bluuebunny/crossref_metadata_2025_split huggingface dataset:
ENDOSCOPIC MUCOSAL RESECTION AND SUBMUCOSAL DISSECTION METHOD FOR LARGE COLORECTAL TUMORS
Authors: Sano Yasushi , Machida Hirohisa , Fu Kuang‐I. , Ito Hiroaki , Fujii Takahiro 
Published: July 2004

ABSTRACTThe goal of endoscopic mucosal resection (EMR) is to allow the endoscopist to obtain tissue or resect lesions not previously amenable to standard biopsy or excisional techniques and to remove malignant lesions without open surgery. In this article, we describe the results of conventional EMR and EMR using an insulation‐tipped (IT) electrosurgical knife (submucosal dissection method) for large colorectal mucosal neoplasms and discuss the problems and future prospects of these procedures. At present, conventional EMR is much more feasible than EMR using IT‐knife from the perspectives of time, money, complication, and organ preservation. However, larger lesions tend to be resected in a piecemeal fashion; and it is difficult to confirm whether EMR has been complete. For accurate histopathological assessment of the resected specimen en bloc EMR is desirable although further experience is needed to establish its safety and efficacy. Further improvements of in EMR with special knife techniques are required to simply and safely remove large colorectal neoplasms.
THE TECHNICAL FUNDAMENTALS OF ENDOSCOPIC MUCOSAL RESECTION IN THE COLON: OUR METHOD
Authors: Oda Yasushi , Goto Hideyo , Hasuda Kiwamu , Tanaka Tomofumi , Hattori Masahiro 
Published: July 2004

ABSTRACTEndoscopic mucosal resection (EMR) is the technique used to resect flat or depressed tumors or larger tumors such as laterally spreading tumors with marginal normal mucosa. Recently, endoscopic mucosal dissection technique has been rapidly accepted, mainly in early gastric cancer in Japan. We need to have firm knowledge of EMR technique in the colon for recovery as we advance this new technique. We describe our conventional EMR method practically.EMR should be performed to locate the target lesion at down side to perform sure EMR. The ideal shape of upheaval by saline injection is hemisphere. The needle sheath and snare should be taken out a little of the endoscopy to manipulate firmly.Another technique of secure EMR is the snare manipulation. We prefer that the shape of the snare is circular and the snare is hard. It is important while trapping to press the target lesion with both the whole snare circle and the end of the sheath. With these fundamental procedures we could resect the target lesions at will.
COMPLICATIONS ASSOCIATED WITH ENDOSCOPIC MUCOSAL RESECTION: DEFINITION OF BLEEDING THAT CAN BE VIEWED AS ACCIDENTAL
Authors: Tajiri Hisao , Kitano Seigo 
Published: July 2004

ABSTRACTThe consensus reached during the meeting on complications associated with EMR entitled ‘The definition of bleeding that can be viewed as accidental’ was held at the third EMR Conference, December 20, 2003, in Tokyo is as follows. (1) The definition of complications associated with EMR as intraoperative bleeding is cases requiring special measures such as emergency surgery, intraoperative blood transfusion, or vasopressor therapy and cases where EMR has to be necessarily discontinued because of intraoperative bleeding; and (2) the definition of complications associated with EMR as postoperative bleeding is marked bleeding from the ulcer‐affected area after EMR, requiring special measures for hemostasis. Bleeding during or after EMR may be deemed as accidental if the Hb level falls by 2 g/dL or more in comparison with the last preoperative level, or if any of apparent bleeding or massive melena, etc. is seen. Providing a clear definition for ‘apparent bleeding’ and ‘massive melena’ was left open to debate.
EARLY GASTRIC CANCER: PROPOSAL FOR A NEW DIAGNOSTIC SYSTEM BASED ON MICROVASCULAR ARCHITECTURE AS VISUALIZED BY MAGNIFIED ENDOSCOPY
Authors: Yao Kenshi , Iwashita Akinori , Yao Tsuneyoshi 
Published: July 2004

ABSTRACTWe have developed a magnified endoscopic technique for observing the microvascular architecture within the gastric mucosa in units as small as capillary and we have reported the characteristic findings of the microvascular architecture in both normal gastric mucosa and early gastric cancer. The findings in the normal stomach were different depending on the section of the stomach. The body mucosa demonatrated a regular honeycomb‐like subepithelial capillary network pattern with a collecting venule, while the antral mucosa demonstrated a regular coil‐shaped subepithelial capillary network pattern. The magnified endoscopic findings of early gastric carcinoma were different depending on the types of histological differentiation. The characteristic findings of differentiated carcinoma were (1) the presence of a demarcation line; (2) the disappearance of the regular subepithelial capillary network pattern; and (3) the presence of an irregular microvascular pattern. The findings of undifferentiated carcinoma showed only a reduction in or else the complete disappearance of the regular subepithelial capillary network pattern. In clinical practice, the magnified endoscopic findings of differentiated carcinoma are useful both for determining the margin of early gastric cancer and for making a differential diagnosis between gastritis and gastric cancer in the case of flat reddened lesions. The microvascular architecture as visualized by magnified endoscopy could be a new diagnostic system for the endoscopic diagnosis of early gastric cancer.
CLINICAL USEFULNESS OF COLONOSCOPIC INSERTION OF A DECOMPRESSION TUBE FOR OBSTRUCTIVE COLORECTAL CANCER
Authors: Kobayashi Kiyonori , Igarashi Masahiro , Yoshizawa Shigeru , Katsumata Tomoe , Saigenji Katsunori 
Published: July 2004

ABSTRACTWe evaluated the clinical usefulness of colonoscopic insertion of a decompression tube (decompression method) for the treatment of ileus associated with left‐sided colorectal cancer. Decompression method was done in 48 patients with colorectal cancer (38 primary cancer, 10 metastatic cancer). A decompression tube was successfully inserted in all but 10 patients who had primary cancer with severe strictures. The overall insertion rate was 79%. Decompression method improved obstructive symptoms and decreased intestinal gas as evaluated on plain X‐ray films of the abdomen. Emergency operation was unnecessary in 96% of the patients with primary cancers, in whom the decompression tube was successfully inserted. We conclude that decompression method can improve abdominal symptoms caused by obstructive colorectal cancer and reduce the need for emergency operation.
METAL STENTS FOR PALLIATION OF INOPERABLE CARCINOMA OF THE GASTROINTESTINAL TRACTS
Authors: Shim Chan Sup , Jung In Seop 
Published: July 2004

ABSTRACTRecently, various self‐expandable metal stents (SEMS) have been developed for palliation of malignant obstruction of gastrointestinal tract. Although they have not been approved for use in benign disease, there are specific clinical indications for which expandable metal stents may be beneficial. This article reviews the use of self‐expandable metal stents for malignant gastrointestinal obstruction and the use of SEMS specially developed for unusual stenting such as antimigration and antireflux mechanism.
ENDOSCOPIC MANAGEMENT OF BILIARY and PANCREATIC DUCTS STRICTURES
Authors: Maguchi Hiroyuki , Takahashi Kuniyuki , Katanuma Akio 
Published: July 2004

ABSTRACTEndoscopic treatment is applied to a relatively large number of biliary and pancreatic duct strictures, and is a practical matter. It is essential to select the most appropriate treatment for each lesion. For instance, when treating malignant biliary stricture, accurate diagnosis of whether surgical treatment is required or not is vital; and in choosing a stent for an inoperable case, location of the stricture, with or without anticancer treatment, prognosis, and management of possible post‐stenting re‐stricture must be taken into consideration. For benign strictures, not only short‐term results in mobility and motality, but also decades of long‐term results must be cautiously questioned. Bearing these in mind, we need to accumulate the worldwide data of the treatments and establish a proper treatment guideline.
MERITS and DEMERITS OF METALLIC STENT FOR TREATMENT OF PANCREATIC DUCT STRICTURES IN PATIENTS WITH CHRONIC PANCREATITIS
Authors: Inui Kazuo , Yoshino Junji , Okushima Kazumu , Miyoshi Hironao , Nakamura Yuta 
Published: July 2004

ABSTRACTWe inserted a metallic stent into the strictures of the main pancreatic duct in two patients with calcified chronic pancreatitis and severe abdominal pain not to be relieved using narcotics. One patient was a 39‐year‐ old male, and the other was 49‐year‐old male. Their etiology of chronic pancreatitis was alcoholism. We inserted a Strecker stent, 7 mm in diameter and 6 cm in length, for achieving long‐term patency than plastic stent. In one patient, the stent was obstructed half a year after the first treatment and pancreatic calculi recurred with abdominal pain. After endoscopic extraction of pancreatic stone and balloon dilatation of the stent was performed three times, a plastic stent was inserted in the metallic stent twice. Even if he was performed nerve block twice, he was administered narcotics for treatment of continuous abdominal pain. In the other patient, the stent was obstructed 1.5 years after insertion and pancreatic calculi recurred with abdominal pain. He was treated with extracorporeal shock‐wave lithotripsy for pancreatic stone, abdominal pain continued. He underwent pylorus preserving pancreato‐duodenectomy 6 years after the first stenting, because the obstructed metallic stent could not be removed. Metallic stent should not be chosen for treatment of pancreatic duct stricture.
ENDOSCOPIC TREATMENT OF LOWER GASTROINTESTINAL STRICTURES
Authors: Igarashi Masahiro 
Published: July 2004

ABSTRACTThe methods of endoscopic treatment to a stricture of colon and rectum, are balloon dilatation, stenting, and transanal tube decompression. Balloon dilatation is useful for the stricture with benign disease. It is simple and is considered to be the first choice by the postoperative stricture. To the stricture of Crohn's disease, the long‐term prognosis effect equivalent to an operation is shown, and it is the therapy that should be tried before an operation. Stenting should not be performed easily at the present time for benign stenosis because there are problems that must be solved. For malignant stricture, balloon dilatation is contraindication, and transanal tube decompression and stenting are useful to an improvement of decompression and a passage obstacle. Both are useful to postoperative complications, and the improvement of quality‐of‐life of the stenotic condition by carcinoma.
COVERED METALLIC STENTS FOR MANAGEMENT OF DISTAL MALIGNANT BILIARY OBSTRUCTION
Authors: Isayama Hiroyuki , Kawabe Takao , Nakai Yousuke , Komatsu Yutaka , Omata Masao 
Published: July 2004

ABSTRACTCovered metallic stent (covered MS) is useful to improve quality‐of‐life in patients with unresectable malignant distal biliary obstruction. We have managed 129 patients with three types of covered MS; polyurethane‐covered Wallstent (hand‐craft), polyurethane‐covered Diamond stent (hand‐craft), and silicone‐covered Wallstent (commercially available). They were compared with 115 cases treated with uncovered metallic stent (uncovered MS). There was no significant difference in survival between the two groups. The cumulative stent patency was significantly higher in the covered MS group than uncovered MS group (P = 0.0027). Stent occlusion occurred in 17 patients (13%) in the covered MS group, and in 48 patients (42%) in the uncovered MS group (P < 0.0001). Complications of covered MS were 8 (6%) in acute cholecystitis, 10 (8%) in acute pancreatitis, and 10 (8%) in migration. We evaluated the risk factors for these complications of covered MS.
A CASE WITH PERFORATION AFTER ENDOSCOPIC BALLOON DILATATION FOR STRICTURE OF MALIGNANT LYMPHOMA
Authors: Cho Eisai , Uno Koji , Tanaka Kiyohito , Yasuda Kenjiro , Nakajima Masatsugu 
Published: July 2004

ABSTRACTWe have experienced a case with perforation after endoscopic balloon dilatation. The patient was diagnosed as having malignant lymphoma in the terminal ileum, and treated with eradication of H. Pylori and chemotherapy. The severe stenosis appeared at the same site of the tumor after the medical treatment. The first dilatation with a 15 mm balloon was successful. The lower small bowel obstruction occurred 14 months after the first balloon dilatation. The second dilatation with an 18 mm balloon was performed. The stricture site was remarkably dilated and could be passed by the scope. Perforation was confirmed because of the complaint of severe abdominal pain. The laparotomy finding showed the hole at the stricture site and remarkable fibrosis without tumorous tissue. The fragility of the tissue, the excessive inflation of the balloon and the insertion of the scope might be causes of the perforation. The case with severe stricture having almost no flexibility should be considered carefully in the determination of treatment procedures for the balloon dilatation.
ENDOSCOPIC MUCOSAL RESECTION FOR EARLY GASTRIC CANCER: A NEW TECHNIQUE USING A SLIT‐HOOD and HOOK KNIFE
Authors: Fujisaki Junko , Yamamoto Yorimasa , Takahashi Hiroshi 
Published: July 2004

ABSTRACTWe report a successful application of a new submucosal dissection method for EMR using an endoscope equipped with a slit‐hood and hook knife. The mucosal lesion is separated from the submucosal layer with the aid the hood and the submucosal fibers are cut with the hook knife introduced through the slit, allowing an easy and safe dissection with good visualization of the tissue. Twenty‐seven patients with early gastric cancer underwent EMR using a slit‐hood and hook knife. Tumors were completely resected in 10 cases, and perforation of the stomach occurred in one case. The hook knife cuts as it is pulled back into the hood, helping to prevent perforation.
ENDOSCOPIC PANCREATIC STENTING IN CHRONIC PANCREATITIS WITH DUCTAL DILATION PROXIMAL TO A STRICTURE: A SAFE and EFFECTIVE PROTOCOL
Authors: Mukai Hidekazu , Yoshinaga Hiroshi , Watanabe Akihiko , Fujiwara Hitoshi , Fujita Tsuyoshi 
Published: July 2004

ABSTRACTAfter removal of intraductal stones, a 10‐Fr or 7‐Fr pancreatic stent was placed in 16 patients with upstream ductal dilation proximal to a stricture of the main pancreatic duct. Stents were removed after a mean duration of 52.5 days. Nine patients underwent repeated stenting. About one year after removal of the initial stent, when the remaining upstream ductal dilation was found on follow‐up pancreatograms, the next stent was replaced. Repeated stenting improved outflow of pancreatic juice more effectively than one‐time stenting. Correlation between long‐term pain relief without recurrence of intraductal stones and reduction of duct diameter was also shown. Stent occlusion was observed in 14 of 30 stents. Stent occlusion was frequently associated with recurrence of pancreatitis and intraductal stones, and was also associated with morphologic changes in the pancreatic ductal system. Although there were no significant differences between stent patency of the initial stents and that of the next stents, stent patency of 10‐Fr stents was superior to that of 7‐Fr stents. 10‐Fr stents should be removed within 8 weeks and 7‐Fr stents should be removed within 4 weeks for the prevention of stent occlusion. Repeated stenting with short‐term stenting is therefore considered a safe and effective protocol of endoscopic pancreatic stenting.
ENDOSCOPIC SUBMUCOSAL DISSECTION FOR THE RELIABLE EN BLOC RESECTION OF COLORECTAL MUCOSAL TUMORS
Authors: Yahagi Naohisa , Fujishiro Mitsuhiro , Imagawa Atsushi , Kakushima Naomi , Iguchi Mikitaka , Omata Masao 
Published: July 2004

ABSTRACTScheduled piecemeal resection has been actively conducted for granular type laterally spreading tumor (LST‐G) in Japan, as long as a definite preoperative diagnosis is made. However, en bloc resection is desirable for depressed lesions (e.g. IIc lesion) as well as non‐granular type laterally spreading tumor (LST‐NG) since they have considerable high risk for submucoasl invasion and require precise histopathological evaluation. Endoscopic submucosal dissection (ESD) has been developed for the en bloc resection of mucosal tumors of gastrointestinal tract and widely applied especially in gastric lesions. Although the large intestine involves structural and technical difficulties, we conducted en bloc resection by ESD while exercising sorts of ingenuity for preparation; endoscopes, instruments, local injections, and others. ESD is a reliable technique that allows en bloc resection of gastrointestinal mucosal lesions, and even has a splendid possibility for the treatment of early stage colorectal cancer.
FACTORS AFFECTING THE PATENCY OF EXPANDABLE METALLIC STENT FOR MALIGNANT BILIARY OBSTRUCTION
Authors: Hasebe Osamu , Arakura Norikazu , Imai Yasuharu , Nagata Atsuo 
Published: July 2004

ABSTRACTAlthough placement of expandable metallic stent (EMS) is an established method for palliation of malignant biliary obstruction, it remains unclear which factors affect the patency of the stent. We retrospectively analyzed the patency of EMS according to the following four factors: location of the stenosis (distal vs. hilar bile duct stenosis); uncovered vs. covered EMS; position of the distal end of EMS (intra bile duct vs. intra duodenal placement); and stent design (Diamond stent vs. Wallstent). The median stent patency was comparable in each group, but there was a trend that it was longer in covered EMS and intraduodenal placement group.
MALIGNANT BILIARY OBSTRUCTION: A COMPARISON OF COST FOR A USE OF METAL OR PLASTIC STENT FOR PALLIATION IN JAPANESE HEALTH CARE SYSTEM
Authors: Fukami Norio , Inoue Haruhiro , Kudo Shin‐ei 
Published: July 2004

ABSTRACTEndoscopic treatment with endoprosthesis for obstructive jaundice is a well‐accepted method for palliation of obstructive jaundice and its associated symptoms. Yet, there is no consensus whether a plastic stent or metal stent to be used. The longer patency period with metal stent is a definite advantage but its high cost limits its routine use. The best use of metal stent is accomplished with consideration of patients’ predicted prognosis and a medical cost in Japan. We used a simulated case scenario to calculate a cost for metal stent and non‐metallic stent. Metal stent use would cost about 437 000 yen per patient at 6 months compared with 276 000–329 000 for non‐metallic stents, and thus metal stent use appears to be more costly in current Japanese medical system. Longer patency rate with covered metal stent would make metal stent more favorable, and less frequent procedure would be beneficial for patients who are at their terminal stage of diseases. Alternatively, many patients would not need stent replacement after first biliary stent placement due to the nature of underlying diseases. In addition to a development of an ideal stent and an appropriate technique, our research should also aim at determining who would benefit most for each stent in our own practice, preferably in prospective randomized trial.
ENDOSCOPIC TREATMENT FOR THE BENIGN BILIARY STRICTURE IN THE PATIENT WITH CHRONIC PANCREATITIS
Authors: Igarashi Yoshinori , Okano Naoki , Miura Tomihiro , Iida Kazunari , Miki Kazumasa 
Published: July 2004

ABSTRACTIn some patients with chronic pancreatitis (CP), strictures are observed in the intrapancreatic bile ducts due to fibrosis and inflammation in the pancreas. Normally, even when biliary strictures exist, obstructive jaundice is rarely observed. It seemed that obstructive jaundice was brought about by temporary pancreatitis due to immoderate alcohol ingestion, followed by the aggravation of the intrapancreatic biliary stricture. When immoderate alcohol ingestion is incriminated for the pancreatic disorder, the patient should be strictly instructed to abstain from alcohol, but failure to observe this instruction seems to render endoscopic biliary stenting ineffective. When CP is complicated with pancreatolithiasis, stone fragmentation using extracorporeal shock wave lithotripsy (ESWL) is effective, and combination with endoscopic lithotomy makes it possible to remove pancreatic stones in the main pancreatic duct (MPD). To treat the beside dilating stricture of the MPD, balloon dilation and pancreatic duct stenting are performed. We obtained good results with 10 Fr pancreatic duct stents, but biliary strictures are better treated with a combination of these methods. When 10 Fr or larger straight biliary stents are used, they may be dislodged or stray if the bile duct is sharply curved. To prevent this accident we have used 10 Fr double layer stents and obtained good results. In patients with benign biliary strictures, stents are temporarily placed and should be removable. Some cases have been reported where Wallstent gave good results in a short period, but the stents were occluded due to hyperplastic proliferation of the biliary epithelium. Metal stents are not considered desirable for benign biliary strictures. Our results seem to support the assumption that benign biliary strictures are improved with 10 Fr or larger biliary stents while exercizing care to keep the patient abstinent from alcohol and performing ESWL and endoscopic treatment for CP.
Politics Within and Without — The Origins and Development of a Rangelands Landcare Group
Authors: Gill Nicholas 
Published: July 2004

AbstractThe 1990s saw a resurgence of interest in land‐use reform in the arid and semi‐arid rangelands of Australia. Scientists and conservationists called for a reassessment of land use in areas now used for extensive grazing of cattle and sheep. Landcare groups formed by pastoralists were criticised for deflecting resources away from questions of land‐use reform. While Landcare groups in agricultural regions of Australia have been subject to considerable assessment, analysis of rangelands Landcare has tended to revolve around questions of land use to the neglect of analysis of the operation of the groups themselves. Based on a case study of a pastoral Landcare group in the rangelands, the research reported in this paper found that pastoral Landcare in the rangelands has comparable outcomes to Landcare elsewhere in terms of the creation of opportunities for improved communication and learning among landholders. In addition, this group has developed from an emphasis on single‐issue projects towards multi‐faceted projects focussed on social as well as ecological sustainability. The analysis also found that political considerations were significant in the forma‐tion of the group and remained important for some pastoralists at the time of fieldwork. Finally, rangelands Landcare in this case study has provided a vehicle for reformist pastoralists and their associates to work actively towards influencing their peers to acknowledge land management problems and to reflect on their management practices.