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Biomedical subjects

A Koga

Publications and source records attributed to A Koga.

At least 91 records · Page 5Linked to original sources
PubMed1986

Aberrant insulinoma in the duodenum.

A rare case of aberrant insulinoma in the duodenum is described. Hyperinsulinemia with typical hypoglycemic symptoms was induced by prolonged fasting. Selective angiography demonstrated a tumor supplied from the first branch of the jejunal artery, and duodenoscopy revealed a submucosal tumor at the third portion of the duodenum. An increase in venous plasma immunoreactive insulin concentration was evident in the vein draining from the tumor, by sampling through percutaneous transhepatic catheterization. Hypoglycemia was ameliorated after the removal of the submucosal tumor of the duodenum. Histologic and immunocytochemical characterization of the tumor showed an insulinoma, predominantly composed of cells with typical B-cell-like granules. The acid extract of the tumor contained 1.2 U/g of insulin, and this insulin, analyzed by reverse-phase high-pressure liquid chromatography, revealed that it had the same amino acid structure as that of human insulin.

Adenoma, Islet Cell↗
PubMed1985

Hepatolithiasis associated with cholangiocarcinoma. Possible etiologic significance.

Three cases of primary bile duct carcinomas (cholangiocarcinomas) were found among 61 cases of hepatolithiasis. Cholangiocarcinoma arose from the extrahepatic bile duct in one and from the dilated intrahepatic bile duct in two patients. Hyperplasia of the columnar cells was often present. These hyperplastic epithelial cells often show papillomatous or adenomatous pattern, which are frequently associated with the presence of stones and the contaminated bile, and may show malignant changes leading to the development of cholangiocarcinoma.

Adenocarcinoma↗
PubMed1985

Ultrasonographic detection of early and curable carcinoma of the gallbladder.

Five patients with early carcinoma of the gallbladder detected by ultrasonography were studied. Three complained of non-specific upper abdominal symptoms or were asymptomatic and two had severe biliary colic. Gallstones were present in the two patients without biliary symptoms. Early carcinoma of the gallbladder was demonstrated as a polypoid tumour by ultrasound in four patients and as thickening of the gallbladder wall in one. The tumour was over 2 cm in diameter in all but one patient in whom the tumour enlarged rapidly from 5 to 10 mm. Size of the tumour and extent of spread were closely related. All but one patient underwent curative resection. Ultrasonography enhances the detection of early carcinoma of the gallbladder especially in old patients with non-specific abdominal symptoms and the operative cure rate is thereby improved.

Aged↗
PubMed1985

Fine structure of the human gallbladder with cholesterosis with special reference to the mechanism of lipid accumulation.

Eight excised gallbladders with cholesterosis were studied by light and electron microscopy. Lipid droplets were found not only in the submucosa, but also in the infranuclear cytoplasm of epithelial cells. These contained well developed mitochondria and agranular reticulum. Lipid droplets were seen to form in the agranular reticulum. Macrophages were often present between the epithelial cells and the submucosa and contained numerous processes and well developed cell organelles, abundant lysosomes and lipid droplets. With the advance of lipid deposition, macrophages were filled with lipid droplets and became foam cells. It is suggested that these may become too large and rigid to pass through the endothelium of lymph vessels or that the lumen of the lymph vessels may be obstructed by large foam cells resulting in the destruction of these vessels and the accumulation of foam cells in the submucosa.

Cholesterol↗
PubMed1985

Primary carcinoma of the gallbladder.

Sixty-five Japanese patients with primary carcinoma of the gallbladder treated in the Department of Surgery I at Kyushu University from 1965 through 1982 were reviewed. Forty-one patients had histologically proven primary carcinoma and the other 24 patients were diagnosed by laparotomy and/or combination of several diagnostic procedures. The female to male ratio was 1.5 to 1. The peak incidence was at the ages of 60-69 years for both sexes. Gallstones were found in 53 per cent of resected patients and were demonstrated in 58 per cent of unresected patients by ultrasonography. Laparotomy was performed on 50 patients and the tumor could be removed in 15 patients. Resection could be done in only one of 18 patients correctly diagnosed. Fourteen of 15 patients who underwent resection had been diagnosed as cases of benign lesions. Curative resections were feasible in six of 15 patients. In curative resection cases, the longest survival time was 42 months; and in cases of non-curative resection, 26 months. Most of the nonresected patients died within 6 months with an operative mortality of 16.6 per cent. This report reinforces the difficulty in diagnosis and the poor prognosis for patients with primary carcinoma of the gallbladder. However, ultrasonography seems to be the best tool at present for detecting early cancer, especially cancer of the polypoid type. We hold the view that more radical approaches for relatively early cancer will enhance the operative results.

Adenocarcinoma↗
PubMed1984

Effect of chenodeoxycholic and ursodeoxycholic acids on isolated adult human hepatocytes.

Chenodeoxycholic and ursodeoxycholic are effective cholelitholytic agents, but differ in their side effects. Chenodeoxycholic acid administration induces diarrhea and a transient rise of GOT, which are virtually nonexistent with ursodeoxycholic acid treatment. Lithocholic acid, a bacterial metabolite of chenodeoxycholic acid, has been implicated as a possible hepatotoxin. In the present investigation, the effect of chenodeoxycholic acid or ursodeoxycholic acid and their glycine and taurine conjugates on isolated human hypatocytes was directly assessed. Chenodeoxycholic acid had drastic effects on isolated human hepatocytes by reducing the number of microvilli and disrupting cell membranes. Pronounced release of GOT was observed. In contrast, ursodeoxycholic acid produced only slight morphological changes and enzyme release. Conjugation of each respective bile acids had a moderating effect.

Adult↗
PubMed1984

[Present status of hepatolithiasis in Japan].

Research Group for Hepatolithiasis, Ministry of Health and Welfare, Japanese Government surveyed cases of hepatolithiasis in the member hospitals. Total of 414 cases were collected between 1977 to 1981. They were divided according to the classification of hepatolithiasis proposed by Research Group for the Study of Damage to the Intrahepatic Bile Duct. Four hundred fifteen patients consisting of 186 males and 228 females. Female predominance was statistically significant (p less than 0.05). Age incidence rose rapidly at their thirties and reached the peak at their fifties. Most stones were calcium bilirubinate stones. In IE classification (intrahepatic and extrahepatic classification), they were equally distributed in each subtype. Left lobe predominated (L and LR Type) in hepatic lobe classification. Bile duct stenosis and dilatation were present in 57% and in 95% of the cases respectively. Bile duct stenosis occurred frequently in the left intrahepatic bile ducts. Possible etiological significance of IE classification difference from those confined to hepatic lobe (I type) to those predominantly in extrahepatic bile duct (IE type) were discussed.

Adolescent↗
PubMed1984

[Pathological study of hepatolithiasis with special reference to unusual cases].

Morphological survey was performed in 140 liver specimens of hepatolithiasis which were collected from several pathological and surgical Departments in Japan. Among them there were 19 cases with unusual features suggestive of presumed lithogenic processes. They consisted of association of congenital dilatation of biliary tree (5 cases), association of stenosis or obstruction of biliary tree occurring prior to lithiasis (4 cases), association of anomalous communication between biliary tree (1 case), presence of serous glands simulating to pancreatic exocrine glands in biliary tree (1 case), association of non-biliary hepatic cirrhosis (4 cases), association of chronic ulcerative colitis (1 case), intrahepatic cholesterol stone (2 cases) and association of granulomatous cholangitis (1 case). Chronic proliferative cholangitis which is consistently seen in a common type of hepatolithiasis was found in about a half of these unusual cases and not in the remaining cases. Based on the observations of these unusual cases, the following suggestions were obtained: dilatation, bile stasis or cholangitis may be a lithogenic factor of hepatolithiasis, and chronic proliferative cholangitis associated with a numerous amount of mucinous glands is not always a prerequisite lesion and exerts a promoting and accelerating effect in hepatolithiasis.

Adult↗
PubMed1983

Management of massive hemobilia with angiographic embolization.

Two cases of angiographic embolization for the management of massive hemobilia due to hepatico-jejunostomy and percutaneous transhepatic biliary drainage are presented. The clinical features are described together with a short review of the literature. In addition to defining the bleeding source, angiography provides an effective and safe alternative to surgery for the control of hemobilia.

Aged↗
PubMed1982

[Treatment of cancer of the gallbladder and bile duct].

The records of 166 patients (85 men and 81 women) with extrahepatic bile duct cancers consisted of 58 patients with gallbladder cancer, 76 patients with bile duct cancer, and 32 patients with cancer of the papilla of vater were reviewed. A mean age was 60 years old (ranged: 30-80 years old). Twelve of 58 patients with gallbladder cancer were treated with simple cholecystectomy or extended cholecystectomy. Remaining 46 patients were treated with palliative treatments. The longest survival time of the resected patients was 3 1/2 years. Mean survival time of patients with palliative treatments was 5.6 months in external biliary drainage and 2.2 months in internal drainage. Thirteen of 76 patients with bile duct cancer were treated with bile duct resection or pancreatoduodenectomy. Remaining 63 patients were treated palliatively. Resectability rate was 10% in upper bile duct, 33% in middle and 36% in lower bile duct. The longest survival time was 3 1/2 years in upper bile duct, 2 2/3 years in middle and 3 5/6 in lower bile duct. Mean survival time of palliative treatments was 5.4 months in external drainage and 8.4 months in internal drainage. Twenty two of 32 patients with cancer of the papilla of Vater were treated with pancreatoduodenectomy. Remaining 10 patients received palliative treatments. The longest survival time was 11 years and 5 year survival rate was 14%. The longest survival time of the palliative treatments was 3 3/4 years and mean survival time was 14.2 months. To improve the resectability and operative results, early diagnosis and extended radical resection are necessary.

Adult↗
PubMed1981

Isolation and primary culture of adult human hepatocytes. Ultrastructural and functional studies.

Biopsy tissue of adult human liver was gently dissociated with collagenase followed by Dispase. By repeated low g centrifugation, a large number of almost pure, viable hepatocytes was obtained. This is the first report of a successful procedure for obtaining adult human hepatocytes for study in tissue culture. The isolated cells have the typical morphology of liver parenchyma, and these characteristics persist throughout the period of culturing. Evidence of their function is indicated by albumin synthesis. This procedure is now being used to study human hepatocyte functions in vitro and the effects of a variety of agents including carcinogens and viruses.

Adult↗