Biomedical subjects

S Kitano

Publications and source records attributed to S Kitano.

At least 487 records · Page 27Linked to original sources

PubMedDate not supplied

Potential role of heparin in prevention of liver metastasis from colon cancer.

The case of a 59 year-old man with sigmoid colon cancer and synchronous liver metastases is described in this report. Sigmoid colectomy and partial hepatectomy were performed, and hepatic arterial cannulation was done for prevention of hepatic recurrence. Heparin was injected to prevent catheter-related clots, and no anticancer drugs were used. He did well without signs of recurrence for 5 years after the initial operation. After we stopped the heparin administration, recurrence was detected in the liver. The patient underwent repeat hepatectomy, and he is now doing well without recurrence 2 years after the second operation. The clinical course of this case suggests that heparin may prevent liver metastasis of colorectal cancer.

Adenocarcinoma↗

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Peritoneal recurrence of ampullary carcinoma following curative pancreatoduodenectomy.

A 72 year-old Japanese man with peritoneal recurrence of carcinoma of the ampulla of Vater after curative pancreatoduodenectomy is presented. He was treated by percutaneous transhepatic biliary drainage (PTBD) for obstructive jaundice. The PTBD catheter dislodged 14 days later. He underwent emergency open peritoneal lavage and external choledochal drainage for diffuse bile peritonitis. Cytologic examination of bile obtained from the T-tube revealed malignant cells. He underwent pancreatoduodenectomy with regional lymph node dissection 2 months later for ampullary carcinoma. Pathologic examination showed a macroscopic protruding, 8 x 7 x 10 mm, papillary adenocarcinoma of the ampulla of Vater. The tumor was classified as stage II with pT2, pN0, and pM0. Eight months later, cytologic examination of ascites demonstrated adenocarcinoma cells. The patient died with peritoneal recurrence 10 months after curative pancreatoduodenectomy.

Adenocarcinoma, Papillary↗

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Factors influencing bowel function after low anterior resection and sigmoid colectomy.

BACKGROUND/AIMS: The aim of this study was to evaluate the subjective bowel function after low anterior resection and sigmoid colectomy and to clarify the clinicopathologic factors influencing postoperative bowel habits. METHODOLOGY: Eighty-six patients who underwent low anterior resection and sigmoid colectomy replied to the questionnaire which consisted of 8 categories of bowel symptoms. The patients were divided into 2 groups: good bowel function showing less than half of symptoms (< 4) and poor bowel function showing more than half of symptoms (> or = 4). RESULTS: After low anterior resection, patients were often complicated with incomplete evacuation (75%), bowel movement at night (60%), defecation more than twice a day (46%), and soiling (27%). The mean number of defecation/day and frequency of patients with night stools was significantly higher after low anterior resection than sigmoid colectomy (2.81 vs. 2.18, P < 0.05; and 60% vs. 29%, P < 0.05). Poor bowel function after low anterior resection was frequent in patients with high ligation of the inferior mesenteric artery (82%, P < 0.05), injury to the pelvic autonomic nerve (82%, P < 0.05), and blood transfusion; while poor bowel function after sigmoid colectomy was frequent in patients with resected colon measuring 25 cm or more (81%, P < 0.05). CONCLUSIONS: These results indicate that poor bowel function after low anterior resection is associated with high ligation of the inferior mesenteric artery and injury to the pelvic autonomic nerve; while poor bowel function after sigmoid colectomy correlates with length of the resected colon. Less aggressive surgery is needed to preserve good bowel function.

Aged↗

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Postoperative complications of repeat hepatectomy for liver metastasis from colorectal carcinoma.

BACKGROUND/AIMS: When a repeat hepatectomy is possible, it is the most effective treatment modality for recurrent colorectal liver metastasis. The aim of this study was to evaluate the surgical risks of repeat hepatectomy for liver metastasis from colorectal carcinoma. METHODOLOGY: Between 1986 and 1996, 60 patients with hepatic metastasis from colorectal carcinoma underwent surgery in the Department of Surgery I, Oita Medical University. Ten of them underwent a repeat hepatectomy. The cases of these 10 patients were studied retrospectively; in particular, postoperative complications and intraoperative blood loss were compared between the initial and second operation. RESULTS: During the second surgery, recurrence was detected adjacent to the hepatic stump in 9 of the 10 patients. During the initial surgery, 6 underwent non-anatomic resections, and 4 had anatomic resection, including 1 extended lobectomy, 1 lobectomy, and 2 segmentectomies. For the second surgery, 3 had anatomic resections, including 2 lobectomies, and 1 segmentectomy, and 7 underwent non-anatomic resections. There were no mortalities during the initial or second operation. There was no morbidity following the initial surgeries and 7 postoperative complications (intraabdominal abscess, 4 cases; biloma, 3 cases) following the second surgeries. Mean blood loss during the second operation (1044 mL) was significantly greater than during the initial operation (561 mL). CONCLUSIONS: The present results show that repeat hepatectomy for recurrent liver metastasis from colorectal carcinoma resulted in significantly greater intraoperative blood loss and postoperative complications than those of the initial surgeries. The blood loss and complications in the second operation, the one for the recurrence, were directly associated with the fact that the recurrence was so close to the hepatic stump. Since the resection line in the second surgery was adjacent to the hepatic hilus, resection of the lesion caused much more injury to the main bile duct and main portal vein than that caused by the.

Aged↗

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Patterns of lymph node metastasis in carcinoma of the ampulla of Vater.

BACKGROUND/AIMS: Identification of lymph node metastasis may guide surgical therapy. The aim of this study was to clarify the lymphatic spread in ampullary carcinoma in relation to local tumor extent (pT category in the pTNM classification). METHODOLOGY: The distribution and number of lymph node metastases were histologically examined in 35 patients with ampullary carcinoma. RESULTS: Lymph node metastases were present in 10 of 15 patients (67%) with pT2 tumor and in 10 of 11 (91%) with pT3 tumor. Nodal involvement was not identified in 9 patients with pT1 tumor. The incidence of node-positive patients was higher in pT2 and pT3 tumors than in pT1 tumors (P < 0.01). The total number of positive nodes per node-positive patient was greater in pT3 tumors than in pT2 tumors (mean 3.50 vs. 1.30, P < 0.001). All node-positive patients had metastasis to the posterior pancreaticoduodenal node. The number of positive nodes per node-positive patient in both the posterior pancreaticoduodenal and the superior mesenteric region was greater in pT3 tumors than in pT2 tumors (P < 0.01 and P < 0.05). CONCLUSIONS: With increasing pT category in ampullary carcinoma, lymphatic spread extended from the posterior pancreaticoduodenal region to the superior mesenteric nodes.

Aged↗

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Right hepatic artery interruption and prostaglandin E1 in total or proximal pancreatectomy for pancreatobiliary malignancy.

BACKGROUND/AIMS: Advanced hepato-biliary-pancreatic malignancy can frequently involve the hepatic artery. We evaluated the use of prostaglandin E1 in total or proximal pancreatectomy with the right hepatic artery interruption. METHODOLOGY: A Consecutive seven of 117 patients (6.0%) in whom the right hepatic artery was interrupted and not reconstructed were reviewed retrospectively. Four of them received prostaglandin E1 (10-20 ng/kg/min) until the fifth postoperative day, while, the remaining three did not. The effect of prostaglandin E1 was compared concerning complication and hepatic function. RESULTS: The right hepatic artery was intentionally resected because of cancer invasion in five patients with biliary tract carcinoma, while, accidentally transected in two with pancreatic carcinoma. Operative deaths did not occur. The biliary leakage was identified in one patient treated without prostaglandin E1. Although a marked rise in glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and lactate dehydrogenase levels was observed, hepatic dysfunction was successfully treated conservatively in all patients. The glutamic oxaloacetic transaminase and lactate dehydrogenase values were significantly lower (P < 0.05) in patients treated with prostaglandin E1 compared with those without prostaglandin E1. CONCLUSIONS: The prostaglandin E1 infusion can be helpful for biliary anastomosis and hepatic function in radical hepato-biliary-pancreatic surgery with the right hepatic artery interruption.

Adult↗

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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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↗

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Effect of elastase in reversing the de-differentiation of rabbit costal chondrocytes in culture induced by the tumor promoter 12-O-tetradecanoylphorbol 13-acetate (TPA).

As elastase is known to affect cell functions in various cell systems, its effects on the functions of control and 12-O-tetradecanoylphorbol 13-acetate (TPA)-treated chondrocytes in vitro were examined. Pretreatment of chondrocytes with TPA (10(-8) M) for 48 h significantly enhanced DNA synthesis, inhibited glycosaminoglycan (GAG) synthesis and inhibited the increase in ornithine decarboxylase (ODC) activity in response to parathyroid hormone (PTH) relative to values in control cultures. Addition of elastase (1, 10 and 50 ng/ml) for 24 h partially inhibited the de-differentiated phenotypes induced by TPA such as the decreased synthesis of GAG and decreased response of ODC activity to PTH without affecting the DNA synthesis. Moreover, elastase significantly increased both the basal level of cyclic AMP and that on PTH treatment of TPA-pretreated cells. These results suggested that elastase partially restored the differentiated phenotypes of de-differentiated chondrocytes probably through its effect in increasing the level of intracellular cyclic AMP.

Animals↗

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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↗

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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

Tolerance of chronically-diseased liver to prolonged hemihepatic ischemia during hepatectomy.

Seventeen patients with chronic liver disease underwent prolonged warm ischemia of hemi-lobe during liver resection. Those included 15 cirrhotic patients and two with chronic hepatitis. The hemi-hepatic ischemia was carried out with a liver clamp. The normothermic liver ischemia time of 40 to 70 minutes (53.8 +/- 10.4 minutes, mean +/- SD) were tolerated well with an acceptable postoperative course and no mortality. The liver with cirrhosis or chronic hepatitis can tolerate a hemi-hepatic ischemia of up to 70 minutes for patients with no high-risk factors.

Aged↗

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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↗

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Fast fluid-attenuated inversion recovery (FAST-FLAIR) of ischemic lesions in the brain: comparison with T2-weighted turbo SE.

PURPOSE: We compared fast fluid-attenuated inversion recovery (FAST-FLAIR) images with Turbo SE T2-weighted images to evaluate the detectability of small ischemic lesions in the brain. MATERIALS AND METHODS: Thirty-six cases of multiple cerebral ischemic lesions were examined with FAST-FLAIR and Turbo SE imaging. The detectability of lesions, ability to discriminate lesions from the cortex, visualization of perivascular space, and visualization of brainstem lesions were compared between the two sequences. RESULTS: The total number of lesions detected on both sequences was 534 in 36 cases. Six lesions in three cases were detected only on FAST-FLAIR, and one lesion in one case was detected only on the Turbo SE. All the 52 lesions located close to the cortex could be discriminated from the cortex on the FAST-FLAIR images, while 23 of these lesions could not be discriminated on the Turbo SE. Perivascular spaces were not visualized as areas of high signal on the FAST-FLAIR images. Pontine lesions that were visualized in four cases were clearer on the Turbo SE images than on the FAST-FLAIR images. CONCLUSION: The FAST-FLAIR images were shown to be useful in the detection of ischemic lesions and in distinguishing them from the surrounding normal structures. The FAST-FLAIR sequence is expected to become a new additional routine sequence.

Aged↗

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↗

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Postoperative adjuvant arterial infusion chemotherapy for patients with hepatocellular carcinoma.

BACKGROUND/AIMS: The efficacy of postoperative hepatic arterial infusion chemotherapy (PAI) in the prevention of the recurrence of hepatocellular carcinoma (HCC) following hepatic resections was examined. MATERIAL AND METHODS: Between November 1982 and February 1994, hepatic resections were carried out in 74 consecutive HCC patients with stage III and IV at Oita Medical University Hospital. They were divided into two groups. In PAI group patients (n = 26), cis-diamminedichloroplatinum or a combination of 5-fluorouracil, adriamycin and mitomycin was alternately infused every 3 months. The remaining patients who did not receive PAI therapy served as the control (n = 48). The patient survival and disease-free survival of the two groups were compared. RESULTS: The cumulative survival rates in the PAI group (90.3%, 71.3%, and 71.3% at 1, 2, and 3 years after hepatectomy, respectively) were significantly higher than those in the control (67.2, 41.7%, and 32.0%, respectively, p < 0.05). The disease-free survival rate in the PAI group (62.9%, 50.3%, and 26.8% at 1, 2, and 3 years after hepatectomy, respectively) was also significantly higher relative to the control (38.6%, 21.7%, and 12.1%, respectively, p < 0.01). CONCLUSIONS: Our data indicate that PAI can be efficacious in preventing postoperative recurrence of carcinoma and may lead to a prolonged survival of advanced HCC patients following hepatic resection.

Adult↗

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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

Repeated injection sclerotherapy is preferable to combined therapy with variceal ligation to avoid recurrence of esophageal varices:--a prospective randomized trial.

BACKGROUND/AIMS: The aim of this prospective randomized study is to investigate the safety, efficacy, complications and recurrence of varices after repeated endoscopic injection sclerotherapy (EIS), and combined therapy of endoscopic variceal ligation (EVL) and repeated EIS, for the treatment of esophageal varices. MATERIAL AND METHODS: Sixty-one consecutively treated cirrhotic patients were examined. Thirty patients were placed randomly in the EIS group and the other 31 in the EVL+EIS group. For the EIS group, EIS was repeated at weekly intervals using 5% ethanol- amine oleate (EO) until all the varices had been eradicated. In the EVL+EIS group, EVL was done at the initial session, then EIS was repeated at weekly intervals from one week after EVL. RESULTS: There was no significant difference between the EIS and EVL+EIS groups with regard to the rate of eradication (80.0% vs 74.2%), the total number of treatment (4.1 +/- 0.8 sessions of EIS vs EVL and 3.0 +/- 0.5 sessions of EIS) and hospitalization time (4.9 +/- 1.6 vs 4.4 +/- 1.0 weeks). The total volume of EO used for the EVL+EIS group was significantly less than that for the EIS group (26.3 +/- 8.3 vs 47.1 +/- 11.6 ml, p < 0.01) and the incidence of minor complications at the initial treatment in the EVL+EIS group was significantly (p < 0.01) lower than that in the EIS group. Follow-up endoscopy showed that the rate of attaining circumferential ulceration and the following fibrotic scarring in the EVL+EIS group was significantly lower than that in the EIS group (21.7% vs 91.7%, p < 0.01) and that the incidence of variceal recurrence was significantly higher in the EVL+EIS group than in the EIS group (39.1% vs 8.3%, p < 0.05) over a median follow-up of 12.3 months. CONCLUSION: The combined therapy of EVL and repeated EIS seems favorable from the viewpoint of fewer complications, but repeated EIS is preferable to combined therapy to avoid recurrence of the esophageal varices.

Adult↗