bluuebunny/crossref_metadata_2025 huggingface dataset:
Does box model training improve surgical dexterity and economy of movement during virtual reality laparoscopy? A randomised triala
Authors: CLEVIN LOTTE , GRANTCHAROV TEODOR P.
Published: December 2007

Objective. Laparoscopic box model trainers have been used in training curricula for a long time, however data on their impact on skills acquisition is still limited. Our aim was to validate a low cost box model trainer as a tool for the training of skills relevant to laparoscopic surgery. Design. Randomised, controlled trial (Canadian Task Force Classification I). Setting. University Hospital. Measurements and main results. Sixteen gynaecologic residents with limited laparoscopic experience were randomised to a group that received a structured box model training curriculum, and a control group. Performance before and after the training was assessed in a virtual reality laparoscopic trainer (LapSim®) and was based on objective parameters, registered by the computer system (time, error, and economy of motion scores). Group A showed significantly greater improvement in all performance parameters compared with the control group: economy of movement (p = 0.001), time (p = 0.001) and tissue damage (p = 0.036), confirming the positive impact of box‐trainer curriculum on laparoscopic skills acquisition. Conclusions. Structured laparoscopic skill training on a low cost box model trainer improves performance as assessed using the VR system. Trainees who used the box model trainer showed significant improvement compared to the control group. Box model trainers are valid tools for laparoscopic skills training and should be implemented in the comprehensive training curricula in gynaecology.
Decreased endopelvic fascia elastin content in uterine prolapse
Authors: KLUTKE JOHN , JI QING , CAMPEAU JOSEPH , STARCHER BARRY , FELIX JUAN CARLOS , STANCZYK FRANK Z. , KLUTKE CARL
Published: December 2007

Background. Genital prolapse is a debilitating manifestation of pelvic floor dysfunction. The cause of this condition has not been elucidated. The purpose of this study was to determine elastin content and RNA expression of related enzymes of elastin synthesis in uterosacral ligament biopsies from women with severe prolapse, and controls with normal pelvic support. Methods. Biopsies were taken from the uterosacral ligament tissue of 31 women with Grade III or greater prolapse and 29 women with normal pelvic support. Elastin content was assessed by measuring desmosine using radioimmunoassay, and quantitative real time PCR was performed to quantify mRNA levels of lysyl oxidase (LOX), lysyl oxidase like‐1 (LOXL1), LOXL2 and fibulin‐5 (FIB‐5). Results. The mean desmosine concentration found in uterosacral ligaments of women with prolapse (n =26) was 103.3±59.3 pmolD/mgP compared to controls (n =29) 120.5±47.4 pmolD/mgP (p =0.1943). In the subgroup of subjects with complete procidentia (n =8), mean desmosine concentration was 50.6±25.8 and 127.1±42.2 pmolD/mgP in age‐matched controls (n =12) (p <0.05). In tissue from subjects with more than 2 vaginal deliveries (n =18), the mean desmosine concentration was 99.9±60.7 and 133.0±44.0 pmolD/mgP in controls (n =17) (p <0.05). Expression of LOX, LOXL1 and LOXL2 decreased 8.2‐fold±3.4, 5.0‐fold±1.7 and 15.2‐fold±5.2, respectively (mean±SD) in cases versus controls (p<0.05). Expression of FIB‐5 was increased 3.1‐fold±0.7 compared to controls (p<0.05). Conclusions. Significantly decreased desmosine content was measured in the uterosacral ligament tissue from women with prolapse versus controls in women with parity >2 and in women with complete procidentia. Suppression of mRNA for LOX and two LOX isoenzymes was correspondingly present. These results suggest that altered elastin metabolism is present in women with uterine prolapse.
Nanoscale friction and wear maps
Authors: Tambe Nikhil S , Bhushan Bharat
Published: December 2007

Friction and wear are part and parcel of all walks of life, and for interfaces that are in close or near contact, tribology and mechanics are supremely important. They can critically influence the efficient functioning of devices and components. Nanoscale friction force follows a complex nonlinear dependence on multiple, often interdependent, interfacial and material properties. Various studies indicate that nanoscale devices may behave in ways that cannot be predicted from their larger counterparts. Nanoscale friction and wear mapping can help identify some ‘sweet spots’ that would give ultralow friction and near-zero wear. Mapping nanoscale friction and wear as a function of operating conditions and interface properties is a valuable tool and has the potential to impact the very way in which we design and select materials for nanotechnology applications.
Alternative approach to a heavy weight problem
Authors: Goren Amir , Kim Eddo , Amit Maayan , Bochner Ron , Lev-Maor Galit , Ahituv Nadav , Ast Gil
Published: December 2007

Obesity is reaching epidemic proportions in developed countries and represents a significant risk factor for hypertension, heart disease, diabetes, and dyslipidemia. Splicing mutations constitute at least 14% of disease-causing mutations, thus implicating polymorphisms that affect splicing as likely candidates for disease susceptibility. A recent study suggested that genes associated with obesity were significantly enriched for rare nucleotide variants. Here, we examined these variants and revealed that they are located near splice junctions and tend to affect exonic splicing regulatory sequences. We also show that the majority of the exons that harbor these SNPs are constitutively spliced, yet they exhibit weak splice sites, typical to alternatively spliced exons, and are hence suboptimal for recognition by the splicing machinery and prone to become alternatively spliced. Using ex vivo assays, we tested a few representative variants and show that they indeed affect splicing by causing a shift from a constitutive to an alternative pattern, suggesting a possible link between extreme body mass index and abnormal splicing patterns.
Nexus, crystallographic computing all around the world
Authors: Cranswick Lachlan Michael David , Bisson William , Cockcroft Jeremy Karl
Published: December 2007

Crystallographic Nexus CD-ROMs, containing a range of free crystallographic software for single-crystal and powder diffraction available on the Internet, have been distributed on request since 1996. The free CD is made in the form of a `virtual Internet' with the main intent of benefiting crystallographers with inadequate Internet access. The IUCr funds an annual/biennial update which is distributed to known previous recipients. Feedback from current recipients indicates the CD is still useful. The most current IUCr-funded CD is being produced by the CCP14 project at University College London and The Royal Institution UK for distribution to the ECM 2007 and AsCA 2007 conferences.
Report on a project on three-dimensional imaging of the biological cell by single-particle X-ray diffraction
Authors: Sayre D.
Published: December 2007

Single-particle X-ray diffraction is an extension of X-ray crystallography which allows the specimen to be any small solid-state bounded object; in Shapiroet al.[Proc. Natl Acad. Sci. USA(2005),102, 15343–15346] and Thibaultet al.[Acta Cryst.(2006), A62, 248–261], the reader can find descriptions of a recent StonyBrook/Berkeley/Cornell two-dimensional imaging of a yeast cell by this technique. Our present work is aimed at extending the technique to the three-dimensional imaging of a cell. However, the usual method of doing that, namely rotating the specimen into many orientations in the X-ray beam, has not as yet given sufficiently good three-dimensional diffraction data to allow the work to go forward, the largest problem being the difficulty of preventing unwanted levels of change in the specimen through the extended exposure to a hostile environment of X-rays and, in some cases, high vacuum and/or extreme cold. The present paper discusses possible methods of dealing with this problem.
Report on a project on three-dimensional imaging of the biological cell by single-particle X-ray diffraction. Addendum
Authors: Shapiro David A.
Published: December 2007

In the paper by Sayre [Acta Cryst.(2008), A64, 33–35], a proposal is made to use stereoscopy as a short-term means of overcoming the primarily technological hurdles involved in three-dimensional imaging of the biological cell by soft X-ray diffraction microscopy. This addendum provides a broader perspective on the techniques used by this rapidly maturing community to investigate structural problems in the biological and material sciences.
Electron crystallography: imaging and single-crystal diffraction from powders
Authors: Zou Xiaodong , Hovmöller Sven
Published: December 2007

The study of crystals at atomic level by electrons – electron crystallography – is an important complement to X-ray crystallography. There are two main advantages of structure determinations by electron crystallography compared to X-ray diffraction: (i) crystals millions of times smaller than those needed for X-ray diffraction can be studied and (ii) the phases of the crystallographic structure factors, which are lost in X-ray diffraction, are present in transmission-electron-microscopy (TEM) images. In this paper, some recent developments of electron crystallography and its applications, mainly on inorganic crystals, are shown. Crystal structures can be solved to atomic resolution in two dimensions as well as in three dimensions from both TEM images and electron diffraction. Different techniques developed for electron crystallography, including three-dimensional reconstruction, the electron precession technique and ultrafast electron crystallography, are reviewed. Examples of electron-crystallography applications are given. There is in principle no limitation to the complexity of the structures that can be solved by electron crystallography.
High-pressure diffraction studies of molecular organic solids. A personal view
Authors: Boldyreva Elena V.
Published: December 2007

This paper discusses the trends in the experimental studies of molecular organic solids at high pressures by diffraction techniques. Crystallization of liquids, crystallization from solutions and solid-state transformations are considered. Special attention is paid to the high-pressure studies of pharmaceuticals and of biomimetics.
An unusual red‐edge excitation and time‐dependent Stokes shift in the single tryptophan mutant protein DD‐carboxypeptidase from Streptomyces: The role of dynamics and tryptophan rotamers
Authors: Maglia Giovanni , Jonckheer Abel , De Maeyer Marc , Frère Jean‐Marie , Engelborghs Yves
Published: December 2007

The fluorescence emission of the single tryptophan (W233) of the mutant protein DD‐carboxypeptidase from streptomyces is characterized by a red‐edge excitation shift (REES), i.e., the phenomenon that the wavelength of maximum emission depends on the excitation wavelength. This phenomenon is an indication for a strongly reduced dynamic environment of the single tryptophan, which has a very low accessibility to the solvent. The REES shows, however, an unusual temperature and time dependence. This, together with the fluorescence lifetime analysis, showing three resolvable lifetimes, can be explained by the presence of three rotameric states that can be identified using the Dead‐End Elimination method. The three individual lifetimes increase with increasing emission wavelength, indicating the presence of restricted protein dynamics within the rotameric states. This is confirmed by time‐resolved anisotropy measurements that show dynamics within the rotamers but not among the rotamers. The global picture is that of a protein with a single buried tryptophan showing strongly restricted dynamics within three distinct rotameric states with different emission spectra and an anisotropic environment.
Crystal structure of 5‐methylthioribose 1‐phosphate isomerase product complex from Bacillus subtilis: Implications for catalytic mechanism
Authors: Tamura Haruka , Saito Yohtaro , Ashida Hiroki , Inoue Tsuyoshi , Kai Yasushi , Yokota Akiho , Matsumura Hiroyoshi
Published: December 2007

The methionine salvage pathway (MSP) plays a crucial role in recycling a sulphahydryl derivative of the nucleoside. Recently, the genes and reactions in MSP from Bacillus subtilis have been identified, where 5‐methylthioribose 1‐phosphate isomerase (M1Pi) catalyzes a conversion of 5‐methylthioribose 1‐phosphate (MTR‐1‐P) to 5‐methylthioribulose 1‐phosphate (MTRu‐1‐P). Herein, we report the crystal structures of B. subtilis M1Pi (Bs‐M1Pi) in complex with its product MTRu‐1‐P, and a sulfate at 2.4 and 2.7 Å resolution, respectively. The electron density clearly shows the presence of each compound in the active site. The structural comparison with other homologous proteins explains how the substrate uptake of Bs‐M1Pi may be induced by an open/closed transition of the active site. The highly conserved residues at the active site, namely, Cys160 and Asp240 are most likely to be involved in catalysis. The structural analysis sheds light on its catalytic mechanism of M1Pi.
Structural determinants of nitroxide motion in spin‐labeled proteins: Solvent‐exposed sites in helix B of T4 lysozyme
Authors: Guo Zhefeng , Cascio Duilio , Hideg Kálmán , Hubbell Wayne L.
Published: December 2007

Site‐directed spin labeling provides a means for exploring structure and dynamics in proteins. To interpret the complex EPR spectra that often arise, it is necessary to characterize the rotamers of the spin‐labeled side chain and the interactions they make with the local environment in proteins of known structure. For this purpose, crystal structures have been determined for T4 lysozyme bearing a nitroxide side chain (R1) at the solvent‐exposed helical sites 41 and 44 in the B helix. These sites are of particular interest in that the corresponding EPR spectra reveal two dynamic states of R1, one of which is relatively immobilized suggesting interactions of the nitroxide with the environment. The crystal structures together with the effect of mutagenesis of nearest neighbors on the motion of R1 suggest intrahelical interactions of 41R1 with the i + 4 residue and of 44R1 with the i + 1 residue. Such interactions appear to be specific to particular rotamers of the R1 side chain.
Protein folding transition states probed by loop extension
Authors: Sánchez Ignacio Enrique
Published: December 2007

We propose a new way to characterize protein folding transition states by (1) insertion of one or more residues into an unstructured protein loop, (2) measurement of the effect on protein folding kinetics and thermodynamics, and (3) analysis of the results in terms of a rate‐equilibrium free energy relationship, αLoop. αLoop reports on the fraction of molecules that form the perturbed loop in the transition state. Interpretation of the changes in equilibrium free energy using standard polymer theory can help detect residual structure in the unfolded state. We illustrate our approach with data for the model proteins CI2 and the alpha spectrin SH3 domain.
Solution structure of the C‐terminal domain of Ole e 9, a major allergen of olive pollen
Authors: Treviño Miguel Á. , Palomares Oscar , Castrillo Inés , Villalba Mayte , Rodríguez Rosalía , Rico Manuel , Santoro Jorge , Bruix Marta
Published: December 2007

Ole e 9 is an olive pollen allergen belonging to group 2 of pathogenesis‐related proteins. The protein is composed of two immunological independent domains: an N‐terminal domain (NtD) with 1,3‐β‐glucanase activity, and a C‐terminal domain (CtD) that binds 1,3‐β‐glucans. We have determined the three‐dimensional structure of CtD‐Ole e 9 (101 amino acids), which consists of two parallel α‐helices forming an angle of ∼55°, a small antiparallel β‐sheet with two short strands, and a 3–10 helix turn, all connected by long coil segments, resembling a novel type of folding among allergens. Two regions surrounded by aromatic residues (F49, Y60, F96, Y91 and Y31, H68, Y65, F78) have been localized on the protein surface, and a role for sugar binding is suggested. The epitope mapping of CtD‐Ole e 9 shows that B‐cell epitopes are mainly located on loops, although some of them are contained in secondary structural elements. Interestingly, the IgG and IgE epitopes are contiguous or overlapped, rather than coincident. The three‐dimensional structure of CtD‐Ole e 9 might help to understand the underlying mechanism of its biochemical function and to determine possible structure–allergenicity relationships.
Selenoproteinless animals: Selenophosphate synthetase SPS1 functions in a pathway unrelated to selenocysteine biosynthesis
Authors: Lobanov Alexey V. , Hatfield Dolph L. , Gladyshev Vadim N.
Published: December 2007

Proteins containing the 21st amino acid, selenocysteine (Sec), have been described in all three domains of life, but the composition of selenoproteomes in organisms varies significantly. Here, we report that aquatic arthropods possess many selenoproteins also detected in other animals and unicellular eukaryotes, and that most of these proteins were either lost or replaced with cysteine‐containing homologs in insects. As a result of this selective selenoproteome reduction, fruit flies and mosquitoes have three known selenoproteins, and the honeybee, Apis mellifera, a single detected candidate selenoprotein. Moreover, we identified the red flour beetle, Tribolium castaneum, and the silkworm, Bombyx mori, as the first animals that lack any Sec‐containing proteins. These insects also lost the Sec biosynthesis and insertion machinery, but selenophosphate synthetase 1 (SPS1), an enzyme previously implicated in Sec biosynthesis, is present in all insects, including T. castaneum and B. mori. These data indicate that SPS1 functions in a pathway unrelated to selenoprotein synthesis. Since SPS1 evolved from a protein that utilizes selenium for Sec biosynthesis, an attractive possibility is that SPS1 may define a new pathway of selenium utilization in animals.
Differences in Fine Mucosal Structure between Superficial Spreading Carcinoma and Non‐neoplastic Bile Duct Mucosa Detected by Percutaneous Transhepatic Cholangioscopy
Authors: SATO Masahiro , INOUE Hirokazu , OGAWA Satoshi , OHASHI Shigeki , MAETANP Iruru , IGARASHI Yoshinori , SAKAI Yoshihiro
Published: December 2007

Abstract: Papillogranular mucosa is reportedly characteristic of superficial spreading bile duct carcinoma, but may also be seen in non‐neoplastic ductal tissue. This study was designed to clarify differences between these conditions by examining fine mucosal structure with percutaneous transhepatic cholangioscopy (PTCS) and methylene blue (MB) staining. Sixty‐three patients with malignant bile duct stenoses and 11 with benign bile duct disorders were examined by PTCS and the relationship between fine mucosal structure and histology was defined using endoscopic photographs and biopsy samples. Papillogranular mucosal samples contained superficial spreading carcinoma significantly more often than smooth mucosal samples (p<0.0001). Papillogranular mucosa was classified by fine structure into four types : regular papillogranular, nodular, finely reticulogranular and highly papillary. The latter three types were associated with superficial spreading carcinoma significantly more often than with non‐neoplastic mucosa (p<0.05). However, regular papillogranular mucosa was associated with both neoplastic and non‐neoplastic tissue. All papillogranular mucosal samples not stained with MB contained superficial spreading carcinoma. In 19% of papillogranular mucosa samples fine mucosal structure was identified by routine observation, while in 84% fine structure was determined by a combination of routine observation and MB staining. In conclusion, nodular, finely reticulogranular and highly papillary forms of papillogranular mucosa, as well as papillogranular mucosa which does not stain with MB, are characteristic of superficial spreading carcinoma. The combination of routine observation and MB staining is useful for analyzing the fine mucosal structure of papillogranular mucosa. However, meticulous observation is needed to diagnose superficial spreading carcinoma in regular papillogranular mucosa.
A Case Report of Clostridium D‐l Toxin Positive Colitis with Ischemic Changes after Antibiotic Treatment
Authors: OKADA Mitsuo , IWASHITA Akinori , YANAI Junichi , OH Kohji , HOSHIKO Kiyomi , SEO Mitsuru
Published: December 2007

Abstract: A 52‐year‐old male was admitted to our hospital complaining of crampy abdominal pain of sudden onset, followed by bloody diarrhea. He had been prescribed cefteram pivoxil for gingivitis three days before the onset. A total colonoscopic examination on admission revealed several shallow longitudinal ulcers and erosions, with erythematous, edematous mucosa and luminal narrowing from the sigmoid to the descending colon. Barium enema showed luminal narrowing and thumbprinting in the same region. Fecal culture for Clostridium difficile (C. difficile) on admission was positive and the D‐1 toxin of C. difficile was strongly positive in stool. Two days after admission, the stool was negative for the D‐1 toxin. Biopsies taken from lesions revealed a desquamation of the surface epithelium and some crypt degeneration, abundant fibrinous exudates in the lamina propria, and mild neutrophilic infiltration. Colonic lesions had resolved by seven days after admission. This case suggests that colitis with ischemic changes may result from antibiotic‐associated overgrowth of C. difficile producing the D‐1 toxin during antibiotic treatment.
Endoscopic Ultrasonography for the Detection of Lymph Node Metastasis in Superficial Esophageal Carcinoma
Authors: SHIMIZU Yuichi , MERA Kiyomi , TSUKAGOSHI Hiroyuki , TAKAMASA Mitsuharu , KAWARAZAKI Mitsuru , WATANABE Yutaka , NAKASATO Tomohiko , OOHARA Masanori , HOSOKAWA Masao , FUJITA Masahiro , ASAKA Masahiro
Published: December 2007

Abstract: Preoperative diagnosis of lymph node metastasis is a very important factor in determining treatment for patients with superficial esophageal carcinoma (SEC), in terms of whether or not extensive lymphadenectomy is necessary. To evaluate the usefulness of endoscopic ultrasonography (EUS) for the diagnosis of lymph node metastasis, we compared preoperative EUS findings with postoperative histological findings of resected lymph nodes in 82 patients with SEC who underwent extensive lymphadenectomy. The regional lymph nodes of the esophagus were divided into seven areas, and the capability to diagnose the presence or absence of metastatic lymph nodes was evaluated for each area. The sensitivity of EUS in the detection of metastatic lymph nodes was 48.6% overall, which was less than satisfactory, and the positive predictive value was 72.0% overall. However, we obtained relatively good sensitivity (63.6%) in the upper mediastinal area, which had the highest frequency of metastasis (42% of cases with metastatic lymph nodes); the status of this area has a major influence on prognosis and the risk of postoperative complications. In conclusion, we should recognize that EUS findings suggesting the absence of positive nodes do not provide conclusive evidence and only allow the risk of remaining metastatic nodes to be reduced by approximately one half. Other factors, such as the depth of invasion, as well as the findings of percutanous echography and CT, must be comprehensively evaluated. On the other hand, in patients in whom positive nodes are suspected on EUS, the findings can be regarded as being fairly reliable; therefore, esophagectomy with lymph node dissection should be performed even in SEC. In such cases, EUS findings in the upper mediastinal area may be a good index of the suitability of minimally invasive surgery.
Appendiceal Involvement in Patients with Ulcerative Colitis
Authors: TAKIZAWA Hideaki , KOIKE Masahiko , HIROSE Sinnichi , ASAKURA Hitoshi
Published: December 2007

Abstract: There have been few case reports of ulcerative colitis with appendiceal involvement because the appendix has generally received little attention in ulcerative colitis patients. We encountered an inflammatory appendiceal lesion in a patient with ulcerative colitis, which piqued our interest in endoscopic findings of the appendix in these patients. Subsequently, we carefully observed the appendiceal orifice during colonoscopy in patients with ulcerative colitis. From December 1994 to December 1996, 44 patients with ulcerative colitis underwent colonoscopy in Nagaoka Red Cross Hospital. Among these 44, there were three in whom it had not been possible to observe the cecum. During this period, we encountered inflammatory appendiceal lesions in eight cases. Therefore, 20% (8/41) of patients with ulcerative colitis undergoing colonoscopy had appendiceal involvement. Five of these eight patients showed a colonoscopically normal cecum, such that appendiceal involvement thought to be a colonoscopic skip lesion was seen in five (12%: 5/41). There was only one case who had an appendiceal lesion without a microscopically diseased cecum. Appendiceal involvement may be frequent in ulcerative colitis. We thus recommend that endoscopists meticulously examine the appendiceal orifice during colonoscopy in patients with ulcerative colitis.
Survival Benefit of Screening for Early Esophageal Carcinoma in Head and Neck Cancer Patients
Authors: HORIUCHI Masatoshi , MAKUUCHI Hiroyasu , MACHIMURA Takao , TAMURA Yoshiyuki , SAKAI Makoto
Published: December 2007

Abstract: Primary cancer of the head and neck was diagnosed in 676 cases. Systematic endoscopic screening of the upper gastrointestinal tract (including iodine staining of the esophagus) was performed within 1 month of diagnosing head and neck cancer in order to determine the possible presence of a second malignancy‐ We divided cases in which esophageal cancer was detected into a group in which the initially diagnosed head and neck cancer had been treated curatively and those in which the treatment had been non‐curative. A pathological diagnosis of primary esophageal cancer was obtained in 37 cases (5.5%). The incidence of esophageal cancer associated with cancer of the oral cavity or pharynx was significantly higher (10.9%) than in cases with an associated cancer of the larynx or paranasal sinus (1.9%, p<0.05). All but one of the 37 cases detected by screening were asymptomatic and had superficial carcinoma. Of these lesions, 19 Were mucosal carcinomas, 17 submucosal carcinomas and only one an advanced cancer. Twenty‐four of these 37 cases had died. The cause of death was head and neck cancer in 17, esophageal cancer in two and other causes in five. The 5‐year survival rate of cases in whom the initial head and neck cancer had been treated curatively was 46.7%.

The risk of synchronous esophageal cancer associated with cancer of the head and neck is high. Early detection of esophageal cancer at the time of diagnosing cancer of the head and neck and treatment at an early stage is a new strategy for improving the long‐term outcome of cases with head and neck cancers associated with esophageal cancer.
Endoscopic Reduction of Acute Gastric Volvulus in a Child
Authors: NAGASHIMA Masako , SHIMIZU Seiji , FUJIMOTO Sotaro , SUYAMA Yoshikazu , OHTSUKA Hirotomo , KUTSUMI Hiromu , SAKAMOTO Shinnichi , SUGETA Nobuyuki , OKUYAMA Yusuke , MYOJYO Satoshi , YAMASHITA Yasuhide , NOMURA Kennichi
Published: December 2007

Abstract: An 11‐year‐old girl with cerebral palsy was admitted with complaints of frequent vomiting and upper abdominal distension. After plain X‐ray examination and upper gastrointestinal contrast study, she was diagnosed as having acute mesenterioaxial volvulus of the stomach. Endoscopic reduction was successfully performed. We describe herein the technical details of the endoscopic reduction in this rare case. In non‐infant pediatric patients with primary gastric volvulus, we recommend that endoscopic reduction be considered prior to surgical intervention.
A Case of Kissing Esophageal Ulcers of Unknown Etiology
Authors: HONMYO Ubehiko , SHIMADA Shinya , MURAKAMI Akitoshi , MIZUMOTO Seiichi , YOSHINAKA Ichiro , MAEDA Masaomi , YAMAMOTO Sin‐ichi , MISUMI Atsunobu , OYAMA Hironori
Published: December 2007

Abstract: A 41‐year‐old man with esophageal ulcers of unknown etiology is reported. Endoscopic examination was performed for evaluation of swallowing difficulty. The lesions were located in the middle portion of the esophagus. There were no findings correlating with either peptic ulcer or reflux esophagitis. In addition, he had no history of provoking factors, such as bacterial, chemical, traumatic or physical agents. Although the cause of these lesions was not clarified, we diagnosed acute benign ulcers following histological examination of the biopsy specimens. The patient was treated with a proton pump inhibitor and sodium alginate. The dysphagia and other symptoms subsided promptly, and the lesions healed completely within three weeks. We discuss herein the relationship between endoscopic findings and the etiology of kissing ulcer.
Complications Following Percutaneous Endoscopic Gastrostomy: Acute Respiratory Infection and Local Skin Infection
Authors: KANIE Jiro , SHIMOKATA Hiroshi , AKATSU Hiroyasu , YAMAMOTO Takayuki , IGUCHI Akihisa
Published: December 2007

Abstract: Few studies of percutaneous endoscopic gastrostomy (PEG) have evaluated the effects of antibiotic prophylaxis, PEG placement technique and early PEG feeding on acute postoperative complications. In this retrospective study, we investigated associations between postoperative management of PEG and complications of infection. The medical records of 271 patients were included in this study. Administration of antibiotics, early and delayed enteral feeding, and PEG placement technique were analyzed as risk factors for infectious complications. The rate of local skin infection correlated with early PEG feeding, but there was no difference in the rate of local skin infection due to postoperative administration of antibiotics. Early feeding with the usual enteral formula was a strong risk factor for local skin infection. The rate of local skin infection was higher in the “Push/Pull” technique than the “Introducer” technique. As for aspiration, the rate of complication was lower in groups with postoperative administration of antibiotics than in groups without administration of antibiotics, but there was no association between aspiration and early feeding or PEG placement technique. Local skin infection correlated with early postoperative feeding and was not correlated with antibiotic prophylaxis. However, the administration of antibiotics is recommended for the prevention of aspiration.
Mucosal Spreading Depressed Type Colorectal Tumors: A Report of Two Cases
Authors: TOGASHI Kazutomo , KONISHI Fumio , KOJIMA Masayuki , ITABASHP Kunihiro , KANAZAWA Kyotaro
Published: December 2007

Abstract: Superficial depressed type colorectal carcinomas usually show invasion into the submucosa while the tumor is small, measuring less than 10 mm in diameter. We experienced two rare cases of superficial depressed type colorectal tumors of more than 15 mm in diameter which only displayed intramucosal spread. These two lesions showed a clearly depressed appearance on colonoscopy and in the resected specimens, which were different from creeping tumors. One of the lesions was histologically diagnosed as being well differentiated adenocarcinoma without submucosal invasion, and the other was an adenoma with severe atypia. Both lesions had no Ki‐ras point mutation and this result was consistent with recent genetic studies on depressed type colorectal tumor. Based on these colonoscopic findings, a simple change in the quantity of air inside the lumen may effectively distinguish a depressed type tumor larger than 15 mm, which is limited to the mucosa, from one with submucosal invasion. Thus bowel resection can be avoided in such cases.
Non Traumatic Neuroma of the Bile Duct: Report of a Case
Authors: Tsitouridis John , Kouklakis Georgios , Xiarhos Panagiotis , Patakiuta Fotini
Published: December 2007

We report a case of a 46‐year‐old man with a stricture of the bile duct which was caused by neuroma. The patient had a history of six months jaundice without a previous history of abdominal surgical operation. MR imaging and MRCP clearly picked up the dilatation of intrahepatic biliary ducts and the level of stenosis, but it was very difficult to differentiate benign neuroma from malignant stenosis of the common bile duct. Results of preoperative CT, MRI and ERCP evaluation and postoperative histological examination were presented.
Endoscopic Fibrin Glue Injection with Coaxial Double Lumen Needle for Severe Upper Gastrointestinal Bleeding
Authors: IWASE Hiroaki , KUSUGAMF Kazuo , TUZUKI Tomoyuki , SUGA Syoji , FURUTA Ryuichi , NAKAMURA Motosuke , FUNAKI Yasusi , HONJYO Takayuki , KOJIMA Keishi , MAEDA Osamu
Published: December 2007

Although endoscopic hemostasis is an effective treatment for acute upper gastrointestinal bleeding, permanent hemostasis may be difficult to achieve by conventional endoscopic treatment alone in some patients. In addition, conventional hemostatic endoscopic therapy is limited in patients with a risk of gastrointestinal ulcer perforation. We tried endoscopic fibrin glue injection in 21 patients as a new approach to control severe upper gastrointestinal bleeding. A new type of coaxial double lumen needle was used in the last 15 patients. Hemostasis was obtained immediately by fibrin glue injection in all 7 patients after unsuccessful attempts using conventional methods, including absolute alcohol or epinephrine injection, clipping, or electrocoagulation. There were no episodes of rebleeding in this group. In 10 of the 14 patients who underwent endoscopic fibrin glue injection as the primary therapy, complete hemostasis was achieved with the initial treatment. The remaining 4 required a second injection within 48 hours. There were no treatment‐related complications. None of the patients required an additional surgical operation for bleeding, and the period of hospitalization was reduced after the introduction of fibrin glue injection. Considering the effect on acceleration of ulcer healing, endoscopic fibrin glue injection is an effective treatment with no risk of tissue injury. This technique can be used as the first choice or after failure of conventional endoscopic hemostatic methods.
Current Status of Laparoscopic Surgery in China: Review of more than 150,000 Cases
Authors: LIU Guoli
Published: December 2007

To review the use of laparoscopic surgery in China, in 1997 the Chinese Society of Laparoscopic Surgery sent questionnaires to all hospitals which undertake laparoscopic surgery. Analyzable questionnaires were returned from 222 hospitals. A total of 156,515 patients in 222 hospitals had undergone laparoscopic surgery by the end of March, 1998. These included 50 categories of laparoscopic general surgery, 9 categories of gynaecologic surgery, 7 categories of urological surgery, and 13 categories of thoracoscopic surgery. Laparoscopic cholecystectomy accounted for 91% of all 156,515 cases. Among these 3005 cases (2.1%) were changed to open cholecystectomy or lapa‐rotomy, and 1025 cases (0.71%) developed operative complications, with a mortality of 0.02% (27 cases). The mean rate of bile duct injury was 0.19% (range 0–2%) with bile leak in 0.14%, hemorrhage in 0.11%, and bowel injuries in 0.04% of patients. Since its introduction in 1991 in China, laparoscopic surgery has become increasingly widely used, especially for choecystectomy. It should continue to develop with further economic progress in China. (Dig Endosc 1999; 11: 215–219)
Endoscopic Bilateral Hepatic Drainage with Self‐Expandable Metallic Stents for Malignant Hilar Stricture
Authors: KIN Hideyuki , KUBOTA Yoshitsugu , SUMITOMO Yasuhiko , KIRIYA Keiichi , AGAWA Hiroyuki , SHIMATANI Masaaki , SUZUKI Naoyuki , KOJIMA Hiroyoshi , ITO Kazuki , KOJIMA Koichi , INOUE Kyoichi
Published: December 2007

Endoscopic insertion of self‐expandable metallic stents is considered to be safer and less invasive than percutaneous stenting for patients with malignant biliary strictures. However, the technique of implantation of multiple self‐expandable metallic stents by endosocpic means has not yet been fully established. We evaluated the technical feasibility of endoscopic negotiation of bilateral hepatic ducts with subsequent placement of multiple self‐expandable metallic stents in parallel. Bilateral hepatic ducts were negotiated with guidewires, and self‐expandable metallic stents were sequentially introduced and deployed over the prepositioned guidewires in seven patients with irre‐sectable malignant hilar strictures. Insertion and deployment of self‐expandable metallic stents into both the right and left hepatic ducts were successful in six of the seven patients. The remaining patient was eventually treated with bilateral hepatic drainage using two wallstents; one was inserted endoscopically and the other percutaneously. The patients were followed up for 36–349 days (mean; 227). In two patients, stent occlusion due to sludge formation occurred 119 and 178 days after the treatment. However, endoscopic reintervention was easily performed with a favorable clinical outcome in both patients. Endoscopic bilateral hepatic drainage of multiple, self‐expandable metallic stents in parallel is considered to be a simple, safe, and reliable for irresectable malignant hilar stricture. (Dig Endosc 1999; 11: 225–230)
Laparoscopic Pancreatic Biopsy in Autoimmune Pancreatitis—Report of TWO Cases
Authors: MATSUMOTO Toshifumi , BANDOH Toshio , YOSHIDA Takanori , KITANO Seigo
Published: December 2007

Two cases of autoimmune pancreatitis that were diagnosed by laparoscopic pancreatic biopsy are reported. Patient 1 was a 71–year‐old woman with obstructive jaundice and dry eyes. Endoscopic retrograde cholangiopancreatography (ERCP) revealed stenosis of the distal common bile duct and proximal main pancreatic duct. Only the head of the pancreas was enlarged. The patient had associated Sjogren's syndrome and sclerosing cholangitis. Patient 2 was a 65–year‐old man with obstructive jaundice that occurred after laparoscopic cholecystectomy. ERCP revealed a diffusely irregular and narrowed pancreatic duct and stenosis of the distal common bile duct. The whole pancreas was enlarged. Both patients underwent laparoscopic pancreatic biopsy to rule out pancreatic cancer. The definitive diagnosis in each case was autoimmune pancreatitis. The postoperative course in both cases was uneventful. Both patients recovered quickly with steroid therapy undertaken soon after the biopsy. In summary, a laparoscopic approach for the pancreatic biopsy in autoimmune pancreatitis appears to be feasible and useful in determining the therapeutic strategy. (Dig Endosc 1999; 11: 250–254)
A Case of Non‐Alcoholic Pancreatitis Treated with Steroid Followed‐up Using Intraductal Ultrasonography and Endoscopic Retrograde Pancreatography
Authors: OKANIWA Shinji , OYAMA Tsuneo , TAKAMATSU Masato , HISA Takeshi , TOMORI Akihisa , HOTTA Kin‐ichi , YAMADA Shigeru
Published: December 2007

A 42‐year‐old man with jaundice was found to have a pancreatic mass in the head by ultrasonography. Endoscopic retrograde cholangiopancreatography (ERCP) showed a segmental narrowing of the main pancreatic duct (MPD) with a mild upstream dilatation and an extrinsic stenosis of the inferior common bile duct (CBD). lntraductal ultrasonography (IDUS) showed a diffuse hypoechoic area with echogenic spots surrounding the narrowed MPD and the stenotic CBD. He was suspected of having autoimmune pancreatitis because of a characteristic pancreatogram, and 30 mg/day predniso‐lone was started. Two weeks later, the narrowing of the MPD and the stenosis of the CBD improved dramatically. But the hypoechoic area remained separate from the MPD with a fine reticular pattern on the inside. It completely disappeared in the eighth week. The diachronic changes in the IDUS were characteristic in that the hypoechoic area, which initially surrounded the MPD, disappeared near the MPD, followed by a distant area. This might explain the discrepancy between the images of ERCP and IDUS in the second week of steroid therapy.
A Case of Esophageal Cyst Excised Successfully Using Laparoscopy
Authors: SAKAMOTO Kazuhiro , MIZOBUCHI Noboru , NARUMI Kenji , WATABE Suguru , OKUZAWA Atsushi , SHIROTA Shigeru , KAJIYAMA Yoshiaki , KOBAYASHI Shigeru , HAYASHIDA Yasuo , KAMANO Toshiki , TSURUMARU Masahiko , FUNABIKI Hitoshi
Published: December 2007

Laparoscopic excision of an esophageal cyst was successfully performed on a 29‐year‐old male. The patient, complaining of back pain, was admitted to our hospital for further evaluation of a submucosal esophageal tumor. Close examination revealed a cystic tumor originating from the proper muscular layer at the distal esophagus, measuring 3 cm in diameter. Under general anesthesia, the tumor was excised laparoscopi‐cally without esophageal mucosal injury, with monitering by esophagoscopy. Postoperative esophagography showed no stagnation or stenosis. He was discharged on the 11th postoperative day. The cyst was diagnosed pathologically as an inclusion cyst of the esophagus. Laparoscopic or thoracoscopic surgery is a useful treatment for benign esophageal tumors, because it is less invasive giving more rapid recovery. Concomitant esophagoscopic monitering is beneficial to avoid injury of the esophageal mucosa, especially in such benign tumors that are firmly adherent to the esophageal muscle and mucosal layer.
Immunological Rapid Urease Test for Detecting Helicobacter pylori: Comparative Study of Biopsy Specimens and Gastric Mucus
Authors: SATO Tadashi , FUJINO Masayuki A. , KOJIMA Yuichiro , KITAHARA Fumiaki , NAKAMURA Toshiya , MOROZUMI Atsuro , NAGATA Kumiko , SEKIGUCHI Tetsushi , NAKAMURA Michihiro , HOSAKA Hidehiro
Published: December 2007

Abstract: A variety of reliable methods are available for the detection of H. pylori during upper gastrointestinal endoscopy. We evaluated the clinical utility of an analyzer for H. pylori urease composed of a solid‐phase tip coated with a monoclonal antibody against H. pylori urease and ion‐sensitive field effect transistor‐based pH sensor system. Samples of both gastric mucus and gastric mucosal specimens were collected and the results from this system were compared. Sensitivity and specificity were 97% and 100% for mucus samples and 92% and 97% for mucosal specimens in the present system; compared to 95% and 96% for histological examination, 92% and 100% for bacteriological test, and 89% and 100% for rapid urease test, respectively. These results confirmed that the present system had high clinical sensitivity and specificity, especially for testing of mucus samples. This method has the advantage of requiring only one sample per patient because mucus can be collected from a broad area of the stomach lumen by stroking the mucosal surface with a brush. (Dig Endosc 1999; 11: 42–46)
Two Cases of Rectal Varices Treated by Endoscopic Variceal Ligation
Authors: SATO Takahiro , YAMAZAKI Katsu , TOYOTA Jouji , KARINO Yoshiyasu , OHMURA Takumi , SUGA Toshihiro
Published: December 2007

Abstract: Case 1 was a 49‐year‐old asymptomatic, woman with enlarged esophageal varices due to cirrhosis of the liver. Fourteen days after the last session of endoscopic injection sclerotherapy (EIS) for esophageal varices, colonoscopy revealed large tortuous rectal varices extending 4 cm from the dentate line. Endoscopic variceal ligation (EVL) was performed for rectal varices, and bands were placed on the varices at seven sites. There were no complications. Seven days after EVL, colonoscopy revealed ulcers in the rectum, and shrinkage of varices. Case 2 was a 62‐year‐old woman with general fatigue due to cirrhosis of the liver. At 50 years of age, she underwent a transection of the esophagus to remove varices, and splenectomy. At 57 years of age, EIS was per formed for recurrent esophageal varices. Colonoscopy was performed because of anal bleeding, and revealed tortuous rectal varices extending 5 cm from the dentate line. EVL was then performed, and bands were placed on the varices at eight sites, with no complications. Seven days after EVL, colonoscopy indicated ulcers in the rectum and shrinkage of the varices. EVL appears to be a safe and effective therapy for rectal varices. (Dig Endosc 1999; 11: 66–69)
Endoscopic Management of Gastric Phytobezoars — Report of a Case
Authors: KOUKLAKIS Georgios S. , EFTHYMIOU Alkiviadis K. , TSITOURIDIS Ioannis A. , DOKAS Stefanos M. , STEFANIDIS Stefanos H.
Published: December 2007

Abstract: We report a case of two large stomach phytobezoars whose removal from the stomach was achieved by means of endoscopic fragmentation. The patient was a 42‐year‐old who had a history of vagotomy with pyloroplasty and practiced excessive consumption of fruits and vegetables; a follow‐up endoscopy revealed two large phytobezoars attached to the mucosa of the fundus and corpus. In two sessions, the phytobezoars were fragmented with large‐diameter polypectomes and a third endoscopy revealed no sign of the remaining parts, which had obviously passed through the pylorus and had been excreted with the feces. The successful endoscopic management of the phytobezoars in this case suggest that this procedure may be the treatment of choice in such cases, especially since surgery and its potential complications are avoided. (Dig Endosc 1999; 11: 165–168)
An Analytical Solution for Shear Stress Distributions During Oblique Elastic Impact of Similar Spheres
Authors: Garland Philip P. , Rogers Robert J.
Published: December 2007

A new solution method for the oblique elastic impact of similar spheres with Coulomb friction is presented. The solution uses approximations of the shear stress distributions at each time step during impact. These distributions are solved from analytical formulations and are able to account for both full sliding and partial-slip scenarios that may both be present for this problem due to inclusion of tangential compliance and friction effects. Comparison to previous continuum models in the literature shows very good agreement for the contact force wave forms obtained. The major advantage of this method is the drastic reduction in computation time required compared to previous solutions.
Resolving the Sequence-Dependent Stiffness of DNA Using Cyclization Experiments and a Computational Rod Model
Authors: Goyal Sachin , Perkins Noel C. , Meiners Jens-Christian
Published: December 2007

Structural deformations of DNA play a central role in many biological processes, including gene expression. The structural deformations are sensitive to the material properties of the molecule, and these, in turn, vary along the molecule’s length according to its base-pair sequence. Examples of “sequence-dependent” material properties include the stress-free curvature and the stiffness for bending and torsion. Quantifying and separating these sequence-dependent properties from experimental data remains a significant challenge as they often work in unison in nature. In this paper, we offer a method for resolving and quantifying the sequence-dependent stiffness of DNA from cyclization (loop closure) experiments using a computational rod model of the molecule.