bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic Factors in Patients With Spontaneous Pneumothorax Treated With Video‐Assisted Thoracoscopy
Authors: Schramel Franz M. N. H. , Sutedja Tom G. , Janssen Julius P. , Cuesta Miguel A. , van Mourik Johan C. , Postmus Pieter E.
Published: August 2007

To analyse the efficacy of video‐assisted thoracoscopy (VAT) in patients with spontaneous pneumothorax (SP) and to identify clinical factors associated with outcome after VAT, one hundred and one VATs were performed in 97 patients in this prospective study. Based on thoracoscopic appearance of the visceral pleura three groups were identified, group 1 (n = 23) showing no abnormalities treated with talcage, group 2 (n = 23) showing bullae less than 2 cm treated with talcage and coagulation, and group 3 (n = 51) showing bullae larger than 2 cm treated with bullectomy by staplers, coagulation and pleural scarification. Data were analyzed with regard to clinical factors such as age, smoking behavior, pulmonary function and recurrent pneumothorax at presentation. No perioperative deaths occurred. Overall relapse rate was 4.0% during a follow‐up period of 3 to 38 months (median 27.2). Univariate analysis did not show any association of clinical factors with postoperative complications (n = 19). Patients with extensive pulmonary lesions had longer drainage and hospitalization time, probably due to insufficient sealing effects of stapler devices and/or pleural scarification. Using multivariate analysis, none of the clinical factors had any association with complication rate, drainage/hospitalization time or relapses after VAT. Only patients with bullae larger than 2 cm treated with bullectomy by stapler devices were associated with longer drainage and hospitalization time. This study suggests that VAT is effective in the treatment of spontaneous pneumothorax, although the use of stapler devices and/or pleural scarification was associated with longer drainage and hospitalization time, however, none of the clinical factors were associated with the outcome after VAT.
Clinical and Arthroscopic Findings of Acute Anterior Cruciate Ligament Tears of the Knee
Authors: Shirakura Kenji , Terauchi Masanori , Fukasawa Naoki , Kimura Masashi , Shimizu Takachika
Published: August 2007

Clinical, arthrographic, and arthroscopic findings in 53 patients with acutely torn anterior cruciate ligaments (ACLs) were documented. Arthroscopy and instability tests under anesthesia were performed on all patients within 2 weeks after the initial injury. Twenty‐three patients complained of extension blocks, and localized tenderness on the medial side was revealed in 26 patients at the initial examination. Aspiration from joints exhibited hemarthrosis in 52 patients. Arthroscopy revealed ACL ruptures in all patients. Four Segond′s fractures, 26 meniscus tears (8 medial and 18 lateral), 1 osteochondral fracture, and 19 medial collateral ligament ruptures were revealed. Arthroscopy detected only 1 of the 5 ruptures of the posteromedial corner of the medial meniscus, which were noted on arthrography. Three ACL stumps were protruding among the femorotibial joint, which seemed to be restricting full extension. Statistical analysis showed that tenderness on the medial side was not revealed more frequently in knees with medial collateral ligament injuries than in the others. The volume of aspirated fluids in knees with no leakage in arthrography significantly increased over those with leakages (p < 0.05). Diagnosis of ACL injuries should be completed by clinical, arthrographic, and arthroscopic examinations.
Laparoscopic Gynecology Procedures: Avoid the Risk
Authors: Carter James E.
Published: August 2007

Laparoscopic approaches to gynecological surgery have been developed by an elite group of highly skilled surgeons. As these procedures become more prevalent in the general gynecological approach to disease and the general gynecologist′s approach to treatment, the complication rate for these procedures is likely to increase. In an effort to assist in avoiding these complications, guidelines for the performance of laparoscopic gynecological procedures need to be established. This article presents approaches to the most common gynecological procedures that can assist in the prevention of complications.
Long‐Term Management of Esophageal Varices by Endoscopic Sclerotherapy (EST): A Review of 12 Years′ Experience
Authors: Bhargava Dinesh K. , Dasarathy S. , Saksena Sushma
Published: August 2007

A total of 566 patients with variceal bleeding caused by cirrhosis of the liver, noncirrhotic portal fibrosis (NCPF) and extrahepatic portal venous obstruction (EHO) were treated by repeated endoscopic injection sclerotherapy. This decreased rebleeding was evidenced by a reduction in mean bleeding risk factor and transfusion requirement. Both the factors were significantly (P < 0.001) decreased in all three groups of patients. Rebleeding occurred before eradication in 27.7% of patients with cirrhosis, 24.3% of those with NCPF, and 11% of those with EHO. Significantly more patients with cirrhosis and NCPF bled in comparison to EHO. Irrespective of the etiology, fewer patients of Child′s A class bled than those of Child′s B and C classes (P < 0.001). The median bleeding‐free period was longer in patients with EHO than in those with cirrhosis (P < 0.05). This period was also significantly longer in Child′s A class than in Child′s B and the latter had a longer median bleeding‐free period than Child′s C class (P < 0.01). Variceal eradication was achieved in 80% of patients with cirrhosis, 87% of patients with NCPF, and 90% of patients with EHO. The success of variceal eradication was higher in EHO patients in contrast with patients with cirrhosis of the liver. Similarly, eradication was better in Child′s A class patients than in Child′s B and C class patients. Recurrence of varices and complications were not influenced by the Child′s status or etiology of portal hypertension. The probability of survival at 10 years was higher in patients with EHO (88%) and NCPF (80%) than in patients with cirrhosis (50%). Similarly, patients with Child′s A (88%) status survived longer than those with Child′s B (42%) status, and patients with Child′s B status had a longer survival than Child′s C status patients (0%). Thus, endoscopic variceal sclerotherapy appears to be a useful procedure for the long‐term management of patients after an esophageal variceal bleeding irrespective of the etiology of portal hypertension.
Endoscopic Evaluation of Peptic Ulcer Disease During Ramadan Fasting
Authors: Malik G. M. , Mubarik M. , Jeelani G. , Tajamul H. , Kadla S. A. , Lone B. A. , Khan M. D.
Published: August 2007

The effects of fasting on peptic ulcer disease were evaluated in a prospective study, involving 23 fasting patients who underwent endoscopy before and after Ramadan. Eighteen patients took an H2‐blocker (ranitidine, 150 mg twice daily) regularly at “Suhur” and “Iftar” as prescribed, while 5 were drug defaulters. On the first endoscopy the diagnosis in 4 patients was active acute duodenal ulcer (AADU), in 8 patients was active chronic duodenal ulcer (ACDU) in 8 patients was healed duodenal ulcer (HDU), in 2 patients was erosive duodenitis (ED), and in 1 patient was chronic gastric ulcer (CGU). All of the patients with AADU showed signs of healing on repeat endoscopy. None of the ACDU patients showed signs of healing on repeat endoscopy. Instead, 7 patients in this group bled during fasting. All of the 5 drug defaulters belonged to the ACDU group. One patient in the HDU group had developed an active ulcer near the previous scar, as which was seen on repeat endoscopy. The 2 patients with ED showed signs of healing, while the only patient with CGU had bled from the same ulcer as seen on repeat endoscopy. The results were compared with those of 15 nonfasting control subjects (6 patients with ACDU, 3 with HDU, and 6 with ED as diagnosed on the first endoscopy), who took an H2‐blocker regularly. The repeat endoscopy did not show any change in these patients. In conclusion, we inferred that Ramadan fasting may prove hazardous in patients with peptic ulcer disease in general and with active chronic ulcers in particular, although the fact that only 23 patients volunteered for this study, of whom 5 were drug defaulters, is a limitation.
Endoscopic Ultrasonic Aspiration of Superficial Bladder Tumors
Authors: Miki Makoto , Shiozawa Hiroaki
Published: August 2007

The gold standard of surgical treatment for superficial bladder tumor is transurethral resection (TUR). However, the procedure has drawbacks: it needs skill to avoid perforation of the bladder wall, while burns on the resected tissue are disadvantageous for histological examination. We developed an endoscopic ultrasonic aspiration system which is easy to manipulate and makes no burns on aspirated tissue. Furthermore, the equipment includes a coagulating system.

Transurethral ultrasonic aspiration was performed in 19 cases of superficial bladder tumor with a prototype 24Fr Y‐shaped rigid endoscope. The efficacy of bladder tumor aspiration was evaluated and ultrasonic aspiration was compared to the conventional TUR procedure. Bladder tumors less than 2 cm were aspirated very rapidly. Blood loss was minimal and the largest tumor aspirated in this series weighed 6.5 grams. Aspirated tissue was large enough for histological examination. Compared to conventional TUR, the ultrasonic aspiration has advantages of no burns on aspirated tissue and easy manipulation. Transurethral ultrasonic aspiration may be an alternative procedure for the treatment of superficial bladder tumor.
Laparoscopic and Other Intrafascial Hysterectomy Techniques or Mucosal Ablation—A Choice for Maximum Organ Conservation
Authors: Semm Kurt , Lehmann-Willenbrock Enrique , Mettler Lieselotte
Published: August 2007

The operative methods of total uterine mucosal ablation (TUMA) as well as new abdominal and vaginal hysterectomy techniques are described. Classic intrafascial serrated edged macro‐morcellator (SEMM) hysterectomy (CISH) by pelviscopy or laparotomy and intrafascial vaginal hysterectomy (IVH) are techniques that allow the nerve and the blood supply of the pelvic floor to remain intact, mainly because only the ascending branches of the uterine arteries are ligated. TUMA avoids the removal of the uterus altogether and is reserved for hypermenorrhea or menorrhagia without major enlargement of the uterus. Both CISH and IVH reduce the physical trauma of hysterectomy considerably and have the advantages of the supravaginal technique. Prophylaxis against cervical stump carcinoma is assured by coring out the cervix with the SEMM. In patients in whom both procedures are possible, IVH is preferred because it combines the minimal trauma and short operative time of vaginal hysterectomy. The decreased diameter of the cervix after coring out greatly simplifies this type of vaginal hysterectomy, the technique that has always been favored because of its short operative times and minimal trauma.
Sonographic and Histological Morphometry of the Uterine Cervix—An Assessment of Laparoscopic and Other lntrafascial Hysterectomy Techniques
Authors: Lehmann-Willenbrock Enrique , Semm Kurt , Lüttges Jutta , Mettler Lieselotte
Published: August 2007

New abdominal and vaginal hysterectomy techniques, such as classic intrafascial serrated edged macro‐morcellator (SEMM) hysterectomy (CISH), by pelviscopy/laparoscopy or laparotomy, and intrafascial vaginal hysterectomy (IVH), are both essentially supravaginal techniques. It has been claimed that they give a prophylaxis against cervical stump carcinoma by coring out the cervix with the SEMM. We set out to answer two questions: 1) How can vaginosonography help to choose an adequate SEMM diameter so that the cervical mucosa and transformation zone are completely removed, and 2) How often do cervical glands remain after the coring out procedure? We were able to show a good correlation between sonographic and histological morphology by giant and serial sections. In 253 CISH operations, resection of both endocervix and transformation zone was complete in 92.9%. Dysplasias were always removed completely; only 18 cervical cores exhibited healthy glands (retention cysts) in the resection margin. Therefore, CISH procedures should be able to prevent most of the cervical stump carcinomata that follow traditional supravaginal hysterectomy, but only long‐term follow‐up will give the final proof.
Clinicopathological Characteristics of Superficial Type Colorectal Adenomas Obtained by Endoscopic Resection
Authors: Fujinuma Sumio , Sakai Yoshihiro
Published: August 2007

Colorectal adenomas may be either protruding type or superficial type lesions. To delineate the clinicopathological characteristics of the latter, 153 superficial type adenomas (including the surrounding mucosa) obtained by endoscopic resection were studied morphologically. Superficial type adenomas were defined as flat or flat depressed adenomas with a height of ≤3 mm; histologically, the tubules proliferated horizontally without vertical overlap. The location of tubules in the mucosa was classified as: involvement of the surface layer only (m1), deeper invasion not reaching the muscularis mucosae (m2), or invasion to the muscularis mucosae (m3). The results of analysis indicated: 1) there was no relationship between atypia and size; 2) although macroscopic features (depression, etc.) were associated with the grade of atypia, a closer association was obtained for the location in the mucosa; 3) based on our classification system for tubule location, m2 and m3 adenomas had a significantly higher frequency of depressed type lesions than did m1 lesions; and 4) the height of superficial type adenomas was 295 to 413 μm. Height was lowest in the m3 group followed by, in ascending order, the m2 and m1 groups. These morphological and histological characteristics are expected to contribute to improved diagnosis of superficial type adenomas.
18 Years of Experience in Knee Arthroscopy Under Local Anesthesia
Authors: Birkner W. , Henche H. R.
Published: August 2007

Today, arthroscopies of the knee joint have become a routine procedure. Generally,
these operations are performed under general or spinal anesthesia. In Rheinfelden, local
anesthesia is our method of choice. We will summarize our experience with nearly 9000
arthroscopies in the last 18 years.

We use 10 mls of ScandicainR as the local anesthetic for the puncture track, followed
by an intraarticular injection of 20 mls of CarbostesinR. From 1977 to 1994, arthroscopies
were performed on 8720 patients, of which 90% were outpatients, under local
anesthesia. When asked about pain sensation, 50% of patients had no pain at all, 34%
expressed mild pain and only 3% reported strong pain. 90% of all patients questioned
responded that they would undergo the same procedure a second time, if necessary.

There are several advantages of local anesthesia, most important the minimal invasive
procedure. Risk factors can be avoided, the pain level described by the patients is acceptable
and the costs are lower than with other anesthetizing techniques. As a prerequisite
for performing these operations under local anesthesia, the surgeon must be very experienced
in the handling and routine of arthroscopic procedures.
Nd‐YAG Laser Treatment for Tracheobronchial Obstruction
Authors: Perng Reury-Perng , Lee Yu-Chin , Chiang Kuo-Hwa
Published: August 2007

The Nd‐YAG laser has good tissue penetration and coagulation effects thus has become an
important weapon for photoresection of tracheobronchial obstructive lesions since 1980.

Treatment of benign lesions including benign tumors and scar tissues using the Nd‐YAG
laser has good results. In the treatment of malignant tumors however, it has a lower
effectivity rate when compared to benign lesions. From July 1984 to September 1995, a
total of 65 patients were treated with Nd‐YAG laser for tracheobronchial obstruction.
There were 32 (49%) malignant tumors and 33 (51%) benign lesions. 116 resections were
performed in 48 patients using the non‐contact Nd‐YAG laser (MBB, Medilas 2) before
1992. Thereafter, another 41 resections were performed in 17 cases using contact Nd‐YAG
laser (SLT, CL‐X). The overall effectivity rate was 60%. The effectivity rate for
benign lesions was 81.3% and 39.4% for malignant tumor. The effectivity rate between
non‐contact and contact Nd‐YAG laser was not significantly different.
Management of Ovarian Dermoid Cysts by Laparoscopy Compared With Laparotomy
Authors: Liyi Pang , Sasaki Hiroshi , Qing Liu Chang , Akiyama Minoru , Watanabe Akihiko , Niimi Shigeki , Tanaka Tadao
Published: August 2007

Thirty patients with ovarian dermoid cysts removed by laparoscopic surgery were compared with 42 patients with ovarian dermoid cysts removed by laparotomy, with respect to the selection criteria, surgical procedures, operating time, intraoperative and postoperative complications, blood loss, and hospital stay. Although the operating time for unilateral cystectomy, unilateral salpingo‐oophorectomy, and bilateral cystectomy performed by laparoscopic surgery was longer (120.3 ± 43.7 min, mean ± SD) than those for the same procedures performed by laparotomy (73.9 ± 21.6 min, p < 0.01), we observed a learning curve with a remarkable declining tendency (linear regression model, p < 0.01). At the end of this study, the times taken for laparoscopic procedures were almost the same as those for laparotomy. Less blood loss (18.2 ± 1.7 ml versus 105.9 ± 84.3 ml, p < 0.01) and shorter hospital stay (5.9 ± 1.9 days versus 12.0 ± 2.9 days, p < 0.01) were also found to be advantages of laparoscopic surgery. This article discusses the technical procedures of laparoscopic surgery. The efficiency and safety of operative laparoscopy as an alternative access route for the management of ovarian dermoid cysts were recognized. We stress that strict criteria for selection of patients should always be followed and the necessity of retraining schedules for gynecologists and nursing staff in the speciality of laparoscopic surgery.
Pelviscopic Compared to Laparotomic and Vaginal Intrafascial Hysterectomy
Authors: Mettler L. , Lutzewitsch N.
Published: August 2007

Between 1993 and 1994, 368 women underwent hysterectomies for benign disorders at the University of Kiel. Of these, 58.7% were performed either by pelviscopic or by laparotomy Classic Intrafascial Supracervical Hysterectomy (CISH). Of the remaining, 14.8% were performed by abdominal hysterectomy, 13.6% by Intrafascial Vaginal Hysterectomy (IVH), 12.2% by Vaginal Hysterectomy (VH), and only 0.05% by Laparoscopic Assisted Vaginal Hysterectomy (LAVH). Comparative data of these six surgical techniques concerning patients characteristics, indications for operation, histological features, blood loss, operating time, hospital stay, uterine weights and postoperatively used analgesics are described.
Lack of Methylene Blue Staining in Superficial Epithelia as a Possible Marker for Superficial Lateral Spread of Bile Duct Cancer
Authors: Maetani I. , Ogawa S. , Sato M. , Igarashi Y. , Sakai Y. , Shibuya K.
Published: August 2007

Longitudinal cancer spread is very important for staging of resectability in bile duct cancer. We verified the difference in methylene blue staining properties between cancerous and noncancerous epithelia that are usually observed by cholangioscopy. We obtained 45 biopsy specimens from the common bile duct of 20 patients with bile duct disease using percutaneous transhepatic cholangioscopy (PTCS) after staining with 0.05% methylene blue. We compared the microscopic staining properties with the gross endoscopic observations and evaluated the characteristics of methylene blue staining on frozen sections of each type of cholangial epithelium. Microscopic staining properties were significantly associated with endoscopic observations (p = 0.00001). While 18 of 20 (90%) specimens of normal epithelia stained with methylene blue, 11 of 16 (69%) specimens of metaplastic epithelia were stained, with no staining obtained in cancerous
epithelia. The cancerous epithelia stained significantly less often than either the normal (p = 0.000005) or the metaplastic (p = 0.001) epithelia. Evaluation of methylene blue staining during PTCS revealed that this stain was absorbed by the cholangial epithelia, not superficially stuck to it. The difference in methylene blue staining properties between the cancerous and normal epithelia could be helpful to clarify the boundary of superficial lateral spread of bile duct cancer.
Photodynamic Therapy for Head and Neck Cancer
Authors: Yoshida Tomoyuki , Kato Harubumi , Okunaka Tetsuya , Saeki Tetsuo , Ohashi Shinya , Okudaira Tadao , Lee A. Masaji , Yoshida Hikari , Maruoka Hidehiro , Ito Hiroyuki , Funasaka Sotaro
Published: August 2007

Photodynamic therapy (PDT) is a recently developed treatment involving the use of a
photosensitizer and low power light, usually from a laser, to selectively destroy tumor
cells. At present, we perform PDT for head and neck cancer using argon or excimer dye
lasers with hematoporphyrin derivative as a photosensitizer. This study attempted to
assess the utility and safety of PDT and to investigate the long‐term outcome. All 24
patients had squamous cell carcinoma: 15 with laryngeal, 5 with lingual or oral, and 4
with pharyngeal cancer and were treated by PDT. Data were obtained from records
from February 1988 through April 1995. After PDT, 12 of 15 laryngeal cancer patients
were classified as having a complete remission (CR), as were 2 of the 5 lingual or oral and
one of the 4 pharyngeal cancer patients. The patients were followed for 8 to 153 months.
The longest duration of CR in patients treated by PDT alone was 148 months.
Photosensitivity was experienced by all patients, but required no treatment. Liver, kidneys,
and bone marrow showed no abnormal values. There were no clinically relevant
adverse reactions, and patients with severe complications due to other types of treatment
and elderly patients were also treated safely with this therapy.
Transbronchial Needle Aspiration in the Staging of Bronchogenic Carcinoma
Authors: Benov Emil , Michev Krassimir , Kostadinov Dimitar , Vlasov Vesselin
Published: August 2007

To evaluate the usefulness of transbronchial needle aspiration biopsy (TBNA) for the
diagnosis of mediastinal involvement, we have prospectively examined 316 patients with
morphologically verified bronchogenic carcinoma. The percentage of positive aspirations
(149 of 316) from the three basic lymph node groups in the mediastinum was not significantly
different. Tumor cells were aspirated from the mediastinum in 75 of 112 patients
with radiologically positive findings and in patients with 74 of 204 radiologically negative
findings. Mediastinal involvement was verified even in 61 of 196 patients with a normal
endoscopic picture. Metastases were proved in 14 of 39 patients with peripheral versus
135 of 277 patients with central carcinoma. Tumor cells were aspirated in 47 of 76
patients with undifferentiated small cell carcinoma, 92 of 227 patients with squamous cell
carcinoma, and 10 of 13 patients with adenocarcinoma. Our results suggest that TBNA
being a highly diagnostic and less invasive method, will prove its clinical importance.
Complications of Laparoscopic Hysterectomy: Avoid the Risks
Authors: Carter James E.
Published: August 2007

Results of more than 1500 laparoscopic hysterectomies have been reported since 1989.
The complication rate is 10 to 11% in expert hands. However, a complication rate of
60% was reported in one community hospital series. The risks of laparoscopic hysterectomy
are acceptable at 10% but not at 60%. Practitioners of laparoscopic assisted vaginal
hysterectomy must review and understand the risks associated with the procedure in
order to avoid them. This article addresses the complications of laparoscopic hysterectomy
and gives techniques to avoid them.
Fiberoptic Bronchoscopy in Thyroid Carcinoma With Tracheal Invasion
Authors: Koshiishi Haruya , Toriya Kunio , Ozaki Osamu , Ito Kunihiko , Konaka Chimori , Kato Harubumi
Published: August 2007

Preoperative bronchoscopic findings of thyroid carcinoma with tracheal invasion were
examined and compared with the histopathological findings. Tracheal sleeve resection
was performed in 20 cases. The bronchoscopic findings were classified into 5 types:
confirmed tumor in the tracheal lumen (5 cases), extramural compression of the trachea
plus mucosal change (9 cases), extramural compression of the trachea (2 cases), mucosal
changes only (3 cases), normal findings (1 case). Pathological findings revealed that the
extent of invasion in the tracheal wall varied according to each of the above bronchoscopic
types. The number of tracheal rings with adventitial invasion averaged 0.8 (maximum
2) more than preoperative bronchoscopic findings of the number of tracheal rings
with mucosal invasion. This study demonstrated the necessity of resective 2 more tracheal
rings than is indicated by the bronchoscopic findings.
Endoscopic Resection of Esophageal Lymphangioma Incidentally Discovered
Authors: Scarpis M. , De Monti M. , Pezzotta M. G. , Sonnino D. , Mosca D. , Milani M.
Published: August 2007

A pedunculated lymphangioma of the esophagus was unexpectedly discovered during an endoscopic investigation performed for epigastric pain in a patient affected by diabetic arteriopathy treated with antiplatelet drugs. The patient neither complained of dysphagia nor other symptoms related to the presence of the lymphangioma which therefore can be considered as an endoscopic “incidentaloma”.

The lesion was removed endoscopically and a follow up, 6 months later, showed no scar
or recurrence.

The authors present this case both for the extreme rarity of this lesion and for the evidence of low‐medium grade dysplasia in the overlying mucosa, particularly since it is only case ever noted in literature.

This aspect suggests that, even if malignant degeneration of these lesions has never been observed, their endoscopic removal is recommended. However, when endoscopic procedures are not feasible, thoracotomic surgical exeresis should be only considered for obstructing and symptomatic lesions; an accurate endoscopic and bioptic follow up can be useful for asymptomatic lesions.
Bile Duct Injuries in Connection With 2500 Laparoscopic Cholecystectomies
Authors: Schmidt P. , Ezer P. , Antal A.
Published: August 2007

Background: Laparoscopic cholecystectomy (LC) is taking the place of an effective
and tested procedure in surgery, therefore it must not be inferior to the standard modality
in any aspect. Some complications specific to the technique, however, are severe and
complication rate seem to be higher than in standard open surgery.

Methods: In this paper the authors report their guiding principles in applying LC
and methods of treatment, and describe the bile duct injuries of 2500 LCs accomplished
during the past 4.5 years.

Results: Seventeen ductal injuries occurred in the whole series, which means an overall
incidence rate of 0.68%. Data obtained in the last period, however, show a decrease
down to 0.14%. Following ductal injuries six ductal strictures became clinically apparent.
The various complications of these injuries caused the death of two patients.

Conclusions: The great number of intraoperatively undetected injuries, many of them
arising not due to technical difficulties, suggest the possibility of an injury caused by
electric current. Depending on the type of injury direct suture, T‐tube drainage or biliodigestive
anastomosis can equally be effective. Long established practice and experience
can help reduce the occurrence of complications to the level in standard open surgery.
Superior Vena Cava Syndrome. From the Bronchus to the Vessel
Authors: Witt C. , Schmidt B. , Borges A. C. , Doerffel W. , Baumann G. , Romaniuk P.
Published: August 2007

This paper addresses the diagnosis and management of superior vena cava syndrome (SVCS) due to malignant intrathoracic tumours. Diagnosis of SVCS is usually established by bedside examination. Chest X‐ray and computed tomography may be helpful, but the cavography remains the “gold‐standard”. Other imaging techniques (MRI, nuclear flow studies) are more of scientific interest. Bronchoscopy helps to evaluate the risk of pulmonary complications and endoscopic procedures often lead to histological findings. In the treatment of malignant SVCS surgery, radiotherapy, and chemotherapy have been successfully used. The placement of a vascular stent might be an additional or alternative possibility. There are no conclusive indication criteria and no conclusive regimen concerning post‐stenting anticoagulation. From all reported results and published papers we draw the conclusion that the immediate effects of stent implantation and the long‐term results of tumour‐specific therapy are complementary to one another. The stent dilates the local venous stenosis while tumour‐specific therapy has a general effect on the vascular and respiratory situation in a multi‐therapy concept.
Peroperative Findings of the Middle Turbinate in 50 Patients With Chronic Sinusitis Who Underwent Total Spheno‐Ethmoidectomy
Authors: Morre T. D. , Clement P. A. R. , Noussios G.
Published: August 2007

This study describes the peroperative endoscopic findings about the size, shape and mucosal
changes of the middle turbinate in patients with chronic sinusitis who underwent total
spheno‐ethmoidectomy. Results confirmed the middle turbinate to be a useful landmark in
performing extensive sinus surgery. The most frequent change due to chronic inflammation
seems to be polypous degeneration followed by hyperplastic mucosa. Anatomical
variations, being paradoxically bent turbinate and concha bullosa, are not seen frequently.
Autofluorescence Detection of Bronchial Tumors With the D‐Light/AF
Authors: Häußinger K. , Stanzel F. , Huber R. M. , Pichler J. , Stepp H.
Published: August 2007

We present a newly developed diagnostic system combining a conventional light source (white light mode and two different fluorescence excitation modes), a bronchoscope and optionally a highly sensitive camera (Baumgartner et al., Photochem. Photobiol. 1987; 46(5): 759–763). Routine diagnostics can be performed with the autofluorescence bronchoscopy (AFB) and the white light bronchoscopy (WLB) in one diagnostic procedure. The image is visible directly with the naked eye. The system was evaluated in a pilot study including 60 patients. Two hundred and sixty‐four biopsies were taken to detect premalignant and malignant findings (Stanzel et al., Contribution to 10th World Congress for Bronchology, June 1998). The sensitivity of the combination of WLB and AFB was 2.8 times higher than that of the conventional WLB. The specificity decreased from 94% (WLB) to 89% (WLB + AFB). The results of this preliminary pilot study are being confirmed in a multicenter study, which will begin at seven European centers.
Photodynamic Therapy for 101 Early Cancers of the Upper Aerodigestive Tract, the Esophagus, and the Bronchi: A Single‐Institution Experience
Authors: Radu A. , Grosjean P. , Fontolliet Ch. , Wagnieres G. , Woodtli A. , Bergh H. Van Den , Monnier Ph.
Published: August 2007

Cancer, when detected at an early stage, has a very good probability of being eradicated by
surgery or radiotherapy. However, less aggressive treatments also tend to provide high rates
of cure without the side effects of radical therapy. We report on the results of our clinical
experience with photodynamic therapy (PDT) for the treatment of early carcinomas in the
upper aerodigestive tract, the esophagus, and the tracheobronchial tree. Sixty‐four patients
with 101 squamous cell carcinomas were treated with three different photosensitizers:
hematoporphyrin derivative (HPD), Photofrin II, and tetra (m‐hydroxyphenyl)chlorin
(mTHPC). Seventy‐seven (76%) tumors showed a complete rsponse with no recurrence
after a mean follow‐up period of 27 months. There was no significant difference in terms of
cure rates among the three dyes. However, mTHPC has a stronger phototoxicity and induces
a shorter skin photosensitization than either of the other photosensitizers. There were eight
major complications: three esophagotracheal fistulae after illumination with red light in the
esophagus, two esophageal stenoses following 360° circumferential irradiation, and three
bronchial stenoses. Illumination with the less penetrating green light and the use of a 180° or
240° windowed cylindrical light distributor render the risk of complications in the esophagus
essentially impossible, without reducing the efficacy of the treatment. Therefore, PDT may be
considered as a safe and effective treatment for early carcinomas of the upper aerodigestive
tract, the esophagus, and the tracheobronchial tree.
Effectiveness of Photodynamic Therapy and Nd‐YAG Laser Treatment for Obstructed Tracheobronchial Malignancies
Authors: Furukawa Kinya , Okunaka Tetsuya , Yamamoto Hideki , Tsuchida Takaaki , Usuda Jitsuo , Kumasaka Hideo , Ishida Junzou , Konaka Chimori , Kato Harubumi
Published: August 2007

Since 1980, advanced lung carcinomas were treated with palliative laser therapy for the
purpose of opening the endobronchial stenosis and obstruction by either photodynamic
therapy (PDT) or Nd‐YAG laser treatment at Tokyo Medical University. A total of 258
lesions were treated, 81 by PDT and 177 by Nd‐YAG laser treatment. PDT achieved effective
results in 61 (75%) of 81 lesions. In the Nd‐YAG laser group, 143 (81%) of 177 lesions showed
effective results. When the tumor was located in the trachea or main bronchi, effective results
were obtained in 73% (19 of 26) of cases treated by PDT and in 93% of cases (64 of 69) treated
by Nd‐YAG laser. However, in cases in which the tumor was located in lobar or segmental
bronchi, the tumor response was effective in 76% (42 of 55) of PDT‐treated patients and 73%
(79 of 108) of Nd‐YAG laser‐treated patients. With a mortality rate of 0%, the greatest
advantage of PDT over Nd‐YAG treatment was safety. Considering complications, PDT
seems to be useful for obstruction of lobar and segmental bronchus. Nevertheless, when
deciding among alternative therapies, physicians treating patients with advanced lung
carcinoma should give careful consideration to the benefit and complications of both laser
therapies and decide the most suitable modality.
Foreign Body Extraction Device
Authors: Lavy A.
Published: August 2007

Foreign bodies in the gastrointestinal tract are common. Mostly they are swallowed accidentally by children but also by adults. When round and slippery, foreign bodies cause a technical problem for removal. After several days in the stomach they are covered with mucus and extraction becomes even harder. There are various devices designed for use through the flexible endoscope for grasping foreign bodies but due to the great variety of objects, one may face a real problem while trying to remove them. We faced a challenge in a woman who underwent vertical band gastroplasty and was obstructed by a round and slippery hazelnut. We managed to remove the nut using a simple homemade device. This device is easy to make, cheap, and simple to use and maybe useful for various foreign bodies.
A 1000 cc Intragastric Balloon for Weight Reduction
Authors: Lavy A. , Lachter J. , Zinder O. , Eidelman S.
Published: August 2007

Objective: To examine the efficiency of a 1000 cc intragastric balloon as an aid for weight reduction.

Subject: Thirty‐three morbidly obese persons, after multiple attempts for weight loss.

Design: Intragastric 1000 cc balloons were endoscopically inserted into the stomachs of
subjects. The balloons were left in place for six months. During that period the patients
received dietary therapy. Hormone levels were measured prior to insertion and upon withdrawal
of balloons.

Results: After a brief initial weight loss, most patients regained the weight initially
lost. Mean weight loss after six months was only 8 kg (range 0–22 kg). We found that
Bombesin levels, but not Gastrin levels, were significantly lower at the end of therapy than
before insertion of the balloon.

Conclusion: We conclude that a large intragastric balloon for a prolonged time did not
assist in weight loss. Our preliminary results show Bombesin levels change significantly, a
finding which warrants further study.
New Incoherent Autofluorescence/Fluorescence System for Early Detection of Lung Cancer
Authors: Leonhard Martin
Published: August 2007

A new autofluorescence (AF) system for bronchoscopy that operates as compact as a
conventional white light bronchoscopy system is described. The system is also capable of white
light illumination and excitation of aminolevulinic acid (ALA) induced fluorescence. Changing between white light and (auto‐) fluorescence mode is easy and always possible. Broad band excitation with blue light (AF: 380–460 nm; ALA 380–440 nm) delivers high
intensity illumination at the distal end of the bronchoscope (AF typically 50 mW). A special
optical observation technique makes the AF directly visible to the eye instead of indirect
techniques used in other AF systems. A compact (160 g)and sensitive (typically 0.2 lux)
camera can be used for documentation.
Biliary Bacteria as an Indicator of the Risk of Recurrence of Choledocholithiasis After Endoscopic Sphincterotomy
Authors: Ishiguro Jun
Published: August 2007

Bacteria have been implicated in recurrent choledocholithiasis associated with endoscopic sphincterotomy (EST). This study was designed to clarify whether bacterial examination of bile provides information useful in predicting the risk of recurrence of choledocholithiasis in patients undergoing EST. Bacteria in bile collected via a duodenoscope before cholangiography were cultured. We compared bacterial isolates and quantity among 41 patients with choledocholithiasis (7 with and 34 without a history of recurrent choledocholithiasis) who had undergone EST more than 3 months previously and 13 control patients with no evidence of pancreatobiliary disease. The bile samples were cultured under aerobic and anaerobic conditions. The bacterial quantity was expressed as the mean logarithm of the number of colony forming units (CFU)/ml. Furthermore, cholescintigraphic studies of bile flow were performed with the use of 99 mTC‐HIDA to study the clinical implication of these variables. No bacteria were detected in 10 of the 13 patients in the control group. In the other three control patients the bacterial count was 2.2 log CFU/ml or less. The mean bacterial count was significantly higher in patients with recurrence than in those without recurrence. Cholescintigraphy revealed a trend toward a higher number of isolates and a higher bacterial count in bile in patients with delayed bile passage than in those with good passage. The results suggest that an increased number of biliary isolates and an increased bacterial count indicate decreased bile flow in patients with choledocholithiasis who are being followed up after EST. These variables may potentially serve as indicators of the risk of stone recurrence. Especially when the bacterial count is higher than 7.0 log CFU/ml, the risk of a decrease in bile flow and an increased stone recurrence would be possibly found.
Early Detection of Bronchial Lesions Using System of Autofluorescence Endoscopy (SAFE) 1000
Authors: Kakihana Masatoshi , Il. Kim Kyong , Okunaka Tetsuya , Furukawa Kinya , Hirano Takashi , Konaka Chimori , kato Harubumi , Ebihara Yoshiro
Published: August 2007

Recently several endoscopic fluorescence detection systems have been developed. In some of
them, laser light was used for the excitation of autofluorescence, and sophisticated techniques were also necessary to amplify the fluorescence signal as well.

The result of fluorescence diagnosis using a simple system with a conventional Xenon lamp
excitation and an image intensifier is reported. The respective results of sensitivity and
positive predictive values of cancer plus dysplasia were 66%, and 62% by standard
bronchoscopy and 92% and 88% by the newly developed autofluorescence system. In this
paper, developed endoscope for detection of tissue/mucosal autofluorescence without the
application of any photosensitizing agents or use of any lasers is evaluated.
Colonoscopic Polypectomy
Authors: Waye Jerome D.
Published: August 2007

Colonoscopic polypectomy is a major advance in the therapy of colon neoplasms. The techniques for safe and efficient polyp removal are described. The uses of a variety of ancillary
devices are discussed, including clips, loops, submucosal injection of fluid, and several thermal
probes, including the argon plasma coagulator. The location of a lesion may be difficult to
ascertain by intracolonic landmarks, but can be more precisely determined by X‐ray, magnetic
imaging, or intraoperative colonoscopy. Alternatively, it is possible to permanently mark the
site of polyp removal with a carbon particle submucosal injection to facilitate subsequent
localization either by surgery or interval colonoscopy.
Bilateral Endobronchial Metastasis in Postoperative Stage I Pulmonary Adenocarcinoma
Authors: Kanzaki Masato , Onuki Takamasa , Tatebayashi Takayuki , Oyama Kunihiro , Murasugi Masahide , Nitta Sumio
Published: August 2007

We reported a case of bilateral endobronchial metastasis in postoperative synchronous
adenocarcinoma. Twenty months ago, a 63‐year‐old man underwent combined operation.
Biopsy was performed, histological diagnosis of pulmonary adenocarcinoma. When surgery is
not indicated because the patient has decreased pulmonary function and contralateral
metastatic lesions, the Nd–YAG laser has been used to treat focal malignancy of the trachea
and mainstem bronchi, and the laser has been effective, especially in patients with inoperable
lesions.
Gastric Cancer Profile in Kashmiri Population With Special Dietary Habits
Authors: Malik G. M. , Mubarik M. , Kadla S. A. , Durrani H. A.
Published: August 2007

The present study is a comprehensive retrospective analysis of 1341 gastric neoplasms out of
10 733 individuals subjected to upper gastrointestinal endoscopy at the main teaching cum
referral hospital in the Kashmir Valley. Of these 78% were males and 22% females, majority
being in the age group of 41–60 years with 60% of the patients being smokers. On endoscopy,
the commonest site of cancer was the body of stomach 40.7%, followed by the antrum 35.5%
and the cardiac region 23.8%. Endoscopic features revealed nodular masses 39%, polypoid
masses 21%, malignant ulcers 11%, infiltrative masses 12%, rounded tumor masses 9%,
linitus plastica 5% and early gastric carcinoma 3%. Histology revealed adenocarcinoma
91%, (including mucoid carcinoma 9%, and schirrous carcinoma 7%), leiomyosarcoma 7%,
and reticulum cell sarcoma 2%. No significant association between Helicobacter pylori
infection and gastric cancer was observed in a short study out of these patients. The peculiar
geography and some special dietary habits with a possible familial predisposition may have
a bearing on the high risk of gastric cancer in the valley.
Angioscopic Evaluation of Thrombi in the Culprit Coronary Lesions in Patients With Acute Myocardial Infarction
Authors: Morio H. , Fujimori Y. , Terasawa K. , Hasegawa O. , Matsuo A. , Osegawa M.
Published: August 2007

The purpose of this study was to evaluate intracoronary thrombi in
the culprit lesions in patients with acute myocardial infarction
(AMI) by angioscopy, and to compare them with clinical and
angiographic features. We angioscopically observed the culprit
coronary lesions in 66 patients with AMI (55 males and 11
females, 63.9±15.4 years old) just before interventional
therapy. Thrombi were observed in 42 of 66 lesions
(64%), namely, red thrombi in 16, mixed thrombi in 15,
white thrombi in 11. In patients with complete obstruction
(TIMI grade 0 and I), red thrombi were more frequently
observed than mixed or white thrombi. On the other hand, in
patients with incomplete obstruction (TIMI grade II and
III), white thrombi were more frequently observed than the
others. Angiographically, haziness and filling defect were
significantly more frequently observed in patients with red
thrombi than the others (p < 0.05). The distance from
proximal side branch to thrombi tended to be longer in patients
with red thrombi than the others. The time from onset of AMI
tended to be longer in patients with white thrombi than the
others. These results suggest that blood flow may be an important
determinant of thrombi characterization.
Fluoroscopic Placement of Double‐Pigtail Ureteral Stents
Authors: Chen Gregory L. , Bagley Demetrius H.
Published: August 2007

Purpose: Double‐pigtail ureteral stent is placed cystoscopically after ureteroscopy. We
describe a technique for fluoroscopic placement of ureteral stents and demonstrate its use in a
non‐randomized prospective study.

Materials and methods: Double‐pigtail stents were placed either fluoroscopically or
cystoscopically in 121 consecutive patients. In the fluoroscopic method, the stent was placed
over a guide wire using a stent pusher without the use of cystoscopy. Conversely, stents were
placed through the working channel of the cystoscope under vision. The procedure, stent
length, width, type, method, ureteral dilation, and use of a retrieval string were noted.

Results: A wide range of stent sizes were used. The success with fluoroscopic placement of
double‐pigtail ureteral stents was 100% (89 of 89 cases). No stents migrated or required
replacement. Stents were placed after ureteroscopic laser lithotripsy (53/89) and ureteroscopic
tumor treatment (22/89). Cystoscopic visualization was used in 32 additional procedures
requiring precise control (15 ureteral strictures and nine retrograde endopyelotomy).

Conclusions: The fluoroscopic placement of ureteral stents is a safe and simple technique
with a very high success rate. We have used cystoscopic placement only after incisional
procedures such as retrograde endopyelotomy, stricture or ureterotomy.
Video Assisted Thoracoscopic Treatment of Pleuropericardial Cysts
Authors: Hermens F. H. W. , Visser F. J. , Termeer A. , Barendregt W. B. , Janssen J. P.
Published: August 2007

Question of the Study In this study, safety and feasibility of
thoracoscopic fenestration of pleuropericardial cysts under local
and general anaesthesia is evaluated. Besides, a rare case of a
pleural cyst, causing a superior vena cava syndrome, is described.

Materials, Patients and Methods In a retrospective study, the results of thoracoscopic
treatment of pleuropericardial cysts in three patients are presented. We performed
videothoracoscopic fenestration of pleuropericardial cysts. One of these was performed
under local anaesthesia. The two other cases were performed under general anaesthesia.
After fenestration, talc poudrage of the inner lining of the cysts was performed in one case.

Results Thoracoscopic fenestration appeared to be safe and
effective. No recurrence was observed. One patient was lost to follow‐up.

Answer to the Question Thoracoscopic fenestration of pleuropericardial cysts is safe
and effective. This procedure can be performed under local anaesthesia in selected cases.
The role of talc poudrage of the cysts is unclear and needs further investigation.
Bilateral Pneumothorax Associated With Lung and Pleural Metastases of Breast Cancer
Authors: Kurihara Terumasa , Kawashima Osamu , Endo Keiichi , Iino Yuichi , Ishikawa Susumu , Morishita Yasuo
Published: August 2007

A rare case of bilateral pneumothorax in a 54‐year‐old woman with advanced breast cancer
associated with lung and pleural metastases is presented. The patient was admitted to our
hospital complaining of unexpected severe dyspnea. A chest X‐ray showed bilateral pneumothorax
associated with multiple lung metastases and pleural effusions, followed by
immediate pleural drainage. Although air leak and effusions of the right lung were well
controlled by the conservative management, massive air leaks of the left lung had continued
for 40 days. Because of patient′s poor general status a surgical closure of the leaking site
was selected using video‐assisted thoracoscopic surgery techniques. Thoracoscopy revealed
a ruptured bulla in the lower lobe (S6), thus, followed by a successful bullectomy with a
stapling device. We speculate that multiple pleural metastasis may disturb the normal
repair mechanism of the lung tissue and cause prolonged persistent air leaks.