Prospect of Endoscopic Mucosal Resection for Early Gastric Cancer: Our Devices in Insulated‐Tip Electrosurgical Knife Method

In Kobe University Hospital, a new method for endoscopic mucosal resection (EMR) using insulated‐tip electrosurgical knife (IT‐EMR) for early gastric cancer (EGC) was introduced from November 2001. To achieve an effective and safe IT‐EMR procedure, we use a high‐frequency surgical unit for cutting and coagulation (ERBOTOM ICC 200) with automatically controlled cutting mode (ENDOCUT). In this study, we show not only our results of IT‐EMR for EGC in comparison with those of the conventional strip biopsy method, but also the optimal conditions for the apparatus of a high‐frequency surgical unit to prevent complications such as bleeding and perforation.     

Clinical features of childhood-onset schizophrenia with obsessive-compulsive symptoms during the prodromal phase

Abstract Thirty-nine patients with schizophrenia, diagnosed according to DSM-III-R, who were under 15 years of age, were studied in two groups; 16 subjects with obsessive-compulsive symptoms during the prodromal phase, and 23 with no obsessive-compulsive disorders. The group with obsessive-compulsive symptoms during the prodromal phase was characterized by a higher ratio of males, higher incidences of perinatal and brain computed tomography (CT) abnormalities, fewer hereditary factors, longer duration of the prodromal phase, and a higher incidence of insidious onset and negative symptoms compared with the group without such prodromal symptoms. Schizophrenic patients with obsessive-compulsive symptoms during the prodromal phase were clinically distinct from those without, which suggests the possibility of subtype categorization.     

Surgical Strategies for Cervical Spinal Neurinomas

Cervical spinal neurinomas are benign tumors that arise from nerve roots. Based on their location, these tumors can also take the form of a dumbbell-shaped mass. Treatment strategies for these tumors have raised several controversial issues such as appropriate surgical indications and selection of surgical approaches for cervical dumbbell-shaped spinal neurinomas. In this report, we review previous literature and retrospectively analyze cervical spinal neurinoma cases that have been treated at our hospital. Surgical indications and approaches based on tumor location and severity are discussed in detail. Thus, with advances in neuroimaging and neurophysiological monitoring, we conclude that appropriate surgical approaches and intraoperative surgical manipulations should be chosen on a case-by-case basis.     

Application of siphon principle to fluid drainage in transurethral surgery

Transurethral resection is usually performed using an all-in-one drape with a fluid collection pouch, drainage port and hose. Gravity drainage of irrigation fluid through the hose is often hampered, resulting in fluid retention in the pouch. We applied a siphon principle to facilitate fluid drainage by making a U-shaped bend near the distal end of the hose, using an adhesive tape, and hooking the distal end of inverted U shape on the edge of bucket placed on the floor. When the hose is filled with irrigation fluid up to the crest of the siphon, fluid flow driven by atmospheric pressure continues until the pouch is evacuated. Repriming and restarting occur automatically throughout the operation. This simple device has virtually eliminated fluid retention in the pouch and proved to be especially useful in transurethral prostatectomy, which requires a large amount of irrigation fluid.     

Echographic Detection of Latent Severe Thrombotic Stenosis of the Superior Vena Cava and Innominate Vein in Patients with a Pacemaker: Integrated Diagnosis Using Sonography, Pulse Doppler, and Color Flow

Thrombosis of the innominate vein and SVC is a serious complication in patients with pacemakers, inducing puhnonary embolism or SVC syndrome. Venography is the definitive method for its diagnosis; however, it is too invasive for related studies. The purpose of this study was to validate sonography, pulse Doppler, and color flow in detecting noninvasively innominate vein or SVC thrombosis in patients with pacemakers. In 53 patients with pacemakers, the 1 severe SVC stenosis and 18 severe innominate vein stenoses due to thrombosis were diagnosed by digital subtraction angiography. Sonography accurately showed the severe SVC stenosis due to thrombosis, but had limitations on the innominate vein thrombosis. Color flow demonstrated mosaic flow, indicating poststenotic turbulence due to stenosis of the innominate vein and SVC caused by thrombosis in 15 of 16 patients, and pulse Doppler disclosed absence of flow due to complete occlusion of the innominate vein in 2 of 2 patients. Sensitivity and specificity for detecting severe innominate vein stenosis due to thrombosis using combined color flow and pulse Doppler was 94% and 100%, respectively. In conclusion, sonography, pulse Doppler, and color flow allow accurate detection of severe innominate vein or SVC stenosis due to thrombosis, and are therefore useful for the follow-up of patients with a pacemaker.     

Pyrimethamine Teratogenesis by Short Term Administration in Goettingen Miniature Pig

Pyrimethamine was mixed with mashed feed and given to pregnant sows of Goettingen miniature pig through a part of the period of organogenesis. A high incidence of the major malformations such as cleft palate, club foot and micrognathia was observed in 13 out of 24 newborns from 5 pregnants which a teratogenic dose (3.6 mg/kg of body weight/day) from day 11 to day 22 of gestation, the first half of the organogenetic period. Only one cleft palate was observed among the 23 newborns from 4 pregnants administered the same dose through the second half of the period. Among the 51 newborns from 10 pregnants which the same dose through the first or second quarter, only 4 newborns showed external major malformations. However, 19 out of 38 live newborns without external major malformations in these groups died within 2 days after birth. Clinical symptoms of these neonatally dead young were similar to splayleg, a naturally occurring functional anomaly in pigs. No internal malformation was revealed by the autopsy of these dead newborns.     

Colon Polyps Detected by Contrast Chromoscopy Using Indigo Carmine Capsule

Contrast chromoscopy of the colon using indigo carmine capsule was performed in 287 patients from July 1990 to March 1991. The distribution and histological features of the polyps detected and resected in these patients were investigated. The overall prevalence of polyps (neoplastic and nonneoplastic) was 85.7% and that of neoplastic polyps was 57.1 %. Moreover, the prevalence of neoplastic polyps in 121 asymptomatic patients was 50.4%. A total of 1179 polyps were resected. Of this total, 1049 polyps were diminutive (>5 mm), and 130 polyps were >5 mm. Histological examinations revealed 35.6% of the diminutive polyps and 83.7% of the large polyps (>5 mm) were neoplastic. Proximally, diminutive neoplastic polyps predominated, accounting for 78% of all of the diminutive polyps in the right colon. The situation was reversed in the distal colon, where diminutive non-neoplastic polyps comprised 91% of all of the diminutive polyps in the rectum. The number of large polyps was evenly distributed throughout the colon. The incidence of carcinoma was 0.5% of the diminutive polyps and 10.1 % of the large polyps. Approximately 70% of all of the neoplastic polyps were located proximal to the sigmoid colon. These findings suggest that there are many more polyps present throughout the colon than previously estimated. This suggests that total colonoscopy be performed more thoroughly than before, by using for instance chromoscopy. Furthermore, all of the polyps encountered during colonoscopy should be removed due to the high prevalence of neoplasia, especially in the proximal side of the colon.