bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of hernia repair operation in Child–Turcotte–Pugh class C cirrhosis and refractory ascites
Authors: Park Joo Kyung , Lee Sang Hyub , Yoon Won Jae , Lee Jun Kyu , Park Su Cheol , Park Bum Joon , Jung Yong Jin , Kim Byeong Gwan , Yoon Jung‐Hwan , Kim Chung Yong , Ha Jongwon , Park Kyu Joo , Kim Yoon Jun
Published: July 2006

Background and Aim:  Abdominal wall hernia is a common feature of decompensated liver cirrhosis and frequently causes life‐threatening complications or severe pain. However, there have been no data reported on postoperative mortality, hepatic functional deterioration and recurrence rate according to Child–Turcotte–Pugh (CTP) class and to the presence of refractory ascites.

Methods:  The study population comprised 53 liver cirrhosis patients who underwent hernia repair operation. Comparisons were made of 30‐day mortality among the different CTP classes, and between those with or without refractory ascites. Liver function was also analyzed just before the operation, in the immediate postoperative period, and in the remote postoperative period.

Results:  Seventeen patients were in CTP class A, 27 patients in class B, and 9 patients in class C. The median follow‐up duration was 24 months. There was single 30‐day postoperative mortality in class C, and no CTP class deterioration after 30 days of operation. There was no mortality or recurrences in 17 patients with medically refractory ascites. The difference in 30‐day mortality according to CTP class and the presence of refractory ascites did not show statistical significance (P = 0.17 and 0.97, respectively).

Conclusion:  Hernia operation could be done safely in CTP class A and B with low rate of recurrences, and there was no definitive increase in the operative risk in class C. In addition, refractory ascites did not increase operative risk and recurrence rate. Therefore, surgical repair might be recommended even in patients with refractory ascites and poor hepatic function to prevent life‐threatening complications or severe pain.
Free oxygen radicals reduce bile flow in rats via an intracellular cyclic AMP‐dependent mechanism
Authors: Kawai Satoru , Arai Toshiyuki , Yokoyama Yukihiro , Nagino Masato , Nimura Yuji
Published: July 2006

Background and Aim:  Oxidative stress reduces hepatic bile formation. Cyclic adenosine monophosphate (cAMP) is important in bile production; however, the role of basal amounts of intracellular cAMP in bile formation is not known. The aim of this study was to determine whether oxygen radicals reduce bile flow by mechanisms involving intrahepatocyte cAMP levels.

Methods:  The effect of an oxygen radical (tert‐butyl hydroperoxide; t‐BHP) on hepatic bile flow was determined in Wistar rats in vivo and in isolated perfused liver. Intracellular cAMP was measured in isolated hepatocytes with and without t‐BHP in culture medium, while adenylate cyclase activity was measured in purified plasma membranes. To examine whether intracellular cAMP restoration could reverse t‐BHP‐induced bile flow reduction, dibutyryl cAMP (DBcAMP), a cell‐membrane permeating cAMP, was used to treat isolated liver perfused with t‐BHP.

Results:  Bile flow was significantly reduced 10 min following t‐BHP administration in vivo and in isolated perfused liver (control vs 0.1 mg/mL t‐BHP in perfusate, 29.3 vs 23.1 µg/kg per min, P < 0.05). Intracellular cAMP in isolated hepatocytes was reduced by adding t‐BHP to the medium; this change was inhibited by DBcAMP. Adenylate cyclase activity in purified liver membrane fractions also was reduced by t‐BHP. Administration of DBcAMP reversed bile flow reduction by t‐BHP in isolated perfused liver.

Conclusions:  Bile flow reduction by oxygen radicals was at least partly explained by inactivation of adenylate cyclase causing decreases in intrahepatocytic cAMP. Exogenous DBcAMP administration restored intracellular cAMP preventing bile flow reduction after exposure to oxygen radicals.
Indications for laparoscopic adrenalectomy for non‐functional adrenal tumor with hypertension: Usefulness of adrenocortical scintigraphy
Authors: IZAKI HIROFUMI , FUKUMORI TOMOHARU , TAKAHASHI MASAYUKI , TAUE RYUICHI , KISHIMOTO TOMOTERU , TANIMOTO SYUJI , NISHITANI MASA‐AKI , KANAYAMA HIRO‐OMI
Published: July 2006

Aim:  Laparoscopic adrenalectomy is currently indicated for biochemically and clinically functional adrenal tumors and potentially malignant tumors of the adrenal glands. Non‐functional adenomas greater than 5 cm in diameter of the adrenal gland are generally considered to represent potentially malignant tumors. The present study shows indications of laparoscopic adrenalectomy for non‐functional adrenal tumors with hypertension in a retrospective fashion.

Methods:  Between 1994 and 2004, 110 laparoscopic adrenalectomies were performed at Tokushima University Hospital. All 110 patients underwent detailed endocrinological examination before surgery. Medical and operative records of these 110 patients (57 men, 53 women), including operative parameters, histopathological findings and pre‐ and postoperative hypertension, were reviewed. Forty‐five patients underwent laparoscopic adrenalectomy for non‐functional adrenal tumors, and [131I]6β‐iodomethyl‐19‐norcholest‐5(10)‐en‐3β‐ol (NP‐59) scintigraphy was performed for patients with preoperative hypertension.

Results:  Mean patient age was 55.0 years (range, 22–77 years). Mean maximum tumor diameter was 42 mm (range, 20–105 mm). All adrenal tumors were removed successfully by laparoscopic surgery. Hypertension was postoperatively improved in seven of the 11 patients with preoperative hypertension, without subclinical Cushing syndrome. Importantly, all patients who improved hypertension after adrenalectomy displayed strong accumulation in adrenal tumors with visualization of the contralateral gland on NP‐59 scintigraphy. Conversely, blood pressure did not improve in four patients for whom scintigraphy yielded negative results.

Conclusions:  The indication of laparoscopic adrenalectomy for non‐functional adrenal tumors is generally considered for lesions more than 5 cm diameter. However, the present study suggests that laparoscopic surgery should be considered even in patients with tumors less than 5 cm in diameter, if both hypertension and accumulation in tumors on NP‐59 scintigraphy are present.
Superficial transitional cell carcinoma of the ureteral orifice: Higher risk of developing subsequent upper urinary tract tumors
Authors: CHOU ERIC CHIEH‐LUNG , LIN ALEX T , CHEN KUANG‐KUO , CHANG LUKE S
Published: July 2006

Aim:  Reports specifically addressing transitional cell carcinoma (TCC) of the ureteral orifice are scarce. This paper presents our experiences of such tumors, including the characteristics of the disease and the incidence of subsequent upper urinary tract recurrence.

Methods:  This study included 572 new cases of TCC of the urinary bladder diagnosed in our institute during a period of 5 years. Thirty‐one (5.4%) patients had superficial tumors involving ureteral orifices. All 31 patients underwent transurethral resection of the bladder tumors, including the involved ureteral orifices. After the surgery, patients received regular follow up with cystourethroscopy, urine cytology and periodic intravenous pyelography (IVP). Ureterorenoscopy was performed in cases of suspicious IVP or urine cytology findings.

Results:  Thirty‐one patients with superficial tumors involving the ureteral orifice were followed up for 5–8 years or until death. The pathological stage was Ta in 16 cases and T1 in 15 cases. Bladder tumor recurrence was noted in three (18.8%) of the pTa patients and in seven (46.7%) of the pT1 patients. Subsequent upper urinary tract tumors developed in four (12.9%) patients between 33 and 67 months (mean: 33.5) after the first transurethral resection. All four cases of upper tract recurrence had pT1 primary bladder tumor, which recurred for 1–3 times (mean 1.8) before upper tract recurrence. None of these patients had ureteral stenting after bladder tumor resection. Three of four patients with upper tract recurrence had single lower ureteral tumor, while the remaining one patient had multiple tumors. Patients with subsequent upper urinary tract tumors underwent nephroureterectomy and bladder cuff excision. One died of the disease; the other three cases were free of the disease after the therapy.

Conclusions:  Patients with primary superficial bladder transitional cell carcinoma involving the ureteral orifice have a higher risk of developing subsequent upper urinary tract tumors, particularly for pT1 primary bladder tumors. Frequent and close follow up is recommended.
Transobturatory tension‐free composite sling for urethral support in patients with stress urinary incontinence: Favorable experience after 1 year follow up
Authors: IGNJATOVIC IVAN , VUCKOVIC MAJA , SRZENTIC ZORAN
Published: July 2006

Objective:  Symptomatic, anatomic and urodynamic results of a composite transobturatory tension‐free sling with an absorbable middle part, in patients with stress urinary incontinence (SUI), were studied.

Methods:  A prospective study in 40 women with SUI was performed. Symptoms, urodynamics and anatomical improvements were evaluated separately. Surgery was performed with the transobturatory approach.

Results:  All patients had both clinically and urodynamically confirmed SUI. Clinical outcome was favorable in 36/40 (90%) patients, after 1 year. Operation improved the position of the bladder neck (2.8 cm and 1.4 cm below the pubic bone, respectively) and significantly decreased mobility of the bladder neck during abdominal straining (3.3 cm and 1.7 cm, respectively). Both symptoms and quality of life were significantly improved 1 month after the surgery. Postoperative maximum flow was lower than the preoperative one but with borderline significance (25.8 and 23.7 mL/s; P = 0.05). Pressure flow study showed unobstructed voiding both preoperatively and postoperatively. Detrusor pressure at the maximum flow was increased (20, 4 and 22, 8 cmH2O, respectively) but not significantly.

Conclusion:  Our results confirmed a high objective cure rate, improvement of symptoms and quality of life, and at the same time, corrected position of the bladder neck and unobstructed voiding.
Mathieu and Barcat repair with a V incision sutured meatoplasty for secondary hypospadias surgery
Authors: HAYASHI YUTARO , KOJIMA YOSHIYUKI , MIZUNO KENTARO , NAKANE AKIHIRO , MARUYAMA TETSUJI , KOHRI KENJIRO
Published: July 2006

Aim:  Today single‐stage methods are more frequently selected for hypospadias repair than multistaged methods, but complications cannot always be avoided. We employed two kinds of meatal based flip‐flap urethroplasty procedures for those with an unsuccessful primary hypospadias repair.

Patients and methods:  From 1997 to 2005, a meatal based flip‐flap urethroplasty was performed as a secondary hypospadias surgery on 17 patients. Basically we attempted the Mathieu repair, but when the wings of the glans were not generously widened and the urethral groove was not sufficiently deep we applied the Barcat procedure. While 11 patients were repaired with the Mathieu technique, six patients underwent the Barcat repair. The V incision sutured meatoplasty was added to obtain a natural ventral slit‐like meatus.

Results:  Ten of the 11 patients who underwent the Mathieu repair had a good outcome, but one patient developed a urethrocutaneous fistula. None of the six patients repaired with the Barcat procedure encountered postoperative complications. Cosmetically, a vertical slit was constructed near the normal neomeatus with the Mathieu and V incision sutured (MAVIS) meatoplasty and the Barcat and V incision sutured (BAVIS) meatoplasty.

Conclusions:  The Mathieu or the Barcat meatal based flip‐flap urethroplasty procedure is feasible as a salvage surgery for those with relatively short urethral defects and adequate mobile ventral skin if an exact procedure is selected. Excellent cosmetic results could be obtained by adding the technique of V incision sutured meatoplasty.
A case of granular cell tumor of the bladder successfully managed with extraperitoneal laparoscopic surgery
Authors: KONDO TSUNENORI , KAJIMOTO SHUNICHI , OKUDA HISASHI , TOMA HIROSHI , TANABE KAZUNARI
Published: July 2006

Abstract  Granular cell tumor is a benign neoplasm which frequently occurs in the oral cavity, skin, and subcutaneous tissue. Granular cell tumor of the bladder is an extremely rare disease, and only nine cases have been reported. We present here an additional case of granular cell tumor occurring in the bladder. Unlike the other tumors reported, this tumor extruded into the Retzius’ cavity. Therefore, the tumor was successfully excised through extraperitoneal laparoscopic surgery. The patient was free from recurrence 40 months after surgery. The small tumor located in Retzius’ cavity could be managed with extraperitoneal laparoscopic surgery.
Progress report on phase I/II clinical trial of Ad‐OC‐TK plus VAL therapy for metastatic or locally recurrent prostate cancer: Initial experience at Kobe University
Authors: HINATA NOBUYUKI , SHIRAKAWA TOSHIRO , TERAO SHUJI , GODA KAZUMASA , TANAKA KAZUSHI , YAMADA YUJI , HARA ISAO , KAMIDONO SADAO , FUJISAWA MASATO , GOTOH AKINOBU
Published: July 2006

Abstract  There is no effective therapy for hormone‐refractory prostate cancer and a novel therapeutic modality, such as a gene therapy, should be actively pursued. Previously, Gardner and Chung conducted a phase I clinical trial of Ad‐OC‐TK (recombinant adenoviral vector containing osteocalcin promoter‐driven herpes simplex virus thymidine kinase gene) plus VAL (valacyclovir) for the treatment of hormone‐refractory prostate cancer at the University of Virginia. We report on our ongoing phase I/II clinical trial of Ad‐OC‐TK plus VAL for the treatment of advanced prostate cancer at the Kobe University Hospital, Japan.
Urethral polyps in children: A review of the literature and report of two cases
Authors: DEMIRCAN MEHMET , CERAN CANAN , KARAMAN ABDURRAHMAN , UGURALP SEMA , MIZRAK BULENT
Published: July 2006

Abstract  A solitary polyp of the urethra is a rare benign fibroepithelial growth and has often been described in boys. Its occurrence in girls is exceptional. In the present paper, two children with solitary polyps of the urethra are presented and discussed. The first case was an 18‐month‐old boy with a posterior urethral polyp arising from the posterior urethra and extending to the bladder. It was excised by cystostomy because of an unsuccessful endoscopic removal attempt. The second case was a 2‐year‐old girl with an interlabial mass arising from the posterior wall of urethra and protruding from the external urethral meatus. It was excised transurethrally.
Intrascrotal calculi: A very rare stone disease
Authors: PARLAKTAS BEKIR SUHA , ULUOCAK NIHAT , FILIZ ERCAN , ERDEMIR FIKRET , OZYURT HUSEYIN
Published: July 2006

Abstract  A stone in the hydrocele sac is very rarely encountered, whereas the occurrence of multiple stones in the hydrocele cavity has not been reported before. Numerous intrascrotal stones were encountered in the hydrocele sac of a patient during operation and has prompted us to report this case.
Control of the large renal vein in limited dissected space during laparoscopic nephrectomy: A simple and reliable method
Authors: KIJVIKAI KITTINUT , LAGUNA M. PILAR , DE LA ROSETTE JEAN
Published: July 2006

Abstract  We describe our technique for large renal vein control in the limited dissected space during laparoscopic nephrectomy. This technique is a simple, inexpensive and reliable method, especially for large and short renal vein ligation.
CLINICAL USEFULNESS OF NEWLY DEVELOPED ELECTRONIC 360° RADIAL ENDOSCOPIC ULTRASONOGRAPHY
Authors: Kida Mitsuhiro , Kikuchi Hidehiko , Iwai Tomohisa , Moriki Hiroko , Kondo Ichiei , Araki Masao , Takezawa Miyoko , Watanabe Maya , Imaizumi Hiroshi , Yamada Yukihito , Sakaguchi Tetsuaki , Saigennji Katsunori
Published: July 2006

After the development of the mechanical radial scanning echoendoscope by Olympus Medical Systems (Tokyo, Japan), endoscopic ultrasonography (EUS) has become an indispensable examination in the clinical fields. Although mechanical radial EUS has no Doppler function because of its scanning method, Olympus Medical Systems developed a new electronic 360° radial EUS in 2003. Newly developed electronic radial EUS provides better penetration, fewer artifacts, color Doppler and power Doppler function, and tissue harmonic imaging. Its maneuverability is nearly the same as conventional mechanical radial EUS. With Doppler function it is easy to differentiate solid tumors such as pancreatic cancer, islet tumor etc., and to diagnose vascular invasion. Although there are some problems, electronic radial EUS has a promising future and it is believed that electronic radial EUS will become the standard model for the next generation of EUS equipment in imaging diagnosis.
ENDOSCOPIC DIAGNOSIS OF INTRAEPITHELIAL SQUAMOUS NEOPLASIA IN HEAD AND NECK AND ESOPHAGEAL MUCOSAL SITES
Authors: Muto Manabu , Sano Yasushi , Fujii Satoshi , Ochiai Atsushi , Yoshida Shigeaki
Published: July 2006

In the multistep process of squamous epithelial carcinogenesis, squamous epithelial dysplasia has been considered to be a preinvasive stage of squamous cell carcinoma. If we could distinguish a dysplasia at high risk, such lesions could be targets for local treatment such as endoscopic mucosal resection to avoid the transformation to invasive carcinoma. Narrow‐band imaging, a new optical technology, is useful to identify the cancerous lesion compared to conventional white light image. In addition, narrow‐band imaging combined with magnifying endoscopy makes it possible to visualize the changes of microvascular architecture occurring in the epithelium. To evaluate whether these endoscopic findings are reliable to diagnose a dysplasia at high risk, a prospective study on the basis of the standards for reporting diagnostic accuracy initiative is needed. If endoscopic assessment of intraepithelial squamous neoplasia is reliable, it would be of benefit to the patients’ outcome and improve cost effectiveness of care because of the avoidance of developing invasive carcinoma and the reduction of unnecessary biopsies.
MAGNIFYING ENDOSCOPIC FINDINGS OF NON‐EROSIVE REFLUX DISEASE
Authors: Kato Mototsugu , Yamamoto Junji , Shimizu Yuichi , Takeda Hiroshi , Asaka Masahiro
Published: July 2006

Magnifying endoscopies have been remarkably developed to visualize the microstructure of gastrointestinal surface mucosa and mucosal vascularity. Close examination is necessary not only for colorectal tumors but also for upper gastrointestinal disease. Magnifying endoscopic observations for a change of capillary vessels in the esophageal epithelium was helpful to diagnose the invasive depth of squamous cell carcinoma. Magnifying endoscopic observations using narrow‐band imaging of capillary vessels in esophageal epithelium is useful for the diagnosis of non‐erosive reflux disease, which cannot be visualized by conventional endoscopy.
HEMOSTASIS WITH HOOK KNIFE DURING ENDOSCOPIC SUBMUCOSAL DISSECTION
Authors: Oyama Tsuneo , Tomori Akihisa , Hotta Kinichi , Miyata Yoshinori
Published: July 2006

Major complications reported with endoscopic submucosal dissection are bleeding and perforation. The most important step in preventing such complications is to maintain visualization of the submucosal layer. The hook knife is not only a useful cutting device for submucosal dissection, but the device also provides effective means for hemostasis and prevention of bleeding during endoscopic submucosal dissection. Vessels with a diameter of 1 mm or less do not bleed if cut with a hook knife using spray mode coagulation.
MAGNIFYING OBSERVATION OF MICROVASCULAR ARCHITECTURE OF COLORECTAL LESIONS USING A NARROW‐BAND IMAGING SYSTEM
Authors: Sano Yasushi , Horimatsu Takahiro , Fu Kuang I. , Katagiri Atsushi , Muto Manabu , Ishikawa Hideki
Published: July 2006

We reviewed the magnifying observation of the microvascular architecture of colorectal lesions and discuss the utility of the detailed observation of the microvascular architecture for differential diagnosis during narrow‐band imaging (NBI) colonoscopy. Angiogenesis is critical to the transition of premalignant lesions in a hyperproliferative state to the malignant phenotype. Therefore, diagnosis based on angiogenic or vascular morphologic changes might be ideal for early detection or diagnosis of neoplasms. In this review, we propose the term ‘meshed capillary’ for the distinction between non‐neoplastic and neoplastic lesions and the capillary classification ‘capillary pattern’ for the differential diagnosis of colorectal lesions. We believe that the combined use of NBI optical chromoendoscopy and real chromoendoscopy decreases the time and cost of screening colonoscopy. To assess the feasibility and efficacy of using the NBI system, further studies are required for colorectal lesions and other lesions of the gastrointestinal tract.
PIT PATTERN DIAGNOSIS FOR COLORECTAL NEOPLASIA USING NARROW BAND IMAGING MAGNIFICATION
Authors: Tanaka Shinji , Oka Shiro , Hirata Mayuko , Yoshida Shigeto , Kaneko Iwao , Chayama Kazuaki
Published: July 2006

Narrow band imaging (NBI) is a newly developed technology that uses optical filters for RGB sequential illumination and narrows the bandwidth of spectral transmittance. NBI enables the observation of the fine capillaries in the superficial mucosa of the gastrointestinal tract. In this report, the authors assessed the clinical usefulness of NBI magnification in pit pattern diagnosis for colorectal neoplasia. A total of 90 colorectal lesions including nine cases of hyperplasia, 60 of tubular adenoma and 21 of early carcinoma were analyzed. Histologic diagnosis was undertaken according to World Health Organization classifications. Magnified observation of the lesions was performed using NBI without chromoendoscopy, and pit pattern diagnosis was then recorded. After endoscopic or surgical resection of the lesion, the authors performed stereoscopic examination to confirm the pit pattern. From these data, the authors estimated the ability to diagnose pit patterns using NBI magnification without chromoendoscopy. The correspondence rate of pit pattern diagnosis between NBI magnification without chromoendoscopy and stereoscopic findings was 100% (9/9) for type II, 100% (56/56) for type IIIl, 100% (3/3) for type IV, 80% (12/15) for type Vi, and 57% (4/7) for type Vn. NBI magnification without chromoendoscopy demonstrated good results for pit pattern diagnosis of colorectal neoplasia, especially for lesions with regular pit pattern.
MANAGEMENT STRATEGIES FOR BRANCH DUCT INTRADUCTAL PAPILLARY‐MUCINOUS NEOPLASMS
Authors: Hanada Keiji , Amano Hajime , Hino Fumiaki , Fukuda Toshikatsu , Kuroda Yoshinori
Published: July 2006

Management strategies for branch duct intraductal papillary‐mucinous neoplasms (IPMN) have been discussed. The authors’ clinical criteria with special attention to the size of cystic lesion, the diameter of main pancreatic duct, and the size of mural nodule established in 2001 is useful for managing branch duct IPMN. A total of 55 of 60 cases with branch duct IPMN had no radiologic progression during an average follow up of 701 days. In addition, no case out of 27 cases with branch duct IPMN followed up for 3 years changed to positive in cytological examination using pancreatic juice. There were four cases of branch type IPMN with some changes in their image findings. There were two cases of branch type IPMN with pancreatic symptoms. A total of three out of these five cases were surgically resected. The ordinary‐type ductal carcinoma was detected in two cases with branch duct IPMN at 3 or 4 years later. These results suggest that a long‐term careful follow‐up study by computed tomography or ultrasonography at every 6 months would be needed in the management of branch duct IPMN. Further studies will be needed to dissolve this problem in the future.
NOVEL AUTOFLUORESCENCE VIDEOENDOSCOPY IMAGING SYSTEM FOR DIAGNOSIS OF CANCERS IN THE DIGESTIVE TRACT
Authors: Uedo Noriya , Iishi Hiroyasu , Ishihara Ryu , Higashino Koji , Takeuchi Yoji
Published: July 2006

An autofluorescence (AF) endoscopy system produces real‐time pseudocolor images from computation of detecting natural tissue fluorescence from endogenous fluorophores that is emitted by excitation light. The system could specify lesions including malignancies by difference in tissue fluorescence properties and reveal early stage neoplasia not detectable by conventional white light (WL) endoscopy. Image quality of the prior autofluorescence imaging systems including fiber‐optic endoscope was not feasible for general clinical use. The authors investigated the clinical utility of the novel videoendoscopy system using a combination of autofluorescence and reflection imaging (AFI) in diagnosis of cancers in the digestive tract. AFI represented early stage cancers in the digestive tract as purple or magenta areas in a green background. The undifferentiated type early gastric cancers in the fundic mucosa showed a unique pattern; green areas in a purple background. Ulcerations or inflammation caused over‐diagnosis in the AF observation. AFI could reveal flat or isochromatic extensions that were not evident in the WL images. Because the current system of AFI has limitations on resolution and accuracy comparing with chromoendoscopy, it has much to be improved for a good adjunct to standard WL videoendoscopy for diagnosing of early stage digestive tract cancers.
CURRENT STATUS AND FUTURE EXPECTATIONS FOR ENDOSCOPIC BILIARY DRAINAGE IN 16 HOSPITALS
Authors: Igarashi Yoshinori , Isayama Hiroyuki , Katanuma Akio , Ryouzawa Shomei , Tanaka Kiyohito
Published: July 2006

The authors examined the performance of endoscopic biliary drainage (EBD) in 16 hospitals. The examination was in the form of a questionnaire given between 1 June and 20 July 2005 to clarify the status of 369 patients who had undergone EBD. A total of 124 patients underwent endoscopic nasobiliary drainage (ENBD), 224 patients underwent endoscopic biliary drainage (EBS), and one patient underwent simultaneous ENBD and EBS. With regard to the underlying diseases, 227 patients had malignant disease and 142 had benign disease. A total of 244 patients underwent EBS. Plastic stent (PS) was used in 200 cases, and metal stent (MS) in 44 cases. One stent was used in 89% of cases, two stents in 10%, three or more stents in 1%. Metal stent was used in 44 patients (23 were covered and 21 uncovered) with unresectable biliary stenosis. One stent was used in 33 patients, two stents in 10 patients, and three stents in one patient. For treating middle and inferior common bile duct stenosis, PS having a caliber of 10 Fr is too soft; newer tubes should be developed utilizing materials that provide longer stent patency. Longer patency can be achieved now by applying EBS using a covered MS. Improving the materials will also improve stent flexibility and the smoothness of the coating film. When treating superior common bile duct and porta hepatic bile duct stenosis, the stent is placed in both lobes of the liver.
ENDOSCOPIC NASOBILIARY GALLBLADDER DRAINAGE AFTER ENDOSCOPIC SPHINCTEROTOMY IN PATIENTS WITH ACUTE CHOLECYSTITIS AND CHOLEDOCHOLITHIASIS
Authors: Itoi Takao , Sofuni Atsushi , Itokawa Fumihide , Kurihara Toshio , Tsuchiya Takayoshi , Moriyasu Fuminori
Published: July 2006

A 77‐year‐old man was admitted for the treatment of obstructive jaundice and right hypochondralgia with high fever. An abdominal computed tomography revealed common bile duct stones and acute cholecystitis with gallstones. Magnetic resonance cholangiopancreatography revealed stones in the common bile duct. Endoscopic retrograde cholangiopancreatography also revealed stones in the common bile duct, and immediately endoscopic sphincterotomy was performed. After lithotripsy of the bile duct, continuous endoscopic nasogallbladder drainage was performed successfully. There was severe pus in the gallbladder. Next day, the patient was doing well; there was no pain and fever was down.
COLUMNAR‐LINED ESOPHAGUS, BARRETT’S ESOPHAGUS AND ADENOCARCINOMA: DIFFERENCES BETWEEN EAST AND WEST
Authors: Takubo Kaiyo , Arai Tomio , Sawabe Motoji , Iwakiri Katsuhiko , Vieth Michael
Published: July 2006

Some topics related mainly to histopathologic aspects of gastroesophageal reflux disease and columnar‐lined esophagus (CLE) are reviewed and discussed briefly in order to understand CLE and Barrett’s adenocarcinoma (BA). The esophagogastric junction (EGJ) is considered in Japan to be the lower limit at which longitudinal vessels can be seen within the lower segment of the esophagus by endoscopy. This definition has been endorsed by the Japan Esophageal Society. In Western countries, the proximal end of the gastric folds is considered to represent the EGJ. Histologic diagnosis of biopsy specimens from CLE is also discussed in relation to the presence of esophageal glands proper. The differences in the histopathologic criteria for BA between Western countries and Japan are also described.
On the morphology of Acanthostomum spiniceps (Looss, 1896) and A. absconditum (Looss, 1901) (Digenea: Cryptogonimidae: Acanthostominae) with particular reference to the juvenile stage
Authors: Ibraheem Mohammed Hasan
Published: July 2006

The morphology of juvenile and adult stages of Acanthostomum spiniceps and A. absconditum, from bagrid fish of the river Nile in Egypt, was studied with both light and scanning electron microscopy. In early juveniles, circumoral spines are absent and the entire body surface is covered with tegumental spines. Late juveniles show gradual differentiation of the circumoral tegument into a collar of spines associated with a reduction in density of tegumental spines at the posterior extremity of the body. Genital primordia appear when juveniles are about 1.75 mm long. The distributions of tegumental spines on adult A. spiniceps and A. absconditum are similar. Spines are denser on the dorsal and ventral surfaces of the anterior and middle parts of the body and less dense towards the posterior end. The tegumental fold surrounding the ventral sucker of A. absconditum has spines while the fold of A. spiniceps lacks them. The most important morphological features differentiating both species are the number of circumoral spines, body shape, ratio of body length to width, sucker sizes, and the presence or absence of spines on the ventral sucker.
Histological variation along and ultrastructural organization of the epithelium of the ductus epididymidis of the fan‐throated lizard Sitana ponticeriana Cuvier
Authors: Akbarsha Mohammad A. , Kadalmani Balamuthu , Tamilarasan Veeramuthu
Published: July 2006

The epididymis of the fan‐throated lizard Sitana ponticeriana was subjected to light and transmission electron microscopic analysis to find the histological variation along the ductus epididymidis, describe the various cell types in the epithelium and compare the resulting descriptions with what is known for other reptiles and for amniotes. The ductus epididymidis of this lizard is differentiated along its length into four histologically distinct zones, initial segment, caput, corpus and cauda. The first three zones appear to be associated with secretion and absorption/endocytosis whereas the cauda appears to be concerned with absorption/endocytosis and storage. The epithelium consists of six different cell types, principal, narrow, apical, clear, basal and intraepithelial leucocytes as in the mammals. Principal cells, basal cells and intraepithelial leucocytes are present along the entire length. Narrow cells and apical cells are confined to the initial segment whereas clear cells occur in the cauda only. The principal cells from the initial segment to the corpus produce biphasic secretion granules measuring 1–2 µm in diameter. This paper reports on four histologically distinct zones along the length of the ductus epididymidis of the lizard S. ponticeriana and six different cell types in the lining epithelium.
Semicystic spermatogenesis and biflagellate spermatozoon ultrastructure in the Nile electric catfish Malapterurus electricus (Teleostei: Siluriformes: Malapteruridae)
Authors: Shahin Adel A. Basyouny
Published: July 2006

Spermatogenesis and spermatozoon ultrastructure in the Nile electric catfish Malapterurus electricus are described using scanning and transmission electron microscopy. Although the testis organization conforms to the ‘unrestricted’ spermatogonial type, the species has a rare type of spermatogenesis not previously described among catfishes, ‘semicystic’, in which the cyst ruptures before the spermatozoon stage. Spermiogenesis also involves some peculiar features such as condensation of the chromatin in the posterior part of the nucleus to form a compact electron‐dense mass with some irregular electron‐lucent lacunae, while the uppermost part of the nucleus is a loose electron‐lucent area, absence of the nuclear rotation and, as a consequence, the centriolar complex and the initial segment of each flagellum arise directly in a position perpendicular to the basal pole of the nucleus, and occurrence of numerous vesicles in the midpiece. In addition, spermiogenesis includes migration of the diplosome and mitochondria to the basal pole of the nucleus, formation of two moderate nuclear fossae, each of which contains the centriolar complex, development of two independent flagella and elimination of the excess cytoplasm. The mature spermatozoon has a more or less round head with no acrosome or acrosomal vesicle, a long midpiece with numerous mitochondria and vesicles and two long tails or flagella having the classical axoneme structure of 9 + 2 microtubular doublet pattern and with no lateral fins and membranous compartment. These findings suggest that the ultrastructural features of spermiogenesis and spermatozoa of M. electricus are synapomorphies of types I and II spermiogenesis and spermiogenesis is closely similar to the type described in the Nile catfish Chrysichthys auratus.
Comparative morphology of mandibular structures in lycid larvae and its phylogenetic implications (Polyphaga, Hexapoda)
Authors: Kazantsev Sergey V.
Published: July 2006

The morphology of the larval mandibular structures of the family Lycidae (Polyphaga) is characterized by facultative dicondyly, posterior articulation with long mandibular rods, lateral location of the anterior condyle and its articulation with a paired non‐cranial structure. It is compared to that of Eucrustacea, Chilopoda, Entognatha, Microcoryphia and Zygentoma and found to be more reminiscent of the Entognatha. The phylogenetic implications of this conclusion are discussed, with the Pterygota and Dicondylia hypothesized to be non‐monophyletic.
Penicillamine administration reverses the inhibitory effect of hyperhomocysteinaemia on endothelium‐dependent relaxation in the corpus cavernosum in the rabbit
Authors: KOUPPARIS ANTHONY J. , JEREMY JAMIE , ANGELINI GIANNI , PERSAD RAJ , SHUKLA NILIMA
Published: July 2006

OBJECTIVE

To elucidate the role of copper in mediating the impact of homocysteine on vasculogenic erectile dysfunction (VED), by investigating the effect of dietary supplementation with the copper‐chelator penicillamine to rabbits rendered hyperhomocysteinaemic (HHC) with a methionine‐rich diet, as a raised plasma level of homocysteine might be a risk factor for VED.

MATERIALS AND METHODS

Homocysteine inhibits the nitric oxide (NO)‐dependent relaxation of the corpus cavernosum (CC), an effect which appears to be mediated via the generation of superoxide (O2·‐), and H2O2. Copper is a catalyst for the generation of H2O2 in the presence of homocysteine and in the presence of copper, H2O2 undergoes reactions resulting in the generation of O2·‐, which reacts with NO to produce peroxynitrite (ONOO‐), thereby reducing the bioavailability of NO and impairing NO‐mediated relaxation of CC. Smooth muscle strips from CC were obtained from two groups of adult New Zealand White rabbits, one rendered HHC with a diet supplemented with methionine (group 1) and another HHC group that had additional dietary supplementation with penicillamine (group 2). Tissue O2·‐ levels were measured in each group. After pre‐contraction with phenylephrine, relaxation responses of CC strips to carbachol were also assessed in both groups.

RESULTS

Methionine supplementation led to profound HHC in all rabbits. Penicillamine in group 2 reduced the total plasma Cu2+ compared to group 1. There was a markedly lower carbachol‐stimulated relaxation of CC from HHC rabbits in group 1, with a mean (sem) maximum relaxation of 37 (4)% (six samples), than in group 2, at 58 (6)%.

CONCLUSION

These data show that elevated levels in vivo of homocysteine in the rabbit markedly impair NO‐dependent relaxation of the CC. Furthermore, this effect appears to be augmented by copper. Further clinical studies on homocysteine and copper status in patients with VED are warranted.
Perineal lipoma in association with scrotal anomalies in children
Authors: PARK KWAN H. , HONG JEONG H.
Published: July 2006

Authors from Korea present five children with perineal lipoma in association with a variety of scrotal anomalies. They speculate that the development of perineal lipomas is closely related to scrotal anomalies, and speculate as to the reason why.

OBJECTIVE

To analyse the characteristics of the perineal lipoma and speculate on its development, as an associated perineal lipoma is implicated in the occurrence of scrotal anomalies in children.

PATIENTS AND METHODS

Five children with a perineal lipoma in association with various scrotal anomalies were included in the study. We analysed the types of scrotal anomalies and their anatomical relationship with the perineal lipomas.

RESULTS

One child had a supra‐inguinal ectopic scrotum, and the others had penoscrotal transposition, either symmetrical or asymmetrical; they included two who had an accessory scrotum combined with a perineal lipoma. The perineal lipoma was on the ipsilateral side of the upward‐positioned hemiscrotum in the ectopic scrotum or the asymmetrical penoscrotal transposition, or it was on the mid‐perineum in the symmetrical penoscrotal transposition.

CONCLUSIONS

The perineal lipoma can be found combined with various scrotal anomalies, including ectopic scrotum as well as an accessory scrotum or penoscrotal transposition; this is the first report describing a perineal lipoma associated with an ectopic scrotum. We speculate that the development of the perineal lipoma is closely related to scrotal anomalies, which result from early division and/or abnormal migration of the labioscrotal swelling. The concomitant perineal lipoma might be formed during the process, and might affect abnormal scrotal development.
The proximal neurovascular plate and the tri‐zonal neural architecture around the prostate gland: importance in the athermal robotic technique of nerve‐sparing prostatectomy
Authors: TEWARI ASHUTOSH , TAKENAKA ATSUSHI , MTUI ESTOMIH , HORNINGER WOLFGANG , PESCHEL REINHARD , BARTSCH GEORG , VAUGHAN E. DARRACOTT
Published: July 2006

OBJECTIVE

To review the neural architecture around the prostate gland, as it is relevant for nerve‐sparing robotic prostatectomy, including in particular the anatomy of the proximal neurovascular tissue, the neurovascular bundle (NVB), and accessory neural pathways (ANPs).

MATERIAL AND METHODS

The aims of this study were achieved in collaboration between the Cornell Institute of Robotic Surgery, New York, NY, USA and the Institute of Urology at the University of Innsbruck, Austria. The broad steps were: (i) anatomical studies of 10 fresh and two fixed male cadavers; and (ii) collection of videotape and still image data from 200 men undergoing radical prostatectomy by the athermal robotic technique at the Cornell Institute.

RESULTS

From a surgical standpoint there was a tri‐zonal neural architecture including the proximal neurovascular plate (PNP), the predominant NVB (PNB) and ANPs. The PNP was a mean (range) of 5 (3–10) mm lateral to the seminal vesicles, was 3 (2–7) mm thick, 7 (5–25) mm wide and 9 (4–30) mm long. It was within 6 (4–15) mm of the bladder neck, 5 (2–7) mm of the endopelvic fascia and overlapped 5 (0–7) mm of the proximal prostate. The PNB varied in shape and size from the proximal to distal end, was thickest at the base and most variable near the apex. In eight of 12 cases, there was a medial extension behind the prostate, which converged medially at the apex in four cases. ANPs were noted within the layers of levator fascia and/or lateral pelvic fascia on the anterolateral aspect in five cases and in three on the posterior aspect of the prostate. In nine cadavers, the proximal third of the prostate was covered by the PNP where these ANPs were most prominent. The ANPs formed a plexus on the posterolateral aspect of the apex in four cases.

CONCLUSION

We have created an anatomical map of neurovascular tissue relevant to robotic prostatectomy. A tri‐zonal neural architecture is described which has helped in standardizing the steps of robotic prostatectomy.
Management of renal cell carcinoma with vena cava and atrial thrombus: minimal access vs median sternotomy with circulatory arrest
Authors: WOTKOWICZ CHAD , LIBERTINO JOHN A. , SORCINI ANDREA , MOURTZINOS ARTHUR
Published: July 2006

The topics covered in this section include renal, prostate, bladder and testicular cancer. As can be seen, these contributions come from all over the world and are of interest for several reasons. For example, the first paper, from the USA, describes the management of RCC with vena caval and atrial extension, using minimal access as against median sternotomy with circulatory arrest. Other more unusual subjects include RCC of native kidneys in renal‐transplant recipients and radical prostatectomy in patients with HIV.

OBJECTIVE

To review our experience with approaches for managing renal cell carcinoma (RCC) with venous thrombi extension at and above the level of the hepatic veins, comparing surgery and peri‐operative outcomes in patients with cardiopulmonary bypass (CPB) with deep hypothermic cardiac arrest (DHCA) either by minimal access (MA) or traditional median sternotomy (TMS).

PATIENTS AND METHODS

From 1986 to 2005, 50 radical nephrectomies with inferior vena cava (IVC) thrombectomies were performed at our institution using TMS (22 patients) and MA (28) techniques. Patient demographics were compared using Student’s t‐, Fisher’s exact and Pearson chi‐square tests. The duration of surgery, CPB, DHCA, mechanical ventilation, length of stay, and peri‐operative transfusion requirements, were compared using the Mann–Whitney U‐test. Estimates of survival were constructed using Kaplan–Meier curves and analysed with the log‐rank test. Subgroups were analysed excluding TMS patients undergoing concurrent coronary revascularization.

RESULTS

There were no significant differences in patient demographics or comorbidities between the MA and TMS group. There were significant decreases in the MA vs the TMS group (P < 0.05) in the duration of surgery, mechanical ventilation, length of stay and peri‐operative transfusion requirements. When patients with coronary revascularization were excluded, the MA group had significant decreases (P < 0.05) in duration of surgery, hospital stay and transfusion requirements. Peri‐operative mortality was not statistically different between the TMS (14%) and MA (4%) patients. Overall and organ system‐specific complications also were not statistically different. The overall median survival in the TMS and MA groups was 0.62 and 2.84 years, respectively (P = 0.06, hazard ratio 2.02; 95% confidence interval, CI, 0.97–4.72). Patients with tumour thrombus extending into the right atrium had a median survival of 1.02 years, vs 2.84 years with no intracardiac extension (P = 0.15, hazard ratio 1.82, 95% CI 0.81–4.0).

CONCLUSIONS

MA surgical techniques in conjunction with DHCA for the treatment of RCC with extensive tumour thrombus provides quicker surgery and a shorter hospital stay. In addition there was less requirement for mechanical ventilation and transfusion than with TMS. Our findings suggest that MA techniques provide significant advantages over TMS.
Efficacy of type‐5 phosphodiesterase inhibitors in the drug treatment of premature ejaculation: a systematic review
Authors: McMAHON CHRIS G. , McMAHON CHELSEA N. , LEOW LIANG JOO , WINESTOCK CHRISTOPHER G
Published: July 2006

The aim of this section is to produce shortened reviews for the reader, in a variety of subjects. Three of the four fulfil these criteria, covering the subject of imaging in paediatric urology, minimally invasive nephron‐sparing surgery, and the ever‐interesting and controversial subject of men’s health.

The first review published in this issue is rather longer than usual and contains more references. It is my intention that occasionally we should publish such longer reviews, particularly as in this case when it is a systematic review of the literature, which would be somewhat difficult to shorten anyway. The question of premature ejaculation is of great general interest and this review investigates the efficacy of type‐5 phosphodiesterase inhibitors in the drug treatment of that condition.

This review examines the role of nitric oxide (NO) as a neurotransmitter involved in the central and peripheral control of ejaculation, the methods of phosphodiesterase type 5 inhibitor (PDE5I) drug treatment studies for premature ejaculation (PE), the adherence of methods to the contemporary consensus of ideal PE drug trial design, the impact of methods on treatment outcomes and the role of PDE5Is in the treatment of PE. NO/cGMP transduction is involved in both the central and peripheral control of emission, but evidence for a direct central or peripheral effect of PDE5Is on ejaculation is speculative. Thirteen of the 14 studies reviewed failed to fulfil the evidence‐based medicine criteria for ideal PE drug trial design. Limitations of the studies include inadequately defined study populations, the lack of a double‐blind placebo‐controlled study design, and the absence of consistent objective physiological measures or sensitive, validated outcome assessment instruments as study endpoints. The broad range of intravaginal ejaculatory latency time (IELT) fold‐increases reported with PDE5Is, on‐demand selective serotonin re‐uptake inhibitor (SSRI) drugs, and combined PDE5I/on‐demand SSRIs is testament to the unreliability of data and conclusions from methodologically flawed studies. The one study that fulfilled the evidence‐based medicine criteria of an ideal clinical trial design reported that treatment with sildenafil failed to significantly increase baseline IELT, supporting our conclusion that there is no convincing evidence to support any role for PDE5Is in the treatment of men with lifelong PE and normal erectile function. However, there is limited evidence to support a potential role for PDE5Is alone or combined with daily or on‐demand SSRIs in the treatment of acquired PE in men with comorbid erectile dysfunction. Further controlled studies adhering to the contemporary consensus of ideal clinical trial design are required to clarify the role of PDE5Is in this subgroup of men with acquired PE.