Biomedical subjects

M Hashizume

Publications and source records attributed to M Hashizume.

At least 217 records · Page 12Linked to original sources

PubMedDate not supplied

Over-tube is preferable to free-hand technique to avoid recurrence of varices after endoscopic injection sclerotherapy. Prospective randomized trial.

One hundred and two patients undergoing sclerotherapy of esophageal varices, using 5% ethanolamine oleate, were randomly allocated to either the over-tube (O-T) or the free-hand (F-H) group, and 100 patients could be followed at monthly intervals for a period of 30.8 +/- 14.7 months (mean +/- SD) after the varices had been eradicated. Endoscopy performed one month after the final session of sclerotherapy revealed circumferential ulcers and scarring in the lower esophagus in 42 of 50 patients (84%) in the O-T group and in 16 of 50 patients (32%) of the F-H group, the difference being statistically significant (P less than 0.01). In the remaining 8 and 34 patients in the O-T and the F-H groups, respectively, a partly fibrotic residual mucosa was seen. There was a recurrence of the varices in the residual mucosa in 14 (28%) in the F-H group during the mean follow-up period of 25.6 months, while there were five patients (10%) with a recurrence of varices in the O-T group, the difference being statistically significant (P less than 0.05). The survival rates showed no statistical significance. Two patients in the F-H group had recurrent bleeding. We conclude that the over-tube technique of sclerosing esophageal varices reduces the rate of recurrence of the varices, in the long term follow-up, and after formation of a circumferential scarring in the lower esophagus.

Esophageal and Gastric Varices↗

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The nature of inner cellular lining of the expanded polytetrafluoroethylene vascular graft: immunohistochemical study.

Histological and immunohistochemical studies of the healing processes of expanded polytetrafluoroethylene (PTFE) vascular graft were performed. In the animal experiment, endothelial cell lining, confirmed by immunohistochemical staining for anti-Factor VIII related antigen, existed nearly over all of the pannus. The endothelial cells also formed to some extent over the graft without pannus. Endothelialization showed a close dependency on the surface condition of the underlying tissue rather than on a time factor. In the human experiment, an endothelial island was observed in the middle portion of the graft in one case, supporting the hypothesis of the blood stream origin of endothelial cells.

Aged↗

PubMedDate not supplied

Successful treatment of Budd-Chiari syndrome with early gastric cancer.

In a patient with Budd-Chiari syndrome associated with early gastric cancer, the membranous obstruction of the inferior vena cava was removed by Percutaneus Transluminal Angioplasty (PTA) without any complication. Due to continuous poor clinical status and hepato-renal dysfunction, her early cancer stomach lesion was treated with Nd: YAG laser. In follow-up biopsies, malignant change became evident three months after laser therapy. By that time hepatorenal function gradually improved, and a partial gastrectomy was performed successfully. PTA is a safe and effective procedure for clinical management of Budd-Chiari syndrome, and when there is concomitant early stage malignancy, PTA followed by laser therapy paves the way for major surgery.

Adenocarcinoma, Mucinous↗

PubMedDate not supplied

Gastric bleeding after endoscopic injection sclerotherapy for esophageal varices may be fatal.

Among 457 Japanese cirrhotic patients with esophageal varices, 28 (6%) bled from the upper gastrointestinal tract after the initial session of endoscopic injection sclerotherapy (EIS); 13 bled during the course of repeated EIS and 15 bled mainly from gastric lesions after eradication of the varices. Of these 28 patients, bleeding from gastritis occurred in 13 (46%), from esophageal varices in 10 (36%), from gastric varices in 4 (14%) and from gastric ulcer in one (4%). Six of 13 patients with gastritis-related bleeding and 3 of 4 patients with gastric variceal bleeding died of uncontrollable hemorrhage complicated liver failure, while 9 of 10 patients with esophageal variceal bleeding were controlled and reinjection was feasible. Ten (36%) of the 28 patients, with Child's grade B or C and severe ascites, died, mainly following bleeding from gastric lesions. This study shows that bleeding from gastric lesions after EIS can be uncontrollable and fatal in patients with poor liver function.

Esophageal and Gastric Varices↗

PubMedDate not supplied

Sclerotherapy superior to surgery for longer survival and less rebleeding in 103 cirrhotics with variceal bleeding.

In the ten years period from 1976-1986, 103 cirrhotic Japanese with acute variceal bleeding underwent either surgical treatment (48) or endoscopic injection sclerotherapy (55) at Kyushu University Hospital. We retrospectively analysed the clinical records of these patients. The two groups were comparable with regard to clinical condition and liver function, except for the higher rate of Child's C patients in the sclerotherapy group than in the surgical group (29 vs. 16; P less than 0.05). Control of variceal bleeding was attained in all of the 48 surgical patients and in 54 (98.2%) of the 55 sclerotherapy patients. Bleeding recurred in five (10.4%) of the surgical group and in one (1.8%) of the sclerotherapy group, resulting in four and one deaths, respectively, during the hospital stay. Mortality rates at 30 days and six months were 16.7% (8/48), 43.8% (21/48) in the surgical group, and 9.1% (5/55), 14.5% (8/55) in the sclerotherapy group. The five-year cumulative survival rate was significantly higher (P less than 0.01) in the sclerotherapy group (53.3%) than in the surgical group (29.4%). Therefore, in our patients sclerotherapy led to a longer survival with fewer rebleedings, as compared to other patients who underwent conventional surgical treatment.

Esophageal and Gastric Varices↗

PubMedDate not supplied

Role of endotoxin in L-arginine-induced relaxation of rat thoracic aorta mediated by muscle-derived nitric oxide.

The contribution of endotoxin to the L-arginine-induced relaxation of the endothelium-denuded rat thoracic aorta, which appears to be mediated by nitric oxide synthase in the vascular smooth muscle, was investigated. Special attention was paid to the time course of the phenomenon and its dependence on the concentration of endotoxin. In the absence of endotoxin, L-arginine induced scarcely any relaxation of the arteries. Treatment of the arteries with endotoxin initiated relaxation in response to 10 microM L-arginine with lag periods of 2-4 hours. The degree of relaxation increased on repeated applications of L-arginine, to reach a consistent level after several hours. Increase in the concentration of endotoxin shortened the lag period, enhanced the degree of relaxation and lowered the threshold concentration of L-arginine required to relax the arteries. In endotoxin-primed arteries, L-arginine, at concentrations necessary to induce relaxation, stimulated the cyclic GMP production. Prophylactic application of actinomycin D or dexamethasone, which inhibits the induction of nitric oxide synthase, prevented the induction by endotoxin of the L-arginine-induced relaxation and cyclic GMP formation. Polymyxin B, which inhibits the action of endotoxin, also prevented the development of the endotoxin-sensitized relaxation and the cyclic GMP formation induced by L-arginine. When the Krebs solution was prepared using deionized water, the amount of endotoxin in the reservoir was above the level required to initiate the L-arginine-induced relaxation and cyclic GMP formation. These results suggest that endotoxin triggered the time-dependent development of the L-arginine-induced relaxation by expressing nitric oxide synthase in the vascular smooth muscle.

Amino Acid Oxidoreductases↗

PubMedDate not supplied

Sclerotherapy-resistant esophageal varices with enormously enlarged cephalad collateral vessels predictable using portography.

BACKGROUND/AIMS: The most common cause of failure of sclerotherapy is recurrent bleeding before eradication is complete. We investigated factors which would make feasible prediction of cases where esophageal varices would be more difficult to eradicate. PATIENTS AND METHODS: Seven hundred and seventy patients underwent endoscopic injection sclerotherapy at Kyushu University Hospital from January, 1982 to June, 1989. For 580 of these patients we used the same sclerosant and a transparent overtube. For 19 of 580 patients over two months were needed to eradicate the varices (group 2), while eradication was complete in less than one month in 64 patients (group 1). RESULTS: There was a tendency toward a lower platelet count and a higher indocyanine green retention rate in group 2, but with no statistically significant difference. The number of sessions required for eradication of the varices was 8.1 +/- 2.5 and the total volume of sclerosant used was 98.2 +/- 62.3 ml in group 2, and 3.0 and 47.0 +/- 10.9 ml, respectively, in group 1 (p < 0.01). There was no significant difference in the number of sessions between the patients with large-sized and moderate-sized varices. Based on the extent of cephalad collateral vessels on the venous phase of celiac or superior mesenteric angiography, the vascular pattern could be classified into three types; Grade III, the most developed type was present in 100% and 57.1% on celiac and superior mesenteric angiography in group 2, while the rates were 11.1% and 5.6% in group 1 (p < 0.05). CONCLUSIONS: This retrospective study shows that in patients with enormously enlarged cephalad collateral vessels it may be difficult to eradicate the varices, and in such cases, preoperative portography is most useful to predict whether or not esophageal varices can be eradicated.

Collateral Circulation↗

PubMedDate not supplied

The treatment of gastric varices by a balloon-occluded retrograde transvenous obliteration; a transjugular venous approach.

Two Japanese women with a solitary gastric varix were successfully and easily treated by obliterating the gastro-renal shunt with a balloon catheter in a transjugular venous approach without any major complications. The transjugular obliteration was thus found to be a bloodless and useful method for the treatment of a solitary gastric varix with a gastro-renal shunt.

Adult↗

PubMedDate not supplied

Hemodynamic analysis of findings in patients with portal hypertension: multicenter analysis in Japan. Japan Portal Hypertension Study Group.

BACKGROUND/AIMS: A multicenter study was done to assess the pathophysiology of malcirculation with portal hypertension. PATIENTS AND METHODS: Patients were admitted to 48 different institutes from 1990 to 1992. RESULTS: Portal venous pressure was 345.9 +/- 72.1 mmH2O in patients with portal hypertension. In patients with liver cirrhosis, the diameter of the splenic artery, of the proper hepatic artery, of the left gastric artery and of the splenic vein was significantly larger (p<0.05) than seen in the controls without portal hypertension. In patients with idiopathic portal hypertension, the diameter of the splenic artery and of the vein was significantly larger (p<0.05) and that of the proper hepatic artery was significantly smaller (p<0.05) than seen in the cirrhotic patients. In the cirrhotic patients, blood flow volume was significantly larger (p<0.05) in the splenic vein. In patient with idiopathic portal hypertension, blood flow volume in the portal vein and splenic vein were significantly larger (p<0.05) and that of superior mesenteric vein showed an increasing tendency to enlarge. CONCLUSION: This study shows that a hyperdynamic state is present in patient with portal hypertension.

Case-Control Studies↗

PubMedDate not supplied

Development of early squamous cell carcinoma of the esophagus after endoscopic injection sclerotherapy for esophageal varices.

A 56-year-old Japanese man with liver cirrhosis was admitted to Kyushu University Hospital in September, 1986 for the treatment of large esophageal varices. Endoscopy revealed four tortuous folds of large esophageal varices, extending proximally from the esophagocardial junction to 34 cm from the dental arch. Endoscopic injection sclerotherapy was performed on the lower esophagus using 5% ethanolamine oleate, and esophageal varices were completely eradicated in 5 sessions with a total of 70 ml of sclerosant. In March 1991, 4 years and 6 months after the treatment, endoscopy revealed a mild redness and an irregular surface 33 cm from the dental arch. The histologic diagnosis was squamous cell carcinoma. The possible relationship between sclerotherapy and the development of esophageal carcinoma should be considered.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

A safe technique for laparoscopic cholecystectomy for incarcerated gallbladder stone.

BACKGROUND/AIMS: We present our new laparoscopic technique for treating incarcerated stones in either the cystic duct or the neck of the gallbladder. PATIENTS AND METHODS: One hundred sixteen patients who underwent laparoscopic cholecystectomy were studied. RESULTS: In all, 18 patients (16%) were found to have incarcerated stones in gallbladder or cystic duct. Eleven patients were drip infusion cholangiography (DIC) negative. The length of the operative time for these patients was significantly longer than that in non-incarcerated stone cases. We present our new laparoscopic technique for treating incarcerated stones in either the cystic duct or neck of the gallbladder and this procedure includes a needle aspiration of the bile juice, the transsection and removal of the incarcerated stone and an extracorporeal ligation. CONCLUSIONS: This above procedure was successfully performed on a series of 4 patients. Our procedure is therefore considered to allow us to complete a laparoscopic cholecystectomy even in extremely hypertrophic cases with incarcerated stones either in the cystic duct or Hartmann's pouch.

Adult↗

PubMedDate not supplied

Clinical and angiographic assessments and treatment of patients with recurrent varices after transabdominal transection of the esophagus.

BACKGROUND/AIMS: Risk factors regarding the recurrence of esophageal varices and were researched preoperative clinical and angiographic findings in patients with variceal recurrence and/or rebleeding after transabdominal esophageal transection were analyzed. MATERIALS AND METHODS: Clinical and angiographic assessments of recurrence of varices after transabdominal esophageal transection were made on 55 patients with portal hypertension. In all these patients, postoperative endoscopy was performed at 3-6 monthly intervals. RESULTS: Varices recurred in 13 patients and 4 patients re-bled during the 5-106 month follow up. There was a significant increase in the rate of recurrence in patients with a history of hematemesis, and in those with a higher grade of development of cephalad collateral vessels in the lesser splanchnic area, as seen on the preoperative portography. Eight of the 13 patients were then effectively treated by endoscopic injection sclerotherapy. CONCLUSIONS: Despite transabdominal transection of the esophagus, varices may well recur if the patient has had a history of hematemesis and a higher grade of development of cephalad collateral vessels. In such cases endoscopic injection sclerotherapy should be done.

Adult↗

PubMedDate not supplied

Eradication of large gastric varices by sclerotherapy combined with percutaneous transhepatic obliteration.

BACKGROUND/AIMS: The long-term results of a combination therapy of sclerotherapy with percutaneous transhepatic obliteration (PTO) was reviewed in 37 patients with large gastric varices. The study suggests that sclerotherapy combined with PTO can safely and effectively eradicate large gastric varices as an alternative approach to surgery. Complete eradication has also been shown to prevent the recurrence of gastric varices. MATERIAL AND METHODS: The long-term results of a combination therapy of sclerotherapy with PTO was reviewed in 37 patients with large gastric varices. RESULTS: Complete eradication of the gastric varices was obtained in 26 patients (70.3%). There was no recurrence of the varices in whom complete eradication had been obtained, but in 11 patients with incomplete eradication gastric varices recurred during the mean follow-up period of 37.5 months. Bleeding occurred in 4 after the treatment and one patient died of massive bleeding from the recurrent gastric varices. There were no major complications with the procedure except for one who had a peripheral pulmonary arterial embolization as a result of a steel coil used for the PTO. CONCLUSION: This study suggests that sclerotherapy combined with PTO can effectively and safely eradicate large gastric varices and is an alternative approach to surgery for treating patients with gastric varices. It is also shown that complete eradication leads to a prevention of recurrence of gastric varices.

Adult↗

PubMedDate not supplied

Laparoscopic repair of a paraesophageal hiatal hernia with gastric volvulus.

We report the case of a massive paraesophageal hiatal hernia with gastric volvulus which presented with the symptom of a precordial sense of pressure for over two years, which was successfully treated with laparoscopic surgery. The patient is presently in good condition, without any recurrence of either the hiatal hernia or other symptoms one year after surgery. This approach is considered to be a safe and effective procedure, and it also provides for rapid recovery from the operation.

Aged↗

PubMedDate not supplied

Jejunal variceal bleeding after esophageal transection in a patient with idiopathic portal hypertension.

This report describes a 38-year-old man with massive gastrointestinal bleeding from jejunal varices. He had been previously diagnosed to have idiopathic portal hypertension and esophageal varices, and had undergone an esophageal transection 8 years earlier. The pre-operative diagnosis was a suspected hemorrhage from the small intestine as visualized by 99mTc-HSAD scintigraphy (technetium 99m-labeled human serum albumin D-type) and was not considered to be repeated massive lower GI tract bleeding. An exploratory laparotomy was performed, and intra-operative endoscopy revealed active bleeding from the jejunal varices. A partial resection of the small intestine resulted in a complete resolution of the bleeding. A review of the literature thereafter disclosed twelve previously reported cases of jejunal variceal bleeding.

Adult↗

PubMedDate not supplied

Laparoscopic splenectomy with the newly devised morcellator.

BACKGROUND/AIMS: One of the major hurdles to overcome in the development of laparoscopic surgery has been finding effective extraction techniques for the removal of large tissue masses. The electromechanical morcellator makes it easy to remove relatively large sections of tissue from the abdomen through the existing incisions. To determine the safety and efficacy of the new morcellator in laparoscopic splenectomy, our preliminary experiences using the morcellator were reviewed and retrospectively compared with the results in patients who previously underwent conventional extraction techniques. METHODOLOGY: From February 1992 to March 1996, 31 patients underwent laparoscopic splenectomy. In the last eight patients, the new morcellator was used to remove the spleen, while in the remaining 23 patients, a laparoscopic splenectomy was performed using the conventional extraction techniques. RESULTS: In the last eight patients who underwent laparoscopic splenectomy, the newly devised morcellator was successfully used without any complications. The spleen could be removed from the abdominal cavity in an average of 15.9 +/- 10.4 minutes using the morcellator, while the average was 45.7 +/- 15.4 minutes using conventional techniques. It was not necessary to extend the skin incision in patients with the morcellator, while, on the other hand, a 2-cm extension of the existing skin incision was always required to remove the spleen in the latter method. CONCLUSION: The morcellator was found to be an effective device which can safely, efficiently and rapidly remove tissue masses. This procedure is therefore considered to be one feasible way to solve the age-old problem of intracorporeal morcellation.

Equipment Design↗

PubMedDate not supplied

Giant gastric varices after a left gastric venous caval shunt operation for esophageal varices: a case report.

A Japanese woman, who had undergone a left gastric venous caval shunt operation for esophageal varices 17 years earlier, was admitted to our hospital because of bleeding from giant gastric varices. An angiographic examination revealed a stealing of the portal blood flow to the inferior vena cava through both a dilated right gastroepiploic vein and a right gastric vein via the left gastric venous caval shunt. The gastric varices disappeared after obliterating both the feeding and drainage vessels by means of intervention radiology. We thus, consider the occlusion of both the afferent and efferent vessels to be an effective treatment for gastric varices.

Adult↗

PubMedDate not supplied

Laparoscopic splenectomy for an inflammatory pseudotumor of the spleen: operative technique and case report.

The case of a primary inflammatory pseudotumor of the spleen in a 44 year-old female is herein reported. This lesion is extremely rare, with only 33 cases previously reported. The splenic tumor was preoperatively diagnosed as a hemangioma by the combined modalities of ultrasonography, computed tomography and magnetic resonance imaging. A laparoscopic splenectomy was, thus, performed in order to make a final diagnosis. Pathological examination of the mass revealed an inflammatory process. Based on the above findings, a laparoscopic splenectomy is recommended when the tumor is suspected to be benign.

Adult↗