bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraurethral Catheter: Alternative Management for Urinary Retention in Patients With Benign Prostatic Hypertrophy
Authors: Punekar Sulabha , Ramkrishnan Prem A. , Kelkar Anand R. , Date Jaydeep A. , Ridhorkar Vasudeo R.
Published: August 2007

A polyurethane intraurethral catheter (IUC) was used in 27 patients with benign prostatic hypertrophy who were unfit for surgery, or were awaiting surgery. All of them had previously had a periurethral catheter inserted. The IUC was inserted with a cystoscope under fluoroscopic control. Spontaneous voiding through the IUC resumed in 25 patients (93%) in the immediate postprocedure period. At the end of 6 months follow‐up, the peak flow rates and the residual volumes estimated in 22 patients were satisfactory. Immediate complications included incontinence due to distal displacement in 2 patients and hematuria in one patient; long‐term complications included mild encrustation of the IUC in 2 patients and calculus formation on the IUC in 1 patient. None of the patients had clinically significant urinary tract infection. The presence of the IUC did not compromise the subsequent transurethral resection of the prostate gland. We recommend the use of an IUC for up to 6 months in patients with urinary retention who are awaiting surgery or are unfit for surgery as an alternative to an indwelling urethral catheter.
Atypia and Surface Structure of Superficial Neoplasms of the Colon Less Than 10 mm in Diameter
Authors: Yasuda Masatoshi
Published: August 2007

Histological specimens of 30 distinct adenomas and 30 distinct carcinomas were studied by image analysis to quantify nuclear size and shape. These data were used to derive a discriminant equation, which permitted the lesions to be classified into two groups based on nuclear atypia. Next, 50 superficial type tumors of the colon (34 IIa lesions, 9 IIc + IIa lesions, and 7 IIc lesions) <10 mm in longest diameter were similarly analyzed. These lesions were classified into a high atypia index group (HAI group, 14 lesions) and a low atypia index group (LAI group, 36 lesions) by the above discriminatory equation. Differences between these two groups in surface structure, marginal zone properties, and macroscopic type, assessed using a dissecting microscope, were studied. A hyperplastic shape of the tubular orifice was seen at the marginal zone in 10 lesions (27.7%) in the LAI group and 11 lesions (78.5%) in the HAI group. This difference was significant. Surface structure and macroscopic type were not correlated with the degree of atypia. The tubular density in lesions showing a hyperplastic pitted pattern at their border was 77.40, significantly higher than that for lesions without such a pattern (73.12). The contribution of various variables to surface structure, marginal zone properties, and macroscopic type was studied by discriminant analysis. A high correlation was found between marginal zone properties and tubular density. Since lesions with high nuclear atypia tend to have high tubular density, marginal zone properties were secondarily correlated with the level of nuclear atypia. Observation of the marginal zone properties of lesions was thus suggested to be helpful in the diagnosis of lesions with severe atypia.
Endoscopic Appearance of the Gastroesophageal Valve and Competence of the Cardia
Authors: Ismail T. , Bancewicz J. , Barlow J.
Published: August 2007

The endoscopic appearance of the gastroesophageal valve, viewed by the retroflexed gastroscope, has been studied in 51 patients with and without reflux esophagitis. Esophagitis was graded according to its severity, and the yield pressure (YP) was measured in all patients to assess the competence of the cardia. There was a close relationship between the YP and the grades of the gastroesophageal valve. YP was significantly lower in patients with endoscopic oesophagitis than in patients with no evidence of reflux esophagitis (p <0.0001). An increased abnormality of the gastroesophageal valve was associated with all grades of esophagitis and with a low YP. The valve mechanism at the cardia has an important role in determining its competence. YP is possibly a measure of the flap valve component of the gastroesophageal junction.
Endourological Evaluation and Management of Leukoplakia of the Renal Pelvis
Authors: Kakizaki Hidehiro , Nonomura Katsuya , Koyanagi Tomohiko , Nantani Masami , Taniguchi Kotaro , Matsuno Tadashi
Published: August 2007

Since August 1989, we have seen 4 patients with leukoplakia of the renal pelvis associated with a longstanding renal stone. In 2 of them, excretory or retrograde pyelography revealed multiple filling defects in the left renal pelvis as well as a renal stone, although urine cytological examination was negative. One of the other 2 patients underwent extracorporeal shock wave lithotripsy (ESWL) for the renal stone, but this was not followed by the passage of stone fragments. The renal stone in the remaining patient was associated with staghorn calculi. For stone extraction as well as endoscopic evaluation of the intrapelvic lesion, percutaneous nephroscopy was performed. A small to large amount of tissue‐like white debris in sheets characteristic of leukoplakia was found in the renal pelvis with stones embedded in it and was removed directly by forceps or suction and then by irrigating with saline. We propose that 1) the endourological approach should be recommended for patients with renal pelvic lesions associated with longstanding renal stones or for patients who show difficulty in passing stone fragments after ESWL and 2) this entity of leukoplakia should be kept in mind for the differential diagnosis of renal pelvic lesions associated with renal stones.
Clinical Analysis of 1,834 Colorectal Cancers
Authors: Miyaoka Masaaki , Watanabe Koichi , Shimizu Naoki , Takeshita Toshitaka , Saito Toshihiko
Published: August 2007

A total of 1,834 cases of colorectal cancers were divided into two diagnostic groups and studied. The ratio of smaller, less advanced carcinomas to the total number of colorectal cancers diagnosed by electronic videoendoscopy has increased as compared to the ratio in cases diagnosed by fiberscopy. This seems to be largely influenced by concomittent developments such as the implementation of colorectal cancer screening assisted by the popularization of immunological fecal occult blood tests and the increase in number of examinees. On the other hand, the use of the electronic videoendoscopy has been accompanied by increases in the diagnosis of minute carcinomas measuring 5 mm or less and flat carcinomas which were previously difficult to diagnose. Under these circumstances, endoscopic mucosal resection has gained popularity, widening the spectrum of therapeutic options. Nonetheless, endoscopic treatment also has been associated with increases in cases requiring laparotomy when carcinoma was found in the resected margin or those demonstrating invasion in the submucosa. This may be one result of the more aggressive application of endoscopic treatment, but the histologically recognized inability to detect carcinoma in the resected intestinal tract leaves room for improvement.
Clinical Study in 11 Cases of Endobronchial Foreign Body
Authors: Atagi Shinji , Furuse Kiyoyuki , Kawahara Masaaki , Kodama Nagahisa , Ogawara Mitsumasa , Okada Tatsuya , Kawaguchi Yuji , Kamimori Takao , Nakao Mitsunobu , Naka Nobuyuki
Published: August 2007

We report 11 cases of endobronchial foreign body. From January 1982 through December 1994, a total of 11 cases were diagnosed roentogenographically and bronchoscopically at our hospital. These patients consisted of 10 men and 1 woman with a mean age of 58.5 years (range 33 to 77 years). Symptoms on presenting were usually cough, sputum, or chest pain. The foreign bodies were inorganic in 10 cases and of organic origin in 1 case. Three patients were not aware that they had aspirated a foreign body. In 9 patients, the endobronchial foreign bodies were successfully removed endoscopically. One patient spontaneously expectorated the foreign body before bronchoscopy. One patient underwent thoracotomy because the foreign body could not be removed bronchoscopically. There were no severe complications during or after the endoscopic removal of the foreign bodies, but in one patient extraction of the foreign body caused pneumonia after bronchoscopy. In conclusion, flexible bronchoscopy is useful for the diagnosis and treatment of endobronchial foreign bodies.
Photodynamic Therapy of Lung Cancer With Bronchial Artery Infusion of Photofrin
Authors: Okunaka Tetsuya , Kato Harubumi , Konaka Chimori , Furukawa Kinya , Harada Masahiko , Yamamoto Yutaka
Published: August 2007

Photodynamic therapy (PDT) utilizing Photofrin is proving to be effective for the treatment of early stage lung cancer. However, wider clinical applications of Photofrin as a photosensitizer for various cancers are hampered by potentially serious and prolonged skin photosensitivity. To prevent these side effects and reduce the hospitalization period, we recently gave reduced doses of Photofrin by bronchial arterial infusion. Five patients with endoscopically evaluated minimally invasive carcinoma of the lung were given 0.7 mg/kg of Photofrin by bronchial arterial infusion 48 hr before PDT. Complete remission was obtained in all 5 cases and no case showed skin photosensitivity when exposed to sunlight under careful surveillance at one week after PDT.
Prevalence of Endometriosis Among Women Undergoing Laparoscopic Procedures
Authors: Chu K. K. , Chen F. P. , Chang S. D.
Published: August 2007

We evaluated 752 patients for endometriosis in consecutive laparoscopic procedures over a one year period. Six hundred eighty patients underwent laparoscopy for indications unrelated to symptoms of endometriosis and 72 patients were diagnosed clinically to have endometriosis before the procedures. In the 72 patients with clinical indications of endometriosis, 59 patients had disease confirmed at surgery (82%). Out of 680 asymptomatic patients, 186 patients (24.7%) were documented to have the disease of various characteristics or appearances in which the typical lesions accounted for 42%. The overall prevalence among these women undergoing laparoscopy was 32.5%. However, a prevalence of 12% was shown in a subset of asymptomatic patients indicated for sterilization. This may reflect the appropriate prevalence in reproductive age population.
Laparoscopic Partial Hepatectomy: Animal Experiments
Authors: Inoue Haruhiro , Goseki Narihide , Izumi Yousuke , Takeshita Kimiya , Nakamura Hiroshi , Endo Mitsuo
Published: August 2007

As a first step in firmly establishing laparoscopic hepatectomy, we introduce a porcine model of laparoscopic partial hepatectomy. This procedure has been successfully performed under the normal‐pressure or low‐pressure pneumoperitoneum condition supported by the full‐thickness abdominal wall lifting technique. An ultrasonic dissector combined with electrocautery, newly developed by Olympus Optical Corporation (Japan) was effectively utilized in facilitating safe and smooth incisions into the liver parenchyma. Although indications for this procedure seem to be limited only to peripheral lesions and not to central lesions, clinical application of this method may be useful for some patients in the near future.
Laparoscopic Sacral Colpopexy: A Proposed Technique
Authors: Goldberg Cynthia C. , Childers Joel M. , Surwit Earl A.
Published: August 2007

This case report describes a laparoscopic sacral colpopexy using Mersilene mesh in a patient with complete vaginal vault prolapse. Mersilene mesh was placed as a hammock between the vaginal apex and the anterior surface of the sacrum, using intracorporeal needles and an extracorporeal knot tying technique. Minor modifications are made from the traditional abdominal approach, because the patient had previously undergone a pelvic lymphadenectomy and vaginal cuff radiation for a stage IB grade 1 adenocarcinoma of the endometrium.
Effectiveness of a Ligating Device for Endoscopic Surgery
Authors: Hachisu T. , Yamada H. , Hamaguchi K.
Published: August 2007

A new detachable snare for hemostasis in the removal of large polyps or other elevated lesion was developed by the author (Olympus Ligating Device). It allows ligation to be performed through the channel of an endoscope using a nonconductive loop that can be detached from the ligator. At Sakura National Hospital, endoscopic ligation with this device was performed in 80 patients from May 1989 to January 1994. The purpose of the procedure was preventive hemostasis prior to the endoscopic resection of large elevated lesions in 71 patients and for control of hemorrhage in 9 patients. The elevated lesions were polyps in 69 patients and submucosal tumor in 2, being pedunculated in 36 and semipedunculated in 35. The maximum diameter of these lesions ranged from 15 to 40 mm (mean: 23 mm), being greater than 20 mm in 57 cases. The 9 patients undergoing endoscopic ligation for hemorrhage had bleeding polypectomy stumps (n = 5), bleeding polyps (n = 3), and a bleeding esophageal varix (n = 1). Endoscopic ligation achieved the complete prevention of hemorrhage following the resection of elevated lesion in 63/71 patients (88.7%) and, in combination with a HX‐3L clip, allowed endoscopic resection to be performed in 70/71 patients (98.6%). In the 9 patients with bleeding lesions, complete hemostasis was achieved without complications.
Video Endoscopy for Laser Photoresection in Tracheobronchial Pathology: Some Considerations After 9 Years Experience With 2105 Treatments
Authors: Diaz-Jimenez Jose Pablo , Ballarin Jose Ignacio Martinez , Muñoz Eva Farrero , Kovitz Kevin L. , Serrano Maria Jesus Castro , Shirakura K.
Published: August 2007

Between 1984 and 1993 we performed 2105 laser treatments in 1210 patients: 52% of treatments were done for malignant pathology, 45% for benign tracheal stenoses and 3% were in a miscellaneous group. The procedure was carried out with a rigid bronchoscope under general anaesthesia. In patients with malignant tumors, it is a good palliative treatment—safe, well tolerated and with immediate results; it can be repeated as many times as needed with and is well accepted by the patient. In patients without tumors, this method avoids emergency tracheotomies. The long term results are now under evaluation.
Video‐Assisted Thoracoscopy is Superior to Standard Computer Tomography of the Thorax for Selection of Patients With Spontaneous Pneumothorax for Bullectomy
Authors: Janssen Julius P. , Golding Richard P. , Cuesta Miguel A. , Sutedja Thomas , Postmus Pieter E.
Published: August 2007

Background: Spontaneous pneumothorax (SP) is a common disease of unknown cause often attributed to rupture of a subpleural bulla or bleb [in this study described as emphysema‐like changes (ELC)]. Treatment of SP varies from conservative (rest) to aggressive (surgery). Patients with bullae >2 cm diameter, found either by chest roentgenogram or during thoracoscopy, are often treated surgically (bullectomy and pleurectomy, or abrasion). Thoracoscopy is frequently used as the method of choice to select patients for surgery. With the recent introduction of video‐assisted thoracoscopy (VAT), it is now possible to combine a diagnostic and therapeutic procedure. However, to do this general anesthesia and a fully equipped operating theater are needed. Proper selection of patients for this costly and time‐consuming procedure is necessary. We evaluated whether standard computed tomography (CT) is appropriate for selection of patients with SP who are candidates for surgical intervention.

Methods: In 43 patients with SP, CT was performed after re‐expanding the lung by suction through a chest tube if the lung was completely collapsed. After <48 hours VAT under general anesthesia was performed. All CT scans were scored by two investigators who were not informed about the VAT findings or the outcome of the patient. CT findings and VAT findings were compared.

Results: In 16 patients (37%), CT scans of the affected lung were considered normal, while in 13 patients (30%) ELCs ≥2 cm were seen and in 14 patients (33%) ELCs <2 cm were found. VAT showed a normal lung in 11 patients (26%), in 24 patients ELCs ≥2 cm were seen, and in 8 patients ELCs <2 cm were present. Of these 32 patients, in 18 bullous degeneration of the apex of the upper lobe was found. Of the 24 patients with ELCs ≥2 cm detected during VAT, 13 were detected by CT. In no patient were ELCs ≥2 cm seen on CT scans that were not detected during VAT. The sensitivity of CT for ELCs ≥2 cm is 54%, and the specificity is 100%. The positive predictive value is 100%; the negative predictive value is 63%.

Conclusions: CT detects ELCs ≥2 cm in 54% of the patients in whom VAT shows these abnormalities. If interventional therapy is deemed appropriate for first time or recurrent SP, VAT should be used since it is superior to CT in demonstrating the presence, number, and size of ELCs.
Endoscopic Treatment of Anastomotic Biliary Stenosis in Patients With Orthotopic Liver Transplantation
Authors: Rossi Alfredo , Grosso Claudio , Zanasi Giulio , Gambitta Pietro , Bini Marta , de Carlis Luciano , Arcidiacono Raffaele
Published: August 2007

The choledocho‐choledochostomy stricture is one of the most frequent complications occurring after liver transplantation. Today endoscopic retrograde cholangiopancreatography may be considered one of the most common methodologic approaches for the diagnosis; at the same time it provides an effective treatment of the stenosis, avoiding more invasive surgery. Biliary flow through a strictured anastomosis definitely improves after endoscopic stenting which, in most cases, resolves the biliary obstruction syndrome; moreover, the stent could allow restoration of the anatomical and functional integrity of the common bile duct. We have successfully treated eight liver transplanted patients with biliary anastomotic stenosis by endoscopic stenting of the common bile duct or by balloon dilation (one patient). The stents were replaced every 3 to 4 months and then removed after 1 year of follow‐up. We observed one patient with acute cholangitis due to the clogging of the prosthetic device.
Laparoscopic Assisted Vaginal Hysterectomy, Setting Up a Service at a Peripheral Teaching Hospital
Authors: Tsaltas Jim , Kovacs Gab , Dennis Jenny , Pratt Amanda
Published: August 2007

The establishment of a laparoscopically assisted hysterectomy program at Box Hill
Hospital is described. The first eight cases have been reviewed and recommendations are
made to other gynaecology units who wish to establish a minimally invasive gynaecological
surgery unit.
lmmuno Histochemical Profile of Endometrium in Patients With Genital Endometriosis
Authors: Mettler L. , Jürgensen A. , Volkov N. I. , Kulakov V. , Parwaresch M. R.
Published: August 2007

The aim of present study was to investigate the occurence of different lymphocyte
subsets in the endometrium of endometriosis patients and in healthy women on every
day of the menstrual cycle with special emphasis to the proliferative activity of
endometrial cells with Ki‐S3 antibody. We also conducted immunohistochemical
studies of T‐lymphocytes, B‐lympho‐cytes, macrophages, natural‐killer‐cells and also
of antigens class II of the histocompatibility complex (HLA‐DR) during the different
phases of the menstrual cycle in endometriosis and non‐endometriosis patients.

Endometrial lymphocyte subsets show equal quantity and distribution in endometriosis
patients and in the control group. After a peak in the early preoliferative phase
the absolute number of T‐lymphocytes decreases while a predominance of
T‐suppressor/cytotoxic T‐lymphocytes (CD8) compared to T‐helper/inducer lymphocytes
(CD4) occurs towards the end of the menstrual cycle.

It can be concluded that endometrium as the potential parent epithelia of endometriotic
lesions seems not to be altered in its lymphatic cell content compared to healthy
women. Furthermore endometrium is clearly characterised as part of the mucosa
associated lymphatic tissue (MALT). T‐lymphocytes show specific quantitative
changes due to different phases of the menstrual cycle.
Thoracoscopy in Pleural Malignant Mesothelioma Diagnosis
Authors: Tassi G. F. , Marchetti G. P. , Fattibene F. , Chiodera P. L.
Published: August 2007

On the basis of our personal experience in 70 cases (66 pleural effusions) observed
during the period January 1984‐ January 1996 we are here illustrating and discussing
the diagnostic role of thoracoscopy in malignant pleural mesothelioma.

A histological diagnosis was achieved in 94.2% of cases. The endoscopic appearance
was clearly neoplastic (masses, nodules) in 53 patients (75.7%) and simply inflammatory
in 17 pachypleuritis in 13 (18.6%) and of diffuse hyperemia in 3 (5.7%). In all
cases fluid cytology (diagnostic yield: 18.5%) and needle biopsy (diagnostic yield
17.1%) were performed.

The extension of pleural involvement (endoscopic staging according to Boutin) was
also determined. In 16 patients (22.8%) a parietal and diaphragmatic involvement
(stage Ia) was found. In 40 patients (57.2%) an associated visceral invasion (stage Ib).
In 14 cases (20%) a diffuse parietal, visceral and mediastinal extension (stage II).
The exam has always been well tolerated with few immediate complications: subcutaneous
emphysema (4 cases) and some negligeable parietal bleeding (2 cases).
Endoscopy in the Diagnosis of Small Intestinal Tumors
Authors: Kawaguchi M. , Saitou Y. , Sakai Y. , Tani Y. , Midorikawa S. , Sanji T. , Handa Y. , Morita S. , Ohno H. , Yosida H. , Turui M. , Misaka R. , Saitou T.
Published: August 2007

The importance of endoscopy in the diagnosis of small intestinal tumors was evaluated
in 15 patients with small intestinal tumors treated in our hospital. Two tumors were
benign, and 13 were malignant (carcinoma in 5 patients, malignant lymphoma in 5 and
leiomyosarcoma in 3). The presence of lesions could be determined by X‐rays before
surgery, but definitive diagnoses were difficult. When preoperative endoscopy of the
small intestine was possible accurate preoperative diagnoses could be made based on the
endoscopic findings and biopsies taken under direct vision. Endoscopy is therefore very
important for the diagnosis of small intestinal tumors. It is necessary to develop small
intestinal endoscopes that are easier to insert.
Endoscopic Nasobiliary Drainage in the Management of Acute Cholangitis: An Experience in 143 Patients
Authors: Goenka M. K. , Bhasin D. K. , Kochhar R. , Nagi B. , Rungta U. , Das K. , Singh K.
Published: August 2007

Acute cholangitis is associated with a high mortality and morbidity and often requires
drainage of the obstructed biliary system. The purpose of this study was to evaluate the
usefulness and safety of endoscopic nasobiliary drainage in the treatment and prevention
of acute cholangitis due to diverse etiology. During a 32‐month period, 143 patients
(67 males, 76 females) with age range of 15 to 84 years underwent urgent fluoroscopy
guided endoscopic nasobiliary drainage using a 7 Fr catheter either to treat acute
cholangitis not responding to antibiotics (group A, n = 116) or to prevent its development
following endoscopic retrograde cholangiography performed in an obstructed biliary
system (group B, n = 27). Underlying etiology included bile duct stones (92), malignant
biliary obstruction (34), choledochal cyst (4), chronic pancreatitis (4), ruptured hydatid
cyst (3), portal hypertensive cholangiopathy (3) and liver abscess (3). Endoscopic
nasobiliary drainage was performed successfully in 129 patients (90.2%). Cholangitis
improved within 1 to 3 days (in group A) or did not develop (in Group B) in 125 patients
(96.7%) with successful endoscopic nasobiliary drainage. Two patients however required
additional drainage by percutaneous transhepatic route, while two died inspite of effective
endoscopic drainage. Of the 14 patients (9.8%) with failed endoscopic drainage, 9 were
managed by surgical decompression or percutaneous transhepatic drainage, 3 died of
septicemia. Endoscopic nasobiliary drainage is a safe and effective method to treat
patients with acute cholangitis as well as to prevent its development following
cholangiography performed in an obstructed biliary system.
Diagnostic Evaluation of Pancreatic Carcinoma and Chronic Pancreatitis by Pancreatoscopy
Authors: Tajiri Hisao
Published: August 2007

We succeeded in viewing the image of pancreatic duct on a TV monitor as a sequential
electronic endoscope image by connecting a converter with a charge‐coupled device to
an ultra‐thin pancreatoscope. Spacial image processing by adaptive enhancement, using
an electronic endoscope, was studied in the pancreatoscope images of 18 cases (10 with
pancreatic cancer and 8 with chronic pancreatitis). As a result, it became clear that the
images obtained in Peak 2 of adaptive enhancement are much better than the original
images. There was an excellent effect of clearly detecting the characteristic mucosal
patterns in pancreatic cancer and chronic pancreatitis. We are convinced that this
method would be very useful in improving the diagnostic ability of pancreatic cancer
using an ultra‐thin pancreatoscope.
Endoscopic Diagnosis and Treatment of a Case of Respiratory Papillomatosis
Authors: Hirano T. , Konaka C. , Okada S. , Shibanuma H. , Shimizu E. , Okunaka T. , Sakai H. , Ebihara Y. , Kato H.
Published: August 2007

Respiratory papilloma is a rare lesion that arises in the larynx, trachea and bronchus.
We describe a patient with laryngeal papilloma that spread to the trachea and which
was effectively treated by Nd‐YAG laser. Two years after the initial treatments of the
laryngeal and tracheal papillomas, a recurrent lesion (solitary papilloma) was observed
on the membranous portion of the trachea. We examined the recurrent lesion by bronchoscopy
including bronchoscopic ultrasound (US), helical computed tomography (CT)
and tracheal biopsies. Respiratory papillomatosis sometimes shows either malignant
transformation or invasion to tracheal wall without displaying cytohistological atypia.
Therefore, we concluded that bronchoscopic US and helical CT were useful for deciding
on therapeutic strategy in cases of recurrence of tracheal papilloma.
New and Simple Endo‐extra Oesophagotracheal Method of Developing the Fistula for the Implantation of a Voice Prosthesis
Authors: Lichtenberger G.
Published: August 2007

The author has simplified the Blom‐Singer1 puncture. The fistula is formed with the help
of his new device, the endo‐extralaryngeal needle carrier and pointed metal cone fixed
to a catheter. The voice prosthesis is placed in the fistula formed thus in an endo‐extra
oesophagotracheal way. The advantage of the method is, that when the fistula being
formed from inside out, the back wall of the oesophagus will not become injured.
Early Localization of Bronchogenic Cancerous/Precancerous Lesions With Lung Imaging Fluorescence Endoscope
Authors: Ikeda N. , Kim K. , Okunaka T. , Furukawa K. , Furuya T. , Saito M. , Konaka C. , Kato H. , Ebihara Y.
Published: August 2007

The result of the clinical trial using the lung imaging fluorescence endoscope (LIFE) was reported. A total of 77 biopsy confirmed sites from 30 patients were evaluated. The sensitivity for metaplasia detection by the LIFE system was 96% compared to 28% by conventional bronchoscopy. The LIFE system was found to be useful in detecting subtle cancerous/precancerous lesions.

Corrigendum to “Early Localization of Bronchogenic Cancerous/Precancerous Lesions With Lung Imaging Fluorescence Endoscope”dx.doi.org/10.1155/DTE.4.107
Results of Endoscopic Treatment for Early Gastric Cancer by Nd‐YAG Laser
Authors: Tani M. , Takeshita K. , Honda T. , Saito N. , Endo M.
Published: August 2007

We have introduced two endoscopic treatments for early gastric cancer: endoscopic mucosal resection using a cap‐fitted panendoscope (EMRC), and endoscopic laser therapy using a Nd‐YAG laser. Thirty‐two patients (34 lesions) with gastric cancer were treated by Nd‐YAG laser; including 23 initial‐therapy cases (25 lesions) and 9 second‐therapy cases representing failures of endoscopic mucosal resection or endoscopic ethanol injection. Endoscopic laser therapy was performed safely without complication in all patients. Three patients had residual cancer, and 2 of these required surgery. Six patients died from other disease. Endoscopic laser therapy can remove early gastric cancer even when the lesion has ulceration or submucosal invasion, and has a powerful hemostatic effect. It is a safe and effective treatment for early gastric cancer.
Clinical Pathological Analysis of Surgically Resected Superficial Esophageal Carcinoma to Determine Criteria for Deciding on Treatment Strategy
Authors: Makuuchi H. , Shimada H. , Mizutani K. , Chino O. , Nishi T. , Tanaka H. , Machimura T. , Mitomi T. , Osamura Y.
Published: August 2007

We performed a clinical pathological study of conventionally resected superficial esophageal carcinomas since this type of lesion has been increasing, in order to develop criteria of determination for therapeutic strategies. Pathological studies were performed on specimens obtained by radical surgical resection in 133 cases of superficial esophageal cancer. Evaluation was performed in terms of the gross classification of the lesion type, depth of invasion, lymph node metastasis, vascular invasion, size of the lesion, outcome, etc. In 0‐I, 0‐IIc+0‐IIa, and 0‐III type submucosal cancer lesions the rate of metastasis to lymph nodes was more than 40%, but in 0‐IIa and 0‐IIb mucosal cancer cases no lymph node metastasis was observed. 0‐IIc type lesions showed a wide range of invasiveness, ranging from m1 to sm3. In cases with m1 or m2 invasion, no lymph node or lymph‐vessel invasion was recognized, but in m3, sm1, sm2, and sm3 cases lymph node metastasis was recognized in 12.5%, 22.2%, 44.0% and 47.4%, respectively. In 47% of lesions with a greatest dimension of less than 30 mm invasion was limited to the mucosa. Seventy‐two percent of m1 and m2 cases were 30 mm in size or less. Lymph node metastasis was recognized in only 16.7% of cases less than 30 mm in size, but in cases of lesions 30 mm or more the rate of lymph node metastasis was 35.8%. 0‐IIb and 0‐IIa type lesions are indications for endoscopic esophageal mucosal resection (EEMR), while 0‐I, 0‐IIc+0‐IIa, and 0‐III lesions should be candidates for radical surgical resection. In the 0‐IIc category, lesions in which the depression is relatively flat and with a finely granular surface are indications for EEMR, but those cases in which the surface of depression shows granules of varying sizes should be treated with radical surgical resection. Cases of 0‐IIa type 30 mm or larger in greatest dimension which have a gently sloping protruding margin shoulder or reddening should be treated with caution, but EEMR can be performed first and subsequent therapeutic strategy decided on, based on the pathological findings of the specimen.
Laparoscopic Bowel Injuries Among Gynecologic Patients
Authors: Garcia Francisco A. R. , Childers Joel M.
Published: August 2007

Bowel injury is an uncommon but recognized risk of operative laparoscopy. Because of the significant morbidity that can occur with this complication, it is important that clinicians be aware of its incidence, presentation, and management. This manuscript outlines the common causes of bowel injury, including herniation and traumatic bowel perforation. Management of laparoscopic bowel injuries is discussed and recommendations are made for avoidance of such complications.
Verrucous Carcinoma of the Larynx Presenting as a Hairy Whitish Tumor
Authors: Kawaida Masahiro , Fukuda Hiroyuki , Kohno Naoyuki
Published: August 2007

A patient was encountered with verrucous carcinoma of the larynx that presented as a hairy whitish tumor. There was a recurrence because simple excision with forceps by endolaryngeal microsurgery was performed in the first operation. However, in the second operation endolaryngeal microscopic laser surgery using a direct laryngoscope was performed and followed by adjuvant chemotherapy with oral UFT, a combination of uracil and tegafur in a molar ratio of 4:1. The patient’s course has been favorable to date. The case is reported in this paper and discussed from the viewpoint of diagnosis and treatment of this neoplasm.
Endoscopic Ultrasonography Assessment for Ampullary and Bile Duct Malignancy
Authors: Zhang Q. L. , Nian W. D. , Zhang L. P. , Liang J. Y.
Published: August 2007

From 1989 through 1992, endoscopic ultrasonography (EUS) was undertaken preoperatively to evaluate the extent of primary tumor, involvement of regional lymph nodes, and
distant metastases in 22 patients with ampullary carcinoma and 18 patients with bile
duct carcinoma. The results were compared with histopathological findings according to
the TNM staging system. The accurate rate in assessing the extent of cancer invasion was
82% for ampullary carcinoma, 66% for common hepatic duct carcinoma, and 78% for
common bile duct carcinoma. The accuracy of EUS in predicting regional lymph node
metastasis was 59% for ampullary carcinoma, 56% for common hepatic duct carcinoma,
and 67% for common bile duct carcinoma. Invasion of the portal vein was correctly
predicted by EUS in 2 of 3 patients. None of the 3 patients with liver metastasis was
detected by EUS. Therefore, endoscopic ultrasonography is an effective method in the
evaluation of the extent of cancer invasion of ampullary and bile duct carcinoma as well
as the involvement of regional lymph nodes preoperatively. However, due to its limited
penetration depth, EUS is inadequate in the assessment of liver metastasis.
Endoscopic Nd:YAG Laser Treatment in the Perioperative Management of Tracheobronchoplasty
Authors: Fujisawa Takehiko , Saitoh Yukio , Baba Masayuki , Shiba Mitsutoshi , Sekine Yasuo , Takeda Tsunehiro , Yoshida Shigetoshi , Yamaguchi Yutaka
Published: August 2007

The objective of this study was to determine the role of endoscopic Nd:YAG laser treatment
in the preoperative or postoperative management of tracheobronchoplasty.
Eighteen patients with severe stenotic lesions of the trachea or bronchus underwent
Nd:YAG laser treatment. Nd:YAG laser treatment was performed in the preoperative
period in 14 patients and in the postoperative period in 4 patients. The indications for
Nd:YAG laser treatment included emergency airway dilatation, confirmation of the distal
margin of tumor, and safe tracheal intubation in patients with severe tracheal stenosis.
The indications for Nd:YAG laser treatment in patients with severe stenosis of the
mainstem bronchus were confirmation of the distal margin of tumor and recovery of
lung ventilation during the preoperative period and reopening of the bronchial lumen to
prevent obstructive pneumonia in the postoperative period. Among patients treated with
Nd:YAG laser preoperatively, the indications were completely achieved in all 14
patients, except for 1 patient with adenoid cystic carcinoma who underwent treatment of
the right mainstem bronchus. Among patients treated with Nd:YAG laser postoperatively
the indications also were achieved in all 4 patients with severe granulomatous
stenosis of the bronchial end‐to‐end anastomosis following sleeve lobectomy. In conclusion,
endoscopic Nd:YAG laser treatment played an important role in the perioperative
management of patients undergoing tracheobronchoplasty.
Endoscopic Treatment of Postoperative External Biliary Fistula in a Patient Operated on for Hepatic Injury Due to Multiple Trauma
Authors: de Monti Marco , Sonnino Davide , Gorziglia Marina , Redaelll Giorgio , Scarpis Marcello
Published: August 2007

After surgery for hepatic injury as a result of blunt abdominal trauma from a motorcycle
accident, an external biliary fistula developed in a young patient. The authors
describe the rapid and complete healing of the fistula by use of a nasobiliary catheter.
These findings emphasize the importance of endoscopic operative technique for postoperative
and traumatic external biliary fistulas.
Newly Designed Specula for Laryngomicroscopy
Authors: Shiotani Akihiro , Fukuda Hiroyuki , Kawaida Masahiro , Kusuyama Toshiyuki , Nakagawa Hideki , Kawasaki Atsushi , Kanzaki Jin
Published: August 2007

We produced specula for laryngomicroscopy to observe blind spots in the operating field. Use of these specula has facilitated detailed observation of the lower surface of the false vocal folds, laryngeal ventricle, and subglottis, which were previously in blind spots. The specula are useful in the following ways:
1) clarifying blind spots for improved diagnosis and providing more accurate surgical margins; 2) observing the lower lips of the vocal folds in phonosurgery; and 3) Vaporizing with laser reflection. The specula are cheap and easy to use and are well worth considering for application to laryngomicroscopy.
Clinical Study on Causative Factors and Recurrence of Choledocholithiasis
Authors: Hoshi Hajime , Sakai Yoshihiro
Published: August 2007

To identify factors involved in choledocholithiasis, clinical characteristics were studied
using univariate and multivariate analyses. Factors involved in recurrence were also
investigated. The subjects consisted of 51 patients with calcium bilirubinate stones (B group) and 52 patients with cholesterol stones (C group). All patients had choledocholithiasis
and underwent lithotripsy by endoscopic sphincterotomy (EST) during the
past 9 years. Twenty variables, including clinical symptoms and endoscopic retrograde
cholangiopancreatography (ERCP) findings, were analyzed using a Statistical Analysis
System (SAS) software package. Univariate analysis were done using Student′s t‐test and
the chi‐square test. Multivariate analyses were done by stepwise logistic regression
analysis. In univariate analyses, there were significant differences between the B group
and C group in nine variables: age, common bile duct diameter, common hepatic duct
diameter, common bile duct stone diameter, cystic duct diameter, and the presence of
gallbladder stones, atypical arrangement of the hepatic duct, parapapillary diverticulum,
and large parapapillary diverticulum. In multivariate analysis, the four variables of
no gallbladder stone, large parapapillary diverticulum, cystic duct less than 8 mm, and
atypical arrangement of the hepatic duct were significant independent factors for the
development of stones in the B group, with relative risks of 37.75, 16.73, 5.56, and 5.49,
respectively. The results indicated that calcium bilirubinate stones were frequently associated
with parapapillary diverticulum and abnormal arrangement of the bile duct. The
formation of these stones was attributed to chronic biliary stasis caused by dysfunction
of the biliary tract, including the papilla. In contrast, most cholesterol stones found in the
common bile duct had apparently descended from the gallbladder. Common bile duct
stones recurred after EST in 9 patients, all of whom had calcium bilirubinate stones. On
ERCP, recurrence was found to be frequently associated with gallbladder stones, large
parapapillary diverticula, and atypical arrangement of the hepatic duct. Patients with
these characteristics on initial ERCP should therefore receive appropriate treatment
and undergo strict follow‐up observations owing to the increased risk of recurrence
caused by dysfunction of the biliary tract.
Conservative Therapy for Nonspecific Granuloma of the Larynx Using a Beclomethasone Dipropionate Inhaler
Authors: Kawaida Masahiro , Fukuda Hiroyuki , Kawasaki Yoshihisa , Shiotani Akihiro , Kohno Naoyuki
Published: August 2007

Nonspecific granuloma of the larynx is a benign tumor that usually occurs on the posterior
glottis. Conventional treatment for this laryngeal lesion has consisted of surgical
resection. However, this lesion has a strong tendency to recur postoperatively and may
require multiple repeated operative procedures. Conservative treatment, consisting
mainly of beclomethasone dipropionate inhalation therapy, was instituted in 20 cases
with good results. We discussed the effect of beclomethasone dipropionate on this lesion
as well as the etiology of this disease.
Minimal and Direct Access Surgery in Urology
Authors: Repassy D. L. , Frang D. , Jako G. J.
Published: August 2007

An alternative method to laparoscopic surgery has been developed for urological procedures.
The surgery is minimal access because the length of the single skin incision ranges
from 3–6 cm depending on the type of operation. It is direct access because the surgeon
sees the operative area directly and stereoscopically by eye without video‐optical support.
The procedure requires a special open‐lumen retractorscope (JakoscopeTM) with a
high intensity fiberoptic light system and modified standard hand instruments. Among
the procedures performed nephrectomy, ureterolithotomy, prostatic adenomectomy,
spermatic vein ligation and others have been performed. The kidney procedures have
been operated retroperitoneally through a minilumbotomy incision. The procedures are
simple, rapid and the instruments are inexpensive. The postoperative pain and morbidity
are comparable to the laparoscopic approach.
Arthroscopic Findings of the Joint Distraction for the Patient With Chondrolysis of the Ankle
Authors: Kanbe Katsuaki , Hasegawa Atsushi , Takagishi Kenji , Kaneko Hiroyuki , Nakajima Yasuyuki
Published: August 2007

This case report describes arthroscopic findings of the effect on articular distraction of
ankle joint by means of external fixator for the patient with chondrolysis. Arthroscopy
showed fibrocartilage tissue lying between the talus and tibia to protect damaged articular
surfaces although apparent repair of surface cartilage failed to find.
Experience of Laparoscopic Exploration and Gonadectomy in lntersex Children
Authors: Morita Ken , Nonomura Katsuya , Ameda Kaname , Kakizaki Hidehiro , Koyama Toshiki , Yamashita Tetsufumi , Murakumo Masashi , Koyanagi Tomohiko
Published: August 2007

The use of laparoscopic technique to diagnose and treat intersex children is gradually
introduced in clinical urology. From 1985 to 1996, abdominal exploration and gonadectomy
were performed in 11 intersex children together with urogenital endoscopy and
genitoplastic surgery in our institutes. Their median age was 6.0 (range 0–15) years old
and initial gender sex was female in 8 and male in 3. The initial 4 cases (group 1)
underwent open abdominal exploration together with gonadectomy, while the latter 7
cases (group 2) underwent laparoscopic exploration simultaneously with 3 laparoscopic
gonadectomy and 1 open one via a inguinal incision. Their final diagnoses were male
pseudohermaphroditism in 4 cases, mixed gonadal dysgenesis in 3, true hermaphroditism
in 2, XX gonadal dysgenesis in 1, and XY gonadal dysgenesis in 1. Consequently, 2 of
initial male were reared as a female. Operation time, use of analgesics, postoperative
hospital stay and postoperative complications were not significantly different between the
two groups, however, postoperative abdominal wound appearance was more acceptable
in group 2. The most significant advantage of laparoscopic surgery in intersex children
is cosmetic appearance especially when social gender is determined as female irrespective
types of intersexuality.
The Use of Fiberoptic Bronchoscopy During Percutaneous Dilatational Tracheostomy With Laryngeal Mask
Authors: Rossi Maurizio , De Monti Marco , Sonnino Davide , Giacometti Bruno
Published: August 2007

The aim of our research is to evaluate the advantage by the combined use of fiberoptic bronchoscopy and laryngeal mask during the performance of percutaneous dilatational tracheostomy in an intensive care unit.

Patients: 16 adult patients who were candidates to middle‐long term mechanical ventilation.

Environment: Intensive Care Unit of a Community General Hospital.

Results: We experienced 3 minor complications (2 minor bleedings and 1 neck emphysema). Difficulties were found in 3 patients with particular anatomical conformation (obese patients with short neck and limited mobility of the cervical spine).

Conclusion: The combined use of fiberoptic tracheo‐bronchoscopy with the laryngeal mask permits a better endoscopic visualisation of the operatory field, providing a more secure and precise procedure.
Helicobacter Pylori Associated Antral Gastritis in Peptic Ulcer Disease Patients and Normal Healthy Population of Kashmir, India
Authors: Romshoo Gh. Jeelani , Malik G. M. , Bhat M. Youssuf , rather Ab. Rashid , Basu Javaid Ahmad , Qureshi Khursheed Ahmad
Published: August 2007

Aim: To study the association of Helicobacter pylori infection with chronic antral
gastritis in peptic ulcer disease patients and healthy population of Kashmir.

Methods: 50 peptic ulcer patients (duodenal ulcer = 46, gastric ulcer = 2 and combined
duodenal and gastric ulcer = 2) and 30 asymptomatic healthy volunteers were included in
this study. Peptic ulcer was diagnosed on endoscopic examination. 4–6 punch biopsies
were taken from gastric antrum in all the individuals and in case of gastric ulcer an
additional biopsy was taken from the edge of the ulcer to exclude its malignant nature.
Helicobacter pylori (H. pylori) organism was diagnosed using three different test methods,
viz. Histology (using Giemsa Stain), Microbiology (Gram Stain) and Biochemistry
(using one minute Endoscopy Room Test). Histological diagnosis of H. pylori was taken
as the “gold standard” for the presence of H. pylori organism. Histological diagnosis of
gastritis was made using Hematoxylin and Eosin Stain and the gastritis was classified
as active chronic gastritis and superficial chronic gastritis.

Results: Out of 30 peptic ulcer disease patients with associated antral gastritis, 27 (90%) were positive for H. pylori on histological examination (13 superficial chronic
gastritis and 14 active chronic gastritis) whereas out of 8 healthy volunteers with
histological evidence of chronic antral gastritis, H. pylori was observed in 7 individuals
(87.50%) (4 active chronic gastritis and 3 superficial chronic gastritis).

Conclusion: A highly significant association between H. pylori infection with chronic
antral gastritis both in peptic ulcer disease patients and healthy volunteers of Kashmir
was found in this study. Association between H. pylori infection and chronic gastritis
was 90% in peptic ulcer group and 87.50% in healthy population (P < 0.005).
Endoscopic Fenestration of Pseudo Cyst in Acute Pancreatitis
Authors: Yamagishi Fuminori , Shimoda Mistuyosi , Sakamoto Takashi , Tauchi Kastunori , Shimada Kastuo , Goka Takeichi , Bandou Tadashi , Fujimaki Masao , Yamanaka Ademar
Published: August 2007

We report a case of pseudo cyst accompanied by acute pancreatitis which was successfully
treated by endoscopic cyst‐gastrostomy. It had been enlarged recurrently after
twice simple needle aspiration under ultrasonic monitoring. Because of the infection of
the cyst, rapid and complete drainage was needed. Upper gastro‐intestinal endoscopy
showed a large bulge of the stomach which was compressed by paragastric pancreatic
cyst. Endoscopic ultrasonography revealed that the cyst wall was attached hard with the
stomach and there was no vessels between them. Endoscopic fenestration of the bulge
was created using papillotome and diathermic snare. The drainage was effective and cyst
was decompressed rapidly. The fenestration was closed after the cyst was diminished.
Recently the endoscopic cyst‐gastrostomy made by cutting linearly or inserting catheter
have been reported, however, these treatments sometimes resulted in infection and
relapse because of the quick closure of the fistula. When the bulge is large and endoscopic
ultrasonogram revealed low bleeding risk, the fenestration may be advisable for
effective drainage of longer duration without infection.