient received 20‐mg prednisolone and dramatically became afebrile. The pathological diagnosis was eosinophilic prostatitis. These findings strongly indicate Churg–Strauss syndrome.
A rare case of right varicocele testis caused by a renal cell carcinoma thrombus in the spermatic vein
Authors: SHINSAKA HIDEO , FUJIMOTO NAOHIRO , MATSUMOTO TETSURO
Published: July 2006

Abstract  We report a rare case of renal cell carcinoma demonstrating right varicocele testis. In the present case, since the right spermatic vein directly drained into the right renal vein, the tumor thrombus extended into the right spermatic vein through the renal vein without any tumor thrombus in the inferior vena cava (IVC). To our knowledge, this is the first description of a renal cell carcinoma thrombus in the right spermatic without a tumor thrombus in IVC.
Spermatic cord metastasis as an initial manifestation of non‐small cell carcinoma of the lung
Authors: KAYA CEVDET , TANRIKULU HANDAN , YILMAZ GULHAN , AKER FUGEN , KARAMAN MUHAMMET IHSAN
Published: July 2006

Abstract  Lung cancer is among the most common cancers which continue to be a major cause of death in the world and many present with distant metastasis in advanced stages precluding curative treatment. Herein, we report a 62‐year‐old male patient admitted to our hospital with complaint of a painful mass in his left inguinal region. Surprisingly, a chest radiograph revealed a mass in his left lung with ipsilateral pleural effusion. Thorough radiological and pathologic examinations he was confirmed to have a non‐small cell lung cancer with only spermatic cord metastasis and unfortunately the patient died two weeks after admission.
Usefulness of tonsil forceps in radical retropubic prostatectomy
Authors: HAMANO SATOSHI , NAKATSU HIROOMI , SUZUKI NORIYUKI , MURAKAMI SHINO
Published: July 2006

Abstract  The presence of positive surgical margins after radical retropubic prostatectomy (RRP) for prostate cancer leads to an increased risk of progression and reduces disease free survival. A positive surgical margin at the apex is more frequent and is associated with worse clinical prognosis compared to other locations. The urethra usually enters the prostate slightly anterior and proximal to the prostatic apex. After dividing the dorsal vessels and separating neurovascular bundles (NVB) from the prostatic urethral junction using scissors, the operator dissects around the urethra just below the apex to avoid incision into the apex and injury of the NVB and sphincter mechanism. We use tonsil forceps instead of a right‐angle clamp to make this important operative step more approachable. Its special curved shape with an angle of 105 degrees and short tip should make it much easier to isolate the urethra just below the apex from the surrounding tissue.
Tension‐free vaginal tape surgery for stress urinary incontinencne: A prospective multicentered study in Japan
Authors: OHKAWA ASAKO , KONDO ATSUO , TAKEI MINEO , GOTOH MOMOKAZU , OZAWA HIDEO , KATO KUMIKO , OHASHI TERUHISA , NAKATA MAKI ,   ON BEHALF OF THE TENSION‐FREE VAGINAL TAPE TRIAL GROUP
Published: July 2006

Aim:  To report the prospective multicentered study of the tension‐free vaginal tape (TVT) procedure for stress urinary incontinence.

Methods:  One hundred and fifty‐one women with stress urinary incontinence were operated on by the TVT procedure and were followed up at 3, 12, and 24 months after surgery. Patients’ age and body mass index (BMI) averaged 57 years and 23.9, respectively. Forty‐nine women were classified as type I, 46 women type II and 56 women type III (McGuire’s classification). Local anesthesia was used in the operations on 137 women (91%) and epidural or general anesthesia was used in 14 (9%). Surgical outcomes were analyzed with Kaplan‐Meier survival curves.

Results:  The subjective and objective cumulative cure rates 24 months later were 92% and 77%, respectively (P > 0.05). The TVT operation for women with type III (62%) resulted in a significantly lower cure rate compared to those with type I or with type II (83%) (P < 0.001). Post‐operatively a urethral catheter was indwelt one day in 77 women (51%), two days in 14 (9%) and 3–7 days in 60 (40%). Surgical complications were encountered in 43 women (28%). The most frequent was bladder perforation in 24 women followed by postoperative difficulty in urination and de novo urgency.

Conclusions:  The TVT surgery was promising for the treatment of stress incontinence because of minimal surgical invasiveness and satisfactory surgical results. Women with type III incontinence resulted in fewer satisfactory outcomes than those with type I or II incontinence.
FLAT AND SMALL SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS DETECTED AND DIAGNOSED BY ENDOSCOPY WITH NARROW‐BAND IMAGING SYSTEM
Authors: Goda Ken‐Ichi , Tajiri Hisao , Kaise Mitsuru , Kato Masayuki , Takubo Kaiyo
Published: July 2006

Reported herein is the case of a 65‐year‐old man who had completely flat and small squamous cell carcinoma in the esophagus. The subtle lesion was initially detected as a brownish area depicted by non‐magnified endoscopy with the narrow‐band imaging system (NBI). The lesion was predicted to be type 0‐IIb mucosal cancer due to assessment of morphologic change of intrapapillary capillary loop under magnified NBI observation. Endoscopic mucosal resection was performed for the lesion. The histological finding of the removed specimen indicated mucosal squamous cell carcinoma. Endoscopic observation with the NBI system was useful for detecting obscure squamous cell carcinoma and predicting the histological finding.
EARLY DETECTION OF HYPOPHARYNGEAL CANCER BY NARROW‐BAND IMAGING
Authors: Kozu Takahiro , Saito Yutaka , Nonaka Satoru , Saito Daizo , Shimoda Tadakazu
Published: July 2006

Twelve years ago, a presently 66‐year‐old male underwent resection of esophageal cancer. He was followed up with annual endoscopy, which in April of 2005 found and by endoscopic mucosal resection removed two small, low‐grade carcinomas of less than 10 mm from his hypopharynx. Before the development of narrow‐band imaging, such early stage cancer could not have been detected. Now, narrow‐band imaging is useful for screening high‐risk groups.
PERORAL PANCREATOSCOPY AND INTRADUCTAL ULTRASONOGRAPHY IN DETERMINING THE RESECTION LINES OF INTRADUCTAL PAPILLARY MUCINOUS TUMORS OF THE PANCREAS
Authors: Mukai Hidekazu , Maguchi Hiroyuki
Published: July 2006

In patients with malignant intraductal papillary–mucinous tumors (IPMT), the tumor spread along the main pancreatic duct is generally inspected as mural nodules within the ducts by peroral pancreatoscopy (POPS). Even the lower mural nodules including fish‐eggs‐like lesions and granular mucosa continued to the main taller mural nodules should be resected. Mural nodules along the main duct and cystic dilation of the branch ducts observed by intraductal ultrasonography (IDUS) are regarded as the tumor spread. Although POPS is superior to IDUS in identifying mural nodules along the main duct, POPS has limitations to detect mural nodules within the branch ducts. Therefore, the accuracy of the diagnosis by POPS is higher in main duct IPMT, whereas that by IDUS is higher in branch duct IPMT. These modalities should be performed as complementary tests in determining the resection lines preoperatively.
DIAGNOSIS AND MANAGEMENT OF INTRADUCTAL PAPILLARY MUCINOUS TUMORS OF THE PANCREAS
Authors: Maguchi Hiroyuki , Mukai Hidekazu
Published: July 2006

Intraductal papillary mucinous tumors (IPMT) of the pancreas are histopathologically adenocarcinoma, adenoma, or even hyperplasia, and, therefore, selection of the treatment strategy is very important. While the International Consensus Guidelines for Management of Intraductal Papillary Mucinous Neoplasms and Mucinous Cystic Neoplasms of the Pancreas have been published, the authors discussed the diagnosis and management of IPMT in the session of Endoscopy Forum Japan 2005. All the discussants agreed to the guideline’s recommendation to resect all main duct IPMT. However, they reserved their consensus on the recommendation of resection for branch duct IPMT which are 5 mm or higher in the mural nodule height. General opinion is that treatment should be considered for lesion where the main duct diameter is over 7 mm, and that dilated branch duct diameter is not an important factor, while it is defined as an important factor in the guidelines.
WHAT KIND OF BENEFIT DO WE EXPECT FOR PERORAL PANCREATOSCOPY IN THE DIAGNOSIS OF INTRADUCTAL PAPILLARY MUCINOUS TUMOR OF THE PANCREAS?
Authors: Yamaguchi Taketo , Ishihara Takeshi , Saisho Hiromitsu
Published: July 2006

Intraductal papillary mucinous tumor (IPMT) of the pancreas is characterized by slow growth and a relatively favorable prognosis, however, invasive cancer originating in an IPMT is associated with a poor prognosis. Although various parameters in imaging modalities have been advocated to differentiate between benign IPMN and malignant ones, it is not easy to obtain definite diagnosis based on these parameters. Peroral pancreatoscopy (POPS) allows a clear and direct visualization of the pancreatic duct, providing useful information regarding tumor nature in IPMT. The authors have studied the usefulness of POPS in the diagnosis of IPMT. Nevertheless, its usefulness is not necessarily widely accepted and the significance of POPS is still controversial. In this review, the authors intended to address the diagnostic value of POPS and to clarify its role in the diagnosis of IPMT. The authors think treatment of IPMT can be improved by introducing POPS because the determination of surgical procedure as well as the area of resection based on the preoperative diagnosis of the involvement of the main pancreatic duct and branch duct is inevitable.
ENDOSCOPIC NASOBILIARY DRAINAGE: CURRENT INDICATIONS AND EVALUATION OF THE PRODUCTS
Authors: Yasuda Ichiro , Iwashita Takuji , Ohnishi Takaya , Mukai Tsuyoshi , Enya Masamichi , Tomita Eiichi , Moriwaki Hisataka
Published: July 2006

Endoscopic nasobiliary drainage (ENBD) is a well established mode of biliary decompression. Although ENBD is certainly an uncomfortable procedure with the potential risk of spontaneous dislocation or removal of the drainage catheter by disoriented patients, it has several advantages over endoscopic biliary drainage (EBD) using an indwelling stent. The current indications for ENBD are: (i) temporary drainage to treat obstructive jaundice and cholangitis caused by malignant or benign biliary stricture; (ii) urgent drainage to treat suppurative cholangitis primarily caused by common bile duct stones; (iii) temporary drainage after stone removal in patients with suspected incomplete clearance and/or with cholangitis; and (iv) biliary leaks that occur primarily after surgery, as well as other indications. Different types of nasobiliary catheters are currently available that have been designed with various diameters, shapes, and materials. However, the current catheters are not considered by most endoscopists to be sufficient. Further improvements are needed to achieve better drainage and better maneuverability.
ROLE OF ENDOSCOPIC NASOBILIARY DRAINAGE INDICATION AND BASIC TECHNIQUE
Authors: Itoi Takao , Sofuni Atsushi , Itokawa Fumihide , Tsuchiya Takayoshi , Kurihara Toshio
Published: July 2006

Endoscopic nasobiliary drainage (ENBD) plays an important role in the treatment of patients with obstructive jaundice. Nowadays, ENBD is widely performed for not only biliary drainage, but also for gallbladder, pancreatic duct, and pancreatic cyst drainage. Herein is presented the indications for ENBD and its technique.
NASOGALLBLADDER DRAINAGE FOR MIRIZZI’S SYNDROME
Authors: Arisaka Yoshifumi , Masuda Daisuke , Kii Takayuki , Takii Michiaki , Katsu Ken‐Ichi
Published: July 2006

The authors experienced a case of Mirizzi’s syndrome successfully treated with endoscopic nasogallbladder drainage (ENGBD). The patient was a 63‐year‐old man. He was admitted with abdominal pain and jaundice. Laboratory data indicated leukocytosis and elevation of serum bilirubin level. Abdominal ultrasound showed marked swelling of gallbladder and debris in the gallbladder, therefore, the authors strongly suspected Mirizzi’s syndrome. He had past history of acute myocardial infarction and treated with anticoagulation therapy. Then, the authors couldn’t perform surgical removal or percutaneous transhepatic drainage, and tried endoscopic transpapillary drainage. Endoscopic retrograde cholangiopancreatography revealed smooth stricture in the superior portion of common bile duct and occlusion of the cystic duct, and ENGBD was then performed. After ENGBD, his complaints, laboratory data, swelling of gallbladder and stricture of common bile duct were all remarkably improved.
MANAGEMENT OF BLEEDING CONCERNING ENDOSCOPIC SUBMUCOSAL DISSECTION WITH THE FLEX KNIFE FOR STOMACH NEOPLASM
Authors: Fujishiro Mitsuhiro , Yahagi Naohisa , Kakushima Naomi , Kodashima Shinya , Muraki Yosuke , Tateishi Ayako , Omata Masao
Published: July 2006

Management of bleeding is crucial for a successful endoscopic submucosal dissection (ESD) with the Flex knife for a stomach neoplasm. Medical approaches to suppress gastric acid secretion and keep systolic blood pressure at the level of < 150 mmHg during ESD are tried to lessen bleeding. But, major concerns for bleeding are whether the blood vessels are cut off or not and endoscopic surgeons have to avoid blind application of devices for ESD as much as possible. Even in the situations where blind application for non‐visible vessels in the submucosa is not preventable such as in the steps of marking, submucosal injection, mucosal incision, and snaring, the efforts to lessen bleeding are necessary. When non‐bleeding visible vessels are noticed, ‘prebleeding coagulation’ with appropriate devices is important. Even if unexpected bleeding occurs, it is also controllable using appropriate devices according to the type of bleeding. All endscopists who perform ESD should also be experts in management of bleeding.
DIAGNOSIS OF BARRETT’S ESOPHAGUS AND ESOPHAGEAL NEOPLASIA: EAST MEETS WEST
Authors: Canto Marcia Irene
Published: July 2006

Barrett’s esophagus has traditionally been considered to be a predominantly ‘Western world’ neoplastic condition. However, over the years, Asian countries are beginning to diagnose increasing numbers of patients with gastroesophageal reflux disease, columnar metaplasia at the gastroesophageal junction, Barrett’s esophagus, and esophageal adenocarcinoma. Hence, the controversies regarding screening for and surveillance of Barrett’s esophagus and esophageal adenocarcinoma have become more widely relevant to gastroenterologists around the world. Emerging concepts related to esophageal cancer prevention and early detection include the screening for Barrett’s esophagus using wireless videocapsule endoscopy, and chromoendoscopy, enhanced high resolution endoscopy. There is also interest in improving surveillance for esophageal neoplasia using novel imaging techniques, such as high resolution and high magnification endoscopy, narrow‐band imaging, autofluorescence imaging, and endocytoscopy/endomicroscopy. The enhanced detection of Barrett’s esophagus and esophageal neoplasia become even more clinically relevant because of accumulating data on the safety and effectiveness of mucosal ablative techniques (such as photodynamic therapy, argon plasma coagulation, low pressure cryotherapy) and endoscopic mucosal resection. This article summarizes the latest developments related to Barrett’s esophagus that are of interest to endoscopists from the East or West.
COMPARISON OF THE HEIGHT OF PAPILLARY TUMOR IN INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM OF THE PANCREAS BETWEEN MEASURED PREOPERATIVE IMAGES AND RESECTED MATERIAL
Authors: Tanaka Kiyohito , Yasuda Kenjiro , Uno Koji , Sakata Munehiro , Nakajima Masatsugu
Published: July 2006

The height of the mural nodules and papillary tumors in main pancreatic duct or dilated branch duct is the most important factor for diagnosis of intraductal papillary mucinous neoplasm (IPMN). In this study, the authors compared the height of the papillary lesions and mural nodules between the height of resected tissues and the height detected by the preoperative imaging tools (endoscopic ultrasonography [EUS] and intraductal ultrasonography [IDUS]) in 38 patients with IPMN. In 21 out of 23 cases of adenoma, and in cases with the non‐invasive cancer, the difference of the height of operative and preoperative analysis measured by EUS and IDUS was within 1–2 mm. EUS and IDUS are useful for diagnosis of degree of malignancy in IPMN.
INTRAOPERATIVE BLEEDING IN ENDOSCOPIC SUBMUCOSAL DISSECTION IN THE STOMACH AND STRATEGY FOR PREVENTION AND TREATMENT
Authors: Toyonaga Takashi , Nishino Eisei , Hirooka Takashi , Ueda Chie , Noda Kazu
Published: July 2006

To control intraoperative bleeding is an important key to successful endoscopic submucosal dissection. The distribution of submucosal vessels encountered during the procedure differ in places in the stomach and are roughly categorized into three groups: those located in the antrum, those in the lesser curvature, and those on the anteroposterior corpus wall which consists of oblique muscle layers. Therefore, knowledge of a suitable setting of diathermy and adjusted depth of dissection in the submucosal layer for each site is imperative. The combination of utilizing the distal attachment forced or swift coagulation (trimming with coagulation mode) have enable the treatment with an insulation tipped knife safer.
WHICH TYPES OF DRAINAGE TUBE SHOULD WE SELECT FOR ENDOSCOPIC BILIARY DRAINAGE? CURRENT STATUS
Authors: Isayama Hiroyuki , Nakai Yousuke , Tsujino Takeshi , Kawabe Takao , Omata Masao
Published: July 2006

Biliary drainage is a standard procedure for cholangitis or obstructive jaundice due to biliary obstruction. However, criterion for the selection of types of drainage tube is not established. The authors analyzed the types of drainage tube used in the University of Tokyo, Tokyo, Japan, during the month of June 2005, and they treated 63 cases. For drainage for cholangitis (31), the authors used endoscopic naso‐biliary drainage (ENBD) tube in 74.1% and plastic stent in 25.9%. In contrast, for the cholestesis cases (16), the authors used ENBD tube in 37.5% and plastic stent in 63.5%. For the unresectable biliary malignancy cases (8) with improved jaundice, the authors used covered metallic stent in seven distally stricture cases and uncovered metallic stent in one proximally stricture case. The remaining eight cases received plastic stent placement. There were six cases of residual common bile duct stones and two cases of prevention of cholangitis after papillectomy. For the patients with unresectable biliary malignancies at distal portion, the authors consider that covered metallic stent is a standard endoprosthesis. For drainage for cholangitis, the authors used ENBD tube because bile juice flow is able to be checked any time. However, the authors used plastic stent rather than ENBD tube for the drainage of cholestesis. A larger study for selection of drainage tube for these aspects is needed in the future.
BILIARY STENTING FOR MALIGNANT STRICTURE OF THE BILE DUCT
Authors: Katanuma Akio , Maguchi Hiroyuki , Takahashi Kuniyuki , Osanai Manabu , Nakahara Kazuyuki , Urata Takahiro , Matuzaki Shinpei
Published: July 2006

Biliary stenting is used as a standard procedure for the relief of jaundice in patients with non‐resectable malignant stricture of the bile duct. The stents available in the market are variously characterized, and surgeons must select an appropriate one for each disease status. For the stricture of the middle and/or lower part of the bile duct, covered metallic stent is superior to plastic stent in the patency period, however, there are questions as to the use of metallic stents in light of cost‐effectiveness and development of complications of stenting. And, the stent selection for the stricture of the hilar part of the bile duct has not been fully studied, which remains a problem yet to be resolved. In the use of metallic stent, it is difficult to manage when stent occlusion or complication occurs, and it holds the risk of developing a very serious complication. In the use of plastic stent, however, long‐term patency cannot be expected, which is also a problem yet to be resolved.
HOW SHALL WE EFFECTIVELY TRAIN GASTROINTESTINAL FELLOWS IN THE NEAR FUTURE?
Authors: Tajiri Hisao
Published: July 2006

The current study outlines an optimum form for future education in gastrointestinal endoscopy based on the present status in Japan and in comparison with Western countries. This study also refers to the curriculum for interns and its effective application, the training system for endoscopic treatment that is normally associated with a high risk, and the structure of the training center. According to conventional endoscopy training, hands‐on training using clinical patients follows observation and classroom lectures. However, to maintain safe and clinically optimum quality, techniques and knowledge should be imparted through the use of a simulator and ex vivo models before one comes into contact with a patient. As for endoscopic submucosal resection (ESD), a better learning curve will certainly be obtained if a computer‐based endoscopic simulator is added to the training program composed of three levels: (i) observation and assistance in ESD; (ii) training in the procedure of ESD using animal stomachs; and (iii) ESD conducted under the supervision of an instructor. Education systems should be made widely available so that even after the physician has become competent to treat a clinical patient, they should be able to attend seminars with technical demonstrations and acquire more advanced professional knowledge and learn the latest techniques.
Histological description of the ink gland of the tropical sea hare Aplysia dactylomela Rang, 1828
Authors: Bezerra Luis E. A. , Silva José R. F. , Carvalho Ana F. U. , Melo Vânia M. M.
Published: July 2006

This work describes for the first time the ink gland of Aplysia dactylomela Rang, 1828 using light microscopy and histochemical tests. The results reveal that this organ is covered by a layer of simple epithelium and that there are some differences between the epithelium facing the mantle shelf and that facing the mantle cavity. The former consists of columnar cells, which may have a secretory function, whereas the latter is a cuboidal epithelium. Underneath the epithelium and along the whole gland there are fibres of smooth muscle and collagen, organized in groups of parallel bundles. There are vesicles of different diameters, apparently with similar morphology. Some are filled with ink, whereas others are either granular or clear. The ink is released through a duct formed by invaginations of the cuboidal epithelium. Tests with bromophenol blue and periodic acid Schiff indicated that the ink and granulated vesicles contain proteins and carbohydrates or maybe glycoproteins. Between the fibre bundles and the vesicles there are dispersed cells. A diagram is presented emphasizing the covering epithelium, the distribution of muscle and collagen fibres, the dispersed cells, vesicles and ducts. This organization is similar to that of the other Aplysia species studied to date, A. californica.
Suburethral sling at the time of radical prostatectomy in patients at high risk of postoperative incontinence
Authors: WESTNEY O. LENAINE , SCOTT SHELLIE , WOOD CHRISTOPHER , EDDINGS TERESA , JOHNSON MARCELLA M. , TAYLOR JENNIFER M. , McGUIRE EDWARD , PISTERS LOUIS L.
Published: July 2006

OBJECTIVE

To evaluate the insertion of a urethral sling at the time of radical prostatectomy (RP) in men at high risk of urinary incontinence after RP.

PATIENTS AND METHODS

Between 1998 and 2000, 49 of 871 men undergoing RP at The University of Texas M.D. Anderson Cancer Center, were identified as at risk of urinary incontinence after RP, based on their age (>65 years), previous transurethral resection of the prostate, previous radiation therapy, clinical stage, and obesity (body mass index of ≥ 30 kg/m2). These 49 men had a suburethral sling inserted at the time of RP, and incontinence after surgery was evaluated using pad counts and patient‐completed questionnaires. Retrospectively, incontinence rates and complications in these men were compared with 122 men also at high risk of urinary incontinence after RP who did not have a sling inserted at the time of RP (control group).

RESULTS

In all, 29 of 49 men (59%) with a suburethral sling reported using either no pad or one pad per day for urinary leakage at 6 months after RP, compared with 83 of 118 (70%) in the control group. At 12 months after RP, 34 of 46 (74%) men with a suburethral sling reported using no or one pad, compared with 75 of 89 (84%) in the control group. Seventeen (35%) men were treated for urethral stricture in the sling group and 17 (14%) in the control group (P = 0.001).

CONCLUSION

The urethral sling modification concurrent with RP is feasible, but does not decrease incontinence compared with a similar group of high‐risk patients who did not have the sling modification. In addition, the stricture rate in the sling group was unacceptably high. Currently, we do not recommend the use of a urethral sling at the time of RP.
Laparoscopic decortication of symptomatic simple renal cysts: 10‐year experience from one institution
Authors: SHIRAISHI KOJI , EGUCHI SATOSHI , MOHRI JUN , KAMIRYO YORIAKI
Published: July 2006

In this Japanese retrospective study, laparoscopic decortication was performed in 36 patients. The authors suggest that this is a safe procedure with satisfactory long‐term symptomatic results. They also found that the procedure was still challenging for peripelvic cysts.

OBJECTIVE

To assess the long‐term results by symptomatic and radiological outcome of laparoscopic decortication of renal cyst, first reported in 1992.

PATIENTS AND METHODS

We retrospectively reviewed the records of 36 patients who had a total of 36 laparoscopic decortications at our institution between December 1993 and March 2004. Of these cysts, 30 were peripheral and six were peripelvic cysts; the patients were asked if they had pain or not. Changes of cyst size after decortication were determined by computed tomography and the serial changes of each cyst were evaluated as the percentage of the diameter before surgery. The relationships between radiological and symptomatic outcome or cyst location were examined.

RESULTS

Peri‐operative morbidity was satisfactory; with a mean (range) follow‐up of 67.2  (13–128) months the symptomatic and radiological success rates were 92% (33 of 36) and 81% (25 of 36), respectively. Peripelvic cysts were significantly correlated with radiological failure. Symptomatic improvement was evident by 3 months, while radiological improvement continued for up to 3–4 years after surgery. Seven asymptomatic patients with radiological failure selected a conservative follow‐up.

CONCLUSIONS

Laparoscopic decortication is safe and provides long‐term satisfactory symptomatic results. The radiological improvement was slower than the symptomatic improvement and several cysts remained large, indicating some reduction in volume that was enough to improve the symptoms. This procedure is still challenging for peripelvic cysts in terms of radiological results, yet feasible for the clinical outcome.
Polymerase chain reaction‐based identification of Propionibacterium acnes types isolated from the male urinary tract: evaluation of adolescents, normal adults and men with prostatic pathology
Authors: SHANNON BEVERLEY A. , COHEN RONALD J. , GARRETT KERRYN L.
Published: July 2006

OBJECTIVE

To assess whether colonization of the male urinary tract with Propionibacterium acnes, in particular types IB and II (which are associated with inflammation in radical prostatectomy specimens and might be involved in the development of prostate cancer), is associated with prostate disease, and thus to develop a urine test to detect men at risk of prostate disease.

PATENTS, SUBJECTS AND METHODS

We developed the first polymerase chain reaction (PCR)‐based technique for identifying P. acnes types IA, IB and II, and used this in combination with selective culture medium to compare the prevalence of these subtypes in the urinary tract of adolescent males, healthy adult men and patients with confirmed prostate pathology.

RESULTS

P. acnes types IB and II were no more prevalent in the urinary tract of patients with prostate pathology than in normal control men. However, the prevalence of types IB and II appeared to be higher in adult men (at 11 of 15 and six of 15, respectively) than in adolescents (two of six and one of six), suggesting an age‐related increase. Comparison of urinary tract and facial skin P. acnes from three subjects showed that type IA was more often predominant on facial skin, whereas types IB or II were more often predominant in the urinary tract.

CONCLUSIONS

A urine test might not be useful for detecting men with prostatic P. acnes infection and thus at greater risk of associated prostate disease. However, this work validated our technique for detecting and identifying the three P. acnes subtypes, and identified some interesting trends worth further investigation.
A randomized controlled equivalence trial of short‐term complications and efficacy of tension‐free vaginal tape and suprapubic urethral support sling for treating stress incontinence
Authors: LORD H. ELIZABETH , TAYLOR JOHN D. , FINN JUDITH C. , TSOKOS NICOLAS , JEFFERY J. TIMOTHY , ATHERTON MICHELLE J. , EVANS SHARON F. , BREMNER ALEXANDRA P. , ELDER GILLIAN O. , HOLMAN C. D’ARCY J.
Published: July 2006

OBJECTIVE

To establish the equivalence between the tension‐free vaginal tape (TVT) and the suprapubic urethral support sling (SPARC). Approximately 35% of women have stress urinary incontinence (SUI), and although TVT is now perceived as the standard treatment, the SPARC is a very similar procedure and is thought to have fewer peri‐operative complications.

PATIENTS AND METHODS

Patients with clinical SUI were recruited from public and private urology/urogynaecology clinics, and participated in the trial of TVT vs SPARC. The primary outcome was bladder perforation; secondary outcomes were blood loss, voiding difficulty, urgency, and cure of SUI symptoms. Sample size calculations, based on an estimated 2% perforation rate, showed that 290 patients would be needed to detect a clinically significant difference of 5%. Stratification was by previous incontinence surgery and the experience of the surgeon.

RESULTS

There were 301 operations; the difference in bladder perforations was not statistically significant, at one/147 TVT (0.7%), and three/154 SPARC (1.9%), with the difference in rate of 0.013 (95% confidence interval (CI) − 0.01 to 0.04; odds ratio 2.89, 95% CI 0.30–28.21; P = 0.62), and nor were differences in estimated blood loss of >100 mL (TVT, 32/147, 21.8%; SPARC 28/154, 18.2%); de novo urgency (TVT 15/37, 40.5%; SPARC 14/33, 42.4%), objective cure (TVT 143/147, 97.3%; SPARC 148/152, 97.4%) or vaginal mesh erosion (TVT 7/147, 4.8%; SPARC 16/152, 10.5%). Acute urinary retention (TVT none of 147; SPARC 10/154, 6.5%; odds ratio ∞, 95% CI 2.2–∞; P = 0.002) and subjective cure (TVT 128/147, 87.1%; SPARC 117/153, 76.5%; odds ratio 2.07, 95% CI 1.13–3.81; P = 0.03) were statistically significantly different.

CONCLUSION

These results are consistent with clinical equivalence between TVT and SPARC for bladder perforation. There was no statistically significant difference between TVT and SPARC in blood loss, urgency or objective cure of SUI symptoms at 6 weeks. However, SPARC was more difficult to adjust correctly, and a statistically significant number of patients required loosening of the tape in theatre (P = 0.002). TVT had a lower rate of vaginal erosion and a statistically significantly higher cure rate of subjective SUI symptoms than SPARC. Overall, voiding difficulty (loosening of the tape), urgency and vaginal mesh erosion were the most important clinical problems. This trial showed the importance of testing new devices which appear to be similar, but which might have relevant differences. There was no financial assistance for this study, and a long‐term follow up is planned.
The treatment of female bladder outlet obstruction
Authors: GOLDMAN HOWARD B. , ZIMMERN PHILIPPE E.
Published: July 2006

Authors from the USA present a review of the treatment of BOO in the female. This topic is important, which should be of considerable help to the reader. It is covered systematically, dealing with anatomy and then therapy. There is also a meta‐analysis comparing industry‐ and non‐industry funded trials of antimuscarinic medication. This careful study shows no difference in outcomes between them, but suggests there are some shortcomings that need to be overcome.
Clinical response to therapy targeted at vascular endothelial growth factor in metastatic renal cell carcinoma: impact of patient characteristics and Von Hippel‐Lindau gene status
Authors: Rini Brian I. , Jaeger Erich , Weinberg Vivian , Sein Nancy , Chew Karen , Fong Kristen , Simko Jeffery , Small Eric J. , Waldman Frederic M.
Published: July 2006

OBJECTIVE

To describe the relationship among patient characteristics, Von Hippel‐Lindau (VHL) gene status and clinical outcome in metastatic renal cell carcinoma (RCC) in patients receiving vascular endothelial growth factor (VEGF)‐targeted therapy.

PATIENTS AND METHODS

All patients with metastatic RCC who received therapy with interferon‐α plus bevacizumab, SU11248 or AG013736 at the authors’ institution were considered. Clinical features were collected and activation status of the VHL gene (VHL) was determined from baseline paraffin‐embedded tumour samples. Tumour response, time to tumour progression (TTP) and overall survival were recorded.

RESULTS

Forty‐three patients were evaluable for determination of VHL status and clinical response. There was an objective response in 18 patients (43%; 95% confidence interval 28–59%). The median TTP for the entire cohort was 8.1 months. There was an improved clinical outcome in patients with the following clinical features: male gender, lack of hepatic metastases, no previous radiation therapy and higher baseline haemoglobin level. Twenty‐six patients (60%) had evidence of VHL mutation or promoter methylation; such patients had an objective response rate of 48%, vs 35% in patients with no VHL mutation or methylation. Patients with VHL methylation or a mutation predicted to truncate or shift the VHL reading frame had a median TTP of 13.3 months, vs 7.4 months in patients with none of these features (P = 0.06).

CONCLUSION

VEGF‐targeted therapy is active in metastatic RCC and the response can be associated with certain clinical features. The TTP with VEGF‐targeted therapy might be prolonged in patients with VHL methylation or mutations that truncate or shift the VHL reading frame. Further investigation of VHL pathway components is needed to understand the biology of the response to VEGF‐targeted agents in metastatic RCC.
One Continent, One Currency? Varieties of Common Currency Experience in Europe and Latin America
Authors: Miles William
Published: July 2006

Currency unions have been promoted as a means to increase trade, investment and growth. A crucial issue in giving up the domestic currency is the loss of a mechanism to absorb real external shocks. High real exchange volatility between countries considering such a policy would suggest that a currency union could be quite costly in terms of large, persistent misalignment and thus balance of payments imbalances. Von Hagen and Neumann (1994) assessed the readiness of nine European countries for Euro‐zone membership by examining real exchange rate variability. In this paper we analyze their predictions, and find them to be quite accurate for Europe. All of the nations which appeared ready for the Euro have joined. Of the three which did not appear prepared, two have retained their own currency, and the third has experienced real appreciation and stagnant exports. Given the prescience of this method, we apply it to nine Latin American nations. A number of countries in this region have begun to form a currency union by unilaterally adopting the U.S. dollar. The Von Hagen‐Neumann method finds very high real exchange rate variability between the U.S. and the Latin American nations‐indeed much higher than that between Germany and the countries which would later adopt the Euro‐so adopting the dollar could cause very painful adjustment in Latin America.
Wage Structure and the Incentive Effects of Promotions
Authors: Van Herpen Marco , Cools Kees , Van Praag Mirjam
Published: July 2006

This paper studies wage structure characteristics and their incentive effects within one firm. Based on personnel records and an employee survey, we provide evidence that wages are attached to jobs and that promotions play a dominant role as a wage determinant. We furthermore show that a promotion affects both intrinsic and extrinsic motivation significantly, though in two different ways: An expected promotion increases extrinsic motivation whereas intrinsic motivation is highest subsequent to a realized promotion. The relationship between extrinsic motivation and expected promotions implies that promotions have a clear incentive effect, consistent with a key – not yet tested – prediction of the tournament model.
Relationship between masculinity‐femininity and concession in an experimental collaborative eyewitness testimony
Authors: Hirokawa Kumi , Matsuno Eriko , Mori Kazuo , Ukita Jun
Published: July 2006

The present study examined the relationships of masculinity and femininity with concession in an experimental collaborative eyewitness testimony task, using the MORI technique. Participants formed same sex or mixed sex pairs and watched a videotaped event. Their eyewitness memories were assessed three times: immediately after watching, after discussing the event together, and individually 1 week later. The participants’ self‐confidence in their recalled memories and percentages of concessions were also examined. The Masculinity‐Humanity‐Femininity Scale was administered to the participants at the end of the experiment. The results showed that masculinity negatively correlated with concession, and that both masculinity and femininity were associated with inaccuracy in collaborative memory recall.
We Know Which One We Prefer but We Don't Really Know Why: The Curious Case of Mixed Member Electoral Systems
Authors: Bowler Shaun , Farrell David M.
Published: July 2006

The literature on electoral systems is one of the more well developed within political science. Unlike many branches of the discipline it has successfully developed a series of commonly adopted definitions, measures and standards. Nevertheless, areas of uncertainty and disagreement exist. Using responses from a survey of scholars who study electoral systems we show where some of these areas of uncertainty lie. Intriguingly, some relate to our (collective) preference for a mixed member proportional system (MMP). MMP is the most highly regarded of electoral systems, yet it is does not seem to be the case that we have clear and consistent criteria for ranking this system so highly. Exploring this puzzle leads us to suggest topics where we, as students of electoral systems, may want to consider developing our studies further.
Corporate Governance, Crony Capitalism and Economic Crises: should the US business model replace the Asian way of “doing business”?
Authors: Singh Ajit , Zammit Ann
Published: July 2006

This paper considers the Greenspan/Summers/IMF (GSI) argument that the Asian way of doing business was the deep cause of the Asian crisis. The IMF reform programme for the crisis‐affected Asian countries suggested they should abandon the Asian business model and adopt the US corporate model. The main findings are: (a) contrary to GSI doctrine, poor corporate governance and lack of competition are not common characteristics of the Asian business model; (b) the stock market‐based US business model has severe limitations for developing country corporations, not least because of imperfect share prices and the imperfect market for corporate control.
Ownership and Financing Structures of Listed and Large Non‐listed Corporations
Authors: Claessens Stijn , Tzioumis Konstantinos
Published: July 2006

In this paper, we use a large firm‐level dataset covering 19 European countries in order to compare the ownership and financing structures and performance of listed (LCs) and large non‐listed companies (NLCs). For the overall sample, we find that the substantial majority of NLCs have either a large or medium blockholder. This contrasts with the ownership structure of LCs, which usually have no large blockholder. Moreover, we present information on typology of large blockholders as well as financial ratios in LCs and NLCs. The results from matched‐pairs analysis, employed in order to directly compare the two categories, suggest that NLCs use relatively less fixed assets and they appear to be more capital intensive than LCs. In terms of performance, NLCs have higher returns on assets and equity than LCs do, but lower margins. Overall, the paper contributes to the understanding of differences between NLCs and LCs.
Transparency and Disclosure Scores and their Determinants in the Istanbul Stock Exchange
Authors: Aksu Mine , Kosedag Arman
Published: July 2006

Recent financial reporting and auditing scandals on both sides of the Atlantic have led to a global realisation of the importance of sound corporate governance (CG) practices in alleviating the agency problems in the corporate form of business and for efficient allocation of capital in international markets. Transparency and disclosure (T&D) practices followed by firms are an important component and a leading indicator of CG quality. Transparent and full‐disclosure of information is especially vital for Turkey where external capital is necessary to sustain the high growth rate and the biggest agency problem centres on asymmetric information and expropriation by majority shareholders.

We collaborate with Standard & Poor’s (S&P) and base our survey on their scoring methodology, a customised version of the 98 desirable T&D attributes they used in several other countries, and their classification of the attributes into three categories: ownership structure and investor relations, financial transparency and information disclosure, and board and management structures and processes. We evaluate the T&D practices of the 52 largest and most liquid firms in the Istanbul Stock Exchange (ISE), based on their English and local language annual reports and websites. Our rankings provide a first time, objective assessment of the corporate disclosure practices of ISE firms and uncover that they are, at best, moderate and vary with respect to the three sub‐categories of T&D.

We also consider a simple model that sequentially links agency problems to CG/T&D mechanisms in place, which in turn impact firm‐level and economy‐wide financial performance. Concentrating on the causal side of the model –the determinants of T&D scores– we provide out‐of‐sample evidence that firm size, financial performance and market‐to‐book equity best explain the variation in T&D scores in the ISE. While our results provide considerable support for prior findings in developed markets, they also shed light on how specific agency problems faced by ISE firms impact their T&D scores.