Management of dental surgery problems for outpatients with cardiovascular diseases.
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Adult↗
Biomedical subjects
S Okamura
Publications and source records attributed to S Okamura.
[Modernization of social welfare and management of leprosy problems].
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Humans↗
Postoperative functioning of the remaining stomach after pyloric sphincter preserving gastrectomy.
Pyloric sphincter preserving gastrectomy (SPG) has been used in 120 cases and the results were compared with those obtained in 73 cases who underwent the Billroth-I operation (B-I). No significant differences were observed in postoperative complications or anastomotic dysfunction. SPG patients, however, showed a longer gastric emptying time than the B-I patients, whereas the B-I patients showed a markedly greater increase in duodenogastric reflux than the SPG patients.
Body Surface Area↗
Esophageal reflux after gastrectomy: a hazard after Billroth-I subtotal gastrectomy.
One hundred and seventy-six patients were evaluated for esophageal reflux after gastrectomy. Apart from proximally and totally gastrectomized cases, the conventional Billroth-I type of distal subtotal gastrectomy destroys many esophageal reflux preventive mechanisms. The Roux-en-Y type of repair should be adopted for the prevention of reflux.
Esophagus↗
Prognostic significance of immunological parameters in patients with esophageal cancer.
BACKGROUND: The role of immunosurveillance in the fight against cancer is well known. In addition, cancer patients have been reported to have an impaired immune function. In patients with esophageal cancer, however, the relationship between the immunological parameters of the host and their survival has not yet been evaluated fully. MATERIALS AND METHODS: Of 103 patients with esophageal cancer who underwent esophagectomy, lymphocyte subsets (CD4+ and CD8+), the PHA response, and natural killer cell (NK) activity were all assessed in relation to clinicopathological features and the prognostic significance was evaluated using both a univariate and multivariate analysis. RESULTS: The CD4+/CD8+ ratio in 58 (56%) patients was higher than the mean of the control, while the PHA response and NK activity in 74 (72%) and 70 (68%) patients, respectively, were lower than 1 SD below the mean of the control. None of these three parameters demonstrated a low value in 5 patients, while 1, 2 and 3 parameters showed a low value in 28, 49 and 21 patients, respectively. The survival rate of the patients with low values in all of three of these parameters was significantly worse than that for the patients in whom the number of low parameters was less than two. A multivariate analysis revealed that tumor invasion and the number of low values in these parameters were independently significant prognostic factors. CONCLUSIONS: This survival analysis revealed that low values in the CD4+/CD8+ ratio, the PHA response, and the NK activity will help predict a poor prognosis in patients with esophageal cancer.
CD4-CD8 Ratio↗
Emptying of the jejunal pouch as a gastric substitute after total gastrectomy for cancer.
BACKGROUND/AIMS: The reservoir and transit capacity of the post-gastrectomy jejunal pouch was evaluated, using a radioisotopic method, to examine the relationship of the gastric emptying to postprandial symptoms and to the food intake status. METHODOLOGY: Thirty-seven patients who had undergone total gastrectomy for cancer (Roux-Y reconstruction, 8; Hunt- Lawrence pouch and Roux-Y, 15; pouch interposition, 5; modified pouch interposition, 9) were retrospectively studied. Based on the percent retention in the gastric substitute, the emptying curves were classed as showing delayed, intermediate, and rapid emptying types. RESULTS: All of the patients with pouch reconstruction showed either delayed or intermediate emptying. High frequency of the sensation of epigastric fullness, nausea, or vomiting was demonstrated in the patients with delayed emptying (p < 0.01). The patients with delayed emptying showed poor food intake compared to those with intermediate emptying (p < 0.05). Given the X-ray video film and endoscopic findings, the delayed emptying was thought to be due to poor drainage of the efferent loop resulting from the post-operative adhesions. CONCLUSIONS: The present study revealed that delayed emptying is associated with postprandial symptoms and with poor food intake. The examination of gastric emptying is useful in evaluating or predicting the postoperative status.
Adult↗
Incidence and prognosis of para-aortic lymph node metastasis in gastric cancer.
BACKGROUND/AIMS: We investigated the frequency of para-aortic lymph node involvement and evaluated the effects on survival of dissection of these lymph nodes in patients with N4 node metastasis. METHODOLOGY: One hundred and forty nine gastric cancer patients with N4 node dissection were analyzed. Total gastrectomy with splenectomy or pancreatosplenectomy was performed in 99, distal gastrectomy 48, pancreaticoduodenectomy 3, and proximal gastrectomy with splenectomy 2. RESULTS: N4 nodal involvement was found in about 30-40% of operable patients with Borrmann's type 3 or 4 tumor, with tumor >8 cm in size, with tumor throughout the entire or in the upper third of the stomach, with tumor invasion to the serosa or adjacent structures, with N2 or N3 regional lymph node metastasis, and with undifferentiated histological type. The survival was quite poor. However, in patients without N3 nodal involvement or intraperitoneal free cancer cells, the survival after resection of tumor with N4 nodal involvement was relatively favorable. CONCLUSIONS: The resection of these involved lymph nodes can be expected to be beneficial in patients without extensive serosal invasion and without extensive lymph nodal involvement such as N3 nodes. Patients with tumor in the upper third of the stomach are appropriate candidates for N4 node dissection.
Adenocarcinoma↗