bluuebunny/crossref_metadata_2025 huggingface dataset:
Jaundice: An unusual presentation of a brunneroma
Authors: Millwala F , Vishwanath MP , Kamban B , Kaliyappa C , Shankar MRC , Ananthakrishnan S , Prathiba D
Published: March 2003

We describe obstructive jaundice as the presenting feature in a 55‐year‐old male with a peri‐ampullary Brunner’s gland hamartoma. Duodenal obstruction and bleeding from such lesions have been noted previously, but obstructive jaundice has not yet been reported. This case is being described for its unconventional presentation and for consideration in the differential diagnosis of obstructive jaundice.
Laparoscopic cholecystectomy in an adult with situs inversus
Authors: Yien Ling Chu Renny , Ip Wai Kit Edmund , Chan Hok Chin Eddy
Published: March 2003

Situs inversus totalis is a rare anatomical entity. We present a case in a young patient with situs inversis totalis and cholelithiasis, who underwent an uncomplicated laparoscopic cholecystectomy, despite the reversed anatomical relationships. The approach used was a ‘left‐right reversal’ of the conventional four‐port technique. The patient’s postoperative recovery was uneventful.
Laparoscopic cholecystectomy in haemodialysis patients
Authors: Chen Guotai , Zheng Chaoxu , Wu Zhimian , Tan Min , Yu Junfeng , Zhao Zhenxian , Chiu Philip Wy
Published: March 2003

Objective: To study the effect and safety of laparoscopic cholecystectomy in haemodialysis patients.

Method: From May 1994 to December 1998, the clinical progress of nine haemodialysis patients who underwent laparoscopic cholecystectomy were reviewed.

Results: Eight patients recovered very well from surgery, while one patient had a mild complication of a collection of seroma represented by ultrasound in the gallbladder region.

Conclusions: Perioperative management is important when performing laparoscopic cholecystectomy in patients on haemodialysis. Those patients on well‐managed haemodialysis will tolerate laparoscopic cholecystectomy.
Greater precision in surgery: The key to improving oncological outcomes
Authors: Heald Richard John
Published: March 2003

For almost 20 years, the concept of total mesorectal excision (TME) has featured in the medical literature. It remains the object of ongoing controversy. Because TME provides the best example of how the competing demands of precision, new technology and alternative access will develop over the years, this article will discuss essential oncological priorities in detail.

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Sentinel node biopsy in breast cancer: Report of 50 cases using combined isotope and blue dye mapping
Authors: Hung Wai‐Ka , Chan Miranda Chi‐Mui , Chong Sui‐Fan , Mak Kong‐Ling , Lau Yvonne , Yip Andrew Wai‐Chun
Published: March 2003

Objective: To assess the accuracy of sentinel lymph node biopsy (SLNB) using combined isotope and blue dye mapping technique.

Method: Prospective analysis of 50 cases of SLNB in patients with breast cancer. Accuracy was assessed by comparing the histology of sentinel lymph node (SLN) with axillary dissection specimen.

Results: Sentinel lymph nodes were localized in 47 cases (94%) and correctly predicted the axillary status in all cases (100% accuracy) with no false negative result. Frozen section analysis of SLN was associated with a 33% false negative rate. Immunohistochemical staining did not improve the detection of metastasis compared with haematoxylin–eosin paraffin sections.

Conclusions: Sentinel lymph node biopsy is highly accurate in staging the nodal involvement in breast cancer using the combined mapping technique.

Chinese Abstract

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Review: Palliative gastrectomy for stage IV carcinoma of stomach
Authors: Chiu Philip Wai‐Yan , Wong Simon Kin‐Hung , Kwong Kwok‐Hung , Kwok Samuel Po‐Yin
Published: March 2003

Currently, there is still controversy on the issue of palliative gastrectomy for patients with advanced carcinoma of stomach in terms of safety and its benefits. From the data available in the literature, palliative gastrectomy seems to be associated with a better survival rate, better relief of symptoms and similar rates of perioperative morbidity and mortality when compared with laparotomy with or without gastrojejunostomy. However, all these studies are retrospective comparative studies or series that carried significant biases. This makes interpretation of the outcome difficult. A selective approach is advocated as palliative gastrectomy carries significant risks.

Chinese Abstract

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Flicker adaptation can be explained by probability summation between ON‐ and OFF‐mechanisms
Authors: Zele Andrew J , Vingrys Algis J
Published: March 2003

This study considered whether the dynamics of flicker adaptation can be explained in terms of probability summation over time between independent ON‐ and OFF‐processors. Foveal thresholds were measured for flickering probes, and for static ON‐ and OFF‐probes that have durations consistent with the flicker duty cycle. Thresholds were obtained using a probe‐flash stimulus onset asynchrony paradigm. The outcome of the experiment suggests that flicker thresholds are lower than the component ON‐ and OFF‐thresholds, and that the flicker response can be predicted by assuming probability summation between the ON‐ and OFF‐mechanisms.
Clinical features at presentation of anterior segment pigment dispersion syndrome
Authors: Gillies William E , Brooks Anne MV
Published: March 2003

One hundred and twenty patients with anterior segment pigment dispersion syndrome were reviewed in order to ascertain the features of the condition and form some idea of their significance. Patients were regarded as having pigment dispersion syndrome on the basis of heavy trabecular mesh pigmentation with at least one other feature of the condition. Although common in men, 44 patients, or a little over one‐third, were women. Average age at presentation was 47.8 years with women presenting 10 years later than men. Intraocular pressure was very variable at presentation being less than 20 mmHg in 23 patients. Some patients with elevated pressure had no field loss. Variable myopia was recorded in 38 patients; 30 patients were not myopic. Anterior chamber depth was also variable, the average being 3.0 mm, but six patients had a depth of 2.2 mm or less. The syndrome is extremely variable in its features at presentation. The mild hypoplasia and the hypoperfusion of the iris previously described is consistent with the laxity of the iris noted by Ritch and colleagues.
Adhesion of Pseudomonas aeruginosa ocular isolates to mucin
Authors: Aristoteli Lina Panayiota , Willcox Mark DP
Published: March 2003

The purpose of this study was to compare the adhesion of Pseudomonas aeruginosa ocular isolates to mucin. An adhesion assay was developed using biotin‐labelled P. aeruginosa strains (two corneal ulcer, two acute red eye, one asymptomatic and one standard strains) incubated with porcine gastric mucin immobilized on a nitrocellulose membrane. The adhesion was semiquantified using densitometry. The results showed that all P. aeruginosa strains tested were able to adhere to mucin to various extents with three strains (one corneal ulcer, one acute red eye, one asymptomatic) binding significantly greater than the negative control (P < 0.1). Results suggest that ocular strains of P. aeruginosa strains differ in their adhesion to mucin but this did not correlate with the pathogenic origin of the strain. It is concluded that the adhesion of P. aeruginosa strains to mucin alone may not be a principal determinant of pathogenesis but may be a contributing factor along with other bacterial virulence traits.
Localization of voltage‐sensitive L‐type calcium channels in the chicken retina
Authors: Firth Sally I , Morgan Ian G , Boelen Meeuwis K , Morgans Catherine W
Published: March 2003

L‐type calcium channels have been associated with synaptic transmission in the retina, and are a potential site for modulation of the release of neurotransmitters. The present study documents the immunohistochemical localization of neuronal α1 subunits of L‐type calcium channels in chicken retina, using antibodies to the α1c, α1d and α1f subunits of L‐type calcium channels. The α1c‐like subunits were localized to Müller cells, with predominantly radial processes, and a prominent band of horizontal processes in the outer plexiform layer. The antibody to α1d subunits labelled most, if not all, cell bodies. The antibody to a human α1f subunit strongly labelled photoreceptor terminals. Fainter immunoreactivity was detected in the inner segments of the photoreceptors, a subset of amacrine cells, two bands of labelling in the inner plexiform layer and many ganglion cells. The differential cellular distributions of these α1‐subunits suggests subtle functional differences in their roles at different cellular locations.
Atypical retinal microvasculopathy after bone marrow transplantation
Authors: Bylsma Guy W , Hall Anthony JH , Szer Jeff , West Robert
Published: March 2003

Objective: Typical early ischaemic retinal microvascular changes with cotton wool spots after allogeneic bone marrow transplantation (BMT) are well recognised. In this study an atypical non‐ischaemic late retinopathy is described.

Methods: Sequential cases of late retinal microvasculopathy following allogeneic BMT were reviewed. Demographic features and clinical and angiographic data were collected.

Results: Of 399 patients undergoing allogeneic BMT between 1992 and 1999, eight eyes of four patients developed atypical retinopathy. All patients were male and the age range was 27–50 (mean 37.5) years. The indications for BMT were acute lymphoblastic leukaemia (two patients), chronic myeloid leukaemia (one patient) and chronic lymphocytic leukaemia (one patient). Two patients had conditioning regimens including irradiation. All had cyclosporine and methotrexate as graft‐versus‐host disease prophylaxis. All but one had cyclophosphamide and busulphan as conditioning treatment. One had interferon. No patients had sustained hypertension or diabetes mellitus. Atypical retinopathy was identified 13–62 (mean 50) months after BMT and clinical features consisted of microaneurysms (MA; 4/4), hard exudates (1/4) and macular oedema (1/4). No patient had cotton wool spots. The median acuity was 6/5. Angiographic features were MA (4/4), late leak (2/4) and peripheral (1/4) or central (1/4) ischaemia. One patient underwent focal photocoagulation for macular oedema.

Conclusion: Retinal microvascular incompetence (without cotton wool spots) with good vision may occur in a small number of patients as a late complication of allogeneic BMT.
The failed probing
Authors: O'Donnell Brett A , Adenis Jean Paul , Linberg John V , Rose Geoffrey E , Sullivan Timothy J , Wobig John L
Published: March 2003

The management of failed probing for congenital nasolacrimal duct obstruction is given by a panel of authors. Treatment options examined are repeat probing, inferior turbinate infracture, closed lacrimal intubation and dacryocystorhinostomy. There is considerable variation as to the timing of these interventional techniques.
A comparison of cataract surgery under topical anaesthesia with and without intracameral lignocaine
Authors: Roberts Tim , Boytell Kerry
Published: March 2003

Purpose: To compare the efficacy of intracameral unpreserved lignocaine with placebo during cataract surgery under topical anaesthesia.

Methods: One hundred and thirty‐five consecutive
cases undergoing clear corneal phacoemulsification were en­rolled in
this single surgeon, prospective, double‐masked, con­trolled
trial. Patients were randomized into two groups, receiving either
intracameral unpreserved lignocaine 1% or placebo (balanced
salt solution). Systolic and diastolic blood pressure, pulse rate
and peripheral oxygen saturation were recorded preoperatively and
during phacoemulsification. The level of intraoperative pain was
assessed by a numerical analogue scale ranging between 0 (no pain)
and 10 (unbearable pain). Data were compared by Student t‐test.

Results: Sixty‐seven cases received lignocaine
(group 1) and 68 received placebo (group 2). Average age was 75 years
and 74 years, respectively. Systolic blood pressure, pulse
rate, oxygen saturation and pain score showed no statistical difference
(P = 0.241, 0.542, 0.712, 0.237,
respectively). Diastolic blood pressure showed a weakly significant change
(P = 0.023). Patients reported minimal discomfort during surgery in both groups.

Conclusion: This study found no additional benefit of intra­cameral unpreserved lignocaine when performing routine clear corneal phacoemulsification under topical anaesthesia.
Combined coliform and anaerobic infection of the lacrimal sac
Authors: McKeag David , Kamal Zahid , McNab Alan A , Sheorey Harsha
Published: March 2003

A case is reported of combined coliform and anaerobic bacterial infection of the lacrimal sac, a condition of which there is only one other published case report. In addition, a literature review is presented of the bacteriology of acute dacryocystitis as it applies to this case. Recommendations for the microbiological investigation and management of acute dacryocystitis are made.
Development and surgical implantation of a vision prosthesis model into the ovine eye
Authors: Kerdraon Yves A , Downie John A , Suaning Gregg J , Capon Malcolm R , Coroneo Minas T , Lovell Nigel H
Published: March 2003

Purpose: A surgical technique was designed and tested to enable the implantation of an intraocular electrical retinal stimulator.

Method: An inoperative perspex and silicone model was constructed to
closely resemble the anticipated properties of the proposed visual
prosthesis. The animal model chosen for these experiments was the
sheep, because the dimensions of its ocular anatomy are approximately
30% larger than the human’s, being otherwise grossly
similar. The surgical method involved transplanar port‐hole lensectomy
and vitrectomy, insertion of the model implant through a limbal
incision, and fixation of the perspex subunit close to the location
of the native crystalline lens, by way of trans‐pars plana fixation sutures. Adequate preretinal positioning of the implant’s silicone extension was obtained by way of its inherent elastic recoil.

Results: The procedure was performed without macroscopic evidence of undue surgical trauma.

Conclusion: Although further long‐term experiments are required to fully assess the surgical procedure and biocompatibility of the implant, intraoperative assessment and postmortem computed tomographic imaging of the globe has confirmed the successful intraocular positioning and fixation of the implant.
Temporal processing of global and local information varies with global precedence
Authors: Lawson Murray L , Crewther Sheila G , Blume‐Tari Astrid , Guminsky Michael , Perdikeas Nektaria , Roebuck Gillian , Simmonds Sara , Crewther David P
Published: March 2003

The concept of global precedence, which suggests that the global aspect of a scene is processed more rapidly than local details, was examined using the attentional blink paradigm. Eighteen adult subjects observed multiple sequences of complex global−local letter figures to see whether the attentional blink duration would be affected by the visual angle size of the stimulus. Within each sequence, the subject was directed to identify either a global or local red target letter and to detect whether a global or local probe letter (X) was presented in the sequence following the target letter. Stimuli were presented at three different sizes. Results showed significantly higher probe detection rates for global probes than for local at small stimulus sizes. However, using large stimulus sizes, mean correct probe detection was sig­nificantly higher in conditions requiring local attention compared to global. No significant difference in probe detection performance was observed between global and local conditions at medium stimulus sizes. The results suggest that the rate of visual information processing varies according to the visual angle of the particular information. The results support the suggestion that the precedence of information is an important factor in the temporal processing of global−local information.
Five‐year outcome of correctable visual impairment: the Blue MountainsEye Study
Authors: Foran Suriya , Rose Kathryn , Wang JieJin , Thiagalingam Sureka , Mitchell Paul
Published: March 2003

This report aims to describe the outcome and socio‐economic characteristicsof older persons attending the Blue Mountains Eye Study (BMES) withpersistent correct­able visual impairment (VI). The BMESI examined 3654 persons aged 49+ during 1992−1994and re‐examined 2335 survivors during 1997−1999 (BMES II).Visual acuity was measured before and after standardized refraction.Participants had correctable VI if their better eye was visuallyimpaired <6/12 before refraction (with distanceglasses if worn) and was unimpaired after refraction. In BMES I,274 persons (7.5%) had correctable VI, of whom 127 returnedto BMES II. Of this group of 127, 34 had persistent correctableVI and 74 were no longer impaired. Fewer persons with correctableVI returned and more died prior to BMES II, compared to personswith no or non‐correctable VI. This study showed that persistentcorrectable impairment was more frequent with increasing age, amongwomen, in those living alone, using community support services,or with a history of heart disease.
Effects of optical defocus and spatial contrast on anterior chamberdepth in chicks
Authors: Barutchu Ayla , Crewther SheilaG , Crewther DavidP
Published: March 2003

The goal of this study was to investigate the effect of optical defocusand spatial contrast on refractive development and, in particular,on anterior chamber growth. Ninety chicks were raised from day 4−10post‐hatching wearing monocular lenses (±10 Dor 0 D), in an environment with either high, low or nospatial contrast patterns: 30%, 6% or 0% contrast, respectively.At day 10, the chicks’ refractive state and ocular componentswere assessed using retinoscopy and A‐scan ultrasonography. Oculardefocus resulted in sign‐dependent significant differences in refractiveerror, axial length and vitreous chamber depth. Lens wear also ledto significant spatial contrast dependent changes in anterior chamber depth.Varying ambient spatial contrast in the chick’s environmentdid not inhibit emmetropization processes; however, anterior chambergrowth was particularly susceptible to changes in spatial contrast.
The flash‐lag effect and equiluminance
Authors: Chappell Mark , Hine Trevor J , Hardwick David
Published: March 2003

An object briefly flashed adjacent to the path of another moving object appears to spatially lag the moving object in the direction of its motion: the ‘flash‐lag effect’. A simple differential lag model account of this effect suggests that it occurs because the moving object activates motion detectors in the faster magnocellular pathway, whereas the flashed object does not. This model was tested by reducing M‐pathway involvement using isoluminant stimuli. All four participants, who were university undergraduate students, were exposed to eight conditions, involving all possible combinations of moving and flashing objects coloured either white or green, shown against either a grey or a black background. Green objects were equiluminant with the grey background. The magnitude of the flash‐lag effect was found using the method of constant stimuli. No reliable support was found for the hypothesis that equiluminance of the moving object reduces the flash‐lag effect. Instead an interaction was found where there was an effect of equiluminance on the flash, but only when the moving object was not equiluminant. Such data is problematic for this and other simple differential lag models of the flash‐lag effect.
Ocular contusion caused by elastic cords: a retrospective analysis using the Erlangen Ocular Contusion Registry
Authors: Viestenz Arne , Küchle Michael
Published: March 2003

Purpose: Elastic cords are common tools to secure luggage to the roof of motor vehicles or the carrier of bicycles. In comparison with other variants of ocular contusion, patients with elastic cord injuries appear to suffer more severe ocular damage.

Methods: The charts of 398 consecutive patients of the Erlangen Ocular Contusion Registry who had been hospitalized for ocular contusion over a 10‐year period were retrospectively reviewed. The acute clinical findings of 23 patients with elastic cord injury were compared with 375 patients with other contusions. Open globe injuries were excluded.

Results: A total of 5.8% of the patients were injured by elastic cords; their mean age was 36.6 ± 17.0 years (range 8−66; median 34 years). The following morphological changes were documented in elastic cord injuries versus other ocular contusions: hyphema 100% versus 75%; angle recession 92% versus 72%; iridodialysis 17% versus 9%; traumatic cataract 14% versus 10%; lens dislocation 38% versus 13%; choroidal rupture 19% versus 6%; peripheral Berlin's oedema 57% versus 35%; and central Berlin's oedema 29% versus 12%. The difference of the incidence was significant for lens dislocation (P < 0.01), choroidal rupture (P = 0.024), and central (P = 0.029) and peripheral Berlin's oedema (P = 0.043). The final visual outcome was lower in patients with elastic cords injuries (P = 0.008).

Conclusion: Elastic cord injuries induce more severe ocular damage than most other contusions. The elastic cords producing industry is called on to develop safer luggage fixation systems and warn against the potential harmful consequences of injury to the eye.
Use of contact lenses to correct aphakia in children
Authors: Chia Audrey , Johnson Kim , Martin Frank
Published: March 2003

Background: Contact lenses play an important role in the management of childhood aphakia. However, the use and care of the lenses can be challenging. The aim of this study was to determine how parents coped and what problems they encountered.

Methods: Thirty‐one families of aphakic children who were fitted with contact lenses between 1990 and 1997 were contacted and invited to participate in a telephone survey.

Results: Thirty families agreed to participate. Eighteen families (60%) were still using contact lenses successfully at the time of the study. Four families (13.3%) stopped using contact lenses within a year because of overwhelming difficulties handling the lenses. There was an initial learn­ing process that was often stressful and frustrating. The learning curve lasted from 1 to 24 months (first quartile 2.0 months; median 3.3 months; third quartile 15.0 months). The personality of the parent, temperament of the child and the frequency at which problems occurred may all have contributed to how each family coped with the lenses. Common initial problems included inserting the lenses into the eyes of an uncooperative child and the loss of lenses. Other problems included irritation associated with dryness, and the financial cost of maintaining the lenses.

Conclusion: Although most parents initially found contact lenses daunting, 70% of families surveyed eventually learned to cope well. Parents felt that proper education of both parents and children on why the lenses were required, a good appreciation of problems that may occur, a strong social support network and adequate financial aid were important factors in learning to cope.
Pituitary apoplexy presenting with an orbital bruit
Authors: Watson Stephanie L , Francis Ian C , Coroneo Minas T
Published: March 2003

Pituitary apoplexy is a sight‐threatening syndrome in which a pituitary adenoma undergoes sudden enlargement as a result of haemorrhage, infarction or both. Classic features of the syndrome include sudden severe headaches, reduced consciousness, visual impairment, ophthalmoplegia and/or endocrinological disturbance. Pituitary apoplexy has been reported following cardiac bypass surgery. The case is reported of a 68‐year‐old man who presented with left external and internal ophthalmoplegia, complete ptosis, mild chemosis, reduced vision, and an orbital bruit following coronary artery bypass grafting. Carotid angiography showed the left internal carotid artery to be bowed anteriorly and narrowed. Magnetic resonance imaging demonstrated features consistent with pituitary apoplexy. It is believed that an orbital bruit has not previously been reported in pituitary apoplexy.
GASTRIC CANCER RETROSPECTIVELY INVESTIGATED FOR 9 YEARS AND 6 MONTHS: A CASE OF LINITIS PLASTICA
Authors: Itoh Hidekazu , Nakata Hidenori , Nishioka Shingo , Aikawa Kazuyo , Yokoya Yukihiro , Nakayama Tuneo , Fuku Koukichi
Published: March 2003

This report presents a rare case of a patient with gastric cancer whose clinical course with the development of tumor from early cancer type IIc to advanced cancer of linitis plastica was observed for 9.5 years. The cancer remained in early stage for 3 years and 8 months after the patient’s first endoscopy. At 5 years and 10 months after initial endoscopy, the lesion progressed to advanced cancer, and after 6 years and 7 months sclerotic changes in the gastric wall were detected at the lesion site. After 9 years, advanced gastric cancer of linitis plastica was present throughout the stomach. The initial stage of linitis plastica is considered to be early gastric cancer type IIc with histologically undifferentiated cancer cells. It is widely accepted that a period of 6–8 years is required for this type of cancer to develop from carcinogenesis to completion of lesions. The present case is valuable in that development from early gastric cancer type IIc to linitis plastica during approximately 10 years of follow up was clinically observed, and will contribute to knowledge of the natural history of gastric cancer.
DEVELOPMENT OF A ROBOTIC COLONOSCOPE
Authors: Ng Wan Sing , Phee Soo Jay , Seow Choen , Davies Brian Lawrence
Published: March 2003

Background: Colonoscopy is a common procedure for the diagnosis of various colon pathologies such as cancer of the colon. Due to the working characteristics of conventional colonoscopes, the present colonoscopy procedure is unpleasant for the patient and is technically demanding for the endoscopist.

Methods: A robotic colonoscope named EndoCrawler is proposed for inspection and surgical procedures. Supported by the colonic walls, it can propel itself into the human colon using its rubber bellow actuators to push against the colonic walls. The bellow actuators are distributed circumferentially and longitudinally in order to derive sufficient propelling forces.

Results: Promising results from in vitro and in vivo experiments (on pigs) suggested that the EndoCrawler was a viable alternative to the conventional colonoscope. It was observed to be able to move at a speed of 150 mm/min in a live pig colon. It achieved a distance of 30 cm before being stopped by feces.

Conclusion: It was demonstrated experimentally on pigs that the plurality of bellow actuators was a viable concept. Efforts are now being dedicated towards reducing the diametral space, improving the ability of the robot to negotiate bends, and improving the crawling speed of the robotic scope.
Five Cases of Recurrent Varices Located in the Middle Esophagus
Authors: Sato Takahiro , Yamazaki Katsu , Toyota Jouji , Karino Yoshiyasu , Ohmura Takumi , Suga Toshihiro
Published: March 2003

Recurrent varices located in the middle esophagus are considered to be rare. We could find no scientific reports on this type of recurrent varices. We report herein on five cases diagnosed by endoscopy and endoscopic color Doppler ultrasonography (ECDUS). Endoscopic findings revealed the disappearance of varices in the lower esophagus and F2 type recurrent varices in the middle esophagus. Color flow images of the left gastric vein and the developed para‐esophageal vein, and the perforating vein of inflow type from para‐esophageal veins to esophageal varices in the middle esophagus were produced using ECDUS. One of the five cases had red color (RC)‐positive recurrent varices located in the middle esophagus and was admitted to our hospital with hematemesis. In such cases, where the recurrent varices show a high‐risk sign, rupture is probable.
A Case of Groove Pancreatitis with Duodenal Stenosis
Authors: Yabuki Kiyotaka , Maekawa Takeo , Satoh Koichi , Tamasaki Yoshihisa , Maekawa Hiroshi , Amano Takayuki , Ogawa Kaoru , Aonuma Kou
Published: March 2003

A 58‐year‐old man presented with a 2‐month history of nausea and vomiting. Blood levels of hepatic enzymes and pancreatitis markers were slightly elevated. Hypotonic duodenographic and endoscopic examinations revealed stenosis encircling the descending duodenum. A computed tomography (CT) scan showed inflammatory changes in the head of the pancreas and thickening of the duodenal wall. Magnetic resonance cholangiography demonstrated stenosis of the intrapancreatic segment of the common bile duct and diffuse dilatation of the main pancreatic duct, without irregularity. At laparotomy, microscopic examination of a needle biopsy specimen of the head of pancreas revealed no evidence of malignancy. Distal gastrectomy with Billroth II anastomosis was performed. Microscopically, fibrous thickening of the duodenal wall, serositis and hyperplasia of Brunner's glands were found. The presence of duodenal stenosis due to segmental pancreatitis, referred to as groove pancreatitis, was confirmed. The elevated blood levels of pancreatitis markers returned to the normal range 8 months after the operation. Ultrasonic echography and abdominal CT also revealed a marked reduction in dilatation of the extrahepatic bile duct and the main pancreatic duct. In patients suspected of having pancreatic carcinoma or regional pancreatitis, groove pancreatitis should be included in the differential diagnosis.
Macroscopic Classificatrion of Early Colorectal Carcinoma: A Comparison Between Japan and China
Authors: Wang Fang‐yu , Hirata Ichiro , Katsu Ken‐ichi , Zhu Ren‐min , Itoh Masahiro , Mitooka Hideki , Kashida Hiroshi , Shinmizu Seiji , Imamura Akimichi , Tsuruta Osamu , Yu Zhong‐lin , Xiao Shu‐dong , Zhang Zhi‐hong , Xu Zhao‐min
Published: March 2003

Background: To clarify the similarities and dissimilarities in the macroscopic classification criteria for early colorectal carcinoma (CRC) between Japan and China.

Methods: Six early CRC cases were included in this study. Eleven Japanese and Chinese endoscopists were asked to review the colonoscopic pictures of these cases, including before and after indigocarmine spraying. After viewing the pictures, all the endoscopists individually made their classificatory diagnoses of these cases and indicated the findings on which they based each diagnosis.

Results: Some lesions diagnosed by Japanese endoscopists as IIa or IIa + IIc, might be classified as Is or Isp by Chinese endoscopists. For superficial lesions consisting of elevation with central depression, IIa + depression, IIa + IIc or IIc + IIa were classified according to the ratio of elevated area/depressed area. However, international as well as interobserver differences still existed in the classification of such lesions. In addition, most Chinese endoscopists overlooked the slightly depressed part on the top of a protruded lesion.

Conclusion: Discrepancies on macroscopic classification for early CRC do exist between Japanese and Chinese endoscopists, which were found not only in terminology, but also in recognition of some lesions. In order to develop a universal macroscopic classification, there is a great need for international communication and cooperation.
Cancer Cell Exfoliation by Preoperative Colonoscopic Examination
Authors: Tomiki Yuichi , Kamano Toshiki , Hayashida Yasuo , Okada Tsuyoshi , Kunii Yasuhiro , Ishibiki Yoshiro , Kawase Yoshihiko , Tsurumaru Masahiko
Published: March 2003

Background: Colonoscopic contact and repeated biopsies have been associated with an increased risk of cancer cell dissemination. We examined whether exfoliated cancer cells were detected during preoperative colonoscopic examination in patients with colorectal cancer.

Methods: Twenty‐five patients with colorectal cancer were studied. Samples were collected by four methods: intestinal lavage solution, endoscope tip, forceps channel (n = 22) and biopsy forceps (n = 3). The collected suspensions were centrifuged, fixed in 95% ethanol, stained with Papanicolaou stain and examined microscopically. Viability of the exfoliated cancer cells was studied in five patients. Samples obtained by endoscope tip and forceps channel were suspended in RPMI 1640 medium supplemented with 10% fetal calf serum stained with trypan blue or fluorescent dye and examined.

Results: Exfoliated cancer cells were detected in 18 of 25 patients (72%). The detection rate was 45.5% in intestinal lavage solution, 68.2% at the endoscope tip and 81.8% in the forceps channel. The detection rate of exfoliated cancer cells adhering to the colonoscope depended on endoscopic contact (P = 0.009). Trypan blue staining and fluorescent staining confirmed the presence of viable cells among the exfoliated cancer cells.

Conclusion: Our findings indicate that cancer cells were exfoliated when the colonoscope passed through a stricture and after biopsy or passage of a colonoscope through a stricture, further manipulation of lesions should be avoided to reduce the risk of implantation metastasis.
Combined Use of Uncovered Duodenal and Covered Biliary Metallic Stent for Carcinoma of the Papilla of Vater
Authors: Sano Hitoshi , Ohara Hirotaka , Nakazawa Takahiro , Yamada Tamaki , Saso Katsuhisa , Ando Hakuji , Hashimoto Takashi , Kajino Shinichi , Ando Tomoaki , Nakamura Soichi , Nomura Tomoyuki , Joh Takashi , Yokoyama Yoshifumi , Itoh Makoto
Published: March 2003

We have reported successful implantation of self‐expandable metallic stents for palliative treatment in a case of an 87‐year‐old female patient with carcinoma of the papilla of Vater. She suffered from both duodenal and biliary stenoses, but refused surgical treatment. For the duodenal stenting, a self‐expandable knitted nitinol metallic stent, for esophageal use, was inserted endoscopically. For the biliary stenting, a self‐expandable metallic stent, partially polyurethane‐covered on the proximal part to prevent tumor ingrowth and overgrowth, was inserted via the percutaneous transhepatic biliary drainage route. No major complications occured during these procedures. After the two stents were inserted in an end‐to‐side fashion, she was able to eat a normal diet adequately and suffered from no abdominal symptoms and jaundice during the follow‐up period of 13 months. These stenting procedures might be less invasive and more useful than surgical treatment and provide long patency of biliary stenting and a good quality of life.
CASE OF A MINUTE SESSILE LESION OF THE SIGMOID COLON WITH MASSIVE CANCER INVOLVEMENT IN THE SUBMUCOSAL LAYER
Authors: Matsukawa Masaaki , Kouda Takahiko , Hiratsuka Noboru , Ishikawa Yuusuke , Wada Masahiro , Yamamoto Wataru , Satou Atsushi , Kurihara Minoru , Shimizu Kouji , Kumagai Kazuhide
Published: March 2003

A 53‐year‐old man was referred to our hospital because of the appearance of a positive fecal occult immunological reaction. We found a domed lesion 0.4 cm in diameter in the sigmoid colon. Bleeding spots were observed on the surface of the lesion on endoscopy. We performed endoscopic mucosal resection of the lesion, which was found to contain well‐differentiated adeno‐carcinoma and cancer cells infiltrating to the cut‐end of resected specimen. Laparoscopy‐assisted sigmoidectomy was then performed with dissection of the lymph nodes. The dissected lesion was diagnosed as adenocarcinoma with moderate fibrosis and massive cancerous involvement. The patient died of recurrent cancer 3 years after the operation. In the minute sessile lesion, bleeding spots on the surface may suggest invasive cancer with massive cancer involvement within the submucosal layer.
SOLITARY PEDUNCULATED GASTRIC GLAND HETEROTOPIA TREATED BY ENDOSCOPIC POLYPECTOMY: REPORT OF A CASE
Authors: Kitabayashi Kazuo , Tanaka Yumiko , Saitoh Hitoshi , Ueno Keiichi , Kosaka Takeo , Kita Ichiroh , Takashima Shigeki , Ueda Yoshimichi
Published: March 2003

The patient, a 68‐year‐old woman with a long‐standing history of schizophrenia, was admitted to our hospital complaining of vomiting which had lasted approximately 3 weeks. Endoscopic examination of the stomach revealed a solitary pedunculated submucosal tumor, of approximately 2 cm in diameter, on the anterior wall of the upper body, close to the greater curvature. The lesion was endoscopically excised using a polypectomy snare without any complication. Microscopic examination was compatible with the diagnosis of gastric gland heterotopia showing submucosal proliferation of pseudopyloric glands, fundic glands and foveolar epithelium with fibromuscular stromal framework. The proliferating foveolar epithelium and fibromuscular stroma were in continuity with the overlaying gastric mucosa and muscularis mucosae, respectively. The lesion was entirely covered by normal gastric epithelium. No atypical cells were revealed in the lesion. The clinical significance of gastric gland heterotopia is unclear because of its controversial histogenesis and carcinogenetic potential. We herein report a rare case of solitary pedunculated gastric gland heterotopia with some review of scientific reports.
NEW MEASURING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY CATHETER FOR STENTING
Authors: Tan Daniel , Yamakawa Tatsuo
Published: March 2003

Background: The first stent inserted by endoscopic retrograde cholangiopancreatography (ERCP) for a biliary stricture is often either too long or too short, because the length as measured on the ERCP film is a magnified image. To overcome this magnification factor, a new measuring catheter was designed to incorporate radio‐opaque markers at known intervals. This is termed a radio‐opaque ruler for measuring the stricture on the ERCP film.

Method: The catheter is inserted until the tip sits at the position where the upper end of a stent should reach. The distance from the tip to the papilla is measured and divided by the distance between the two most distant markers. This ratio is then multiplied by the actual distance between the markers to give the exact length. One cm is added to allow for the lower end to protrude into the duodenum. When the two markers exactly mark the desired distance, the known distance between the markers becomes the exact length because the ratio is one.

Results: Six patients with biliary strictures were stented using this measuring catheter. The correct stent was inserted at the first attempt every time. In two patients, the stent was trimmed down to the desired length exactly. The average time taken to complete the procedure was 35 min and no additional sedation was required after the first dose.
Endoscopic balloon dilation of postoperative duodenal stricture by using a new type of wire‐guided balloon catheter
Authors: Tatsumi Yoshihide , Konishi Hideyuki , Nakajima Tomoki , Sakamoto Yoshikuni , Yamane Yukio , Misawa Shin‐ichi , Amaike Hisashi , Naito Kazuyo
Published: March 2003

When the stricture of gastrointestinal tract is complicated, the insertion of the balloon catheter is very difficult even with ‘through‐the‐scope’ balloon dilators. We present here a new type of multifunctional balloon dilator, controlled radial expansion (CRE) wire‐guided balloon dilatation catheter (Boston Scientific, MA, USA). This instrument enabled successful treatment of a complicated postoperative stricture of the duodenum. A 74‐year‐old man, who had undergone duodenum‐preserving resection of the head of the pancreas for mucin‐producing tumor, had severe stenosis at the duodenal second portion. After failed trials in negotiating the stricture by means of conventional balloon dilators, CRE wire‐guided balloon dilatation catheter was introduced through the working channel of the scope and advanced over a guide wire into the stricture under fluoroscopic control. The stenosis was successfully dilated up to the full size of the balloon (20 mm) by increasing the inflation pressure in a stepwise manner. After the procedure, the patient could consume soft food and gruel easily without complications. The dilation effect has been maintained up to the present for more than 12 months. This new instrument is recommended in endoscopic dilation as a safe and useful tool, even for a complicated stricture.
German experience with endoscopic transmural drainage for pancreatic pseudocysts
Authors: Dohmoto Matatoshi , Rupp Dietrich K.
Published: March 2003

Background: Endoscopic drainage provides a good alternative or supplement to a surgical approach for the therapy of pancreatic pseudocysts.

Methods: Between 1987 and 2000, 47 patients had been treated for pancreatic pseudocysts by transmural or transductal drainage. In 79% the pseudocysts were due to chronic pancreatitis mainly caused by alcoholism. The main symptoms were abdominal pain in 85% of patients and loss of appetite or weight in 60% of patients. In 17% of patients, signs of septicemia were observed.

Results: In 42 patients pancreatic pseudocysts disappeared completely. In the remaining five cases drainage was not successful. Six patients suffered a relapse 7–38 months after drainage. No other recurrences were followed up within 4–10 years. In another six patients the prostheses were renewed because of occlusion or dislocation. Overall six patients had to undergo surgery, three patients because of relapsing cyst, two patients because of insufficient drainage and one patient because of severe bleeding. There was no case of death related to the endoscopic treatment.

Conclusions: Since the development of a modified needle type cystotom, the puncture and insertion of the prosthesis for pancreatic cyst drainage is less precarious and quicker. The endoscopic sonography is a valuable supplement to the diagnostic procedure to localize the optimal spot for puncture and to avoid hemorrhage because of damage of intramural or extramural blood vessels. Advantages of endoscopic drainage are minimal invasiveness, short period of hospitalization and low costs. These aspects make endoscopic therapy the first choice of treatment of pancreatic pseudocysts.
Pedunculated gastric carcinoma demonstrating a gastric foveolar phenotype
Authors: TANAKA MUNEHIRO , ITO KEN‐ICHI , HARADA NAOHIKO , KUBOKAWA MASARU , SADAMOTO YOJIRO , TAKATA MIYUKI , YAO TAKASHI , NOSHIRO HIROKAZU , NAWATA HAJIME
Published: March 2003

We report a case of gastric cancer complicated with very well differentiated adenocarcinoma containing signet ring cells. An endoscopic examination revealed a pedunculated polyp in the fornix of the stomach. A surgical operation was performed and the pathological findings showed very well differentiated adenocarcinoma mimicking gastric foveolae with a poorly differentiated component containing signet ring cells. This is the first case of pedunculated gastric cancer complicated with very well differentiated adenocarcinoma containing signet ring cells and also demonstrating a gastric foveolar phenotype.
Churg–strauss syndrome: importance of colonoscopy and endoscopic biopsy in establishing diagnosis
Authors: OKANIWA SHINJI , ITOH NOBUO , NAKAMURA YOSHIYUKI , MATSUO KYOUSUKE , OHTA HIROSHI , NAKAJIMA KOUJI , UEHARA TAKESHI
Published: March 2003

A 31‐year‐old Japanese man was admitted with complaints of left lower abdominal pain and diarrhea. He had a history of bronchial asthma since he was 26 years old. On admission, his eosinophil count was 4100/mm3
and increased as high as 12 000/mm3. A neurological examination disclosed mononeuritis multiplex with paresthesia in both lower and upper extremities. Because of hematochezia, colonoscopy was performed and disclosed multiple colonic ulcers and erosions from the rectum to the ascending colon. Endoscopic biopsy showed fibrinoid necrosis of small‐sized vessels with moderate infiltration of eosinophils in the mucosa and submucosa. He was suspected of being a case with Churg–Strauss syndrome (CSS; allergic granulomatous angiitis), and prednisolone of 30 mg/day was administered. After the administration of prednisolone, his eosinophil count decreased dramatically. His symptoms also improved gradually, except for numbness in the extremities. Three weeks later, colonoscopy revealed improvement of the mucosal appearance, but the colonic ulcers and erosions were still present. Endoscopic biopsy showed exravascular granuloma with moderate infiltration of eosinophils in the submucosa. Colonoscopy and endoscopic biopsy may be important in establishing the diagnosis of CSS with intestinal symptoms.
Safe Endoscopic Resection Using a Detachable Snare: Large Pedunculated Brunner's Gland Hyperplasia
Authors: Kubokawa Masaru , Hata Jun , Ochiai Toshiaki , Araki Yuzuru , Ito Ken‐ichi , Matsumoto Masahiro , Hamada Shuji , Harada Naohiko , Nishi Hidehiro , Tani Keisuke , Nawata Hajime
Published: March 2003

We report a case of Brunner's gland hyperplasia that was resected by an endoscopic polypectomy using a two‐channel fiberscope and a detachable snare. A 59‐year‐old woman had tarry stool and anemia. Upper endoscopy revealed a large pedunculated polyp that arose from the anterior wall of the duodenal bulb. As we thought this polyp to be the source of bleeding, we performed an endoscopic removal. The lesion was removed by using a detachable snare without any complications. The resected specimen revealed a Brunner's gland hyperplasia. Endoscopic resection using the detachable snare was found to be a useful method for the prevention of the polypectomy‐related bleeding in the treatment of Brunner's gland hyperplasia.
SUCCESSFUL ENDOSCOPIC HEMOSTASIS OF RECTAL DIEULAFOY's ULCER BY CLIPPING: AGING MAY BE A FACTOR
Authors: ABE TAKASHI , OKADA NORIKO , AKAMATSU HIROKI , HASHIMOTO KEISUKE , HAYASHI TAMOTSU , TANABE JUN , TANIMURA HIROHISA , MEREN HARUYA , KUBO MITSUHIKO , MASUZAWA MANABU , MURATA HIROAKI , KAWANO SUNAO
Published: March 2003

Dieulafoy's ulcer is a rare form of gastrointestinal bleeding. Although the original descriptions and early reports were of lesions in the proximal stomach, similar lesions have subsequently been reported in the esophagus, duodenum, jejunum, colon and rectum. A 55‐year‐old man was admitted to hospital for a sudden acute headache. On admission he was conscious, and had severe occipitalgia due to a subarachnoid hemorrhage demonstrated on computed tomography. On the fifteenth hospitalization day, he passed fresh blood together with stool, followed by several further episodes of massive hematochezia. Although no lesion was found by gastroduodenoscopy, colonoscopy revealed fresh blood and clots in the rectum. No obvious source of hemorrhage could be identified until careful irrigation revealed pulsatile bleeding from a protuberant vessel (2 mm in size) in the rectum 5 cm from the anal verge. The patient underwent an endoscopic hemostasis in which the pulsatile vessel was easily sutured with seven clips. The patient did not have another episode of bleeding. The finding of Dieulafoy's ulcer in the elderly‐patient group suggests that sclerotic changes to the artery may be associated with this type of rectal ulcer.
PELIOSIS HEPATIS: IMPROVEMENT OF ESOPHAGEAL VARICES AFTER THE SURGICAL TREATMENT OF PLACENTAL SITE TROPHOBLASTIC TUMOR OF THE UTERUS
Authors: NAKANISHI SEIJI , MIYATA TOMOSHI , MURATA YOSUKE , OHNO YOSHINORI , HATAKEYAMA YUKO , KUMAGI TERU , ABE MASANORI , MATSUI HIDETAKA , IUCHI HIDEHITO , MICHITAKA KOJIRO , HORIIKE NORIO , ONJI MORIKAZU
Published: March 2003

We report a case of peliosis hepatis associated with placental site trophoblastic tumor (PSTT) of the uterus. A 46‐year‐old woman was admitted to our hospital with complaints of leg edema, pleural effusion and ascites, complicated with esophageal varices. Peritoneoscopy did not show any evidence of liver cirrhosis and liver biopsy revealed peliosis hepatis. Later, uterine tumor was detected and, after a hysterectomy, peliosis hepatis and esophageal varices were dramatically improved. We suggest that the uterine tumor caused peliosis hepatis with fibrosis and that portal hypertension developed as a consequence of these lesions. The present case is of interest because esophageal varices were improved without ordinary treatment.