bluuebunny/crossref_metadata_2025 huggingface dataset:
Recombination, balancing selection and adaptive evolution in the aflatoxin gene cluster of Aspergillus parasiticus
Authors: CARBONE IGNAZIO , JAKOBEK JUDY L. , RAMIREZ‐PRADO JORGE H. , HORN BRUCE W.
Published: August 2007

Aflatoxins are toxic and carcinogenic polyketides produced by several Aspergillus species that are known to contaminate agricultural commodities, posing a serious threat to animal and human health. Aflatoxin (AF) biosynthesis is almost fully characterized and involves the coordinated expression of approximately 25 genes clustered in a 70‐kb DNA region. Aspergillus parasiticus is an economically important and common agent of AF contamination. Naturally occurring nonaflatoxigenic strains of A. parasiticus are rarely found and generally produce O‐methylsterigmatocystin (OMST), the immediate precursor of AF. To elucidate the evolutionary forces acting to retain AF and OMST pathway extrolites (chemotypes), we sequenced 21 intergenic regions spanning the entire cluster in 24 A. parasiticus isolates chosen to represent the genetic diversity within a single Georgia field population. Linkage disequilibrium analyses revealed five distinct recombination blocks in the A. parasiticus cluster. Phylogenetic network analyses showed a history of recombination between chemotype‐specific haplotypes, as well as evidence of contemporary recombination. We performed coalescent simulations of variation in recombination blocks and found an approximately twofold deeper coalescence for cluster genealogies compared to noncluster genealogies, our internal standard of neutral evolution. Significantly deeper cluster genealogies are indicative of balancing selection in the AF cluster of A. parasiticus and are further corroborated by the existence of trans‐species polymorphisms and common haplotypes in the cluster for several closely related species. Estimates of Ka/Ks for representative cluster genes provide evidence of selection for OMST and AF chemotypes, and indicate a possible role of chemotypes in ecological adaptation and speciation.
TheLeptynia hispanicaspecies complex (Insecta Phasmida): polyploidy, parthenogenesis, hybridization and more
Authors: GHISELLI FABRIZIO , MILANI LILIANA , SCALI VALERIO , PASSAMONTI MARCO
Published: August 2007

TheLeptynia hispanicastick insect species complex includes bisexuals, triploid and tetraploid parthenogenetic populations, suggesting that polyploidy has played a central role in the evolution of this complex. An analysis of karyotype, mitochondrial DNA (cox2) and nuclear DNA (ef1‐α) markers was carried out to clarify phylogenetic relationships and microevolutionary/phylogeographical patterns of theL. hispanicacomplex. Our analyses suggested a subdivision of bisexual populations into four groups, tentatively proposed as incipient species. Moreover, triploids and tetraploids showed two independent origins, the latter being more ancient than the former. Fromef1‐α analysis, triploids showed hybrid constitution, while the hybrid constitution of tetraploids is likely, but more data are needed. We suggest thatL. hispanicais a case of ‘geographical parthenogenesis’ with parthenogenetic strains colonizing large peripheral ranges, and bisexuals confined to glacial refuge areas. Moreover, the age, wide distribution and competitive advantage of polyploids over diploids, demonstrate their significance in the evolution of theL. hispanicaspecies complex.
Financial implications of surgical complications in pediatric liver transplantation
Authors: Ammori John B. , Pelletier Shawn J. , Mathur Amit , Cohn Joshua , Ads Yasser , Campbell Darrell A. , Magee John C. , Englesbe Michael J.
Published: August 2007

Abstract:  Surgical complications following pediatric liver transplantation are common and expensive. We examined the incremental costs of surgical complications and determined who pays for these complications (center or payer). We reviewed the records of 36 pediatric liver transplant patients aged ≤12 yr transplanted between July 1, 2002 and December 31, 2005. The association of recipient and financial data points was assessed. On univariate analysis, total hospital costs were significantly increased in patients with ACR, PNF, HAT, biliary complications, and ARF. Reimbursement by the payer was significantly increased in patients with PNF, HAT, biliary complications, and ARF. Hospital profits were significantly decreased in recipients with ACR and pneumonia. Multiple linear regression models (controlling for recipient factors) revealed that ARF and HAT were independently associated with a significant increase in median hospital costs (incremental costs of $238 990 and $125 650, respectively). ARF and HAT were also independently associated with a significant increase in median reimbursements (incremental costs of $231 611 and $125 287, respectively). No complications were independently associated with hospital margins. All parties (patient and families, physician, payer, and medical center) should benefit from quality improvement efforts, with payers having the largest financial interest.
Seismic study on oceanic core complexes in the Parece Vela back‐arc basin
Authors: Ohara Yasuhiko , Okino Kyoko , Kasahara Junzo
Published: August 2007

Abstract  In the present study the seismic structure of oceanic core complexes (OCC) in the Parece Vela Basin, Philippine Sea have been imaged. Together with recent work on the Atlantis Massif OCC on the Mid‐Atlantic Ridge, including deep drilling, this work provides an unprecedented opportunity to advance our understanding of OCC internal structure. A continuous, strong and relatively smooth reflection that was ca 0.15 s (two way time) below the sea floor of an OCC in the Chaotic Terrain of the Parece Vela Basin was identified. This reflection, termed the D‐reflector, is similar to that observed beneath Atlantis Massif. A faster P‐wave velocity (>6 km/s) is observed very shallow beneath the Chaotic Terrain OCC, suggesting that the core of these OCC is dominantly gabbroic. The D‐reflector might be common beneath OCC, owing to localized alteration along fractured zones within gabbro. We further observed a series of three detachment events in the Chaotic Terrain. The first and second detachments exhumed shallow basaltic crust to deeper gabbroic core, whereas the last one only exhumed shallow basaltic crust.
Fault configuration produced by initial arc rifting in the Parece Vela Basin as deduced from seismic reflection data
Authors: Yamashita Mikiya , Tsuru Tetsuro , Takahashi Narumi , Takizawa Kaoru , Kaneda Yoshiyuki , Fujioka Kantaro , Koda Keita
Published: August 2007

Abstract  The Parece Vela Basin (PVB), which is a currently inactive back‐arc basin of the Philippine Sea Plate, was formed by separation between the Izu‐Ogasawara Arc (IOA) and the Kyushu‐Palau Ridge (KPR). Elucidating the marks of the past back‐arc opening and rifting is important for investigation of its crustal structure. To image its fault configurations and crustal deformation, pre‐stack depth migration to multichannel seismic reflection was applied and data obtained by the Japan Agency for Marine‐Earth Science and Technology and Metal Mining Agency of Japan and Japan National Oil Corporation (Japan Oil, Gas and Metals National Corporation). Salient results for the pre‐stack depth‐migrated sections are: (i) deep reflectors exist around the eastern margin of KPR and at the western margin of IOA down to 8 km depth; and (ii) normal fault zones distributed at the eastern margin of the KPR (Fault zone A) and the western margin of the IOA (Fault zone B) have a total displacement of greater than 500 m associated with synrift sediments. Additional normal faults (Fault zone C) exist 20 km east of the Fault zone B. They are covered with sediment, which indicates deposition of recent volcanic products in the IOA. According to those results: (i) the fault displacement of more than 500 m with respect to initial rifting was approximately asymmetric at 25 Ma based on PSDM profiles; and (ii) the faults had reactivated after 23 Ma, based on the age of deformed sediments obtained from past ocean drillings. The age of the base sediments corresponds to those of spreading and rotation after rifting in the PVB. Fault zone C is covered with thick and not deformed volcanogenic sediments from the IOA, which suggests that the fault is inactive.
Endoscopic Biliary Drainage for Acute Obstructive Cholangitis: Analysis of 100 Consecutive Patients
Authors: IKEDA Seiyo , TANAKA Masao , YOSHIMOTO Hideo , MAESHIRO Kensei , MATSUMOTO Shinji
Published: August 2007

Abstract: Acute obstructive suppurative cholangitis is a life‐threatening condition and prompt biliary decompression is essential if the patient is to survive. One hundred patients with acute obstructive (suppurative) cholangitis were treated by simple endoscopic cannulation for biliary drainage. Forty‐eight patients had common duct stones alone, 33 patients had additional stones in the gallbladder, and 18 patients had stones in the intrahepatic ducts. Another patient had a confluence stone. Twenty‐six patients had undergone endoscopic sphincterotomy. Bile duct dilatation was present in only 25 of 47 patients (53%) studied by ultrasound tomography. Biliary decompression was achieved in 98 patients. One tortuous distal bile duct and one oversized stone were the causes of failure in two patients. Forty‐seven patients proved to have suppurative cholangitis. Most patients felt instant and dramatic relief of their syniptoms. Bleeding at sphinctetomy was the only complication associated with the decompression ocurring in 2 patients. Bending (2 patients) and withdrawal (2 patients) of a nasobiliary catheter, and nasal bleeding (1 patient) were the complications related to nasobiliary drainage. Two patients with suppurative cholangitis died despite successful decompression performed 3 and 5 days after the onset of cholangitis. This delay seemed responsible for their deaths. Thus the mortality rate was 2.0% for all the patients arid 4.3% for those with suppurative cholangitis. These results suggest that endoscopic cannulation, which is feasible even in the absence of bile duct dilatation, is a prompt, safe, and effective procedure for emergency biliary decompression for the treatment of acute obstructive (suppurative) cholangitis.
The Detection of Campylobacter pylori (Cp) in Gastro‐Duodenal Disease: The Efficacy of the Rapid Urease (RU) Test and Relationship between Endoscopic Findings, Histological Gastritis and Presence of Cp
Authors: SHIRAI Takayuki , HARASAWA Shigeru , MIWA Takeshi
Published: August 2007

Abstract: In the comparison of bacteriological and histological methods, the rapid urease (RU) test was considered a specific (100%) method for detection of Campylobacter Pylori (Cp), by which the presence of Cp can be rapidly judged (more than 90% in 20 min.). For an accurate and reliable diagnosis, other methods should be used concurrently, because the sensitivity of this test was inferior to bacteriological methods by 10 to 20%.

In the histological study, polymorphonuclear leukocyte infiltration in the antral mucosa clearly reflected Cp infection. This pathological change responded well to antibacterial therapy.

Of some endoscopic findings in the gastric antrum, verrucous change was considered to have a relatively close association with Cp infection. However, about 30% of Cp‐present cases had endoscopically no abnormal appearance in the gastric antrum.
Possible Involvement of Tissue‐Type Plasminogen Activator in Gastric Ulcer Formation —Biochemical Evaluation Using Biopsy Specimens From Gastric Mucosa—
Authors: KUROSE Iwao , MIURA Soichiro , SUEMATSU Makoto , ASAKO Hiroshi , SERIZAWA Hiroshi , OGATA Haruhiko , HIBI Toshifumi , TSUCHIYA Masaharu
Published: August 2007

Abstract: Microvascular endothelial changes are thought to be a crucial step in the development of hemorrhagic changes in various pathological states. Tissue‐type plasminogen activator (t‐PA) is an endothelium‐derived fibrinolytic mediator which regulates microvascular permeability. In this study, we determined the activity and amount of t‐PA in the biopsy specimens taken from gastric mucosa of patients with gastric ulcers to evaluate endothelial alterations and vascular permeable changes in situ. In addition, to elucidate the relationship between local fibrinolytic disturbance and systemic blood coagulation, several factors such as plasminogen activator inhibitor were also assayed. The results of this investigation revealed that the mucosal t‐PA amount in the active ulcer proved to be 2–3 folds higher than that in healthy controls, however, t‐PA levels in plasma samples showed no remarkable differences among the groups. Increased t‐PA activity appeared to well correlate to the degree of inflammation of gastric mucosa in contrast to t‐PA amount which was still increased in healed ulcer lesion. PAI‐1 in plasma samples from gastric ulcer patients showed a significantly high level as compared with healthy subjects. The present study indicates that t‐PA activation may play an important role in the pathogenesis of gastric ulcer formation and that t‐PA determination in gastric biopsy specimens may be useful for the evaluation of clinical activity of gastric ulcers in terms of the mucosal microvascular endothelial changes.
A Case of Adenosquamous Carcinoma of the Pancreas With a Large Cyst.
Authors: FUJISAKI Junko , MINE Tetsuya , AKIMOTO Kimihiko , YOSHIDA Shigeo , HASEGAWA Yoshiyasu , OGATA Etsuro
Published: August 2007

Abstract: An 81‐year‐old female was admitted to our hospital with right upper abdominal pain and an abdominal mass. She has suffered from diabetes mellitus for 10 years. She did not have other past history. In addition, her serum level of CA19–9 was remarkably high, 39,000U/ml. Investigations of ultrasonography, computed tomography and angiography were done. These radiological findings showed that a large cystic mass, including the pancreatic head and body, had hypervascularity. Endoscopic retrograde cholangiopancreatography (ERCP) suggested that this cystic mass originated from the main pancreatic duct and was malignant. These studies revealed that this tumor might its histological diagnosis of intraoperative biopsy revealed adenosquamous carcinoma. There have been no reports about adenosquamous cell carcinoma with a large cyst.
Clogging of Biliary Stents: Mechanisms and Possible Solutions
Authors: LEUNG Joseph W. C. , BANEZ Virgilio P.
Published: August 2007

Abstract: Recurrent jaundice or cholangitis resulting from stent clogging is a late complication of endoscopic stenting for malignant biliary obstruction. The cause of clogging is blockage of the stent lumen by biliary sludge. Chemical analysis of this material revealed the presence of calcium bilirubinate, calcium palmitate, mucoproteins and unidentified insoluble materials. Electron microscopic examination of the sludge and stent surface revealed presence of microcolonies of bacteria forming a biofilm. In vitro studies showed that bacteria adhered to the stent surface within two hours of exposing the stent to bacreria. Bacterial B‐glucuronidase causes deconjugation of bilirubin diglucuronide resulting in precipitation of calcium bilirubinate which further contributes to sludge formation. Prevention of late stent clogging should aim at preventing bacterial adherence. The use of broad spectrum antibiotics may sterilize the biliary system but carries a risk of inducing resistant bacteria. Coating the stent surface with antibiotics, chemical or metallic ions may modify the surface and prevent bacterial adherence. In the absence of effective methods to prevent bacterial adherence and biofilm formation, the use of larger stents with bigger lumen may delay the process of clogging. Cleaning with guidewires or brush may unblock the stent but the effect is only temporary. Elective exchange of the stent at a regular interval may help to prevent this complication.
Minute Rectal Cancer Associated with Nodular Involvement —A Case Study—
Authors: OHTA Takahito , MAI Masayoshi , OGINO Tomomi , KIDA Yuri , MINAMOTO Toshinari , TAKAHASHI Yutaka , SAWAGUCHI Kiyoshi , JINKAWA Shigeru , YASUDA Yoshiaki
Published: August 2007

Abstract: This study presents the case of a patient with minute type Ha rectal cancer with a diameter at its largest of only 5 mm, with infiltration as far as the submucosal layer (sm) and positive parietal lymph node metastasis.

The patient was a 54 year‐old male who visited Yasuda Medical Hospital because of diarrhea which appeared in early May 1988.

During sigmoidscopy, a small protruding lesion was seen in the rectum (Rs) about 12 cm from the margin of the anus, and the patient was referred to the authors' surgical service for an endoscopic polypectomy because of a biopsy diagnosis of adenocarcinoma. The polyp had a smooth, shiny surface, and had a well demarcated hemispherical shape.

A histopathological examination of the polypectomized specimen, showed that it was an invasive carcinoma extending into the submucosal layer without any adenoma component. Since the cut end of the specimen strongly suggested positive cancer cells and lymphatic permeation was also confirmed from the polypectomized specimen, a low anterior resection was performed on August 4, 1988. The postoperative histological examination revealed a small amount of residual cancer cells in the submucosal layer which appeared to be at the cut end of the resected polyp.

One metastatic focal point was seen in the pararectal lymphnode, and this patient's case provided valuable suggestions for deciding upon therapeutic policies for early cancer of the large intestine.
Gastric Mucosal Blood Flow Before and After TAE
Authors: TSUCHIGAME Tadatoshi , ITOH Kohshiro , HAR Masafumi , WATANABE Okimitsu , OHYAMA Youichi , BABA Takashi , YOSHIMATSU Syunji , UOZUMI Hideaki , UENO Sukeyoshi , TAKAHASHI Mutsumasa
Published: August 2007

Abstract: An evaluation of gastrointestinal complications after transcatheter arterial embolization (TAE) was conducted by endoscopy in order to investigate the pathogenesis of post TAE gastrointestinal complications. In addition, the gastric mucosal blood flow (GMBF) was evaluated by a laser doppler.

The incidence of complications following the administration of a H2–blocker was 34.1%, whereas the incidence following the administration of PGE1 and without medication were 2.3% (P >0.01) and 9.4%, respectively.

In the group which did not receive medication, just after a TAE the GMBF decreased markedly in the lesser curvature of the gastric antrum (P >0.01), and in the lesser and greater curvature of the gastric body. This persisted from 1 to 7 days after the TAE with the GMBF showing a tendency to recover. On the other hand, in the group who received PGE1, the GMBF did not decrease in any site of the stomach following TAE.

These findings suggested that the ischemia which occurred due to a decrease in the GMBF caused the gastrointestinal complications seen.
A Comparative Study Between Laparoscopic Findings and Histological Stages in Primary Biliary Cirrhosis
Authors: MATSUMOTO Masafumi , KAGAWA Keizo , SHINTANI Hiroyuki , NISHIYAMA Akitsugu , MIZUNO Masayuki , SAKABE Kazuo , HIKITA Hiroshi , TAKEUCHI Takayuki , TADA Hisashi , FUKUI Susumu , DEGUCHI Takeshi , OKANOUE Takeshi , KASHIMA Kei
Published: August 2007

Abstract: Histopathologically, early lesions of primary biliary cirrhosis (PBC) are focal within the liver and there is segmental involvement of the bile ducts. In addition, the development of PBC is variable within the liver. PBC is characterized by the following laparoscopic findings: reddish patch, mesh‐like white marking and gentle undulation, etc.

In the present study, we analyzed the correlation between the laparoscopic findings and the histological stage as per Scheuer's classification in 22 patients with PBC. The results of this study are summarized as follows:

1) Reddish patch was frequently observed in the early stage of PBC. 2) Mesh‐like white marking was observed in cases of stage I, II and III. 3) Gentle undulation was seen in stage II and III. The absence of this finding is useful in the diagnosis of stage I. 4) In stage IV, these three findings were not observed. 5) From these three findings, it was difficult to differentiate stage II or III. But the presence of portal hypertension and increased vascularity of the liver capsule were observed in accordance with the progression of the disease. Indications of portal hypertension were seen even in the early stage and in some asymptomatic cases of PBC.

In conclusion, the laparoscopic findings such as reddish patch, mesh‐like white marking, gentle undulaion and portal hypertension are very valuable for stage diagnosis and the evaluation of prognosis in patients with PBC.
Endoscopic Diagnosis of Intestinal Lipomas
Authors: MURATA Ikuo , MUTA Koki , ITSUNO Minoru , MAKIYAMA Kazuya , HARA Kohei , IMAMURA Kazuyuki , TAGUCHI Hisao , MATSUNAGA Keiichiro , YAMANAKA Hideo
Published: August 2007

A retrospective endoscopic study of 11 patients with intestinal lipomas was conducted. The patients included 2 with duodenal—, 2 with small intestinal—, and 7 with large intestinal lipomas. Endoscopically, in addition to features common to all submucosal tumors, lipomas often present characteristic findings including a yellowish surface color and softness of the tumor. The yellowish color was noticed in the 6 patients whose tumors were 10 mm and more in size. In the 2 patients with lipomas in the small intestine, the yellowish color was diminished by hemorrhages, inflammation and fibromusculosis in the lamina propria mucosa due to mechanical irritations such as peristalsis and intussusception. Thus, the appearance of the yellow color was related to the size of the tumors and the histological changes in the overlying mucosa. Endoscopic palpation with biopsy forceps aids in making a diagnosis of lipomas; and the cushion sign was noticed in 3 of 4 patients who underwent the palpation. The naked fat sign is pathognornonic but was observed in only 1 patient with a duodenal lipoma, in which the fat tissue was exposed by denuding the mucosa with the biopsy forceps. Scopic biopsies revealed lipomas in 3 patients. Careful observation of the color and palpation during the endoscopic examination are important for making a correct diagnosis and avoiding the unnecessary resection of lesions.
Colon Polyps Detected by Contrast Chromoscopy Using Indigo Carmine Capsule
Authors: MITOOKA Hideki , FUJIMORI Takahiro , MAEDA Sakan , HONSAKO Yoichiro , OHNO Shigekazu , OKANO Hiroyuki , MIYAMOTO Masaki , AOYAMA Nobuo
Published: August 2007

Contrast chromoscopy of the colon using indigo carmine capsule was performed in 287 patients from July 1990 to March 1991. The distribution and histological features of the polyps detected and resected in these patients were investigated. The overall prevalence of polyps (neoplastic and nonneoplastic) was 85.7% and that of neoplastic polyps was 57.1 %. Moreover, the prevalence of neoplastic polyps in 121 asymptomatic patients was 50.4%. A total of 1179 polyps were resected. Of this total, 1049 polyps were diminutive (>5 mm), and 130 polyps were >5 mm. Histological examinations revealed 35.6% of the diminutive polyps and 83.7% of the large polyps (>5 mm) were neoplastic. Proximally, diminutive neoplastic polyps predominated, accounting for 78% of all of the diminutive polyps in the right colon. The situation was reversed in the distal colon, where diminutive non‐neoplastic polyps comprised 91% of all of the diminutive polyps in the rectum. The number of large polyps was evenly distributed throughout the colon. The incidence of carcinoma was 0.5% of the diminutive polyps and 10.1 % of the large polyps. Approximately 70% of all of the neoplastic polyps were located proximal to the sigmoid colon. These findings suggest that there are many more polyps present throughout the colon than previously estimated. This suggests that total colonoscopy be performed more thoroughly than before, by using for instance chromoscopy. Furthermore, all of the polyps encountered during colonoscopy should be removed due to the high prevalence of neoplasia, especially in the proximal side of the colon.
A Study on the Shape of Colorectal Hyperplastic Polyps—Consideration of the Importance of the Location—
Authors: OHARA Noboru , NAGASAKO Kou , BABA Rika , YASHIRO Kurato , SUZUKI Shigeru
Published: August 2007

Sixty‐nine hyperplastic polyps over 6mm in diameter were studied with respect to their size and location. Of these polyps, 47% in the rectum, 35% in the right colon, and 80% in the left colon were pedunculated. In other words, polyps with stalks were prevalent in the left colon. Horizontally growing tumors like hyperplastic polyps tended to be pedunculated depending on their location.
Hepatocellular Carcinoma with Metastasis to the Duodenum: —A Case Report—
Authors: ARIMA Kazuhiro , SUGA Mitsuo , IKEDA Noriyasu , TAKAHASHI Tohru , NAKATA Masayuki , SHIBATA Kaori , KOBAYASHI Takeaki , YABANA Tsuyoshi , YACHI Akira , WAKABAYASHI Junichi
Published: August 2007

Abstract: A case of hepatocellular carcinoma with metastasis to the duodenum is reported on together with a review of the literature. A 61‐year‐old male was admitted with hematemesis and melena. An endoscopic examination revealed a large hemorrhagic ulcer at the duodenal bulbi. A biopsied specimen taken from the bottom of the ulcer revealed an infiltrating hepatocellular carcinoma. The postmortem examination revealed a hepatocellular carcinoma with metastasis in the duodenum. This is the third report of hepatocellular carcinoma with metastasis in the duodenum.
A Case of Funnel Liver Induced by Dimethylformamide
Authors: KAKIO Takeshi , UKIDA Minoru , ITO Toshio , YAMAMOTO Kazuhide , TANIMIZU Masahito , MIZUTAMARI Koukichi , MORIMOTO Youichi , KOBASHI Haruhiko , MATSUO Ryuichi , SAKAI Nobuyuki , MIYAMOTO Rieko , YAMADA Gotaro , TSUJI Takao
Published: August 2007

Abstract: The laparoscopic and histological findings of a patient suffering from dimethylformamide (DMF) intoxication are discussed. A 20‐year‐old man was admitted to our department for further evaluation of a liver injury. A laparoscopy revealed that the liver was markedly deformed by a combination of depressions and protuberances, and this finding was compatible with the funnel liver reported by H. Kalk. After an intravenous injection of high dose indocyanine green, broad whitish depressions appeared as a non‐staining area and surrounding protuberances were stained a dark green color. A biopsy specimen taken from the site of the depression showed massive hepatic necrosis and a scar under the capsule. The histological diagnosis was a convalescent stage of toxic liver injury. The present report is apparently the first to consider the detailed laparoscopic findings of a liver injury induced by DMF.
Endoscopic Clipping of Esophageal Varices
Authors: MIYOSHI Hiroshi , SHIKATA Jun‐ichi , TOKURA Yasuyuki
Published: August 2007

Abstract: A new method of endoscopic therapy for esophageal varices using a clipping apparatus was devised and applied prophylactically in nine patients with esophageal varices which were not bleeding. Eighty two ligations were placed in 21 separate treatment sessions in this study. All the esophageal varices were eradicated or reduced in size and length within 2 months following treatment. No major complications such as massive bleeding, the development of deep esophageal ulcers, esophageal perforation, esophageal stenosis and pleural effusion developed. The follow‐up period ranged from 6 months to 18 months. Three patients (33%) were re‐treated by the same method because of the regrowth of esophageal varices during this period, but no bleeding occured in these patients. It seems that this newly developed method is a safe, simple and effective technique for the treatment of esophageal varices.
Laparoscopic Findings of the Liver of Adult T cell Leukemia with Hepatic Injury— A Case Report
Authors: SADAMOTO Takaharu , YOSHIDA Naoya , SHIBATA Minoru , SUMINO Yasukiyo , OKADA Tadashi , SATO Genichiro , UENO Yukihisa , SUGIMOTO Motonobu , ABEI Toru , NONAKA Hiroko
Published: August 2007

Abstract: A 54 year‐ old man was admitted to our hospital because of general fatigue and marked hepato ‐splenomegaly. Laboratory findings revealed marked leukocytosis including atypical lymphocytosis and abnormalities in the hepatic function tests. A diagnosis of acute stage of adult T‐cell leukemia (ATL) was made from his positive serum anti‐ATL (HTLV‐1). Since the complication of alcoholic liver disease could not be ruled out because of his heavy consumption of alcohol, hepato ‐ splenomegaly and abnormal liver function tests, a laparoscopic examination was performed. The laparoscopic findings of the liver revealed it was yellow / brown in color, and showed swelling of both lobes, granular unevenness and diffuse white markings on the surface. Histological findings of the liver biopsy specimen revealed an enlargement of the portal areas with diffuse infiltration of ATL cells but no evidence of alcoholic liver diseases. It is suggested that the white markings on the liver surface, which showed slight elevation unlike those seen in chronic hepatitis, might reflect an infiltration of ATL cells.
Chlamydia Trachomatis Colitis in an Aged Male Homosexual
Authors: IKEDA Masahiro , FUKUDA Kazunori , KAWAI Tsutomu , FUJINO Masayuki A.
Published: August 2007

Abstract: An 83‐year‐old male was admitted to our hospital complaining of hematochezia and anal pain. He was an active homosexual. His physical examination was normal except for anal pain and bloody stool which were discovered on digital examination. Serum samples showed positive antibodies to Chlamydia trachomatis (C. trachomatis) by EIA. Stool cultures were negative for pathogenic bacteria and parasites. A colonoscopy revealed multiple aphthous erosions in the rectosigmoid and ileocecal regions. The histological findings were non‐granulomatous colitis with inflammatory cell infiltration and atrophy of the glands. An immunohistological staining of biopsy specimens was positive for C. trachomatis. Antibiotic therapy was an effective treatment for the symptoms. This case appears to be a nonlymphogranuloma type C. trachomatis infection to the large bowel. Ileocecal lesions have not been reported in non‐lymphogranuloma type C. trachomatis colitis.
A New Classification System for Early Carcinomas of the Esophagus
Authors: KUMAGAI Yoshiya , MAKUUCHI Hiroyasu , MITOMI Toshio , OHMORI Tai
Published: August 2007

Abstract: Carcinomas of the esophagus have a higher degree of malignancy than gastric carcinomas. Likewise, the therapeutic response of esophageal cancer patients to radical surgery has been poor because a thoracotomy and/or laparotomy are required. Since the advent of the iodine staining technique for the detection of esophageal carcinoma, the diagnosis of small, thin lesions limited to the mucosa ha become endoscopically possible. Progress in diagnostic techniques has thus resulted in the detection of increasing numbers of early carcinomas. Recent advances in techniques for the endoscopic mucosectomy of early esophageal carcinomas have similarly contributed to an increasing trend towards early detection and endoscopic resection. As mucosectomy is indicated for the treatment of small, thin lesions without lymh node metastases, a new endoscopic classification system has become necessay, to insure improved diagnostic accuracy.
Trans‐endoscopic Drug Propulsion Therapy
Authors: HOSHINO Teruo , OZEKI Arata , KUSAKARI Kouji , ISHIDA Masashi , Barron J. Patrick
Published: August 2007

Abstract: A new endoscopic drug delivery system was developed by the authors. This system allows for drugs in the form of solid pills, grains, and powders to be delivered to target sites using an air gun propulsion system. Following initial in vitro trials, in vivo studies were performed on dogs, using steel pills, grains of activated carbon, and of sucralfate, and bovine thrombin powder. The depth of pill penetration increased linearly with increases in air pressure. The extent of grain distribution increased in relation to the distance from the tip of the endoscope to the target. Propulsion pressures over certain thresholds (which varied according to the materials propelled) produced bleeding in the stomach wall, but no clearly observed ulceration was observed at any of the pressures tested. The targets were adequately covered by the grains and powder. This drug delivery system shows promise for the treatment of malignant lesions, ulcers and bleeding, and other applications where localized delivery, of drugs is indicated.
Low‐pressure Pneumoperitoneum for Laparoscopic Surgery Using a Disposable, Flexible Abdominal Wall Retractor
Authors: INOUE Haruhiro , MURAOKA Yukihiko , TAKESHITA Kimiya , GOSEKI Narihide , ENDO Mitsuo
Published: August 2007

Abstract: Since April 1991, we have studied 160 patients who had had a successful laparoscopic cholecystectomy. Nine patients who presented with chronic cholecystitis with severe local adhesion and who were also considered to require a longer operative time were selected as suitable candidates for this procedure. They were successfully treated under a zero‐ to four‐mmHg low‐pressured pneumoperitoneum procedure combined with total abdominal wall lifting using a disposable, flexible vinyl tube retractor. This method enabled exactly the same clear laparoscopic vision as is possible in the routinely‐used high‐pressure pneumoperitoneum even in the marginal portions of the abdominal cavity. Moreover, it facilitated early reinsufflation after the cauterization‐produced smoke was exhausted, which minimized the operative time and reduced the surgeon's anxiety concerning the maintenance of a sufficiently airtight condition. We believe that this low‐pressure pneumopeqitoneum procedure also benefits the poor‐risk patient who has restricted cardiopulmonary function, especially during advanced laparoscopic surgery which requires a longer operative and anesthetic time.
Branch Fusion Between the Ventral and Dorsal Pancreatic Duct
Authors: HIROOKA Takashi , KATAOKA Shinichi , OHCHI Hiroaki , MARUO Takanori , TOYONAGA Takashi , DOZAIKU Toshio , HAMADA Takaaki , NAKAMICHI Kouji , UEZU Asahiro , NAKAMOTO Takeshi , MAKIMOTO Shinichirou , SHINBO Masaya , YAMAMOTO Hiroshi , NISHIHARA Hideki , TACHIBANA Shogo , KUMAGAYA Akifumi , KIKUCHI Hiroshi
Published: August 2007

Abstract : Fusion of the dorsal and ventral pancreatic ducts exhibits various forms and one of them is branching fusion. Branch fusion was divided into 3 types according to ERP findings. Fusion of the upper branches of the ventral pancreatic duct with the dorsal pancreatic ducts was designated as being type 1. Fusion of the lower branch of the dorsal pancreatic duct with the ventral pancreatic duct in roundabout way was designated as being type 2. Fusion of the lower branch of the dorsal pancreatic duct with the ventral pancreatic duct in short way was designated as being type 3.

We demonstrated the presence of branch fusion involving the branch of the dorsal pancreatic duct by histopathological examination and immunohistochemical examination using pancreatic polypeptide cells as an indicator in one patient with type 1 branch fusion and one with type 3 branch fusion who underwent a pancreatoduodenectomy.

ERP showed chronic pancreatitis in 3 of 4 patients with type 1, 3 of 8 patients with type 2, and 7 of 18 patients with type 3 branch fusion, of whom 1, 2, and 4, respectively had non‐alcoholic pancreatitis. The high incidence of pancreatitis suggested that branch fusion is the cause of pancreatitis.

In addition, evaluation of ERP images revealed Santorini's duct originating from the ventral pancreatic duct in 5 patients with type 1 branch fusion, suggesting the presence of the ansa pancreatica proposed by Dawson. This finding may also be closely associated with the development of pancreatitis. (Dig Endosc 1994; 6 : 87–93)
Complications of Laparoscopic Cholecystectomy
Authors: YAMAKAWA Tatsuo
Published: August 2007

Summary: Fourteen papers clearly describing morbidity and mortality are evaluated to assess the frequency of major operative and postoperative accidents or complications associated with laparoscopic cholecystectomy and the key technical points important in the prevention of bile duct injury which is the most common operative complication during laparoscopic cholecystectomy.

A total of 108, 612 laparoscopic cholecystectomies were performed in these series. Technical complications relating to the cause of death were encountered in 22 out of 49 cases (44.9%) and the mortality rate was 0.02%. The most common reason for conversion was difficult adhesions around the gallbladder, unclear anatomy of Carot's triangle and bile duct injury. Moreover bile duct injury was the most common technical complication, although injury to the major vessels and intestine led to higher mortality rates than common bile duct injury. Almost all authors have postulated in their papers that the majority of these major complications occured at institutions operating on less than 100 cases. These facts suggest that technical complications can be minimized by guidelines for prevention of operative injury, namely adequate training and experience in humans. In this paper, our technique was introduced and the importance of how to explore Carot's triangle is emphasized to prevent bile duct injury.
Endoscopic Retrograde Cholangiopancreatography in Laparoscopic Cholecystectomy
Authors: SUGAWA Choichi , JOSEPH A. Louis , TAKEKUMA Yoshi , ELLIS Jeri L. , OTAKI Shuji
Published: August 2007

Abstract: With the widespread use of laparoscopic cholecystectomy (LC), the role of pre‐ and postoperative endoscopic retrograde cholangiopancreatography (ERCP) and / or endoscopic sphincterotomy (ES) has become very important. Indications for ERCP with possible ES before LC include clinical suspicion of a common bile duct (CBD) stone alone, evidence of jaundice, recent cholangitis or pancreatitis that is probably due to a duct stone or dilated CBD. Local endoscopic and surgical expertise are important factors in deciding the approach to the pre‐LC patients. The success rate of ductal clearance of stones by ES approaches 90 to 95% in expert hands. ERCP is very effective in the management of post‐LC patients with symptoms, as well as in diagnosing and treating complications such as retained stones, ductal leaks and strictures.
Chronic Ischemic Colitis Associated with Marked Calcifications of the Mesenteric Vessels —Report of Two Cases—
Authors: IKEHATA Atsushi , HIWATASHI Nobuo , KAWARADA Hiroaki , YAMAZAKI Hideo , ITO Kaoru , KINOUCHI Yoshitaka , KIMURA Mitsuo , NOGUCHI Mitsunori , MAEKAWA Hiroki , SUZUKI Hiroto , SHIMADA Takenobu , YAMAGATA Jun , TOYOTA Takayoshi
Published: August 2007

Abstract: Phlebosclerosis of the mesenteric vein is a rare cause of ischemic colitis. The current report includes two patients with segmental ischemic colitis associated with marked calcifications of the mesenteric vessels. No evidence of systemic vasculitis, tuberculosis nor amyloidosis was observed. The patients were previously healthy and had no history of drug use of any kind. Clinical findings included abdominal pain in the right upper quadrant and diarrhea alternating with constipation, and colonic narrowing were discoverd by barium enema. An abdominal X‐ray examination revealed some patchy calcifications in the right and left upper quadrants. An angiography of the superior mesenteric artery revealed sclerosis of the artery, disturbance of colonic blood flow, and calcifications of the mesenteric vessels. The patients were treated with an anticoagulant. In follow‐up studies, barium enema and colonoscopy revealed a gradual progression of the disease over the last five years. Treatment with an anticoagulant may have prevented rapid advancement of the disease and thereby eliminated the need for emergency operations. These unusual venous lesions have been rarely reported, and their etiology and pathogenesis remain unknown.
Present Status of Early Colorectal Cancer in Japan
Authors: SATAKE Yoshiharu , KAMINAGA Norihiro , KATAKURA Shigehiro , FUJITA Rikiya
Published: August 2007

We examined and clinicopathologically analyzed 422 patients with early colorectal cancer that we encountered, and discussed the problems typical of early colorectal cancers in Japan.

In Japan we define early colorectal cancer as consisting of intramucosal cancer and cancer with submucosal invasion. Because histopathologists subjectively diagnose patients with intramucosal cancer, their diagnoses for the same specimen often differ from each other. The only way to avoid such confusion caused by diagnostic differences and to reach a consensus on the diagnosis of intramucosal cancer is to make a diagnosis of intramucosal cancer only in those patients who clearly show the structural atypia and/or the cellular atypia, that are typical of cancer.

No one will deny the importance of the depressed type early cancer, the number of cases of which have recently been increasing in Japan. However, it is also important to assert that endoscopically‐discovered depressed neoplastic lesions are not always cancer. In the depressed neoplastic lesions discovered in our patients, the number of adenoma was almost three times that of cancer. Forty percent of the patients with depressed type early cancer also had an adenoma component. Therefore, at this moment we cannot conclude that early cancer with a depression is de‐novo‐genetic colorectal cancer.

Eighty percent of early colorectal cancers are discovered to be the protruded type of early cancer. Twenty‐six percent of early cancers with submucosal invasion, including early cancers with massively submucosal invasion, are 6 to 10 mm in diameter and 76% of these are protruded early cancers. These facts indicate that colorectal tumors, protruded or depressed, which are more than 6 to 10 mm in diameter should be endoscopically removed to prevent them from becoming advanced cancers.
A Case of Choledochocele Associated with Carcinoma of the Pancreas
Authors: IMAEDA Kenrou , KATAGIRI Kenji , MIYAMOTO Tadahisa , ANDOU Tomoaki , TOKUNAGA Hirokazu , IDE Masayoshi , TSUJI Shigeharu , YAMADA Kyouichi , HOSHINO Makaoto , ITOH Makoto , TAKEUCHI Toshihiko
Published: August 2007

A‐59‐year old woman was admitted with lumbago and back pain. An abdominal ultrasonography and abdominal computed tomography demonstrated a tumor of the body of the pancreas and multiple space occupying lesions in the liver. Endoscopic retrograde chorangiopancreatography revealed a 11 mm cystic dilatation of the terminal portion of the common bile duct protruding into the duodenal lumen and an obstruction of the pancreatic duct in the body portion. Celiac artery angiography showed an irregularity in the wall of the splenic artery. In line with these findings, the patient was diagnosed as suffering from choledochocele associated with carcinoma of the pancreas. As she already had multiple metastatic liver tumors, her treatment was limited to amelioration of her symptoms. Increasing stenosis of the common bile duct, however, required endoscopic sphinctomy and endoscopic retrograde biliary drainage. Type 3 Choledochocele of Alonso‐Lej's classification is very rare, and only a few cases have been reported in association with malignant bile duct tumors. We believe this case to be the first one in our country linked with carcinoma of the pancreas.
Percutaneous Endoscopic Gastrostomy, Duodenostomy and Jejunostomy for Alimentation in Gastrectomized Patients
Authors: NISHIGUCHI Yukio , YOSHIKAWA Kazuhiko , ARIMOTO Yuichi , TAKEUCHI Kazuhiro , YAMASHITA Yoshito , SHIGESAWA Akira , NISHIMURA Shigehiko , SAWADA Ryugo , OGAWA Masafumi , YUKIMOTO Kiyotaka , FUYUHIRO Yuichi , LEE Jae‐To , KANG Soon‐Myoung , BABA Mitsuru , SOWA Michio
Published: August 2007

Percutaneous Endoscopic Gastrostomy (PEG) which can be accomplished with local anesthesia and without the necessity for laparotomy is now gaining popularity as a clinical treatment for patients who have difficulties in swallowing and require long term nutritional support but have an intact gut. A total of 40 patients underwent percutaneous endoscopic placement of a feeding tube in our clinic. They included 37 patients who had had PEG, 1 Percutaneous Endoscopic Duodenostomy (PED) and 2 Percutaneous Endoscopic Jejunostomy (PEJ). Of these patients, 3 had previously had a partial gastrectomy and 1 had had an esophagectomy with esophago‐jejunostomy. Three patients who had undergone a previous partial gastrectomy received different procedures; 1 PEG, 1 PED and 1 PEJ, which were considered to be most appropriate for each patient. One patient with a previous esophagectomy had a PEJ. PEG, PED and PEJ for the patients who had previously undergone a gastrectomy were successfully done with great care. Our experience suggests that PEG, PED or PEJ are rapid, safe and useful procedures for patients who are a poor anesthetic or poor operative risk and can be used even for patients who have undergone previous surgery.
Endoscopically Resected Colorectal Sessile Tumors with Nodular Surface Aggregates
Authors: NISHIKAWA Kunihisa , HIRAI Yoshihiko , MATSUMURA Masaru , YAMAMOTO Hiroyuki , MATSUSHITA Toshio , KUSAKA Toshihiro , TOYOOKA Shigetake , KAWASE Mitsuo , MUKAINO Sakae , SATOH Humiaki , HIROSE Yuki , NOGUTI Masato , KONISHI Humio , KOHLI Yoshihiro
Published: August 2007

Twenty colorectal sessile tumors, with nodular surface aggregates, were endoscopically resected in 20 patients. Among 17 tumors less than 19 mm in diameter, 16 were completely resected in one session and one required piecemeal resection to achieve complete removal. All three lesions measuring over 30 mm were resected piecemeal, and one of these lesions was concurrently heat‐probe treated.

Thus, all lesions were completely resected endoscopically. Histologically, tubular adenoma was identified in nine resected specimens, tubulovillous adenoma in eight, serrated adenoma in one, and carcinoma in adenoma in two. None of the malignant lesions had invaded the submucosa. Adenomas showing severe atypia and carcinomas in adenomas accounted for 55% of all lesions. These findings indicate that endoscopic mucosal resection is the treatment of choice for sessile tumors with nodular surface aggregates; lesions which cannot be managed by this procedure should be surgically resected.
Early Recognition of Isolated Splenic Vein Thrombosis: Diagnostic Value of Endosonography
Authors: HIZAWA Kazuoki , JIMI Seiichirou , AOYAGI Kunihiko , SUEKANE Hiroshi , OGAWA Yoshiaki , TANAKA Masao , FUJISHIMA Masatoshi
Published: August 2007

A 71‐year‐old man was followed‐up for chronic pancreatitis and gastric mucosal cancer after endoscopic resection. Repeated endoscopic ultrasonography incidentally depicted isolated gastric varices and paramural collateral vessels, which had gone unrecognized on conventional endoscopy and abdominal ultrasonography. The features of subsequent angiography were consistent with isolated splenic vein thrombosis. Isolated splenic vein thrombosis, which often follows pancreatitis, is characterized by gastric varices and splenomegaly without portal hypertension. This condition has a poor medical prognosis due to possible variceal hemorrhage, if the condition is left undiagnosed. For patients with chronic pancreatitis, we should not only examine the pancreas but also check for gastric varices using endoscopic ultrasonography, which is a non‐invasive yet sensitive procedure for uncovering this abnormality.