Biomedical subjects

S Aoyagi

Publications and source records attributed to S Aoyagi.

At least 109 records · Page 6Linked to original sources

PubMed1999

Serum hyaluronan as a predictor of hepatic regeneration after hepatectomy in humans.

BACKGROUND: The capacity for hepatic regeneration after hepatectomy is important for allowing surgeons to determine the appropriate extent of resection. However, conventional preoperative liver function tests are unsatisfactory for estimating the post-operative regenerative capacity of the remnant liver. The aim of this study was to evaluate the relationship between preoperative serum hyaluronan and hepatic regeneration. METHODS: Preoperative serum hyaluronan levels and the hepatic regeneration rate were estimated in 49 patients using computerized tomographic volumetry. The hepatic fibrotic rate was calculated with non-tumorous tissues stained with Azan-Mallory. Immunolocalization of factor VIII-related antigen (FVIIIAg) was examined as a marker for hepatic sinusoidal capillarization. RESULTS: The serum hyaluronan level was significantly correlated with the hepatic regeneration rate (P < 0. 001). Patients with serum hyaluronan levels below 200 ng mL-1 exhibited a significant correlation between the hepatic regeneration rate and the hepatic fibrotic rate. However, patients with serum hyaluronan levels above 200 ng mL-1 did not demonstrate a distinct correlation. The hepatic regeneration rate of patients with FVIIIAg in the liver and serum hyaluronan levels above 200 ng mL-1 were very low compared with those without FVIIIAg (P < 0.001). Multiple regression analysis revealed that serum hyaluronan was a significant predictor of post-operative hepatic regeneration among several clinical variables (r = 0.857, R2 = 0.735). CONCLUSION: It has been suggested that hepatic regeneration is closely related to both hepatic fibrosis and hepatic sinusoidal capillarization. The serum hyaluronan level is regarded as a useful predictor for hepatic regeneration after hepatectomy.

Adult↗

PubMed1999

Recovery from lymphocytopenia following extracorporeal circulation: simple indicator to assess surgical stress.

This study investigated whether the lymphocyte count is a useful indicator to assess surgical damage following extracorporeal bypass. In Study 1, to investigate the correlation between extracorporeal circulating time (ECCT) and lymphocyte counts, 40 elective CABG patients were studied retrospectively. The lymphocyte recovery ratio (LRR), which represented the actual lymphocyte count divided by the preoperative lymphocyte count, was determined preoperatively, and on postoperative day (POD) 1, POD 3, and POD 5. In Study 2, the correlation between the interleukin-8 (IL-8) level and LRR was examined prospectively in elective CABG patients (n = 20). We measured the LRR and serum IL-8 levels preoperatively and during extracorporeal circulation (ECC) at 5 min, at the end of ECC, and 1, 3, and 12 h following ECC termination. Study 1 showed that the LRR decreased until POD 1 and gradually increased thereafter. The LRR had a negative correlation with the ECCT. In Study 2, the IL-8 level demonstrated a time course opposite to that of the LRR; it increased until 3 h after ECC termination and declined thereafter. There was a significant negative correlation between the LRR on POD 3 and the IL-8 level at 3 h after ECC termination. In summary, long-term ECC induced significant and prolonged lymphocytopenia. The LRR had a negative correlation with IL-8. These results indicated that the LRR may represent the degree of surgical stress following ECC; therefore, the counting of lymphocytes can be a quite useful bedside monitor to assess surgical damage and prognosis.

Coronary Artery Bypass↗

PubMed1999

Isolated primary chylopericardium.

A 16-year-old man was found to have an enlarged cardiac silhouette. Primary chylopericardium was diagnosed when pericardiocentesis yielded the characteristic milky-white fluid. The thoracic duct was easily identified by giving milk and butter and an injection of ethylene blue immediately before the operation. Intraoperative thoracic ductography showed no abnormal findings. Mass ligation of the thoracic duct above the diaphragm and partial pericardiectomy were successfully performed through a right thoracotomy approach. In addition, many of the lymphatics were ligated above the diaphragm. The right thoracotomy approach was a useful method for resection and ligation of the thoracic duct just above the diaphragm. Follow-up showed no accumulation of pericardial fluid or pleural effusion.

Adolescent↗

PubMed1999

Aortic valve replacement for aortic regurgitation caused by aortitis.

Between January 1984 and December 1998, 19 patients (16 with Takayasu's arteritis, 3 with non-Takayasu's aortitis) underwent surgical treatment for aortic regurgitation resulting from the aortitis. Of the 19 patients, 14 had aortic valve replacement (AVR) and 5 had aortic root replacement. One patient (5.3%) died of graft infection during the hospital stay. During the follow-up period, 1 (5.6%) of the 18 postoperative patients died of paravalvular leakage due to valve detachment, which also required redo-operations in 2 patients with non-Takayasu's aortitis. Both patients were operated on during the active phase of the inflammation without perioperative steroid therapy. Although transmural pledgeted sutures were used for replacement of the detached prosthetic valve in 1 of these 2 patients, disruption of the aortic wall resulted in recurrence of valve detachment. In the other patient, aortic root replacement was successfully performed with the Cabrol technique in the second operation. Perioperaitve steroid therapy plays an important role in preventing complications after AVR when the valve replacement is carried out during the active phase of the inflammation, and for patients with non-Takayasu's aortitis, aortic root replacement should be considered to reduce the tension on the suture line and the native aortic valve annulus.

Adult↗

PubMed1999

Endocrine tumor of the pancreas--an evaluation of eighteen patients who underwent resection followed by long-term survival.

Tumors arising from the pancreatic endocrine (islet) cells represent a heterogeneous group of lesions. Some tumors present with well characterized syndromes, while others appear to be nonfunctioning. Eighteen patients with pancreatic endocrine tumors who received surgical treatment at Kurume University Hospital during a 24-year period were reviewed. There were 10 patients with nonfunctioning tumors including 3 patients with benign tumors, and 8 patients with insulinomas. No patients had multiple endocrine neoplasms. Location of the pancreatic tumor was determined preoperatively in 83.3% of the patients. Immunohistochemical analysis of the resected specimens showed multi immunoreactivity to gut hormones among benign lesions and one malignant lesion, whereas malignant lesions showed no or mono immunoreactivity except in one case. In this series, there were no characteristic immunohistochemical findings in the tumors. Both patients with malignant and benign lesions have good prognoses if the main tumors and metastatic lesions are removed.

Adult↗

PubMed1999

A resected case of pancreatic metastasis from primary renal cell carcinoma.

A 71-year-old man, who had received a right nephrectomy for a primary renal cell carcinoma 8 years earlier, and had two years later received a distal gastrectomy for duodenal ulcer, was admitted. In the subsequent clinical course, a solitary low echographical tumor was found in the pancreas. Abdominal computed tomography revealed a tumor of low density area, and celiac angiography revealed a hypervascular tumor stain of the pancreas. From the above findings, a diagnosis of pancreatic tumor was made, and a distal pancreatectomy was performed. Examination of the resected tissues confirmed the presence of a solitary tumor in the pancreatic tail. Histologically, the tumor corresponded to the initial renal cell carcinoma and pancreatic metastasis of renal cell carcinoma was diagnosed. We report a resected case of such a metastasis and review the literature.

Aged↗

PubMed1999

Angiomyolipoma of the liver--a case report and review of 48 cases reported in Japan.

Hepatic angiomyolipoma was considered to be a rare benign tumor, but the number of cases has been increasing recently as imaging techniques improve. We describe a case of hepatic angiomyolipoma for which a definitive diagnosis could not be made on imagings and in which resection was performed. The patient had anti-HCV antibody and slight dysfunction of the liver. The tumor showed a heterogeneous high echo on ultrasonography and a low attenuation value of +32.6 Housfield Units, which was much higher than fat density, on plain computed tomography. Discrimination from hepatocellular carcinoma with fatty change was difficult preoperatively. Microscopically, the tumor consisted of spindle-shaped and epithelioid smooth muscles, adipose tissues and proliferating blood vessels and these histological findings confirmed the diagnosis of hepatic angiomyolipoma. The appearance of hepatic angiomyolipoma on imaging diagnosis varies widely due to the fact that the relative proportion of vessels, muscles and fats varies widely from tumor to tumor. The tumor in our case had relatively few fat components. We review 48 cases reported in Japan and discuss imaging diagnosis and surgical indications for tumors.

Angiomyolipoma↗

PubMed1999

Differential diagnosis between tumor-forming pancreatitis and pancreatic cancer by percutaneous transhepatic portography and selective direct pancreatic venography.

In 32 patients with tumor-forming pancreatitis and 109 patients with pancreatic cancer, the usefulness of percutaneous transhepatic portography (PTP) and selective pancreatic venography (SPV) for differential diagnosis of the two diseases was evaluated. The PTP images were type I in 53.1%, type II in 21.9%, type III in 12.5%, and type IV in 12.5% of the patients with tumor-forming pancreatitis and type I in 20.2%, type II in 23.9%, type III in 37.6%, and type IV in 18.3% of the patients with pancreatic cancer. Advanced images (type III or type IV) were observed in more than half the patients with pancreatic cancer. Mild images classified as type II were observed slightly more frequently in the patients with pancreatic cancer, but the differential diagnosis of the two diseases was difficult in patients showing type II PTP images. SPV findings were primarily hypervascularization (78.1%) and vasodilation (68.8%) in the patients with tumor-forming pancreatitis. Although encasement (smooth encasement) was noted in 31.3%, obstruction was found in only 3.1%. In the patients with pancreatic cancer, obstruction was observed in 85.3%, and encasement (irregular encasement) was noted in 78.9%. However, hypervascularization or vasodilatation was infrequent, and the tumor was characteristically imaged as a hypovascular area. PTP and SPV were considered to be useful for the differential diagnosis of tumor-forming pancreatitis and pancreatic cancer.

Diagnosis, Differential↗

PubMed1999

A so-called carcinosarcoma of the gallbladder in a patient with multiple anomalies--a case report.

The patient was a 65-year-old woman with a chief complaint of right upper quadrant pain. Under the diagnosis of gallbladder tumor, preduodenal portal vein and absence of the pancreatic tail, cholecystectomy was performed. Intraoperative findings resulted in a diagnosis of gallbladder tumor, absence of the pancreatic tail, presence of preduodenal portal vein, and malrotation of the intestine. Histological examination of the resected specimens showed a so-called carcinosarcoma. Carcinosarcoma of the gallbladder is a rare tumor of the hepatobiliary region. The present case differs from previously reported cases in its presentation with multiple anomalies including the presence of preduodenal portal vein. Many cases of preduodenal portal vein in an association with duodenal stenosis in children have been reported, but reports of cases of preduodenal portal vein in adult patients are rarely seen in the literature.

Adult↗

PubMed1999

A case of Turner's syndrome complicated with desmoid tumor of the transverse colon.

The association of Turner's syndrome and endometrial carcinoma has been previously established, but has never been described in conjunction with a desmoid tumor of the colon. A case is described of a colonic desmoid tumor developing in a 38-year-old female with Turner's syndrome. The association has not been previously reported. In this report, we describe a 38-year-old woman who has Turner's syndrome with a colonic desmoid and review the literature.

Adolescent↗

PubMed1999

A case of intraabdominal bleeding following pancreatoduodenectomy successfully treated by transcatheter arterial embolization.

A 58-year-old male underwent pancreatoduodenectomy based on a diagnosis of middle bile duct cancer. Because abdominal drainage revealed bile leakage 5 days postoperatively, leakage at the site of cholangiojejunostomy was diagnosed, and continuous aspiration was performed. Seventeen days postoperatively, pus was discharged through the abdominal drain. Because bleeding was detected by abdominal drainage, and shock ensued 20 days postoperatively, emergency abdominal angiography was carried out to identify the bleeding site. A false aneurysm in the proper hepatic artery and extravasation from the gastroduodenal artery stump were recognized, and therefore, the proper hepatic artery and common hepatic artery were embolized at a site distal to the false aneurysm using microcoils. Celiac arteriography after transcatheter arterial embolization (TAE) did not show extravasation, and revealed blood flow from the right inferior phrenic artery to the liver. Liver function was normal after TAE, and the patient recovered and was discharged from the hospital 54 days postoperatively. This paper presents a patient in whom intraabdominal bleeding due to leakage at the site of cholangiojejunostomy complicated by infection was successfully treated by hemostasis with TAE.

Abdomen↗

PubMed1999

A case of lymphoepithelial cyst of the pancreas.

We report a relatively rare case of lymphoepithelial cyst of the pancreas. The patient, a 43-year-old man with no subjective symptoms, was found to have a pancreatic tumor during a physical examination. Based on the ultrasonographic and abdominal computed tomographic findings, a pancreatic cystic tumor was diagnosed. Endoscopic retrograde pancreatography showed a normal duct system. Enucleation was easily performed. Macroscopically, the cyst resembled an atheroma. Histopathologic examination disclosed lymphoepithelial cyst of the pancreas.

Adult↗

PubMed1999

A long-term survival patient with advanced gallbladder cancer massively metastasizing to the liver.

A case of gallbladder carcinoma was reported. A 42-year-old woman was admitted with epigastralgia. Abdominal ultrasonography, computed tomography, and other diagnostic modalities suggested gallbladder carcinoma with multiple liver metastases. These findings indicated no surgical procedure because of the advanced nature of her disease. After the hepatic arterial chemoinfusion therapy, her multiple liver metastatic lesions showed a decrease in size and number. Therefore, extended left lobectomy of the liver with gallbladder and bile duct resection were performed. Five years after initial operation, a solitary liver metastatic lesion (S5) was diagnosed by ultrasonography. Partial resection of the liver was performed for the liver metastasis, and her postoperative recovery was uneventful and had a good follow-up course. One year after the second operation bone metastases occurred, therefore, peroral administration of UFT (Tegafur + Uracil) and radiation therapy for the metastatic lesions of sternum and lumbar vertebra (L1) were performed.

Adult↗

PubMed1999

Evaluation of curability and prediction of prognosis after surgical treatment for hepatocellular carcinoma by lens culinaris agglutinin-reactive alpha-fetoprotein.

The clinical significance of serum lens culinaris agglutinin-reactive alpha-fetoprotein (AFP-L3), which can distinguish between hepatocellular carcinoma and hepatitis by detecting a sugar chain micro heterogeneity, was evaluated for its possible ability to recognize previously undetectable residual tumors, and for increasing the accuracy of prognosis after surgical treatment for hepatocellular carcinoma. Serum lens culinaris agglutinin-reactive alpha-fetoprotein was measured pre- and post-operatively in 130 patients who underwent curative surgical treatment for hepatocellular carcinoma. The preoperative AFP-L3 positive rate was 35.4%. AFP-L3 remained positive postoperatively in 28 of the 46 preoperative AFP-L3 positive patients, and converted to positive in 4 of the 84 preoperative AFP-L3 negative patients. Regardless to preoperative AFP-L3, the postoperative AFP-L3 positive patients had a poorer recurrence-free rate (p<0.0001). The postoperative L3 positive patients had a high incidence of recurrence due to metastasis, but did not have recurrence due to multicentric origin. Multivariate analysis revealed that AFP-L3 (p<0.0001) was the most independently significant factor for predicting survival after surgery among several conventional prognostic factors. Thus, AFP-L3 is a valuable marker for evaluation of curability of surgical treatment and for improving the accuracy of prognosis.

Aged↗

PubMed1999

Prognostic benefit in cytoreductive surgery for curatively unresectable hepatocellular carcinoma - comparison to transcatheter arterial chemoembolization.

As a strategy for treating advanced hepatocellular carcinoma (HCC), cytoreductive surgery was studied comparing to transcatheter arterial chemoembolization (TACE). Patients who had curatively unresectable intrahepatic multiple HCC with the main tumor 30 mm or more in size were selected for this study. The patients were classified into two groups; i) cytoreductive surgery group (CRS group): 28 patients in whom the main tumor was resected but other cancer nodules remained in the remnant liver, ii) TACE group: 25 patients at Child A grade who underwent TACE, and in whom it was also evaluated retrospectively that the main tumor had been resectable. The cumulative 5-year survival rate was significantly higher in CRS (48.7%) than TACE (17.1%) group. Multivariate analysis revealed that performing cytoreductive surgery was a significant and independent factor to prolong survival. However, 6 of 28 patients died within one year of surgery. Residual tumor thrombus, and the absence or non-effectiveness of adjuvant therapy were significant high risk factors for postoperative death within one year. Conclusively, cytoreductive surgery contributes to a significant lengthening of survival in patients with advanced HCC. To reduce the risk of early postoperative death, the importance of postoperative adjuvant therapy is also recognized.

Aged↗

PubMed1999

[Breast cancer at the site of an implanted pacemaker].

We report here an 81-old-female patient who had a permanent pacemaker implanted in the right chest and who developed breast cancer near the site of the implanted generator. The cancer was diagnosed as stage I adenocarcinoma and radical mastectomy preserving pectoral muscles was indicated. During temporary pacing via the femoral approach, the pacemaker lead was transferred to the left subclavicular area crossing before the sternum and the generator was reimplanted in the left chest without use of lead extension kit. After reimplantation of the generator, radical mastectomy was performed. Clinical course was uneventful after the operation without infection or pacing failure. For the patient who needs surgical procedure in the site of implanted pacemaker generator, this technique of reimplantation is one of the useful choices.

Adenocarcinoma↗

PubMed1999

Intraoperative transesophageal echocardiography for evaluation of mitral valve repair.

BACKGROUND AND AIM OF THE STUDY: Although mitral valve repair is a well-established procedure, incorrect assessment of the repaired valve may occasionally lead to the need for reoperation. This study was performed to evaluate the accuracy of color Doppler in assessing the competence of the repaired mitral valve. METHODS: Transesophageal echocardiography (TEE) and left ventriculography were each performed in 72 patients to compare the two techniques and a semi-quantitative index derived. Using this relationship, post bypass intraoperative TEE was then performed in 34 patients who underwent mitral valve repair, in order to assess the competence of the repaired valve. RESULTS: Significant differences were apparent in maximal regurgitant mosaic area between angiographic grade 0, and grades 1+ (p = 0.0006), 1+ and 2+ (p < 0.0001) and 2+ and 3+ (p = 0.0010). A maximal regurgitant area < 2 cm2 predicted angiographic grade as 0 (sensitivity 100%, specificity 95%), an area of 2-4 cm2 as 1+ (sensitivity 82%, specificity 100%), an area of 4-7 cm2 as 2+ (sensitivity 78%, specificity 90%), and an area > 7 cm2 as grade 3+ or 4+ (sensitivity 79%, specificity 93%). All 34 patients completed valve repair with the maximal regurgitant mosaic area < 2.5 cm2. Postoperative left ventriculography showed grade +1 in only five patients; four of these completed mitral valve repair with a maximal mosaic area > 2.0 cm2 as assessed by post bypass intraoperative TEE. During follow up, transthoracic echocardiography (TTE) detected recurrent mitral regurgitation which required mitral valve replacement in one patient, and rapid progression of mitral regurgitation in three patients. CONCLUSIONS: It is important that mitral valve repair should be completed with a maximal mosaic area < 2.0 cm2 as assessed by intraoperative TEE, in order to reduce the need for reoperation.

Adult↗

PubMed1999

Isolated tricuspid valve regurgitation resulting from severe annular dilatation: case report.

A rare case of isolated tricuspid regurgitation (TR) in a 65-year-old man is presented. Echocardiography revealed enlargement of the right atrium, dilatation of the tricuspid valve annulus without thickening or prolapse of the leaflets, and an intact atrial septum. No downward displacement of the tricuspid septal leaflet was observed by echocardiography. Mild mitral regurgitation and severe TR were detected on color flow Doppler studies. Cardiac catheterization indicated elevated right atrial pressure, with a pronounced V-wave. No left-to-right shunt was detected at the right atrium. At surgery, severe annular dilatation of the tricuspid valve (without organically diseased or deformed tricuspid leaflets) was observed, and tricuspid annuloplasty with a prosthetic ring performed. Postoperative echocardiography and right ventriculography showed trivial TR.

Aged↗