bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of orbital colour Doppler findings with computed tomography angiography
Authors: Gillies Bill , Scott Mark , Brooks Anne , Kay Jenny , Ryan Lyn
Published: March 2003

Colour Doppler imaging (CDI) of orbital vessels is non‐ invasive but may be fallacious, while computed tomography (CT) angiography displays a visual outline of orbital vessels. We compared clinical findings of the two methods in 33 patients with a wide variety of clinical conditions. It was not possible to visualize the central retinal arteries with CT angiography, but it was possible to show the intracranial carotid, which CDI could not. Changes in the ophthalmic arteries on CDI usually showed changes in calibre on CT angiography. Patients with unexplained or gross visual loss often showed marked abnormalities on CT scanning, not entirely consistent with the clinical picture. Several patients showed marked ectasia of the intracranial carotid along with variable clinical findings. Findings on CT angiography complement and augment those on CDI, and are likely to be more clinically valuable in the future.
Beta radiation as an adjunct to low‐risk trabeculectomy
Authors: Barnes Rachel M , Mora Justin S , Best Stephen J
Published: March 2003

Purpose: To assess a single dose of intraoperative beta radiation used to enhance the success rate of trabeculectomy in a population of low‐risk glaucoma patients in whom antimetabolites might not be indicated.

Methods: A prospective randomized trial of 65 eyes was designed, with 31 eyes receiving 750 rads of intraoperative beta radiation (group 1), and 34 eyes receiving no supplementation (group 2).

Results: Mean follow‐up time was 24 months. Mean postoperative intraocular pressure was 12.2 mmHg in group 1, and 13.7 mmHg in group 2 (P = 0.16). Mean decrease in intraocular pressure was 10.3 mmHg in group 1, and 9.3 mmHg in group 2 (P = 0.49). The two groups were not significantly different in terms of surgical complications.

Conclusion: For this population of low‐risk patients, there was no significant difference in outcome after applications of a single intraoperative dose of beta radiation.
Ocular trauma in an urban population in southern India: the Andhra Pradesh Eye Disease Study
Authors: Dandona Lalit , Dandona Rakhi , Srinivas M. , John Rajesh K. , McCarty Catherine A , Rao Gullapalli N
Published: March 2003

Purpose: To assess the cumulative prevalence of ocular trauma and presence of vision loss due to ocular trauma in an urban population in southern India.

Methods: As part of the population‐based Andhra Pradesh Eye Disease Study, 2522 people of all ages from 24 clusters representative of the population of Hyderabad city in southern India, underwent a detailed interview and standardized dilated ocular evaluation. An eye was considered to be blind due to trauma if best corrected distance visual acuity was worse than 6/60 due to trauma.

Results: One hundred and thirteen subjects gave a history of ocular trauma and another two had evidence of ocular trauma by examination, a combined age–sex‐adjusted rate of 3.97% (95% CI 2.52–5.42%). Blindness in one eye due to trauma was present in 17 subjects, and in both eyes in one subject, a combined age–sex‐adjusted prevalence of 0.60% (95% CI 0.23–1.04%). Visual acuity in all the blind eyes except one was worse than 3/60. With multiple logistic regression, the odds of blindness in at least one eye due to trauma were highest for current age range of 30–39 years (odds ratio 6.33, 95% CI 1.69–23.77 compared with a current age of less than 30 years), were significantly higher for lower socioeconomic status (3.74, 95% CI 1.18–11.84), and were higher for males (2.48, 95% CI 0.91–6.82) though this did not reach statistical significance. Trauma resulting in blindness had occurred by the age of 15 years in 55% of subjects, and before the age of 40 years in 92.1% of subjects; this had occurred most commonly while playing (53.6% of the cases). With multiple logistic regression, the odds ratios for any ocular trauma were significantly higher for males (2.10, 95% CI 1.40–3.15), and for labourers than for other occupations (2.50, 95% CI 1.62–3.86).

Conclusions: Ocular trauma affects one in 25 people in this urban population in India, and one in 167 people in this population are estimated to be blind in at least one eye due to trauma. The majority of the trauma resulting in blindness occurs during childhood and young adulthood, and slightly more than half occurs while playing. Targeting mothers and children of lower socioeconomic strata in eye health awareness strategies to reduce blindness due to trauma needs to be considered in urban India.

Key words: blindness, India, population‐based, trauma, urban.
Primary posterior capsulorhexis with optic capture and intracameral heparin in paediatric cataract surgery
Authors: Dada Tanuj , Dada V K , Sharma Namrata , Vajpayee Rasik B
Published: March 2003

Purpose: To study the efficacy of using a primary posterior capsulorhexis with optic capture and intracameral heparin in preventing secondary posterior capsule opacification, in paediatric cataract surgery.

Methods: Primary posterior capsulorhexis and optic capture with a heparin‐coated intraocular lens (IOL) was performed after lens aspiration in 14 cataractous eyes of 13 children (group 1). Ten international units of heparin were added in the irrigating solution. The results were compared with 14 eyes of 11 children who underwent a similar surgical procedure but without a posterior capsulorhexis (group 2).

Results: The mean age of the patients in group 1 was 4.2 ± 1.5 years (mean ± SD) and in group 2 was 4.5 ± 1.8 years (range 3–6 years in both the groups). The mean duration of follow up was 36 ± 6.4 months in group 1 and 38 ± 8.1 months in group 2. A best corrected visual acuity of 6/24 or better was achieved in 12 eyes in group 1 and 11 eyes in group 2. The visual axis remained clear in all the eyes in group 1, while 8 eyes (57.14%) in group 2 developed posterior capsule opacification (P = 0.0034) which required a neodymium:yttrium‐aluminum‐garnet laser capsulotomy.

Conclusions: Lens aspiration using intracameral heparin, combined with primary posterior capsulorhexis and optic capture of a heparin‐coated IOL, is a useful technique to prevent secondary visual axis opacification in paediatric cataracts.
Infectious keratitis in orthokeratology
Authors: Hutchinson Kenneth , Apel Andrew
Published: March 2003

Orthokeratology is a method of changing refraction in myopic patients by using rigid contact lenses to reduce the curvature of the cornea. This treatment was in use in the two cases of corneal ulcer described in this paper and appears to have contributed to the development of their disease. As with extended wear contact lenses, patients undergoing orthokeratology treatment are frequently advised to wear the orthokeratology lenses overnight increasing the risk of corneal ulceration and infection. Patients should be adequately warned of the associated risks and advised that any envisaged benefits of the procedure are temporary.
Visual field assessment and the Austroads driving standard
Authors: McLean Isabel M , Mueller Elisabeth , Buttery Robert G , Mackey David A
Published: March 2003

Purpose: To compare the conventional (Humphrey 24‐2) automated visual field testing with the Goldmann standard visual field test for driving, and to predict how many patients with glaucoma may not meet the Australian driving standard with respect to visual fields.

Methods: Four patients (retinitis pigmentosa, glaucoma or vigabatrin treatment) with marked visual field defects as determined by uniocular static computerized perimetry (conventional testing) were re‐evaluated with binocular kinetic Goldmann IV4e target field test (Australian driving standard). A series of 48 consecutive patients seen by the Glaucoma Inheritance Study in Tasmania were assessed with both static computerized perimetry and the Goldmann IV4e target test.

Results: The four patients with severe visual field defects (on computerized perimetry) were found to meet the driving standard on the binocular Goldmann IV4e target test. On computerized perimetry, 15 of 48 patients from the Glaucoma Inheritance Study in Tasmania were found to have visual field defects of sufficient severity that they may not meet the driving standard. However, only five of these patients failed the driving standard for visual fields, two of whom were still driving.

Conclusions: Patients with severe field defects on conventional uniocular automated perimetry may still meet the Goldmann standard visual field test for driving. Approximately 30% of glaucoma patients would have visual field loss shown on Humphrey 24‐2 test of a severity that requires further testing to determine if they meet the driving standard. Ten per cent of glaucoma patients tested did not meet the driving standard for visual fields.
Relationship between intraocular pressure and systemic health parameters in a Korean population
Authors: Lee Jong Soo , Lee Sang Hyup , Oum Boo Sup , Chung Joo Sup , Cho Byung Mann , Hong Jong Wook
Published: March 2003

Purpose: This study aimed to evaluate the relationship between intraocular pressure (IOP) and age and obesity, adjusted for systemic health parameters such as sex and mean blood pressure, in a Korean population.

Methods: A total of 13 212 healthy participants underwent automated multiphasic tests, including tonometry, automated perimetry, fundus photography, blood pressure and body mass index (BMI). Six age groups were used, divided by decades ranging from 20−29 years to 70+ years. The association between IOP and systemic health para­meters was examined using cross‐sectional analysis.

Results: The median age of participants was 47.6 years (range 20−84 years), and 6684 (50.6%) of participants were men. The mean IOP of participants was 15.5 mmHg. The mean IOP, blood pressure and BMI values were significantly higher in men than in women (P < 0.05). The overall prevalence of ocular hypertension, defined as IOP >21 mmHg without signs of glaucomatous visual field loss or optic disc damage, was 6.1% in men and 2.5% in women. Intraocular pressure was associated with mean blood pressure, sex, age and BMI by multiple regression analysis (P < 0.05). The relationship between IOP and age adjusted for sex, mean blood pressure and BMI had a significantly negative tendency for both sexes (P < 0.05). Body mass index had a significantly positive relation with IOP after controlling for age, sex and mean blood pressure in men (P < 0.05), but not in women.

Conclusions: In this Korean population, after multiple adjust­ment, IOP was found to decrease with age and to increase with BMI in men.
Femoral Vein Stasis During Laparoscopic Cholecystectomy Effect of an Intermittent Sequential Pneumatic Compression Device
Authors: Isoda Norio , Suzuki Takanori , Ido Kenichi , Kawamoto Chiaki , Nagamine Nobuhiko , Sohara Hiromitsu , Ono Kazunori , Kumagai Machio , Hirayama Yoshimi , Sugano Kentaro
Published: March 2003

Background:
During laparoscopic cholecystectomy (LC), venous stasis of the legs may occur which cannot be prevented by a graded compression bandage used for a standard laparotomy. In this study, we investigated whether femoral vein stasis during LC could be prevented using an intermittent sequential pneumatic compression device (IPC).

Methods:
The effects of an IPC on blood flow in the legs prior to pneumoperitoneum (baseline), at pneumoperitoneum, at postural change and at deflation were examined by color Doppler ultrasonography on each of two groups, namely the patients without an IPC on the lower extremities (group 1, n = 20) and the patients with an IPC (group 2, n = 20).

Results:
The peak femoral vein velocity in group 1 at a pneumoperitoneum pressure of 10 mmHg in the reverse Trendelenburg's position was significantly decreased to 29.3 ± 3.4% of the baseline value (P < 0.05). However, in group 2, the velocity was maintained and there was no significant decrease. The blood flow velocity when the IPC was used significantly differed from that when the IPC was not used (P < 0.01). The area of the femoral vein in group 1 at a pneumoperitoneum pressure of 10 mmHg in the reverse Trendelenburg's position significantly increased to 379.5 ± 16.3% of the baseline value (P < 0.05). In group 2, it significantly increased to 387.0 ± 19.1% (P < 0.05). However, the area of the femoral vein when the IPC was used did not significantly differ from that when the IPC was not used.

Conclusion:
The use of an IPC maintained the peak femoral vein velocity even under pneumoperitoneum and in the reverse Trendelenburg's position.
Gastric Wall Structure Using a 30 MHz Endoscopic Ultrasound Probe, Focusing upon Delineation of the Muscularis Mucosae
Authors: Yoshino Junji , Nakazawa Saburo , Inui Kazuo , Katoh Yoshimichi , Wwkabayashi Takao , Okushima Kazumu , Kobayashi Takashi , Nakamura Yuta , Watanabe Shinya , Asakura Naoko
Published: March 2003

Background:
The normal gastric wall has been reported to appear to be a five‐layered structure. The structure of the gastric wall using a 30 MHz endoscopic ultrasound probe and especially the identification of the muscularis mucosae (MM), has not been analyzed clearly.

Methods:
In a basic study, 11 sections of normal gastric wall with 26 horizontally inserted nylon sutures were immersed in water. The sections were scanned and the findings correlated using standard histology. In a clinical study, 15 early gastric cancers were examined by a 30 MHz endoscopic ultrasound probe.

Results:
In a basic study, layers deeper than the lower part of the submucosa could not be seen using ultrasonography. The first to fourth layers represented the mucosal layer except the MM, the fifth layer (high‐echo layer) represented the boundary echo and a part of the MM, while the sixth layer (low‐echo layer) represented the rest of the MM. The muscularis mucosae was seen clearly in all samples. In a clinical study the layers deeper than the submucosal layer could not be seen and the MM was visible in 87% of cases. The depth of invasion was estimated accurately in 90% of mucosal cancers and in 80% of submucosal cancers.

Conclusion:
A 30 MHz endoscopic ultrasound probe, which cannot image the entire gastric wall, can visualize the MM and may help to confirm the structure of gastric wall layers and improve the ability to determine the depth of invasion in gastric cancer.
Experience with Laparoscopic Repair of a Strangulated Obturator Hernia: Report of a Case
Authors: Fujita Junko , Uyama Ichiro , Sugioka Atsushi , Komori Yoshiyuki , Matsui Hideo , Soga Ryohei , Hasumi Akitake
Published: March 2003

Laparoscopic hernia repair and resection of the small bowel were performed in a 78‐year‐old woman with a strangulated obturator hernia. The hernia orifice was closed primarily by intracorporeal interrupted sutures, as a result of caution to prevent infection with mesh. To minimize the size of the skin incision, the intestinal resection and entero‐anastomosis were performed intracorporeally. The postoperative recovery was uneventful. We consider that laparoscopic obturator hernia repair with intracorporeal bowel resection and anastomosis should be considered as a method of choice in some cases, in order to minimize the risk of morbidity and mortality.
Gastric Neoplasia Developed After Proximal Gastrectomy: Report of Three Cases
Authors: Bandoh Toshio , Sato Koichi , Shiraishi Norio , Aramaki Masanori , Adachi Yosuke , Kitano Seigo
Published: March 2003

The incidence of proximal gastric cancer is increasing and proximal gastrectomy is widely accepted as a standard operation for early staged proximal gastric cancer. Recently, we encountered three aged patients with distal gastric cancer or adenoma after proximal gastrectomy: one with mucosal adenocarcinoma and two with adenoma. These patients showed that carcinoma or adenoma could develop in the distal gastric remnant after proximal gastrectomy. Although gastric remnant cancer has been defined as a cancer that arises in the proximal gastric remnant after distal gastrectomy, it hereafter includes a cancer that arises in the distal gastric remnant after proximal gastrectomy. Endoscopic examination of the distal gastric remnant is important in asymptomatic patients who underwent proximal gastrectomy.
INTRABILIARY OBSTRUCTION DUE TO RUPTURED HEPATIC HYDATID CYST: EVALUATION WITH COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING
Authors: Tsitouridis Joannis , Kouklakis George , Tsitouridis Kostantinos , Melidis Dimitrios , Krokos Nikolaos , Emmanoyilidoy Maria
Published: March 2003

Background: One of the most common and very serious complications of a hepatic echinococcal cyst is the intrabiliary rupture of the cyst and, in some cases, the obstruction of the biliary system. The effectiveness of computed tomography (CT) and magnetic resonance imaging (MRI) was evaluated for the preoperative diagnosis of hydatid cyst into the biliary tree.

Methods: The techniques of CT, MRI and magnetic resonance (MR) cholangiography were used to examine nine cases of intrabiliary rupture of the hepatic hydatid cyst. The confirmation of the diagnosis was made at surgery in four cases and with endoscopic retrograde cholangiopancreatography in five cases.

Results: By using CT and MRI, the intrabiliary rupture of an echinococcal cyst was diagnosed readily and accurately in all cases. In eight cases, we found a dilated intrahepatic biliary vessel near the ruptured echinococcal cyst, without any evidence of communication between the cyst and the biliary system. Also in six cases there was an abnormal configuration of the terminal part of the biliary radicle.

Conclusion: This study suggests that a dilated biliary radicle with conical configuration of its end‐part and in close proximity with hydatid cyst is strong evidence of previous or active rupture of hydatid cyst into the biliary system. A combined study of CT or MRI and MR cholangiography is mandatory for proper preoperative evaluation of the intrabiliary rupture of hepatic hydatid cyst.
LAPAROSCOPIC WEDGE BIOPSY OF THE LIVER WITH USE OF AN ULTRASONICALLY ACTIVATED SCALPEL
Authors: Seki Shuichi , Sakaguchi Hiroki , Kadoya Hirokazu , Morikawa Hiroyasu , Kitada Takuya , Habu Daiki , Tamori Akihiro , Nishiguchi Shuhei , Shiomi Susumu
Published: March 2003

Background: Wedge biopsy of the liver yields more accurate diagnosis of liver diseases than does needle biopsy, but is usually more invasive. We have designed a new method for laparoscopic wedge biopsy under local anesthesia with use of an ultrasonically activated scalpel.

Methods: We performed wedge biopsy in seven patients with liver diseases. Under local anesthesia, two trocars punctured the abdomen and the edge of the liver was dissected with the scalpel. We evaluated the differences in operating time, grade of pain during/after the biopsy, changes of laboratory data and changes of body temperature, between seven wedge and 18 needle biopsies.

Results: No differences were found in all factors between wedge and needle biopsies.

Conclusions: This new method of laparoscopic wedge biopsy under local anesthesia was safe and more useful than needle biopsy. It was also no more invasive than needle biopsy.
VASCULAR ECTASIA OF THE COLON TREATED BY ARGON PLASMA COAGULATION: REPORT OF A CASE
Authors: Tada Yoshie , Okamura Seisuke , Okita Yoshio , Tsujigami Koji , Ichikawa Soichi , Sogabe Masahiro , Muguruma Naoki , Ito Susumu
Published: March 2003

A 72‐year‐old woman presented with hematochezia. Colonoscopy revealed branch‐like vasodilation in the ascending colon and chronic hemorrhage from vascular ectasia of the colon was suspected. Argon plasma coagulation was performed. After treatment, epithelialization of the lesion site was noted and her anemia improved. Vascular ectasia of the colon is recognized as the etiology of lower gastrointestinal bleeding with increasing frequency. Infrared ray electronic endoscopy is useful for determining the extent of disease and argon plasma coagulation, a new hemostatic technique, is suitable for treatment of this condition.
ENDOSCOPICALLY RESECTED LIPOMA OF THE ESOPHAGUS: REPORT OF A CASE
Authors: Nagashima Mamiko , Ohki Ichirou , Nagasato Yasuyuki , Mori Masatomo , Murakami Masahiko , Fukoue Yoshihiro , Lee Ugen
Published: March 2003

Lipoma of the esophagus is rare. There are few reports of the endoscopic resection of esophageal lipoma. We present a 73‐year‐old woman with lipoma of the esophagus which was successfully extirpated using the technique of endoscopic mucosal resection. To determine the depth of tumor invasion, endoscopic ultrasonography was used. A total of 31 cases of esophageal lipoma have been reported in Japan. Of these, seven were successfully resected using endoscopic techniques. Lipomas of the esophagus can grow to become large pedunculated tumors which can obstruct the airway. The majority of these tumors occur in the cervical portion of the esophagus. Most patients have no symptoms. These tumors can be resected using minimally invasive surgery when they are small.
Korean experience of superficial depressed‐type early colorectal cancer
Authors: Kim Hyun Shig , Lee Jung Dal , Kim Kwang Yun
Published: March 2003

Background: Unlike the adenoma–carcinoma sequence theory, the de novo carcinoma theory has been highlighted recently because of the emergence of superficial depressed‐type early colorectal cancers. In addition, some flat‐elevated or sessile‐type early colorectal cancers have been identified as originating from superficial depressed‐type early colorectal cancers. Thus, studies of superficial depressed‐type early colorectal cancers may provide an opportunity to clarify the morphogenesis of colorectal cancers in the foreseeable future.

Methods: The authors studied 231 cases of early colorectal cancer from 1997 to 2000. Among them, 17 cases (7.4%) were superficial depressed‐type. According to Kudo's classification, the 17 lesions were classified as three types based on their growth patterns: IIc, IIa + IIc, and Is + IIc. They were also classified as sm‐s (sm1) and sm‐m (sm2–3) cancers based on the depth of submucosal invasion according to Kudo's classification. They were analyzed with emphasis on size, depth of submucosal invasion and treatment.

Results: Type IIc lesions were 11 mm in diameter on average; types IIa + IIc and Is + IIc had diameters of 15 mm and 11 mm on average, respectively. Sm‐m cancers' diameters were all larger than 10 mm. Fifty‐seven percent (57%) of type IIc cancers were submucosally invasive, while 90% of type IIa + IIc and type Is + IIc cancers together were submucosally invasive. The overall surgical resection rate was 41.2%, and surgical resection was performed in 80% of the sm‐m cases.

Conclusion: Recognition of superficial depressed‐type early colorectal cancers, especially type IIa + IIc and type Is + IIc cancers, is important because their biological behavior will most likely be different from that of the usual protruding early cancers. Accordingly, the treatment modality should be selected prudentially, and early detection is imperative in order for their sizes to be less than 10 mm.
Gastric bleeding due to Dieulafoy's ulcer successfully treated with an esophageal variceal ligation (EVL) kit
Authors: Chino Yoshihide , Kashima Yoichi , Shiomi Mikio , Suzuki Yutaka , Ubukata Nobuo , Yoshihara Kazuo , Tani Tadanobu , Ogata Masakata , Fujimura Masaki
Published: March 2003

Dieulafoy’s ulcer is a cause of life‐threatening upper gastrointestinal hemorrhage. With advanced endoscopic procedures, Dieulafoy’s ulcer is easily diagnosed and treated. However, a few patients still need surgery to stop bleeding or they will die of shock. Further improved procedures are therefore required to treat bleeding in Dieulafoy’s ulcer. A 77‐year‐old man was admitted to our hospital with hematemesis and general malaise. He had moderate anemia and azotemia but no past history of gastric ulcer. He was diagnosed with Dieulafoy’s ulcer endoscopically. Dieulafoy’s ulcer was ligated with an endoscopic variceal ligation kit without surgery. Although an ulcer was found at the ligation point after 1 week, the ulcer changed to the scar on administration of Histamine H2 receptor blockers. The patient has suffered no recurrent ulcer and no bleeding for 24 months. Endoscopic variceal ligation may be an alternative new method for hemostasis of Dieulafoy’s ulcer.
Blood flow, acidity and atrophic changes of the gastric mucosa in Mongolian gerbils infected with Helicobacter pylori
Authors: Miyazaki Sebastião Mitsuji , Matsuda Mimian Graciela , Misumi Atsunobu , Honmyo Ubehiko , Murakami Akitoshi , Murata Hiroshi , Sagara Katsuro , Kurano Ryouichi , Okabe Hiroaki
Published: March 2003

Background:

We used a Mongolian gerbil model to evaluate the effects of long‐term Helicobacter pylori infection on blood flow, gastric acidity and atrophic change of the gastric mucosa.

Methods:

Infected animals were divided into eight groups according to the duration of infection: 3 months infection (MI), 6 MI, 9 MI, 12 MI, 18 MI, 24 MI, 30 MI and 36 MI (n = 6 in the 3–30 MI groups and n = 11 in the 36 MI group). Control animals were divided into the same eight groups (3–36 MC; n = 6 in each group). Blood flow and gastric acidity were measured and atrophic changes were analyzed in each group. The gastric mucosa was divided into areas termed F (chief cells observed continuously), f1 (number of chief cells decreased and no longer continuous), f2 (parietal cells scattered and chief cells not seen) and P (only pyloric glands observed). Atrophic changes were classified as normal, mild, moderate and severe on the basis of the percentage of the F area and the presence or absence of the f2 area.

Results:

Blood flow did not show any significant difference between the control groups, but decreased significantly in the 12–36 MI groups compared with the 3–9 MI groups (P < 0.0001). The pH was significantly higher in the 12–36 MC groups than in the 6 and 9 MC groups (P < 0.002). The pH was significantly higher in the 9–36 MI groups than in the 6 MI group (P < 0.006). Atrophic changes were not found in the 3–9 MC groups, but mild atrophic changes were observed in the 12–24 MC groups and moderate atrophic changes were observed in the 30 and 36 MC groups. Atrophic changes were moderate in the 3–18 MI groups and severe in the 24–36 MI groups.

Conclusion:

The present study shows that atrophic changes progress with aging naturally and that H. pylori infection accelerates this change to induce a severe decrease in blood flow and gastric acid secretion.
Probiotic therapy for pouchitis and its endoscopic findings
Authors: MIMURA TOSHIKI , KAMINISHI MICHIO , KAMM MICHAEL A.
Published: March 2003

Restorative proctocolectomy with ileal pouch anal anastomosis has become the most frequently performed operation for ulcerative colitis. Patients having this operation, however, experience more short‐ and long‐term complications than those with a permanent ileostomy. Pouchitis, acute non‐specific inflammation within an ileal pouch, is one of the most common long‐term complications after this procedure, and is specific to it. Although most pouchitis is amenable to simple antibiotic therapy including metronidazole and ciprofloxacin, 5–15% of patients suffer from refractory pouchitis, in which the acute inflammation either relapses frequently after the cessation of the antibiotics or does not respond to them at all. Probiotic therapy is intended to re‐establish natural bacterial conditions with live organisms belonging to natural bacterial flora. Recently, there have been an increasing number of reports that probiotic therapy is effective for inflammatory bowel disease including pouchitis, and might be the best approach to treat them. In this paper, the rationale and evidence for benefit of probiotic therapy in treating pouchitis have been reviewed, and representative endoscopic pictures of pouchitis have been included.
Endoscopic Placement of Metallic Stent for Colonic Stricture Resulting from Carcinoma Located at the Splenic Flexure
Authors: Obayashi Makoto , Katube Tomoya , Shimizu Noriko , Kotani Jin , Takano Yasuna , Amano Ryosuke , Yanagawa Kenichi , Nishimori Takeo , Sawa Yoshinori , Matsumoto Takayuki , Arakawa Tetsuo
Published: March 2003

A 67‐year‐old woman was admitted to Ikuwakai Memorial Hospital with sub‐ileus symptoms. Radiographic and endoscopic examination revealed that the patient had a colonic cancer approximately 15 cm in length from the descending colon to the distal transverse colon with severe stricture. The histopathological finding was mucinous adenocarcinoma. Abdominal computed tomography showed multiple liver metastases and intraperitoneal lymph‐node swelling. A per‐rectal decompression tube was inserted temporarily, and surgical colostomy was initially proposed. However, the patient rejected surgery, and stent therapy was considered as an alternative therapy. An ultraflex esophageal expandable metallic stent was installed. At day 4, tumor projection through the expandable metal‐stent mesh was observed and additional balloon dilatation was carried out under colonoscopic assistance. At day 7, ileus symptoms disappeared and the patient had been able to maintain oral feeding for 3 months until she died as a result of cachexia by systemic metastasis of colonic cancer.
Endoscopic Resection of Gastric Plasmacytoma
Authors: Shimizu Kengo , Michida Tomoki , Nishimura Yoshiya , Satomi Eriko , Kawahara Kunimitsu , Kurata Akihiko , Ikeda Masahiro
Published: March 2003

Gastric plasmacytoma is a rare form of extramedullary plasmacytoma. It is usually diagnosed with a barium meal or endoscopy for various gastrointestinal symptoms. Most gastric plasmacytomas are treated by surgical resection, even when they are confined to gastric mucosal lamina propria or submucosa, that is, in the early stages. We present here a case of gastric plasmacytoma showing an endoscopic feature of submucosal tumor approximately 2.5 cm in diameter, found through an X‐ray study in a mass screening. Endoscopic ultrasonography revealed a hypoechoic tumor located in the submucosal layer, and the tumor appeared to be safely excised by routineendoscopic resection. In order to obtain histlogical diagnosis, we resected the tumor, which was diagnosed as a plasmacytoma. The patient did not shown any sign of local and/or generalized recurrence during follow up for 2.5 years. We have not found a successful case of endoscopic resection of gastric plasmacytoma reported previously.
Telomerase activity in gastric cancer
Authors: Jinping Ma , Wenhua Zhan , Shirong Cai , Junsheng Peng , Jianping Wang
Published: March 2003

OBJECTIVE: To examine telomerase activity and its clinical significance in human gastric carcinoma and to evaluate the feasibility of non‐radioisotopic TRAP (telomeric repeat amplification protocol) assays to detect telomerase activity.

METHODS: Telomerase activity in tissue samples from 58 gastric carcinomas (and their matched normal tissues), 12 gastric adenomas and nine gastric ulcers was examined by using a modified non‐ radioisotopic PCR (polymerase chain reaction)‐based TRAP assay.

RESULTS: Forty‐nine of 58 gastric cancer specimens were positive for telomerase activity, with a positive rate of 84.5%. In contrast, none of the normal tissues exhibited telomerase activity (P < 0.001). One of each of the 12 gastric adenomas and nine gastric ulcers was also positive. The prevalence of telomerase activity in gastric carcinoma tissues was not correlated with age, tumor diameter, histological grade, tumor invasion depth, lymph node metastasis or tumor node metastasis (TNM) stage.

CONCLUSIONS: Telomerase activity could be a good diagnostic marker for the detection of gastric carcinoma. The non‐radioisotopic TRAP assay is a feasible method for detecting telomerase activity.
Inhibitory effect of arsenic trioxide on peritoneal metastasis in nude mice with colon cancer
Authors: Hongpei Cai , Zhihua Deng , Shi Li , Xingrong Zhang , Jianwei Shen
Published: March 2003

OBJECTIVE: To investigate the effects of As2O3 on the peritoneal metastasis of colon cancer in nude mice.

METHODS: BALB/c‐nu/nu mice were injected intraperitoneally with Lovo cells and were allocated to five groups at random: control, epirubicin and varying concentrations of As2O3. The length of their survival period and rates of tumorigenesis and ascitic fluid formation were evaluated.

RESULTS: Epirubicin and low doses of As2O3 clearly inhibited ascitic fluid formation and extended the survival period of tumor‐bearing nude mice. Moderate and large doses of As2O3 were able to eradicate cancer cells through apoptosis.

CONCLUSIONS: As2O3 can induce apoptosis in intraperitoneal colon cancer cells, inhibit ascitic fluid formation and extend the survival periods of nude mice to varying degrees.
Clinical application of transarterial thermochemotherapy in hepatic cancer
Authors: Jijin Yang , Qingde Kong , Jianming Tian , Zhaoshen Li , Yulin Ma , Xinjun Gao , Wenliang Zhou
Published: March 2003

OBJECTIVE: To investigate the effectiveness and safety of transhepatic arterial infusion with warm chemotherapeutic agents in treating hepatic cancer.

METHODS: Thirty‐five cases of hepatic cancer were treated with transhepatic arterial thermochemotherapy. Lipiodol, 5‐Fu and carbonplatinum were warmed to 60–65°C before infusion into the hepatic arteries. Nine patients had two or more treatments and the effectiveness of this treatment was compared with that observed in 14 patients who received ordinary interventional treatment within the same period. Four patients had their tumors removed 2–3 months later and the pathological results were compared with those of four other patients who received regular treatment.

RESULTS: The tumor growth rate of the thermochemotherapy group was –10 ± 33.3%, while that of the control group was 36.4 ± 59.0%, a statistically significant difference. The tumor necrosis rates on the axial sections of the resected samples were 93.5%± 5.97% and 73.5%± 28.3%, respectively, but the difference was not statistically significant. Microscopically, the pathological changes in the two groups were similar. Only one patient in each group had arterial injury. Comparing the thermochemotherapy group (19 cases) with the control group (22 cases), all of whom received ‘sandwich’ therapy, we found that the prevalence of mild–moderate adverse effects was 72.7 and 63.6%, respectively, while that of severe adverse effects was 26.3 and 37.4%, respectively. However, these differences were of no statistical significance.

CONCLUSIONS: Transhepatic arterial perfusion of warmed Lipiodol and chemotherapeutic agents (60–65°C) combined with hepatic arterial embolization with gelfoam is a simple and safe method for treating hepatic cancer. It can markedly enhance the effectiveness of simple transarterial interventional therapy.
Prospective study of diagnostic value of magnetic resonance cholangiopancreatography versus endoscopic retrograde cholangiopancreatography in cholangiopancreatic diseases
Authors: ZHI Fa Chao , YAN Zhi Qiang , LI Xiao Lin , ZHU Jian Xin , CHEN Cun Long , ZHANG Xue Lin , ZHOU Dian Yuan
Published: March 2003

OBJECTIVE:  To compare the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) versus endoscopic retrograde cholangiopancreato­graphy (ERCP) in the detection of cholangiopan­creatic diseases via a prospective study.

METHODS:  Magnetic resonance cholangiopancreatography was performed in 63 patients with suspected cholangiopancreatic diseases and followed by ERCP within 24 h. The MRCP and ERCP images were analyzed and compared.

RESULTS:  Of the 63 patients studied, 56 (88.9%) were correctly diagnosed by using ERCP and seven (11.1%) by using percutaneous transhepatic cholangio­graphy (PTC); however, all these patients were successfully diagnosed by using MRCP. Cholangio­pancreatic diseases were diagnosed by MRCP with a sensitivity of 98.2%, a specificity of 83.3%, a misdiagnostic rate of 16.7% and a missed diagnostic rate of 1.8%. The total concordance rate of MRCP, ERCP and PTC was 85.7%. For specific conditions, the concordance rates were as follows: biliary calculi 100%; tumors of the bile duct 92.9%; papillary lesions 70.6%; hepatic distomiasis 66.7%; chronic pancreatitis 100%. The complications associated with ERCP were five cases of acute pancreatitis and one case of perinephric abscess. The patient with perinephric abscess had previously had a B‐II operation. The complication rate associated with ERCP was 9.5% (6/63), but no complications were associated with MRCP.

CONCLUSION:  We conclude that MRCP is as effective as ERCP for the diagnosis of bile duct lesions, such as biliary calculi and tumors, but not for papillary lesions and liver fluke infections. Although MRCP can be used in patients who can’t tolerate ERCP or when there are contraindications to using ERCP, it should not be used for therapeutic purposes.
Prevention of respiratory infections in the elderly
Authors: Yamaya Mutsuo , Ohrui Takashi , Kubo Hiroshi , Ebihara Satoru , Arai Hiroyuki , Sasaki Hidetada
Published: March 2003

The risk of nosocomial infections is 3–5‐fold higher among older patients than among younger adults. Both the increased incidence of respiratory infections and the high mortality among older people are a consequence of a number of age‐related factors, including coexisting illnesses, therapeutic interventions, and the aging process itself. Risk factors for the development of respiratory infections in older people can be broadly classified into factors that alter host defenses and factors that increase exposure to bacteria. These factors combine to adversely affect the person's capacity to defend against pathogens of the upper and lower respiratory tract. Despite the availability of potent new antimicrobials, the increasingly limited treatment efficacy of these antimicrobials is related to emerging microbial resistance. Recently, new methods of treating respiratory infections according to the mechanisms of infection have been introduced. Effective methods of preventing respiratory infections in older people were reviewed.
Two elderly cases of nocturnal onset stroke with stenosis of carotid arteries during the treatment of hypertension
Authors: Watanabe Shintaro , Narita Junichi , Kario Kazuomi
Published: March 2003

Two hypertensive elderly patients developed ischemic stroke during night‐time after blood pressure reduction using antihypertensive drugs. Case 1 was a 67‐year‐old man and his blood pressure had been controlled at 120–140/55–80 mmHg by the administration of amlodipine besilate (5 mg per day). At 04:00 hours on 25 August 2000, he experienced left hemiparalysis and was brought to the hospital within 1 h of onset. He had severe stenosis of the right internal carotid artery. His left hemiparalysis showed stepwise worsening, and atherectomy of carotid artery was performed. Ambulatory blood pressure monitoring after the operation demonstrated that his systolic blood pressure fell to a minimum of 74 mmHg while he was asleep. Case 2 was a 69‐year‐old man who had developed nasal bleeding due to blood pressure elevation of 240/80 mmHg in January 2000. Strict blood pressure control using long‐acting nifedipine (40 mg per day) and lisinopril (20 mg per day) was initiated. After his blood pressure had been controlled at 130–140/60–80 mmHg, he suffered sudden left hemiparesis at 01:00 on 4 November 2000, showing complete obstruction of the right internal carotid artery. In a patient with carotid artery stenosis, nocturnal hypotension can cause an ischemic stroke. Ambulatory blood pressure monitoring and carotid ultrasound detecting carotid stenosis would be useful to identify patients with a high risk of stroke among elderly hypertensive patients treated with antihypertensive medication.
Post‐thyroidectomy sore throat following endotracheal intubation
Authors: Hisham Abdullah N. , Roshilla Hashim , Amri Nil , Aina Emran N.
Published: March 2003

Background:  Sore throat is not an uncommon complaint following general anaesthesia (GA) with endotracheal intubation. It has been a source of considerable discomfort particularly in those patients who had thyroid surgery. Driven by the increased number of patients with post‐intubation sore throat following thyroid surgery, the aim of the present study was to evaluate the contributing factors of sore throat in patients who had thyroid surgery under general anaesthesia.

Methods:  A total of 57 consecutive patients who had thyroid surgery from November 1998 to April 1999 was included in this prospective study. Factors such as intubation time, number of intubation attempts, size and type of endotracheal tube (ETT) used, gender and age were recorded. The nature and extent of the surgical procedures were also studied. Postoperative symptoms were assessed by questionnaire on the day after surgery and the different parameters were compared and analysed.

Results:  The incidence of post‐intubation sore throat following thyroid surgery was documented in 39 (68.4%) patients. Twenty‐seven (47.4%) patients had a mild complaint of sore throat, which resolved after the third day. The data from the present study show that the size of ETT and extent of surgical procedure were significant contributing factors affecting the postoperative recovery.

Conclusion:  The outcome of the present study demonstrated a substantial increased incidence of sore throat after thyroid surgery under GA. Postoperative sore throat following thyroid surgery under GA may be caused by multiple contributing factors. Nonetheless effort and care should be taken during endotracheal intubation and surgery to reduce this unpleasant complaint arising mainly from pharyngeal irritation or trauma.
Palliative surgery for neoplastic unilateral vocal cord paralysis
Authors: Iseli Tim A. , Brown Christopher L. , Sizeland Andrew M. , Berkowitz Robert G.
Published: March 2003

Background:  Locally advanced, recurrent or metastatic neoplasms are the commonest causes of unilateral vocal cord paralysis (UVCP). The aim of the present study was to evaluate both survival and results of treatment of vocal cord medialization procedures in this group of patients.

Methods:  Fifty‐seven patients (36 male, 21 female) with UVCP considered to be due to advanced malignancy who underwent medialization (Teflon injection or type I thyroplasty) between January 1994 and July 2000 were retrospectively reviewed.

Results:  The malignancy responsible for UVCP was non‐small‐cell lung carcinoma (NSCLC) in 43 patients, small‐cell lung car­cinoma (SCLC) in four patients, thyroid carcinoma in three patients and metastatic lower cervical lymph nodes in seven patients. All patients complained of dysphonia and 29 patients had symptoms of aspiration. Teflon injection was performed in 44 patients and thyroplasty in 13. Improvement in voice occurred in 51 patients (89%) and resolution of aspiration in 28 patients (97%) after 2 months. The median time from onset of symptoms of UVCP to death in NSCLC was 170 days; SCLC, 69 days; thyroid carcinoma, 783 days; and metastatic lower cervical lymph nodes, 304 days.

Conclusion:  Surgical treatment of neoplastic UVCP provides satisfactory palliation of symptoms, and management decisions should be based on patient survival expectations.
Acute epiglottitis in adults: the Royal Melbourne Hospital experience
Authors: Wong Elaine Y. H. , Berkowitz Robert G.
Published: March 2003

Background:   To examine the common presentations and management of acute epiglottitis in adults.

Method:  Retrospective clinical study of 17 consecutive adult patients who presented to the Royal Melbourne Hospital between January 1988 and December 2000 was undertaken.

Results:   The mean patient age was 47 years (range 20–87 years) and the male‐to‐female ratio was 1.8 : 1.0. Peak incidence occurred in September during early spring. All patients presented with sore throat and dysphagia; however, respiratory distress was only noted in 65%. The most common signs were temperature and tachycardia. Four patients (23%) required endotracheal intubation, which was performed electively in three and as an emergency in one. Three of 14 blood cultures were positive, two yielded Haemophilus influenzae type b and one yielded Streptococcus mitis. One of the four throat cultures was positive for Haemophilus influenzae type b. Twelve patients underwent awake flexible laryngoscopy under topical anaesthetic as part of their initial assessment, and there were no complications associated with this procedure. There was no mortality.

Conclusions:   The diagnosis of acute epiglottitis in the adult population is difficult as respiratory distress may be absent. Patients who have a significant sore throat with no obvious aetiology should have direct visualization of their larynx by flexible laryngoscopy. Lateral X‐ray of neck is of limited value. Once diagnosed, these patients should be hospitalized and monitored as airway obstruction may develop rapidly.
Eversion carotid endarterectomy
Authors: Iseli Tim A. , Puttaswamy Vikram , Campbell William A. , Atkinson Noel R.
Published: March 2003

Background: Eversion carotid endarterectomy (ECEA) is a technique that obviates the need for traditional longitudinal arteriotomy and patch closure, with low stroke and restenosis rates. The aim of the present study was to report an Australian experience and technique of ECEA.

Methods: All patients who underwent ECEA by the investigating surgeons between October 1997 and July 2000 were followed up clinically and with duplex ultrasound. The technique of ECEA is described.

Results: One hundred and fifty‐two ECEA were performed, 13 combined with coronary artery bypass grafting (CABG). The combined perioperative stroke and death rate was 2%; 0.65% excluding CABG combined cases. This compares with 2.9% for standard carotid endarterectomy throughout Victoria. Significant restenosis occurred in 2.6% after a mean follow up of 21.7 months.

Conclusion: ECEA is a simple and safe alternative to standard carotid endarterectomy.
The submental artery island flap for head and neck reconstruction
Authors: Merten S. L. , Jiang R. P. , Caminer D.
Published: March 2003

Background: Following excisional surgery for head and neck cancer, most complex defects are reconstructed using microvascular free tissue transfer. These methods offer many advantages; however, they are of increasing complexity with attendant risks of flap loss and donor site problems. The submental artery island flap is a recently described local flap that may be used for reconstruction of the lower and middle thirds of the face and oral cavity, and offers the advantages of simplicity, reliability and excellent cosmesis. We have been using this flap as an alternative to free tissue transfer, and in this paper we present our series of 11 cases, after a review of the recent literature, anatomy and surgical technique. The advantages and limitations of the use of this flap are presented.

Methods: A consecutive series of 11 patients in which this reconstruction was performed was reviewed retrospectively, and the results studied. Advantages and disadvantages of this reconstructive method were determined to define appropriate indications and contra‐indications for its use.

Results: We have used this flap in 11 patients for post‐excisional soft tissue reconstruction of the head and neck, both as skin and as a mucosal replacement. In all but two patients the results were satisfactory, with excellent cosmesis when used as skin replacement. One patient required secondary debulking and one had complete flap loss. In all, the donor site was satisfactory.

Conclusions: The Submenal Artery Island Flap is a useful addition to the reconstructive surgeon’s options and has definite advantages over distant flaps in terms of ease of dissection, final cosmetic appearance and donor site appearance.