bluuebunny/crossref_metadata_2025 huggingface dataset:
An easy and versatile embedding method for transverse sections
Authors: De Smet I. , Chaerle P. , Vanneste S. , De Rycke R. , Inzé D. , Beeckman T.
Published: December 2003

In several research areas, transverse sections are indispensable for studying structural aspects of specimens. However, the oriented embedding of small cylindrical samples can become problematic, especially when transverse sections at right angles to the main axis of the object are desired. Here, we describe an easy and low‐cost technique for oriented embedding of small (∅ < 500 µm) as well as of larger specimens (∅ > 500 µm). The usefulness of the technique is demonstrated for roots and stamens of Arabidopsis thaliana and for adventitious roots of Asplenium demerkense, as examples of small and larger cylindrical samples, respectively. Furthermore, several types of resin (glycol methacrylate, epoxy and acrylic resins) were successfully tested, showing the applicability of the technique for light and electron microscopy and for immunolocalizations. In conclusion, the principle of the technique can be extended to several resins and a wide variety of specimen types, such as stems, leaves and textile fibres. The originality of the technique lies in its simplicity combined with its high efficiency to produce well‐oriented transverse sections.
Fluctuation analysis of mitochondrial NADH fluorescence signals in confocal and two‐photon microscopy images of living cardiac myocytes
Authors: Blinova K. , Combs C. , Kellman P. , Balaban R. S.
Published: December 2003

A fluctuation analysis was performed on the reduced nicotine adenine dinucleotide (NADH) fluorescence signal from resting rabbit myocytes using confocal and two‐photon microscopy. The purpose of this study was to establish whether any co‐ordinated biochemical processes, such as binding, metabolism and inner mitochondrial membrane potential, were contributing to NADH signal fluctuations above background instrument noise. After a basic characterization of the instrument noise, time series of cellular NADH fluorescence images were collected and compared with an internal standard composed of NADH in the bathing medium. The coefficient of variation as a function of mean signal amplitude of cellular NADH fluorescence and bathing media NADH was identical even as a function of temperature. These data suggest that the fluctuations in cellular NADH fluorescence in resting myocytes are dominated by sampling noise of these instruments and not significantly modified by biological processes. Further analysis revealed no significant spatial correlations within the cell, and Fourier analysis revealed no coherent frequency information. These data suggest that the impact of biochemical processes, which might affect cellular NADH fluorescence emission, are either too small in magnitude, occurring in the wrong temporal scale or too highly spatially localized for detection using these standard optical microscopy approaches.
SNOM and AFM microscopy techniques to study the effect of non‐ionizing radiation on the morphological and biochemical properties of human keratinocytes cell line (HaCaT)
Authors: Rieti S. , Manni V. , Lisi A. , Giuliani L. , Sacco D. , D’Emilia E. , Cricenti A. , Generosi R. , Luce M. , Grimaldi S.
Published: December 2003

In this study we have employed atomic force microscopy (AFM) and scanning near‐field optical microscopy (SNOM) techniques to study the effect of the interaction between human keratinocytes (HaCaT) and electromagnetic fields at low frequency. HaCaT cells were exposed to a sinusoidal magnetic field at a density of 50 Hz, 1 mT. AFM analysis revealed modification in shape and morphology in exposed cells with an increase in the areas of adhesion between cells. This latter finding was confirmed by SNOM indirect immunofluorescence analysis performed with a fluorescent antibody against the adhesion marker β4 integrin, which revealed an increase of β4 integrin segregation in the cell membrane of 50‐Hz exposed cells, suggesting that a higher percentage of these cells shows a modified pattern of this adhesion marker.
Body extracts from the forest ant and honeybee: chromatographic comparison of factors affecting the ant Malpighian tubule
Authors: Laenen Bart , Wiehart Ursula , De Decker Nadine , Steels Paul , Van Kerkhove Emmy
Published: December 2003

Abstract.  Crude trifluoroacetic acid extracts were prepared from different body parts of the forest ant, Formica polyctena Foerster, Hymenoptera, Formicidae, and the honeybee, Apis mellifera carnica Pollmann, Hymenoptera, Apidae. Extracts were prepurified by means of solid phase extraction over reversed‐phase cartridges. The effects of the resulting fractions on fluid secretion rates were tested on single preparations of ant Malpighian tubules. Diuretic and antidiuretic factors were shown to be present. High‐performance liquid chromatography allowed for the identification of a diuretic factor from the bee‐head extract which had a similar elution profile to a previously purified diuretic peptide from ant‐head extracts. An antidiuretic factor was also identified from the bee abdominal extract. Similar to an antidiuretic peptide, which was purified from ant abdominal extracts, this antidiuretic factor inhibited fluid secretion and depolarized the transepithelial potential of ant Malpighian tubules.
Bats and moths: what is there left to learn?
Authors: Waters Dean A.
Published: December 2003

Abstract.  Over 14 families of moths have ears that are adapted to detect the ultrasonic echolocation calls of bats. On hearing a bat, these moths respond with an escape response that reduces their chances of being caught. As an evolutionary response, bats may then have evolved behavioural strategies or changes in call design to overcome the moth's hearing. The nature of this interaction is reviewed. In particular, the role of the echolocation calls of bats in the shaping of the structure, neurophysiology and behavioural responses of moths is discussed. Unresolved issues, such as the structural complexity of the moth's auditory system, the nature of temporal integration and the role of the non‐auditory B cell, are described. Issues in which the interactions between bats and moths may be of more general interest to biologists, such as noise filtering within the central nervous system, protean behaviours and coevolution between predator and prey, are also discussed. The interaction between bats and moths has much to interest general biologists, and may provide a useful model in understanding the neurophysiological basis of behaviour, including protean escape behaviours. The validity of the term coevolution as applied to this system is discussed, as there is no doubt that the auditory system of moths is a response to the echolocation calls of bats, although the evolutionary response of bats to moths is more ambiguous.
A comprehensive plan for treating the major polluted regions of Lake Taihu, China
Authors: Jin Xiangcan , Hu Xiaozhen
Published: December 2003

The Lake Taihu drainage basin is an economically developed area, containing almost the highest population density and most populous cities and towns in China. It is also among the largest lake basins in China that has been seriously degraded because of ecological destruction and eutrophication. The pollution of Lake Taihu presently exerts an enormous hindrance to the sustainable development of the basin and threatens the health of the population surrounding the lake. For this reason, it has been an urgent task for local government and relevant staffs to take measures to protect and treat the water of Lake Taihu. Based on the analysis of its present condition, as well as the trends in its water quality and the pollution sources in the drainage basin of Lake Taihu, this article identifies the six major polluted regions requiring remediation and control, and presents an engineering plan for comprehensive treatment of the lake.
The effects of climate and hydrology on the trophic status of Sélingué Reservoir, Mali, West Africa
Authors: Arfi Robert
Published: December 2003

This work investigates the effects of climate and hydrology as factors controlling the trophic status of Sélingué, a monomictic reservoir in Mali, West Africa. Environmental (water transparency, hydrochemistry, nutrients) and biological (chlorophyll a concentrations) descriptors were studied on water samples collected biweekly from November 2000 to November 2001 in a station representative of the northern part of the water body. Statistical methods were used to estimate the existence and significance of breaks in the time series and environmental data were used to explain these breaks. In Sélingué Reservoir, the water column is stratified from March to May as a result of the cooling induced by the harmattan (North‐East trade winds). Stratification lasts a few weeks, until the beginning of the monsoon (South‐West trade winds), after which progressive warming allows vertical mixing of the lake. In harmattan or monsoon situations, the winds do not play a significant role except for storm events during the rainy season. Such events can change transiently, but markedly, the physical conditions prevailing in the whole water column. The water quality closely follows the hydrological cycle, characterized by a unique flood, which lasts a few weeks, from mid‐July. Input of nutrients during the flood events is limited and local mineralization of organic matter in the hypolimnion during the stratification period seems to play a major role in the availability of dissolved inorganic nitrogen and soluble reactive phosphorus. This availability is subject to vertical mixing which is only possible when the water height is sufficiently low and the wind‐induced energy is sufficiently high. Dry (dust during the harmattan period) and wet deposition (linked to rains) play a role in supplying nutrients to the lake and can be factors in the observed increased chlorophyll a concentrations. Thus, environmental factors in Sélingué change with the current hydrological conditions. Sélingué Reservoir can be regarded as oligotrophic during the high water period, but as meso‐eutrophic during the low water period. Each annual flood initializes the ecological conditions in this water body. This pattern limits the risks of trophic change (which can lead to algal blooms) to short periods of very low water levels immediately preceding flood events.
The pollution of Lake Ladoga by organochlorine pesticides and petroleum products
Authors: Krylova Julia V. , Kurashov Evgeny A. , Korkishko Nikolay N.
Published: December 2003

According to information available from scientific literature, Europe's largest lake, Lake Ladoga, is heavily polluted by organochlorine pesticides (OCPs) and petroleum products. Our studies (1992–1999) were conducted over the entire lake, and at various depths, throughout the year. The substances detectable by gas chromatography were natural compounds, most of which are the product of planktonic algae metabolism. For each phytoplankton group, the use of multivariate statistics has revealed a complex of low molecular weight (LMW) haloid‐organic compounds. Studies revealed that OCPs are not detectable, even in extremely high concentrations of hexane extracts. Investigations showed that OCPs could not be identified in Lake Ladoga even at concentrations of 0.0001–0.000025 µg L−1(that is, 100 and 400 times lower than the maximum permissible concentrations for fisheries). It was discovered that the chromatographic retention times of some detected LMW haloid‐organic metabolites of phytoplankton coincide with the retention times of some OCPs and of hydrocarbons from petroleum products. The distribution of different hydrocarbons in the lake is also related to the distribution of planktonic algae, which is the main source of hydrocarbons in Lake Ladoga.
The spatio‐temporal characteristics of water transparency and temperature in shallow reservoirs in Kenya
Authors: Mwaura Francis
Published: December 2003

Water transparency and temperature in eight small reservoirs, ranging from 0.065–0.249 km2, in a rugged escarpment landscape and stepped plateau in the Eastern Rift Valley of Kenya were investigated between 1998 and 2000. Water transparency and temperature were measured with a 20‐cm Secchi disk and a portable Jenway probe, respectively. The water transparency ranged from 0.02–0.8 m, which was low, but still similar to some larger reservoirs in the country (such as Masinga Dam). Reservoirs in the rugged escarpment had more water transparency than those in the high altitude plateau. The mean temperature ranged from 15–21°C. The reservoirs were either hypertrophic or oligo‐mesotrophic, and mostly polytrophic, based on their water transparency in accordance with the trophic status classification of the Organization for Economic Cooperation and Development. Most of the reservoirs experienced short‐lived stratification during the transition from the dry to rainy seasons. The results did not illustrate large spatio‐temporal variability in water transparency or temperature, mainly because of physiographic and ecohydrological uniformity. All the reservoirs were considered to be in a poor state of domestic water quality, based on their water transparency.
The environmental and operational impacts of Curuá‐Una, a reservoir in the Amazon region of Pará, Brazil
Authors: Gunkel Günter , Lange Uwe , Walde Detlef , Rosa João W. C.
Published: December 2003

An increasing demand for electrical power can be observed in the Amazon region. Although hydropower is the main source of energy production, only a few reservoirs have been built. In view of the significant energy deficit, the construction of new reservoirs certainly merits serious consideration. However, reservoir construction has significant impacts on natural water systems. The environmental effects of reservoirs in the northern hemisphere have been well‐documented but little is known about those in the Amazon area. Therefore, we studied Curuá‐Una, a 23 year‐old reservoir in the Amazon region, to evaluate developments in the catchment area and aquatic ecosystem, as well as dam use. The long‐range environmental effects of the reservoir included deforestation in the watershed, erosion and the introduction of new land and water‐borne diseases. Human migration and settlement was another significant consequence. New results of soil damage analysis are presented, illustrating a large export of iron and mercury from the system. The dam had several detrimental effects on the aquatic ecosystem, including enhanced eutrophication, inhibited decay of inundated vegetation and increased iron corrosion of electromechanical equipment related to the accumulation of iron in the water. The main downstream effect of the dam was the prevention of fish migration.
The intermittent Lake Cerknica: Various faces of the same ecosystem
Authors: Gaberščik Alenka , Urbanc‐Berčič Olga , Kržič Nina , Kosi Gorazd , Brancelj Anton
Published: December 2003

The turnover of matter and through‐flow of energy in the intermittent Lake Cerknica is facilitated by the exchanging wet and dry periods, which either promote or suppress growth and development of organisms, depending on the season of the year. Any deviation from normal floods significantly affects the productivity of reed stands. Drainage of the lake prevents a constant presence of aquatic organisms, particularly planktonic species. Drying and wetting accelerates the decomposition of organic matter. The nutrient input into the lake by one surface tributary proved to be relatively high. The quantity of nutrients in the lake water is lower, however, because of the high buffering capacity of the densely vegetated ecosystem.
Case of early gastric cancer with nodular gastritis
Authors: Kamada Tomoari , Haruma Ken , Sugiu Kuniaki , Nagashima Yuichi , Qian Dong Mei , Koga Hideki , Takeda Masaharu , Kusunoki Hiroaki , Honda Keisuke , Fujimura Yoshinori , Tsunoda Tsukasa , Sadahira Yoshito
Published: December 2003

A case of depressed early gastric cancer with nodular gastritis is described. A 47‐year‐old Japanese man was referred to our hospital and admitted for surgical treatment of gastric cancer. Barium upper gastrointestinal study and endoscopy examination showed a 4.5 × 3.0 cm depressed lesion with a deep central ulceration in the anterior wall of the lower corpus. An unusual miliary pattern resembling ‘goose flesh’ was observed endoscopically in the antrum. Biopsy specimens from the tumor showed poorly differentiated adenocarcinoma, and specimens from the antrum showed many lymphoid follicles with a germinal center. Immunoglobulin G antibody and histological tests (Giemsa stain) for Helicobacter pylori were both positive. Early gastric cancer with nodular gastritis was diagnosed and a subtotal gastrectomy was performed. Histological examination of the resected specimen showed a stage I tumor infiltrating a poorly differentiated adenocarcinoma with a depressed lesion in the corpus (type 0 IIc + III) and nodular gastritis in the antrum. The patient is doing well 1 year after surgery.
Endoscopically managed superficial carcinoma overlying esophageal lipoma
Authors: Usui Shinsuke , Inoue Haruhiro , Yoshida Tatsuya , Fukami Norio , Kudo Shin‐ei , Kawano Tatsuyuki , Iwai Takehisa
Published: December 2003

The occurrence of superficial carcinoma over a benign tumor of the esophagus is considered to be rare. Only a few reports have been reported and all of them were treated surgically. We now report one case of superficial carcinoma overlying an esophageal lipoma that was successfully resected endoscopically. The patient was a 61‐year‐old man who had no symptoms. A submucosal tumor was found at the thoracic esophagus by upper gastrointestinal endoscopy. The top of the tumor was slightly depressed with mild redness and its surface was irregular. This depressed lesion was not stained by iodine. Histological examination of endoscopic biopsy revealed squamous cell carcinoma. To completely remove this tumor in a single fragment, we used an insulation‐tipped electrosurgical knife. An en bloc resection of the tumor was completed without complications.
Intramural esophageal hematoma after endoscopic injection sclerotherapy for bleeding varices
Authors: Van Beljon Johan , Krige Jake E. J. , Bornman Philippus C.
Published: December 2003

Endoscopic variceal sclerotherapy (EVS) is widely used to treat bleeding esophageal varices. A variety of complications have been reported after EVS, including intramural hematoma of the esophagus (IHO), which occurs infrequently. The present report describes four new cases of IHO after EVS and reviews the pathogenesis, diagnosis and treatment of the condition. In addition, 10 patients with IHO after EVS documented in the literature are analyzed. Between 1984 and 2001, 580 patients with bleeding esophageal varices had 5038 endoscopies and underwent a total of 2628 variceal injection sessions. The incidence, presentation and response to conservative management of IHO were evaluated. Four of the 580 patients (0.7%) developed IHO as a complication of EVS. All developed severe retrosternal chest pain, sudden‐onset dysphagia and odynophagia after EVS. Diagnosis was confirmed using upper gastrointestinal contrast studies. Patients were kept nil per mouth and received intravenous fluids until able to swallow without difficulty. Symptoms usually began to resolve spontaneously within 36–72 h and disappeared completely in 2–3 weeks. In a patient who has recently had EVS and has a clinical picture compatible with the diagnosis of IHO, contrast studies provide the simplest way of confirming the diagnosis and excluding an esophageal perforation. Treatment of IHO after endoscopic variceal sclerotherapy should be conservative, due to the benign, self‐limiting nature of this uncommon complication.
Massive bleeding from a duodenal diverticulum successfully treated with transarterial embolization and endoscopic coagulation
Authors: Inoue Takao , Nakazawa Saburo , Hattori Toshiyuki , Katayama Makoto , Taki Tomoyuki , Takashima Toshin , Inui Kazuo
Published: December 2003

Duodenal diverticula are common in adults, but are usually asymptomatic. Massive hemorrhage is a rare, but potentially lethal, complication that can be difficult to diagnose and treat. A 21‐year‐old woman was referred with duodenal hemorrhage of uncertain origin. Endoscopy revealed a duodenal diverticulum, but a discrete bleeding source was not identified. Transarterial embolization via the posterior pancreaticoduodenal artery decreased bleeding to where endoscopic electrocoagulation could be used effectively to stop all blood loss. Initial management of duodenal diverticular hemorrhage should be endoscopic. If unsuccessful, transarterial embolization should be attempted. When bleeding is slowed, but not arrested completely by embolization, endoscopic coagulation should be attempted again before surgery is undertaken. Advances in endoscopic hemostasis and angiography allow patients with bleeding duodenal diverticula to be managed non‐operatively in some cases.
Localized wall thickening of the gallbladder mimicking a neoplasm
Authors: Kimura Katsumi , Fujita Naotaka , Noda Yutaka , Kobayashi Go , Ito Kei , Horaguchi Jun , Sugawara Toshiki , Takasawa Osamu
Published: December 2003

Clinical diagnosis of chronic cholecystitis is made based on diffuse hyperechoic thickening of the gallbladder wall as shown by ultrasonographic examination. We herein report three cases of chronic cholecystitis showing localized hypoechoic thickening of the gallbladder wall that mimicked gallbladder cancer by ultrasonography. Histologically, hypertrophy of the muscularis propria was a common characteristic finding in these three patients. A smooth surface of the inner hypoechoic layer of the thickened wall was considered to be a reliable finding in the differential diagnosis between this type of chronic cholecystitis and gallbladder cancer.
Retrospective endoscopic study of developmental and configurational changes of early colorectal cancer: Eight cases and a review of the literature
Authors: Matsui Toshiyuki , Tsuda Sumio , Iwashita Akinori , Ohshige Kaname , Kikuchi Yosuke , Yorioka Makoto , Furukawa Keiichi , Hirai Fumihito , Yao Tsuneyoshi
Published: December 2003

Background:  A retrospective endoscopic follow‐up study was conducted to elucidate the development of minute or superficial‐type cancers.

Methods:  The development of eight colorectal cancers that were followed up by endoscopy was evaluated.

Results:  (i) Cancer with high‐grade atypia frequently developed from lesions diagnosed histologically by biopsy as adenoma; (ii) two polypoid adenomas developed into invasive cancers with non‐polypoid configuration; (iii) a superficial elevated‐type cancer with high‐grade atypia remained a mucosal cancer for more than 1 year; (iv) a superficial depressed (SD)‐type cancer that had a concomitant adenomatous component grew slowly, maintaining the same configuration for more than 2 years. Another SD‐type cancer grew rapidly to an advanced cancer; and (v) a superficial elevated adenoma developed into a IIa + IIc‐type submucosally invasive cancer while maintaining the size of the initial tumor. From the analysis of the literature, 35 lesions were collected, but it was impossible to speculate which specific type of tumor grew rapidly.

Conclusions:  From the endoscopic observations of the present study and the review of the literature, developments of superficial type cancers were diverse, sessile‐type cancers with marked configurational change, and early cancers developed slowly, although the speed of their growth accelerated according to the downward invasion of the cancer.
Endoscopic transpapillary abscess drainage for a patient with giant pyogenic liver abscess
Authors: Hayashi Hiroyuki , Hosokawa Osamu , Dohden Kenji , Hattori Masakazu
Published: December 2003

The primary modalities for management of liver abscesses are usually antibiotics and percutaneous drainage. However, in patients with ascites or bleeding tendency, the percutaneous puncture of liver abscesses may be unsuitable. We applied a new approach, nasobiliary tube drainage, for a giant pyogenic liver abscess following diagnostic endoscopic retrograde cholangiopancreatography. Pyogenic liver abscess is often biliary in origin, and this new approach includes assessment of biliary abnormality for the management of the abscess, enabling treatment of parients in whom puncture of the abscess is considered dangerous because of massive ascites around the liver. We propose that this procedure is useful in the management of a subgroup of patients with pyogenic liver abscess. To our knowledge, no previous reports of endoscopic transpapillary abscess drainage in pyogenic liver abscess are available.
A Case of preoperatively diagnosed mucosal carcinoma of the terminal ileum successfully treated by laparoscopy‐assisted surgery
Authors: Ishikawa Koichi , Arita Tsuyoshi , Shimoda Katsuhiro , Hagino Yoshiaki , Kitano Seigo
Published: December 2003

We report herein a case of primary early ileal adenocarcinoma diagnosed definitively by colonoscopy before surgery and treated by laparoscopy‐assisted ileocecal resection. A 66‐year‐old man visited our hospital because of fecal occult blood. Colonoscopy revealed a relatively clearly demarcated, flat elevation in the terminal ileum; it was slightly red, surrounding a hemorrhagic spot, and had a small depression at its center. The lesion was diagnosed on biopsy as a well‐differentiated adenocarcinoma. Laparoscopy‐assisted ileocecal resection was performed. Macroscopically, the resected specimen appeared as a partially elevated, partially depressed, reddish lesion on Kerckring's fold. It was 1.5 × 1.0 cm and located 3.5 cm from the ileocecal valve. Microscopically, the tumor was diagnosed as a type IIa + IIc well‐differentiated adenocarcinoma; it was confined to the mucosa, and lymph node metastasis was not found. The patient's postoperative course was uneventful, and he is now alive, well and showing no evidence of recurrence 1 year after surgery. Early detection of ileal cancer depends on careful colonoscopic observation of the terminal ileum, where small bowel cancer usually locates, even during routine examination. To our knowledge, this is the first report of laparoscopic surgery for preoperatively diagnosed early ileal carcinoma.
A Case of Cronkhite–Canada Syndrome markedly improved with mesalazine therapy
Authors: Takakura Mihoko , Adachi Hitomi , Tsuchihashi Nobuko , Miyazaki Eiji , Yoshioka Yoko , Yoshida Kazunari , Oryo Fuyuki , Sawada Tatsuo
Published: December 2003

We report a 50‐year‐old Japanese woman with typical clinical manifestations of Cronkhite–Canada Syndrome (CCS) and possible novel treatment modality for this disease. The patient was diagnosed as CCS based on the presence of several clinical manifestations, such as a diffuse alopecia, nail deformities, hypogeusia, pigmentation of skin, and abdominal discomfort combined with diarrhea and wasting. In addition, she also had multiple polypoid lesions in the gastrointestinal (GI) tract. She was first treated with hyperalimentation and corticosteroid. While this combination therapy seemed to reduce several clinical manifestations, abdominal symptoms and diarrhea recurred with the beginning of oral nutrition. Endoscopy and histology showed that inflammatory changes remained, especially in the lower intestine. Therefore, mesalazine was started. A few days after this therapy, her clinical symptoms disappeared and the polypoid lesions in the large bowel completely resolved. It was therefore possible to restart oral nutrition. We predict that the administration of mesalazine might be one of the useful therapies for CCS.
Primary composite tumor with bipartite differentiation of the esophagogastric junction
Authors: Onishi Yutaka , Fujisawa Takashi , Maeda Mitsuo , Sakamoto Norikazu , Sakaguchi Kazuhiko , Kuroda Shoji , Ikehara Hisatomo , Miyamoto Katsufumi , Haraguchi Tomonori , Kusumoto Chosei , Nishigami Takashi
Published: December 2003

We describe a rare case of primary composite tumor with bipartite differentiation of the esophagogastric junction. An 88‐year‐old Japanese man with a history of distal subtotal gastrectomy was admitted to Harima Hospital of Ishikawajima‐harima Heavy Industries with dysphagia of 2 months duration. Endoscopy showed a round, sharply demarcated lesion with a smooth surface in the lower esophagus. Distally, the lesion was irregular and elevated with a deep central depression. The gastric cardia was slightly elevated with a granular mucosa. After surgical resection, histological and histochemical findings showed a primary composite tumor with bipartite differentiation of the esophagogastric junction. There is no evidence of recurrence for 21 months after surgery without adjuvant chemotherapy. The present case indicates the necessity for a careful evaluation for accessory lesions in composite tumors containing small cell carcinoma of the esophagogastric junction, and that resectional surgery might not only be the treatment of choice, but also important in the evaluation of immature composite tumor without distant metastases.
Jejunogastric intussusception: Case report and review of the literature
Authors: Achyut Joshi Mohan , Ishwar Jambhulkar Minakshi , Jayantkumar Balsarkar Dharmesh , Mohan Badhe Rakesh , Ramesh Chandak Mahendra , Hemant Nemade , Jitendra Jadhav
Published: December 2003

Jejunogastric intussusception is a rare and potentially serious complication of gastrojejunostomy and gastrectomy. The clinical presentation of epigastric pain, vomiting, hematemesis and upper abdominal mass in a patient with previous gastrointestinal operation is almost diagnostic. Upper gastrointestinal scopy is a highly diagnostic investigation. Other radiological investigations like barium meal studies, ultrasonography and computed tomography scan may prove helpful. There are two modalities of treatment, either by endoscopic reduction of the intussuscepting loop or by surgical intervention. The majority of the patients require surgical intervention. We present here a case of chronic jejunogastric intussusception developed in a patient following gastro‐jejunostomy, which was diagnosed by barium meal study and endoscopy. The patient was successfully treated by operative reduction through anterior gastrotomy. A side‐to‐side jejuno‐jejunostomy was done for prevention of recurrence.
Mucosal cancer of the esophagus that presented significant changes of endoscopic findings in repeated observations
Authors: Yoshida Tatsuya , Inoue Haruhiro , Obata Makoto , Chiu Philip W. Y. , Kawachi Hiroshi , Usui Shinsuke , Satodate Hitoshi , Kudo Shin‐ei
Published: December 2003

We report our experience of a very unique case with superficial esophageal cancer presenting significant changes of endoscopic findings within 2 months. A 60‐year‐old man was referred to our hospital because of abrupt and severe chest pain. Upper gastrointestinal endoscopy demonstrated a shallow depressed lesion covered with whitish slough at the middle thoracic esophagus, which was identified as an unstained area by iodine dye spray. In the lower thoracic esophagus, we did not detect any abnormality during initial endoscopy. Although we diagnosed this lesion as atypical esophagitis, histological examination of the biopsy specimen confirmed squamous cell carcinoma. Furthermore, the endoscopic appearance showed dramatic changes over 2 months. The initial lesion at the middle thoracic esophagus gradually diminished, while the mucosa became slightly clouded in the lower thoracic esophagus. This cloudy area became unstained after iodine dye spray. The unstained area of the lower thoracic esophagus gradually spread. We performed four endoscopic mucosal resections separately in 4 days over a period of 5 months. All of the specimens were shown to be squamous cell carcinoma on histological examination. The patient is on endoscopic surveillance and over a period of 1 year, there has been no recurrence.
Impact of gastrointestinal endoscopy on HIV‐infected children
Authors: Ukarapol Nuthapong , Lertprasertsuk Nirush , Fuchs George J. , Wongsawasdi Lumduan , Sirisanthana Virat
Published: December 2003

Objective:  To evaluate the role of gastrointestinal (GI) endoscopy in human immunodeficiency virus (HIV)‐infected children with GI problems.

Methods:  From 1998 to 2002, we retrospectively reviewed all cases of HIV‐infected children presenting with GI problems in which an upper or lower GI endoscopy was indicated. The initial diagnostic endoscopic examination and any repeat endoscopic session leading to a new diagnosis were used in the data analysis. Tissue biopsies were obtained from all abnormal lesions and representative sites of normal‐appearancing GI mucosa.

Results:  Fourteen patients (median age: 22.5 months) underwent 23 sessions of GI endoscopy, including 10 esophagogastroduodenoscopy, nine colonoscopy and four flexible sigmoidoscopy. Chronic diarrhea was the most common indication, followed by lower GI bleeding, abdominal/retrosternal pain, dysphagia/odynophagia, and upper GI bleeding. Gross endoscopic abnormalities were observed in 78.3%; whereas histological inflammation and opportunistic pathogens were identified in 87% and 43.5%, respectively. Cytomegalovirus was the most common identified pathogen. Abnormal gross findings were significantly associated with histological inflammation and identification of pathogens (P = 0.006 and 0.046, respectively). Specific changes in medical management were made in 50% of cases as a result of endoscopic investigation.

Conclusion:  If non‐invasive investigations for HIV‐infected children with GI symptoms fail to establish a diagnosis, gastrointestinal endoscopy should be performed and often yields a positive result leading to changes in medical management.
Usefulness of the Memory® 8‐wire basket forceps for endoscopic extraction of common bile duct stones after endoscopic sphincterotomy
Authors: Kitajima Yasuhiro , Okayama Yasutaka , Ban Tessin , Ueno Koichiro , Naito Itaru , Hirai Masaaki , Hayashi Kazuki , Okamoto Tetsu , Akita Shinji , Gotoh Kazuo , Nakazawa Takahiro , Ohara Hirotaka , Joh Takashi , Yokoyama Yoshifumi , Itoh Makoto
Published: December 2003

Background:  The present study was performed to evaluate the usefulness of the Memory® 8‐wire basket forceps for extracting small common bile duct stones after endoscopic sphincterotomy (EST).

Methods:  Sixty‐one patients with common bile duct stones underwent EST. In patients with stones of 1 cm or more diameter, stones were crushed into fragments having a diameter of less than 1 cm using a mechanical lithotriptor. Stones were extracted using a conventional 4‐wire basket forceps and a stone retrieval balloon catheter. After endoscopic and fluoroscopic confirmation of the absence of stones, stone extraction was again attempted using the Memory® 8‐wire basket forceps, which consists of a 5 Fr catheter sheath and a helical 8‐wire nitinol monofilament basket. After a few days, the presence or absence of residual stones was examined by cholangiography via the endoscopic nasobiliary drainage tube.

Results:  Further extraction of stones was possible using the Memory® 8‐wire basket forceps in 47.5% (29/61) of the patients who underwent extraction of stones by a 4 wire‐basket forceps and a stone retrieval balloon catheter. Cholangiography some days after using the Memory® 8‐wire basket forceps showed residual stones in only two patients (3.3%).

Conclusions:  The Memory® 8‐wire basket forceps was a useful device for the accurate and rapid endoscopic extraction of common bile duct stones with a diameter of less than 1 cm after EST.
Endoscopic submucosal dissection for early gastric cancer using the tip of an electrosurgical snare (thin type)
Authors: Yahagi Naohisa , Fujishiro Mitsuhiro , Kakushima Naomi , Kobayashi Katsuya , Hashimoto Takuhei , Oka Masashi , Iguchi Mikitaka , Enomoto Shotaro , Ichinose Masao , Niwa Hirohumi , Omata Masao
Published: December 2003

Background:  Although the strip biopsy method and aspiration method are popular endoscopic mucosal resection techniques for its convenience and reliability, they have limitations in resectable tumor size and location. Endoscopic submucosal dissection techniques using the diathermic needle knife or the insulated‐tip diathermic knife have been introduced to overcome this disadvantage, but they have high risks for bleeding and perforation. Therefore, we have developed a new endoscopic submucosal dissection technique using the tip of an electrosurgical snare (thin type) and assessed its efficacy.

Methods:  Fifty‐nine lesions with differentiated‐type gastric cancer without ulceration were treated with our technique at the University Hospital. The tip of an electrosurgical snare (thin type) was used for mucosal incision and submucosal dissection as a flexible diathermic knife.

Results:  The size of tumor was 5–85 mm in diameter (mean size: 29 mm) and the location varied from cardia to antrum. Among 59 lesions, 56 lesions (56/59, 95%) were resected completely in an en‐bloc fashion with much less perforation (2/59, 3.4%) and bleeding (1/59, 1.7%) regardless of their size and location.

Conclusion:  New endoscopic submucosal dissection technique using the tip of an electrosurgical snare (thin type) is safe and reliable. We were able to resect early gastric cancer with a much higher en‐bloc resection rate and fewer complications using this technique.
Esophageal and multiple gastric cancers treated by endoscopic mucosal resections
Authors: Nakagawa Motohito , Kawano Yukio , Akasaka Yoshikiyo , Takabayashi Tsukasa , Kanai Toshio , Miyazawa Naoto
Published: December 2003

A case of successful endoscopic therapy of superficial esophageal and multiple gastric cancers in an 87‐year‐old man is reported. A slightly elevated superficial cancer 10 mm in diameter in the proximal stomach (type 0‐IIa) was detected by esophagogastroduodenoscopy (EGD) and treated by endoscopic mucosal resection (EMR) in September 1999. Four months later, in January 2000, a slightly depressed superficial cancer 10 mm in diameter in the proximal esophagus (type 0‐IIc) was found in follow‐up EGD and treated by EMR. Further, in August 2000, a slightly elevated superficial cancer 10 mm in diameter in the distal stomach (type 0‐IIa) was found in follow‐up EGD and treated by EMR. Microscopic examination of these resected specimens showed that invasion was limited to the mucosal layer, and confirmed that no lymphatic or vascular permeation had occurred. No endoscopic or histological recurrence was detected for 33 months after the most recent EMR for gastric cancer. As multiple primary cancers in the upper gastrointestinal tract are not rare in Japan, periodic endoscopic follow up is important for early detection of recurrence of new primary cancers.
Endoscopic mucosal resection of colorectal tumors
Authors: Inoue Yuji , Tezuka Toru , Shinohara Tomoaki , Katoh Hiroshi , Ooi Itaru , Takasaki Ken
Published: December 2003

It has been possible to resect early colorectal cancer by endoscopy due to the progress of colonoscopic diagnosis and technology. Therefore, most cases of colorectal mucosal cancer and benign tumor have been resected by endoscopy only. We report some techniques for endoscopic resection of colorectal tumors. The technique of endoscopic resection: (i) The B‐Wave bipolar snare device: It is difficult to resect flat lesions that are not sufficiently elevated to be ligated by a usual snare. The snare of the B‐Wave bipolar snare device is coated to prevent slipping on the colorectal mucosa. (ii) ‘Sculpting down’ polypectomy: It is difficult to resect large sessile lesions because the bases of these lesions cannot be well observed endoscopically. ‘Sculpting down’ polypectomy is a useful method for safe resection of such tumors. (iii) Endoscopic resection through a retroflexed scope: Under retroverted colonoscopic observation, submucosal injection and partial resection is performed. Then, under ordinary observation, complete resection of the residual tumor is performed. (iv) Endoscopic mucosal resection using a cap‐fitted panendoscope (EMRC): EMRC is useful for lesions located in the lower rectum because there is no risk of free perforation. At first, submucosal injection is performed. The snare is set in the transparent cap and the lesion is aspirated into the cap. Then, it is snared and resected.
Clinical evaluation of the Haber RAMPTM catheter for endoscopic bilateral metal stent placement in patients with malignant hilar strictures
Authors: Hayashi Kazuki , Okayama Yasutaka , Naito Itaru , Hirai Masaaki , Kitajima Yasuhiro , Okamoto Tetsu , Akita Shinji , Gotoh Kazuo , Sano Hitoshi , Ohara Hirotaka , Joh Takashi , Yokoyama Yoshifumi , Itoh Makoto
Published: December 2003

Background:  Endoscopic bilateral expandable metal stent (EMS) placement has been performed in malignant hilar strictures. To perform EMS placement successfully, insertion of guidewires into the bilateral intrahepatic bile ducts is an important and necessary step. In the present study, we evaluated the usefulness of the Haber RAMPTM catheter (HRC) for the selective insertion of guidewires.

Methods:  EMS placement was performed in 17 patients with malignant hilar strictures. As the HRC has three lumens connected to apertures facing in different directions, the direction of the guidewire can be controlled at the catheter tip. Insertion of guidewires into bilateral intrahepatic bile ducts was attempted with and without the HRC.

Results:  The success rate of guidewire insertion into the bilateral intrahepatic bile ducts was 100% (7/7) when the HRC was used, whereas it was 50% (5/10) without the HRC. In the five patients with insertion failure, reinsertion was successfully performed using the HRC. The time required for the bilateral insertion of guidewires was reduced using the HRC. Bilateral EMSs placement was successful in 14 of the 17 patients (82%).

Conclusions:  The HRC was very useful for the accurate and rapid bilateral insertion of guidewires.
How well do doctors know their patients with severe asthma?
Authors: Abramson M. J. , Bailey M. J. , Forbes A. B. , Walters E. H.
Published: December 2003

Abstract

Background:  Rates of asthma mortality have fallen in Australia since the commencement of the National Asthma Campaign and promotion of the Australian asthma management plan. New strategies are now needed to further reduce mortality.

Aim:  To examine agreement about key features between asthma patients and their general practitioners (GPs).

Methods:  We interviewed: (i) the next of kin of 56 asthma deaths, (ii) 91 asthma patients presenting to emergency departments with acute severe asthma and (iii) 147 of their GPs.

Results:  Agreement was substantial for usage of oral symptomatic medication, but poor for inhaled symp­tomatic and preventive medications. There was moderate agreement regarding hospital admissions within the last 12 months among the cases, but little about other markers of severity. There was moderate agreement where the presenting or fatal attack was triggered by an upper respiratory‐tract infection or aspirin. The next of kin and GPs agreed about family problems, but not about other psychosocial issues. They also agreed about which cases had been given action plans or verbal instructions, but few other aspects of asthma management. There was also moderate agreement regarding the use of peak flow meters by the controls.

Conclusions:  Doctors often have relatively poor insights into self‐management practices, social background or trigger factors, even in high‐risk patients. This should be considered when planning future campaigns to improve asthma management and further reduce mortality. (Intern Med J 2003; 33: 557−565)
Audit of surgeon awareness of readmissions with venous thrombo‐embolism
Authors: Swan J. , Spigelman A. D.
Published: December 2003

Abstract

Aim: An audit was undertaken to assess whether surgeons were informed of the readmission of their patients with postoperative deep venous thrombosis (DVT), or pulmonary embolus (PE).

Methods: A retrospective medical record review was conducted to detect patients who had an unplanned readmission in which DVT or PE formed part of the diagnosis and the first admission included a surgical procedure. The readmission was to John Hunter Hospital, Newcastle, Australia, a major tertiary referral teaching hospital, and the first admission was to any acute care hospital. The main outcome measures were: (i) hospital and specialty of the admitting doctor, (ii) the type of surgery performed, (iii) the length of time between admissions and (iv) the patient's previous medical history. The medical record was reviewed for documented evidence that the surgeon who performed the procedure was aware of the readmission.

Results: Of the 215 patient reviewed, 34 were classified as unplanned readmissions following a surgical pro­cedure. Twenty‐four patients (70.6%) were readmitted under a different specialty, three (8.8%) patients were readmitted under the same specialty but under a different surgeon, and seven (20.6%) patients were readmitted under the same surgeon. Of the 27 patients admitted under a different consultant, only 12 (44.4%) had documented evidence that the previous surgeon was aware of the readmission.

Conclusion:  The rate of DVT/PE complications following surgery is underestimated. This may lead to a reduced emphasis in DVT/PE prophylaxis in the mistaken belief that DVT/PE frequency is rarer than it is. Improved communication between teams is necessary to improve care. (Intern Med J 2003; 33: 578−580)
Diagnosis of primary hyperparathyroidism: controversies, practical issues and the need for Australian guidelines
Authors: Glendenning P.
Published: December 2003

Abstract

Primary hyperparathyroidism (PHPT) is one of the most common endocrine disease processes, however the clinical presentation in 2003 is typically characterized by minimal signs or symptoms of hypercalcaemia or para­thyroid hormone (PTH) excess. Recent developments in imaging and management of PHPT have been published, however the area of biochemical investigation has been relatively neglected. A group of experts convened in April 2002 to consider whether changes were needed to the 1990 consensus guidelines which defined criteria for the diagnosis and management of asymptomatic PHPT. It is appropriate to review the revised recommendations, which have been disseminated by the panel and were recently published. Each of the laboratory ­analytes used to establish the diagnosis of PHPT and exclude alternative diagnoses or complications will be considered in succession in this review: (i) calcium, (ii) intact PTH, (iii) urinary calcium and (iv) 25 hydroxy­vitamin D. Furthermore, critical appraisal of the new diagnostic criteria and their applicability to Australian laboratories will be addressed. Finally, limitations and problems associated with the measurement of each analyte will be reviewed. (Intern Med J 2003; 33: 598−603)