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Biomedical subjects

H Noshiro

Publications and source records attributed to H Noshiro.

At least 37 records · Page 2Linked to original sources
PubMed1998

Changes in pancreatic function after pancreatoduodenectomy.

BACKGROUND: The objective of this study was to compare the alterations in pancreatic function after pancreatoduodenectomy between malignant and benign diseases. METHODS: In 34 patients who underwent pancreatoduodenectomy for pariampullary cancer (malignant group; n = 18) and benign pancreatic disorders (benign group; n = 16), exocrine and endocrine functions were analyzed before surgery, at a short-term period (< or = 2 months), and at a long-term period (>12 months) after surgery. Assessment was based on the BT-PABA excretion test, fasting blood sugar level, and oral glucose tolerance test. RESULTS: Compared with the preoperative level, urinary PABA excretion rate in the malignant group significantly decreased on short-term follow-up but recovered on long-term follow-up. However, that in the benign group increased on long-term follow-up without showing a short-term decline. Diabetes mellitus was present in 11 (61%) of the 18 patients in the malignant group and 6 (38%) of the 16 in the benign group before surgery. Glucose tolerance improved in 6 (55%) of the 11 patients in the malignant group but in only 1 (17%) of the 6 in the benign group shortly after surgery. In the benign group, 3 (30%) of 10 patients with normal preoperative glucose tolerance became diabetic after surgery, while no patient in the malignant group developed diabetes on short-term follow-up. CONCLUSIONS: Surgeons should pay attention to exocrine pancreatic function in patients with a periampullary cancer and to glucose metabolism in patients with benign disease over the short-term period after pancreatoduodenectomy.

4-Aminobenzoic Acid↗
PubMed1996

Effect of terminal ileal transposition on gallbladder bile composition following proctocolectomy.

Enterohepatic circulation of bile acid is impaired and the percentage of secondary bile acids in bile decreases after proctocolectomy and ileo-anal anastomosis. Moreover, the site-specific function and morphology of the terminal ileum are likely to be damaged by acute and chronic inflammation because the ileum is being used as a reservoir in this procedure. A jejunal segment was interposed between the terminal ileum and the anus to spare the terminal ileum from being used as a reservoir following proctocolectomy in dogs. We performed this study to investigate the effects of this procedure on gallbladder bile lipid composition. Adult mongrel dogs underwent either terminal ileal transposition procedure (n = 7) or conventional ileoanal anastomosis (n = 7) following two-stage proctocolectomy. The animals were laparotomized and gall-bladder bile was collected 12 weeks later. In the terminal ileal transposition group, the total bile acid concentration significantly decreased (P < 0.01), while the secondary bile acid percentage did not. In the conventional group, the percentage of secondary bile acid significantly decreased (P < 0.05), while the total bile acid concentration remained unchanged. Proximal transposition of the terminal ileum may have an advantage in preserving the percentage of secondary bile acid in gallbladder bile. This procedure effects bile lipid metabolism differently than conventional ileo-anal anastomosis.

Animals↗
PubMed1996

Gallstone formation and gallbladder bile composition after colectomy in dogs.

A high prevalence of gallstones has been described in patients following colectomy. The aim of this study was to examine whether lithogenicity is attributed to colectomy. In the present study, changes in gallbladder bile composition and the mechanism of gallstone formation after colectomy were examined in dogs. Ten mongrel dogs underwent restorative proctocolectomy. Seven dogs which received sham operations served as controls. Over a 12-week postoperative period, samples of gallbladder bile, formed gallstones and serum were collected and analyzed. In 7 of the 10 (70%) colectomized dogs, gallstones were found in the gallbladder, while the control dogs had no stones. Macroscopically the gallstones were similar to black pigment stones observed in humans. Chemical analysis and Fourier transform-infrared spectroscopy examination revealed that the stones were composed mainly of sodium bilirubinate and proteins, with minor amounts of calcium salts and cholesterol. Significant increases in biliary pH and concentrations of ionized calcium and unconjugated bilirubin were observed in the gallbladder bile of the colectomy group compared with that of the control group. The total bile acid and total bilirubin concentrations were significantly decreased in the colectomy group. Cholesterol crystal nucleation did not occur. The inhibitory effect of gallbladder bile on calcium carbonate precipitation in an in vitro assay system was preserved even after colectomy. In conclusion, proctocolectomy increases the concentration of unconjugated bilirubin in gallbladder bile and induces pigment gallstones which are composed mainly of sodium bilirubinate and proteins since calcium ions and cholesterol are stabilized in dogs.

Animals↗
PubMed1995

Deoxycholic acid in gall bladder bile does not account for the shortened nucleation time in patients with cholesterol gall stones.

The relations between the concentration of deoxycholic acid (DCA), the cholesterol saturation index, and the nucleation time in gall bladder bile were measured to determine the role of DCA in bile in the pathogenesis of cholesterol gall stone disease. Bile was obtained from patients with cholesterol gall stones (n = 30), subjects without gall stones (n = 35), and patients with pigment gall stones (n = 9). Three of 30 cholesterol gall stone patients and 10 of 35 gall stone free subjects were treated with antibiotics by mouth to decrease the concentration of bile DCA and determine the effect of DCA on biliary lithogenecity. Both the percentage and concentration of DCA in bile were similar in patients with and without cholesterol gall stones despite significant differences in their cholesterol saturation indices and nucleation times. Neither the percentage nor the concentration of DCA in bile correlated with either the cholesterol saturation index or the nucleation time. Analysis of subgroups with matching cholesterol saturation indices showed no correlation between the proportion of DCA in the bile and the cholesterol nucleation time. The proportion of DCA in bile was decreased by antibiotic treatment, but this had no effect on the cholesterol saturation index or nucleation time. These results suggest that DCA in bile is not responsible for biliary cholesterol saturation or cholesterol nucleation time.

Aged↗
PubMed1995

Hepatic resection for hepatolithiasis and long-term results.

BACKGROUND: Hepatic resection is an established procedure for treating patients with hepatolithiasis. The long-term results after hepatic resection for hepatolithiasis were appraised. STUDY DESIGN: Of 127 patients with hepatolithiasis seen between 1973 and 1993, 43 patients underwent hepatic resection, and constituted the basis of this study. RESULTS: There was one operative death (operative mortality rate of 2.3 percent) and three deaths as a result of concomitantly associated cholangiocellular carcinoma. Of the remaining 39 patients, the complete stone clearance rate was 67 percent with operation alone, but reached 87 percent when cholangioscopy was used. Operative morbidity was recorded in five patients (12 percent), but they recovered with conservative therapy. Stones recurred in 15 percent of patients after a mean follow-up period of four years (range of three to six years). Eleven (28 percent) of 39 patients died after hepatectomy as a result of related diseases after a mean follow-up of 6.2 years. These 11 patients had associated biliary drainage procedures. They experienced a higher mortality rate (p < 0.05) than patients who did not have biliary drainage. CONCLUSIONS: We conclude that hepatic resection is adequate treatment for hepatolithiasis. The patients having additional biliary drainage procedures had a higher mortality, but one cannot reach conclusions about the negative effect of the drainage procedures because the drainage procedures were done in a selected and not a randomized manner.

Adult↗
PubMed1994

[A case of advanced breast cancer with multiple lung metastases responding well to postoperative combined administration of doxifluridine (5'-DFUR) and tamoxifen].

A 72-year-old female with right breast cancer having multiple lung metastases was treated by combined administration of 5'-DFUR at 800 mg/day, and tamoxifen, at 20 mg/day, after standard radical mastectomy. Plain chest X-ray and computed tomography examinations have shown complete disappearance of the multiple lung tumor since the therapy. No serious side effects have been observed during the treatment course, and there has been no definite evidence of tumor recurrence.

Adenocarcinoma, Papillary↗
PubMed1993

High vesicular cholesterol and protein in bile are associated with formation of cholesterol but not pigment gallstones.

To examine the differentiating parameters between cholesterol and pigment gallstones, we compared the nucleation times, concentrations of biliary lipid and protein, and the distribution of vesicular cholesterol in gallbladder bile of 16 patients with cholesterol, eight patients with black pigment gallstones, and nine gallstone-free control patients. Cholesterol monohydrate crystals were present in the fresh bile of only the cholesterol gallstone group. The nucleation time was significantly faster in the cholesterol stone group (3.3 +/- 3.2 days) than in the other two groups (pigment stone: 15.8 +/- 6.6, control: 16.9 +/- 5.7). The cholesterol saturation indices and the distribution of vesicular cholesterol were significantly higher in the cholesterol gallstone group than those in the other two groups. The total biliary protein concentration was significantly (P < 0.01) higher in the cholesterol gallstone group [2.57 +/- 1.91 (SD) mg/ml] than that in the black pigment stone group (1.09 +/- 0.59). All parameters in patients with black pigment gallstone were essentially similar to the controls. We conclude that the presence of cholesterol crystals, rapid nucleation time, high vesicular cholesterol distribution, elevated cholesterol saturation index, and high protein concentration are associated with cholesterol gallstones but not with black pigment gallstones.

Aged↗
PubMed1993

Cholesterol crystal appearance time of gallbladder bile in middle-aged women.

The aim of our study was to examine the hypothesis that the cholesterol nucleation time of gallbladder bile might be rapid in women in their fourth and fifth decades, which increases their risk of cholesterol gallstones. Fifty-four gallbladder bile samples were collected from gallstone-free patients and patients with cholesterol gallstones in a functioning gallbladder. We examined the relations of nucleation time to age and sex in each group. The nucleation time of gallbladder bile tended to be prolonged with age, but there was no correlation between nucleation time and age in each group. Cholesterol nucleation time was not significantly different between age-matched females and males in each group, nor was it faster in middle-aged females than in older females. Thus, nucleation time was not rapid in middle-aged females even in the gallstone-free group. These results indicate that cholesterol nucleation time is not significantly influenced by either sex or age, and cannot therefore account for the higher frequency of cholesterol gallstone disease in females in the fourth and fifth decades.

Age Factors↗
PubMed1992

Activity of cholesterol in human gallbladder bile in relation to nucleation of cholesterol monohydrate crystals.

To examine the hypothesis that the chemical activity of cholesterol molecules reflects the amount of cholesterol phasing out from bile associating with cholesterol monohydrate crystal nucleation, the cholesterol activities in human gallbladder biles from cholesterol gallstone patients, either untreated or treated with ursodeoxycholic acid, and from gallstone-free patients were determined in relation to the nucleation time and vesicular lipid composition. The cholesterol activity (nmol/disc/h) determined by the polyethylene disc uptake method was higher in the untreated gallstone group than the gallstone-free group (P less than 0.05) and the ursodeoxycholic acid treated group (P less than 0.01). The cholesterol activity correlated negatively with the nucleation time (P less than 0.01) and positively with both the vesicular cholesterol concentration (P less than 0.05) and the cholesterol/phospholipid ratio in vesicles (P less than 0.05). After the separation of vesicles from micelles by gel filtration, the cholesterol activity in the vesicular phase was found to be similar to that in the micellar phase. Interestingly, both the activities of cholesterol in the vesicular and micellar phases were significantly higher in the untreated gallstone group than in the gallstone-free group (P less than 0.05). These results suggest that cholesterol activity represents the amount of thermodynamically unstable cholesterol in bile.

Aged↗
PubMed1992

Decreased protein concentration and improved metastability of bile induced by ursodeoxycholate.

Previous studies demonstrated that higher biliary protein is associated with reduced metastability of bile. This study attempted to examine the induced effect of ursodeoxycholate on metastability of bile by measuring the nucleation time and biliary protein in cholesterol gallstone patients. Thirty-seven patients with functioning gallbladders were studied 10 control patients without gallstones and 27 with cholesterol gallstones. Ten of 27 cholesterol gallstone patients were treated with ursodeoxycholate (600 mg/day) prior to surgery. Twelve of 17 untreated gallstone patients had cholesterol crystals in gallbladder bile while cholesterol crystals were absent in the ursodeoxycholate-treated gallstone patients and in the controls. Total protein concentration and cholesterol saturation index were significantly greater in the untreated gallstone patients with crystals than in those without crystals in bile. The treatment with ursodeoxycholate significantly decreased biliary protein concentration and cholesterol saturation index associated with the prolonged nucleation time. Cholesterol nucleation time correlated with biliary total protein concentration and cholesterol saturation index but not with total lipid concentration. It is concluded from the present study that ursodeoxycholate decreases biliary protein thereby partly increasing metastability of gallbladder bile.

Bile↗
PubMed1992

Effect of chenodeoxycholate and ursodeoxycholate on nucleation time in human gallbladder bile.

The effects of treatment with chenodeoxycholic acid (CDCA) or ursodeoxycholic acid (UDCA) on nucleation time, biliary lipid concentration, and vesicular lipid composition were studied. Gallbladder bile was collected at the time of surgery from 33 cholesterol gallstone patients who were divided into three groups: 16 untreated, 9 pretreated with CDCA (400 mg/day), and 8 pretreated with UDCA (600 mg/day) for 1-3 weeks before surgery. Control bile samples were also collected from nine patients without cholelithiasis. Nucleation time was prolonged significantly in both CDCA- and UDCA-treated groups [12.6 +/- 8.5 (SD) and 21.0 +/- 0 days, respectively] compared with the untreated gallstone group (3.3 +/- 3.2 days). Both treatments significantly decreased the proportion and concentration of both cholesterol and phospholipids present in the vesicular phase. Treatment with UDCA decreased the cholesterol saturation index more than did CDCA at the dose used in this study. In the CDCA-treated group, patients without much change in cholesterol saturation index (greater than 1.0) showed a prolongation of the nucleation time with a significant decrease in vesicular cholesterol concentration, indicating a shift of cholesterol from vesicles to micelles. UDCA-treated patients and CDCA-treated patients with decreased cholesterol saturation index (less than 1.0) showed a greater effect. The authors conclude that UDCA prolongs the nucleation time mainly by decreasing the cholesterol saturation index, whereas CDCA does so by the dual effect of lowering the cholesterol saturation index and shifting cholesterol from vesicles to micelles.

Bile↗
PubMed1992

Human gallbladder bile becomes lithogenic during short-term intravenous hyperalimentation.

Biliary sludge formation is reported to be one of the complications of intravenous hyperalimentation (IVH); however, the change in human biliary lithogenicity during IVH treatment has been little studied. To clarify the pathogenesis of IVH-induced biliary sludge, we determined biliary lipid composition, vesicular cholesterol concentration, and nucleation time using gallbladder bile samples collected from three groups: The IVH group comprised 9 patients who received IVH with fasting for a period of 2-8 days prior to surgery for gastrointestinal diseases. The control group comprised 10 patients operated after overnight fasting for gastrointestinal diseases. The cholesterol gallstone group comprised 14 patients surgically treated for cholesterol gallstone disease after overnight fasting. The nucleation time in the IVH group was significantly shorter (7.8 +/- 5.3 days, mean +/- SD) than that in the control group (17.3 +/- 5.5 days), while it did not reach the value in the cholesterol gallstone group (3.1 +/- 3.3 days). The cholesterol saturation index in the IVH group (1.01 +/- 0.27) was higher but not significantly different compared with the control group (0.80 +/- 0.21). The concentrations of biliary lipids and individual bile acid were similar in the IVH and control groups. The vesicular cholesterol concentration in the IVH group (3.0 +/- 2.1 mM) was significantly higher than that in the control group (0.9 +/- 1.0 mM). In conclusion, IVH with fasting causes a rapid cholesterol nucleation time and a higher vesicular cholesterol concentration, thereby inducing an initial stage of gallbladder sludge formation.

Aged↗
PubMed1992

Diurnal variation in cholesterol metastability of hepatic bile and its acute modulation with ursodeoxycholic acid in humans.

We studied the alteration of cholesterol metastability of hepatic bile caused by diurnal variations in hepatic biliary lipid excretions and acutely induced changes following ursodeoxycholic acid (UCDA) administration. Hepatic bile was collected at 6-h intervals for 24 h from 6 patients with an indwelling choledochal drainage before and after UDCA administration. A basal diurnal variation showed the highest cholesterol saturation index (p < 0.05) and cholesterol distribution in vesicles (p < 0.01) and the shortest nucleation time (p < 0.05) in the early morning. After the ingestion of ursodeoxycholic acid for 1 day, early morning biliary cholesterol concentrations were reduced. Interestingly, significant decreases in vesicular cholesterol concentrations (1.0 +/- 0.2 to 0.1 +/- 0.04 mM, p < 0.01) and in the vesicular cholesterol/phospholipid ratio (1.6 +/- 0.1 to 0.7 +/- 0.1, p < 0.05) were associated with prolongation of the nucleation time (11.5 +/- 1.2 to 18.7 +/- 1.5 days, p < 0.01). Biliary protein had no diurnal variations and did not decrease significantly with UCDA. These results indicate that during a day the early morning hepatic bile is the most unstable and that UCDA acutely enhances hepatic biliary metastability mainly by decreasing the rate of vesicular cholesterol saturation.

Aged↗