bluuebunny/crossref_metadata_2025 huggingface dataset:
Stent Scraping for Histology: An Alternative Method for Obtaining Tissue to Rule out Neoplasia
Authors: Siegel Jerome H. , Veerappan Annamali , Prudente Romulo , Kasmin Franklin E. , Cohen Seth A.
Published: August 2007

Despite improvement in diagnostic modalities, confirmation of a histologic diagnosis of cancer of
the biliary tree and pancreas remains elusive. Attempts to collect positive cytology specimens from
vigorous brushings or washings obtained at endoscopy or percutaneously are often unsuccessful. In
our unit, we have increased the yield by obtaining tissue scraped from prostheses that have been previously
placed in either the bile duct or the pancreatic duct. The stents are first flushed with saline
to collect cytology specimens, after which, they are bisected and scraped, and these contents are prepared
in a manner similar to that used to prepare biopsy samples. Twelve of 16 scraped samples, 9
bile duct and 3 pancreas, were positive for adenocarcinoma. The cytology specimens were positive
in only 4 of the 12. We recommend this method of sampling from material contained within prostheses
as an adjunct when previous brushings, washings, or biopsies are negative.
A Biliary Endoprosthesis Functioning After Six Years
Authors: Plumer Alan , Iswara K. , Siegel Jerome H.
Published: August 2007

The functional lifetime for biliary endoprostheses has typically been 7 months. When combined with sphincterotomy for common bile duct stones, it affords an alternative to surgery in high risk patients.
Biliary endoprostheses often require replacement in these patients, though recent reports suggest they
are functioning longer. We present an 85‐year‐old asymptomatic woman with a 6‐year‐old biliary
endoprosthesis, believed to be the longest functioning stent reported in the literature.
Conservative Management of Transitional Cell Carcinoma ofthe Kidney and Ureter
Authors: Bales Gregory T. , Lyon Edward S. , Gerber Glenn S.
Published: August 2007

We report six patients with upper tract transitional cell neoplasms who were treated by an endourologic
approach. Two patients had undergone nephroureterectomy previously, whereas one patient
had a single functioning kidney. Two patients were deemed candidates for endourologic procedures
secondary to significant comorbid disease precluding major open surgery. The final patient had a
low‐grade distal ureteral lesion and desired a conservative approach.Of six patients, two were rendered tumor free without recurrence 48 months and 60 months after
surgery. Two patients had multiple superficial recurrences managed endoscopically and are currently
disease free after 12 and 48 months, respectively. One patient died from metastatic transitional cell
cancer 18 months postoperatively whereas one died perioperatively secondary to bleeding and multiple
organ failure.Of five patients who tolerated endoscopic therapy, four were disease free with a mean follow‐up
of 30 months. Endoscopic treatment of upper urinary tract transitional cell carcinoma is feasible, although
the risk of disease recurrence and progression may be significant.
Videoendoscopy of Colonic Early Cancer
Authors: Sakai Yoshihiro
Published: August 2007

Since January 1982, 275 early colonic carcinomas undergoing total endoscopic resection were studied. Of this series, 234 lesions showed some adenoma components, whereas the remaining 41 lesions
lacked adenoma components. Minute carcinomas measuring ≤ 5 mm (21 lesions) were most commonly
the hemispheric protruding type lesions (IIs, 9 lesions), followed by superficial protruding
type lesions with a height of ≤ 3 mm (IIa, 6 lesions). There also were 2 superficial depressed‐type
lesions that were slightly concave. Eight of these minute carcinomas may have developed by de novo
carcinogenesis, and 2 had already invaded the submucosa. Therefore every effort should be made
not to overlook lesions measuring ≤ 5 mm in diameter. That none of these lesions were located in
the rectum indicates the acute necessity for improved examination procedures. With regard to IIa lesions
measuring > 5 mm, 92.3% were discovered by videoendoscopy. This high detection rate was
attributed to the growing use of videoendoscope systems and reflects heightened interest on the part
of endoscopists in superficial type lesions.
Laparoscopy in the Treatment of Early Cervical Carcinoma
Authors: Hallum, Alton V. , Childers Joel M.
Published: August 2007

Recent investigators have used several indications to incorporate laparoscopy in the management of patients with cervical cancer. This manuscript reviews the current literature on the role of modern
operative laparoscopy in early cervical cancer and recommends a simple approach for its use in these
patients.
Hormonal Treatment and Pelviscopic Myomectomy
Authors: Mettler L. , Alvarez-Rodas E. , Semm K.
Published: August 2007

In cases of benign lesions, pelviscopy is used in about 70% of all abdominal operations at our
Department of Obstetrics and Gynecology. From 1990 to 1992, 851 patients with myomas were
treated by surgery. In 57% pelviscopy, in 2% laparotomy, and in 1% hysteroscopic myomectomies
were treated. In 11%, a CISH (Classical Intrafascial SEMM—serrated edged macro morcellator—Hysterectomy) without colpotomy was applied using the operative technique of pelviscopy or laparotomy.
The application of this new surgical technique preserves the patient′s pelvic floor
(diaphragm pelvis and urogenitalis), its blood supply, and neural function. Details of the surgical
techniques used in pelviscopic myomaenucleations are described. One hundred sixteen patients were
treated with a gonadotropin releasing hormone analogue (GnRH‐a) before the pelviscopic myomaenucleation
took place. In this study, 64 (55%) patients received 3,75 mg leuprorelin, and 52
(45%), patients 3.75 mg triptorelin. The monthly injections took place over a period of 3 to 6 months.
After 3 months, an identical reduction of the myomas of about 10% to 50% was observed in 103 patients
(88%) in both therapy groups. The preservation of the uterus by this minimal invasive surgery
technique was generally accepted. No serious complications occurred.
Percutaneous Endoscopic Gastrostomy, Duodenostomy and Jejunostomy
Authors: Nishiguchi Yukio , Fuyuhiro Yuichi , Lee Jae-To , Kang Soon-Myoung , Baba Mitsuru , Arimoto Yuichi , Takeuchi Kazuhiro , Yamashita Yoshito , Shigesawa Akira , Yoshikawa Kazuhiko , Sowa Michio
Published: August 2007

Although enteral feeding by nasal gastric tube is popular for the patients who have a swallowing disability and require long‐term nutritional support, but have intact gut, this tube sometimes causes aspiration
pneumonia or esophageal ulcer. For these patients, conventional techniques for performance
of a feeding gastrostomy made by surgical laparotomy have been used so far. However, these patients
are frequently poor anesthetic and operative risks. Percutaneous endoscopic gastrostomy (PEG)
which can be accomplished with local anesthesia and without the necessity for laparotomy has become
popular in the clinical treatment for these patients. PEG was performed in 31 cases, percutaneous endoscopic duodenostomy (PED) in 1 case, and percutaneous endoscopic jejunostomy (PEJ)
in 2 cases. All patients were successfully placed, and no major complication and few minor complications
(9%) were experienced in this procedure. After this procedure, some patients could discharge
their sputa easily and their pneumonia subsided. PED and PEJ for the patients who had previously
received gastrostomy could also be done successfully with great care. Our experience suggests that
PEG, PED, and PEJ are rapid, safe, and useful procedures for the patients who have poor anesthetic
or poor operative risks.
Endoscopic Findings of 100 Early‐Stage Esophageal Cancers
Authors: Monnier Ph. , Fontolliet Ch. , Ollyo J. B.
Published: August 2007

The morphologic analysis of 100 early squamous cell carcinomas of the esophagus has shown that
the barely visible or invisible forms (erythroplakias and occult forms) are predominant. This explains
the poor yield of upper gastrointestinal (GI) endoscopies in detecting early cancers, at least in Western
countries. Leucoerythroplakias correspond to the most advanced form of early cancers (submucosal
invasion in approximately 38% of cases). Pure erythroplakias and occult forms correspond to in situ
or intramucosal cancers in over 90% of the cases.Accurate endoscopic staging is possible using morphologic criteria, superficial spread, and rigidity
of the wall as parameters. In a prospective study, we show that the degree of accuracy of this staging
system reaches 95% for an experienced endoscopist.T1aN0 cancers can benefit from an endoscopic treatment (mucosectomy or photodynamic therapy),
because the risk of lymph node metastasis is low (6%). In T1bN0 cancers, the best treatment option
is an esophageal resection with extensive mediastinal lymph node dissection for good surgical candidates;
PDT combined with adjuvant radiotherapy is a reasonable option for inoperable patients.
A Simple Suturing Technique for Laparoscopic Ligation of Vascular Pedicles
Authors: Aqua Keith A. , Childers Joel M.
Published: August 2007

We report on the performance of 348 adnexectomies and 35 uterine artery ligations for both benign and malignant disease using a simple laparoscopic suturing technique. Only 5‐mm ports are required, and there was no morbidity directly associated with this approach. The procedure can be performed quickly, is relatively inexpensive, and allows hysterectomy and oophorectomy to be performed without bipolar electrocautery.
New Strategies for Treating Myomas
Authors: Wood Carl , Maher Peter
Published: August 2007

Laparoscopic minilaparotomy in 6 patients using the Maher abdominal elevator facilitated both quicker enucleation and morcellation of the myoma and suture of the myoma cavity. Myoma reduction in 12 patients by electrosurgery resulted in a 60% reduction in myoma diameter with failure in 2 patients. This technique may avoid myomectomy and be particularly useful in patients with infertility or near menopause.
Video‐Assisted Thoracoscopic Surgery in Patients With Clinically Resectable Lung Tumors
Authors: Sakai H. , Borgstein P. J. , Cuesta M. A. , Meijer S. , van Mourik J. C. , Sutedja G. , Postmus P. E.
Published: August 2007

To investigate the feasibility of thoracoscopic resection, a pilot study was performed in patients with clinically resectable lung tumors. In 40 patients, Video‐assisted thoracic surgery (VATS) was performed because of suspicion of malignancy. There were 29 men and 11 women with a median age of 54.8 years (range 18 to 78). Preoperative indications were suspected lung cancer and tumor in 27 patients, assessment of tumor resectability in 7 patients, and probability of metastatic tumors in 6 patients. The final diagnoses in the 27 patients with suspected lung cancer were 12 primary lung cancers, 6 lung metastases, and 9 benign lesions. The success rates for VATS (no conversion to thoracotomy) were 1 of 12 (8.3%) for resectable stage I lung cancer, 8 of 12 (66.7%) for metastatic tumors, and 9 of 9 (100%) for benign tumors. With VATS, 6 of 7 patients (85.7%), possible stage III non‐small cell lung cancer, an explorative thoracotomy with was avoided, significantly reducing morbidity. The reasons for conversion to thoracotomy were 1) oncological (N2 lymph node dissection and prevention of tumor spillage) and 2) technical (inability to locate the nodule, central localization, no anatomical fissure, or poor lung function requiring full lung ventilation). The ultimate diagnoses were 19 lung cancers, 12 metastatic lung tumors, and 9 benign lung tumors. Our data show the limitations of VATS for malignant tumors in general use. These findings, together with the fact that experience in performing thoracoscopic procedures demonstrates a learning curve, may limit the use of thoracoscopic resection as a routine surgical procedure, especially when strict oncological rules are respected.
Trichophytobezoar Without Gastrointestinal Complaints
Authors: Malik G. M. , Mubarik M. , Nisar A. , Kadla S. A. , Malik M. S. , Khan M. D. , Lone B. A.
Published: August 2007

Gastrointestinal complaints may be the presenting symptoms of trichophytobezoar. We report a patient, who had an epigastric lump and enlarged lymph nodes on the left side of the neck, but without any gastrointestinal complaint. The clinical diagnosis suggested lymphoma or gastric cancer with secondary masses in the cervical lymph nodes. The diagnosis ultimately proved to be tubercular lymphadenitis on biopsy and gastric trichophytobezoar on endoscopy and laparotomy.
The Role of Operative Laparoscopy in Gynecologic Oncology
Authors: Hartenbach E. M. , Fowler J. M.
Published: August 2007

The potential applications of operative laparoscopy have expanded with improvements in technology and instrumentation. With newly developed techniques to complete both pelvic and paraaortic lymph node dissection, the use of the laparoscope has increased in patients with pelvic malignancies. Gynecologic oncologists are currently incorporating the techniques of operative laparoscopy in the management of patients with cervical, endometrial, and ovarian cancer. Multicenter prospective clinical trials are necessary to further define the role of laparoscopy in gynecologic oncology.
Usefulness of Transurethral Incision as a Primary Treatment of Ureterocele in Children
Authors: Takeuchi Ichiro , Nonomura Katsuya , Kanagawa Koichi , Yamashita Tetsufumi , Kakizaki Hidehiro , Gotoh Toshiaki , Koyanagi Tomohiko
Published: August 2007

Seventeen patients (11 girls and 6 boys, with bilateral cases in 4 for a total 21 units), in whom ureterocele was diagnosed at from 5 days to 11 years old, were treated with transurethral incision as a primary treatment. Urinary tract infection was the most common presenting sign in 8 patients. A voiding disturbance was observed in 10 patients. Seven units were diagnosed as intravesical ureteroceles of a single system and 14 units as ectopic ones (12 associated with the duplex system and 2 with a single system). De novo reflux occurred in 12 units, but in 5 units resolved spontaneously. All 5 refluxes in mate units improved, and 2 refluxes in the contralateral ureter also disappeared. The control of infection became easy in all patients except for one with a sphincteric ureterocele. Split renal function on  99mTc‐diethylenetriamine pentaacetic acid scintigraphy was prominently improved in 5 systems (35.7%) and normal kidney growth was obtained in 11 systems (78.6%). A total of 13 affected units (68.4%), including 7 units (6 intravesical and 1 ectopic) for which transurethral incision seemed to have been the sole necessary treatment, were saved. We believe that transurethral incision of ureteroceles is a very useful technique as a primary treatment for all types of ureteroceles in children of all ages.
Endobronchial Electrocautery Using Snare
Authors: Kawahara Masaaki , Furuse Kiyoyuki , Kodama Nagahisa , Ogawara Mitsumasa , Atagi Shinji , Kamimori Takao , Nakao Mitsunobu , Naka Nobuyuki
Published: August 2007

Between May 1987 and March 1994, upper airway and tracheobronchial electrosurgery with snare was performed in 13 patients (10 men and 3 women), ranging in age from 18 to 87 years. Four patients had benign lesions, and nine had malignant tumors. Total eradication has been achieved in the two patients with benign lesions. Electroexcision of the endobronchial portion of the tumor helped to clear the respiratory airways in all cases with malignant tumors. There has been no major side effects such as bleeding due to this method. Electrocautery is an available economical tool, which helps to diagnose and treat obstructing airway mass lesions.
The Role of Bronchoscopic Therapy in Bronchial Granular Cell Myoblastoma: Presentation of Three Cases
Authors: van Felius C. L. , Postmus P. E. , Beaumont F. , Strankinga W. , Teengs J. , Sutedja T. G.
Published: August 2007

Tracheobronchial granular cell myoblastoma (GCM) is rare. Although the tumor has some malignant properties, it is considered benign, and there is no consensus regarding treatment. Three cases are reported here. Bronchoscopic treatment in patients with GCM may be attempted as a first approach in case the tumor is intraluminal.
Computed Tomography‐Guided Bronchoscopy With an Ultrathin Fiberscope
Authors: Kobayashi Toshiaki , Shimamura Kayako , Hanai Kohzoh , Kaneko Masahiro
Published: August 2007

Bronchoscopy was performed under computed tomography (CT) guidance using an ultrathin fiberscope in a patient with a fluoroscopically invisible lesion that was visualized by CT in the right S8 and with poor pulmonary function. Under local anesthesia, the ultrathin fiberscope (3 mm in diameter) was inserted close to the lesion (1.5 mm in diameter) under direct visual guidance, and a brush was inserted into the lesion under CT guidance. Cytologic specimens obtained by the brush and washing revealed adenocarcinoma. This is the first report of CT‐guided bronchoscopy, which is a new examination method for peripheral small lung lesions and is a less invasive examination than either endoscopic examination with a conventional bronchoscope or open lung biopsy, especially for those with poor pulmonary function.
Lymphoepithelial Cyst of the Hypopharynx
Authors: Kawaida Masahiro , Fukuda Hiroyuki , Shiotani Akihiro , Kohno Naoyuki
Published: August 2007

A rare case of lymphoepithelial cyst formed in the piriform sinus of the hypopharynx is reported. Histopathological examination revealed a lymphoepithelial cyst. It was removed by laryngomicrosurgical technique using a side‐opened direct laryngoscope. Because this cyst was wide‐based on the antero‐medial region in the right piriform sinus of the hypopharynx, the mucous membrane around the cyst was incised electrosurgically and then detached to facilitate removal. In this paper, we describe our surgical procedure for removing the cyst in this case and discuss the possible causes of the disease.
Does Dysphagia Indicate Recurrence of Benign Esophageal Strictures?
Authors: Ekberg Olle , Borgström Anders , Fork Frans-Thomas , Lövdahl Eje
Published: August 2007

Esophageal dilatation in dysphagic patients with benign strictures is usually considered successful if the patients′ dysphagia is alleviated. However, the relation between dysphagia and the diameter of a stricture is not well understood. Moreover, the dysphagia may also be caused by an underlying esophageal motor disorder. In order to compare symptoms and objective measurements of esophageal stricture, 28 patients were studied with interview and a radiologic esophagram. The latter included swallowing of a solid bolus. All patients underwent successful balloon dilatation at least one month prior to this study. Recurrence of a stricture with a diameter of less than 13 mm was diagnosed by the barium swallow in 21 patients. Recurrence of dysphagia was seen in 15 patients. Thirteen patients denied any swallowing symptoms. Chest pain was present in 9 patients. Of 15 patients with dysphagia 2 (13%) had no narrowing but severe esophageal dysmotility. Of 13 patients without dysphagia 9 (69%) had a stricture with a diameter of 13 mm or less. Of 21 patients with a stricture of 13 mm or less 14 (67%) were symptomatic while 7 (33%) were asymptomatic. Four of 11 patients with retrosternal pain had a stricture of less than 10 mm. Three patients with retrosternal pain and obstruction had severe esophageal dysmotility. Whether or not the patients have dysphagia may be more related to diet and eating habits than to the true diameter of their esophageal narrowing. We conclude that the clinical history is non‐reliable for evaluating the results of esophageal stricture dilatation. In order to get an objective measurement of therapeutic outcome, barium swallow including a solid bolus is recommended.
Report of a Case of Video‐Assisted Thoracoscopic Resection of Bronchogenic Cyst Developed in the Aorto‐Pulmonary Window
Authors: De Giacomo T. , Venuta F. , Rendina E. A. , Guarino E. , Flaishman I. , Ricci C.
Published: August 2007

We report the case of a 28‐years‐old male with a bronchogenic cyst developed in the
aorto‐pulmonary window. Left video‐assisted thoracoscopy was performed and the cyst
was removed intact and completely. Operative time was 48 minutes. The postoperative
course was uneventful and the patient was discharged on the third postoperative day.
We believe that an uncomplicated mediastinal bronchogenic cyst can be successfully
approached by video‐assisted thoracoscopy. In the case of an intraparenchymal or complicated
cyst, thoracoscopic resection can be technically difficult and hazardous, and
open approach is preferable.
Synchronous Quadruple Lung Cancer Treated Curatively by Photodynamic Therapy
Authors: Saito Makoto , Kato Harubumi , Konaka Chimori , Okunaka Tetsuya , Furukawa Kinnya , Sakai Harumasa , Nakamura Haruhiko , Ebihara Yoshihiro
Published: August 2007

A 54‐year‐old male was diagnosed as having synchronous quadruple early stage lung
cancer. All four tumors showed the same histologic type of in‐situ or microinvasive
squamous cell carcinoma, but existed independently in different bronchi. Photodynamic
therapy of these four lesions was successfully performed by fiberoptic bronchoscopy
because of the patient′s poor pulmonary function. The patient is alive and well 51
months later.
Effect of Diazepam Sedation on Arterial Oxygen Saturation and Patient Tolerance During Esophagogastroduodenoscopy
Authors: Malik G. M. , Mubarik M. , Kadla S. A. , Basu J. A. , Tajamul H.
Published: August 2007

The impact of intravenous (I/V) diazepam sedation on arterial oxygen saturation
(SaO2) and patient tolerance was studied in 100 patients in the age group of (27–60) years, who were subjected to esophagogastroduodenoscopy (EGD) for different indications. Equal number of patients in the same age group, who did not receive the sedation
acted as controls. It was observed that SaO2 showed a transient fall during the first few
minutes of the endoscopic procedure even without sedation and diazepam administration
did not significantly (p > 0.05) aggravate this oxygen desaturation. It was also
observed that diazepam sedation increased the procedure tolerance of the patients when
compared with controls (p < 0.01). In conclusion, it was inferred that I/V diazepam
may act as a safe and favourable sedative for EGD.

Corrigendum to “Effect of Diazepam Sedation on Arterial Oxygen Saturation and Patient Tolerance During Esophagogastroduodenoscopy”dx.doi.org/10.1155/DTE.4.51
Role of Endoscopic Retrograde Cholangiography and Nasobiliary Drainage in the Management of Postoperative Biliary Leak
Authors: Goenka M. K. , Kochhar R. , Bhasin D. , Nagi B. , Wig J. D. , Singh G. , Sriram P. V. J. , Singh K.
Published: August 2007

In order to assess the role of endoscopic retrograde cholangiography in evaluating the patients with post‐operative biliary leak and of endoscopic nasobiliary drainage in its management, 36 patients with biliary leak seen over a period of 9 years were studied. Thirty‐two had biliary leak following cholecystectomy, 3 following repair of liver trauma and 1 following choledochoduodenostomy. Patients presented at an interval of 4 days to 210 days (mean ± SEM, 32.4 ± 6.7 days) following laparotomy. Hyperbilirubinemia was noticed in only 13 patients (36.1%), while abdominal ultrasonogram showed ascites or biloma in 24 (66.7%). Endoscopic retrograde cholangiography showed the leak to involve the common bile duct in 55.6%, cystic duct in 33.3% and intrahepatic biliary radicles in 8.3%. Associated lesions included bile duct obstruction due to stricture or accidental ligature in 20%, bile duct stone in 20% and liver abscess in 2.8%.

Endoscopic nasobiliary drainage using a 7 Fr pig‐tail catheter was attempted in 14 patients and could be established in 12 of them. Bile duct leak sealed in all but one of these 12 patients after an interval of 3 days to 40 days (mean ± SEM, 12.2 ± 3.2 days). A single patient with large defect and a proximal bile duct stricture did not respond and required surgery. Common bile duct stones were removed by endoscopic sphincterotomy in 3 out of 4 patients. One patient with large stone required surgical choledocholithotomy. In conclusion, endoscopic retrograde cholangiography was safe and useful in confirming the presence of leak as well as its site, size and associated abnormalities. Endoscopic nasobiliary drainage proved an effective therapy in post‐operative biliary leak and could avoid re‐exploration in 71.4% patients.
Ureteroscopic Lithotripsy
Authors: Bagley Demetrius H.
Published: August 2007

There is a wide array of endoscopic lithotriptors presently available. Each of these has
its own advantages and disadvantages. No single lithotriptor is suitable for all applications
and none can meet the goal of fragmenting all calculi while remaining harmless to
tissue.
Arthroscopic Meniscus Repair: Clinical and Isokinetic Results
Authors: Erggelet Christoph , Grosse Carmen , Henche Hans-Rudolph , De Koning Bart
Published: August 2007

The importance of the menisci for transmitting workloads in the knee joint to protect the
articular cartilage is widely acknowledged. Therefore various techniques have been introduced
to repair the damaged meniscus.

We performed an arthroscopic meniscus repair with a modified outside‐in technique on 29
patients (average 25 years) between 2/91 and 10/94. The average time between trauma and
operation was 29 weeks (1–186) – the follow‐up 16.3 months (4–49). All the patients were
interviewed by phone – 23 were available for clinical respectively isokinetic examination,
and categorized following the Lysholm and Lais scores.

Twenty‐eight patients were happy with the result of the procedure. Following the Lysholm
score we found 78% good/excellent results (Lais score 74%). Isokinetic testing showed a
muscular deficit of less than 20% in 91% of the cases for flexion (extension 69%). No
significant influence neither of the age of the patient nor the time period between trauma and
operation on the outcome of the procedure could be found. No complications were reported.

Based on our results and well aware of the deleterious long term effects of total meniscectomy
the arthroscopic menical repair performed by an experienced surgeon should be
generous choice of therapy for the treatment of the ruptured meniscus.
A Case of Pill‐Induced Esophagitis With Mucosal Dissection
Authors: Adachi Wataru , Watanabe Hiroyuki , Yazawa Kazuyuki , Koide Naohiko , Koike Shoichiro , Amano Jun , Tamai Chisato
Published: August 2007

With the advance of gastrointestinal endoscopy, pill‐induced esophagitis has been detected
more frequently, but the association of mucosal dissection is rare. We reported a case of pill‐induced
esophagitis associated with mucosal dissection.

A 66‐year‐old male with combined valvular heart disease was admitted for cardiac
surgery. Cefotiam hydrochloride tablet was administered for postoperative wound infection
of cardiac surgery. Next morning severe odynophagia and retrosternal pain were occurred.
Upper gastrointestinal endoscopy performed 2 days after onset of the symptom showed
detached mucosa at the upper thoracic esophagus and acute esophagitis at middle and lower
thoracic esophagus. Histological examination of the mucosa revealed that the esophageal
mucosa was detached from the lamina propria. After the treatment for esophagitis, almost
normal esophageal mucosa covered the esophagus without scarring or stricture.

The present case was diagnosed as cefotiam hydrochloride tablet induced esophagitis
because of the onset of this disease. Mucosal dissection of the esophagus may be associated
with both the esophagitis and bleeding tendencies caused by anticoagulant therapy.
Cooperative Clinical Trial of Photodynamic Therapy for Early Gastric Cancer With Photofrin Injection® and YAG‐OPO Laser
Authors: Mimura Seishiro , Narahara Hiroyuki , Hirashima Toshio , Fukutomi Hisayuki , Nakahara Akira , Kashimura Hiromasa , Matsui Hirofumi , Tanimura Hiroshi , Nagai Yugo , Suzuki Shigeru , Murata Yoko , Yoshida Kazunari , Isono Kaichi , Kozu Teruo , Ide Hiroko , Kato Harubumi
Published: August 2007

Background and Objective: Photodynamic therapy (PDT) treats malignant tumors using photosensitizers and light. We employed a new pulse laser as the excitation light source for PDT, i.e. an optical parametric oscillator (OPO) system pumped by a Q‐switched Nd:YAG laser, because it provides extremely high peak power.

Study Design/Materials and Methods: The effects of PDT using the photosensitizer Photofrin® and the new laser were evaluated in 12 patients with early gastric cancer.

Results: Complete responses (CR) were obtained in 75% of 12 assessable patients, CR was observed in all cases with mucosal carcinoma (response rate 100%).

Regarding toxicity, mild photosensitivity was seen in one case and it lasted several weeks. The other major side effect was decrease of total protein, which was observed in six patients (40%), lasting several months. There were no serious abnormalities in symptoms or laboratory tests.

Conclusion: We conclude that the YAG‐OPO laser is suitable as an excitation light source for PDT.
Laparoscopic Evaluation and the Management of the Nonpalpable Testis
Authors: Koyama Toshiki , Nonomura Katsuya , Ameda Kaname , Kakizaki Hidehiro , Matsugase Yasukuni , Shinno Yuichiro , Kanno Takayuki , Yamashita Tetsufumi , Murakumo Masashi , Koyanagi Tomohiko
Published: August 2007

From June 1992 to December 1996, we performed laparoscopic evaluation for 28 nonpalpable
testes in 22 patients (1–21, median 3 years old).

The location of 28 testes were divided into 4 categories according to the classification
by Malone et al.: canalicular in 17 testes, just canalicular in 2, abdominal in 7, and
absent in 2. Two‐stage Fowler–Stephens orchiopexy was performed in 3 abdominal
testes and planned two‐stage orchiopexy was performed in one abdominal testis, while
one‐stage standard orchiopexy was performed in 10 testes (canalicular 5, just canalicular
2, and abdominal 3). In 10 of 17 canalicular testes no testicular element was found on
histological examination of the excised remnant tissue. In two completely absent testicular
structures, as verified by vanishing spermatic vessels, no further exploration was
done after laparoscopy. There was one complication in this series: jejunal injury which
needed oversewing, otherwise there was no postoperative sequela in all cases.

Laparoscopic evaluation in patients with nonpalpable testes gives us precise information
as to the existence and location of the testicle which is helpful in determining
subsequent appropriate procedure and avoiding unnecessary abdominal exploration.
Long Term Complete Remission of Intraluminal Squamous Cell Carcinoma by Bronchoscopic Electrosurgery
Authors: De Vries Peter M. J. M. , Postmus Pieter E. , Sutedja Tom G.
Published: August 2007

A patient is described with a synchronous intraluminal squamous cell carcinoma of the left upper lobe carina. He refused photodynamic therapy after sleeve lobectomy of the right upper lobe. The intraluminal tumor was treated with fiberoptic bronchoscopic electrosurgery. Complete remission was achieved, at the moment already for 36 months.
Rigid Bronchoscopic Removal of Multiple Airway Foreign Bodies
Authors: Lano Charles F. , Smith Timothy L. , Holmes Douglas K.
Published: August 2007

Despite new equipment, such as the Hopkins rod‐lens telescopes and optical forceps, foreign bodies in the airway continue to present a diagnostic and therapeutic challenge to the endoscopist. Airway foreign bodies are more common in children than adults and frequently, the patient may have aspirated more than one foreign body or the original foreign body fragments into pieces. Vegetable matter is the most frequently aspirated material by children. This material can swell as it absorbs water, it can cause an intense mucosal reaction and it can fragment during removal. A case with endoscopic photographs demonstrating these issues and a discussion are presented.
5‐Aminolaevulinic Acid (ALA) for the Fluorescence Detection of Bronchial Tumors
Authors: Huber Rudolf M. , Gamarra F. , Hautmann H. , Häußinger K. , Wagner S. , Castro M. , Baumgartner R.
Published: August 2007

At the moment only early detection of lung cancer offers a good prognosis for the patients. Conventional white light endoscopy is mostly insufficient for early diagnosis. Therefore we
developed a system of fluorescence diagnosis using 5‐aminolaevulinic acid (ALA)
exogeneously applied. As precursor of the heme synthesis it is metabolized to protoporphyrin
IX – a red fluorescent substance. Therefore protoporphyrin IX accumulates in tumorous and
premalignant tissue, and can be directly visualized by fluorescence bronchoscopy. Excitation
with blue light (380–435 nm) causes a red fluorescence, which can be detected after filtering
most of the blue component with the naked eye or a camera system. After earlier work with
laser systems and cold light sources we now use the system D‐Light AF for the fluorescence
diagnosis using ALA‐induced protoporphyrin IX fluorescence.
Clinical Experience Using a Real Time Autofluorescence Endoscopy System in the Gastrointestinal Tract
Authors: Ogihara Tatsuo , Watanabe Haruo , Namihisa Akihiro , Kobayashi Osamu , Miwa Hiroto , Sato Nobuhiro
Published: August 2007

Autofluorescence spectra of neoplastic tissues have been reported to be significantly different
from those of normal tissues when excited by blue or violet light. From this concept, a light‐induced
autofluorescence endoscopic imaging system for gastrointestinal mucosa (LIFE‐GI;
Xillix, Canada and Olympus, Japan) has been newly developed and the clinical evaluation of
the prototype system has been conducted in hospitals in Canada, Netherlands and Japan.

We examined the clinical usefulness of the prototype LIFE‐GI system for the detection of
gastrointestinal cancer and high and low grade dysplasia. The LIFE‐GI system was also
applied to the early detection of remnant lesions after endoscopic treatment of early gastric
cancer and to the detection of laterally spreading superficial colonic tumors.

This system has potential application for the diagnosis of dysplastic lesions and early
cancers in the gastrointestinal tract as an adjunct to ordinary white light endoscopy. This
system, which needs no administration of a photosensitive agent, may be suitable as a
screening method for the early detection of neoplastic tissues.
A New Endoscopic Technique for Examination of Esophageal Stenosis: The Funnel‐shaped Transparent Cap Technique
Authors: Katayama O. , Wakabayashi N. , Ishihama S. , Ohi I.
Published: August 2007

We have devised a funnel‐shaped transparent cap for the endoscopic diagnosis and treatment
of stenosis in the digestive tract. This funnel‐shaped cap is made of highly transparent
methacrylic resin. A 73‐year‐old woman with reflux esophagitis (categorized as grade
D by the Los Angeles Classification) visited our hospital with the chief complaint of
dysphagia. She was examined using an endoscope equipped with a transparent vinyl
chloride hood at its tip. Many pieces of food were found to be trapped in the esophagus. These were removed using tripod forceps or aspirated into the hood. The internal diameter
of the stenotic segment was as small as 1 or 2 mm, and it was difficult to advance the
endoscope past the stenosis. The endoscope was withdrawn, and the attached hood was
removed and replaced with a transparent cap. This provided clear visualization of the
mucosal surface of the stenotic segment, which could not be examined using any conventional
device, permitting the stenosis to be relieved.
External Pancreatic Juice Drainage Through a Percutaneous Endoscopic Drainage Tube for the Patient With a Postoperative Pancreatic Juice Leakage
Authors: Nishiguchi Yukio , Nishino Hiroji , Yoshikawa Kazuhiko , Nakamura Mikio , Takaishi Osamu , Shiba Masatsugu , Nakamura Hajime , Nomura Tsutomu , Ikeda Katsumi , Ohira Masaichi , Asai Takeshi , Yamagata Shigehito , Takeuchi Kazuhiro , Sowa Michio , Suzuki Noriko
Published: August 2007

Percutaneous endoscopic gastrostomy (PEG) has been widely accepted for patients who have
no swallowing ability but have an intact gut. Its clinical application is mainly for nutritional
support and decompression of the intestine in patients with bowel obstruction. In this paper, we
report external pancreatic juice drainage through a percutaneous endoscopic drainage tube in
a patient with postoperative pancreatic juice leakage. Soon after this procedure, pancreatic
juice leakage subsided. This procedure was minimally invasive for the patient and may be a
new application of PEG to maintain the good quality of life (QOL) in a patient with pancreatic
juice leakage.
Progress of Photodynamic Therapy in Gastric Cancer
Authors: Mimura Seishiro , Narahara Hiroyuki , Otani Toru , Okuda Shigeru
Published: August 2007

Progress of photodynamic therapy (PDT) in gastric cancer and the clinical outcome are
described in this paper. (1) We included the whole lesion and a 5 mm margin in the field for
irradiation. Marking by injection of India‐ink showing the irradiation field was performed
beforehand. (2) We established the standard light dose to be 90 J/cm2 for an argon dye
laser and 60 J/cm2 for a pulse wave laser. (3) The size of cancerous lesion curable by PDT
was expanded from 3 cm in diameter, i.e. 7 cm2 in area to 4 cm in diameter, i.e. 13 cm2 by
employing a new excimer dye laser model, which could emit 4mJ/pulse with 80 Hz pulse
frequency. (4) The depth of cancer invasion which could be treated by PDT was increased from
about 4 mm, i.e. the superficial part of the submucosal layer (SM‐1) to more than 10 mm in
depth, i.e. the proper muscular layer. These improvements owe much to the pulse laser, the
photodynamic action induced by which permits deeper penetration than that of a continuous
wave laser. (5) We employed a side‐viewing fiberscope for gastric PDT to irradiate the lesion
from an angle of 90°. (6) We designed a simple cut quartz fiber for photoradiation with a spiral spring thickened toward the end. (7) We developed an endoscopic device for photoradiation in
PDT which achieves accurate and efficient irradiation. As a result of these improvements a
higher cure rate was obtained even with a lower light dose of irradiation.
Application of PDT for Uterine Cervical Cancer
Authors: Muroya T. , Kawasaki K. , Suehiro Y. , Kunugi T. , Umayahara K. , Akiya T. , Iwabuchi H. , Sakunaga H. , Sakamoto M. , Sugishita T. , Tenjin Y.
Published: August 2007

We have been performing PDT using Excimer Dye Laser (EDL) or YAG‐OPO laser, a type
of low power laser, both of which have a considerably higher degree of tissue penetration even
when compared to PDT using Argon Dye Laser (ADL).

PDT is a relatively simple procedure without any bleeding and does not require anesthesia
since it causes no pain. PDT is performed 48 h after intravenous injection of 1.5–2.0 mg/kg
of PHE (Photofrin®). Precise spot irradiation is possible using a colposcope with an optical laser path. We also use a cervical probe which enables photoirradiation of the entire cervical canal.

We have performed PDT on 131 cases (95 CIS, 31 dysplasia, 1 vulval dysplasia (VIN),
3 squamous cell carcinoma, microinvasion, and 1 CIS + endocervical adenocarcinoma,
microinvasion). Of these cases, 127 became CR (96.9%). The first CR case was 10 years ago
and no recurrence has been observed yet.

PDT is extremely effective to preserve fertility. Except for sensitive reactions to sunlight,
there are no noticeable side effects or difficulties related to pregnancy or delivery. We expect
that in the near future PDT will be performed using diode lasers and without hospitalization
due to new photosensitizers which have shorter retention times.
Percutaneous Transhepatic Cholecystoscopic Lithotomy in the Management of Acute Cholecystitis Caused by Gallbladder Stones
Authors: Ohashi Shigeki
Published: August 2007

Percutaneous transhepatic cholecystic drainage (PTCCD) with percutaneous transhepatic cholecystoscopic lithotomy (PTCCSL) were performed in 53 patients with acute cholecystitis caused by gallbladder stones and studied stone removal rates, complications, endoscopic findings, and stone recurrence. The stones were successfully removed in 96% of the patients, and there were no serious complications. The coexistence of cancer was confirmed in three patients, and all cases were accurately diagnosed on the basis of uitrasonographic, endoscopic, and biopsy findings. The mean duration of follow‐up after stone removal was 42 months, and the stone recurrence rate was 2.5%. Among the 39 patients followed up for at least 1 year, the gallbladder could be preserved with no evidence of sludge in patients in whom drainage was performed early after the onset of symptoms, those with a normal gallbladder after PTCCSL, and those with normal gallbladder contractility after PTCCSL. Sludge was present in patients with evidence of extensive areas of yellowish white fibers on percutaneous transhepatic cholecystoscopy. If instituted early after the onset of symptoms, PTCCD combined with PTCCSL was considered useful in the treatment of patients with acute cholecystitis associated with gallbladder stones.
Photodynamic Diagnosis and Treatment for Atherosclerosis by an Endoscopic Approach
Authors: Hayashi Junichi , Saito Takashi , Aizawa Katsuo
Published: August 2007

The photosensitizer, mono‐L‐aspartyl chlorin e6 (NPe6), specifically accumulates in the
atheromatous plaque. We detected the fluorescence spectra of NPe6 emitted from
atheromatous plaques on the descending thoracic aorta by an angioscopic approach using
the animal model of atherosclerosis. We also showed that a fluorescence spectrum peak at
675 nm was obtained laparoscopically only in parts of the abdominal aorta with an
atheromatous plaque. By a fluorescence endoscope, atheromatous plaques on the carotid
artery were recognized as reddish spots from outside the artery. In addition, we visualized
specifically at the beating heart surface small coronary atherosclerosis using an epifluorescence
stereoscope system.

We examined the effects of photodynamic treatment with NPe6 on the atheromatous
plaque. The change in the elastic framework in the atheromatous plaque after photodynamic
treatment was evaluated using scanning electron microscopy. The destruction of the
architecture of the elastic fiber network in the atheromatous plaque was revealed. We also
studied the change in the lipid components of the atheromatous plaque using Fourier
transform infrared (FTIR) microspectroscopy. FTIR microspectroscopic analysis showed
a dissociation of ester bonds of cholesterol esters in the atheromatous plaque after
photodynamic treatment. The framework of the atheromatous plaque and the lipids
accumulated in the plaque could be destroyed following such treatment.
Combined Endoscopic and Laparoscopic Treatment of Gallstones and Bile Duct Stones
Authors: Longhini A. , Pellegrino R. , Kazemian A. R. , Borelli P. , Munarini G. , Buccilli E. , Marcolli G.
Published: August 2007

The best treatment of bile duct lithiasis in the era of the laparoscopic cholecystectomy has not
yet been defined, as we can choose between different kinds of therapies which range from the
traditional laparotomic treatment to the more modern endoscopic and laparoscopic
techniques. Although in some centres a wholly laparoscopic access to the bile duct is used,
we believe that the fastest, safest and most reliable method is still the sequential treatment,
endoscopic and laparoscopic. In our experience the endoscopic cleaning of the choledochus
was performed in 87.1% of the cases, with no mortality and 4.2% morbidity.
Longstanding Endobronchial Foreign Body
Authors: Trisolini R. , Dore R. , Bertolini R. , Pasturenzi L. , Catania A. Fede , Gualtieri G. , Luisetti M. , Torre M.
Published: August 2007

There are many circumstances in which the diagnosis of endobronchial inhalation of a foreign body (FB) can be missed. Generally, in such cases, within weeks or at most months from the event, clinical bronchopulmonary symptoms develop which allow a correct diagnosis to be made and significant complications to be avoided. We report the case of a patient in whom an endobronchial FB remained undiagnosed, because of lack of symptoms, for almost three years, and then caused signifiicant complications before being identified and removed. Problems related to diagnosis and therapy are discussed.
A Case of Endobronchial Lipoma
Authors: Iwabuchi Hiroshi , Kamura Tetsuo , Tanaka Michio , Kato Harubumi
Published: August 2007

Endobronchial lipomas are very rare tumors originating from the tracheo‐bronchial wall. We have experienced a case of endobronchial lipoma which was found at the orifice of the left lower lobe bronchus and obstructive pneumonia distal to it. Left lower lobectomy was performed, and the patient has been well without any symptoms so far.

Endobronchial lipomas are histologically benign tumors, but more than half of the reported cases underwent lobectomy or pneumonectomy due to the presence of varying degrees of irreversible peripheral lung damages.
Endoscopic Characteristics of the Healing Process of Ulcerative Colitis
Authors: Kishi Hideyuki
Published: August 2007

This study compared the histologic characteristics of ulcerative colitis with findings on conventional colonoscopy and on magnification and dye application for 70 sites that underwent biopsy. The primary objective was to study the correspondence between histologic findings and endoscopic findings with respect to glandular restructuring and the resolution of inflammation from the active to the remission phase of ulcerative colitis. Widened grooves, as assessed by the endoscopic staining technique and magnified observation, most closely correlated with histologic evidence of resolution of inflammation, and vascular markings and color tone of the mucosa on general colonoscopy most closely correlated with histologic evidence of glandular restructuring, such as glandular maturity. Magnifying endoscopy after dye application, in addition to conventional endoscopy, is therefore considered essential in the evaluation of ulcerative colitis during the resolving phase.
Development of the Autofluorescence Endoscope Imaging System
Authors: Adachi Rensuke , Utsui Tetsuya , Furusawa Koichi
Published: August 2007

It is a well known fact that light emitted at a specific wavelength induces fluorescence in the
human body. This kind of fluorescence is called autofluorescence. The application of
autofluorescence diagnosis, on the other hand, is a more complicated system designed to
detect faint autofluorescence inherent in tissues/cells. We have adopted this autofluorescence
diagnosis method and developed a new autofluorescence endoscope imaging system called
the SAFE‐1000. Normal mucosa emitting autofluorescence appears green on the monitor,
while abnormal mucosa shows a dark image caused by the lack of autofluorescence.
Early Detection of Bronchial Lesions Using Lung Imaging Fluorescence Endoscope
Authors: Ikeda N. , Honda H. , Katsumi T. , Okunaka T. , Furukawa K. , Tsuchida T. , Tanaka K. , Onoda T. , Hirano T. , Saito M. , Kawate N. , Konaka C. , Kato H. , Ebihara Y.
Published: August 2007

The performance of the Lung Imaging Fluorescence Endoscope (LIFE) system was compared with conventional bronchoscopy in 158 patients: 68 patients with invasive cancer, 42 patients
with abnormal sputum cytology findings (12 early cancer and 26 dysplasia), 17 cases with
resected lung cancer and 31 smokers with symptoms. The respective results of conventional
bronchoscopy and LIFE for detection of dysplasia were; sensitivity 52% and 90% (biopsy
basis), 62% and 92% (patient basis). Fluorescence bronchoscopy may be an important
adjunct to conventional bronchoscopy to improve the localization of subtle lesions of
bronchus.