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Biomedical subjects

S Shionoya

Publications and source records attributed to S Shionoya.

At least 37 records · Page 2Linked to original sources
PubMed1992

Interventional embolization with fibrin glue for a large inferior mesenteric-caval shunt.

We report an unusual case of a large inferior mesenteric-caval shunt in a 25-year-old man without cirrhosis with hypoproteinemia and hypochromic anemia. In this large shunt the direct communication was between the inferior mesenteric vein and the internal iliac vein. Hemodynamic change as a result of the shunt was thought to cause his present clinical problems and future portosystemic encephalopathy. Percutaneous transcatheter embolization of the shunt with fibrin glue was performed through the internal iliac vein, and this offered amelioration of hypoproteinemia and reduction of serum ammonia levels without any complications. An interventional radiologic approach instead of surgical ligation should be attempted for portosystemic shunts, and fibrin glue, as well as coils or a detachable balloon, is also valuable as an embolizing material.

Adhesives↗
PubMed1992

[A case of intrahepatic cholesterol stone complicated with atrophy of the anterior superior ventral and anterior superior lateral subsegments (S8ab) of the liver].

A 61-year-old male patient with intrahepatic cholesterol stone is reported. Stones were detected in the anterior superior lateral subsegment (S8ab) of the right lobe with bile duct stenosis, the lateral anterior segment (S3) of the left lobe, and the left caudate lobe (S11). Partial hepatectomy including S8ab, S3 and S11 was performed to remove all stones. Atrophy of S8ab was diagnosed by CT, and PTP clarified the patency of the subsegmental portal vein (P8ab). This is a rare case with cholesterol intrahepatic stone with regional bile duct stenosis and subsegmental atrophy of S8ab of the liver.

Atrophy↗
PubMed1991

Combined portal vein and liver resection for carcinoma of the biliary tract.

Twenty-nine patients with advanced carcinoma of the bile duct or gallbladder underwent combined portal vein and liver resection. Segmental excision of the portal vein was performed in 16 cases and wedge resection of the vessel wall in 13. The operative mortality rate was 17 per cent. The median survival for the 24 patients who left hospital was 19.8 months. Actuarial survival rates at 1, 3 and 5 years for all 29 patients were 48 per cent, 29 per cent, and 6 per cent respectively, whereas the median survival for 46 patients with unresectable carcinoma was 3 months and the 1 and 3-year actuarial survival rates were 13 per cent and zero respectively. This difference in survival times between patients undergoing hepatectomy with portal vein resection and those with unresectable carcinoma were statistically significant (P less than 0.01). Combined portal vein and liver resection is recommended as a reasonable surgical approach in selected patients with advanced carcinoma of the biliary tract.

Adult↗
PubMed1991

Argon laser-assisted anastomoses in medium-size vessels: one-year follow-up.

Laser-assisted anastomosis of medium-size vessels can be performed with satisfactory short-term patency. This study was undertaken to evaluate patency and structural integrity up to 1 year. An argon laser was used to make bilateral femoral arteriovenous anastomoses in 12 dogs compared to conventional suture method in another 8 dogs. These anastomoses were evaluated for patency and aneurysm formation at 1 hour; 1, 2, 4, and 8 weeks; and 12 months after surgery. All anastomotic sites were patent and without aneurysmal change or luminal narrowing at all harvesting intervals. Histologic examination revealed that within 1 month laser anastomotic sites were almost completely healed and without intimal hyperplasia. In suture anastomoses, foreign-body reaction remained evident up to 1 year. Use of the argon laser for medium size vessel anastomoses resulted in excellent patency without aneurysm formation or intimal hyperplasia even in the long term. These data suggest promising clinical applications.

Anastomosis, Surgical↗
PubMed1991

Hemodynamic assessment of chronic venous insufficiency.

To study the pathogenesis of chronic venous insufficiency (CVI), photoplethysmography and strain-gauge plethysmography were simultaneously performed in 84 patients. Of the 128 limbs studied, 24 were normal, 64 had primary varicose veins and 40 had post-thrombotic syndrome. Venography was also performed in all patients. The results of this study indicate that reflux in the superficial veins is the main pathophysiology involved in the development of CVI, though incompetence of the perforators and deep veins plays some role. In post-thrombotic syndrome, however, CVI is mainly a sequel of deep venous incompetence, the condition being complicated by incompetent perforators and superficial venous reflux.

Chronic Disease↗
PubMed1991

Etoposide inhibition of methylaminoisobutyric acid transport and its recovery in K562 cells.

Sodium-dependent amino acid transport of methylaminoisobutyric acid (MeAIB) in a human myelogenous leukemic cell line K562 was inhibited by 30 nM etoposide (VP-16). Cell growth in suspension was almost completely suppressed by 30 nM VP-16 after 72 h. Colony formation by K562 cells markedly decreased after 24 h in a culture medium containing 30 nM VP-16, whereas MeAIB transport was inhibited after 72 h. K562 cell proliferation was restored in drug-free medium after recovery from 72-h culture with 30 nM VP-16. Colony formation and MeAIB transport were restored to pretreatment levels after 1-2 weeks. Thus, two conclusions may be drawn. (1) MeAIB transport may be correlated with cellular growth and (2) the effects of VP-16 on MeAIB transport were partially reversible.

Aminoisobutyric Acids↗
PubMed1991

Aneurysm of the extracranial internal carotid artery caused by fibromuscular dysplasia.

A case of aneurysm of the extracranial internal carotid artery (ICA) caused by fibromuscular dysplasia (FMD) is reported. The patient also had an aneurysm of the contralateral intracranial ICA, but the renal arteries were normal. A review of the literature shows extracranial ICA aneurysms to be uncommon, with only 3% caused by FMD. The surgical management of such difficult lesions at the base of the skull is discussed.

Carotid Artery Diseases↗
PubMed1991

Induction of DNA replication and cell growth in rat liver by obstructive jaundice.

Obstructive jaundice, produced by ligating the common bile duct, induced a transient DNA replication followed by cell proliferation in rat liver. At 48 h after the operation, DNA polymerase alpha activity started to increase and reached its maximum level (more than twice the control) at day 4. At day 7, the enzyme level had decreased to the control level. Pulse-labeling experiment using radioactive thymidine showed that the rate of DNA synthesis increased approximately 2.5-fold in the same pattern as that of DNA polymerase alpha. The mitotic index in hepatocytes also increased 10-fold at day 4 and then decreased. The proliferation of liver cells induced by obstructive jaundice mimics the regeneration of partially hepatectomized liver, although the response was slightly delayed and the proliferation was transient.

Alanine Transaminase↗
PubMed1991

Purification and characterization of calcium-calmodulin kinase II from human parathyroid glands.

Calmodulin has been identified in parathyroid cells and is thought to play an important role in the production or secretion of parathyroid hormone. However, a detailed investigation of calmodulin-binding proteins in parathyroid glands has not been conducted. In this study, we attempted to determine the presence of calmodulin-binding protein in human parathyroid adenoma by affinity chromatography. The eluted protein from a calmodulin-coupled Sepharose 4B column with EGTA was analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis which revealed a major protein band of Mr 50,000. A Ca2+/calmodulin-dependent protein kinase activity was detected at the protein peak using dephosphorylated casein as a substrate. The 50 kDa band was identified as calcium/calmodulin-dependent protein kinase II (CaM-kinase II) by immunoblotting. The substrate specificity, pH dependency and affinity for calmodulin of this enzyme were identical to those of CaM-kinase II from rat brain. Also, the kinase activity was sensitive to KN-62, a specific inhibitor of CaM-kinase II. In total, 0.48 mg of this kinase was purified from 3 g human parathyroid adenoma.

Calcium-Calmodulin-Dependent Protein Kinases↗
PubMed1991

Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract.

Twenty-four patients with advanced carcinoma of the gallbladder and/or the bile duct underwent hepatopancreatoduodenectomy, that is, en bloc hepatic resection with pancreatoduodenectomy. They included 14 cases of gallbladder carcinoma, nine cases of bile duct carcinoma, and one case of double cancer of the gallbladder and the bile duct. Eleven kinds of hepatic lobectomy or segmentectomy with pancreatoduodenectomy were carried out, and the caudate lobe was also removed en bloc from 17 patients with carcinoma involving the hepatic hilus. Combined resection of the portal vein was performed in 11 patients, of the inferior vena cava in 2, and of the colon in 5, patients. Forty-four postoperative complications occurred in 22 patients (91.7%). The operative mortality rate was 12.5% (3/24). The median survival and the 2-year survival rate were 7.0 months and 17.9% for all 24 patients, including 3 operative deaths, or 11.0 months and 20.4% for 21 patients surviving hepatopancreatoduodenectomy, and 12.4 months and 20.8% for all 14 patients with gallbladder carcinoma, and 5.2 months and 14.8% for all 9 patients with bile duct carcinoma. The longest survivor died of recurrent tumors at 5 years and 7 months. Hepatopancreatoduodenectomy offered not only an unexpectedly long survival period, but also unexpected morbidity in some cases.

Adenoma, Bile Duct↗
PubMed1991

A case of early asymptomatic carcinoma of the hepatic hilus.

We describe a 54-year-old asymptomatic male with carcinoma of the hepatic hilus. Elevated serum transaminases were detected during the annual medical examination. The diagnosis was confirmed by ultrasonography (US), computed tomography (CT), percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP). Curative surgery, which included right hepatic lobectomy with total caudate lobectomy, was performed. The resected specimen revealed a localized tumor in the right anterosuperior dorsal intrahepatic bile duct branch. The histological diagnosis was moderately differentiated tubular adenocarcinoma. The patient's postoperative recovery was smooth and he has remained in good health for 15 months after surgery without any signs of recurrence. This case report discusses the early diagnosis and rational surgical treatment for carcinoma of the hepatic hilus.

Adenoma, Bile Duct↗
PubMed1991

[Management of cholangitis complicated in biliary carcinoma with hilar bile duct stenosis].

We reviewed 60 cases of biliary carcinoma with hilar bile duct stenosis which had received percutaneous transhepatic cholangio-drainage (PTCD). Of the 60 cases, nine were complicated with acute cholangitis (AC) and three with segmental acute obstructive suppurative cholangitis (S-AOSC). The incidence of cholangitis was 20%. Six patients with AC and three with S-AOSC underwent hepatic resection for carcinoma. As to preoperative management for cholangitis in these 9 cases, conservative chemotherapy was effective in only 2 cases, and additional PTCD or segmental introduction of the drainage catheter under PTCS were useful in 5 cases. The remaining 2 cases with S-AOSC needed urgent hepatic resection including suppurative hepatic segments after various interventional treatments. No significant difference was found in resectability, morbidity and mortality between the cholangitis group and non-cholangitis group. In conclusion, it is emphasized that postoperative outcome of biliary carcinoma with cholangitis will be improved by adequate PTCD and/or urgent hepatic resection.

Acute Disease↗
PubMed1991

[Cholangiographic studies on bile duct branches of the caudate lobe in resected cases with biliary tract carcinoma involving the hepatic hilus].

Diagnostic value of the cholangiography was studied for carcinoma of the biliary tract involving the hepatic hilus, and special attention was paid on the cholangiogram of the bile duct branches (B1) of the caudate lobe. Cholangiograms of B1 were compared with pathologic findings in 42 (27 bile duct carcinomas, 15 gallbladder carcinomas) of 43 cases of biliary tract carcinomas. Sixty-four of B1 in the 42 cases could be studied radiologically and histopathologically. The findings of the root of B1 were classified into 4 groups: group A, not stenotic; group B, short segmental stenosis; group C, long segmental stenosis and group D, poorly imaged. Carcinoma invasion was found in 6 of 18 of group B, and in 9 of 16 of group C. Carcinoma was confirmed near the root of B1 in the remaining 7 of the 16 group C. Carcinoma invasion was found in 20 of 21 of group D, and invasion was suspected in the remaining one. Carcinomas were found in the root of B1 in all cases of poorly imaged or long segmental stenosis of B1, and in 33% of short segmental stenosis of B1. Therefore caudate lobe resection should be performed for carcinoma of the biliary tract involving the hepatic hilus.

Adult↗
PubMed1991

Urinary cotinine measurement in patients with Buerger's disease--effects of active and passive smoking on the disease process.

Although Buerger's disease is known to be closely related to smoking, no objective analysis of the smoke-associated problems has been performed. In this study, cotinine, the major metabolite of nicotine, was used as a sensitive marker to measure levels of active smoking and the exposure of nonsmokers to tobacco smoke because it has a relatively long half-life and because cotinine levels can be determined by noninvasive means in urine. According to urinary cotinine levels, 40 patients with Buerger's disease were classified as (1) smokers: those with urinary cotinine levels above 50 ng/mg creatinine; (2) passive smokers: those with levels between 10 and 50 ng/mg creatinine; and (3) nonsmokers who did not experience noticeable passive smoking: those with levels below 10 ng/mg creatinine. There were 10 smokers, 9 passive smokers, and 21 nonsmokers. The course of the disease, after the initial treatment at our hospital, was studied retrospectively. Seven of the 10 smokers, none of the 9 passive smokers, and 4 of the 21 nonsmokers experienced aggravation of the disease. Of the four nonsmokers who experienced aggravation, three had still been smokers and one had been exposed to tobacco smoke in the workplace at the time of relapse. There was a significant difference in the aggravation rate between the smokers' group and the other two groups. Among the smokers, the seven patients whose conditions worsened showed significantly higher cotinine levels than the three remaining patients who were in the stage of remission.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Effects of acute portal hypertension by portal venous stenosis on systemic hemodynamics in dogs.

Effects of acute portal hypertension on systemic hemodynamics after hepatectomy were evaluated by portal venous stenosis (PVS) model in dogs. In protocol 1, portal hypertension of about twice portal venous pressure (PVP) decreased cardiac output (CO) and left atrial pressure (LAP) by 24.5% (p less than 0.01) and 1.0 mm Hg (p less than 0.01), respectively. In protocol 2, stepwise PVS demonstrated that CO change (%) and LAP change (mm Hg) were inversely proportional to PVP change (r = -0.937 and -0.883, respectively). The ratio of CO change to LAP change with stepwise PVS was comparable to that obtained by repeated hemorrhage in protocol 3. The present study shows that low CO with portal hypertension is caused by a reduction of venous return to the heart.

Acute Disease↗
PubMed1990

Resection of intrahepatic bile duct carcinoma with hilar bile duct and portal vein invasion--a case report.

A case of resected intrahepatic bile duct cancer with hilar bile duct and portal vein invasion is presented. Percutaneous transhepatic biliary drainage was performed to alleviate jaundice and evaluate the biliary system. Intraductal tumor extension was determined, and an accurate histological diagnosis was made in biopsy material obtained under percutaneous transhepatic cholangioscopy. Preoperative surgical planning was carried out on the basis of an evaluation of the findings of ultrasonography, computed tomography, arteriography, portography and percutaneous transhepatic cholangioscopy. Curative surgery, which included right hepatic lobectomy with total caudate lobectomy and combined resection and reconstruction of the portal vein, was performed. Bilioenteric continuity was re-established by a Roux-en-Y jejunal loop. The histological diagnosis was moderately differentiated tubular adenocarcinoma originated in the right posterior branch of the intrahepatic bile duct. Postoperative recovery was very good, and the patient has now been enjoying a good active social life for the past three years with no signs of tumor recurrence. This case report discusses the accurate diagnosis and rational surgical treatment for intrahepatic bile duct carcinoma with hilar invasion.

Adenoma, Bile Duct↗