Biomedical subjects

Makoto Hashizume

Publications and source records attributed to Makoto Hashizume.

46 records · Page 3Linked to original sources

PubMed2002

[Recent advances in surgical technology--open MRI and "real-time" navigation].

Many advances of neurosurgery had been achieved about diagnostic and operative tools such as CT scan, MRI, stereotaxy, and microscope, in 20th century. However, intraoperative diagnostic tools are not sufficient for providing solid data. So we developed new operating system for 21st century (Intelligent Operating Theater: IOT). The IOT has an open MRI machine for intraoperative MR imaging that provides objective anatomical data and the "real-time" navigation updated with iMRI that navigates surgeons to the target area. The IOT has contributed to the improvement of the resection rate in brain tumor cases.

Brain↗

PubMedDate not supplied

The effect of prostacyclin on the gastric mucosa in portal-hypertensive rats.

BACKGROUND/AIMS: This study investigates the effect of prostacyclin, which is thought to be involved in the hemodynamic circulation, on the gastric mucosa of rats with portal hypertension. METHODOLOGY: Various gastric functions were evaluated in portal vein ligated rats after the intraperitoneal administration of either a placebo or prostacyclin for 7 days. RESULTS: The gastric mucosal damage induced by the instillation of 90% ethanol was significantly greater in the prostacyclin-treated group than in placebo-treated group. The portal pressure was similar in both groups. There was no significant difference between the two groups in plasma concentration of 6-keto-PGF1a (a stable metabolite of prostacyclin), whereas the mucosal content of 6-keto-PGF1a was significantly higher in the prostacyclin-treated group than in the placebo-treated group. Prostacyclin pretreatment significantly increased the gastric mucosal blood flow, estimated by laser-Doppler flowmetry, and the hemoglobin content of the gastric mucosa, measured by reflectance spectrophotometry, whereas the oxygen content remained unchanged. CONCLUSIONS: We speculate that the increased gastric mucosal perfusion induced by a high content of prostacyclin in the portal hypertensive gastric mucosa may play a role in the pathogenesis of ethanol-induced gastric mucosal damage.

6-Ketoprostaglandin F1 alpha↗

PubMedDate not supplied

Therapeutic strategy of emergency surgery for colon cancer in 71 patients over 70 years of age in Japan.

BACKGROUND/AIMS: The prognosis for colon cancer is poorest in cases of emergency situation in the elderly not only in Japan, but worldwide. The aim was to design a therapeutic approach used for colon cancer in the elderly. METHODOLOGY: Seventy-one patients, who were all older than 70 years, with colon carcinoma in an emergency situation were examined. Lethality, surgical procedure, risk of comorbidity, multiple organ system failure and the effect of endotoxin absorption were examined. RESULTS: Any increase in comorbidity was associated with a higher clinical lethality in the lungs, heart, kidney, and diabetes. The highest postoperative mortality rate was recorded in patients who underwent primary resection after perforation, while the lowest postoperative mortality rate was recorded in patients who underwent primary resection after obstruction. Postoperative failure of the lungs and heart and renal failure were associated with a significantly higher mortality rate. Twenty-five septic patients received an endotoxin adsorption due to blood filtration and 8 patients survived. Of the eight survivors, the endotoxin concentration was significantly decreased by an endotoxin absorption. CONCLUSIONS: In cases of ileus, the resection may be performed positively. In cases of perforation, we may safely say now that stoma and resection is to be recommended. Endotoxin absorption due to blood filtration may be an effective additional therapy for post-operative septic shock.

Adenocarcinoma↗

PubMedDate not supplied

Pulmonary embolism following laparoscopic surgery: a report of two cases.

Laparoscopic abdominal surgery is considered a low-risk procedure for postoperative complications because of reduced surgical stress and earlier mobilization. We report two patients who experienced pulmonary embolism following laparoscopic surgery; one patient underwent umbilical hernia repair and the other cholecystectomy. Although pulmonary embolism is indeed rare after laparoscopic surgery, early detection and early treatment are determinative factors for a good prognosis. Therefore, medical caregivers must remember that pulmonary embolism can be a critical complication after laparoscopic surgery and preventive measures should be employed for high-risk subjects.

Adult↗

PubMedDate not supplied

Laparoscopic splenectomy for portal hypertension.

BACKGROUND/AIMS: Laparoscopic splenectomy is now increasingly being performed. However, controversy remains regarding the effectiveness of a laparoscopic splenectomy for patients with portal hypertension. METHODOLOGY: Seventy-three patients with portal hypertension who underwent a laparoscopic splenectomy from February 1992 until October 2000 were reviewed and the effectiveness of the procedures for portal hypertension was evaluated. Forty-two patients had esophagogastric varices and twenty had a concomitant hepatocellular carcinoma. The indications for surgery were bleeding tendency due to thrombocytopenia (n = 40), difficulty in receiving treatment for hepatocellular carcinoma due to thrombocytopenia (n = 18), and sclerotherapy-resistant esophagogastric varices (n = 15). RESULTS: A laparoscopic splenectomy was successfully performed in all the patients. The rate of conversion to conventional open surgery was 9.6% (7/73). The mean operative time was 210.1 +/- 101.9 minutes, and the estimated blood loss was 374.7 +/- 352.4 mL. There were no cases of mortality, and morbidity was encountered in 11.0% of patients. The increase in the platelet count correlated significantly to the spleen weight (P < 0.001). The platelet count had been maintained at over 10 x 10(4)/mm3 for over three years. Eighteen patients with hepatocellular carcinoma successfully underwent treatment for hepatocellular carcinoma after surgery and no recurrence of esophagogastric varices was encountered. CONCLUSIONS: A laparoscopic splenectomy resulted in the successful secondary treatment of hepatocellular carcinoma and esophagogastric varices. Portal hypertension was not a contraindication. A laparoscopic approach is therefore the procedure of choice for a splenectomy in portal hypertension.

Aged↗

PubMedDate not supplied

New insight for management of blunt splenic trauma: significant differences between young and elderly.

BACKGROUND/AIMS: Although highly successful in children and young patients, the non-operative management of blunt splenic injury in the elderly has yet to be clearly studied. The purpose of this study was to determine whether or not a relationship exists among the mechanism of injury, the grade of splenic injury, the associated injuries, and whether patterns of injury differ between the young group (younger than 60 years old) and the elderly group (60 years and older than 60 years). METHODOLOGY: One hundred and sixty-seven patients (116 young patients including 30 early deaths and 51 elderly patients including 20 early deaths) with blunt splenic injury were admitted to our clinic from 1983 to 1997. Computed tomography scans were interpreted in a blind fashion. In addition, the Injury Severity Score, Glasgow Coma Scale, blunt splenic injury grade, length of hospital stay, length of intensive care unit stay, survival, number of abdominal injuries and number of total diagnoses were investigated in both the young and elderly groups. The different types of management for blunt splenic injury were also studied. RESULTS: Higher injury severity scores, lower Glasgow Coma Scales, and higher mortality all indicated that the elderly were more severely injured than the young patients. The rate of non-operative treatment was also significantly greater for young patients than for elderly patients (62.8 vs. 32.3%, P < 0.05) and the rate of a splenectomy was significantly less for the young patients than for the elderly patients (29.1 vs. 51.6%, P < 0.05). Regarding infectious complications, the rates of pneumonia (14.0 vs. 23.1%, P < 0.05), subphrenic abscess (9.3 vs. 23.1%, P < 0.05), and urosepsis (7.0 vs. 23.1%, P < 0.05) was significantly greater for the elderly patients than for the young patients. The overall failure of non-operative management was 5.2% in the young patients and 9.8% in the elderly patients. CONCLUSIONS: The final selection of splenic management decision was individualized for each patient and based on multiple variables. For persistent hemodynamic instability or unresolved concerns for other individual pathologic conditions, aggressive management is recommended. In the absence of these two important conditions, the variables that predicted a need for operative intervention include an Injury Severity Score above 20 in younger and elderly patients; an American Association for the Surgery of Trauma splenic grade above III in elderly; a large hemoperitoneum on an initial computed tomography scan; the presence of active extravasation on an initial computed tomography scan; and high-energy mechanisms. In conclusion, selecting the optimal non-operative management of blunt splenic injury in elderly patients remains difficult. An aggressive initial operation is thus recommended because the specific fragility of the spleen and the decreased physiologic reserve in elderly patients is difficult to estimate, especially at small hospitals where performing emergency splenic angiography and treating embolisms is difficult.

Adult↗

PubMedDate not supplied

New therapeutic strategy of open pelvic fracture associated with rectal injury in 43 patients over 60 years of age.

BACKGROUND/AIMS: A diversion of the fecal stream is generally regarded as an integral component of minimizing both the infectious morbidity and mortality associated with an open pelvic fracture. However, the efficacy of the fecal diversion in elderly has yet to be clearly elucidated. We performed a formal retrospective comparison between the elderly patients who underwent diversion and those who did not. METHODOLOGY: Forty-three consecutive patients who were over 60 years of age and suffered a pelvic fracture associated with rectal injury. The use of fecal diversion was used to delineate the comparison groups: group 1, underwent diversion; group 2, did not undergo diversion. The 2 groups were compared based on the outcome variables and patient demographics. RESULTS: The diverted patients were more severely injured as demonstrated by a higher ISS (p < 0.05). The length of hospital stay was also significantly greater for the diverted patients than for the non-diverted patients (p < 0.05). The number of abdominal injuries (p < 0.05) and the number of total diagnoses (p < 0.05) were also significantly greater for the diverted patients than for the non-diverted patients. There was a significant difference in the distribution of intraabdominal fecal contamination (p < 0.05). No significant difference was observed in the distribution of fracture stability, fracture patterns, wound location, or wound severity between the diverted and non-diverted groups. On the other hand, the chi 2 test for trend (Mantel-Haenszel) for fecal diversion and the Gustilo grade produced a P value of 0.04. A primary repair with end-colostomy was performed in 7 of 23 patients and a resection with an end-colostomy was performed in 16 of 23 patients in group 1. On the other hand, a primary repair was performed in 3 of 20 patients and a resection with anastomosis was performed in 17 of 20 patients in group 2. By the third postoperative month, no significant difference was seen in the survival rate: 61% in group I versus 65% in group 2 (P = 0.40). By the first postoperative month, the survival rate was significantly lower in group 1 than in group 2 (P = 0.04). CONCLUSIONS: Diversion should not be regarded as an absolutely safe intervention for open pelvic fracture associated with rectal injury. However, if a failure of the primary repair or resection with anastomosis once occurs, then the patient's condition could change suddenly or worsen. Elderly patients especially have a poor physiological reserve, and thus a failure to perform a primary repair or resection with anastomosis can quickly lead to patient mortality. There may be some bias when selecting fecal diversion or not based on each surgeon's subjective judgment. In our cases, diversions tended to be done in severe cases. If surgeons encounter a pelvic fracture with severe rectal injury, then aggressive fecal diversion may thus be the procedure of choice in emergency elderly cases.

Aged↗

PubMedDate not supplied

Results of endotoxin absorption after a subtotal resection of the small intestine and a right hemicolectomy for severe superior mesenteric ischemia.

BACKGROUND/AIMS: The purpose of this study is to analyze the results of endotoxin absorption therapy after a subtotal resection of the small intestine and a right hemicolectomy for severe superior mesenteric ischemia. METHODOLOGY: From April 1980 through August 1999, 82 patients with severe superior mesenteric ischemia were operated on an emergency basis, and they were divided into two groups. Group 1 (n = 51), did not undergo postoperative endotoxin absorption therapy, while group 2 (n = 31), underwent this therapy. The two groups were compared based on the outcome variables. RESULTS: When the number of risk factors was 1 or 2, the mortality rate in group 2 was significantly lower than in group 1 (p < 0.05). For postoperative lung or liver failure, the mortality rate was significantly higher in group 1 than in group 2. For an intraabdominal abscess, the mortality rate was significantly higher in group 1 than in group 2. Twenty-two of the thirty-one patients in group 2 survived. In the surviving cases, this therapy significantly decreased the intravenous concentration of endotoxin (p = 0.04). As for the fatalities (n = 9), no significant change in the concentration of endotoxin before or after endotoxin absorption was recognized. By the first postoperative month, the survival rate was significantly lower in group 1 than in group 2 (58.8% vs. 71.0%, P = 0.04). CONCLUSIONS: In conclusion, we may now safely say that both stoma and a resection are recommended while endotoxin absorption using blood filtration may also be an effective additional therapy for post-operative septic shock.

Absorption↗

PubMedDate not supplied

Laparoscopic rectopexy for recurrent rectal prolapse: a safe and simple procedure without a mesh prosthesis.

Two female patients, 65 and 61 years old, respectively, suffering from a recurrent rectal prolapse underwent laparoscopic rectopexy. Our modified method using an ultrasonically activated scalpel (Harmonic Scalpel) and a laparoscopic suturing device (Endo Stich) both shortened and simplified the operation. The operation times were 140 minutes and 120 minutes, respectively. Neither of the patients demonstrated either intraoperative complications or recurrence of the prolapse during the 24-month follow-up. Our procedure using these new instruments could be performed simply, safely, and in a short time, without the use of a mesh prosthesis.

Aged↗

PubMedDate not supplied

New concept of cholecystectomy combined resection of the gallbladder bed for chronic cholecystitis.

Cholecystectomy is sometimes the most difficult operation to perform. When the atrophic gallbladder with severe inflammation falls into the spongy soft liver, it is not easy to perform a standard cholecystectomy without causing bleeding and serious injury around the hilar structures. Some selected patients with chronic cholecystitis under some particular circumstances might be better suited to undergo a cholecystectomy combined resection with the gallbladder bed rather than the ordinary standard cholecystectomy. Herein, we showed a partial hepatic resection of the gallbladder bed with the gallbladder using an intermittent hepatic inflow occlusion.

Cholecystectomy, Laparoscopic↗