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Biomedical subjects

M Kayahara

Publications and source records attributed to M Kayahara.

At least 91 records · Page 5Linked to original sources

[Efficacy of early use of continuous isoproterenol inhalation therapy for severe asthma attacks in children].

The aim of this study was to evaluate the efficacy and safety of continuous isoproterenol inhalation therapy for asthma attacks in children. We used l-body isoproterenol (Proternol L) in 22 children with 32 episodes of severe attacks. One of them did not respond to this therapy, and two had complications (atelectasis and pneumothorax). Twenty-nine cases were divided into three subgroups according to their clinical scores; A) scores less than or equal to 4, which meant that they were in the early stage of severe attack (n = 9), B) scores 5-6, which meant impending respiratory failure (n = 17), C) scores greater than or equal to 7, which meant respiratory failure (n = 3). The values of SpO2 at the start of this therapy were 94.8, 91.5, 82.0%, respectively. The more severe their attacks were, the lower their SpO2 levels were. The periods until their scores became zero were 0.78, 6.3, 17.2 hours, respectively. There were significant differences between each period respectively (p less than 0.001, p less than 0.01). Heart rates decreased when their symptoms improved, and other adverse effects were not detected. These results suggest that this therapy is effective and safe for children with severe asthma attacks, especially in the early stage.

Administration, Inhalation↗

[Efficacy of continuous isoproterenol inhalation therapy for severe asthma attacks in younger children].

The aim of this study was to evaluate the efficacy of continuous isoproterenol inhalation therapy for severe asthma attacks in younger children, compared with its efficacy in older children. We used l-body isoproterenol (Proternol L) in 31 children with 42 episodes of severe attacks. They were divided into two group according to age: 20 cases under 6 years old (Group A), and 22 cases over 7 years old (Group B). All of the patients except for one in Group B, eventually improved with this therapy. Wood's clinical scores for Group A were significantly higher than those for group B (p < 0.01). In 22 cases whose scores were 5-6, their SpO2 values at the onset of this therapy were 90.8 +/- 3.17 in group A and 92.4 +/- 3.82% in group B. The improvement time of group A (13.6 +/- 16.2 hours) was significantly longer than that of group B (2.5 +/- 5.66, p < 0.01). The nebulized isoproternol doses for group A were 0.47 +/- 0.168 and for group B 0.26 +/- 0.096 mg/kg/saline 500 ml. The dose for group A was significantly higher than that for group B (p < 0.01). We concluded that continuous isoproterenol inhalation therapy was effective even in younger children. But the degree of efficacy was slightly lower in younger children, although they inhaled higher doses of isoproterenal than older children.

Administration, Inhalation↗

Longitudinal study of bronchial hyperreactivity in preschool children with bronchial asthma.

Forty asthmatic children aged 4 to 6 years performed histamine inhalation tests over 2 to 3 years. We used a previously reported method for examining bronchial hyperreactivity; measuring the transcutaneous oxygen pressure to evaluate whether bronchial hyperreactivity in younger children with bronchial asthma changed, and which potential factors affected changes in bronchial hyperreactivity. Although there was no significant relationship between the severity of asthma and respiratory threshold to histamine (RT-Hist) at the initial test, RT-Hist results in the severely asthmatic group were significantly lower than those of the remission and mild groups at the final test (P less than .01), respectively. RT-Hist significantly decreased in only the group whose asthma worsened (P less than .05). In the remission and improvement groups, RT-Hist did not improve despite their favorable clinical courses. When divided into two subgroups according to the extent of their RT-Hist, a high responder group had significantly more subjects who family histories of asthma than the low-responder group (P less than .05). There was no difference, however, in family history of allergic diseases between the two groups. We conclude that bronchial hyperreactivity in younger asthmatic children is influenced by multiple factors that may be congenital or acquired.

Administration, Inhalation↗

The results and problems of extensive radical surgery for carcinoma of the head of the pancreas.

Since 1973, 152 patients with pancreatic carcinoma have undergone surgery in our clinic, including 110 with carcinoma of the head of the pancreas. Of these 110 patients, resections were performed on 43 (39.1 per cent), 33 (30 per cent) of whom underwent a curative resection based on macroscopic evidence. Six of the patients who underwent macroscopic curative resection survived for five years, giving a five-year survival rate of 36.5 per cent by the Kaplan-Meier method after excepting 6 operative deaths. We compared the extent of pancreatic cancer by constructing survival curves according to the General Rules published by the Japan Pancreas Society. There was no statistical difference in survival based on tumor size or stage, however, there was a significant difference in the survival curves of so and se, being the absence or presence of the anterior capsule of the pancreas, rpo and rpe, being the absence or presence of invasion of the retroperitoneal tissue; ew(-) and ew(+) being the absence or presence of invasion at the surgical margin of resection, or n0 and n1 being the extent of lymph node metastasis. The results of this comparison suggest that extended radical pancreatectomy may be indicated for the treatment of pancreatic cancer as the standard radical operation for pancreatic cancer may miss tumors which have spread to the retroperitoneum and extrapancreatic nerve plexus.

Carcinoma↗

Histomorphological study on the minor duodenal papilla.

The morphological characteristics of the minor duodenal papilla were studied histologically using surgically resected specimens according to the presence or absence of an opening of the accessory pancreatic duct in 30 patients (22 with a ductal opening and 8 without such an opening) who had undergone pancreatoduodenectomy within the past 4 years. The following results were found: 1) The minor duodenal papilla was composed fundamentally of the accessory pancreatic duct, pancreatic tissue of the dorsal pancreas which penetrated the duodenal proper muscular tunics and the surrounding fibrous connective tissue. 2) In those specimens with a ductal opening, smooth muscle fiber bundles derived from the duodenal proper muscular tunics surrounded the accessory pancreatic duct and seemed to possess sphincter action similar to that of Oddi sphincter muscles. 3) In those specimens without a ductal opening, the accessory pancreatic duct terminated blindly in the minor duodenal papilla which was comprised mostly of pancreatic tissue and seemed to have no sphincter muscles. 4) Islet cells in the pancreatic tissue of the minor duodenal papilla were rich in B-cells which were round to ovoid in shape and sharply outlined.

Ampulla of Vater↗

Clinicopathological study of pancreatic carcinoma with particular reference to the invasion of the extrapancreatic neural plexus.

A clinicopathological study of 44 ductal carcinomas of the head of the pancreas revealed 39 with retroperitoneal invasion, of which 27 showed extrapancreatic plexus involvements. The second portion of the plexus pancreaticus capitalis was the most frequent site of invasion. A statistically significant correlation was found between neural invasion in the pancreatic tissue and plexus invasion, but no clear correlation was found between plexus invasion and lymphatic invasion or tumor size. Even small-sized tumors (t1) showed plexus invasion. The cases with plexus invasion had a statistically higher incidence of lymph-node involvement around the superior mesenteric artery than those without plexus invasion. These results indicate that complete dissection of extrapancreatic plexus around the superior mesenteric artery, including lymph nodes and soft tissue, could prolong the survival of patients with ductal carcinoma of the pancreas, even in cases of small-sized carcinomas.

Humans↗

Patterns of neural and plexus invasion of human pancreatic cancer and experimental cancer.

Specimens from four patients who underwent resection of cancer of the pancreatic head were examined histologically by serial sections to study the patterns of extrapancreatic nerve plexus invasion of cancer. To understand the mode of neural invasion and its specificity for pancreatic cancer, we also examined retropancreatically transplanted virus-induced rabbit papilloma (VX2) cells in six rabbits. Histological evaluation of the specimens from patients revealed neural invasion near the primary lesion, where cancer cells broke the perineurium and showed communication of cancer cells between the inside and outside of the perineurium. Tumor cells found distant from the primary cancer were confined to the perineurium, grew in a continuous pattern, and followed the branches of nerves. When the rabbit's VX2 cells were implanted into the retropancreatic region of recipient rabbits we also observed neural invasion. This study shows that neural invasion is a common, but not a specific, feature of pancreatic cancer, and it suggests that en bloc excision of the retropancreatic tissue, including fat tissue and the extrapancreatic nerve plexus, should be the basic procedure of radical surgery in the treatment of pancreatic cancer.

Animals↗

Surgical treatment of pancreatic cancer. The Japanese experience.

Since 1973, 194 patients with pancreatic carcinoma have undergone surgery in our clinic, including 134 with carcinoma of the head of the pancreas. Of these 134 patients, resections were performed on 61 (45.5%), 49 (36.6%) of whom underwent a curative resection based on macroscopic evidence. Seven of the patients who underwent macroscopic curative resection survived for five years, giving a five-year survival rate of 26.4% by the Kaplan-Meier method after excepting seven operative deaths. We compared the extent of pancreatic cancer by constructing survival curves according to the General Rules published by the Japan Pancreas Society. There was no statistical difference in survival based on tumor size or stage; however, there was a significant difference in the survival curves of so and se, being the absence or presence of the anterior capsule of the pancreas; rpo and rpe, being the absence or presence of invasion of the retroperitoneal tissue; ew(-) and ew(+), being the absence or presence of invasion at the surgical margin of resection; and n0 and n1, being the extent of lymph node metastasis. The results of this comparison suggest that extended radical pancreatectomy may be indicated for the treatment of pancreatic cancer, since the standard radical operation for pancreatic cancer may miss tumors that have spread to the retroperitoneum and extrapancreatic nerve plexus.

Adult↗

Acute pancreatitis associated with anomalous union of the pancreaticobiliary ductal system.

Between 1978 and 1989, 13 of 48 patients with anomalous union of the pancreaticobiliary ductal system (AUPBD) were diagnosed as having acute pancreatitis. We have studied the clinical, radiologic, and surgical features of these 13 patients. A transient rise in the intraductal pressure of the pancreatic duct during an episode of abdominal pain is responsible for pancreatitis in patients with AUPBD. This rise in the intraductal pressure must be due to bile reflux into the pancreatic duct when an abnormally long common channel is blocked by cholelithiasis, protein plug, or dysfunction of the sphincter of Oddi. The pancreatitis resolves when the common channel obstruction is removed, and bile and pancreatic juice flow easily into the duodenum. We believe that this phenomenon is responsible for acute relapsing pancreatitis. It is our belief that the pancreas appears almost normal during symptom-free intervals.

Acute Disease↗

Adenomatous hyperplasia of the bile duct epithelium of the canine liver, caused by bacterial infection.

Morphologic changes of the intrahepatic bile ducts after induction of bile stasis and bacterial infection of the biliary tract in two lobes of the liver in mongrel dogs were studied to examine the pathophysiology of hepatolithiasis. Three groups of dogs were prepared by cannulation of the bile duct branch draining the left lateral lobes of the liver and were treated as follows: in group 1 the cannula was clamped after injection of 10(7) Escherichia coli (aerobic bacteria) and 10(7) Bacteroides fragilis (anaerobic bacteria) organisms; in group 2 the cannula was clamped after injection of E. coli only; and in group 3 the cannula was clamped without injection of bacteria. Three months later the livers of killed dogs were examined. In group 1 epithelial adenomatous hyperplasia was noted in association with chronic cholangitis characterized by moderate to severe periductal fibrosis with a large number of inflammatory cells. In group 2 periductal fibrosis was severe, but epithelial hyperplasia was found to a much lesser degree than in group 1. In group 3 no periductal fibrosis or epithelial adenomatous hyperplasia was demonstrated. These findings suggest that adenomatous hyperplasia of the bile duct epithelium may be caused by bacterial infection of the biliary tract in combination with bile stasis.

Animals↗

[Immunochemical quantification of the airborne chironomid allergens].

We collected airborne particles in the air using a high-volume air sampler, and measured chironomid allergen in the air-filter extract by use of RAST inhibition assay. The results obtained were as follows: 1) The assay revealed the presence of chironomid allergen in the air varying from 6.8 to less than 0.3 ng/m3. 2) In Toyama, seasonal fluctuations of airborne chironomid allergen demonstrated some large peaks in summer (June to August), and showed a tendency to decrease in winter. 3) There were significant correlations between airborne chironomid allergen and dry weight of chironomid midges, collected by using light traps, in all period of a week just before, 1 to 2 weeks before, 2 to 3 weeks before, or 3 to 4 weeks before air sampling. There were not significant correlations between airborne chironomid allergen and weathers (temperature, wind speed and precipitation) during or just before air sampling. 4) In Toyama, the frequency of asthma attacks in the asthmatic children with positive C.p. RAST was much increased in summer compared with that of the negative, in which the amount of airborne chironomid allergen was increased. These results show that there is large amount of chironomid allergen in the air from spring to autumn, especially large in summer, and it is related for some asthmatics to the increase of the frequency of asthma attack.

Air Pollutants↗

Clinical experience of biliary tract carcinoma associated with anomalous union of the pancreaticobiliary ductal system.

Between 1978 and 1988, 15 patients with gallbladder cancer and 2 patients with bile duct cancer were seen among 49 patients with anomalous union of the pancreaticobiliary ductal system. Radiographic findings revealed two types of this anomalous condition: one in which the pancreatic duct entered the common bile duct (type 1) and one in which the common bile duct entered the pancreatic duct (type 2). In gallbladder cancer, the common bile duct presented no dilatation, or in some patients, mild dilatation, and type-1 anomalous union was frequently found among these patients. In contrast, the two patients with bile duct cancer had cystic dilatation of the common bile duct and type-2 anomalous union. The bile amylase level, which was determined in seven patients, was extremely high in all the patients. Histopathologically, the tumors in most patients showed papillary to papillo-tubular proliferation in the mucosal layer while atypical epithelial hyperplasia was noted in the vicinity of the tumor area. These findings suggest that this congenital anomaly in both ducts results in a loss of the normal sphincteric mechanism of the duodenal papilla, and that chronic relapsing cholecystitis or cholangitis, caused by the reflux of pancreatic juice into the biliary tract, can induced progressive changes to atypical epithelial hyperplasia which may develop into carcinoma.

Adult↗

[Nationwide intradermal test with chironomid midge extract in asthmatic children in Japan].

Chironomidea (Insecta) is recently considered one of the most common inhalant antigen in Japan. Intradermal tests with Chironomus plumosus (CP) extract were undertaken on seven hundred and eighteen asthmatic children aged from 6 to 15 years in 10 areas (11 medical institutions) in Japan. The number of cases who showed positive intradermal tests with CP extract was 200 (27.9%) and the positive rate increased in proportion to their age (p less than 0.005). In each of the 11 medical institutions the positive rates ranged from 12.6% in Akita to 45.5% in Okinawa. There were no significant correlations between the results of the intradermal test with CP and those of RAST, prick test and intradermal test with mite, HD and silk, whereas correlation was noted in the prick test with silk (p less than 0.01). The CP positive asthmatics had significantly more attacks than the CP negative ones in the summer (p less than 0.01). The positive rate of asthmatics living near paddy or farm fields was significantly higher than that of those in urban residential areas (31.3% vs 23.8%, p less than 0.05). Chironomid midge is one of the most common and important allergen in Japan.

Adolescent↗

The spread and prognosis of carcinoma in the region of the pancreatic head.

Tumor infiltration and prognosis were studied in 73 patients who underwent surgery for carcinoma in the region of the pancreatic head, in order to evaluate the grade of malignancy of pancreatic cancer. Twenty three patients had carcinoma of the head of the pancreas, 16 had carcinoma of the intrapancreatic bile duct and 34 had carcinoma of the papilla of Vater. It was found that the prognosis in carcinoma of the head of the pancreas was not related to tumor size, but to lymph node metastasis and the pancreatic capsular or perineural invasion of the tumor. The poorer prognosis seen in carcinoma of the head of the pancreas could be attributed to the fact that lymph node metastasis and invasion of the pancreatic capsule or nerve plexus occurred much more frequently in this carcinoma than in carcinoma of the other two areas. The 5-year survival rate of the patients with carcinoma of the head of the pancreas was 12.5 per cent, this being significantly lower than that of the patients with either carcinoma of the papilla of Vater (50.0 per cent) or carcinoma of the intrapancreatic bile duct (44.4 per cent). These findings suggest that lymph node metastasis and pancreatic capsular or perineural invasion closely correlate with the prognosis of patients with pancreatic carcinoma.

Ampulla of Vater↗

[Immunochemical quantification of the airborne mite allergens].

We collected airborne particle from indoor air by using a high-volume air sampler, and measured mite allergens in the air-filter extract by use of RAST inhibition assay. The results obtained were as follows: 1) The assay revealed the presence of house dust mite allergen in the indoor air varying from 690 to 129000 pg/m3. 2) In apartments, seasonal fluctuations of house dust mite allergen in the indoor air demonstrated a peak in autumn (September and October), and showed a tendency to increase in spring. In our outpatient clinic, the quantity of house dust mite allergen in the indoor air varied from 690 to 5670 pg/m3, while there were few mites on the floor, and showed a tendency to increase in winter. 3) There was a significant correlation between the quantity of house dust mite allergen in the indoor air and the number of mite in house dust (r = 0.535, p less than 0.01). 4) The amount of D.f. allergen in the indoor air was significantly decreased by using air cleaners (p less than 0.005). These results showed that the quantification of house dust mite allergen was useful from the clinical point of view as a parameter of mite pollution indoors, and it was important for asthmatics to live in clean environment, and to decrease the number of mites in house dust.

Allergens↗

Clinical experience of intrahepatic cholangiocarcinoma associated with hepatolithiasis.

Between 1960 and 1986, seven patients with intrahepatic cholangiocarcinoma and one patient with intrahepatic bile duct adenoma, related to hepatolithiasis, were seen among 112 cases of hepatolithiasis. Histopathologically, the tumors associated with hepatolithiasis arose from the periphery of the stone-containing bile duct, spread chiefly along the luminal surface, and invaded the ductal wall or periductal tissue. The tumors showed papillary to papillo-tubular proliferation and were diagnosed as the intraductal or periductal spreading type of cholangiocarcinoma. In addition, atypical epithelial hyperplasia was noted in the vicinity of the tumor area. These findings suggest that chronic relapsing cholangitis in patients with hepatolithiasis can induce progressive changes to atypical epithelial hyperplasia which may develop into cholangiocarcinoma.

Adenoma, Bile Duct↗

[Metabolic and nutritional management after extended radical operation for pancreatobiliary carcinoma].

The physiology after extended radical operation in patients with pancreatobiliary carcinomas and the metabolic and nutritional management were studied. Twenty-four patients who underwent pancreatoduodenectomy with extended dissection were compared with 17 patients with semi-extended dissection and 44 patients with limited or no dissection. Extended dissection meant complete dissection of the nerve plexus around the superior mesenteric artery and para-aortic node dissection. The frequency of defecation (2.7 times/day) and the blood osmolarity in the extended dissection group were significantly higher than those in the other groups during the first week after operation. The level of serum protein was significantly lower in the extended dissection group. Insulin dosage during the first 14 days after surgery was significantly greater in the extended dissection group, yet no difference was recognized in the amount of glucose administered among the 3 groups. The conclusion was as follows; frequent diarrhea, a large amount of lymph loss and increased urine volume due to an osmotic diuresis were the main causes of volume loss. So a large volume of fluid containing a high concentration of protein should be injected immediately after extended dissection to normalize serum osmotic pressure. Because of increased insulin requirement and decreased endogenous insulin production, the administration of large amount of glucose immediately after operation should be undertaken carefully.

Biliary Tract Neoplasms↗