bluuebunny/crossref_metadata_2025 huggingface dataset:
Complex humanitarian emergencies: A major global health challenge
Authors: Brennan Richard J , Nandy Robin
Published: March 2003

Complex humanitarian emergencies have been a major political, security and public health feature of the post‐Cold War world. These man‐made disasters account for more morbidity and mortality than all natural and technological disasters combined. In order to deliver effective aid during complex humanitarian emergencies, international relief agencies must have a solid understanding of the political and social climates in which they are operating. In addition, they should base their health interventions on objective epidemiological data, especially standardized rates of morbidity and mortality. Most deaths during complex humanitarian emergencies are due to preventable causes, especially increased rates of infectious diseases malnutrition and violent trauma. The most appropriate health interventions are therefore based on the models of public health and primary health care, emphasizing disease prevention and health promotion. The field of humanitarian assistance has become increasingly professionalized in recent years, with its own professional standards, literature, research agenda and training opportunities. It is an unfortunate reflection on the current state of international affairs that the number of complex humanitarian emergencies and the enormous levels of suffering associated with them are unlikely to decline in the foreseeable future. See Commentary, page 143.
Massive overdose with controlled‐release carbamazepine resulting in delayed peak serum concentrations and life‐threatening toxicity
Authors: Graudins Andis , Peden Guy , Dowsett Robert P
Published: March 2003

Introduction: Peak serum levels following overdose with immediate‐release formulations of carbamazepine have been reported to occur up to 2 days postingestion. We report a case of poisoning with carbamazepine controlled‐release resulting in peak levels 96 h postingestion.

Case Reports: A 31‐year‐old female presented following a suspected polypharmacy overdose. She was haemodynamically stable with a Glasgow Coma Scale score of 3 and was endotracheally intubated in the emergency department. A single‐dose of activated charcoal was administered on admission and her neurological status improved gradually. Results of qualitative urine drug screen available 24 h postadmission to the intensive care department revealed benzodiazepines and carbamazepine. The serum carbamazepine concentration at this time was 66 µmol/L (therapeutic 17–42 µmol/L). A history of therapy with controlled‐release carbamazepine was discovered. Repeat‐dose activated charcoal and whole‐bowel irrigation were commenced, but poorly tolerated. Serum carbamazepine levels continued to rise and gastrointestinal tract decontamination was ceased due to the presence of an ileus. By day 4, the serum carbamazepine concentration peaked at 196 µmol/L. This was associated with coma, generalized intermittent seizure activity and hypotension. Charcoal haemoperfusion was commenced due the presence of end‐organ toxicity and failed gastrointestinal tract decontamination. Serum carbamazepine concentrations fell from 176 to 106 µmol/L after 1 h of haemoperfusion and the patient was rousable to voice and could obey commands at this time. She confirmed ingestion of 300 Tegretol‐CR® (200 mg) on extubation and was discharged without long‐term sequelae.

Conclusion: Unrecognized poisoning with controlled‐release carbamazepine has the potential to produce significant delayed carbamazepine toxicity and delayed peak serum carbamazepine concentrations. This may occur much later than previously reported with immediate‐release carbamazepine preparations.
A follow‐up study of electromagnetic interference of cellular phones on electronic medical equipment in the emergency department
Authors: Tat Fung Hin , Wah Kam Chak , Hung Yau Hon
Published: March 2003

Objective: Considering the growing use of cellular phones and the fast appearance of new phone models, the electromagnetic interference of currently popular cellular phones on electronic medical equipment was tested.

Methods: Three Personal Communication System cellular phones were put at different distances from multiple electronic medical devices, the interference effect was observed and the electromagnetic field strength measured with a spectrum analyser.

Results: Only two small pieces of equipment, the CO2 airway adapter and the haemoglucostix meter were affected and then only when the phone was in very close proximity.

Conclusion: Compared to the results of our study in 1997 testing Global System for Mobile Communication phones, the Personal Communication System phones generated less electromagnetic interference. However a much larger scaled study and an accurate international electromagnetic interference standard are recommended before any change in the current restrictive hospital policy on mobile phone usage could be recommended.
Adverse events and complications among patients admitted to hospital in the home directly from the emergency department
Authors: Liu Anita L , Taylor David McD
Published: March 2003

Introduction: The nature and incidence of adverse events and complications among patients admitted from the emergency department to hospital in the home has not been investigated. This study aimed to investigate this problem and make recommendations for prevention strategies.

Methods: This was an explicit retrospective chart review of patients admitted from the emergency department directly to hospital in the home between 22 February 1995 and 1 September 2000. A data extraction document was designed specifically for the study and used to extract data relating to patient demographics, diagnosis, past medical history and outcome. The outcomes of interest include adverse events, complications and death. An adverse effect is defined as an unintended injury or complication that results in disability, death or prolonged hospital stay and is caused by health care management. These adverse events may occur prior to or during the index admission and may be noted during or after the index admission. A complication is defined as an undesirable outcome that occurs during the management but not causing disability, death or prolonged hospital stay.

Results: Three hundred and fifty‐seven patients were enrolled (51.3% male; median age 52 years, range 16–96 years). Fifty‐five adverse events were identified: 49 adverse events (89%) were due to management prior to hospital in the home admission and six adverse events (10.9%) were directly attributable to hospital in the home management. This represents a rate of 1.7 adverse events per 100 hospital in the home admissions directly attributable to hospital in the home management. One hundred and eighteen complications were identified. Most complications were easily managed. Thirty‐one patients had unplanned re‐admissions and two patients died within 28 days of hospital in the home admission.

Conclusion: Most patients admitted to hospital in the home from the emergency department were managed successfully. Few adverse events arose from hospital in the home treatment. Complications were common but minor in nature. Strategies for the prevention of phlebitis and constipation are recommended.
Trauma systems and emergency medicine
Authors: Rainer Timothy H , De Villiers Smit Pieter
Published: March 2003

The impact of trauma is a major public health challenge which is likely to escalate in the early 21st century. A systematic approach to this problem is required. This review explains the conceptual framework that defines a trauma system, gives a brief historical perspective and describes some of the essential elements of the system which should make a difference to patient outcome. Emergency physicians are well placed to play a leading role in the development and implementation of trauma systems.
Upper mini‐sternotomy for aortic valve operations
Authors: Wan Iyp , Izzat Mb , Sihoe Adl , Lee Tw , Wan S , Yim Apc
Published: March 2003

Objective: To review our experience in using an upper mini‐sternotomy approach to aortic valve surgery.

Materials and methods: Nineteen consecutive non‐selected patients (15 males, mean age 66 years) underwent isolated aortic valve replacement using an upper mini‐sternotomy approach. Twelve patients had isolated aortic valve stenosis, four patients had isolated aortic valve incompetence and three patients had mixed aortic valve disease.

Results: In all cases, an excellent view of the aortic valve was obtained, aortic valve replacement was performed and no intra‐operative difficulties were encountered. Mean aortic cross‐clamp time was 83 min and mean cardiopulmonary bypass perfusion time was 97 min. All patients except two were extubated in the operating theatre and there were no major postoperative complications. Mean hospital stay was 4 days. There were no late complications.

Conclusions: Aortic valve surgery can be performed, in the conventional manner and using standard surgical instruments, through an upper mini‐sternotomy with no alteration to cardiopulmonary bypass or myocardial protection routines.
The origins of surgery: 1. From prehistory to Renaissance*
Authors: Louis Kuo Tai Fu
Published: March 2003

The art, craft and science of surgery is a highly interpersonal skill, central to a variety of traditions and cultures throughout human history. The development of surgery parallels the evolution of the human race from prehistory to the present time. This review attempts to examine the changing concepts and practices in surgery from the earliest era, enshrouded in mysticism and magic, through a manual craft performed by barbers and artisans, to a dignified profession based on science and technology. The evolution of surgery in the previous millennia is reviewed against the culture and morals, the politics and religion, and the philosophy and science of its period; in so doing assessing its perspective on the threshold of a new millennium.
Thyrotoxicosis secondary to acute suppurative thyroiditis induced by a chicken bone
Authors: Chow TL , Lam Clement Y W , Chiu Philip WY , Kwok Samuel PY
Published: March 2003

Acute bacterial thyroiditis is uncommon. Recently we had encountered a case of retropharyngeal abscess following chicken bone ingestion and complicated by thyrotoxicosis due to acute infective thyroiditis. We believed this is the first reported case of thyrotoxicosis induced by foreign body impacted at the upper digestive tract.
Trauma surgeons, trauma centres
Authors: Chung Thomas KM
Published: March 2003

Trauma is an important health problem. With the anticipated decline in communicable diseases and nutritional problems in the next millennium, trauma might replace communicable diseases as a problem and rank second only to non‐communicable diseases. Trauma is a surgical disease and a general surgeon’s leadership is imperative to the success of regional trauma systems. Designation of trauma centres would improve patient outcomes, increase surgeons’ experience and reduce costs in health care. The success of the Advanced Trauma Life Support Programme has shown how the input of surgeons can change the concept of our care for trauma victims. The lack of local trauma data has limited our appraisal to intellectual guessing. To objectively appraise local demand, a territory‐wide major trauma outcome study should be conducted in Hong Kong.
Maggots in surgery
Authors: Lau Hung , Lee Francis
Published: March 2003

Maggots are the larvae of flies. Infestation of humans by maggots is called myiasis and this can be harmful and occasionally fatal. Maggots should, therefore, be removed when discovered. However, maggots are also known to promote wound healing and have been used in ancient civilisations for the treatment of wounds. However, contamination of the wound by pathogenic anaerobes has been a major concern of maggot therapy in the past. Sterility of maggots is therefore a prerequisite for the medical use of maggots; this has been achieved recently. Maggot therapy is now a viable option for the management of necrotic ulcers or wounds that have failed to respond to conventional treatment.
Principles and applications of positron emission tomography in oncology
Authors: Yeung Eugene , Chu Kent‐Man
Published: March 2003

Positron emission tomography (PET) builds images based on the biological processes of the body. It is, therefore, a ‘functional’ rather than an ‘anatomical’ imaging modality. Positron‐emitting radionuclide labelled physiological molecules are injected intravenously. One of the more frequently used radiopharmaceuticals is fluorine‐18 labelled deoxyglucose (FDG). The differential uptake of FDG by different cells of the body after its administration gives rise to a functional image. Currently, FDG‐PET is used most often in neurological science, cardiology and oncology. Malignant cells are known to have a higher rate of glycolysis and, therefore, FDG uptake would be higher in cancer cells. Malignancies in various organs have been investigated with FDG‐PET. To date, FDG‐PET has been found useful for detecting tumours, staging and grading tumours, differentiating between recurrences and benign effects of treatment, monitoring the response to treatment, and assessing tumour drug uptake. Nevertheless, local data on PET are currently not available and its cost‐effectiveness also needs further investigation.
Notable names in the history of surgery: 1. Percivall Pott (1714–1788) *
Authors: Fu Louis Kuo‐Tai
Published: March 2003

Surgery today owes much to the services of early practitioners who made their advances as a result of wide clinical experience and compassion. This two‐part series explores the careers of Percivall Pott and William Arbuthnot Lane. Percivall Pott was born in 1714 in east London. Pott was apprenticed to Nourse of St. Bartholomew's Hospital at 15 years of age. After gaining licence to practise in 1736, Pott remained as surgeon to the hospital from 1745 till his retirement aged 73. After falling from his horse in 1756, Pott sustained a fracture of his leg, confining him to bed. During this time, he wrote on his own fracture, as well as hernia and head injuries. Several diseases are named after him, viz. Pott's fracture, Pott's puffy tumour, and Pott's disease of the spine. He was the first to describe cancer of the scrotum in chimney sweepers, as the earliest occupational cancer.

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Unplanned inpatient admissions in a day surgery service in Hong Kong
Authors: Tam Carven Yuen‐Fong , Lee Francis
Published: March 2003

Objective: To evaluate the cause of inpatient admissions in the first 50 months of a day surgery service in Hong Kong.

Method: A retrospective analysis of all unplanned inpatient admissions from the Day Surgery Centre in Tung Wah Hospital from November 1995 to December 1999 was undertaken. The causes of admission were classified and analysed to whether they might be avoidable.

Results and conclusion: Two percent of the 1688 day‐patients required inpatient admission. The commonest cause of admission was extended surgery followed by retention of urine. None of the admissions was due to a major complication. Over one‐third of admissions might be avoidable.
The location of insulin receptors in bovine retina and isolated retinal cells
Authors: Gosbell Andrew D , Favilla Ian , Jablonski Paula
Published: March 2003

Purpose: The binding of insulin to its cell‐surface receptor is the sole means by which the hormone influences cellular activity. The location of insulin receptors in bovine retina and on isolated retinal cells was investigated to determine the specific cells sensitive to insulin.

Methods: Insulin receptors were located in frozen retinal sections prepared from enucleated bovine eyes, with polyclonal anti‐insulin receptor antibodies using an immuno­peroxidase method. Isolated cells were obtained by enzymatic and physical dispersion of bovine retinal tissue. Insulin receptors on isolated cells were located by a monoclonal anti‐insulin receptor antibody using an immunogold silver staining technique.

Results: Insulin receptors demonstrated a widespread dis­tribution throughout the bovine retina, being present in all retinal layers. A particular association with the plexiform layers and Müller cells was identified in the frozen sections. Consistent with these findings, insulin receptors were predominantly located on dendritic processes of isolated retinal neurones and on Müller cells.

Conclusions: The widespread distribution of retinal insulin receptors in the bovine retina supports the hypothesis that insulin has a role in regulating retinal activity. Insulin receptors associated with plexiform regions suggests that insulin may influence neural activity, while receptors on Müller cells indicate that insulin may have a role in metabolic or functional mechanisms in bovine retina.
Hypersensitivity reaction to intravitreal clindamycin therapy
Authors: Kim Peter , Younan Nancy , Coroneo Minas T
Published: March 2003

A Caucasian woman presenting with recurrence of intra­ocular toxoplasmosis was given intravitreal clindamycin. She subsequently developed a hypersensitivity reaction in the form of a generalized erythematous rash. To the authors’ knowledge, hypersensitivity reactions to an antibiotic given by the intra­vitreal route have not previously been reported.
The value of paddock trees for regional conservation in an agricultural landscape
Authors: Gibbons Philip , Boak Miles
Published: March 2003

Summary Isolated trees and small patches of trees – paddock trees – are a prominent feature of agricultural landscapes in Australia, but are declining in many areas due to natural senescence, clearing, dieback and the general absence of recruitment. We assessed the importance of paddock trees for woodland conservation in a 30 000 ha sample of the New South Wales (NSW) South‐west Slopes using Satellite Pour l’Observation de la Terre (SPOT) panchromatic satellite imagery combined with models predicting the original distribution of vegetation communities. Tree‐cover occurred over 12% of the study area. The patch‐size distribution of vegetation in the study area varied between woodland types. For woodland communities that were confined to hills and ridges, most tree‐cover occurred as few, large remnants. For woodland communities of the foothills and plains (Blakely's Red Gum, Eucalyptus blakelyi and Yellow Box, Eucalyptus melliodora, or White Box, Eucalyptus albens and Red Stringybark), 54% of remnant tree‐cover occurred as patches < 1 ha. The loss of paddock trees will cause substantial reductions to some woodland communities. For example, the loss of patches < 1 ha in woodlands dominated by Blakely's Red Gum and Yellow Box would reduce this association from 7.4% to 3.4% of its predicted pre‐1750 distribution. Mean distance to tree‐cover across the study area increased almost fourfold if patches < 1 ha were removed from the landscape, which may have consequences for movements of some flora and fauna. Failure to protect and perpetuate paddock trees will diminish the likelihood of achieving the conservation objectives of comprehensiveness, adequacy and representativeness in agricultural landscapes.
Intravitreal pefloxacin therapy in postoperative endophthalmitis
Authors: Kumar A , Sridhar M S , Dada T , Tewari H K , Gupta S K
Published: March 2003

Purpose: To study the efficacy of intravitreal pefloxacin in the management of suspected bacterial endophthalmitis.

Methods: Twenty eyes with suspected postoperative bacterial endophthalmitis were given an intravitreal injection of pefloxacin (200 μg in 0.1 mL). If required the injection was repeated after 24 h. The main parameters evaluated were visual acuity, response to intravitreal therapy and any complications due to intravitreal pefloxacin.

Results: Fourteen eyes (70%) responded to intravitreal pefloxacin therapy alone, while an additional pars plana vitrectomy was required in six eyes (30%). Nineteen eyes retained a visual acuity of 6/60 or better at 3 months after the initiation of therapy. A retinal detachment developed in one of the eyes which received intravitreal therapy.

Conclusions: Intravitreal pefloxacin may be a useful alternative therapy in bacterial endophthalmitis.
Bilateral choroidal infarction in a patient with antiphospholipid syndrome: a case report
Authors: Ang Leonard Pek‐Kiang , Yap Eng‐Yiat , Fam Han‐Boh
Published: March 2003

Purpose: To report a case of bilateral choroidal infarction occurring as a complication of primary antiphospholipid syndrome.

Methods: The case notes of the patient were reviewed.

Results: A 25‐year‐old man with primary antiphospholipid syndrome and a previous history of deep vein thrombosis and pulmonary embolism, developed episcleritis and bilateral choroidal infarction, with deterioration of vision to 6/12 OD and counting fingers at 5 feet OS. Anticoagulation therapy with warfarin was administered and the patient’s vision gradually improved to 6/6 OD and 6/9 OS.

Conclusion: Primary antiphospholipid syndrome is associated with thrombotic phenomena, which may affect the ocular arterial and venous vasculature. Therefore, a detailed ophthalmological examination is warranted in those patients who present with ocular symptoms and deteriorating vision. Retinal fluorescein angiography is valuable in confirming the diagnosis when in doubt, and in determining the extent of vessel occlusion.
Visually significant calcification of hydrogel intraocular lenses necessitating explantation
Authors: Fernando Glen T , Crayford Basil B
Published: March 2003

Purpose: To report two cases of HydroviewR (Storz H60M) hydrogel intraocular lens (IOL) opacification necessitating explantation. To analyse the explanted lenses and compare them with a new lens in order to determine the cause of opacification.

Methods: Two cases are presented. Both patients complained of subjective decreases in vision approximately 1 year following uneventful cataract extraction and implantation of hydrogel lenses by the same experienced surgeon in the same institution. The reduced contrast sensitivity was thought to be due to failure of the hydrogel lenses which appeared opacified at the slit‐lamp. They were then exchanged for acrylic lenses. Pre‐ and postoperative contrast sensitivity testing was performed using the VectorvisionR CSV‐1000E instrument. A detailed comparative analysis of the opacified explanted lenses and a new lens was undertaken. This included surface microscopy, infrared spectral analysis, X‐ray elemental analysis, scanning electron microscopy, and electron microscopy of lens slices.

Results: Lens exchange resulted in an improvement in subjective visual acuity (VA) and in objective contrast sensitivity testing. Analysis revealed deposits of calcium phosphate (hydroxyapatite) on the explanted lens’ surfaces.

Conclusions: The surface of the HydroviewR H60M intraocular lens is subject to opacification as a result of calcium phosphate (hydroxyapatite) deposition, thereby limiting the patient’s visual outcome, and in some cases necessitating explantation. The reason for surface calcification requires further study.
Differential diagnosis of corneal oedema assisted by in vivo confocal microscopy
Authors: Grupcheva Christina N , Craig Jennifer P , Sherwin Trevor , McGhee Charles NJ
Published: March 2003

The purpose of this study was to demonstrate microstructural differences between clinically similar, but aetiologically different, cases of corneal oedema in four subjects. In vivo confocal microscopy highlighted oedema of the basal epithelium, prominent nerve–keratocyte interactions, and typical ‘epithelialization’ of the endothelium in a case of iridocorneal endothelial syndrome; however, a similar microstructural appearance was observed in a case of presumed herpetic disciform keratitis. The latter diagnosis was subsequently revised on this basis. Confocal examination of Fuchs’ endothelial dystrophy demonstrated oedema of the basal epithelium, prominent wing cells, anterior stromal alterations, fibrosis of Descemet’s membrane and a typical ‘strawberry’ appearance of the endothelium. In contrast, in vivo microstructural examination of bilateral keratoconus with hydrops confirmed oedema mainly involving the epithelium and anterior stroma. In vivo confocal microscopy allows the clinician to observe the living cornea at a microstructural level and to better diagnose and differentiate borderline or unusual cases of corneal oedema.
The contribution of cone responses to rat electroretinograms
Authors: Nixon Peter J , Bui Bang V , Armitage James A , Vingrys Algis J
Published: March 2003

The contribution of rods and cones to the scotopic electroretinogram (ERG) of small animals is unclear, with a recent report suggesting that the mouse has no cone a‐wave. The present study considered the contribution of cones to the ERG of the rat. Dark‐adapted Long Evans rats (n = 4) had ERG signals collected following a single flash, which stimulated rods and cones (mixed response), or a twin‐flash paradigm (short interstimulus interval, 1 s), which isolated cone responses. Rod signals were derived by digital subtraction of the cone signal from the mixed rod/cone ERG. The rat a‐wave was found to be dominated by rod responses but cone responses contributed substantially (45%) to post‐receptoral waveforms (b‐wave) at higher light levels.
Pathogenesis and intervention strategies in diabetic retinopathy
Authors: PhD Dao‐Yi Yu Md , PhD Stephen J Cringle , PhD Er‐Ning Su Md , PhD Paula K Yu , Fracp George Jerums , Fracp Mark E Cooper
Published: March 2003

Diabetic retinopathy is the leading cause of new blindness in the working‐age population. If improved treatment regimens are to be developed it is crucial that the underlying pathophysiological mechanisms responsible for diabetic retinopathy are better understood. The multifactorial nature of the many pathways implicated in diabetic retinopathy requires a very detailed approach to elucidate the key mechanisms involved and their interactions in order to develop logical strategies aimed at therapeutic intervention. Fortunately, the streptozotocin rat model of diabetes displays many of the morphological and functional changes to the retinal vasculature that are evident in human diabetic retinopathy. This study reviews some of the recent experimental work by the authors in the streptozotocin rat, compares their findings to the human pathology, and outlines potential new avenues for therapeutic intervention. In particular, the improved understanding of which layers of the inner retina have the most stringent metabolic demands has helped identify which retinal layers are most susceptible to metabolic or hypoxic/ischaemic insult. It is concluded that improved treatment outcomes may ensue if the therapy is targeted at the appropriate tissue at specific stages of the disease.
Review of treatment of pterygium in Queensland: 10 years after a primary survey
Authors: Troutbeck Robyn , Hirst Lawrence
Published: March 2003

Purpose: To assess the practices in pterygium removal as a follow‐up study to a similar project 10 years ago, in order to compare the current trends with those noted a decade ago.

Methods: A survey was sent to all practising ophthalmologists in Queensland (100).

Results: Eighty‐seven of the 100 ophthalmologists undertook pterygium surgery with no change in indications for removal, grading or anaesthesia compared to 10 years ago. Nearly half of the ophthalmologists varied their surgical technique from eight commonly used methods according to the individual patient. More than half the respondents used a swinging conjunctival flap and 29% used simple excision leaving the area bare for primary pterygia, although nearly one‐quarter of the ophthalmologists added adjunctive therapies such as beta irradiation or mitomycin. For recurrent pterygia, one‐third of ophthalmologists preferred adjunctive therapies, and 57% used an autoconjunctival transplant.

Conclusion: There has been no consistent trend in surgical removal of pterygia with a significant number of primary pterygia still removed using bare scleral closure.
Trends in health service delivery for cataract surgery at a large Australian ophthalmic hospital
Authors: Yi Qing , Flanagan Sandra J , McCarty Daniel J
Published: March 2003

Purpose: To evaluate trends in health service delivery for cataract surgery at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia.

Methods: A retrospective study was conducted of computerized hospital admissions for cataract surgery from July 1994 through June 1999. Main outcome measures included the annual number of cataract surgeries, waiting time, percentage of patients hospitalized overnight, length of overnight hospitalization, type of cataract surgery, surgery duration and total time in the operating theatre.

Results: Although the annual number of patients undergoing cataract surgery increased from 3395 to 4796 over the 5‐year study interval, there was a 13‐day reduction in mean waiting time for public patients, a 30% reduction in overnight hospitalizations and a half‐day reduction in length of hospitalization for all patients. There was also an increasing trend in use of phacoemulsification cataract extraction.

Conclusions: The health‐care delivery for cataract surgery appears to have improved during the past 5 years at the Royal Victorian Eye and Ear Hospital.
Corticosteroid‐induced glaucoma in a child after a scleral reinforcement procedure
Authors: Park Joseph J , Gole Glen A
Published: March 2003

Corticoteroid‐induced glaucoma can result from either topical or systemic corticosteroid use. Compared with adults, the corticosteroid response in children is less well known. The case is reported of a child who developed glaucoma after receiving topical corticosteroids following a scleral re­inforcement procedure. The raised intraocular pressure was controlled after cessation of the corticosteroids and with the use of antiglaucoma therapy. As many forms of cortico­steroids are widely used, children on corticosteroids should have regular intraocular pressure measurements as part of their management.
Questioning the need for routine bone marrow aspiration and lumbar puncture in patients with retinoblastoma
Authors: Azar Domit , Donaldson Craig , Dalla‐Pozza Luciano
Published: March 2003

Purpose: This study assesses the value of routinely investigating children with retinoblastoma with bone marrow aspiration and lumbar puncture, staging investigations not without risk and trauma to the patient, emotional stress on parents and financial cost to the community.

Methods: Medical files and specimens were obtained and examined for patients with retinoblastoma presenting to the Royal Alexandra Hospital for Children, Camperdown and the Children's Hospital at Westmead, Sydney, from 1975 to 2001.

Results: In total, 123 patients presented; 62 (50.4%) were boys and 61 (49.6%) were girls. Of these 123 patients, 74 (60.2%) had unilateral disease, 46 (37.4%) involving the left eye and 28 (22.8%) involving the right eye. There were 47 (38.2%) patients with bilateral disease, and two (1.6%) with trilateral disease. Mean age of presentation was 17.9 months (23.1 months for unilateral subjects; 10.3 months for bi­lateral subjects; 3.5 months for trilateral subjects). There were 13 (10.6%) with a positive family history. Of 74 unilateral subjects, 70 (94.6%) required enucleation and four (5.4%) were salvaged. Of 47 bilateral subjects, 13 (27.7%) did not require enucleation, 27 (57.4%) required unilateral enucleation and seven (14.9%) required bilateral enucleation. Both trilateral subjects died. Of all 123 subjects, 112 (91.1%) had bone marrow aspiration and lumbar puncture performed during initial assessment, and none showed evidence of malignancy.

Conclusions: Given the small but significant risks associated with these procedures, the results of this study cannot support bone marrow aspiration and lumbar puncture as routine investigations in all patients presenting with retinoblastoma, suggesting a more limited usage of these investigations is warranted.
ENDOSCOPIC ULTRASONOGRAPHY IN TAIWAN
Authors: Wang Hsiu‐Po
Published: March 2003

Endoscopic ultrasonography (EUS) has been applied to many disorders of gastroenterology since 1980 when the first prototype of an ultrasound endoscope was used in Japan. As in other countries, EUS has been one of the diagnostic modalities used in Taiwan island since 1985 when the first EUS was performed in National Taiwan University Hospital (NTUH). From the 1980s to early 1990s, the cases where EUS was used were limited in Taiwan because the equipment was cumbersome to operate. After the EUM20 and EUM30 system equipped with miniprobe (Olympus Optical Co., Tokyo, Japan) were introduced to Taiwan in 1995, application of EUS became widespread. Endoscopic ultrasonography is now performed in over 40 hospitals of this island.
A prospective study of endoscopic treatment for early gastric cancer in Japan: An interim report
Authors: Ida Kazunori , Nakazawa Saburo , Hiki Yoshiki , Kurihara Minoru , Yoshino Junji , Tada Masahiro , Shimao Hitoshi , Katoh Takahiro , Niwa Hirofumi , Sakita Takao
Published: March 2003

Background: This prospective study was designed to clarify the present status and problems inherent in endoscopic treatment of early gastric cancer by endoscopic mucosal resection and other modalities in Japan and to investigate the possibility of extending the indications for endoscopic treatment.

Methods: A total of 409 patients with early gastric cancer lesions were enrolled in this study. Of these, 219 lesions (182 in group I and 37 in group II) were evaluated.

Results: Histological evaluation in group I showed that complete resection, relatively incomplete resection, and absolutely incomplete resection were carried out for 103 (56.6%), 20 (11.0%), and 59 (32.4%) lesions, respectively. Surgery was performed for two lesions of the absolutely incomplete resection group. The remaining 180 lesions were followed up with endoscopy after endoscopic treatment. Recurrence occurred in 14 of 57 lesions with absolutely incomplete resection receiving additional endoscopic treatment, while no recurrence was noted in the lesions of the complete resection or relatively incomplete resection group. At present, 175 lesions of group I have been followed up with endoscopy. Histological evaluation of 30 lesions with differentiated carcinoma in group II revealed that complete resection was successful in only six (20%) lesions. Thirty lesions, including 24 receiving additional endoscopic treatment for absolutely incomplete resection, were followed up endoscopically. None of the lesions showed recurrence.

Conclusion: An interim report of this study is presented herein. Both groups have been followed up over the past 5 years, and in the final report of this study the authors aim to discuss the effectiveness of various kinds of therapeutic modalities and extend the indication of endoscopic treatment for early gastric cancer.
ILEITIS AS A MAIN RECURRENT LESION IN A PATIENT WITH ULCERATIVE COLITIS: REPORT OF A CASE
Authors: Sano Shuichi , Nishimori Isao , Tamura Satoru , Onishi Saburo , Yamauchi Chikako , Tanaka Hajime , Morita Masanori
Published: March 2003

We report a case of ulcerative colitis complicating ileitis that endoscopically and histologically resembled a colonic lesion. Eight years prior to the time of writing, the patient had undergone proctosigmoidectomy and ileocecal resection because of severe hemorrhagic lesions of ulcerative colitis. A month prior to the time of writing, bleeding from the stoma occurred. Endoscopy revealed erosions on easy‐bleeding mucosa in the ileum but no active inflammatory lesions in colonic mucosa except for small erosions in the descending colon beneath the stoma. Histologic findings of biopsy specimens from the ileal mucosa showed marked inflammation including neutrophile infiltration and crypt abscesses. This is a rare case of ulcerative colitis showing ileitis as a main recurrent lesion, suggesting that careful observation of the small intestine will be required after ileocecal resection in ulcerative colitis patients.
ARGON PLASMA COAGULATION FOR THE ENDOSCOPIC TREATMENT OF A NON‐RESECTABLE KLATSKIN TUMOR: IN VITRO AND IN VIVO STUDY
Authors: Shim Chan Sup , Moon Jong Ho , Cho Young Deok , Hong Su Jin , Kim Jin Oh , Cho Joo Young , Lee Moon Sung , Jeon Hoon Bae , Hur Kyung Yul , Jin So Young
Published: March 2003

Background: Palliative treatment including stenting is limited in patients with Klatskin tumor. Argon plasma coagulation (APC) is a new local treatment modality for the devitalization and debulking of tumors. Argon plasma coagulation could be a candidate method for relief of biliary strictures in patients with non‐resectable Klatskin tumor in whom biliary stenting has failed. This study provides an evaluation of the technical feasibility, safety, and effect of APC as a palliative strategy in patients with non‐resectable Klatskin tumor.

Methods: In vitro studies were performed in order to investigate the dimension of coagulation necrosis in 11 human gallbladders. The currents were applied in normal air conditions and a bowl filled with normal saline in five and six specimens, respectively. Argon plasma coagulation was also performed on three patients with Klatskin tumor who showed no effective drainage via percutaneous transhepatic approach with a cholangioscope.

Results: A coagulation current was delivered to the specimen even if in normal saline. The maximum depth and diameter of necrosis was 3 and 6.5 mm under normal air conditions, compared with 2 and 5 mm in water conditions. No perforation of the gallbladder wall occurred in any of the lesions. The dimension of the necrosis increased with increasing impact time and energy settings. Argon plasma coagulation application was possible on tumors of patients without severe complication.

Conclusion: Argon plasma coagulation seems to be applicable, effective and relatively safe in palliative treatment for advanced non‐resectable Klatskin tumor via cholangioscopy. Longer follow ups and comparative trials with other treatment modalities are, however, required.
CONGENITAL DUODENAL WEB EXCISED ENDOSCOPICALLY IN AN ADULT PATIENT WITH RELAPSING ACUTE PANCREATITIS
Authors: Fujitomi Yutaka , Fujiyoshi Kenji , Nagai Takayuki , Nakashima Hiroshi , Suzuki Koji , Kashima Kenji
Published: March 2003

A 26‐year‐old man came to our hospital with the chief complaint of abdominal pain. Based on the results of endoscopy and duodenography, the patient was diagnosed as having pancreatitis caused by a duodenal web. From childhood, the patient had frequently experienced postprandial abdominal distension and vomiting. After the age of 20 years, he had relapsing pancreatitis. When a part of the web was endoscopically excised, the symptoms disappeared. The preoperative relationship between the location of the duodenal papilla and the web is unclear in most cases of duodenal web. Therefore, in order to safely perform endoscopic treatment of duodenal webs, a small incision of the web should be initially made with duodenographic guidance. Subsequently, the relationship between the duodenal papilla and the web should be confirmed by endoscopic retrograde cholangiopancreatography and the remaining web should be excised.
Endoscopic Resection Using a Ligating Device for Esophageal Granular Cell Tumors: A Report of Two Cases
Authors: Koyama Nobuatsu , Yosida Hatsuo , Sakonji Mitsuaki , Takebuchi Kazuhiro , Muto Yoshiki , Watanabe Mitsuyuki , Wachi Eiko
Published: March 2003

Many esophageal granular cell tumors (GCT) diagnosed incidentally during endoscopic examinations are less than 10 mm in diameter and can be treated endoscopically for histological examination of the entire lesion. However, it is difficult to remove them with sufficient surgical margins by conventional endoscopic methods because GCT, even if small in diameter, lie in the submucosal layer and lesions in the esophagus make it difficult to manipulate cutting devices. To overcome these drawbacks we tried using a ligating device that has recently been employed for endoscopic resection of early gastrointestinal carcinoma. Two patients diagnosed with GCT by biopsy, and with lesions confirmed to be in the submucosal layer by endoscopic ultrasonography, were treated easily and completely by this method without any complications. The tumors measured 5 × 5 mm and 8 × 6 mm. Endoscopic resection with the ligating device is thought to be the simplest and most effective endoscopic treatment for GCT.
Gastric Antral Vascular Ectasia as a Cause of Anemia in Systemic Sclerosis
Authors: Yamada Masahiko , Ichikawa Masafumi , Takahara Osamu , Tsuchida Takeshi , Matsubara Akira , Yamada Masahiro
Published: March 2003

We describe a patient with systemic sclerosis (SSc) in whom chronic blood loss from gastric antral vascular ectasia (GAVE) presented a major problem. A 69‐year‐old man, with Raynaud's phenomenon, sclerodactyly, hyperpigmentation on the forehead and nailfold capillary dilatation, required repeated transfusions but still exhibited persistent anemia due to recurrent upper gastrointestinal bleeding. He did not have cutaneous telangiectasias; neither hereditary hemorrhagic telangiectasia of Osler–Weber–Rendu disease nor any collagen disease was reported in his family. Gastroendoscopy showed an array of intensely red stripes radiating to the pylorus, resembling the stripes of a watermelon, with oozing hemorrhages. Biopsy samples were taken from this region of the distal gastric antrum and showed foveolar hyperplasia and superficial vascular ectasia, consistent with GAVE. Endoscopic treatment with a heater probe unit was effective in controlling blood loss from GAVE. The patient tolerated the procedure well and there were no resultant complications. Five sessions of treatment resulted in an eradication of almost all the vascular lesions, as well as negative fecal occult blood test results and a marked improvement of anemia without further transfusions. GAVE should be a diagnostic consideration in patients with SSc who develop recurrent upper gastrointestinal bleeding and anemia.
Nodule‐aggregating lesion of the ileum: Report of a case and a review of the literature
Authors: Sakamoto Norikazu , Fujisawa Takashi , Maeda Mitsuo , Sakaguchi Kazuhiko , Onishi Yutaka , Kuroda Shoji , Toyoda Masanori , Teranishi Tetsuya , Miyamoto Katsufumi , Kawaraya Nobuaki , Kusumoto Chosei , Nishigami Takashi
Published: March 2003

We describe here a rare case of nodule‐aggregating lesion of the terminal ileum detected by colonoscopy. An 82‐year‐old Japanese woman was admitted to our hospital with diarrhea. Colonoscopy revealed a flat elevated tumor with conglomerated nodular surface involving the entire circumference of the terminal ileum, suggesting a nodule‐aggregating lesion. Magnifying the colonoscopic view showed the branch‐like or gyrus‐like pits. On biopsy, the tumor was diagnosed as a tubulovillous adenoma. Retrograde ileogram using a colonoscope revealed an elevated tumor with nodular irregularity, measuring 5 cm in length. Ileocecal resection was performed. Macroscopically, the tumor in the terminal ileum, 8 cm distant from the ileocecal valve, showed a nodule‐aggregating lesion, measuring 44 × 60 × 6 mm in size. Histologically, the tumor showed a focal carcinoma in tubulovillous adenoma. To our knowledge, this is the fifth case of early cancer of the ileum in Japan, and the first case of nodule‐aggregating lesion of the ileum detected by colonoscopy in the world.
Visualization of gastric cardial varices by balloon‐sheathed ultrasonic microprobe
Authors: Sato Takahiro , Yamazaki Katsu , Toyota Jouji , Karino Yoshiyasu , Ohmura Takumi , Suga Toshihiro
Published: March 2003

Background:

There is little information in the literature on the diagnosis of esophagogastric varices via ultrasonic microprobe (UMP).

Methods:

Twenty‐one patients with esophageal varices (five cases F3; 16 cases F2) were studied. First, ultrasonographic observation of the cardiac area using deaerated water through the biopsy channel (the water repletion method) was performed followed by the balloon sheath method using MH‐246R (3.2 mm in diameter; Olympus, Tokyo, Japan).

Results:

The vessel images of intramural gastric varices were delineated in all 21 patients with both the water repletion method and the balloon sheath method. The overall features of perigastric collateral veins were obtained in 14 of 21 patients (66.7%) using the water repletion method and in 18 of 21 patients (85.7%) with the balloon sheath method. Vessel images of communicating veins were obtained in 10 of 21 patients (47.6%) with the water repletion method and in 17 of 21 patients (81.0%) with the balloon sheath method.

Conclusion:

We conclude that detailed evaluation of esophageal varix hemodynamics in the cardia is most successfully accomplished by using the balloon sheath method of UMP in conjunction with the water repletion method.
Sphincter of Oddi dysfunction: role of sphincterotomy
Authors: Sugawa Choichi , Higuchi Daisuke , An Teisa , Lucas Charles E , Tokioka Satoshi
Published: March 2003

Sphincter of Oddi dysfunction (SOD) is one of the causes of post‐cholecystectomy syndrome and biliary pain and is a challenge from both the diagnostic and therapeutic points of view. Sphincter of Oddi dysfunction is typically diagnosed months to years after cholecystectomy. Continued biliary type pain after cholecystectomy may occur in as many as 10–20% of patients. Ten percent or more of these patients may eventually be shown to have SOD. The syndrome is often associated with a variety of other gastrointestinal disorders thought to be caused by dysmotility. According to the Milwaukee classification, patients with biliary pain can be divided into three types. Type I patients show all the objective signs suggestive of a disturbed bile outflow (i.e. elevated liver function tests, dilated common bile duct and delayed contrast drainage during endoscopic retrograde cholangiopancreatography). Type II patients have biliary type pain along with one or two of the criteria from type I. Type III patients have biliary pain only, with no other abnormalities. The present paper will focus primarily on SOD syn‐drome, papillary stenosis and the diagnostic and therapeutic approaches, in particular endoscopic sphincterotomy.
Solitary juvenile polyp developing adenocarcinoma with submucosal invasion
Authors: CHIE KURUSU , MASANORI MATSUSHITA , TOSHIHIKO WATANABE , YOSHITSUGU KUBOTA , NORIKO SAKAIDA , AKIHARU OKAMURA , KYOICHI INOUE
Published: March 2003

Solitary juvenile polyps are generally non‐neoplastic hamartomatous polyps. Inflammation is suggested as the cause of proliferation and progression of these polyps, and adenomatous and carcinomatous changes are rare. We report a rare case of a solitary juvenile polyp with malignant transformation that developed in the sigmoid colon of a 12‐year‐old boy. A 3 cm, pedunculated polyp was endoscopically resected, and histologic evaluation revealed the characteristic features of a juvenile polyp. However, mucous‐filled ectatic glandular spaces were lined by mucin‐secreting columnar epithelial cells with atypical change, and an admixture of adenocarcinoma invading the submucosa was confirmed. The histologic features may suggest the involvement of the adenoma–carcinoma sequence in the development of adenocarcinoma in the present case. Although rare, solitary juvenile polyps should develop adenocarcinoma and thorough histologic evaluation of the resected polyps is warranted to identify the adenomatous tissue.
Liver abscess that developed after a long interval of transcatheter arterial embolization followed by formation of hepatoduodenal fistula
Authors: NAKAMURA HIROSHI , MIZOKAMI YUJI , SHIRAISHI TAKAHISA , OTSUBO TOSHIYA , SHIRAI KENJI , KARIYA YOSHIYUKI , OMATA TAKAYUKI , TAKEYAMA HIROKI , MATSUOKA TAKESHI , NISHIGAMI TAKESHI
Published: March 2003

A 55‐year‐old male patient with hepatocellular carcinoma underwent transcatheter arterial embolization (TAE). He became febrile and experienced pain at the right hypochondrial region 323 days later, which led to the discovery of a liver abscess that fistulated into the duodenal bulb. There have been no reports on the fistulation of liver abscesses into the digestive system following TAE. Rhodococcus equi was isolated as a causative agent, which distinguished the case further.