Biomedical subjects

M Kayahara

Publications and source records attributed to M Kayahara.

102 records · Page 6Linked to original sources

PubMed1987

[A long-surviving case of gastric cancer with liver metastasis without signs of recurrence for six years after palliative operation].

A 51-year-old man was admitted because of Borrmann 2 type gastric cancer located in the antrum. Since he had bilateral liver metastasis, palliative gastrectomy and liver biopsy was performed. Histopathologically, the primary cancer showed poorly differentiated adenocarcinoma and the liver biopsy showed the same. This patient has been alive without sign of recurrence for more than six years after he was given 40 mg of MMC, 12.5 KE of Picibanil and 528 g of PSK postoperatively. In addition, eight similar cases, with a survival rate of more than 5 years after resection of liver metastasis, have been reported in Japan and are reviewed.

Adenocarcinoma↗

PubMedDate not supplied

Obstructive jaundice caused by lymphangitis carcinomatosa of bile duct wall from gastric carcinoma.

We report a case of advanced gastric carcinoma presenting with obstructive jaundice. Computed tomography showed marked lymphadenopathy in the hepatoduodenal ligament and concentric bile duct wall thickening. Histologically, extrahepatic bile duct wall was thickened due to submucosal lymphangitic spread of gastric carcinoma (lymphangitis carcinomatosa). Lymphangitis carcinomatosa may be considered when extrahepatic bile duct wall thickening is seen in patients with obstructive jaundice.

Adenocarcinoma↗

PubMedDate not supplied

Anomalous pancreaticobiliary ductal junction without bile duct dilatation in gallbladder cancer.

BACKGROUND/AIMS: Anomalous pancreaticobiliary junction is a rare anomaly but is a risk factor for primary carcinoma of the gallbladder. To define the relationship between anomalous pancreaticobiliary junction, especially if it is not associated with common bile duct dilatation, and gallbladder carcinoma, we retrospectively reviewed data of 126 patients with gallbladder carcinoma. METHODOLOGY: All these patients had undergone direct cholangiography either by endoscopic retrograde cholangiopancreaticography or percutaneous transhepatic cholangiography. RESULTS: Among 126 patients with gallbladder cancer, 23 patients (18.3%) exhibited anomalous pancreaticobiliary junction. Patients with anomalous pancreaticobiliary junction were younger (mean age: 54 +/- 9.1 years) than patients without anomalous pancreaticobiliary junction (mean age: 65 +/- 9.7 years). The incidence of gallstones in patients with anomalous pancreaticobiliary junction (17%) was significantly lower than in those without this anomaly (64%) (P < 0.01). Among the 23 patients with anomalous pancreaticobiliary junction, 12 patients (52%) had no bile duct dilatation and, 11 patients (48%) had bile duct dilatation in the form of fusiform or cylindrical dilatation. However, no cases with severe cystic dilatation were found. Patients of anomalous pancreaticobiliary junction without common bile duct dilatation had more advanced disease and poor prognosis than those with common bile duct dilatation. CONCLUSIONS: The present study revealed that gallbladder cancer in the patients of anomalous pancreaticobiliary junction without common bile duct dilatation was diagnosed at advanced stage and the prognosis was very poor. Therefore, if a minor abnormality is detected in the wall of acalculous gallbladder on ultrasonography, direct cholangiography should be done to exclude this anomaly.

Adult↗

PubMedDate not supplied

The mode of lymphatic and local spread of pancreatic carcinomas less than 4.0 cm in size.

To clarify the mode of lymphatic and local spread of small pancreatic carcinomas, we studied the histopathology of 33 patients with invasive ductal adenocarcinoma of the head of the pancreas less than 4 cm in diameter. Microscopically, lymph node metastases were found in 72.7% (24 of 33) of the patients: 17 patients had lymph node metastases at the first barrier and 7 patients had lymph node metastases at the second barrier. Capsular invasion was present in 21.2% (7 of 33) patients, retroperitoneal invasion in 84.8% (28 of 33) patients. Invasion to the common hepatic artery was identified in 9.1% (3 of 33) patients, and invasion to the portal vein system in 24.2% (8 of 33) patients. In addition, five of the seven patients with lymph node metastases at the second barrier had spread to the periaortic lymph nodes. Thus, even patients with small pancreatic cancers which were macroscopically confined to the pancreas showed microscopic extrapancreatic tumor extension, especially invasion to the retroperitoneal tissues and to the periaortic lymph nodes. This suggests that an aggressive surgical approach, including complete resection of surrounding connective tissues in the retroperitoneum and extensive lymph node dissection, is necessary to improve the surgical therapeutic results even for small pancreatic cancers.

Adult↗

PubMedDate not supplied

Intrabiliary pressure measurement by duodenal pressure loading for the evaluation of duodenal parapapillary diverticulum.

BACKGROUND/AIMS: We report a method of intrabiliary pressure measurement by duodenal pressure loading for evaluating the effects of duodenal parapapillary diverticulum. MATERIAL AND METHODS: Forty-eight patients with primary choledocholithiasis were investigated based on usual intrabiliary pressure measurement developed at our department. RESULTS: Ten of these patients with parapapillary diverticulum showed higher intrabiliary residual pressure (P) and biliary resistance (R) values than the remaining patients without diverticulum, but the difference were not significant. There were no significant differences in the frequency of patterns of the B zone angulation of the pressure curve between the two groups with and without parapapillary diverticulum. Intrabiliary pressure was measured while maintaining a manometer pressure of 250 mm H2O by infusing or aspirating physiologic saline. CONCLUSION: From the results of this measurement for 6 patients, when P and R values show increases of 50 mm H2O or more and 3.5 units or more, respectively, additional surgery for parapapillary diverticulum was considered to be indicated.

Biliary Tract↗

PubMedDate not supplied

Assessment of postoperative digestive function after pancreatico-duodenectomy: a comparison of reconstruction techniques.

BACKGROUND/AIMS: Malabsorption is a frequent complication following pancreatico-duodenectomy (PD) for pancreatic carcinoma. Gastrojejunostomy followed by Billroth I type of reconstruction (PD III) has been advanced to prevent this disorder. We compared postoperative digestion and absorption determined by 131I-triolein, D-xylose and pancreatic function diagnostant (PFD) after extensive PD followed by one of two reconstructive procedures. MATERIAL AND METHODS: Postoperative digestive and absorptive functions in patients operated by Child's method (PD II) were compared with patients in whom the stomach emptied proximal to the pancreas and bile duct (PD III). RESULTS: The absorption of D-xylose was significantly higher (1.24 +/- 0.36 g vs. 0.72 +/- 0.21 g) in the PD III group. No difference was noted in pancreatic endocrine secretion between the two groups. Biliary scintigraphy revealed increased bile secretion in the PD III group. CONCLUSIONS: These results suggest that PD III is superior to PD II following extensive PD.

Anastomosis, Surgical↗

PubMedDate not supplied

A new technique for variable-load cholangiomanometry. Implication for biliary tract surgery.

BACKGROUND/AIMS: Variable-load cholangiomanometry was performed to obtain data on terminal biliary function during the surgical treatment of cholelithiasis. The decision of whether or not to perform a definitive biliary drainage procedure was based on the results of this test. MATERIAL AND METHODS: The rate of perfusion was reduced in four steps from 15.3 ml/min to 1.2 ml/min, and the resultant perfusion pressures were plotted. The gradient produced by the straight line was considered the resistance, R. The baseline pressure without perfusion was regarded as the static pressure, P. RESULTS: A review of 444 patients with cholelithiasis who underwent intraoperative cholangiomanometry during the past 11 years led to the following indications for definitive biliary drainage: (1) R > 10 units and P > 200 mm H2O, (2) if only R or P is elevated, priority is given to R, and (3) if the elevation of R or P is borderline, the presence of a type I curvature in the segment of low flow rate is an indication for surgery. CONCLUSION: By performing an intraoperative cholangiomanometry concrete indications for a biliary drainage procedure can be defined.

Cholelithiasis↗

PubMedDate not supplied

A new classification of Mirizzi syndrome from diagnostic and therapeutic viewpoints.

BACKGROUND/AIMS: A new classification of Mirizzi syndrome was developed based on our experience with 30 cases. MATERIAL AND METHODS: Using diagnostic and therapeutic criteria, four distinct entities were identified. Type I characterized by stenosis of the common hepatic duct due to a stone impacted in the cystic duct or the neck of the gallbladder. Type II is characterized by fistulization of the common hepatic duct as a result of a stone embedded in the cystic duct or the neck of the gallbladder. Type III is defined by hepatic duct stenosis due to a stone of the confluence, and Type IV by hepatic duct stenosis as a complication of cholecystitis in the absence of calculi impacted in the cystic duct or the neck of the gallbladder. RESULTS: Of the 30 patients there were 14 Type I, 2 Type II, 6 Type III, and 8 Type IV patients. Distinctive cholangiographic features were identified. CONCLUSION: The therapeutic approach differs from each of the four distinct pathologic entities.

Adult↗

PubMedDate not supplied

A comparison of the complication rate for three pancreaticojejunostomy techniques.

BACKGROUND/AIMS: A variety of techniques for pancreaticojejunostomy have been employed with introduction of safer anastomosing methods in our department as an extended excision of the pancreas was performed. In this study, complications associated with the various techniques of pancreaticojejunostomy were investigated in order to find a safer anastomosing method. METHODOLOGY: The extent of excision and complication rate of three types of pancreaticojejunostomy (impaction method, subserosal anastomosis and non-division procedure) were investigated in 64 patients who underwent pancreatoduodenectomy for diseases of the pancreas and biliary system. The end-to-side anastomosis of the pancreas and jejunum without division of the jejunoserosal tunica muscularis (non-division method) is an anastomotic method with a low risk of suture insufficiency. RESULTS: The incidence of secondary complications in the patients with suture insufficiency was higher than that in the patients with leakage of pancreatic juice. Once leakage of pancreatic juice and suture insufficiency occurred, the incidence of secondary complications was high after extended excision. CONCLUSIONS: From these results, the non-division method was found to be a safe anastomosing method. After an extended excision is performed, intraperitoneal drainage is necessary.

Bile Duct Neoplasms↗

PubMedDate not supplied

Distal pancreatectomy--does it have a role for pancreatic body and tail cancer.

BACKGROUND/AIMS: Pancreatic resection is the only hope for clinical improvement for patients with carcinoma of the body and tail of the pancreas. However, it is unclear whether palliative pancreatic resection is effective or not for patients with carcinoma of the body and tail of the pancreas. METHODOLOGY: To determine the appropriate treatment for patients with pancreatic body and tail cancer, we analyzed the records of 74 patients with ductal carcinoma of the body or tail of the pancreas who were treated at Kanazawa University Hospital between 1970 and 1995. RESULTS: Using a multivariate Cox proportional-hazard model (factors: age, sex, chemotherapy, radiotherapy, hepatic metastasis, peritoneal dissemination, operative procedure), the presence of hepatic metastasis, peritoneal dissemination, and the type of operative procedures (resection or not) were found to be significant prognostic factors. Surgical resection was the most important prognostic factor. The patients with surgical resection had a significantly higher survival rate than those without resection (p < 0.0001). The survival rate of the patients with palliative resections was also significantly higher than that of the patients without resection, except for the patients with advanced liver metastasis (H3). The survival rate of the patients with palliative resections was also higher than that of the patients without resection, even in patients with peritoneal dissemination. CONCLUSIONS: Surgical resection prolongs the average survival for patients with carcinoma of the body and tail of the pancreas, except for the patients with multiple liver metastasis. These data support the role of palliative pancreatectomy in patients with carcinoma of the body and tail pancreas.

Adult↗

PubMedDate not supplied

Extended radical pancreatectomy for carcinoma of the head of the pancreas.

BACKGROUND/AIMS: Pancreatic cancer has a poor prognosis, which is, in part due, to the unfortunately advanced stage, in which the tumor is diagnosed. Since 1973, we have utilized a unique method of extended radical pancreatectomy, using the translateral retroperitoneal approach (TRA) to facilitate combined portal resection. The advantages of this operation are described herein, for patients with carcinoma of the head of the pancreas. In addition, the problems associated with this operation are discussed. METHODOLOGY: Survival was calculated based on type of resection, degree of invasion of the retroperitoneal tissues, degree of lymph node involvement, and cancer stage. Extensive surgery has been performed for pancreatic carcinoma 216 patients. Of these, 14 patients had carcinoma of the head of the pancreas. There were 58 patients who underwent macroscopically curative resections. RESULTS: Only 39 patients were microscopically curative. Ten of the patients who underwent microscopically curative resections, survived for 5 years (34.0%). There were no statistically significant differences in survival based on tumor size. However, there was a significant difference in survival based on extent of invasion of the anterior capsule of the pancreas, extent of invasion of the retroperitoneal tissue, extent of lymph node involvement, cancer stage, and extent of invasion at the surgical margin of resection. CONCLUSION: The results suggest that extended radical pancreatectomy may be indicated for the treatment of cancer of the head of the pancreas.

Adult↗

PubMedDate not supplied

Clinicopathological evaluation of long-term survivors treated for cancer of the head of pancreas.

BACKGROUND/AIMS: This is a study of 43 patients with cancer of the pancreatic head treated by resection in the past 13 years; 8 patients survived for 3 years or more and were compared with 17 who died of cancer within 3 years, in terms of histopathological spread. METHODOLOGY: Eight patients with cancer of the pancreatic head who survived for 3 years or more after resection were evaluated clinically. They were compared histologically with 17 patients who died of cancer within 3 years. RESULTS: The long-term survivors had s0 lesion (no frontal invasion of the pancreatic capsule). Lymph node metastasis was absent, or if present, limited to the n1 group. Histological examination showed rpe (positive retroperitoneal invasion) in four of the eight patients (50%). E-ew (-) (no evidence of invasion to the exposed cut surface) was obtained in all patients. They had stage (histological cancer Stage) II or III except for one patient with stage IV. CONCLUSIONS: Based on the results of the evaluation of our patients, the preconditions at present for prolonged survival for patients with cancer of the pancreatic head would appear to be as follows: --no frontal invasion of the pancreatic capsule; --no retropancreatic invasion or no evidence of invasion to the exposed cut surface even if the retroperitoneal tissues are invaded; --no lymph node metastasis or metastasis limited to the first lymph node group.

Adenocarcinoma↗