bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hemodynamics of esophageal varices on three‐dimensional endoscopic ultrasonography and indication of endoscopic variceal ligation
Authors: Nakamura Shinichi , Murata Yoko , Mitsunaga Atsushi , Oi Itaru , Hayashi Naoaki , Suzuki Shigeru 
Published: September 2003

Background:  Esophageal varices are treated by endoscopic variceal ligation or sclerotherapy, but the indications for each procedure are not standardized. The present study was designed to determine the indication of endoscopic variceal ligation based on vascular pattern classified by 3‐dimensional endoscopic ultrasonography (3‐D‐EUS).Methods:  The pattern of variceal blood flow detected on 3‐D images was classified into type 1 (cardial‐inflow without paraesophageal veins), type 2 (cardial‐inflow with paraesophageal veins), type 3 (azygos‐perforating pattern) and type 4 (complex pattern). 3‐D‐EUS was performed in 89 patients with esophageal varices. Subsequently, ligation was performed in 44 patients, while sclerotherapy with 5% ethanolamine oleate was applied in 45 patients in a prospective randomized trial. Clinical outcome was assessed.Results:  Based on the 3‐D‐EUS data, 41 patients (46.1%) were classified as type 1, 12 (13.5%) as type 2, seven (7.9%) as type 3 and 29 patients (32.6%) as type 4. The cumulative recurrence‐free probability at 24 months after treatment was 28.9% for ligation versus 71.1% for sclerotherapy (P < 0.05) in type 1, while the respective probabilities were 72.9% versus 50.0% (NS) for type 2 varices, 100% versus 100% (NS) for type 3 varices and 61.9% versus 64.8% (NS) for type 4 varices.Conclusions:  Classification of the vascular pattern of esophageal varices by 3‐D‐EUS enabled us to clarify the criteria for selection of endoscopic procedure. Ligation is indicated for patients who have collaterals, such as paraesophageal veins running parallel to the varices, as the blood flow can be diverted to these blood vessels and controlled by localized ligation.
Clinical role of endoscopic ultrasonography for the diagnosis of early colorectal cancer and selecting the treatment procedure
Authors: Kobayashi Kiyonori , Kida Mitsuhiro , Katsumata Tomoe , Yoshizawa Shigeru , Yokoyama Kaoru , Sada Miwa , Igarashi Masahiro , Saigenji Katsunori 
Published: September 2003

Background:  Accurate evaluation of the depth of tumor invasion, including the degree of submucosal invasion, is a prerequisite to selecting the treatment procedure for early colorectal cancer (CRC). The purpose of the present study was to evaluate the significance of endoscopic ultrasonography (EUS) for diagnosing the depth of invasion of early CRC and selecting the treatment procedure. We concurrently estimated the usefulness of three‐dimensional EUS (3‐D‐EUS) compared with that of conventional EUS.Methods:  We studied 413 consecutive early CRC for which the depth of invasion was examined by EUS. They consisted of 239 lesions of mucosal cancers and 174 lesions of submucosal cancers (sm cancers). We divided sm cancers into two groups, sm‐slight cancers (38 lesions) and sm‐massive cancers (136 lesions), according to the degree of infiltration in the vertical direction in the submucosa. The diagnostic accuracy of the depth of cancerous invasion by EUS and the characteristics of tumors that were difficult to image by EUS were examined. For 59 lesions, the depth of invasion was concurrently evaluated by 3‐D‐EUS to compare the clinical usefulness of this diagnostic tool with that of conventional EUS.Results:  In 364 lesions (88%) of early CRC, we could diagnose the depth of invasion by EUS. Differentiation between mucosal or sm‐slight cancers, which were generally treated by endoscopic resection or local excision, and sm‐massive cancers, which were suitable for radical operation, was possible in 90%. A total of 49 lesions (12%) could not be imaged by EUS. Difficulty in imaging often occurred with lesions located proximally to the transverse colon and with protruded‐type lesions. The accuracy rate of 3‐D‐EUS for differentiating between mucosal or sm‐slight cancers and sm‐massive cancers, including difficult‐to‐image lesions, was 86%. This figure was slightly, but not significantly higher, than the accuracy rate of 73% for conventional EUS (P = 0.07). However, the concurrent application of 3‐D‐EUS was considered useful in 31 of the 59 lesions (53%) evaluated by both techniques.Conclusion: EUS is useful for evaluating the depth of tumor invasion and selecting the treatment procedure for early CRC. The concurrent use of 3‐D‐EUS may further improve diagnostic accuracy and decrease the number of difficult‐to‐image lesions.
Association of testicular undescent induced by prenatal flutamide treatment with thickening of the cremaster muscle in rats
Authors: Matsuno Yoshiharu , Komiyama Masatoshi , Tobe Toyofusa , Toyota Naoji , Adachi Tetsuya , Mori Chisato 
Published: September 2003

Background and Aims:  Previously, in cryptorchid rats, which were induced by prenatal exposure to flutamide, we found a thickening of the cremaster muscle. This study was undertaken to quantify the increase of the cremaster muscle thickness in the cryptorchid rats, and to examine its possible relationship with the proliferation of muscle cells.Methods:  To obtain cryptorchid rats, pregnant Wistar rats were subcutaneously injected with flutamide (100 mg/kg per day) during gestational days 16–17. Serial sections of the scrotum, containing the testis and cremaster muscle, were prepared from the control and cryptorchid rats that were 2–6 weeks of age, and stained with hematoxylin–eosin for morphometry, or stained with antibody against the proliferating cell nuclear antigen (PCNA) to analyze the cell proliferation ability.Results:  The thickened cremaster muscle was always associated with cryptorchid testis and, in the case of unilateral cryptorchidism, the cremaster muscle of the contralateral (descended testis) side exhibited normal thickness. The average thickness of the affected cremaster muscle was 0.80 and 1.89 mm at 4 and 6 weeks of age, respectively, although that of the normal muscle was 0.28 and 0.33 mm at the same time period, respectively.Conclusion:  Our results showed that the cremaster muscle of the cryptorchid rats was significantly thicker than that of the control rats. The immunohistochemical analysis revealed that a thickened cremaster muscle contained many PCNA‐positive nuclei even at 4 weeks of age, in contrast to the control, which had only a few positive nuclei. Our present study indicates that continuous proliferation of the muscle cells associated with cryptorchid testis increases the thickness of cremaster cells in rats exposed to flutamide prenatally. (Reprod Med Biol 2003; 2: 109–113)
Infertile women without sensitization to an appropriate amount of sperm do not produce sperm‐immobilizing antibodies in their sera
Authors: Shibahara Hiroaki , Kikuchi Kumiko , Shiraishi Yasuko , Suzuki Mitsuaki , Shigeta Minoru , Koyama Koji 
Published: September 2003

Background and Aim:  The factors that affect sperm immobilizing antibody production in some women are not fully understood. This study was performed to investigate if production of sperm immobilizing antibodies in women is associated with their husbands’ sperm count.Methods:  The sperm immobilization test (SIT) was performed on 221 infertile women whose husbands had normal semen characteristics according to the criteria by WHO; 160 patients were treated by intracytoplasmic sperm injection (ICSI) because of poor semen characteristics, and 1013 virgin female children acted as the controls.Results:  A significant difference of the incidence in SIT was observed between the virgin female children and the women whose husbands had a normal sperm count (P < 0.0001). There was also a significant difference of the incidence in SIT between the women treated by intracytoplasmic sperm injection (ICSI) because of a severe male factor and those whose husbands had a normal sperm count (P < 0.05).Conclusions:  These results indicate that production of sperm immobilizing antibodies in women begins after they have been exposed to a large enough amount of sperm. However, the precise amount of sperm required to produce the antibodies is not clarified by the present study. (Reprod Med Biol 2003; 2: 105–108)
Identification of complexes of gelatinase A and tissue inhibitor of metalloproteinase‐2 in human follicular fluid
Authors: Shimokawa Ken‐Ichi , Katayama Masatoki , Matsuda Yoshifumi , Takahashi Hidenobu , Hara Izumi , Sato Hirohisa 
Published: September 2003

Background and Aims:  Ovulation involves considerable tissue remodeling in normal ovarian function. These processes are expected to involve matrix metalloproteinases (MMP). Follicular rupture is caused by the degradation of the basement membrane between the thecal and granulose layers, as well as disruption of the extracellular matrix (ECM) at the site of rupture. We report on the existence of the complexes of progelatinase A (proMMP‐2), MMP‐2 and a tissue inhibitor of metalloproteinase‐2 (TIMP‐2) using zymographic and immunological techniques in human follicular fluid (HFF).Methods and Results:  Partial purification of the complexes was achieved by using gelatin affinity column chromatography. The peak (tubes 68–73) in this chromatography showed gelatinase activities by gelatin‐zymography, and also an inhibition by EDTA (metalloproteinase inhibitor). The molecular weights of the gelatinase activities were approximately 72 and 67 kDa, and were consistent with standard proMMP‐2 and MMP‐2, as found by using gelatin‐zymography. Similarly, the band in this peak was consistent with standard recombinant full‐length TIMP‐2, as found by the use of western blot analysis, and the molecular weight of the band was approximately 21 kDa.Conclusion:  As proMMP‐2, MMP‐2 and TIMP‐2 exist in the peak from the gelatin affinity column, we expected that these form the complexes. These results indicate that the complexes of proMMP‐2/TIMP‐2 and MMP‐2/TIMP‐2 exist in HFF. (Reprod Med Biol 2003; 2: 115–119)
Two‐step consecutive transfer of early embryos and blastocysts
Authors: Kyono Koichi , Fukunaga Noritaka , Chiba Setsuyo , Nakajo Yukiko , Fuchinoue Kohei , Yagi Akiko , Araki Yasuhisa 
Published: September 2003

Aim:  To evaluate and confirm the merit of two consecutive transfer attempts of early embryos and blastocysts.Methods:  A total of 685 patients underwent routine in vitro fertilization (IVF) cycles. The study population consisted of three groups: (i) Group 1, early stage embryos were transferred (460 patients; 567 cycles); (ii) group 2, blastocysts were transferred (88 patients; 105 cycles); and (iii) group 3, a two‐step (consecutive) transfer was performed on 137 women (141 cycles). Specifically, a standard embryo transfer was performed on day 3, together with a two‐step (consecutive) transfer of blastocysts. After the early embryo transfer, an extended culture of supernumerary embryos was conducted, followed by a second transfer of blastocyst(s).Results:  No significant differences were found in the three groups with regards to either pregnancy or implantation rates for groups 1, 2, or 3; pregnancy: 34.6, 29.9, and 33.6%, respectively; implantation: 18.6, 15.9, and 15.1%, respectively. The miscarriage rate for each group was also not significant; 20.4, 30.8 and 28.6% for groups 1, 2 and 3, respectively. The multiple pregnancy rate of the three groups was 30.4, 30.8 and 35.7%, respectively, and these were not found to be significant results.Conclusion:  No significant difference was found between the three groups with regards to the pregnancy, implantation, multiple pregnancy and miscarriage rates. The multiple pregnancy rate was highest in the two‐step (consecutive) transfer group. This difference was not regarded to be highly significant. (Reprod Med Biol 2003; 2: 133–137)
Activation of protein kinase C inhibits the secretion of platelet‐activating factor acetylhydrolase by human decidual macrophages
Authors: Narahara Hisashi , Utsunomiya Hiroko , Nishida Masakazu , Nasu Kaei , Kawano Yasushi , Miyakawa Isao 
Published: September 2003

Background and Aims:  Platelet activating factor (PAF), a potent phospholipid mediator, has been implicated in a number of reproductive processes through ovulation to parturition. To clarify the regulatory mechanism of PAF metabolism in the decidua, we have investigated the effect of activation of protein kinase C (PKC) on the secretion of PAF‐acetylhydrolase (PAF‐AH), a PAF‐inactivating enzyme, by human decidual macrophages.Methods:  Decidual macrophage populations were isolated from human decidua by using enzymic digestion, Ficoll–Paque centrifugation, or flow cytometric sorting. The cells were treated with a PKC activator (TPA), H‐7, dibutyryl cyclic adenosine monophosphate (AMP), Bis‐(o‐aminophenoxy)‐ethane‐N,N,N’,N’‐tetraacetic acid, tetra (acetoxymethyl)‐ester (BAPTA/AM) and/or nifedipine. The activity of PAF‐AH secreted in the culture medium was assayed.Results:  The PKC activator, TPA, inhibited the PAF‐AH secretion by decidual cells in a dose‐dependent manner. The TPA also decreased the enzyme secretion by flow cytometrically purified macrophages. The inhibitory effect of TPA was blocked by a PKC inhibitor, H‐7. Protein kinase A (PKA) activation by dibutyryl cyclic AMP was without effect on the enzyme secretion. Calcium channel blockers, BAPTA/AM and nifedipine had no effect on the PAF‐AH secretion.Conclusion:  It is suggested that the TPA‐induced inhibition of PAF‐AH secretion may be mediated, in part, by a PKC‐dependent signal transduction, and that activation of PKC may result in the increase in the local concentration of PAF in the decidua because of its inhibitory effect on the PAF‐AH secretion by decidual macrophages. (Reprod Med Biol 2003; 2: 121–126)
Clinical experience of vasoepididymostomy using a triangulation technique
Authors: Hibi Hatsuki , Ohori Tadashi , Amano Toshiyasu , Yamada Yoshiaki , Honda Nobuaki , Fukatsu Hidetoshi , Asada Yoshimasa 
Published: September 2003

Background: Although the number of patients receiving vasoepididymostomies is gradually increasing, these individuals are limited in the recent advanced assisted reproductive technology (ART) era. A novel technique involving vasoepididymostomy with epididymal tubular invagination has been reported. We attempted to define the results of this method and to compare them with the conventional end‐to‐side technique in patients with suspected epididymal obstruction and no previous history of vasectomy.Methods and Results: Eight eligible triangulation end‐to‐side vasoepididymostomy procedures performed on five azoospermic patients exhibiting either unilateral or bilateral epididymal obstruction are described. The overall patency rate following operation was 100% (five of five). Two pregnancies were achieved by natural intercourse and one was accomplished via artificial insemination. A single pregnancy was obtained with an intracytoplasmic sperm injection using frozen‐thawed sperm collected during the operation.Conclusion: Vasoepididymostomy, using the triangulation technique for epididymal obstruction, resulted in an earlier patency in all patients. This method may afford advantages when compared with the conventional end‐to‐side approach; however, larger subject populations are required in order to assess further the efficacy of this procedure. In addition, long‐term follow up is necessary. (Reprod Med Biol 2003; 2: 101–104)
Migraine: diagnosis and management
Authors: Goadsby P. J. 
Published: September 2003

Abstract Migraine is the most common form of disabling primary headache and affects approximately 12% of studied Caucasian populations. Non‐pharmacological management of migraine largely consists of lifestyle advice to help sufferers avoid situations in which attacks will be triggered. Preventive treatments for migraine should usually be considered on the basis of attack frequency, particularly its trend to change with time, and tract­ability to acute care. Acute care treatments for migraine can be divided into non‐specific treatments (general anal­gesics, such as aspirin or non‐steroidal anti‐­inflammatory drugs) and treatments relatively specific to migraine (ergotamine and the triptans). The triptans − sumatriptan, naratriptan, rizatriptan, zolmitriptan, almotriptan, eletriptan and frovatriptan − are potent serotonin, 5‐HT1B/1D, receptor agonists which represent a major advance in the treatment of acute migraine. Chronic daily headache in association with analgesic overuse is probably the major avoidable cause of headache disability in the developed world. (Intern Med J 2003; 33: 436−442)
Clinical and economic benefits of ramipril: an Australian analysis of the HOPE study
Authors: Smith M. G. , Neville A. M. , Middleton J. C. 
Published: September 2003

Abstract Background:  The Heart Outcomes Prevention Evaluation (HOPE) study has demonstrated that ramipril 10 mg/day for 5 years in an at‐risk population results in clinically and statistically significant reductions in the occurrence of cardiovascular death, myocardial infarction (MI), stroke and revascularization procedures. The likely impact of the intervention in Australia, in terms of the number of potential events avoided and the cost per life‐year saved, has previously not been determined.Aims:  To assess the clinical and economic impacts of the use of daily ramipril in the Australian at‐risk popu­lation from the perspective of the public health‐care budget.Methods: The clinical benefits were calculated from endpoints used in the trial, which were converted to the ‘number needed to treat’. These were then applied to the at‐risk population, which was determined nationally from the relevant Australian statistics. The result of this calculation is the potential number of events avoided in Australia.The economic benefits were established by undertaking an incremental cost‐effectiveness analysis. The economic model considered the clinical benefits and the costs (and cost offsets) arising from ramipril 10 mg/day therapy for 5 years. Life‐years saved was determined by calculating the difference in total years survived between the ramipril and control arms of the study. Net costs divided by life‐years saved is the cost per life‐year saved, and this is reported in Australian dollars as the incremental cost effectiveness.Results:  The clinical benefits over a 5‐year period were expressed as the number of potential events avoided and comprised approximately: 9188 strokes; 14 658 MI; 14 317 revascularization procedures; and 12 534 cardiovascular‐related deaths, nationally. The incremental cost‐effectiveness analysis showed the estimated cost per life‐year saved to be $A17 214.Conclusion:  The use of ramipril 10 mg/day over a 5‐year period in the at‐risk Australian population could prevent many thousands of cardiovascular events, including 12 534 cardiovascular‐related deaths. The cost per life‐year saved compares favourably to other health care interventions. (Intern Med J 2003; 33: 414−419)
Use of fluorodeoxyglucose positron emission tomography scans in patients with advanced germ cell tumour following chemotherapy: single‐centre experience with long‐term follow up*
Authors: Karapetis C. S. , Strickland A. H. , Yip D. , Steer C. , Harper P. G. 
Published: September 2003

Abstract Aims:  Fluorodeoxyglucose positron emission tomog­raphy (FDG‐PET) may detect residual or recurrent malignancy in patients with germ cell tumours (GCT) following chemotherapy. The objective of the present study was to evaluate the use of FDG‐PET in the setting of advanced GCT, and to determine the influence of FDG‐PET on subsequent patient management.Methods:  A computerized search of the patient database of the Department of Medical Oncology, Guy's Hos­pital, London, United Kingdom, and a manual search of medical records, were conducted. All male patients with metastatic or extragonadal GCT treated with chemotherapy between July 1996 and June 1999 inclusive were identified. Data from patients that had a PET scan following chemotherapy were analysed. Reported PET scan findings were compared with subsequent clinical management and patient outcome.Results:  A total of 30 patients with metastatic testicular GCT and three patients with extragonadal GCT were treated with chemotherapy. Of these, 15 patients (12 testicular; three extragonadal; 10 non‐seminoma; and five seminoma) were investigated following chemo­therapy with at least one FDG‐PET scan. Seven patients had two or more PET scans, and a total of 26 FDG‐PET scans was performed. The most frequent indication for PET scan was evaluation of a residual mass (11 patients). Three patients had an FDG‐PET to evaluate thymic prominence. Minimum follow up from first PET scan was 18 months. Three of 26 PET scans had false positive findings. Four PET scans yielded findings of equivocal significance with repeat PET scan recommended. Relapse of disease occurred in three patients; two of whom had normal previous PET scans and one had a previous equivocal result. PET had an impact on patient management in only one case where it ‘prompted’ surgical excision of a residual mass. Normal PET scans provided reassurance in patients with residual small masses but did not alter their subsequent ­management.Conclusions:  A residual mass was the most common indication for PET. For the majority of patients PET did not have a discernible influence on clinical management. Oncologists should exercise caution in their interpretation of PET scan findings and guidelines for the appropriate use of PET in testicular cancer management need to be developed. Prospective trials are required to define the clinical role of PET in this setting. (Intern Med J 2003; 33: 427−435)
Snapshot of acute asthma: treatment and outcome of patients with acute asthma treated in Australian emergency departments
Authors: Kelly A.‐M. , Powell C. , Kerr D. 
Published: September 2003

Abstract Aims: To characterize presentations due to acute asthma at Australian emergency departments (ED), including their severity, treatment and disposition.Methods: This prospective, observational study involved 38 departments of emergency medicine throughout ­Australia participating in the Snapshot of Asthma Study Group project 2000 and 2001. Data were collected for patients presenting with acute asthma between 21 August 2000 and 3 September 2000, and 20 August 2001 and 2 September 2001 and included demographics, severity classification, treatment and disposition.Results: There were 1340 acute asthma presentations in the study periods. Of these presentations, 67% were for children aged <15 years. Asthma severity (according to the Australian National Asthma Guidelines classifi­cation) was ‘mild’ in 49% of cases; ‘moderate’ in 45% of cases; and ‘severe’ in 6% of cases. Treatment administered included: (i) salbutamol to 90%, (ii) ipratropium bromide to 59% and (iii) corticosteroids to 71%. Only six patients received aminophylline. Spacer use for sal­butamol was rare (1%) in adults and only moderate (43%) in children. Sixty‐five percent of patients were discharged home from the ED. Less than 1% of patients required ventilatory assistance, of which half was provided non‐invasively. One percent of patients were admitted to the intensive‐care unit or high‐dependency unit.Conclusion: Overall adherence to treatment guidelines was good. There appears to be underuse of spacers and corticosteroids in some groups and overuse of ipra­tropium bromide. The majority of patients are treated and discharged from the ED. (Intern Med J 2003; 33: 406−413)