bluuebunny/crossref_metadata_2025 huggingface dataset:
A Clinical Study of Photodynamic Therapy for Superficial Esophageal Carcinoma by YAG‐OPO Laser
Authors: Yoshida Kazunari , Suzuki Shigeru , Mimura Seishiro , Narahara Hiroyuki , Tanimura Hiroshi , Nagai Yugo , Isono Kaichi , Kozu Teruo , Fukutomi Hisayuki , Nakahara Akira , Kashimura Hiromasa , Hirashima Toshio , Murata Yoko , Ide Hiroko , Kato Harubumi
Published: August 2007

A cooperative clinical study of photodynamic therapy (PDT) for superficial esophageal
carcinoma was conducted at 6 medical institution. PHE (2mg/kg) with high tumor
affinity was used as the oncotropic compound. The light source was a pulse wave YAG‐OPO
laser with high penetration into the tissue. Irradiation was performed at an energy
density of 60–180 J/cm2 48–72 h after PHE administration. Eight lesions in 6 patients
were treated. All were type 0‐II superficial carcinomas. The depth of invasion was EP–MM
for 6 lesions and SM for 2 lesions. A complete response (CR) was achieved in all
patients after one session of PDT. Five adverse events, including anemia and fever, were
reported by 4 patients, but all were WHO grade 2 or lower and transient. PDT using
PHE and YAG‐OPO laser was therefore considered effective as a curative therapy for
superficial esophageal carcinoma.
Video‐Assisted Thoracoscopy is Feasible Under Local Anesthesia
Authors: Smit Hans J. M. , Schramel Franz M. N. H. , Sutedja Tom G. , ter Laak-Uytenhaak Luud S. C. , Nannes-Pols Marjolein H. , Postmus Pieter E.
Published: August 2007

Video‐assisted thoracoscopy (VAT) is usually performed under general anesthesia (GA). We performed an analysis to determine whether multithoracoport VAT under local anesthesia (LA) is feasible.

Methods: Forty‐five VAT under LA were performed in 34 men and 11 women (mean age 46.8 years) in the endoscopy room.

Results: The waiting time for VAT under LA was 0.5–6h on working days. There were no major complications during or after the VAT. In 9 patients, pleural malignancy was diagnosed, and in 7 patients suspected malignancy was excluded. In 5 patients we found bacterial empyema, of whom 4 had diathermic adhesiolysis during VAT. In 4 patients, the clinical diagnosis was tuberculosis by exclusion, and in 2 patients no conclusive diagnosis could be drawn. VAT influenced treatment policy 15 times, and in 17 pneumothorax patients talc poudrage was performed during the procedure.

Conclusion: VAT under LA is safe, effective, logistically simple, and requires no long waiting times. No conversion to GA was necessary.
The Endoscopic Treatment of Carpal Tunnel Syndrome as an Outpatient Procedure
Authors: Buchhorn T. , Cameron E. A. , Klausmann H. G. , Erggelet C. , Krämer J.
Published: August 2007

From September 1995 to July 1996 50 patients were treated for carpal tunnel syndrome
as outpatients by endoscopic release in the rooms of an orthopaedic surgeon (two‐portal‐technique).
The average age was 51.3 years (27–61 years). The average length of
symptoms was 43 months, the postoperative time off work averaged 27 days. Six months
postoperatively wasting of the thenar persisted in 2 out of 16 patients, a positive Tinel′s
sign in 1 out of 46 patients and delayed median nerve conduction in 2 out of 48
presenting these symptoms preoperatively. At 6 months the average handgrip strength
had recovered to 109% of the preoperative value. One out of 49 patients still presented
paresthesia and 1 out of 50 nocturnal dysesthesia. There were minor complications in 7
patients (14%), only one patient requires further treatment. We conclude that endoscopic
carpal tunnel release done on outpatients in a private surgery can be reliable, safe
and cost efficient.
Interventional Pneumology in Pulmonary Bleeding; A Review: From the Bronchus to the Vessel
Authors: Witt Christian , Romaniuk Paul , Schmidt Bernd , Geisler Anika , Klein Katrin , Fietze Ingo , Borges Adrian Constantin , Liebers Uta , Dörffel Wolf , Baumann Gert
Published: August 2007

Interventional pneumology includes both bronchological and vascular methods of diagnosis
and therapy, especially in emergency situations such as pulmonary hemorrhage. In
massive pulmonary hemorrhage bronchological diagnosis is required to determine the site
and extent of bleeding, as well as angiography of bronchial arteries, and of pulmonary
arteries. Bronchus occlusion by aid of balloon catheter or double lumen tube are holding
measures until definitive surgery or embolization of bronchial or pulmonary arteries can
be performed. The paper suggests a close relationship between bronchoscopic and angiographic
diagnosis and therapy in case of severe pulmonary bleeding.
Stress Reduction Through Listening to Indian Classical Music During Gastroscopy
Authors: Kotwal M. Raj , Rinchhen C. Z. , Ringe Vishwajeet V.
Published: August 2007

The purpose of this study was to examine the effects of music on elevated state of anxiety as many patients become stressed and anxious during diagnostic procedures. The study was conducted on 104 consecutive patients undergoing GI endoscopy for various reasons. Patients were randomly assigned to two groups regardless of sex, age and underlying disease. One group of 54 patients were made to listen to a recorded Indian classical instrumental music before and during the procedure, while the other group of 50 patients did not. Blood pressure, heart rate and respiratory rate were recorded at the beginning of consultation and end of procedure. Perception of procedure using a three point attitude scale was assessed. Our results indicate that the background Indian classical music is efficacious in reducing psychological distress during a gastroscopic examination. We suggest that music could be applied to other medical situations as well, which tend to generate undue psychological stress and anxiety. Music, as a familiar personal and culture medium, can be used to ease anxiety, to act as distractor, to increase discomfort and pain threshold.
Electronic Videoendoscopy of Laryngeal Lesions Using a New Type of Rhinolarynx Endoscope Portion
Authors: Kawaida Masahiro , Fukuda Hiroyuki , Kohno Naoyuki
Published: August 2007

Patients with laryngeal lesions were observed and the lesions were recorded with an
electronic videoendoscope system using the PENTAX EPM‐3300 video processor and the
PENTAX VNL‐1330 endoscope portion. The electronic videoendoscope system differs
from the conventional fiberoptic endoscope connected to a video camera in that a small
monochrome charge‐coupled device (CCD) chip is built in the tip of the endoscope portion.
The PENTAX VNL‐1330 rhinolarynx endoscope portion has a tip and insertion tube of
approximately 4mm in outer diameter to allow its introduction through the nasal passages
into the larynx. The dynamic color images provided by this system were superior to those
obtained by a conventional rhinolarynx flexible fiberscope connected to a video camera in
both quality and resolution of detail. This system should be useful in diagnosing laryngeal
lesions.
Gastroduodenal Morphology and Related Symptoms in Chronic Alcoholics
Authors: Hauge T. , Persson J. , Nilsson Å.
Published: August 2007

Twenty‐four chronic alcoholics admitted to hospital for detoxification after a drinking spree were examined by upper gastrointestinal endoscopy. Biopsy specimens were taken from corpus/fundus, antrum and duodenum for tissue histology (eosin stain). From the duodenum villus index and ultrastructure (scanning electron microscopy, SEM) were also performed. As a control group 12 subjectively healthy non‐alcoholics referred to upper gastrointestinal endoscopy mainly for dyspepsia were chosen.

Gastrointestinal symptoms were common in alcoholics (88%). Endoscopic and histological gastroduodenitis were not more common in the alcohol group. There was no correlation between gastrointestinal symptoms and endoscopic or histological gastroduodenitis in both groups. In the duodenum, 50% of the alcoholics and 82% in the control group had alterations by scanning electron microscopy. Ten of the 11 alcoholics with an abnormal ultrastructure had diarrhoea. In the control group dyspepsia (ulcus suspect) was correlated to a pathological SEM.
Helicobacter Pylori Infection in Endoscopic Biopsy Specimens of Gastric Cancer: A Preliminary Evaluation in a High Risk Population of Kashmir Valley
Authors: Malik G. M. , Kadla S. , Mubarik M. , Hussain T. , Jeelani G. , Basu J. , Rashid S. , Ahmad M. , Nafee A. , Khan A. R.
Published: August 2007

Objective: The aim of the present study was to assess the prevalence of Helicobacter
pylori (H. pylori) infection in Kashmiri patients with gastric cancer and to compare this
with a matched control population.

Methods: Fifty patients with gastric cancer and thirty age/sex matched controls were
included in the study. All the subjects were hailing from Kashmir Valley. For detection
of H. pylori, biopsy specimens were used both from cases and controls.

Results: An insignificant association was shown between H. pylori and both intestinal
and diffuse type of gastric cancer.

Conclusions: The data provides support against the significant association between
H. pylori and gastric cancer in this part of world, a place where the age standardized
incidence of gastric cancer is alarmingly high. We conclude that other factors like
personal and special dietary habits of Kashmiri population may be more important for
the development of gastric cancer.
Color Changes in Electronic Endoscopic Images Caused by Image Compression
Authors: Katayama O. , Ishihama S. , Namiki K. , Ohi I.
Published: August 2007

In recent years, recording of color still images into magneto–optical video disks has been
increasingly used as a method for recording electronic endoscopic images. In this case,
image compression is often used to reduce the volume and cost of recording media and
also to minimize the time required for image recording and playback. With this in mind,
we recorded 8 images into a magneto‐optical video disk in 4 image compression modes
(no compression, weak compression, moderate compression, and strong compression)
using the Joint Photographic Image Coding Experts Group (JPEG) system, which is a
widely used and representative method for compressing color still images, in order to
determine the relationship between the degree of image compression and the color
information in electronic endoscopic images. The acquired images were transferred to an
image processor using an offline system. A total of 10 regions of interest (ROls) were
selected, and red (R), green (G), and blue (B) images were obtained using different
compression modes. From histograms generated for these images, mean densities of R,
G, and B in each ROI were measured and analyzed. The results revealed that color
changes were greater for B, which had the lowest density, than for R or G as the degree
of compression was increased.
Endoscopic Obliteration for Bleeding Peptic Ulcer
Authors: Włodarczyk A. W. , Zawadzki J.J. J. , Gajda A.G. G. , Kamiński P. Ł. , Lembas L. , Bielecki K.
Published: August 2007

A group of 133 patients treated for bleeding peptic ulcer in our Department, is reviewed.
Within several hours of admission, all patients underwent upper gastrointestinal tract
gastroscopy and obliteration of the bleeding ulcer. Bleeding gastric ulcers were found in
41 patients, and duodenal ulcers in 92 patients. Patients were classified according to the
Forrest scale: IA – 11 patients, IB – 49 patients, IIA – 35 patients, lIB – 40 patients.
In 126 (94.7%) patients the bleeding was stopped, and 7 required urgent surgery: 3
patients with gastric ulcer underwent gastrectomy, and 4 with duodenal ulcer – truncal
vagotomy with pyloroplasty and had the bleeding site underpinned. Fifty‐five patients
underwent elective surgery: gastrectomy and vagotomy (18 patients with gastric ulcer),
highly selective vagotomy (25 patients with duodenal ulcer) and truncal vagotomy and
pyloroplasty (12 patients with duodenal ulcer). None of the patients was observed to
have recurrent bleeding.
Helicobacter pylori Infection in Various ABO Blood Groups of Kashmiri Population
Authors: Romshoo Gh. Jeelani , Bhat Md. Youssuf , Malik G. M. , Rather Ab. Rasheed , Naikoo B. A. , Basu Javaid A. , Hussain Tajamul , Rashid Samia
Published: August 2007

Aim: This study was carried out to assess the prevalence of Helicobacter pylori infection
in various ABO blood groups of people of Kashmir.

Method: The study comprised 80 individuals – 50 peptic ulcer patients (whose disease
was diagnosed by endoscopy) and 30 asymptomatic volunteers. Every subject′s
blood group and Rhesus status was determined by standard serological tests. Helicobacter
pylori infection was diagnosed by three different methods viz., one minute endoscopy
room test (urease test), Gram staining and by histology. The detection of Helicobacter
pylori by histological examination using Giemsa staining was taken as the ‘gold standard’
for the presence of Helicobacter pylori infection.

Results: Out of 80 individuals, 67 were males and 13 females aged between 18–65
years. The majority of peptic ulcer patients had blood group ‘O’ (n = 28.56%). The
prevalence of Helicobacter pylori infection amongst peptic ulcer patients was 76%.
There was no difference in Helicobacter pylori positivity in various blood groups.

Conclusion: Blood group ‘O’ though a risk factor for peptic ulcer (Duodenal ulcer)
is not a risk factor for acquiring Helicobacter pylori infection.
Photodynamic Therapy With YAG‐OPO Laser for Early Stage Lung Cancer
Authors: Kato Harubumi , Okunaka Tetsuya , Konaka Chimori , Furuse Kiyoyuki , Kusunoki Yoko , Horai Takeshi , Takifuji Nobuhide , Negoro Syunichi , Fukuoka Masahiro , Yaya Takashi , Kawase Ichiro
Published: August 2007

Photodynamic therapy (PDT) utilizing Photofrin is proving to be effective for the treatment of early stage lung cancers. The effect of PDT utilizing YAG‐OPO laser as new light source was evaluated in 26 patients (29 lesions) with early stage lung cancers. YAG‐OPO laser is solid state tunable laser which is easy to change wavelength between 620 and 670 nm exciting various kinds of photosensitizers. Moreover, YAG‐OPO laser is more reliable, smaller and has less consumables than argon‐dye laser or excimer‐dye laser. As the result of PDT with YAG‐OPO laser, complete remission (CR) was obtained in 82.6% of the 29 lesions, partial remission (PR) in 13.8% and no change (NC) was obtained in 3.4%. We conclude that PDT utilizing YAG‐OPO laser is efficacious in the treatment of early stage lung cancers and can achieve complete remission.
Squamous Cell Carcinoma With Sarcomatous Stroma of the Mesopharynx
Authors: Kawaida Masahiro , Fukuda Hiroyuki , Kohno Naoyuki
Published: August 2007

A case of squamous cell carcinoma with sarcomatous stroma of the mesopharynx is
presented. The patient was a 62‐year‐old man who complained of a foreign body sensation. Endoscopic examination revealed a large pedunculated mass arising from the posterior wall of the mesopharynx. The lesion was surgically resected, using a cutting snare by the endo‐oral approach, and was completely removed. A diagnosis of squamous cell carcinoma with sarcomatous stroma was made histopathologically. The clinicopathological features of this case are described and compared with those of previously reported cases.
Lung Cancers Treated With Photodynamic Therapy and Surgery
Authors: Okunaka Tetsuya , Hiyoshi Toshimitsu , Furukawa Kinya , Yamamoto Hideki , Tsuchida Takaaki , Usuda Jitsuo , Kumasaka Hideo , Ishida Junzou , Konaka Chimori , Kato Harubumi
Published: August 2007

Laser endoscopic surgery, especially the effectiveness of photodynamic therapy (PDT) using
Photofrin as a photosensitizer, has now achieved a status as effective treatment modality for
lung cancer. Twenty‐six lung cancer patients received the preoperative PDT for the purpose of
either reducing the extent of resection or increasing operability. Bronchoscopical PDT is
performed with topical anesthesia approximately 48 h after the intravenous injection of
2.0 mg/kg body weight of Photofrin. Operation was performed 2–9 weeks after initial PDT. The initial purpose of PDT, i.e. either to reduce the extent of resection or convert inoperable
disease to operable status, was achieved in 22 out of 26 patients treated. The survival rate of T3
(main bronchus invasion) cases treated by surgery alone increased significantly from 50.9% to
60.0% with the application of preoperative PDT. This remarkable result may imply that this
new option of PDT as preoperative laser irradiation may contribute to the management of
advanced lung malignancy.
Photodynamic Therapy for Obstructive Esophageal Malignancies
Authors: McCaughan James S.
Published: August 2007

Objectives Determine factors affecting survival rates, benefits and complications of patients with obstructive esophageal cancer treated with photodynamic therapy (PDT).

Methods From 1982 to January 1998, we used PDT to treat 140 patients with obstructive
adeno or squamous carcinoma and evaluated survival up to November 1998. All patients had failed, refused, or were ineligible for surgery, ionizing radiation or chemotherapy. The effect of different variables on survival was estimated using multivariate analysis. The Karnofsky Performance Status (KPS), weight, diet and complications were recorded and biopsies and brushings were taken at each endoscopy. At the beginning and end of each endoscopy the minimal diameter open of the esophagus, and the length, thickness and color of the tumor were recorded. Edema, exudate, bleeding, and mucositis were evaluated and recorded on an ordinal scale.

Results The only significant variable affecting survival was the clinical stage. The median survival after PDT for all patients was 6.5 months (mean = 13.9). Kaplan–Meier survival after PDT curves were statistically significantly different when stratified by the clinical Stage at the time of PDT (p < 0.0001). Median survival (months) were for: Stage I = 56; Stage II = 12; Stage III = 6.5; Stage IV = 3.5. Analysis of each individual stage showed the KPS was the only confounding variable with a statistically significant effect on survival after PDT and this was only for Stages III and IV. The most significant effect occurred when the KPS was ≥ 70. For Stage III the median survival when the KPS was ≥ 70 was 7.7 months and for a KPS < 70 it was 5.0 months (p = 0.0001). For Stage IV the median survival when the KPS was ≥ 70 was 5.5 months and for a KPS < 70 it was 2.5 months (p = 0.0002). The mean minimum diameter open before PDT was 6.2 mm (median 6.0mm) and at the end of the PDT treatment endoscopy 11.1 mm (median 12.0 mm) for a mean increase in the minimum diameter open of 4.9 mm (median 5.0 mm) This was statistically significant using paired t‐tests
(p < 0.0001).

Conclusions Photodynamic therapy for esophageal carcinoma caused minimal complications
and procedure related mortality. Complete obstruction can be relieved by the end of the PDT endoscopy. The length of palliation for “non‐curative” patients was equal to or better than that reported historically for most other treatment regimens.
A Study of Intratumoral Fibrous Interstitium in the Growth and Proliferation Process in Rectal Carcinoid Tumors
Authors: Matsumura Shuji
Published: August 2007

The aim of the study was to investigate the relationship between the fibrous interstitium found
in the spaces between tumor nests and the growth and proliferation process in 33 rectal
carcinoid lesions (26 resected endoscopically and 7 resected surgically).

The proportion of the tumor occupied by fibrous interstitium (F/T ratio) was measured
in tissue specimens using an image analyzer, and the composition and distribution pattern
of the fibrous interstitium were classified based on 21 lesions in which special staining was
performed successfully. The results were then compared with tumor nest malignancy and
preoperative endoscopic ultrasonography (EUS) findings for 23 lsions.

The F/T ratio was significantly higher in the 16 lesions smaller than 5 mm and composed of
low malignancy tumor nests (0.49 ± 0.14) than in the 17 lesions 5 mm or larger (0.25 ± 0.10).
However, the F/T ratio was high (mean 0.41) for 2 of the 17 lesions 5 mm or larger comprised
of highly malignant tumor nests.

The fibrous interstitium was composed of part of the smooth muscle resulting from
destruction of the muscularis mucosae and collagenous fibers. The 9 lesions with mixed
interstitium in which smooth muscle predominated were comprised of low malignancy tumor
nests with a significantly higher F/T ratio (0.55 ± 0.09). In contrast, of the 12 lesions with
separated interstitium, the 4 lesions in which collagenous fibers predominated had a significantly
higher F/T ratio (0.34 ± 0.05) than the 8 lesions in which smooth muscle
predominated (0.18 ± 0.05). Three of these 4 lesions had infiltrated as far as the deeper
sections of the submucosal layer on EUS, and 1 of the lesions was a highly malignant tumor
with an invasion depth of adventitia.

The EUS internal echo images of the tumors were classifiable into: (1) homogenous
low‐echoic; (2) honeycomb; (3) multiple high‐echoic dots; and (4) unvisualized. These
classifications reflected the tumor structure (structure of the dominant nest, F/T ratio, and
fibrous interstitium distribution pattern) and depth of invasion.

At the immature stage, there were large amounts of destroyed muscularis mucosae present
in the spaces between the dispersed tumor nests. At the mature stage, the tumor nests formed a
single solid mass, and in lesions that had infiltrated to the deeper sections of the submucosal
layer or were highly malignant, the number of collagenous fibers inside the tumor increased, suggesting that fibrous interstitium is closely related to rectal carcinoid tumor growth and proliferation. These histologic findings can be predicted from EUS, and may therefore be useful in assisting preoperative diagnosis.
Bronchus Cardiacus Accessorius Dexter
Authors: Barzó P. , Nagy B.
Published: August 2007

The diagnosis of bronchus cardiacus accessorius dexter (BCAD) has occurred in 25 cases
during the bronchoscopic investigations of 30,000 adult patients of the authors. In most of the
cases, this bronchial anomaly has been revealed as an accessory phenomenon, nevertheless, in
one of the patients, it was the source of a considerable hemorrhage. In another case reported
here in detail, it occurred together with multiple developmental anomalies, such as
tracheobronchomegaly, mitral valve prolapse, pectus excavatum, hypoplasy of sinus frontalis
on the right side, inguinal hernia on the left side and hyperlipidemia type IV. Family
analysis did not confirm the presence of any chromosomal disorders or accumulation of
similar developmental anomalies. The forms and frequency of associations of the anomalies
are surveyed on the basis of literary data. The recognition of BCAD is of diagnostic
importance, since it may explain the persistence of some bronchopulmonary symptoms;
furthermore, the exploration of the associated abnormal vascular branches may be very useful
in case of an eventual thoracic surgical intervention.
Clinical Evaluation of the Peroral Cholangioscopy Using a New Videoscope
Authors: Igarashi Yoshinori , Ukita Takeo , Inoue Hirokazu , Ishiguro Jun , Ogawa Satoshi , Satou Masahiro , Maetani Iruru , Sakai Yoshihiro
Published: August 2007

Peroral cholangioscopy (PCS) has been performed in 22 cases using XCHF‐B200 (Olympus
Optical Co.) since June 1995 and in 77 cases using CHF‐B20 (Olympus Optical Co.) after
EST from Jan. 1989. XCHF‐B200 has a longer rigid portion of distal end and a smaller
channel diameter than CHF‐B20. The successful rate of PCS using XCHF‐B200 (82%) was
lower than that of CHF‐B20 (89%). The vascular pattern and fine vertical groove of the bile
duct mucosa were shown more clearly on the photographs obtained with XCHF‐B200 than
those obtained with CHF‐B20. However, not enough biopsy specimens could be obtained
because the channel diameter of XCHF‐B200 was rather small.

If the length of rigid portion and biopsy channel of XCHF‐B200 are improved, PCS using
XCHF‐B200 will be more useful for the diagnosis of bile duct disorders.
Successful Endoscopic Resection of an Early Carcinoma of the Duodenum
Authors: Tada Tomoko , Arai Jyunya , Ohta Akihiko , Satoh Kouitirou , Hattori Katuya , Ishiguro Jun , Igarashi Yoshinori , Sakai Yoshihiro
Published: August 2007

We describe a patient in whom an early carcinoma of the duodenum was able to be resected
endoscopically. A 77‐year‐old man presented with epigastric pain. Upper gastrointestinal
endoscopy revealed a mass in the duodenum, and the patient was admitted. A whitish nodular
aggregated lesion, measuring 20 mm in diameter, was found in the second portion of the
duodenum. Examination of a biopsy specimen showed a Group III tubular adenoma. Endoscopic ultrasonography showed that the lesion was confined to the mucosa. The large size
of the lesion suggested the possibility of malignancy. Endoscopic mucosal resection was
therefore performed. Histopathologically, the diagnosis was carcinoma in adenoma. The
depth of invasion was mucosal. We conclude that endoscopic muosal resection can be used
to treat mucosal lesions arising in the duodenum.
Photodynamic Therapy in Advanced Tracheobronchial Cancers
Authors: Sutedja Tom G.
Published: August 2007

Photodynamic therapy (PDT) has been introduced in the early eighties for treating patients
with malignancies in the tracheobronchial tract. After intravenous injection of the
photosensitizers, the tumor area in the tracheobronchial tree is illuminated bronchoscopically
using a laser fiber to transmit light of a specific wavelength during the procedure. Secondary
tissue necrosis ensues, because of the thrombosis of the tumor vasculature leading to late tissue
hypoxia. Ample data have shown that PDT is effective to obtain full depth tissue necrosis with
relative sparing of the normal tissue. Local tumor control can be achieved. Competitive
endoscopic techniques such as lasers and electrocautery are applicable to debulk tumor in a
less selective but more immediate manner. Skin photosensitivity is a potential morbidity of
PDT, especially in using the first generation photosensitizers. This limits its palliative
potential. More selective and more phototoxic sensitizers in combination with the use of
portable diode laser, may improve the clinical usefulness of PDT in the management of
lung cancer patients. However, cost‐effectiveness studies comparing PDT and other local
bronchoscopic treatment modalities such as thermal lasers, electrocautery, cryotherapy,
brachytherapy, whether or not in addition to external radiotherapy and chemotherapy, should
be conducted to define its definite role in the palliative treatment of advanced obstructive
bronchial cancers.
Endoscopic Diagnosis of Leiomyosarcoma of the Esophagus, a Rare Neoplasm
Authors: Ravini Mario , Torre Massimo , Zanasi Giulio , Vanini Marco , Camozzi Mario
Published: August 2007

We report a case of leiomyosarcoma of the distal third of the esophagus in a 51‐year‐old
woman presenting with a six‐month history of severe epigastric pain, disphagia and weight
loss. The diagnosis, suspected on endoscopic examination, was preoperatively acheived
by biopsy and immunohistological stain. Surgical treatment was undertaken with good
results. Differentiation between leiomyosarcoma and more common esophageal neoplasm
may be difficult if based on radiographic and endoscopic appearance. Preoperative histological
confirmation is therefore mandatory to schedule a wide surgical excision.
Laparoscopically Resected Foregut Cyst Adjacent to the Right Adrenal Gland
Authors: Yamamoto E. , Nakayama H. , Ozaki N. , Kitamura Y. , Funatsuka M. , Ueda M. , Chikugo K. , Hirata A. , Kurashina A. , Kuratsuka H. , Nakagawa M. , Nagaoka S.
Published: August 2007

A case of 49‐year‐old woman with a retroperitoneal undifferentiated foregut cyst attached
to the right adrenal gland is reported. The bronchogenic cyst is a type of foregut cyst with
a cartilage component, but in this case the multicystic tumor lacked both cartilage and
gland. It is quite rare among retroperitoneal tumors and has not been reported so far to
have malignant potential. The preoperative diagnosis was an adrenal benign incidentaloma, and the patient successfully underwent laparoscopic resection of the cystic tumor together
with the right adrenal gland by lateral transabdominal approach. Laparoscopic surgery for a retroperitoneal tumor is problematic, however, since benignancy cannot be predicted. In laparoscopic adrenalectomy for non‐functioning adrenal tumor, therefore, a differential diagnosis from retroperitoneal tumor should be given serious consideration.
Endoscopic Diagnostic System Using Autofluorescence
Authors: Takehana S. , Kaneko M. , Mizuno H.
Published: August 2007

A fluorescence imaging system (Xillix LIFE – Lung Fluorescence Endoscopy system) using
fluorescence for the accurate diagnosis and early detection of lesions through an endosocope
has been developed. This system has applied an optical diagnostic technology to functionally
diagnose lesions which have been difficult to morphologically recognize or are occult with
conventional endoscope. The benefit of this system in the diagnosis of lung cancer has already
been confirmed in the US and Japan, and feasibility of the system in the gastric intestinal field
has also been evaluated.
Results of Two Years Expenience with Fluorescence Bronchoscopy in Detection of Preinvasive Bronchial Neoplasia
Authors: Venmans Ben J. W. , Van Boxem Ton J. M. , Smit Egbert F. , Postmus Pieter E. , Sutedja Tom G.
Published: August 2007

The aim of the study was to determine whether use of fluorescence bronchoscopy improves the detection of preinvasive neoplastic bronchial lesions. The data of all patients who underwent fluorescence bronchoscopy and in whom bronchial biopsies were taken, were analyzed. Most patients were at risk for preinvasive lesions. A total of 174 bronchoscopies were performed in 95 patients. Of the 681 representative biopsies, 31 were found to be moderate dysplastic, 39 were found to be severe dysplastic and 9 exhibited carcinoma in situ. These 79 preinvasive lesions were found in 34 patients. The respective results of fluorescence bronchoscopy in addition to conventional bronchoscopy and of conventional bronchoscopy alone for detection of preinvasive lesions were: sensitivity 85% (67/79) and 59% (47/79); specificity 60% (351/581) and 85% (493/581); positive predictive values of 23% (67/297) and 35% (47/135); negative predictive values of 97% (351/363) and 94% (493/525). A separate analysis of only the first bronchoscopy of each patient showed similar results. Results of fluoresence bronchoscopy were better in the second part of the patient group. We conclude that after a learning period fluorescence bronchoscopy can increase the yield of finding preinvasive neoplastic lesions when used in addition to conventional bronchoscopy.
Detection of Bronchial Neoplasia in Uranium Miners by Autofluorescence Endoscopy (SAFE‐1000)
Authors: Horvath T. , Horvathova M. , Salajka F. , Habanec B. , Foretova L. , Kana J. , Koukalova H. , Pafko P. , Wurst F. , Novotna E. , Pecina J. , Vagunda V. , Vrbacky R. , Talac R. , Coupková H. , Pacovsky Z.
Published: August 2007

The increase in the detection rate for premalignant changes of bronchial epithelium was studied in 56 symptom‐free volunteers from the risk group of Czech uranium miners (mean age 50.69 years, mean WLM 21.06 (1 Working Level Month is equal to the absorption of latent energy of 2.08 × 10–5 J/m3 in one month, i.e. 170 working hours)) by the additional employment of the System of Autofluorescence Endoscopy (SAFE‐1000 Pentax) to conventional white‐light bronchoscopy, comparing results with those of bronchial biopsy histopathology examination. Histopathology using hematoxylin and eosin staining confirmed intraepithelial neoplasias in 15 areas in 10 persons. White‐light bronchoscopy sensitivity was 21.05%, and specificity 93.7% which an autofluorescence bronchoscopy sensitivity was 78.95% and specificity 81.89%.
Fluorescence Bronchoscopic Surveillance in Patients With a History of Non‐Small Cell Lung Cancer
Authors: Weigel Tracey Lee , Kosco Pamela J. , Dacic Sanja , Yousem Samuel , Luketich James D.
Published: August 2007

Background Second lung primaries occur at a rate of 2% per patient per year after curative resection for non‐small cell lung carcinoma (NSCLC). The aim of this study was to
evaluate the role of fluorescence bronchoscopy using the Xillix® LIFE‐Lung Fluorescent
Endoscopy SystemTM (LIFE‐Lung system) in the surveillance of patients for second
NSCLC primaries after resection or curative photodynamic therapy (PDT).

Methods NSCLC patients who were disease‐free following resection or endobronchial
PDT were identified and recruited to participate in a LIFE bronchoscopy surveillance
program. All suspicious areas were biopsied; areas of apparent normal mucosa served as
negative controls. Biopsy specimens were reviewed by a single pulmonary pathologist.

Results Thirty‐six patients underwent 53 surveillance LIFE bronchoscopies and 6/112 biopsies revealed intraepithelial neoplasia (IEN) or invasive carcinoma in 6/36
(17%) of patients. The overall relative sensitivity of LIFE versus conventional bronchoscopy
was 165% with a negative predictive value of 0.96, for the post‐resection subset of
patients these values increased to 200% and 0.97, respectively.

Conclusions Surveillance LIFE bronchoscopy identified intraepithelial or invasive lesions in 17% of patients previously thought to be disease‐free. These data support future
multicenter trials on fluorescence bronchoscopic surveillance of NSCLC patients after
curative surgical resection or PDT.
Indication for Endoscopic Resection of Submucosal Colorectal Carcinoma: Special Reference to Lymph Node Metastasis
Authors: Tsuruta Osamu , Tsuji Yuichiroh , Kawano Hiroshi , Miyazaki Shiroh , Watanabe Masahide , Nakahara Keita , Tateishi Hideo , Fujita Mitsutake , Ban Shigeki , Sata Michio , Toyonaga Atsushi , Morimatsu Minoru
Published: August 2007

We investigated the relationship between histological factors and lymph node metastasis in
77 lesions with submucosally invasive colorectal carcinomas to establish useful criteria for
lesions in which endoscopic treatment alone results in cure of malignancy. There were positive
correlations between histological factors, including the level of invasion, the histologic grade,
presence or absence of lymphatic invasion, presence or absence of budding, and lymph node
metastasis (p < 0.05, p < 0.05, p < 0.005, p < 0.01). The presence or absence of venous
invasion did not influence lymph node metastasis. Laparoscopic surgery involving lymph node
dissection should be indicated for sm1 carcinoma lesions with unfavorable histological factors.
In lesions diagnosed as sm2 or sm3 prior to resection, intestinal resection involving lymph node
dissection by laparoscopic surgery should be directly performed without endoscopic resection.

In treating submucosally invasive colorectal carcinomas, the level of invasion can be
clinically diagnosed, consequently endoscopic resection should be initially performed when
lesions are evaluated as sm1 prior to resection. When histological investigation reveals sm1
carcinoma with histologic grade I (well‐differentiated) or II (moderately‐differentiated), and
the absence of lymphatic invasion and budding, endoscopic treatment alone is sufficient.
Laparoscopic Surgical Techniques for Endometriosis and Adenomyosis
Authors: Wood C. , Maher P. , Woods R.
Published: August 2007

The details of surgical techniques for laparoscopic removal of endometriosis and adenomyosis
are described briefly in textbooks and gynaecological journal articles. We have described a
wide variety of techniques for the various procedures required in the treatment of endometriosis
and adenomyosis, excluding hysterectomy. The principles are based upon those used
in removal of primary cancer lesions. The limitations of thermal ablation are discussed, and
evidence of improved results after excision of lesions have been submitted for publication.
Study of Superficial Type Colorectal Neoplasms With Central Depression
Authors: Fujinuma Sumio , Sakai Yoshihiro
Published: August 2007

Superficial lesion with central depression obtained by endoscopic resection (23 carcinomas
limited in the mucosa and 40 adenomas) were studied morphologically and histologically.
These lesions were calculated concerning the height from the muscularis mucosa, depth of
depressed central portions and the height of circumferential mucosa. Then, using the image
analyzer, followings were determined with two‐dimensional analysis: (1) the size of neoplasms
and also (2) the size of whole mucosal lesions which was calculated by drawing a perpendicular
from the border of the neoplasms; and thus, the ratio of each area was calculated.

Little difference was found between the adenomas and carcinomas. The sizes of carcinomas
were found to be of 8.8 ± 4.7 mm and the adenomas of 5.1 ± 2.3 mm (p < 0.01). As for the depth of depression, it was found to be of 352 ± 147 μm in the carcinomas and 277 ± 93 μm in the adenomas (p < 0.05). Concerning the ratio of carcinomatous area in the mucosa, it was found to be 78 ± 10% in the carcinomas, while in the adenomas, it was found to be 70 ± 10% (p < 0.05).

Accordingly, it was found that compared with the adenomas, carcinomas showed
significantly larger in size, deeper depression in configuration and the ratio of their size in
the mucosa is rather high.
Incidence of Gastric Metaplasia and Helicobacter pylori Infection in Duodenal Bulb – With Specific Reference to Patients With Duodenal Ulcers
Authors: Kawaguchi Minoru , Saito Toshihiko
Published: August 2007

We determined the incidence of gastric metaplasia in the duodenal bulb of duodenal ulcer
patients and the Helicobacter pylori (H. pylori) infection rate at sites with gastric metaplasia. Biopsy of the duodenal bulb showed the presence of gastric metaplasia in 61 of 86 patients
(71%) overall and in 18 of 47 patients (38.3%) who had gastrectomy at an early gastric
cancer. The histological diagnosis of H. pylori infection showed good agreement (83.3%)
with the result of the rapid urease test, indicating that H. pylori occurs in regions with gastric
metaplasia. This finding suggests that H. pylori infects gastric metaplasia in the duodenal
bulb, causing mucosal injury, which is then transformed into duodenal ulcers. The exact
mechanism by which gastric metaplasia is caused is unknown, but it is believed to occur in
the transitional zone in the duodenal mucosa.
Successful Treatment of Bronchial Dehiscence With Endobronchial Stent in Lung Transplantation
Authors: Ferraroli G. M. , Ravini M. , Torre M. , Valvassori L. , Belloni P. A.
Published: August 2007

Bronchial dehiscence in lung transplantation is still a significant and threatening cause of
morbidity, even if several progresses have been made in this field. In the present report we
discuss a case of incomplete dehiscence of the right bronchial anastomosis in a patient who
underwent sequential double lung transplantation for bronchiectasis. This complication has
been successfully treated with endobronchial stent positioning, with the aim to allow the
healing of the anastomosis around a rigid endobronchial support and to prevent the airway
stenosis. The usefulness of 3D spiral CT reconstruction of bronchial tree is also underlined,
for its capacity to detect the dehiscence and to monitor the healing of this complication.
Propofol Sedation for Oesophago‐Gastro‐Duodenoscopy
Authors: Watt J. M. , Fielding J. W. L.
Published: August 2007

A questionnaire was sent to 53 patients who had undergone an upper gastrointestinal
endoscopy under total intravenous anaesthesia (TIVA) using intermittent Propofol. All of the
patients would accept the same technique again. Out of 20 patients who had previously had the
procedure performed under Diazepam sedation, 18 preferred the use of Propofol.
This technique can only be used with an anaesthetist present.
Corrosive Effect of Nifedipine in the Upper Gastrointestinal Tract
Authors: Lavy Alexandra
Published: August 2007

Upper gastrointestinal tract mucosa is prone to injury. Drugs may disturb gastric mucosa
protective mechanisms and cause damage. Injury by NSAIDs is a well described complication.
Nifedipine, a widely used drug, was not described before as having a potential to damage
gastrointestinal mucosa. We describe here, two patients, who developed esophageal and
gastric mucosal damage, probably related to Nifedipine ingestion.
The Development of a New Setup for Video‐assisted Thoracic Surgery
Authors: Tsuboi Masahiro , Sakai Harumasa , Nagata Shinichi , Kono Takafumi , Furukawa Kinya , Konaka Chimori , Kato Harubumi
Published: August 2007

In order to accomplish video‐assisted thoracic surgery (VATS) in a much easier and safer
way, especially for assistant operators, we have developed a new display system for VATS.
The original thoracoscope has been designed for this new system. The monitor is fixed at
approximately 10 cm away from the surface of the chest wall just above the operative field.
In using this procedure, the operator and assistants can see the patient and the monitor at
the same time. According to this new idea, the previous problem in the area of hand–eye
coordination and the three‐dimensional understanding of this procedure can be improved
compared to the image of the conventional thoracoscopy, because it is not necessary for the
operator and assistants to look up at the monitors. When the thoracoscopy was placed in an
adequate position to resect the target pathology, this new system led to good and easy handling
of instruments, as it was with the standard thoracotomy.
Video‐Assisted Endoscopic Laryngosurgery Using a Direct Laryngoscope and a Long Rigid Endoscope
Authors: Kawaida Masahiro , Fukuda Hiroyuki , Kohno Naoyuki
Published: August 2007

Endolaryngeal microscopic laryngosurgery (microlaryngosurgery) using a direct laryngoscope
is the preferred surgical method for treating laryngeal lesions under general anesthesia.
However, this method does not provide a wide‐angle view of the larynx and does not allow
detailed observations of the ventricle and subglottis of the laryngeal cavity, resulting in blind
areas. Video‐assisted endoscopic laryngosurgery using a direct laryngoscope and a long
transurethral rigid endoscope was therefore utilized to allow clear observations and complete
resection of laryngeal lesions in these blind areas. This endoscopic surgical technique is
introduced, and clinical cases are presented.
Study on the Optimal Interval of Monitoring Following Gastric Polyp
Authors: Kawaguchi Minoru , Saito Toshihiko
Published: August 2007

The present study was conducted to determine how long hyperplastic polyps (HPs) and fundic
gland hyperplastic polyps (FGPs) should be endoscopically followed up. Our findings showed
that in the case of FGPs, yearly endoscopy is not required and it is sufficient to repeat X‐ray
and compare films with those obtained in the previous year. In contrast, yearly follow‐up by
endoscopy is necessary in the case of HPs.
Long‐Term Outcome of Endoscopic Balloon Dilation in Obstructive Gastrointestinal Crohn′s Disease: A Prospective Long‐Term Study
Authors: Matsui Toshiyuki , Ikeda Keisuke , Tsuda Sumio , Yao Kenshi , Sou Suketo , Satoh Shigeru , Hatakeyama Sadamune , Matake Hiroaki , Sakurai Toshihiro , Yao Tsuneyoshi
Published: August 2007

Background The short‐ and long‐term results of balloon dilation therapy in Crohn′s
patients with non‐anastomotic obstructive gastrointestinal lesions are investigated.

Materials and methods Fifty‐five patients with Crohn′s disease who had obstructive
gastrointestinal lesions were treated prospectively by endoscopic balloon dilation.

Short-term results Eight of the initial dilations were unsuccessful giving no symptomatic
relief (14.5%).

Long-term results The subjects of the long‐term prognosis were 40 cases followed up
for more than 6 months (average 37 months) and their strictures were non‐anastomotic in
more than half (59%). Avoidance of surgery, was possible in 31 of 40 patients (78%). Surgery
was avoided in 92%, 81% and 77% of patients after one, two, and three years, respectively
(Kaplan–Meier′s method). There was no difference in long‐term outcome between
anastomotic strictures and strictures in the absence of prior surgery.

Conclusion Our results suggest that, (1) strictures in the absence of prior surgery
might be treated in this way as well as anastomotic strictures; (2) if followed for a prolonged
time period, more than 70% of patients, who have undergone balloon dilation for
obstructive gastrointestinal Crohn′s disease, may be able to avoid surgery.
Current Endoscopic Treatment of Dysphonia
Authors: Schweinfurth John M. , Ossoff Robert H.
Published: August 2007

Benign laryngeal disorders result in dysphonia because of effects on glottic closure and the
vibratory characteristics of the true vocal fold. Treatment is initially directed at reversing
medical conditions and patterns of abuse with surgery reserved for unresolving lesions resulting
in troublesome dysphonia. Benign lesions that require surgery are excised as precisely as
possible sparing overlying mucosa and the underlying vocal ligament. Vocal fold scarring is
currently best treated by augmentation procedures, and atrophy may be compensated for by
medialization thyroplasty or by adding bulk to the affected folds. Application of current
knowledge of laryngeal histology and physiology is prerequisite to endoscopic surgical
intervention.
Analysis of the Cost‐effectiveness of PhotodynamicTherapy in Early Stage Lung Cancer
Authors: Kato Harubumi , Okunaka Tetsuya , Tsuchida Takaaki , Shibuya Hiroshi , Fujino Shiro , Ogawa Kyoko
Published: August 2007

Methods A cost‐effectiveness analysis was carried out for photodynamic therapy (PDT)
performed in early stage lung cancer cases, which by definition have no lymph node metastasis.
The alternative treatment method was lobectomy, which conventionally would have
been the first choice of treatment. Costs (C) and effectiveness (E) both of the PDT group
and operation group were compared. Effectiveness was determined using quality adjusted
life years saved (QALYs) which is the 5‐year survival rate adjusted in terms of the quality
of life of the patient, and the cost‐effectiveness rate was obtained based on the costs of
treatment methods during the patient′s stay in the hospital. Health care costs, including
drugs, were calculated according to the 1992 National Health Insurance list in yen. Costs
which were non‐reimbursable by the public insurance system, such as for special rooms and
sun block cream, were also expressed in yen.

Results The total cost of the operated group was ¥1,793,832 and that for the PDT
group was ¥1,017,104. The cost‐effectiveness rate of the operated group, that is the
average cost of treatment per postoperative living month, was ¥37,537, while that of
the entire PDT group was ¥30,003. This indicates that the cost‐effectiveness rate for the
operated group is apparently 1.3 times higher than that of the PDT group. The monthly
cost‐effectiveness rate for the PDT group of lesions smaller than 2 cm was ¥25,533.
Therefore the cost in the operated group is 1.5 times higher.

Conclusions This study demonstrated the merits of PDT for early stage lung cancer
from the point of view of cost‐effectiveness.
Endoscopic Neck Surgery for Thyroid Carcinoma
Authors: Kitano Hiroya , Kinoshita Takashi , Kataoka Hideyuki , Hirano Masamitsu , Takeuchi Eiji , Kitajima Kazutomo , Fujimura Masaki
Published: August 2007

In the past 5 years, endoscopic neck surgery has been performed by various surgeons in Japan.
However, many problems remain to be solved, including indications for this related in
malignant thyroid tumors. For small thyroid cancers and legions suspected of malignancy, we
found that we could obtain radicality in endoscopic neck surgery that was comparable to that
attainable by conventional methods. Here, we describe our recent endoscopic surgical
experience in five patients with preoperative diagnoses of definite or suspected thyroid
carcinoma.