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K Chijiiwa

Publications and source records attributed to K Chijiiwa.

At least 73 records · Page 4Linked to original sources
PubMed1998

Significance of serum delta-bilirubin in patients with obstructive jaundice.

BACKGROUND: Delta-bilirubin is a bilirubin covalently bound with albumin, which is nontoxic and excreted neither in urine nor in bile. We previously reported that the percentage of delta-bilirubin increased after biliary drainage and that the rapidly excretable bilirubin fraction (total minus delta-bilirubin) was a better parameter to predict the effectiveness of biliary decompression in the dog model. The aim of the present study was to elucidate whether it is applicable to humans. MATERIALS AND METHODS: The serum bilirubin concentration was measured and its fractions were analyzed by high-performance liquid chromatography in 22 patients with obstructive jaundice before and after biliary drainage. In addition, the patients were subgrouped into good and poor drainage groups according to the decline index of serum bilirubin to examine the significance of delta-bilirubin. RESULTS: The concentration of total bilirubin decreased from 14.1 mg/dl before biliary drainage to 5.4 mg/dl 28 days after drainage. During this period, the percentage of conjugated bilirubin steeply declined from 47.1 to 8.8% and that of excretable bilirubin from 63.4 to 28.6%. In contrast, the proportion of serum delta-bilirubin increased from 36.6 to 71.4%. There was an inverse correlation between percentage of delta-bilirubin and total bilirubin concentration (r = -0.69, P < 0.01). In the good drainage group, the percentage of delta-bilirubin increased above 60% within 7 days after biliary drainage, but it did not reach 60% by 28 days in the poor drainage group. A decreasing rate of total bilirubin minus delta-bilirubin, the excretable bilirubin fraction, was a better index than that of total bilirubin to assess the efficacy of biliary drainage (P< 0.01). CONCLUSIONS: The increase in the percentage of serum delta-bilirubin indicates an effectiveness of biliary drainage in man. An analysis of serum delta-bilirubin for 7 days can distinguish the good drainage patients from the poor drainage patients.

Bilirubin↗
PubMed1998

Carcinoma of the pancreas associated with anomalous junction of pancreaticobiliary tracts: report of two cases and review of the literature.

We report two cases of carcinoma of the pancreas with anomalous junction of the pancreaticobiliary tracts. A 71-year-old Japanese woman had obstructive jaundice. Ultrasonography showed a hypoechoic mass in the pancreatic head and computed tomography demonstrated a low-density nodule in the pancreatic head. Endoscopic retrograde cholangiopancreatography displayed a double duct sign and an anomalous junction of the pancreaticobiliary tracts. The patient underwent a pancreatoduodenectomy. The histopathologic diagnosis of the resected specimen was adenocarcinoma of the pancreatic head. A 56-year-old Japanese man also developed obstructive jaundice. Ultrasonography and computed tomography showed a huge mass almost replacing the whole pancreas and involving the superior mesenteric artery, splenic artery, splenic vein, and portal vein. Multiple hepatic metastases and peritoneal dissemination were present. Endoscopic retrograde cholangiopancreatography demonstrated an anomalous junction of the pancreaticobiliary tracts. The patient died of hemorrhage from esophageal varices. We discuss the relationship between the anomalous junction of the pancreaticobiliary tracts and pancreatic carcinoma.

Adenocarcinoma↗
PubMed1998

Chronic asymptomatic pseudocyst with sludge aggregates masquerading as mucinous cystic neoplasm of the pancreas.

Pseudocyst of the pancreas is sometimes difficult to distinguish from mucinous cystic neoplasm of the pancreas. A 37-year-old asymptomatic Japanese man was diagnosed with hypertension. He had a 20-years history of habitual drinking of alcohol, but no history of pancreatitis or abdominal trauma. During examinations to ascertain the cause of hypertension, ultrasonography and computed tomography incidentally demonstrated a huge cyst in the head of the pancreas. Laboratory data were within normal limits, including serum levels of amylase, carcinoembryonic antigen, and carbohydrate antigen 19-9. Imaging studies showed a huge unilocular cyst, measuring 7 cm, in the head-to-body of the pancreas, and two small unilocular cysts, measuring 1.4 and 1.5 cm, in the tail and head of the pancreas, respectively. A mural nodule was suspected in the largest cyst. Endoscopic retrograde cholangiopancreatography demonstrated communication of the main pancreatic duct with the two small cysts in the head and tail of the pancreas but not with the huge cyst. There were no ductal changes suggesting chronic pancreatitis. Laparotomy was performed under the tentative diagnosis of potentially malignant mucinous cystic neoplasms of the pancreas. However, inflammatory adhesion was dense around the pancreas and the mural nodule suspected preoperatively was found to be sludge aggregates in a pseudocyst. The diagnosis of an intraoperative frozen section of the cyst wall was pseudocyst of the pancreas. Cystojejunostomy was performed. We report this case because the preoperative diagnosis was mucinous cystic neoplasm of the pancreas, but the diagnosis changed with careful intraoperative examinations, to pseudocyst of the pancreas. We discuss the differential diagnosis of the two conditions.

Adult↗
PubMed1998

A large inflammatory polyp of the gallbladder masquerading as gallbladder carcinoma.

An inflammatory polyp of the gallbladder is a rare variant of benign gallbladder polyp. Differentiation between an inflammatory polyp and polypoid gallbladder carcinoma is difficult when the polyp is more than 1 cm in diameter. We report a rare case of a large inflammatory polyp of the gallbladder masquerading as gallbladder carcinoma in a 37-year-old Japanese woman who was incidentally diagnosed with a large gallbladder polyp, measuring 1 cm in diameter, by ultrasonography. She was asymptomatic and physical examination was unremarkable. Abdominal ultrasonography and endoscopic ultrasonography revealed three polypoid lesions in the gallbladder. One lesion was an isoechoic polyp, measuring 15 x 8 mm, showing a nodular surface and located in the fundus of the gallbladder. The other two lesions were hyperechoic polyps, measuring 5 x 5 mm, in the body of the gallbladder. Computed tomography and magnetic resonance imaging revealed marked enhancement of the largest polypoid lesion by dynamic study, and no lymph node enlargement was noted. Endoscopic retrograde cholangiography revealed a 12 x 8 mm polyp with an irregular surface in the fundus of the gallbladder. Superselective angiography of the cystic artery revealed neovascularity and a tumor stain in the fundus of the gallbladder. Cholecystectomy with lymph node dissection was performed. Intraoperative frozen section diagnosis of the largest polyp was an inflammatory polyp of the gallbladder. The other two polyps were cholesterol polyps. Inflammatory polyp should be considered as a differential diagnosis of hypervascular gallbladder polyps that measure more than 1 cm in diameter.

Adult↗
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↗
PubMed1998

Duct-parenchymal ratio predicts exocrine pancreatic function after pancreatoduodenectomy and distal pancreatectomy.

BACKGROUND: The postoperative exocrine pancreatic function was compared between pancreatoduodenectomy and distal pancreatectomy, and we studied the relationship between the preoperative morphology of the pancreas expected to remain and pancreatic function after surgery. PATIENTS AND METHODS: In 27 patients who underwent pylorus-preserving pancreatoduodenectomy (PPPD group) and 12 who underwent distal pancreatectomy (DP group), the exocrine pancreatic function was assessed using the BT-PABA excretion test before surgery and short term after surgery (< or =2 months). Preoperative morphology of the pancreas at a presumed line of transection was also investigated on computed tomography. RESULTS: The mean urinary PABA excretion rate in the PPPD group decreased from 68.3% to 53.7% (P = 0.0029), whereas that in the DP group showed no significant change (70.7% versus 72.7%). The mean size of the main pancreatic duct at the presumed transection line in the PPPD group was significantly greater than that in the DP group (6.5 mm versus 2.6 mm, P = 0.0002). The mean parenchymal thickness of the pancreatic gland at the presumed transection line in the PPPD group was significantly smaller than that in the DP group (16.1 mm versus 18.6 mm, P = 0.04). The mean ratio of the pancreatic duct caliber to parenchymal thickness (duct-parenchymal ratio) in the PPPD group was significantly higher than that in the DP group (0.43 versus 0.14, P = 0.0004). There was a significant negative correlation between the postoperative PABA excretion rate and the duct-parenchymal ratio (P = 0.0057). CONCLUSIONS: The postoperative exocrine pancreatic function after PPPD and DP was significantly influenced by the morphology of the pancreas at the presumed transection line. It is important to evaluate the preoperative morphology of the presumably remaining pancreas, especially duct-parenchymal ratio, to predict the exocrine pancreatic function short term after pancreatectomy.

Adult↗
PubMed1998

Short-term and long-term pancreatic exocrine and endocrine functions after pancreatectomy.

Exocrine and endocrine functions of the pancreas were assessed in 44 Japanese patients who underwent pancreatic head resection. Functions were analyzed comparing levels before surgery, at a short-term follow-up (<2 months), and at a long-term follow-up (12-31 months). The N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) excretion test, fasting blood sugar (FBS) level, and oral glucose tolerance test (OGTT) were used to determine pancreatic function. The patients were divided into three groups according to the size of the main pancreatic duct: group 1, 15 patients with a normal sized duct (< or =3 mm); group 2, 20 with a moderately dilated duct (>3 mm, <10 mm); and group 3, 9 with a markedly dilated duct (> or =10 mm). The mean BT-PABA value (6-hr urinary PABA recovery rate) in group 1 showed no change during the postoperative period. In contrast, the BT-PABA values in groups 2 and 3 had dropped by the short-term follow-up and returned to the preoperative level by the long-term examination. FBS and 120-min OGTT levels were not different between the three groups preoperatively. Although these values showed no change in all the three groups at the short-term measurements, the FBS in group 3 and 120-min levels in all the three groups had increased at the long-term. These findings suggest that exocrine pancreatic function shows a short-term deterioration in patients with a dilated pancreatic duct but recovers to the preoperative level over the long term after pancreatic head resection. Endocrine insufficiency, however, may occur at a long-term point after surgery irrespective of the preoperative pancreatic ductal dilatation.

4-Aminobenzoic Acid↗
PubMed1998

Advantage of preoperative portal vein occlusion for hepatectomy that exceeds portal vein occluded lobes.

BACKGROUND: The purpose of our study was to examine the effect of preoperative portal vein (PV) occlusion on hepatic reserve function after extended hepatectomy that is an excision of areas beyond the PV occluded lobes. METHODS: Male Wistar rats were divided into three groups and underwent a two-stage operation: a PVL-hepatectomy group (ligation of the PV [PVL] of the left and median lobes followed by hepatectomy of the right lobes together with the PV occluded lobes), a sham-88% hepatectomy group (sham operation without PVL followed by hepatectomy corresponding to the lobes excised in the PVL-hepatectomy group), and a sham-67% hepatectomy group (sham operation followed by hepatectomy of the left and median lobes to approximate the volume excised in the PVL-hepatectomy group). In all subjects, hepatectomy was carried out 7 days after the PVL or sham operation. On days 0, 1, 2, and 3 after hepatectomy, liver weight, histologic elements, DNA synthesis rates, energy charge, adenine nucleotides, and lipoperoxide levels of the remaining liver were determined. RESULTS: In the sham-88% hepatectomy group, the volume of resected liver was 88.2% +/- 0.5%. In the PVL-hepatectomy group it was 69.1% +/- 0.8%, although anatomically identical lobes were excised. At the time of hepatectomy, DNA synthesis, hepatic concentrations of adenine nucleotides and lipoperoxide, and serum liver function tests showed similar results in all three groups. The survival rate 3 days after hepatectomy was significantly low (53%) in the sham-88% hepatectomy group, whereas it was 100% in the PVL-hepatectomy and sham-67% hepatectomy groups. The gain in liver weight per day was significantly lower in the sham-88% hepatectomy group than in the other two groups. The decline in hepatic energy charge after hepatectomy was less, with less activated DNA synthesis, in the PVL-hepatectomy group compared with the sham-88% hepatectomy and sham-67% hepatectomy groups. Lipoperoxide concentration in the PVL-hepatectomy group was significantly lower than that in the sham-88% hepatectomy and sham-67% hepatectomy groups. CONCLUSIONS: Preoperative PV occlusion not only increases the remaining liver volume but also is advantageous to hepatic reserve after hepatectomy that exceeds PV occluded lobes.

Adenine Nucleotides↗
PubMed1998

Adenosquamous carcinoma of the pancreas: report of two cases.

Adenosquamous carcinoma of the pancreas is a rare variant of pancreatic exocrine carcinoma. We herein report two patients with this entity. One patient was a 60-yr-old Japanese man complaining of a palpable mass, 5.5 cm in the greatest diameter, in the epigastrium. Serum CA 19-9 was increased (2010 U/ml). Ultrasonography and computed tomography showed a mass in the pancreatic tail with central necrosis and invading the posterior wall of the stomach. Angiography showed an encasement of the splenic artery and complete obstruction of the splenic vein. Distal pancreatectomy, splenectomy, and partial resection of the stomach were done. The patient died of uncontrolled bleeding from the duodenal ulcer four months after operation. The other patient was a 73-yr-old man who presented with jaundice. The CA 19-9 was also elevated (354.8 U/ml). Ultrasonography showed a pancreatic head mass of heterogeneous echogeneity and computed tomography demonstrated a cystic mass with an enhanced rim, indicating necrosis in the tumor center. Angiography showed a hypervascular mass in the head of the pancreas. Pylorus-preserving pancreatoduodenectomy was done, but the patient died of multiple liver metastases 10 months after the operation. From our experience with the two patients, the presence of central necrosis in an infiltrative huge pancreatic tumor seems to be suggestive of the diagnosis of adenosquamous carcinoma of the pancreas.

Aged↗
PubMed1998

Pleomorphic carcinoma of the pancreas: reappraisal of surgical resection.

Pleomorphic carcinoma is a rare variant of pancreatic exocrine carcinoma. The aim of this communication is to reappraise surgical resection of pleomorphic carcinoma of the pancreas. Clinicopathological findings of four Japanese patients with pleomorphic carcinoma of the pancreas were reviewed and compared with those of 24 Japanese patients with adenocarcinoma of the pancreas to clarify possible surgical implications of pleomorphic carcinoma. Of the four patients, three were female and one male, aged 64, 65, 66, and 74 yr, respectively. Two carcinomas were located in the head of the pancreas, one in the body, and the other in the tail. Ultrasonography demonstrated a well defined hypoechoic mass measuring 5-10 cm, with central necrotic area in all of the patients. Computed tomography showed a low density tumor with sharp margin and heterogeneous internal structure in all. On angiography, three tumors were hypervascular and another was hypovascular. Extensive vascular encasement was observed in all. Pancreatoduodenectomy was done in two patients and distal pancreatectomy in the other two. Multiple liver metastases occurred 1 month after surgical resection in two patients and local recurrence 1 month in one and 2 months in the other, leading to death either 2 (2 patients) or 3 months (2 patients) after pancreatectomy. Significantly differentiating features of the four pleomorphic carcinomas of the pancreas and the 24 adenocarcinomas of the pancreas were the mean diameter (6.6 +/- 1.3 cm vs 3.5 +/- 0.3 cm, p = 0.0007), margin of the tumor (expansive in the four pleomorphic carcinomas versus infiltrative in 21 of the 24 adenocarcinomas, p = 0.003) and vascularity on angiography (hypervascular in three of the four pleomorphic carcinomas versus hypovascular in 21 of the 23 adenocarcinomas, p = 0.013). The 1-yr and 3-yr survival rates of the four patients with pleomorphic carcinoma were 0% and 0%, whereas those of the 24 patients with adenocarcinoma of the pancreas were 42% and 13%, respectively (p < 0.0001). These findings suggest that the clinical course of patients with pleomorphic carcinoma of the pancreas is so poor even after surgical resection that pleomorphic carcinoma of the pancreas is not a candidate for pancreatectomy despite its locally expansive growth.

Adenocarcinoma↗
PubMed1998

Complex cystic duct is associated with cholelithiasis.

The relationship between complex cystic ducts and cholelithiasis has seldom been investigated quantitatively. Thus we attempted a retrospective survey on two case series with and without cholelithiasis in a university hospital. A total of 500 patients who underwent endoscopic retrograde cholangiography were reviewed, 250 of whom had cholelithiasis and another 250 no gallstones. They were sampled at random during the period from 1979 through 1993. Parameters including the length, inner diameter and configuration of the cystic duct, and the angle formed by the cystic duct, and the axis of the gallbladder were compared between the groups with or without cholelithiasis. The patients with gallstones has significantly (p < 0.001) longer and narrower cystic ducts (a mean of 48 mm and 4 mm in length and diameter, respectively) than did those without stones (a mean of 28 mm and 7 mm, respectively). Moreover, patients with gallstones showed a significantly (p < 0.001) more acute angle between the gallbladder and the cystic duct than those without (a mean angle of 84 degrees and 119 degrees respectively). The overall frequency of the disfigurements of the cystic duct was significantly higher in the group with gallstones (99%) than in the group without (29%). The results therefore suggested that complex cystic ducts are associated with cholelithiasis.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1998

Value of MR cholangiopancreatography in evaluating choledochal cysts.

OBJECTIVE: The aim of this retrospective study was to clarify whether MR cholangiopancreatography (MRCP) is a suitable replacement for ERCP in evaluation of the choledochal cyst. MATERIALS AND METHODS: Sixteen patients (six adult and 10 pediatric) with choledochal cysts underwent MRCP using a half-Fourier acquisition single-shot turbo spin-echo sequence. Extent of the cyst, defects within the biliary tree, and presence or absence of the anomalous junction of the pancreaticobiliary duct were evaluated. Findings were compared with those of ERCP. RESULTS: MRCP better defined the proximal biliary tree than did ERCP in two patients. Defects within the biliary tree were diagnosed correctly on MRCP in eight patients; however, two defects within the distal common bile duct were missed in pediatric patients. The presence of the anomalous junction of the pancreaticobiliary duct was revealed accurately by MRCP in all adult patients but was revealed accurately in only four of the 10 pediatric patients. CONCLUSION: MRCP appears to offer diagnostic information that is equivalent to that of ERCP for assessment of choledochal cysts in adults. In pediatric patients, MRCP should not replace ERCP; however, MRCP can play an important role as a noninvasive examination and should be considered a first-choice imaging technique for evaluation of choledochal cysts.

Adult↗
PubMed1998

Modulation of cholesterol metabolism affects tumor growth in hamsters.

To investigate the effects of cholesterol and cholesterol-lowering agents on cholesterol metabolism and tumor growth, 0.5% cholesterol, 2% cholestyramine, or 0.01% simvastatin was fed to hamsters with transplanted Simian virus40 transformed tumor cells. Tumor weight, tissue cholesterol and DNA concentrations, and HMG-CoA reductase activities were determined. Cholesterol or cholestyramine feeding did not affect the tumor growth, however, the tumor weight and DNA concentration were decreased and tumor HMG-CoA reductase activity was increased in the simvastatin group. In conclusion, simvastatin may inhibit the DNA synthesis and growth of the Simian virus40 transformed tumor cells possibly through the inhibition of cholesterol and isoprenoids synthesis in the hamster.

Animals↗
PubMed1998

Hepatolithiasis: outcome of cholangioscopic lithotomy and dilation of bile duct stricture.

BACKGROUND: Cholangioscopic lithotomy (CSL) for hepatolithiasis, a minimally invasive procedure, has a place in complicated or recurrent hepatolithiasis. CSL itself, however, carries inherent risk for recurrence. We analyzed follow-up data after CSL for primary or repeat hepatolithiasis to determine the frequency of recurrence. METHODS: This retrospective analysis includes 21 patients with hepatolithiasis admitted to the hospital from September 1992 to December 1995 who underwent CSL. Through a percutaneous biliary drainage route, cholangioscopy was inserted to remove calculi with basket forceps or electrohydraulic lithotripter. Stenotic ducts, defined as less than 2 mm in diameter, were dilated with silicone rubber stenting or a balloon dilator. RESULTS: Ten patients were treated for primary hepatolithiasis and 11 for repeat hepatolithiasis. Of the patients with primary hepatolithiasis, one died of complications and the other nine patients underwent complete lithotomy. Among 11 patients who had repeat hepatolithiasis, four had undergone hepatectomy for hepatolithiasis and two previous CSLs; 10 patients (91%) underwent complete lithotomy. During the follow-up, four (40%) of the 10 patients with biliary stenosis at the time of cholangioscopic treatment showed recurrent calculi, whereas all eight patients without stricture had uneventful courses. Of the 19 patients who underwent complete lithotomy, calculi recurred in four (21%), three cases of which recurred less than 1 year after CSL. CONCLUSIONS: Against hepatolithiasis of primary and postoperative repeat cases, CSL can allow complete lithotomy. The bile duct stricture, however, carries a high risk for recurrent calculi; hence, permanent relief of stricture is mandatory.

Adult↗