http://www.hindawi.comThe latest articles from Hindawi Publishing Corporation© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/713521Background: Adequate bowel preparation is essential for accurate colonoscopy. Both oral sodium phosphate (NaP) and polyethylene glycol-based lavage (PEG-ELS) are used predominantly as bowel cleansing modalities. NaP has gained popularity due to low drinking volume and lower costs. The purpose of this randomized multicenter observer blinded study was to compare three groups of cleansing (NaP, NaP + sennosides, PEG-ELS + sennosides) in reference to tolerability, acceptance, and cleanliness. Patient and Methods: 355 outpatients between 18 and 75 years were randomized into three groups (A, B, C) receiving NaP = A, NaP, and sennosides = B or PEG-ELS and sennosides = C. Gastroenterologists performing colonoscopies were blinded to the type of preparation. All patients documented tolerance and adverse events. Vital signs, premedication, completeness, discomfort, and complications were recorded. A quality score (0–4) of cleanliness was generated. Results: The three groups were similar with regard to age, sex, BMI, indication for colonoscopy, and comorbidity. Drinking volumes (L) (A = 4.33 + 1.2, B = 4.56 + 1.18, C = 4.93 + 1.71) were in favor of NaP (P = .005). Discomfort from ingested fluid was recorded in A = 39.8% (versus C: P = .015), B = 46.6% (versus C: P = .147), and C = 54.6%. Differences in tolerability and acceptance between the three groups were statistically not significant. No differences in adverse events and the cleanliness effects occurred in the three groups (P = .113). The cleanliness quality scores 0–2 were calculated in A: 77.7%, B: 86.7%, and C: 85.2%. Conclusions: These data fail to demonstrate significant differences in tolerability, acceptance, and preparation quality between the three types of bowel preparation for colonoscopy. Cleansing with NaP was not superior to PEG-ELS.S. Schanz, W. Kruis, O. Mickisch, B. Küppers, P. Berg, B. Frick, G. Heiland, D. Hüppe, B. Schenck, H. Horstkotte, and A. Winkler© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/465272Situs inversus totalis is an inherited condition characterized by a mirror-image transposition of thoracic and abdominal organs. It often coexists with other anatomical variations. Transposition of the organs imposes special demands on the diagnostic and surgical skills of the surgeon. We report a case of a 34-year-old female patient presented with left upper quadrant pain, signs of acute abdomen, and unknown situs inversus totalis. Severe acute cholecystitis was diagnosed, and an uneventful laparoscopic cholecystectomy was performed. A posterior cystic artery was identified and ligated. Laparoscopic cholecystectomy is feasible in patients with severe acute calculus cholecystitis and situs inversus totalis; however, the surgeon should be alert of possible anatomic variations.Theodoros E. Pavlidis, Kyriakos Psarras, Apostolos Triantafyllou, Georgios N. Marakis, and Athanasios K. Sakantamis© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/156496A seventy-year-old male presented with severe myasthenia gravis and an episode of obscure bleeding. There was a history of gastric ulcer leading to Billroth II surgery twenty-five years ago. Upper endoscopy revealed no pathology. Colonoscopy showed a few solitary diverticula and traces of old blood in the terminal ileum. Capsule endoscopy pictured red smear in the upper jejunum. Diverticula were seen as well. Suspecting bleeding jejunal diverticulosis double balloon enteroscopy was performed. The complete jejunal ascending loop and about 100 cm of the jejunum through the descending jejunal loop could be inspected. Large diverticula with fecoliths were found in both loops. Bleeding had ceased. The patient was discharged to neurology for optimizing therapy for myasthenia gravis.I. Zuber-Jerger, E. Endlicher, and F. Kullmann© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/471512Bouveret's syndrome is a rare condition of gastric outlet obstruction resulting from the migration of a gallstone through a choledochoduodenal fistula. Due to the large size of these stones and the difficult location in which they become impacted, endoscopic treatment is unsuccessful and most patients require surgery. We report the case of an elderly male who presented with nausea and hematemesis, and was found on CT scan and endoscopy to have an obstructing gallstone in his duodenal bulb. After several endoscopic sessions and the use of multiple instruments including a Holmium: YAG laser and electrohydraulic lithotripter, fragmentation and endoscopic removal of the stone were successful. We believe this to be the first case of Bouveret's syndrome successfully treated by endoscopy alone in the United States. We describe the difficulties encountered which necessitated varied and innovative therapeutic techniques.Jason N. Rogart, Melissa Perkal, and Anil Nagar© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/2008/257185A 57 year old woman was presented to the emergency department with upper abdominal pain and left sided chest discomfort. No cardiac or pulmonary cause could be determined and the patient underwent upper gastrointestinal endoscopy. Inversion of the scope to the fundus and subsequent fluoroscopy revealed a diaphragmatic hernia with a large herniation of the gastric fundus. Immediate laparotomy showed a 3 cm orifice of the diaphragm. The orifice was widened and a partial necrosis of the incarcerated fundus was resected. The patient recovered fully and was discharged 12 days after laparotomy.Hans Bödeker, Steffen Leinung, Henning Wittenburg, Julia Fischer, Ingolf Schiefke, and Niels Teich© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.5.145Cancer, when detected at an early stage, has a very good probability of being eradicated by surgery or radiotherapy. However, less aggressive treatments also tend to provide high rates of cure without the side effects of radical therapy. We report on the results of our clinical experience with photodynamic therapy (PDT) for the treatment of early carcinomas in the upper aerodigestive tract, the esophagus, and the tracheobronchial tree. Sixty-four patients with 101 squamous cell carcinomas were treated with three different photosensitizers: hematoporphyrin derivative (HPD), Photofrin II, and tetra (m-hydroxyphenyl)chlorin (mTHPC). Seventy-seven (76%) tumors showed a complete rsponse with no recurrence after a mean follow-up period of 27 months. There was no significant difference in terms of cure rates among the three dyes. However, mTHPC has a stronger phototoxicity and induces a shorter skin photosensitization than either of the other photosensitizers. There were eight major complications: three esophagotracheal fistulae after illumination with red light in the esophagus, two esophageal stenoses following 360° circumferential irradiation, and three bronchial stenoses. Illumination with the less penetrating green light and the use of a 180° or 240° windowed cylindrical light distributor render the risk of complications in the esophagus essentially impossible, without reducing the efficacy of the treatment. Therefore, PDT may be considered as a safe and effective treatment for early carcinomas of the upper aerodigestive tract, the esophagus, and the tracheobronchial tree.A. Radu, P. Grosjean, Ch. Fontolliet, G. Wagnieres, A. Woodtli, H. Van Den Bergh, and Ph. Monnier© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.5.91The 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%.T. Horvath, M. Horvathova, F. Salajka, B. Habanec, L. Foretova, J. Kana, H. Koukalova, P. Pafko, F. Wurst, E. Novotna, J. Pecina, V. Vagunda, R. Vrbacky, R. Talac, H. Coupková, and Z. Pacovsky© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.5.197The 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).Shuji Matsumura© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.5.211The 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.P. Barzó and B. Nagy© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.1.75The performance of a fluorescence imaging device was compared with conventional white-light bronchoscopy in 100 patients with lung cancer, 46 patients with resected stage I non-small cell lung cancer, 10 patients with head and neck cancer, and 67 volunteers who had smoked at least 1 pack of cigarettes per day for 25 years or more. Using differences in tissue autofluorescence between premalignant, malignant, and normal tissues, fluorescence bronchoscopy was found to detect significantly more areas with moderate/severe dysplasia or carcinoma in situ than conventional white-light bronchoscopy with a similar specificity. Multiple foci of dysplasia or cancer were found in 13–24% of these individuals. Fluorescence bronchoscopy may be an important adjunct to conventional bronchoscopic examination to improve our ability to detect and localize premalignant and early lung cancer lesions.S. Lam, C. Macaulay, J. C. Leriche, N. Ikeda, and B. Palcic© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.1.29Recently, endoscopic interventional procedures were introduced for nonsurgical therapy of symptomatic pancreas pseudocysts. We reported 25 patients treated by endoscopic retrograde pancreas drainage (ERPD), endoscopic cystogastrostomy (ECG), or endosopic cystoduodenostomy (ECD).M. Dohmoto and K. D. Rupp© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.4.127The use of laparoscopic technique to diagnose and treat intersex children is gradually introduced in clinical urology. From 1985 to 1996, abdominal exploration and gonadectomy were performed in 11 intersex children together with urogenital endoscopy and genitoplastic surgery in our institutes. Their median age was 6.0 (range 0–15) years old and initial gender sex was female in 8 and male in 3. The initial 4 cases (group 1) underwent open abdominal exploration together with gonadectomy, while the latter 7 cases (group 2) underwent laparoscopic exploration simultaneously with 3 laparoscopic gonadectomy and 1 open one via a inguinal incision. Their final diagnoses were male pseudohermaphroditism in 4 cases, mixed gonadal dysgenesis in 3, true hermaphroditism in 2, XX gonadal dysgenesis in 1, and XY gonadal dysgenesis in 1. Consequently, 2 of initial male were reared as a female. Operation time, use of analgesics, postoperative hospital stay and postoperative complications were not significantly different between the two groups, however, postoperative abdominal wound appearance was more acceptable in group 2. The most significant advantage of laparoscopic surgery in intersex children is cosmetic appearance especially when social gender is determined as female irrespective types of intersexuality.Ken Morita, Katsuya Nonomura, Kaname Ameda, Hidehiro Kakizaki, Toshiki Koyama, Tetsufumi Yamashita, Masashi Murakumo, and Tomohiko Koyanagi© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.1.217In cases of benign lesions, pelviscopy is used in about 70% of all abdominal operations at our Department of Obstetrics and Gynecology. From 1990 to 1992, 851 patients with myomas were treated by surgery. In 57% pelviscopy, in 2% laparotomy, and in 1% hysteroscopic myomectomies were treated. In 11%, a CISH (Classical Intrafascial SEMM—serrated edged macro morcellator—Hysterectomy) without colpotomy was applied using the operative technique of pelviscopy or laparotomy. The application of this new surgical technique preserves the patient's pelvic floor (diaphragm pelvis and urogenitalis), its blood supply, and neural function. Details of the surgical techniques used in pelviscopic myomaenucleations are described. One hundred sixteen patients were treated with a gonadotropin releasing hormone analogue (GnRH-a) before the pelviscopic myomaenucleation took place. In this study, 64 (55%) patients received 3,75 mg leuprorelin, and 52 (45%), patients 3.75 mg triptorelin. The monthly injections took place over a period of 3 to 6 months. After 3 months, an identical reduction of the myomas of about 10% to 50% was observed in 103 patients (88%) in both therapy groups. The preservation of the uterus by this minimal invasive surgery technique was generally accepted. No serious complications occurred.L. Mettler, E. Alvarez-Rodas, and K. Semm© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.4.191The 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.M. Raj Kotwal, C. Z. Rinchhen, and Vishwajeet V. Ringe© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.1.19Recent investigators have used several indications to incorporate laparoscopy in the management of patients with cervical cancer. This manuscript reviews the current literature on the role of modern operative laparoscopy in early cervical cancer and recommends a simple approach for its use in these patients.Alton V. Hallum, III and Joel M. Childers© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.1.25The approach to patients with indeterminate pulmonary nodules is poorly defined. Should every pulmonary nodule be biopsied, is needle biopsy adequate, and other questions are challenges. Video assisted thoracic surgery or thoracoscopy has added a new diagnostic possibility which is evaluated in this paper. Fifty-five patients underwent thoracoscopy for diagnosis of a solitary pulmonary nodule. There were few complications and mortality was zero. A definitive diagnosis was obtained in all patients, although one required a second thoracoscopic wedge resection and 10 required conversion to an open thoracotomy.Janet L. Albright, Rick I. MacArthur, Julie A. Swain, Alan T. Tran, and Alex G. Little© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.5.155Laser 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.Tetsuya Okunaka, Toshimitsu Hiyoshi, Kinya Furukawa, Hideki Yamamoto, Takaaki Tsuchida, Jitsuo Usuda, Hideo Kumasaka, Junzou Ishida, Chimori Konaka, and Harubumi Kato© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.5.161Since 1980, advanced lung carcinomas were treated with palliative laser therapy for the purpose of opening the endobronchial stenosis and obstruction by either photodynamic therapy (PDT) or Nd-YAG laser treatment at Tokyo Medical University. A total of 258 lesions were treated, 81 by PDT and 177 by Nd-YAG laser treatment. PDT achieved effective results in 61 (75%) of 81 lesions. In the Nd-YAG laser group, 143 (81%) of 177 lesions showed effective results. When the tumor was located in the trachea or main bronchi, effective results were obtained in 73% (19 of 26) of cases treated by PDT and in 93% of cases (64 of 69) treated by Nd-YAG laser. However, in cases in which the tumor was located in lobar or segmental bronchi, the tumor response was effective in 76% (42 of 55) of PDT-treated patients and 73% (79 of 108) of Nd-YAG laser-treated patients. With a mortality rate of 0%, the greatest advantage of PDT over Nd-YAG treatment was safety. Considering complications, PDT seems to be useful for obstruction of lobar and segmental bronchus. Nevertheless, when deciding among alternative therapies, physicians treating patients with advanced lung carcinoma should give careful consideration to the benefit and complications of both laser therapies and decide the most suitable modality.Kinya Furukawa, Tetsuya Okunaka, Hideki Yamamoto, Takaaki Tsuchida, Jitsuo Usuda, Hideo Kumasaka, Junzou Ishida, Chimori Konaka, and Harubumi Kato© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.5.167Objectives Determine factors affecting survival rates, benefits and complications of patients with obstructive esophageal cancer treated with photodynamic therapy (PDT). James S. McCaughan Jr.© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.5.175Progress of photodynamic therapy (PDT) in gastric cancer and the clinical outcome are described in this paper. (1) We included the whole lesion and a 5 mm margin in the field for irradiation. Marking by injection of India-ink showing the irradiation field was performed beforehand. (2) We established the standard light dose to be 90 J/cm2 for an argon dye laser and 60 J/cm2 for a pulse wave laser. (3) The size of cancerous lesion curable by PDT was expanded from 3 cm in diameter, i.e. 7 cm2 in area to 4 cm in diameter, i.e. 13 cm2 by employing a new excimer dye laser model, which could emit 4mJ/pulse with 80 Hz pulse frequency. (4) The depth of cancer invasion which could be treated by PDT was increased from about 4 mm, i.e. the superficial part of the submucosal layer (SM-1) to more than 10 mm in depth, i.e. the proper muscular layer. These improvements owe much to the pulse laser, the photodynamic action induced by which permits deeper penetration than that of a continuous wave laser. (5) We employed a side-viewing fiberscope for gastric PDT to irradiate the lesion from an angle of 90°. (6) We designed a simple cut quartz fiber for photoradiation with a spiral spring thickened toward the end. (7) We developed an endoscopic device for photoradiation in PDT which achieves accurate and efficient irradiation. As a result of these improvements a higher cure rate was obtained even with a lower light dose of irradiation.Seishiro Mimura, Hiroyuki Narahara, Toru Otani, and Shigeru Okuda© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.5.183We have been performing PDT using Excimer Dye Laser (EDL) or YAG-OPO laser, a type of low power laser, both of which have a considerably higher degree of tissue penetration even when compared to PDT using Argon Dye Laser (ADL).T. Muroya, K. Kawasaki, Y. Suehiro, T. Kunugi, K. Umayahara, T. Akiya, H. Iwabuchi, H. Sakunaga, M. Sakamoto, T. Sugishita, and Y. Tenjin© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.5.191The photosensitizer, mono-L-aspartyl chlorin e6 (NPe6), specifically accumulates in the atheromatous plaque. We detected the fluorescence spectra of NPe6 emitted from atheromatous plaques on the descending thoracic aorta by an angioscopic approach using the animal model of atherosclerosis. We also showed that a fluorescence spectrum peak at 675 nm was obtained laparoscopically only in parts of the abdominal aorta with an atheromatous plaque. By a fluorescence endoscope, atheromatous plaques on the carotid artery were recognized as reddish spots from outside the artery. In addition, we visualized specifically at the beating heart surface small coronary atherosclerosis using an epifluorescence stereoscope system.Junichi Hayashi, Takashi Saito, and Katsuo Aizawa© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.1.vDenise A. Cortese© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.1.viiHarubumi Kato© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.1.1The concept of using a stent to maintain patency of a lumen is not new. As early as 1969, stents were being investigated in the peripheral arterial system as a means of preventing restenosis after dilatation by balloon angioplasty (Dotter, 1969). Since then, numerous reports have demonstrated the use of stents in both the peripheral and coronary artery systems (Maass et al., 1982; Dotter et al., 1983; Wright et al., 1985; Palmaz et al., 1987). Concomitant with the investigation of expandable endovascular metal prosthesis has been the development of prosthetic devices for management of tracheobronchial, gastrointestinal, and genitourinary diseases. We will review the use of endoscopically placed prosthetic devices in the management of diseases affecting these systems.Eric S. Edell, Rollin W. Hughes Jr., Joseph E. Oesterling, and Denis A. Cortese© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.1.9Lung cancer is a leading cancer site in men and women with a high incidence and mortality rate. Most patients are diagnosed when the disease has already spread. An early, detection and immediate and accurate histological or cytological diagnosis are essential for a hopeful outcome. In most patients, bronchoscopy is the method of choice in establishing a suspected lung neoplasm. With the rigid and flexible method, two complementary techniques are available. The methods bear a very low mortality rate if sufficient monitoring and resuscitative instrumentation is available. Rigid bronchoscopy offers the possibility of obtaining large biopsy specimens from the tumorous tissue and provides an effective tool in the control of major haemorrhage. However, it cannot be used for the inspection of further peripherally located parts of the bronchial system and needs general anaesthesia. In contrast, the flexible method can be quickly and readily performed at practically any location using portable equipment. Bronchi can be inspected up to the 8th order and with bronchial washing, forceps biopsy, brush biopsy and fluorescence bronchoscopy techniques with a high diagnostic yield are available. This holds true, especially if these sampling techniques are used as complementary methods.R. W. Hauck and H. P. Emslander© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.4.199Patients 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.Masahiro Kawaida, Hiroyuki Fukuda, and Naoyuki Kohno© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.5.1This study describes the peroperative endoscopic findings about the size, shape and mucosal changes of the middle turbinate in patients with chronic sinusitis who underwent total spheno-ethmoidectomy. Results confirmed the middle turbinate to be a useful landmark in performing extensive sinus surgery. The most frequent change due to chronic inflammation seems to be polypous degeneration followed by hyperplastic mucosa. Anatomical variations, being paradoxically bent turbinate and concha bullosa, are not seen frequently.T. D. Morre, P. A. R. Clement, and G. Noussios© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.5.9Bacteria have been implicated in recurrent choledocholithiasis associated with endoscopic sphincterotomy (EST). This study was designed to clarify whether bacterial examination of bile provides information useful in predicting the risk of recurrence of choledocholithiasis in patients undergoing EST. Bacteria in bile collected via a duodenoscope before cholangiography were cultured. We compared bacterial isolates and quantity among 41 patients with choledocholithiasis (7 with and 34 without a history of recurrent choledocholithiasis) who had undergone EST more than 3 months previously and 13 control patients with no evidence of pancreatobiliary disease. The bile samples were cultured under aerobic and anaerobic conditions. The bacterial quantity was expressed as the mean logarithm of the number of colony forming units (CFU)/ml. Furthermore, cholescintigraphic studies of bile flow were performed with the use of 99 mTC-HIDA to study the clinical implication of these variables. No bacteria were detected in 10 of the 13 patients in the control group. In the other three control patients the bacterial count was 2.2 log CFU/ml or less. The mean bacterial count was significantly higher in patients with recurrence than in those without recurrence. Cholescintigraphy revealed a trend toward a higher number of isolates and a higher bacterial count in bile in patients with delayed bile passage than in those with good passage. The results suggest that an increased number of biliary isolates and an increased bacterial count indicate decreased bile flow in patients with choledocholithiasis who are being followed up after EST. These variables may potentially serve as indicators of the risk of stone recurrence. Especially when the bacterial count is higher than 7.0 log CFU/ml, the risk of a decrease in bile flow and an increased stone recurrence would be possibly found.Jun Ishiguro© 2008, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/GetArticle.aspx?doi=10.1155/DTE.5.19Percutaneous transhepatic cholecystic drainage (PTCCD) with percutaneous transhepatic cholecystoscopic lithotomy (PTCCSL) were performed in 53 patients with acute cholecystitis caused by gallbladder stones and studied stone removal rates, complications, endoscopic findings, and stone recurrence. The stones were successfully removed in 96% of the patients, and there were no serious complications. The coexistence of cancer was confirmed in three patients, and all cases were accurately diagnosed on the basis of uitrasonographic, endoscopic, and biopsy findings. The mean duration of follow-up after stone removal was 42 months, and the stone recurrence rate was 2.5%. Among the 39 patients followed up for at least 1 year, the gallbladder could be preserved with no evidence of sludge in patients in whom drainage was performed early after the onset of symptoms, those with a normal gallbladder after PTCCSL, and those with normal gallbladder contractility after PTCCSL. Sludge was present in patients with evidence of extensive areas of yellowish white fibers on percutaneous transhepatic cholecystoscopy. If instituted early after the onset of symptoms, PTCCD combined with PTCCSL was considered useful in the treatment of patients with acute cholecystitis associated with gallbladder stones.Shigeki Ohashi© 2008, Hindawi Publishing Corporation. All rights reserved.