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Biomedical subjects

J Kamiya

Publications and source records attributed to J Kamiya.

At least 181 records · Page 10Linked to original sources

Gardner's syndrome associated with periampullary carcinoma, duodenal and gastric adenomatosis. Report of a case.

A 48-year-old man with Gardner's syndrome, who had abdominoperineal resection for rectal carcinoma in 1962, was found to have an ulcerating growth of the duodenum, and pancreaticoduodenectomy was performed in 1979. Histologic examination by complete step-serial sectioning disclosed a well-differentiated adenocarcinoma with adenomatous remnants, a large adenoma with focal carcinoma, 256 adenomas of the duodenum, and 91 adenomas of the gastric antrum. The world medical literature was reviewed, and 29 cases of periampullary carcinoma and 12 cases of gastric carcinoma complicating familial polyposis coli or Gardner's syndrome were analyzed.

Adenocarcinoma↗

RNA interference may be more potent than antisense RNA in human cancer cell lines.

1. RNA interference (RNAi) is a newly discovered cellular pathway for the silencing of sequence-specific genes at the mRNA level by the introduction of the cognate double-stranded (ds) RNA. Because antisense (AS) mechanisms have similar effects, we compared these two effects in human cancer cell lines, considering a possible application of RNAi for cancer therapy. 2. We tested RNAi effects by transfecting human hepatoma and pancreatic cancer cell lines with AS and sense (S) RNA expression plasmids corresponding to the exogenous luciferase gene or the endogenous c-raf gene in the form of complexes with a cationic lipopolyamine or a tumour-targeting peptide vector we developed. In addition, we compared the effects of small interfering RNA and AS oligoDNA complexed with the peptide vector. 3. From the viewpoint of AS actions, the effect of the AS RNA may be cancelled by the S RNA, although, interestingly, we found that the combination of the AS and S RNA expression plasmids was more effective than the AS RNA expression plasmids alone in reducing target gene expression, whereas the S RNA expression plasmids had no effects. The combination of the luciferase AS and S RNA had no effects on the expression of either the beta-galactosidase gene or the c-raf gene. In the presence of 2-aminopurine (an inhibitor of dsRNA-activated protein kinase), the inhibitory effect of the combination of AS and S RNA on gene expression did not change in the case of the endogenous c-raf gene, but was reduced in the case of the exogenous luciferase gene. The effect of 22 nucleotide RNA duplexes corresponding to the luciferase gene was by one order stronger than that of the phosphorothioate AS DNA. 4. Thus, it is suggested that RNAi may be more potent than AS RNA in reducing target gene expression in human cancer cell lines, regardless of the length of dsRNA. With further studies on the RNAi phenomenon in cancer cells, RNAi could provide a novel approach for cancer gene therapy.

2-Aminopurine↗

Serum alkaline phosphatase after extensive liver resection: a study in patients with biliary tract carcinoma.

BACKGROUND/AIMS: To clarify a correlation between serum alkaline phosphatase (ALP) levels and liver function and regeneration after major hepatectomy. METHODOLOGY: Post-operative changes in serum ALP levels were retrospectively examined in 91 non-cirrhotic patients with biliary tract carcinoma who underwent right hepatic lobectomy or more extensive liver resection. In addition, changes in liver volume after resection were assessed in 31 patients who underwent computed tomography before surgery and within 1 month after resection. RESULTS: Serum ALP levels reached its nadir on post-operative day 1, followed by a gradual increase until post-operative day 28. In patients with post-hepatectomy liver failure (n = 32), serum ALP levels were significantly lower on days 1, 7, 10, 14, 21, and 28 after resection than in those without such failure (n = 59). Unexpectedly, the volumetric study of the liver showed no significant difference between the two groups in the remnant liver volume after resection. CONCLUSIONS: Serum ALP levels can function as an indicator of liver function after hepatectomy, but not reflect morphological regeneration of the liver. Thus, increased ALP levels after hepatectomy may not reflect the cellular proliferation process itself.

Adult↗

Ten-year survival after pancreatoduodenectomy for advanced gastric cancer--report of two cases.

We performed pancreatoduodenectomy for 5 patients with gastric cancer, and here we present 2 who have survived for more than 10 years. Patient one had a large antral tumor tightly adherent to the head of the pancreas. Pancreatoduodenectomy with lymph node dissection was performed. Pathologic examination of the resected specimen revealed that the tumor was a well differentiated adenocarcinoma invading the duodenum, but not the pancreas. Patient two had an infrapyloric lymph node metastasis invading not only the pancreatic head, but also the duodenocolic ligament and the transverse mesocolon. Pancreatoduodenectomy and right hemicolectomy with lymph node dissection were performed. Pathological examination of the resected specimen revealed grade III lymph node metastasis, and invasion of the pancreas by the metastatic infrapyloric lymph node. These results indicate that complete resection of tumor by pancreatoduodenectomy may result in a long survival not only for the patients in whom pancreatic invasion and/or lymph node metastasis is limited, but also for some patients with tumor invading the pancreatic parenchyma and/or of grade III lymph node metastasis.

Adenocarcinoma↗

Advanced adenosquamous carcinoma of the gallbladder with bilio-biliary fistula: an uncommon case treated by hepatopancreatoduodenectomy.

A 70 year-old female, who presented with jaundice and abdominal pain, was found to have an advanced gallbladder cancer involving the liver parenchyma, duodenum, and transverse colon. This was complicated by a bilio-biliary fistula between the gallbladder and both the right and left hepatic ducts. After obtaining an accurate pre-operative diagnosis, the patient underwent hepatopancreatoduodenectomy (HPD) with lymph node dissection around the hepatic pedicle, celiac trunk, aorta, and inferior vena cava. Histologic examination revealed adenosquamous carcinoma. This rare variant accounts for 3.5% of gallbladder cancers, and is associated with a worse prognosis than adenocarcinoma. The patient is in good condition without any signs of recurrence 42 months after the HPD. In this case report, we discuss the histological type and internal biliary fistula with regard to the literature, and the usefulness of an aggressive surgical procedure such as HPD with extended lymph node dissection which can improve survival and quality of life in selected patients.

Aged↗

Asymptomatic portal vein obstruction after hepatobiliary resection: early detection by Doppler ultrasonography.

We report two different types of portal vein obstruction after liver resection: portal vein thrombosis due to steal phenomenon via a splenorenal shunt, and kinking of the skeletonized left portal vein after right hepatic lobectomy with caudate lobectomy. The two cases of portal vein obstruction were asymptomatic without any suggestive laboratory findings. Only routine Doppler ultrasonography detected portal vein obstruction which was successfully treated by emergency operation.

Aged↗

Anomaly of the portal vein with an anomalous hepatic vein--the first case report.

An anomaly of the portal vein associated with an anomalous hepatic vein is described as the first reported case. A 44-year-old woman was incidentally found to have a huge hemangioma by ultrasonography. Computed tomography revealed an anomalous portal system with a normally located gallbladder and round ligament. Arterial portography revealed anomalous branching of the portal vein, with absence of the left umbilical portion, the curved right portal branch mimicked the right-sided umbilical portion. Hepatic venography demonstrated patent umbilical veins communicating with the left hepatic vein. Intraoperatively the hepatic vein branch was found on the surface of the right hepatic lobe and the common bile duct was dorsal to the hepatic artery. A limited excision of the involved liver was performed safely with the help of the preoperative definition of the abnormal liver anatomy.

Adult↗

Effective plasma concentrations of aprindine in canine ventricular arrhythmias.

Antiarrhythmic effects of aprindine were examined using three canine ventricular arrhythmia models (induced by digitalis, adrenaline, and two-stage coronary ligation), and the minimum effective plasma concentration of aprindine was determined for each arrhythmia model. Aprindine suppressed all three arrhythmias, and the minimum effective plasma concentrations for arrhythmias induced by digitalis, adrenaline, and 24-h and 48-h coronary ligation were 0.8 +/- 0.4, 1.0 +/- 0.4, 1.6 +/- 0.3, and 3.1 +/- 0.5 micrograms/ml, respectively (mean +/- SD, n = 6-7). The minimum effective plasma concentrations of aprindine for digitalis- and adrenaline-induced arrhythmias were significantly lower than those for coronary ligation-induced arrhythmias. Oral aprindine was also effective in suppressing both the 24- and 48-h coronary ligation-induced arrhythmias. Aprindine had a hypotensive effect when it was given intravenously, but this effect was not observed when it was given orally. The correlations between the aprindine plasma concentrations and the antiarrhythmic effects were not very strong and indicated individual variations in sensitivity to aprindine.

Animals↗

Biofeedback training for reduced respiratory rate in chronic obstructive pulmonary disease: a preliminary study.

The overall objective of this preliminary investigation was to determine whether breathing patterns of patients with chronic obstructive pulmonary disease could be altered by training patients to voluntarily change their breathing, using techniques of biofeedback training. The specific aims were (1) to develop a method of monitoring respiratory rate and tidal volume with a device that was both accurate and usable without discomfort or inconvenience to the patient; (2) to use the method with patients having chronic obstructive pulmonary disease to determine whether respiratory rate could be slowed by voluntary controls; and (3) to determine whether patients who could slow their breathing rate would increase their tidal volume and demonstrate other respiratory changes.

Biofeedback, Psychology↗

A clinicopathologic study of primary cholesterol hepatolithiasis.

BACKGROUND/AIMS: We conducted the present study in order to clarify the clinicopathologic features of primary cholesterol hepatolithiasis and compare them with those in primary calcium bilirubinate hepatolithiasis. MATERIALS AND METHODS: We reviewed the clinicopathologic features of 24 patients with primary cholesterol hepatolithiasis. The clinical symptoms were mild, and the median duration of symptoms was 5 years. RESULTS: In 22 patients complete stone clearance was obtained using percutaneous cholangioscopic lithotomy, partial hepatectomy, or their combination. The patients showed excellent clinical outcome (median follow-up period, 6 years) despite the absence of bilioenteric drainage. Stones have recurred in 4 patients, who remain asymptomatic. The histopathologic findings in 7 hepatectomized patients were compared with those in 7 patents with calcium bilirubinate hepatolithiasis. The inflammatory changes around the stone-containing duct, i.e., wall thickening, fibrosis, sludge formation, and glandular hyperplasia, were significantly milder in the cholesterol hepatolithiasis patients (p < 0.01 or p < 0.05). CONCLUSIONS: These clinical and histopathologic findings indicate that primary cholesterol hepatolithiasis should be regarded as a different clinical entity from calcium bilirubinate hepatolithiasis which has a close relationship with bile stasis and bacterial infection as etiological factors.

Adolescent↗

Case of bile duct carcinoma of the hepatic hilus with segmental obstructive cholangitis.

Cholangitis is a risk factor for posthepatectomy liver failure and therefore should be treated aggressively by urgent biliary drainage before definitive liver surgery for bile duct carcinoma. We present a case of bile duct carcinoma of the hepatic hilus with segmental cholangitis. The patient was a 38-year-old man. Percutaneous transhepatic biliary drainage (PTBD) was performed in the left anterior, right anterior, and right posterior segmental ducts to alleviate jaundice and to evaluate the biliary system. One month after PTBD, the patient developed high fever with leukocytosis, suggesting the onset of segmental cholangitis. An urgent repeat PTBD was carried out at the caudate and left medial segmental bile ducts. The bile juice was purulent, and the tube cholangiogram revealed miliary abscesses. After PTBD, cholangitis was subsided, and extended left hepatic lobectomy with caudate lobectomy was performed. The postoperative recovery was uneventful and the patient has been well for 13 months. We conclude that the onset of fever in patients with hilar bile duct cancer, PTBD catheters, and undrained biliary segments suggests the presence of segmental cholangitis.

Adult↗

Resection of metastatic liver cancer in a patient with an anomalous intrahepatic portal system: a case report.

Resection of metastatic liver cancer in a patient with an anomalous intrahepatic portal system is presented. A 67-year-old man was referred to our hospital with a liver tumor. Percutaneous transhepatic portography demonstrated that the right anterior branch of the portal vein rose from the left portal vein with agenesis of the umbilical portion. Cholangiography disclosed obstruction of the right posterior segmental bile duct by the tumor. Barium enema demonstrated a Borrmann type II cancer in the sigmoid colon. Right hepatic lobectomy and high anterior resection of the colon were performed, and postoperative histologic examination confirmed that the liver tumor was metastatic adenocarcinoma of the colon. The ligamentum teres arose from the right anterior portal vein and separated the left medial segment from the right anterior portal segment of the liver. These anomalies led to the performance of right lobectomy instead of trisegmentectomy and the patient died 10 months later of hepatic recurrence. This case emphasizes the importance of delineating the hepatic vascular anatomy before liver resection and illustrates one of the pitfalls related to portal venous anomalies.

Adenocarcinoma↗

Duodenal obstruction due to annular pancreas associated with pancreatic head carcinoma.

A patient with obstructive jaundice due to carcinoma of the pancreas head showed painless vomiting from the supra-papillary duodenal obstruction. Computed tomography demonstrated a space-occupying lesion in the head of the pancreas, which was not so large as to make an obstruction of the proximal portion of the duodenum. Pylorus preserving pancreatoduodenectomy was performed and the surgical specimen showed that the duodenal obstruction was caused by a swollen annular pancreas associated with obstructive pancreatitis by the carcinoma of the pancreas head. Duodenal obstruction is a rare symptom of annular pancreas in adults. It is thought to be necessary to remind of the coexistence of the annular pancreas, when patients with pancreatic or periampullary malignancies are complicated with unexpected obstruction of the second portion of the duodenum in proportion to the size.

Adenocarcinoma↗

Biliary cystadenocarcinoma resected by segment 3 and 4 hepatectomy.

We describe a case of biliary cystadenocarcinoma of the liver in a 72 year-old woman presented to our hospital with abdominal fullness. Laboratory data showed an elevation of alkaline phosphatase and a decreased excretion of Indocyanine green (ICG). CT revealed a cystic tumor with papillary projections, measuring 13A approximately 15cm, in the left medial segment of the liver (S4). Percutaneous transhepatic cholangioscopy (PTCS) disclosed the tumor in the dorsal subsegmental duct of S4 and the cholangioscopic biopsy from the tumor revealed papillary adenocarcinoma. PTCS showed the left lateral posterior segmental bile duct (B2) joined the common tract of the left medial (B4) and left lateral anterior (B3) segmental bile duct, and the tumor involved B4 and B3 but not the common tract of B4 and B3. A radical surgery, which included segment 4 and 3 resection with preservation of the left hepatic duct and the segment 2 was performed. The histopathological examination revealed that the tumor did not involve the liver parenchyma and had no lymph node metastasis. Postoperative course was unremarkable and the patient at present time, 4 years after the operation, is doing well. This case report discusses the importance of preoperative evaluation by PTCS for a rational surgical procedure.

Aged↗

Partial hepatectomy for metastatic seeding complicating pancreatoduodenectomy.

We present a case report of metastatic seeding at the percutaneous transhepatic biliary drainage tract in a 68 year-old man who previously underwent pancreatoduodenectomy with bile duct resection for distal bile ductal carcinoma. Three years and 5 months after the initial operation, dilation of the left lateral segmental bile ducts was detected by abdominal ultrasonography. Percutaneous transhepatic cholangiography disclosed a stricture at the confluence of the ventral and dorsal branches of the left lateral anterior segmental duct. This region corresponded to the punctured point of the previous percutaneous transhepatic biliary drainage. Implantation of the bile duct carcinoma at the percutaneous transhepatic biliary drainage sinus tract was diagnosed, and the recurrent tumor was successfully resected by an extended left hepatic lobectomy with a total caudate lobectomy. Currently, 8 years and 3 months after the second surgery, the patient is in good health without any signs of tumor recurrence. This case report discusses the entity of metastatic seeding, a rare but serious complication of percutaneous transhepatic biliary drainage. An aggressive surgical approach is important for recurrent biliary tract malignancies.

Adenocarcinoma↗

Multiple hepatic cysts along the intrahepatic bile duct--case report.

A case of multiple hepatic cysts of the periductal gland located along the left intrahepatic bile duct is described. Ultrasonography and computed tomography disclosed many cystic lesions along the left portal vein in the left lateral segment of the liver. Percutaneous transhepatic cholangiography showed many compressed lesions. The resected specimen revealed multiple cysts of 2-7mm in diameter along the intrahepatic bile duct. Microscopically, cysts within the large Glisson's capsule were intermixed with lobuli of the periductal glands, thus suggesting periductal gland origin. Histopathological features of these cysts were similar to those of "multiple hilar cysts" reported by Nakanuma, but lack of portal hypertension and underlying chronic liver disease is the significant characteristics in this case which is different from "multiple hilar cysts".

Aged↗