bluuebunny/crossref_metadata_2025 huggingface dataset:
CYTOMEGALOVIRUS‐ASSOCIATED GASTRIC ULCERS IN IMMUNOCOMPROMISED PATIENTS
Authors: Fukami Takanori , Akiyama Kazumi , Ohbayashi Yuka , Ohyama Tomoyo , Horikawa Makoto , Ishida Toshihiko , Kurata Noriyuki , Ohbayashi Seiichi
Published: March 2003

Gastric ulceration is a rare manifestation of cytomegalovirus (CMV) infection in the immunocompromised host. Two cases with CMV‐associated gastric ulcers in immunocompromised patients are reported. Case 1 involved a 65‐year‐old male who underwent a cadaveric renal transplantation because of chronic renal failure. He was treated with immunosuppressive agents and steroids. After 3 months of the treatment, he developed CMV‐associated gastric ulcers with evidence of CMV inclusion bodies, CMV antigen and CMV–DNA in the gastric ulcers. After three courses of ganciclovir therapy for 5 months, endoscopic images revealed complete healing of the gastric ulcers. This case supports the use of ganciclovir, which can lead to complete healing of gastric ulcers caused by CMV. Case 2 involved a 69‐year‐old male with interstitial pneumonia who was admitted to hospital because of rapid progression of interstitial pneumonia. He was treated with repeated pulses of methylprednisolone and cyclophosphamide. He developed CMV‐associated gastric ulcers with evidence of CMV inclusion bodies, CMV antigen and CMV–DNA in the gastric ulcers after 1 month of the treatment with high doses of methylprednisolone and cyclophosphamide. Endoscopic images revealed multiple ulcers and erosions in the gastric antrum. Ganciclovir treatment was started, but he died of interstitial pneumonia. In this case, the ulcers were considered to be precipitated by CMV infection and the use of a high dose methylprednisolone. These cases emphasize the need for a careful histological examination for CMV in gastric ulcers in immunocompromised patients.
Endoscopic mucosal resection for early adenocarcinoma arising in Barrett's esophagus
Authors: Hironaka Shu‐ichi , Boku Narikazu , Ohtsu Atsushi , Ochiai Atsushi , Yoshida Shigeaki , Ejiri Yutaka
Published: March 2003

A 58‐year‐old man was diagnosed to have an esophageal adenocarcinoma arising in Barrett's esophagus by screening examination at the previous hospital. Endoscopically, a slightly reddish elevated lesion with a central depressed component was detected in the Barrett's epithelium. Endoscopic ultrasonography showed the thickness of the second layer of the esophagus and no enlarged lymph node. Histological examination of a biopsy specimen revealed well or moderately differentiated adenocarcinoma. From these findings, the lesion was diagnosed as a mucosal esophageal cancer, type IIa + IIc, arising in Barrett's esophagus. As he refused operation, the lesion was resected endoscopically with his informed consent. Histologically, the resected specimens showed moderately differentiated adenocarcinoma arising in Barrett's esophagus. The adenocarcinoma had invaded the superficial muscularis mucosa, but was limited to the deep one with no vessel invasion. Barrett's esophagus often has a double muscularis mucosa. Connective tissues containing vascular and lymphatic vessels exist between them. However, one consideration is whether the existence of vessels between the double muscularis mucosa and the presence of vessel invasion are risk factors for metastasis. In order for a definitive indication for endoscopic mucosal resection, the frequency of lymph node and distant metastasis in cases of early Barrett's cancer needs to be investigated.
Adrenal adenoma mimicking a submucosal tumor of the stomach
Authors: Shudo Ryushi , Yazaki Yasuyuki , Sakurai Shinobu , Uenishi Hiroshi , Yamada Hiroto , Sugawara Kenji
Published: March 2003

The widespread use of diagnostic imaging modalities has increased the incidental detection of adrenal masses. We experienced a case of adrenal adenoma that was detected incidentally on mass X‐ray examination of the stomach, with findings that were initially suggestive of a gastric submucosal tumor. Only a few cases of adrenal adenoma that resembles a gastric submucosal tumor on diagnostic imaging have been reported. In addition, only a few papers have described the endoscopic ultrasonography findings of adrenal tumors. As the preoperative endoscopic ultrasonography findings of the tumor in our patient correspond with the features of the cut surface of the resected tumor, endoscopic ultrasonography appears to be useful as a new imaging technique in the diagnosis of adrenal adenoma. As endoscopic ultrasonography is minimally invasive, it can be performed in an outpatient setting to collect useful information. As adrenal tumors can be visualized relatively easily, the presence of adrenal lesions should also be searched for when endoscopic ultrasonography is performed for biliary or pancreatic disorders.
Successful endoscopic therapy of superficial esophageal cancer on varices in a patient with alcoholic liver cirrhosis
Authors: Funakoshi Kazuhiro , Akiyama Nobuhiro , Kozakai Ikuo , Arai Futoshi , Motoyama Hirotaka , Kato Toshiyuki , Ogoshi Kazuei , Ohta Tamaki
Published: March 2003

A case of successful endoscopic therapy of superficial esophageal cancer on varices in a patient with alcoholic liver cirrhosis is reported. A slightly depressed superficial cancer (type 0‐IIc) occupied half the inner surface of the middle esophagus. Endoscopic ultrasonography revealed esophageal varices and periesophageal collaterals, but no perforating veins connecting the varices and collaterals were observed where the cancer was located. The esophageal cancer could not be detected even with a 20 MHz microprobe. The tortuous esophageal varices in the lower esophagus were endoscopically ligated to reduce blood flow just below the cancer and 10 mL polidocanol solution was endoscopically injected to induce sclerosis of the varices. After these procedures, the mucosal cancer was endoscopically resected without any severe complications and residual cancer was eliminated by cauterization using a heater probe. Histopathological examination revealed that poorly differentiated squamous cell carcinoma invaded into the lamina propria mucosae but not into the vessels or the lymphatic system. Three years after treatment, the patient showed no signs of local recurrence of cancer. It is considered that the endoscopic techniques used in this patient constitute a valuable and minimally invasive treatment for superficial esophageal cancer on varices.
Pulsatile Wave Observed by Endoscopic Color Doppler Ultrasonography in Rectal Varices
Authors: Sato Takahiro , Yamazaki Katsu , Toyota Jouji , Karino Yoshiyasu , Ohmura Takumi , Kuwata Yasuaki , Suga Toshihiro
Published: March 2003

A 52‐year‐old man with portal hypertension due to Hepatitis C developed anal bleeding, and endoscopic variceal ligation was performed for the internal hemorrhoids. This patient experienced anal bleeding after 1 year, and colonoscopy revealed tortuous rectal varices extending 4 cm from the dentate line. Color flow images of rectal varices and a continuous wave with fast‐Fourier transform analysis were detected via endoscopic color Doppler ultrasonography, and a pulsatile wave was delineated at the anal site of the rectal varices. Endoscopic injection sclerotherapy for rectal varices was performed on this patient, and endoscopic color Doppler ultrasonography revealed the disappearance of variceal blood flow and the decrease of pulsatile wave at anal site of rectal varices.
New integrated ultrasonic surgical system, ‘Sonosurg’
Authors: Yamakawa Tatsuo , Kitano Seigo , Kimura Taizo , Matsumoto Sumio
Published: March 2003

A new surgical system named ‘SonoSurg’ integrating both the ultrasonic coagulating cutter and the conventional ultrasonic aspirator has been developed for clinical use. It maintains the functions of each independent device. Various types of hand pieces can be easily exchanged at the time of surgery. Moreover, all output switches are installed in the common foot switch. Therefore, the extent of the application of this system has been extremely expanded through these additional ancillary units with different function or varieties of hand pieces that are usable in accordance with the purposes. Experience with this system used in endoscopic or open surgeries at a couple of institutions is evaluated in this paper. We believe that the integration of these two different models will be very useful in various aspects, such as the improvement of surgical safety and to simplify surgical procedures as well as functional improvement of the operating theater.
Changes in endoscopic findings of primary aortoduodenal fistula
Authors: Fujimori Shunji , Kishida Teruyuki , Uchida Naoya , Ohiso Giichiro , Kotoyori Makoto , Yoshizawa Masashi , Matsumoto Satoshi , Tanaka Noritake , Yamashita Kiyohiko , Sakamoto Choitsu
Published: March 2003

Primary aortoenteric fistula is very rare and a highly lethal entity. It is very important not to miss a few chances to diagnose it endoscopically. We report our experience of a case of primary aortoduodenal fistula. An 80‐year‐old woman complained of repeated hematemesis, bloody bowel discharge, and hemorrhagic shock. An abdominal aortic aneurysm was detected by an abdominal angiography. Duodenoscopy was performed 3 and 5 days after hematemesis, showing two different patterns of endoscopic findings. Three days after hematemesis, an undermining ulcer with a dark red clot at its bottom was detected in the third part of the duodenum. Five days after hematemesis, the base of the ulcer was covered with yellowish matter on the red clot. Six days after hematemesis, aortoduodenal fistula was confirmed in the third part of the duodenum at surgery. An ulcer with yellowish matter as well as with a red clot in the third and fourth parts of the duodenum by endoscopy might be indicative of aortoduodenal fistula.
COMPARATIVE STUDY AMONG THREE METHODS FOR ORAL COLONOSCOPY PREPARATION: MANITOL, POLYETHYLENE GLYCOL and ORAL SODIUM PHOSPHATE ENEMA
Authors: Macedo Erika P , Ferrari Angelo P
Published: March 2003

Background: Only appropriate colon cleansing enables total and detailed evaluation of the whole colonic mucosa, essential for safe colonoscopy, and good diagnostic and therapeutic results. The present study compared three methods of outpatient colonoscopy preparation (manitol, polyethylene glycol and oral sodium phosphate enema).

Methods: Ninety patients referred for colonoscopy were prospectively randomized into three groups (group 1 manitol; group 2 polyethylene glycol; group 3 oral sodium phosphate enema). Patient tolerance to preparations was evaluated by levels of abdominal pain, nausea, vomiting and taste. The effectiveness of intestinal cleansing and the amount of residual liquid in the colon was recorded. Serum levels of creatinin, sodium, potassium, calcium, phosphorous and bicarbonate were determined before colonic lavage, before colonoscopy and after the procedure.

Results: The three groups were similar in patient tolerance and preparation quality, and electrolyte changes occurred in every group, without clinical manifestation. In spite of these alterations, serum levels were inside normal limits in most of the patients.

Conclusions: The three methods of colon cleansing were equally tolerated and effective. Electrolyte changes were present universally, being less important in the polyethylene glycol group. In spite of such changes, there were no clinical complications.
ACCURACY OF ENDOSCOPIC DIAGNOSIS OF HELICOBACTER PYLORI IN PATIENTS WITH HEMORRHAGIC PEPTIC ULCERS
Authors: WONG REI MING , OTA SHINICHI , BAMBA HIROMI , ITOYAMA SHINJI , SEKINE SUSUMU , KAWAMOTO CHIAKI , YOSHIDA YUKIO
Published: March 2003

Background:  Recent progress in Helicobacter pylori eradication has resulted in dramatic improvements in the incidence of peptic ulcers and decreased rates of ulcer relapse. Because bleeding is an important complication of ulcer diseases, accurate diagnosis of H. pylori infection is necessary.

Methods:  We studied the efficacy of diagnostic methods to detect H. pylori in hemorrhagic peptic ulcer patients. A total of 59 patients who had received emergency endoscopy because of symptoms such as hematemesis, melena or tarry stool, were examined. Endoscopic methods of H. pylori diagnosis (culture, histological assessment and rapid urease test) and serum anti‐H. pylori assays were used in the hemorrhagic peptic ulcer group and the control group.

Results:  The percentage of endoscopically determined H. pylori‐negative patients was significantly higher in the hemorrhagic ulcer group than the control group (P < 0.05). Out of the endoscopically determined H. pylori‐negative patients in the hemorrhagic ulcer group, 78.9% were serologically H. pylori‐positive.

Conclusion:  Endoscopic methods are not sufficient for the diagnosis of H. pylori infection in hemorrhagic ulcer patients. Therefore, serum anti‐H. pylori assessment should also be performed for such patients.
Epidemiological study of symptomatic gastroesophageal reflux disease in China: Beijing and Shanghai
Authors: Guozong Pan , Guoming Xu , Meiyun Ke , Shaomei Han , Huiping Guo , Zhaoshen Li , Xiucai Fang , Duowu Zou , Sucai Lu , Jing Liu
Published: March 2003

OBJECTIVE: To explore the 1‐year point prevalences (July–September 1996) of symptomatic gastroesophageal reflux (GER), gastroesophageal reflux disease (GERD) and reflux esophagitis (RE) in the adult population of two Chinese city‐regions (Beijing and Shanghai) and to identify the conditions that predispose patients to GERD.

METHODS: Phase I: 5000 residents of the two regions aged between 18 and 70 years were studied via a questionnaire. The study was carried out by cluster sampling from city, suburban and rural areas by using simple random sampling. Symptom scores (Sc) of the intensity and frequency of heartburn, acid reflux and regurgitation within 1 year of the time of study were taken as indices of acid reflux (highest score, Sc = 18) and Sc ≥ 6 indicated the presence of symptomatic GER. Phase II: a small number of patients who were identified as having symptomatic GER in the survey were enrolled in a case– control study using gastroscopy and 24‐h pH monitoring to obtain correct diagnostic rates of GERD and RE. Estimates of the prevalence of GERD and RE were then adjusted according to the rates of correct diagnosis.

RESULTS: A total of 4992 subjects completed the survey, 2.5% had heartburn once daily, 8.97% had symptomatic GER (Sc ≥ 6) and the male to female ratio was 1:1.11. Point prevalences for the year for GERD and RE were 5.77 and 1.92%, respectively. Stratified analysis indicated that the prevalence of symptomatic GER in Beijing (10.19%) was higher than that in Shanghai (7.76%) and there was also a higher prevalence of GER in males, manual laborers, people from rural areas and people older than 40 years of age in Beijing as compared with Shanghai. Stepwise logistic analysis indicated that GER had a close relationship with dental, pharyngolaryngeal disorders and respiratory diseases. The conditions that predispose patients to GERD are (OR, odds ratio): age > 40 (OR = 1.01), eating greasy/oily food (OR = 6.56), overeating (OR = 1.99), tiredness (OR = 2.35), emotional stress (OR = 2.22), pregnancy (OR = 6.80) and constipation (OR = 1.65).

CONCLUSIONS: Gastroesophageal reflux disease is a common disease in the adult Chinese population and it is more common in Beijing than in Shanghai.
Experimental study on pancreatic cancer gene therapy using the HSV‐TK gene mediated by a retroviral vector
Authors: Suqing Xie , Guoming Xu , Zhaoshen Li , Guangwen Cao
Published: March 2003

OBJECTIVE: To study the value of the herpes simplex virus type I thymidine kinase (HSV‐TK) gene mediated by a retroviral vector in the treatment of human pancreatic cancer cell line 8988.

METHODS: The HSV‐TK gene was directionally cloned into a site following the SV40 promoter that was adjacent to the 5′ LTR (long terminal repeats) and the neomycin phosphotransferase gene in the retroviral vector pMNSM. This enabled the TK gene to integrate into the chromatin of the host cell. The recombinant plasmid pMNS‐TK‐M was then transfected into the retrovirus‐packaging cell Pa317. Finally, the HSV‐TK gene was transfected into pancreatic cancer cell line 8988 by the recombinant retrovirus after selection with G418.

RESULTS: The HSV‐TK gene was stably integrated into the host cell and its expression confirmed by Southern blotting and drug‐sensitivity tests. In vitro studies showed that the acyclovir (ACV) sensitivity level in the 8988/TK+ cells was higher than that of the parent cells. The cells that were transfected with the TK gene were significantly susceptible to ACV. In vivo studies in nude mice showed that intraperitoneal injection of ACV might postpone the formation of implanted tumors and produce a treatment effect on the tumors.

CONCLUSIONS: This study demonstrated that the HSV‐TK/ACV retroviral system could be used in vivo to treat pancreatic cancer.
Pathological development of the gastric mucosa in Helicobacter pylori‐related diseases
Authors: Liu Tianshu , Wang Jiyao , Chen Shiyao , Yue Fan
Published: March 2003

OBJECTIVE: To study the relationship between Helicobacter pylori eradication and the pathological development of the gastric mucosa in H. pylori‐related diseases.

METHODS: One hundred and ninety‐one H. pylori‐infected patients were randomly given anti‐H. pylori or non‐anti‐H. pylori medications. Endoscopic examination was carried out 1 year after treatment. Pathological classifications followed the Sydney System.

RESULTS: Of the 191 patients, those with chronic inflammation of the gastric mucosa improved (P < 0.05), as did those with atrophy and intestinal metaplasia (P < 0.05). Helicobacter pylori was eradicated in 107 patients, but not in 84 patients. Compared with those patients in whom H. pylori was not eradicated, those with H. pylori eradicated had ameliorated chronic inflammation of the gastric mucosa (P < 0.05) and active inflammation reduced in some cases (P < 0.05). Notwithstanding a stratification of different gastric diseases and different treatments, patients with H. pylori eradicated showed a more marked improvement in mucosal chronic inflammation than did patients in whom H. pylori was not eradicated (P < 0.05).

CONCLUSIONS: These results suggest that H. pylori infection is closely related to active inflammation of the gastric mucosa. Helicobacter pylori eradication is beneficial in improving chronic inflammation of the gastric mucosa.
Prevalences of metronidazole‐ and clarithromycin‐resistant Helicobacter pylori isolates in Shanghai and molecular mechanism of resistance to clarithromycin
Authors: Shi Tong , Liu Wenzhong , Xiao Shudong , Xu Weiwen
Published: March 2003

OBJECTIVE: To investigate the prevalences of metronidazole‐ and clarithromycin‐resistant Helicobacter pylori over the period from 1995 to 1999 in Shanghai, and the molecular mechanism of resistance to clarithromycin.

METHODS: A total of 150 H. pylori strains were randomly selected from the isolates collected in 1995, 1997 and 1999, and tested for sensitivity against metronidazole and clarithromycin by using the E‐test. The mechanism of resistance was studied by polymerase chain reaction (PCR)–restriction fragment length polymorphism (RFLP).

RESULTS: It was found that 42% (21/50), 57% (27/50) and 70% (35/50) of the tested strains were resistant to metronidazole among the isolates collected in 1995, 1997 and 1999, respectively. In 1995, there was no strain (0/50) resistant to clarithromycin, of which the prevalence rose to 2% (1/50) in 1997, and to 10% (5/50) in 1999. The prevalences of metronidazole‐ and clarithromycin‐resistant H. pylori in 1999 were significantly higher than those in 1995 (P < 0.05). Of nine clarithromycin‐resistant H. pylori strains, eight were found to have an A→G mutation at position 2144 of domain V of the 23S rRNA.

CONCLUSIONS: These results suggest a significant increase in the prevalences of metronidazole‐ and clarithromycin‐resistant H. pylori in Shanghai during the 1995–1999 period. The majority (88.8%) of clarithromycin‐resistant H. pylori isolates have an A2144G mutation in domain V of the 23S rRNA.
Characteristic features of folate‐deficient neurological diseases in the elderly
Authors: Yukawa Motoko , Miyachi Takafumi , Ochi Hidekazu , Katayama Sadao , Kohriyama Tatsuo , Mimori Yasuyo , Nakamura Shigenobu
Published: March 2003

Background:  Folic acid (folate) deficiency causes neurological disorders in aged people, the characteristic features of which were examined.

Methods:  Serum folate levels were determined in 343 neurological patients by chemiluminescence. We found 36 folate‐deficient patients (10.5%) who were divided into elderly ≥ 65 years old (12 cases) and younger group, < 65 years old (24 cases), and were administered folate (15 mg/day) for 60 days.

Results:  Serum folate levels were not different between the elderly and younger group, while folate levels were lower in elderly females than elderly males. Neuropathy was more frequent in elderly male than elderly female patients. Elderly neurological patients with neuropathy more readily responded to folate supplementation than those without neuropathy. Folate‐deficient patients with dementia were older than those without dementia, although nine younger patients had dementia and four of nine cases showed frontal dementia. Anemia or female sex was more frequent and neuropathy was less frequent among elderly patients with central nervous system involvement. Serum folate levels were lower in elderly anemic than nonanemic patients. Tube feeding was more frequent in elderly folate‐deficient neurological patients than in younger ones. Folate therapy was less effective in elderly patients with dementia, although three cases improved. Elderly folate‐deficient patients treated with tube feeding did not respond to the folate supplement.

Conclusion:  Folate deficiency was not rare among aged neurological patients, and its features were different from younger patients. Since folate‐deficient neuroencephalopathies are responsive to folate supplementation in the elderly, the examination of elderly patients’ serum folate level is valuable.
Rising incidence of breast cancer in Papua New Guinea
Authors: Halder Anirudh , Morewya Jacob , Watters David A. K.
Published: March 2003

Background: Three previous reports have shown the incidence of breast cancer in Papua New Guinea (PNG) to have risen in the 30 years between 1958 and 1987. In the present report the incidence and pathology of breast cancer in the decade 1989–1998 are described.

Methods: This was a retrospective review of all histopathology specimens in PNG from 1989 to 1998. During this period the female population grew from 1 640 000 to more than 2 000 000.

Results: There were 790 cases of breast cancer. The age of the patient was not known in 221 cases (26%). The age‐standardized incidence was 6.9 per 100 000. The incidence of breast cancer has been steadily rising in the 40 years since cancers were recorded in PNG. The incidence has risen in all four regions, most notably in the islands. The peak incidence was in the 45–54‐year‐old age group (18.4/100 000); 83.9% of women with breast cancer were aged 54 or less. Fifteen per cent were under 35 years old and 55.7% were under 45. The incidence fell in the elderly. The tumours tended to be advanced. The actual size was recorded in only 163 cases (20.7%) but there were only three T1 tumours in this group. Clinical signs of advanced breast cancer were recorded in 206 cases: ulceration of skin (91 cases), peau d’ orange (69 cases), nipple retraction (43 cases) and lymphoedema of the upper extremity (three cases). Axillary nodes were positive in 185 of 247 patients (75%) in whom they were sampled.

Conclusions: The incidence of breast cancer in PNG women has steadily risen over the past 40 years and the highest age‐specific incidence occurs in the 35–54 age group. Tumours present late at an advanced stage. Clinical information on pathology request forms is poor and a prospective clinical audit is needed. Strategies need to be developed to detect breast cancer earlier in this population of women.
Electrolysis and other local ablative treatments for non‐resectable colorectal liver metastases
Authors: Teague Benjamin D. , Wemyss‐Holden Simon A. , Fosh Beverley G. , Dennison Ashley R. , Maddern Guy J.
Published: March 2003

The present paper is a review of the current ablative treatment options for the treatment of colorectal liver metastases. Cryotherapy, microwave coagulation therapy, radiofrequency ablation and laser‐induced thermotherapy are discussed. Electrolysis, a novel non‐thermal ablative treatment, is described. Potential benefits of electrolysis include the apparent ability to safely and effectively treat lesions abutting major hepatic structures and the lack of a systemic inflammatory reaction following electrolytic ablation. Further studies in animals and humans are needed to confirm this potential and to further refine the methods of electrolytic treatment of colorectal liver metastases.
Colon trauma: Royal Melbourne Hospital experience
Authors: Steel Malcolm , Danne Peter , Jones Ian
Published: March 2003

Background: Recent studies from the USA and South Africa suggest that primary repair or resection and primary anastomosis have become the recommended treatment for most traumatic colon injuries. The aim of the present review is to determine the applicability of these studies to the urban Australian setting.

Methods: All patients with colon injuries operated on at the Royal Melbourne Hospital from March 1989 to March 1999 were identified. Data were collected by a retrospective chart review.

Results:  A total of 20 patients sustained 26 injuries to the colon. Blunt

injuries were more common than penetrating injuries (14 vs 6). Significant other injuries occurred in 15 patients. Colostomies were performed in four patients. The overall mortality rate was 10%. There were no anastomotic leaks. Primary repair or resection and primary anastomosis were not associated with any increase in intra‐abdominal complications.

Conclusion:  Evidence from large trauma centres supporting primary repair or resection and primary anastomosis is also applicable to regions that have a low rate of traumatic colon injury.
Synovial ablation in a rabbit rheumatoid arthritis model using photodynamic therapy
Authors: Beischer Andrew D. , Bhathal Prithi , De Steiger Richard , Penn David , Stylli Stan
Published: March 2003

Background:  At present there is no ideal minimally invasive method for ablating inflamed synovium in joints that has been unres­ponsive to optimal medical management in patients with rheumatoid arthritis. The aim of this study was to determine whether photo­dynamic therapy could be used for this purpose.

Methods: In a rabbit knee model of rheumatoid arthritis the pharmacokinetics of the photosensitizer Haematoporphyrin Derivative (HpD) into periarticular tissues and blood was measured following intravenous injection of HpD. The second phase of the study was to determine the histological effect of HpD activation by 63 nm light delivered via an intra‐articular optic fibre using a dye pumped KTP‐YAG laser. The light dose was varied from 0−200 joule/cm2.

Results:  Pharmacokinetic studies determined that inflamed synovium rapidly accumulated HpD, with peak levels being reached 12 h following intravenous injection. The ratio of HpD uptake into inflamed synovium versus peri‐articular quadriceps muscle was found to be 22.8. Histological examination of the treated knees indicated that selective destruction of inflamed synovium was achieved at light doses 100 joules/cm2 and above. No significant effect was observed on normal intra‐articular tissues.

Conclusion:  We have demonstrated that the first generation photosensitizer HpD selectively accumulates within inflamed ­synovium. Activation of HpD by intra‐articular light administration resulted in selective ablation of the inflamed synovium. These findings indicate that PDT offers potential as a new selective, minimally invasive synovectomy technique.
A compliant tip reduces the peak pressure of laparoscopic graspers
Authors: Marucci Damian D. , Cartmill John A. , Martin Christopher J. , Walsh William R.
Published: March 2003

Background:  Previous studies have demonstrated that high pressures are generated at the tips of laparoscopic graspers, which can cause tissue injury. This study examines the effect of a compliant edge on tip pressure.

Methods:  One of a pair of identical laparoscopic graspers was modified by refashioning the tip out of silicone. A thin film pressure transducer (I‐scan 6900 sensor) was deployed between the jaws of the grasper and a simulated tissue (leather strap). Load and handle pressures were kept constant. Peak tip pressure readings were taken as the load orientation was increased from the perpendicular to 135° (n = 10). The data was analysed using anova and a post‐hoc Duncan's multiple range test.

Results:  Peak tip pressures generated by the compliant tipped grasper were significantly less than those developed by the unmodified grasper, particularly at high‐load orientations.

Conclusion:  High pressures generated at the tip of laparoscopic graspers can be reduced by altering the mechanical properties (compliance) of the tip.
Does frozen section have a role in the intraoperative management of thyroid nodules?
Authors: Cheng Michael S. P. , Morgan Joanna L. , Serpell Jonathan W.
Published: March 2003

Background: Frozen section in thyroid surgery is used to make an intraoperative pathological diagnosis of malignancy in a thyroid nodule at the time of hemithyroidectomy. A positive diagnosis allows completion of thyroidectomy, thus avoiding reoperation. However, the use of fine needle aspiration cytology in making a preoperative diagnosis of cancer has resulted in the lack of a defined role for frozen section. We examined the role of frozen section as an adjunct to fine needle aspiration cytology in determining which cytological subset will benefit from frozen section.

Methods: All patients who underwent thyroidectomy between 1992 and 2000 by a single endocrine surgeon were reviewed.

Results: Two hundred and nine frozen sections were performed, of which 144 underwent preoperative fine needle aspiration cytology. Frozen sections reported 135 benign nodules, 59 follicular neoplasms, five specimens with suspicious histology and 10 cancers. Ten out of 20 thyroid cancers were correctly identified by frozen section (sensitivity: 50%; specificity: 100%), eight cancers were reported on frozen section as indeterminate and two benign. Of 144 fine needle aspiration cytological procedures, frozen section on seven suspicious aspirates identified two cancers, and frozen section on 70 follicular aspirates identified four cancers, allowing intraoperative conversions to total thyroidectomy. Frozen section on seven malignant aspirates confirmed four cancers but resulted in reoperation for three because of the indeterminate frozen section reports. There were no cancers found on 135 benign aspirates.

Conclusions: Frozen section on benign aspirates is unhelpful in the management of thyroid nodules. It need not be performed for cytologically proven malignant thyroid nodules. Selective use of frozen section complements fine needle aspiration cytology findings of suspicious or follicular lesions, especially in the subset with papillary cancer, allowing one‐stage total thyroidectomy.
Open access endoscopy in rural and remote Western Australia: Does it work?
Authors: Hughes‐Anderson Wayne , Rankin Sarah L. , House Jill , Aitken James , Heath Dugal , House Anthony K.
Published: March 2003

Background:  Access to diagnostic endoscopy is limited in rural and remote Western Australia. Published reports suggest open access referrals may result in over‐servicing, this is reduced by adherence to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines.The aim was to assess whether an out reach surgical service offering open access endoscopy to rural areas was being over utilized.

Methods:  Prospective data collection from all patients undergoing upper and lower endoscopy procedures between January 1996 and June 2000 were included in the present study. Indications for referral between the general practitioners and the visiting surgeons were reviewed in patient records and assessed for compliance with the ASGE guidelines. The groups were analysed for appropriateness of referrals and frequency of positive pathology investigations. Records for all patients undergoing colonoscopy were reviewed to determine the reason and number of cancelled procedures.

Results:   A total of 772 endoscopies were performed and 75% were booked as open access services. The referral rate for procedures was greater for general practitioners (583) compared to the visiting surgeons (189), the overall compliance rate for approved indications using the ASGE guidelines for both groups was 92%. There was no significant difference in pathology found between groups.

Conclusion:  The present study shows that an outreach rural surgical service programme in Western Australia offering open access endoscopy conforms to international guidelines and does not induce unnecessary procedures. Rural patients benefit from a personal cost savings andconvenience. There is an associated reduction in government‐assisted travel costs to larger centres as well as decreased waiting lists.
DUCTILE TEARING SIMULATION BASED ON A LOCAL ENERGETIC CRITERION
Authors: Marie S , Chapuliot S
Published: March 2003

It is well known that the tearing resistance curve J–Δa is not a material property and that probably the energy dissipation rate is preferable to the integral J to characterize crack growth. The G parameter represents the energy dissipated in plasticity and fracture and, under certain conditions, this parameter could be used directly as a critical value for a criterion based on an energy release rate calculated near the crack tip to simulate propagation. Indeed, we see that a local energy release rate could be calculated near the crack tip to take account only of that portion of energy which participates in the fracture.

We applied this approach to simulate the crack growth for CT specimens with and without side grooves in a 20 MnMoNi 55 ferritic steel, and compared the results with Rousselier’s model.
INFLUENCE OF LOW‐INTENSITY SHOT PEENING ON THE FATIGUE STRENGTH OF AN Al/Al
Authors: Baragetti S , Guagliano M
Published: March 2003

Metal matrix composites are increasingly utilized in engineering applications because of their favourable strength/weight ratio. However, their applications are still limited because of their relatively poor fatigue resistance, which could be improved by using some appropriate surface treatment. In this paper, an Al/Al2 O3 (20%) composite material is considered. In particular its fatigue strength is examined to verify if, how and when shot peening can be used to improve the performances of MMC components that are cyclically loaded. Fatigue tests allow one to evaluate the influence of shot peening on the fatigue limit of both smooth and notched specimens. Residual stress measurements, fracture surface analyses and metallographic examinations allow one to evaluate the role of residual stresses, hardening and grain distortion on the improvement that can be achieved with this treatment. On the basis of these results, some guidelines are drawn on how to optimize the choice of peening parameters.
A COMMENTARY ON THE ROLE OF NITROGEN IN ENHANCING SLOW CRACK GROWTH IN C–Mn STEEL
Authors: Östberg
Published: March 2003

More than two decades ago, cracks growing slowly at temperatures below the creep range were first discovered in tubing of C–Mn steel in thermal power plants. So far, no completely satisfactory explanation for such behaviour has been found. Available information on the influence of nitrogen on deformation and cracking of C–Mn steel under prevailing conditions, however, seems to indicate that this element may play a critical role in the failure in question. It appears that a mechanism involving both metallurgical and mechanical processes has to be considered more comprehensively and in a more integrated manner than is usually the case.
A MICROMECHANICAL DAMAGE THEORY FOR BRITTLE MATERIALS WITH SMALL CRACKS
Authors: Zhan S , Wang C , Han X
Published: March 2003

For brittle solids containing numerous small cracks, a micromechanical damage theory is presented which accounts for the interactions between different small cracks and the effect of the boundary of a finite solid, and includes growth of the pre‐existing small cracks. The analysis is based on a superposition scheme and series expansions of the complex potentials. The small crack evolution process is simulated through the use of fracture mechanics incorporating appropriate failure criteria. The stress–strain relations are obtained from the micromechanics analysis. Typical examples are given to illustrate the potential capability of the proposed theory. These results show that the present method provides a direct and efficient approach to deal with brittle finite solids containing multiple small cracks. The stress–strain relation curves are evaluated for a rectangular plate containing small cracks.
TORSIONAL FATIGUE OF A MEDIUM CARBON STEEL CONTAINING AN INITIAL SMALL SURFACE CRACK INTRODUCED BY TENSION–COMPRESSION FATIGUE: CRACK BRANCHING, NON‐PROPAGATION AND FATIGUE LIMIT
Authors: Murakami  , Takahashi
Published: March 2003

In order to examine the threshold condition for the fatigue limit of materials containing a small crack under cyclic torsion, reversed torsional fatigue tests were carried out on 0.47% C steel specimens containing an initial small crack. Initial small semi‐elliptical cracks ranging from 200 to 1000 μm in length were introduced by the preliminary tension–compression fatigue tests using specimens containing holes of 40 μm diameter. The threshold condition for the fatigue limit of the specimens containing artificial small defects under rotating bending and cyclic torsion are also reviewed. Crack growth behaviour from an initial crack was investigated. The torsional fatigue limit for a semi‐elliptical small crack is determined by the threshold condition for non‐propagation of Mode I branched cracks. The torsional fatigue limit of specimens containing an initial small crack can be successfully predicted by the extended application of the √area parameter model in combination with the σθmax criterion.
INITIATION AND GROWTH OF SMALL CRACKS IN DIRECTIONALLY SOLIDIFIED MAR‐M247 UNDER CREEP‐FATIGUE PART II: EFFECT OF ANGLE NETWEEN STRESS AXIS AND SOLIDIFICATION DIRECTION
Authors: Okada M , Tsutsumi M , Kitamura T , Ohtani R
Published: March 2003

This paper deals with the effect of anisotropy on fracture processes of a directionally solidified superalloy, Mar‐M247, under a push–pull creep‐fatigue condition at high‐temperature. Three kinds of specimen were cut from a cast plate such that their axes possess angles of 0°, 45° and 90° with respect to the 〈001〉 orientation that is aligned parallel to the solidification direction (also to the grain boundaries and primary dendrite axis); these specimens being denoted the 0° specimen, the 45° specimen, and the 90° specimen, respectively. The tests were conducted at 1273 K (1000 °C) in air under equal magnitudes of the range of a ΔJ‐related parameter, ΔWc , which represents the driving force for crack growth in creep‐fatigue. Although the grain boundaries are macroscopically parallel to the solidification direction, they are wavy or serrated microscopically. Small cracks nucleate along parts of the grain boundaries perpendicular to the stress axis in all specimens. The 90° specimen has the shortest crack initiation life and the 0° specimen has the longest. In the 90° and 45° specimens, intergranular cracks continue to nucleate and a main crack is formed along the grain boundary due to the frequent coalescence of small cracks. In the 0° specimen, cracks grow into the grain, and transgranular cracks coalesce along the primary dendrite or grain boundary. The 0° specimen exhibits the slowest crack growth rate and the 90° specimen the fastest. These differences in the initiation and growth behaviour of small cracks cause the longest failure life in the 0° specimen and the shortest in the 90° specimen.
SMALL FATIGUE CRACKS IN AN AUSTENITIC STAINLESS STEEL
Authors: Lindstedt U , Karlsson B , Nystr M
Published: March 2003

The present study concerns nucleation and growth of small surface cracks during the low‐cycle fatigue of a nitrogen‐containing austenitic stainless steel. Metallographic replicas as well as longitudinal sectioning were used to record the developing crack pattern on the specimen surface. The influence of grain size and nitrogen content is considered. Small surface cracks are observed after about 10% of the fatigue life. The nucleation of cracks continues until about half of the lifetime, when the crack density saturates. This saturation phenomenon is related to the local unloading effect of growing cracks.

The mean crack length increases continuously as a power‐law until specimen failure. However, small grains and a low nitrogen content amplify the effect of crack–grain boundary interactions resulting in an intermediate retardation in growth.

At high nitrogen contents, the crack growth characteristics are very much related to the slip bands formed. This results in a more simultaneous growth of cracks, a more jagged feature of the cracks introducing a higher roughness‐induced crack closure effect, and, consequently, better fatigue properties.
Fatigue of cemented hip replacements under torsional loads
Authors: McCormack B.A.O. , Prendergast P.J. , O’Dwyer B.
Published: March 2003

Fatigue resistance of hip replacement prostheses is becoming ever more important as the operation is carried out on younger and more active patients. Torsional loading of the implant, which occurs especially during activities, such as rising from a chair or climbing stairs, is implicated in the failure process. To examine fatigue failure of the implant–bone fixation, which is made using polymethylmethacrylate cement, an experimental model was designed and 16 specimens tested at torsional moments of 50 Nm and 80 Nm to both 1 and 2 million cycles. The numbers and lengths of cracks initiated under cyclic loading were quantified using dye penetrant to highlight the cracks and a profile projector to magnify them. The majority of cracks initiated from the PMMA/metal and PMMA/bone interfaces, more often than from pores in the PMMA. A bimaterial fracture mechanics analysis confirmed that the interfaces are too weak to sustain in vivo levels of cyclic loading. It is proposed that, under torsional loading, fatigue failure of PMMA fixated implants originates from pores located on the interfaces.
Interaction and evolution of short fatigue cracks
Authors: Zhao  , Gao  , Wang
Published: March 2003

Distinguishing the different contributions to fatigue damage of short cracks having different sizes and locations on the specimen surface, three new concepts, referred to as effective short fatigue cracks (ESFCs), dominant effective short fatigue cracks (DESFC), and density of ESFCs, respectively, are introduced to facilitate an understanding of the mechanism of interaction and evolution of short cracks. These concepts are interrelated and in conjunction produce an ‘effective short fatigue crack criterion’. Replica observations of 19 smooth axial specimens of 1Cr19Ni9Ti stainless steel weld metal during low‐cycle fatigue tests reveal that the short cracks contribute to the fatigue damage of specimens due to the formation of a critical density of ESFCs. The density reflects the local microstructural growth conditions ahead of the DESFC tips. The DESFC behaviour is a result of interactive short cracks, and this behaviour is deemed suitable to describe the collective behaviour of short cracks. In the microstructural short‐crack stage, the DESFC are located in the weakest zone. Due to an irregular microstructural barrier effect, the crack density is higher in this zone and increases with fatigue cycling to reach a maximum value at the transition point into the physical short‐crack stage. Then, due to the effects of accelerating coalescence and the DESFC size shielding the formation of new cracks, the density decreases rapidly and tends gradually to a saturation value. This is why the short‐crack growth rate is high initially and tends gradually to that of long‐crack behaviour. The difference and change in local microstructural growth conditions ahead of DESFC tips are the intrinsic cause of the statistical behaviour of short cracks and the scatter of fatigue lives.
Energy criteria of multiaxial fatigue failure
Authors: Macha  , Sonsino
Published: March 2003

This paper contains a review of energy‐based criteria of multiaxial fatigue. The criteria have been divided into three groups, depending on the kind of strain energy density per cycle which is assumed as a damage parameter. They are: (i) criteria based on elastic strain energy for high‐cycle fatigue; (ii) criteria based on plastic strain energy for low‐cycle fatigue; and (iii) criteria based on the sum of plastic and elastic strain energies for both low‐ and high‐cycle fatigue. The criteria which take into account strain energy density in the critical plane seem to be the most promising. In the energy approach to multiaxial fatigue there is an important unsolved problem, i.e. the evaluation of energy, especially plastic strain energy density, from closed stress–strain hysteresis loops under random loadings.
A fatigue criterion for general multiaxial loading
Authors: Jiang
Published: March 2003

An incremental fatigue damage model is proposed. The model incorporates the critical plane concept in multiaxial fatigue, plastic strain energy and material memory in cyclic plasticity. With an incremental form the model does not require a cycle counting method for variable amplitude loading. The model is designed to consider mean stress and loading sequence effects. Features of the new model are discussed and the determination of material constants is detailed. Verification of the model is achieved by comparing the predictions obtained by using the new model and experimental data of four materials under different loading conditions.
Fatigue crack growth threshold conditions at notches. Part II: generalization and application to experimental results
Authors: Vallellano  , Domínguez
Published: March 2003

The theoretical foundation of a micromechanical model that accounts for the fatigue crack growth threshold conditions at notches was described in Part I of this study. Strictly speaking, the proposed formulation is restricted to the analysis of a component with an elliptical notch under antiplane stress. In this section of the study, the expressions derived in Part I are generalized for application to axial stress states and non‐elliptical notch geometries. The procedure is validated by comparing the model’s predictions with reported experimental results.
Prediction of crack growth direction under plane stress for mixed‐mode I and II loading
Authors: Wasiluk  , Golos
Published: March 2003

The estimation of the plastic zone geometry ahead of a crack is fundamental to the evaluation of crack growth. Presented here is an analytical investigation for predicting crack growth direction for mixed‐mode I and II loading under plane stress conditions. It is proposed that under complex loading the crack will extend in the direction where the radius of the plastic zone attains a minimum value. There is good agreement between the predicted results which are computed on the basis of this criterion and experimental data published in the literature.