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At least 793 records · Page 44Linked to original sources
PubMed2001

Coronary calcium: the case for helical computed tomography.

This article provides the rationale for using helical (aka spiral, conventional, and mechanical) computed tomography (CT) systems from measuring coronary calcium. The current state and active research concerning measuring coronary calcium with single- and multi-slice systems is reviewed. The components of image quality, which are important to cardiac imaging with CT, are discussed. Companion articles will review electron beam CT (EBCT) for measuring coronary calcium and perhaps most importantly the scientific data relating coronary calcium to coronary heart disease and atherosclerosis.

Calcinosis↗
PubMed1997

Mucociliary clearance and buffered hypertonic saline solution.

Nasal irrigations have been used for centuries without any scientific data to determine efficacy. For 10 years, the senior author has used buffered hypertonic saline nasal irrigation for patients with acute/chronic sinusitis and for those having undergone sinus surgery. A simple study was undertaken using volunteers without any significant sinonasal disease. Patients served as their own control using a saccharin clearance test before any nasal irrigation was used. Patients then used one of two solutions to irrigate their nose-buffered normal saline or buffered hypertonic saline-and were then retested. On a separate day, the control test was repeated, followed by irrigation with the alternate solution and a second saccharin clearance test. The outcome showed buffered hypertonic saline nasal irrigation to improve mucociliary transit times of saccharin, while buffered normal saline had no such effect.

Adult↗
PubMed1992

Assigning appropriateness ratings for diagnostic upper gastrointestinal endoscopy using two different approaches.

Methods that combine information in the medical literature with expert clinical judgment are needed to determine the appropriateness of use of a procedure. The purpose of this study is to better understand the reliability and construct validity of this process by comparing ratings of appropriateness for diagnostic upper gastrointestinal endoscopy that were developed using different approaches by two independent groups. Both the RAND/UCLA Health Services Utilization Study (HSUS) and the American Society for Gastrointestinal Endoscopy (ASGE) combined scientific data with expert physician judgment to rate the appropriateness of specific clinical indications for the use of upper gastrointestinal endoscopy. This study applies the ratings developed by each group to a nationally representative sample of 1,585 endoscopies performed on people 65 years of age and older in 1981. HSUS developed indications that could be used to rate all 1,585 procedures; ASGE indications were less comprehensive and applied to 70% (n = 1,115) of procedures. Of those rated by both groups, appropriateness category ratings agreed for 94% of the procedures. However, the procedures not rated by ASGE were unevenly distributed across HSUS appropriateness ratings. Twelve percent of procedures rated as appropriate by HSUS were not rated by ASGE, but 80% of procedures rated as equivocal by HSUS and 73% rated as inappropriate by HSUS were not rated by ASGE, for those procedures rated by both approaches there was good agreement; however, a more explicit and comprehensive method may be required if equivocal and inappropriate use of a procedure is to be identified.

Aged↗
PubMed1997

Were you knocked out? A team physician's approach to initial concussion management.

To present an evidence-based approach reviewing the acute management of concussive brain injury in sport. All published articles on the acute management of sport-related brain injury were extracted using searches of computerised databases (Medline, Embase, Sport Discus) as well as detailed literature reviews based upon the published bibliographies in this area. The review details the aspects where prospective scientific data is available upon which to base clinical management strategies. The first few minutes after an athlete receives a concussive injury provides a window of opportunity during which time the initial medical management forms a crucial and potentially lifesaving treatment. All clinicians involved in care of the concussed athlete need to have an understanding of the early management of the concussed athlete and a strategy by which they may manage such problems. An efficient and appropriate response to the immediate concussion management will help minimise the potential sequelae which may impact upon the athletes ability to return to sport.

Athletic Injuries↗
PubMed1997

Alternative approaches to the assessment of mild head injury in athletes.

OBJECTIVES: Athletic trainers and team physicians are often faced with decisions concerning the severity and timing of an athletes return to play following mild head injury (MHI). These decisions can be the most difficult ones facing clinicians because of the limited amount of quantitative information indicating injury severity. Several authors have published guidelines for return to play following MHI, however these guidelines are based on limited scientific data. The purpose of this paper was to examine the effects of MHI on two objective measures, postural stability and cognitive function, to determine their usefulness in MHI assessment. The data gathered from these two measures has the potential to establish recovery curves based on objective data. METHODS: Eleven Division I collegiate athletes who sustained a MHI and eleven matched control subjects were assessed for postural stability and cognitive function at four intervals following injury. Postural stability was assessed using the Sensory Organization Test on the NeuroCom Smart Balance Master. Cognitive functioning was measured through the use of four neuropsychological tests: Stroop Test, Trail Making Test, Digits Span and Hopkins Verbal Learning Test. Separate mixed model repeated measures ANOVAs were calculated for the composite score and three ratio (vestibular, visual and somato-sensory) scores from the Sensory Organization Test and the scores from the neuropsychological test to reveal significant differences between groups and across days postinjury. RESULTS: A significant group by day interaction for overall postural stability (composite score) revealed that MHI athletes displayed increased postural instability for the first few days following MHI (p < .05). Analysis of the ratio scores revealed a significant interaction for the visual ratio. No significant group differences were revealed for any of the neuropsychological tests (p > .05), however significant day differences were revealed (p < .05). CONCLUSIONS: The results from this study indicate that athletes demonstrate decreased stability until 3 days postinjury. It appears this deficit is related to a sensory interaction problem, whereby the injured athlete fails to use their visual system effectively. These findings suggest that measures of postural stability may provide clinicians with a useful clinical tool for determining when an athlete may safely return to competition, although these findings need to be confirmed in larger groups of athletes.

Adolescent↗
PubMed1997

Physiological profiles of elite off-road and road cyclists.

There are minimal scientific data describing international caliber off-road cyclists (mountain bikers), particularly as they compare physiologically with international caliber road cyclists. Elite female (N = 10) and male (N = 10) athletes representing the United States National Off-Road Bicycle Association (NORBA) Cross-Country Team were compared with elite female (N = 10) and male (N = 10) athletes representing the United States Cycling Federation (USCF) National Road Team. Submaximal and maximal exercise responses were evaluated during the "championship" phase of the training year when athletes were in peak condition. All physiological tests were conducted at 1860 m. Among the female athletes, physiological responses at lactate threshold (LT) and during maximal exercise (MAX) were similar between NORBA and USCF cyclists with two exceptions: 1) USCF cyclists demonstrated a significantly greater (P < 0.05) absolute (16%) and relative (10%) maximal aerobic power, and 2) MAX heart rate was significantly higher (P < 0.05) for the USCF athletes (6%). Among the male athletes, physiological responses at LT and MAX were similar between NORBA and USCF cyclists with two exceptions: 1) USCF cyclists produced significantly greater (P < 0.05) absolute (18%) and relative (16%) power at LT, and 2) USCF cyclists produced significantly greater (P < 0.05) absolute (12%) and relative (10%) power at MAX. These data suggest that, in general, elite off-road cyclists possess physiological profiles that are similar to elite road cyclists.

Adult↗
PubMed2000

Joint Position Statement: nutrition and athletic performance. American College of Sports Medicine, American Dietetic Association, and Dietitians of Canada.

It is the position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine that physical activity, athletic performance, and recovery from exercise are enhanced by optimal nutrition. These organizations recommend appropriate selection of food and fluids, timing of intake, and supplement choices for optimal health and exercise performance. This position paper reviews the current scientific data related to the energy needs of athletes, assessment of body composition, strategies for weight change, the nutrient and fluid needs of athletes, special nutrient needs during training, the use of supplements and nutritional ergogenic aids, and the nutrition recommendations for vegetarian athletes. During times of high physical activity, energy and macronutrient needs-especially carbohydrate and protein intake-must be met in order to maintain body weight, replenish glycogen stores, and provide adequate protein for building and repair of tissue. Fat intake should be adequate to provide the essential fatty acids and fat-soluble vitamins, as well as to help provide adequate energy for weight maintenance. Overall, diets should provide moderate amounts of energy from fat (20% to 25% of energy); however, there appears to be no health or performance benefit to consuming a diet containing less than 15% of energy from fat. Body weight and composition can affect exercise performance, but should not be used as the sole criterion for sports performance; daily weigh-ins are discouraged. Consuming adequate food and fluid before, during, and after exercise can help maintain blood glucose during exercise, maximize exercise performance, and improve recovery time. Athletes should be well-hydrated before beginning to exercise; athletes should also drink enough fluid during and after exercise to balance fluid losses. Consumption of sport drinks containing carbohydrates and electrolytes during exercise will provide fuel for the muscles, help maintain blood glucose and the thirst mechanism, and decrease the risk of dehydration or hyponatremia. Athletes will not need vitamin and mineral supplements if adequate energy to maintain body weight is consumed from a variety of foods. However, supplements may be required by athletes who restrict energy intake, use severe weight-loss practices, eliminate one or more food groups from their diet, or consume high-carbohydrate diets with low micronutrient density. Nutritional ergogenic aids should be used with caution, and only after careful evaluation of the product for safety, efficacy, potency, and whether or not it is a banned or illegal substance. Nutrition advice, by a qualified nutrition expert, should only be provided after carefully reviewing the athlete's health, diet, supplement and drug use, and energy requirements.

Altitude↗
PubMed2001

Cardiovascular, metabolic, and hormonal parameters in professional tennis players.

During the past decade, the physical and mental stress in professional tennis has been constantly increasing. The overall intensity in tennis ranges between 60 and 70% of maximum oxygen uptake and the energy requirements are mainly provided by aerobic energy metabolism. Therefore, particularly with respect to the duration of the tournaments and the length of the matches, a good aerobic capacity promotes continuous success in professional tennis. During frequent periods of high intensity, however, muscular energy is derived from anaerobic glycolysis. Therefore, sports-specific conditioning programs in tennis should improve both glycolytic and oxidative muscular metabolism. Years of training and competition induce a number of cardiovascular and metabolic adaptations: an increase in heart size in terms of an athlete's heart, higher oxygen uptake capacity, improved muscular oxidative enzyme activities, reduced baseline catecholamine levels, and a lower resting heart rate. In addition, tennis induces side-specific increments in bone density, bone diameter, and bone length of the upper extremity. Furthermore, structural and functional adaptations of the conducting arteries in the preferred arm could be demonstrated in professional tennis players. In conclusion, tennis is a very complex sport involving strength, power, speed, agility and explosiveness, as well as endurance components. Scientific data on exercise-related cardiovascular and metabolic parameters in professional tennis are important to evaluate the players individual fitness level and will help to improve sports-specific conditioning programs. This in turn will not only enhance performance but also prevent overstrain and burnout syndromes.

Adaptation, Physiological↗
PubMed1996

Hormone replacement therapy.

More than 40 million women in the United States are now going through or are past menopause. Another 3.5 million or more will reach midlife in the next decade. As their life expectancy increases (mean life expectancy of women is now approximately 84 years), so does the need for therapeutic regimens related to reproductive function and aging in woman. Few medical treatments available to menopausal and postmenopausal women have as much potential benefit as well as possible health risks as hormone replacement therapy (HRT). Despite the increasing amount of scientific data available regarding the benefits of HRT, a degree of uncertainty still remains, both in the minds of some women, and with some health professionals, regarding the risks associated with long-term therapy. Even though the literature is voluminous, contradictory, and unclear, health providers must be able to keep abreast of current knowledge about the benefits, risks, and unknowns of these drugs. The purpose of this article is to provide a review and an update on the types of hormones available for HRT, their pharmacology and pharmacokinetics, and their risks, benefits, and contraindications. Newer products, specially compounded formulas, new regimens, and new modes of delivery that offer women alternatives and allow care to be individualized are described. In addition, some of the ongoing management dilemmas that practitioners face with the woman who chooses HRT are presented with practical solutions and suggestions.

Contraindications↗
PubMedDate not supplied

Myths and realities of the menopause.

Menopause is a reproductive milestone in a woman's life around which many different myths have developed. We reviewed three sets of myths that middle-aged premenopausal women hold and evaluated those myths according to scientific data from our own work and that of others. First, middle-aged women expect to experience depression, irritability, and vasomotor symptoms during the menopause. It appears that the vast majority of postmenopausal women do not experience depression, but do experience vasomotor symptoms that are uncomfortable and may have secondary effects on psychological well being, especially during the perimenopause. Second, middle-aged women believe that holding negative expectations about the menopause affects the quality of the menopausal experience. Indeed, that appears to be the case, perhaps because myths can function as self-fulfilling prophecy. The third myth is that there are no important changes that occur during the menopause. That is incorrect. Estrogen deficiency during the menopause sets the stage for substantial changes in risk for CHD, which becomes clinically apparent later in life. We discussed how estrogen deficiency may influence both lipids and lipoprotein levels and the magnitude of neuroendocrine and cardiovascular respond to mental stress. That latter pathway is of particular interest because middle-aged women may be exposed more often to interpersonal stress and may respond more emotionally to it, relative to men, suggesting a potential interactive effect of the decline in reproductive hormones and co-occurring social and psychological changes during the menopausal period. This discussion of the myths and realities of the menopause has deliberately not been exhaustive.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1993

Intravenous cefazolin in penetrating eye injuries. Treatment of experimental posttraumatic endophthalmitis.

The use of intravenous antibiotics as prophylaxis in penetrating eye injuries is strictly empiric and not based on scientific data supporting their use. To determine the efficacy of prophylactic intravenous cefazolin in penetrating eye injuries, a rabbit model of posttraumatic endophthalmitis was developed. Forty rabbits received penetrating eye injuries followed immediately by an intravitreal inoculum of live Staphylococcus epidermidis. The rabbits then were randomly divided into four groups: group 1 received three doses of intravenous cefazolin; group 2 received six doses, and group 3 received nine doses; group 4 received no treatment and served as controls. All control rabbits developed 4+ vitreitis; rabbits receiving three doses of the antibiotic developed 2+ vitreitis, and those receiving six or nine doses of cefazolin showed no vitreous inflammation (P < or = 0.0001). Histologic examination of control eyes showed an exuberant reaction with formation of retrolental membranes, vitreous abscess, and retinal detachment. Eyes treated with nine doses of cefazolin were devoid of inflammatory cells. These findings suggest that intravenous cefazolin is effective in preventing the development of posttraumatic endophthalmitis in a rabbit model.

Animals↗
PubMed2002

Guidelines for using verteporfin (visudyne) in photodynamic therapy to treat choroidal neovascularization due to age-related macular degeneration and other causes.

OBJECTIVE: Guidelines were developed based on best available scientific data as well as consensus of expert opinion in absence of controlled clinical trial data to: 1) assist ophthalmologists with selection of patients for whom photodynamic therapy with verteporfin, termed "verteporfin therapy," should be considered; and 2) offer suggestions regarding treatment, follow-up, and re-treatment. METHODS: Consensus from roundtable of retina specialists who either participated in randomized clinical trials evaluating verteporfin therapy or had clinical experience with verteporfin therapy was based on results of these trials and expert opinion. Additional input and advice were received from representatives on behalf of the Macula Society, the Retina Society, and the Vitreous Society, as well as principal investigators of randomized clinical trials evaluating verteporfin therapy. RESULTS: Patient selection criteria included the following: 1) in cases due to age-related macular degeneration (AMD), lesion composition either predominantly classic choroidal neovascularization (CNV) or occult with no classic CNV; 2) CNV location subfoveal or so close to the foveal center that conventional laser photocoagulation treatment almost certainly would extend under the center; 3) lesion etiology from AMD, pathologic myopia, or other causes in which the outcome without treatment is likely to be worse than with treatment; 4) vision at a level where further loss would be recognized as detrimental to the quality of life of the patient. Criteria did not include lesion size, except in cases composed of occult with no classic CNV in AMD in which therapy for lesions >4 Macular Photocoagulation Study (MPS) disc areas usually should be considered only when presenting with lower levels of best-corrected visual acuity. Criteria also did not include patient age, history of systemic arterial hypertension, or prior laser photocoagulation. Therapy should occur ideally within 1 week of the initial fluorescein angiogram on which the clinical decision to treat is based. Patients should return for follow-up at least as often as every 3 months after any initial or subsequent treatment to determine if there is fluorescein leakage from CNV. Re-treatment should be considered as often as every 3 months if fluorescein leakage from CNV is noted at that time. Re-treatment could be deferred if the biomicroscopic and fluorescein angiographic appearance of the lesion is unchanged and shows minimal leakage, especially when there is no subretinal fluid or fluorescein leakage from CNV underlying the center of the foveal avascular zone. Patients should avoid exposure of skin or eyes to direct sunlight or bright indoor light for 48 hours after treatment or until resolution of any swelling or discoloration from extravasation. CONCLUSION: These recommendations provide guidelines on the role of verteporfin therapy in the management of CNV due to AMD and other causes. Revisions of these guidelines may be required as new data become available.

Choroidal Neovascularization↗
PubMedDate not supplied

Guidelines for using verteporfin (Visudyne) in photodynamic therapy for choroidal neovascularization due to age-related macular degeneration and other causes: update.

Guidelines originally were published in 2002 based on best available scientific data as well as consensus of expert opinion in the absence of controlled clinical trial data to assist ophthalmologists with selection of patients for whom photodynamic therapy with verteporfin (Visudyne, Novartis AG, Basel, Switzerland), termed "verteporfin therapy," should be considered, and to offer suggestions regarding initial treatment, follow-up, and additional courses of treatment at follow-up. Consensus was based on results of clinical trials and expert opinion. Additional input and advice were received from representatives on behalf of the American Society of Retina Specialists, the Macula Society, and the Retina Society, as well as principal investigators of randomized clinical trials evaluating verteporfin therapy. Since 2002, additional information relevant to clinical care was published in the peer-reviewed literature; therefore, revisions to the originally published guidelines judged warranted are provided here. Patient selection criteria include the following: (1) in cases due to age-related macular degeneration (AMD), lesion composition of (a) predominantly classic choroidal neovascularization (CNV), (b) occult with no classic CNV with presumed recent disease progression, or (c) relatively small minimally classic lesions; (2) CNV location subfoveal or so close to the foveal center that conventional laser photocoagulation treatment almost certainly would extend under the center; (3) etiology of CNV from AMD, pathologic myopia, or other causes in which the outcome without treatment is likely to be worse than with treatment; and (4) vision at a level where further loss would be recognized as detrimental to the quality of life of the patient. Criteria include lesion size for AMD patients with either a minimally classic lesion composition (where treatment usually should be considered only for relatively smaller lesions) or occult with no classic lesions (where treatment usually should be considered for relatively smaller lesions or those >4 Macular Photocoagulation Study disc areas with a relatively lower or poorer best-corrected visual acuity) but not patient age, history of systemic arterial hypertension, or prior laser photocoagulation. Therapy should be initiated ideally within 1 week of the initial fluorescein angiogram on which the clinical decision to treat is based. Patients should return for follow-up at least as often as every 3 months (+/-2 weeks) after any initial or subsequent treatment to determine if there is fluorescein leakage from CNV. Additional courses of treatment should be considered as often as every 3 months (+/-2 weeks) if fluorescein leakage from CNV is noted at that time. Additional courses of treatment could be deferred if the biomicroscopic and fluorescein angiographic appearances of the lesion are unchanged and show minimal fluorescein leakage, especially when there is no subretinal fluid or fluorescein leakage from CNV underlying the center of the foveal avascular zone. Patients should avoid exposure of skin or eyes to direct sunlight or bright indoor light for 48 hours after treatment or until resolution of any swelling or discoloration from extravasation. Follow-up of relatively larger minimally classic lesions and occult with no classic lesions that initially do not undergo therapy appears indicated so therapy can be considered if a predominantly classic lesion develops or, in the case of occult with no classic lesions, if visual acuity declines slightly to a lower (poorer) level without a marked increase in lesion size. Additional revisions of these guidelines may be required as new data become available.

Choroidal Neovascularization↗
PubMed2001

Fluorescence polarization immunoassay: can it result in an overestimation of vancomycin in patients not suffering from renal failure?

It has been reported in scientific data that fluorescence polarization immunoassay (FPIA) results in overestimation of vancomycin in patients with renal failure. This overestimation is caused by interference of the degradation product, CDP-1, in this assay. Increases in vancomycin levels have also been reported in patients not suffering from renal failure (nonrenal failure patients) who are receiving vancomycin therapy for approximately 10 days or more. The authors tested whether this increase in vancomycin in nonrenal failure patients is a result of CDP-1 interfering with FPIA or a change in the pharmacokinetics of the drug. Serum vancomycin peak and trough samples were obtained from 10 adult (mean age +/- SD: 55.9 years +/- 17.5) nonrenal failure patients (mean ClCr +/- SD: 76.2 mL/min +/- 29.20) receiving vancomycin therapy for at least 10 days. These peaks and troughs were obtained at steady state and again at approximately 10 days of therapy. All serum samples were analyzed initially by fluorescence polarization immunoassay (FPIA, TDx) (Abbot Diagnostics; Irving, TX) and again by enzyme multiplied immunoassay (EMIT Vancomycin Assay) (Dade Behring; San Jose, CA). Statistical analysis (Wilcoxon signed-rank test) determined that there was no difference between the values obtained from the two assays. This demonstrates that the increase in vancomycin levels is not caused by the accumulation of CDP-1 and may be the result of a change in the pharmacokinetics of the drug.

Adult↗
PubMed1997

Regulatory aspects of functional foods.

Functional foods and claims belong together, so that many people would define functional goods as those which are claimed to have health-promoting effects. Within the EU such claims are regulated by the Food Labelling Regulations, which prohibit food labelling or advertising to claim that a particular food has the property of preventing, treating or curing a disease, or any reference to such property. Food Labelling Regulations are obviously interpreted differently within the EU; but whatever the interpretation, allagree that claims must not be misleading, and consequently should be based on sound scientific data.

Denmark↗
PubMed1992

The influence of implant design, application, and site on clinical performance and crestal bone: a multicenter, multidisciplinary clinical study. Dental Implant Clinical Research Group (Planning Committee).

This investigation is designed to provide scientific data that is directly relevant to the placement of dental implants. The study is concerned with the influence of implant design, application, and location on long-term clinical performance and crestal bone response over 5 years of function. It involves approximately 700 patients at 30 Veterans Administration Medical Centers from various geographic regions. Patients are being entered into the study over an 18-month period and monitored (post-loading) over 5 years. The participating centers were randomly assigned to one of two separate, independent study groups. Complications and adverse responses associated with the placement and use of the implants will be evaluated and all failures thoroughly documented. The experimental design and sample size are based on the primary hypothesis that an implant-supported prosthesis will be successful/functional over a 5-year period in at least 90 percent of the cases treated. Secondary hypotheses to be tested are (1) the success rate among implant designs are the same over a 5-year period; (2) the success rate among implant applications are the same over a 5-year period; (3) the success rate of individual implants are the same with regard to jaw location over a 5-year period; (4) the loss of crestal bone at the individual implant sites are the same among the implant designs over a 5-year period; and (5) the complications and adverse responses experienced with the different implant designs are the same over a 5-year period. The experimental design of this multicenter, multidisciplinary, randomized investigation is a cooperative effort of the Department of Veterans Affairs and several United States dental schools.

Alveolar Bone Loss↗
PubMed2003

New medical management techniques for acute exacerbations of chronic rhinosinusitis.

In the past 2 years, intranasal nebulized medications have emerged as a widely prescribed treatment for medical management of chronic rhinosinusitis. This represents an innovative and advanced approach to treating acute exacerbations of chronic rhinosinusitis topically. The use of specially formulated medication compounds delivered by unique nebulization equipment is reviewed in the treatment of patients with chronic sinus disease. Scientific data including related upper and lower respiratory literature is included, as well as the important aspects of factors affecting nebulized medication delivery to the sinuses. The benefits, effectiveness, risks, and adverse effects of intranasal nebulized medications are also addressed. A treatment algorithm identifying appropriate use of nebulized medications in the treatment plan for chronic sinusitis patients is then presented in diagrammatic format.

Acute Disease↗
PubMed2006

Early gastric cancer: diagnosis, pathology, treatment techniques and treatment outcomes.

Recent improvements in endoscopic techniques and technologies and an increased understanding and recognition of the importance of early gastric cancer (EGC) will result in increases in the detection and diagnosis of precancerous or early cancerous lesions. The incidences of nodal metastasis of intramucosal and submucosal EGC are 3 and 20%, respectively. Therefore, major surgery may be inappropriate in many of these patients, and many cases of EGC may be treated by endoscopic mucosal resection (EMR). EMR was first introduced in Japan 20 years ago. Most EMR have been performed by the so-called 'strip biopsy' or EMR-C methods. However, we have sometimes experienced local recurrence in cases that had been resected in multiple fragments by these methods. To obtain 'complete resection', we developed the endoscopic submucosal dissection (ESD) technique using a special endoscopic knife, the insulation-tipped diathermic knife (IT knife). The rate of complete resection, i.e. cut margin free from cancer and one-piece resection, was remarkably higher for the IT knife technique than conventional EMR. ESD cases are increasing rapidly in Japan. EMR including ESD is a good method for patients with gastric cancer to preserve the stomach. For EMR, it is necessary to find EGC. Both diagnosis and treatment are important, and scientific data regarding lymph node metastasis and clinicopathological features are required.

Endoscopy↗