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Biomedical subjects

S Shionoya

Publications and source records attributed to S Shionoya.

At least 55 records · Page 3Linked to original sources
PubMed1990

[A clinicopathological study of mucus producing bile duct carcinoma].

Bile duct carcinoma, which produces clinically recognizable mucus, was defined as "mucus producing bile duct carcinoma", and clinicopathological study was carried out in 7 cases of bile duct carcinoma suitable for the definition. All the tumors arose from the intrahepatic bile duct. There were no tumors arising from the extrahepatic bile duct. Superficially spreading mucosal infiltration of carcinoma was recognized in 6 cases out of 7, and accordingly distinct cholangiography after draining mucus through percutaneous transhepatic cholangio-drainage (PTCD) and percutaneous transhepatic cholangioscopy (PTCS) were indispensable for accurate diagnosis of the extent of carcinoma. The prognosis of patients with mucus producing bile duct carcinoma were almost satisfactory if rational operation had been performed according to accurate diagnosis. On the other hand, since mucus producing bile duct carcinoma frequently has a cystic lesion, the relation to biliary cystadenocarcinoma may become a subject of question. We advocate that biliary cystadenocarcinoma should be included in mucus producing bile duct carcinoma since biliary cystadenocarcinoma originally arises from the intrahepatic bile duct and very rarely from the extrahepatic bile duct. But now the concept of biliary cystadenocarcinoma is equivocal and further investigations will be requested.

Adult↗
PubMed1990

[A study on postoperative bile duct stricture with intrahepatic stones].

From January 1976 through December 1988 we encountered ninety nine cases of intrahepatic stones. Eight of them were complicated with postoperative bile duct strictures which were formed on cholangiojejunostomy in 5 cases, cholangioduodenostomy, hepatic hilum and common hepatic duct in 1 case, respectively. Six cases of them are anastomotic strictures. The stones were mainly composed of bilirubin calcium. We guessed that the bile duct stricture resulted from cholangiojejunostomy without Roux-en-Y in 1 case and anastomotic insufficiency in 5 cases. Intrahepatic stones were removed by percutaneous transhepatic cholangioscopy (PTCS), and the treatment for the stricture was cholangiojejunostomy in 1 case and the dilatation by PTCS in 5 cases, including 3 endoprostheses by pig-tail silicone catheter and 2 internal-external biliary drainage. Two patients who did not undergo cholangioscopic dilatation died of sepsis due to cholangitis. Three of 5 patients who underwent endoscopic dilatation by PTCS could return to social life without recurrence of gallstones. In other two cases an endoprosthetic catheter was removed by PTCS because of dislodgement or obstruction of the catheter after confirming anastomotic strictures had improved. Authors recommended that PTCS should be applied for postoperative bile duct stricture complicated with intrahepatic stone.

Adult↗
PubMed1990

[Rationale of paraaortic lymph nodes dissection for advanced gallbladder cancer].

Paraaortic lymph nodes dissection was performed routinely in 28 patients with advanced gallbladder cancer who underwent curative or relative non-curative resection. In 10 patients out of 28 (36%), metastasis was found in the dissected paraaortic nodes. The incidence of paraaortic lymph nodes metastasis was 50% when the gallbladder serosa or adjacent organs were involved by cancer. If routine paraaortic lymph nodes dissection had not been carried out, the operation would be regarded as curative in 4 patients out of 10 with paraaortic lymph nodes metastasis. The incidence of paraaortic lymph nodes metastasis was twice higher than that of the mesenteric root and the metastatic route was possibly derived directly from the retroportal and/or retropancreactic nodes. Therefore, we emphasize that the paraaortic nodes should be regarded as the nodes between the 2nd group such as the retroportal or retropancreatic nodes and the 3rd group including the nodes of mesenteric root. In spite of positive paraaortic nodes, mean survival time of the patients without other non-curative factors was 26 months and the longest survival was 42 months. It seems that paraaortic nodes dissection has palliative effects to prolong the survival period of those patients. Paraaortic lymph nodes dissection should be employed in radical operative procedures for advanced gallbladder cancer.

Aorta↗
PubMed1990

Combined resection of the inferior vena cava for hepato-biliary and pancreatic malignancies.

Seven cases of hepato-biliary and pancreatic malignancies that underwent partial resection of the inferior vena cava) were reviewed. Histological findings of inferior venca cava involvement were direct invasion in 5 cases, tumor thrombus in 1 case, and adhesion in 1 case. Correct preoperative diagnosis of inferior vena cava involvement was made in only 2 cases. A retrospective study on enhanced CT revealed that irregular deformity of the inferior vena cava had suggested inferior vena cava involvement. Total occlusion of the inferior vena cava was employed temporarily for inferior vena cava resection in 3 cases. A saphenous vein graft was used for reconstruction in 2 cases. Complications due to inferior vena cava resection are, as yet, unknown. One patient is alive, without recurrence, 24 months after the operation. One case underwent re-resection of liver metastasis, and is alive 17 months after the operation. Although advanced hepato-biliary and pancreatic malignancies involving inferior vena cava have been regarded as having a poor prognosis, an aggressive surgical approach may be applicable in some cases.

Biliary Tract Neoplasms↗
PubMed1989

Sphincter of Oddi response to caerulein after endoscopic sphincterotomy for papillary stenosis.

Using a percutaneous transhepatic cholangioscopy (PTCS) catheter, sphincter of Oddi motility was measured in a patient with papillary stenosis secondary to bile duct stones. Prior to sphincterotomy, intramuscular injection of 20 micrograms caerulein did not inhibit pathological contraction waves of the sphincter of Oddi or relieve abdominal pain. Endoscopic sphincterotomy of the lower segment of the sphincter of Oddi resulted in recovery of the normal response to caerulein, i.e. relaxation of the sphincter of Oddi. This observation indicates that the pathological contraction and lack of relaxation to cholecystokinin in a patient with papillary stenosis is due to high common bile duct pressure. The measurement of motility of sphincter of Oddi via the PTCS route is useful in diagnosing motor disorders in the sphincter of Oddi and is helpful in deciding to perform endoscopic sphincterotomy.

Aged↗
PubMed1989

Cholangioscopic differentiation of biliary strictures and polyps.

Since April 1977 percutaneous transhepatic cholangioscopy (PTCS) has been carried out in 428 cases comprising 213 cases of malignant disease and 215 benign cases. PTCS is performed through the dilated sinus track of percutaneous transhepatic biliary drainage. When irregularly dilated and tortuous vessels, which we called tumor vessels, are revealed on biliary strictures or polyps, a correct diagnosis of cancer can be made. Benign biliary strictures with or without gallstones, or polypoid lesions without tumor vessels such as granulomas, can be differentiated by cholangioscopic biopsy. The positive rate of cholangioscopic biopsy in 57 cases of bile duct cancer was 96%. PTCS should be used pre-operatively as a definitive diagnostic procedure for biliary tract strictures and polyps.

Bile Duct Diseases↗
PubMed1989

Hepatic transcatheter arterial embolization with gastroduodenal artery blocking by finger compression.

Hepatic transcatheter arterial embolization was performed in two patients by blocking the gastroduodenal artery with finger compression on the abdominal surface. The embolizing material, which was injected into the common hepatic artery, did not enter the gastroduodenal artery. No postoperative complications were experienced. This method may be useful for patients in whom superselective catheterization of the proper hepatic artery is not feasible.

Angiography↗
PubMed1989

Postprandial gastric blood flow in conscious dogs.

Left gastric arterial blood flow was measured with an electromagnetic flowmeter in conscious dogs. Immediately after the ingestion of 300 g of meat or milk, gastric blood flow increased to 250-270% of the control but declined to preprandial levels in 10 min despite the presence of milk in the stomach. Gastric distension with a 300-ml balloon evoked a response of approximately 50% of that of milk, but continuous distension failed to maintain gastric hyperemia. The initial peak response to milk and distension was reduced by hexamethonium (-58 and -62%, respectively) and oxethazaine (-43 and -29%, respectively) but not by phenoxybenzamine, propranolol, or atropine. Thus the initial response was induced by both the contact of food with the mucosa and the distension of the stomach partly via the activation of neural reflexes. Gastric blood flow after the peak was dependent on the type of food and its route of administration; it was elevated by 30% after a meat meal, remained close to fasting levels after oral administration of milk, and fell below fasting levels (-17%) after intragastric administration of milk. An intraduodenal infusion of milk, but not water, reduced gastric blood flow below the control (-26%). Pentagastrin, which caused approximately 50% of the maximal acid secretion, increased gastric blood flow by only 10%.

Animals↗
PubMed1989

[Studies on cholangiographic and endoscopic findings of primary intrahepatic cholesterol stones].

Cholangiographic investigations in 16 patients with primary intrahepatic cholesterol stones yielded some characteristic findings as follows. 1. Several numbers of stones were filled within locally dilated portion of the subsegmental or more peripheral intrahepatic bile duct branches, with no or minimal dilatation of the more peripheral portion and no stenosis-like lesions of the more hilar portion. 2. The lesion was single or multiple scattered in the liver and intrahepatic cholangiogram excluding involved segments was almost normal. 3. Although extrahepatic bile duct and/or gallbladder stones were often associated, the normal gallbladder, cystic duct and papillary portion and slightly dilated common bile duct were demonstrated. These cholangiographic findings were compatible with the endoscopic findings that inflammatory changes of the bile duct were rarely observed. According to above mentioned findings, it is suggested that the etiology of this disease differs from intrahepatic stones of calcium bilirubinate and dissolution therapy with bile acid may be available.

Adult↗
PubMed1989

[The prognosis of intermittent claudication].

The purpose of this study is to obtain the informations about the fate of the limbs and lives of claudicants due to arteriosclerosis obliterans. Two hundred and seven lower limbs of 165 patients suffering from intermittent claudication were observed for an average period of about six years. Eighty-seven limbs of 69 patients were managed nonsurgically (Group A). Ninety-eight percent of limbs in Group A remained unchanged or improved, and no limb was amputated. One hundred and twenty limbs of 96 patients had arterial reconstructions (Group B). Although 75 percent of limbs in Group B had benefits by successful operations, 26 percent of them experienced graft failures, and 2.7 percent of them were amputated. Five year graft patency rates in the limbs with supra- and infra-inguinal reconstructions were 82.1 percent and 65.7 percent, respectively. Operative mortality rate was 2.1 percent, and mortality rate due to late complications was 3.3 percent. The prognosis of intermittent claudication with regular follow-up was relatively good, therefore, it is important to recognize that arterial reconstruction is not the only way to treat limbs with mild intermittent claudication. About 30 percent of claudicants died within 5 years, and 60 percent of them died from cardiac or cerebrovascular disease. The results suggested that much attention should be paid to the lives as well as the limbs of claudicants.

Aged↗
PubMed1989

Quantification of leg muscle perfusion using thallium-201 single photon emission computed tomography.

The purpose of this study is to quantify leg muscle perfusion with 201Tl single photon emission computed tomography (SPECT). Six normal controls and 21 patients with peripheral arterial disease underwent this examination. Thallium-201 leg SPECT of both stress and redistribution was performed using a dual-headed digital gamma camera. Each slice of transverse images was normalized with pixels and whole-body counts. In normal controls, the activity of posterior tibial muscle components was significantly higher than that of anterior tibial muscle components (p less than 0.001). In 14 components, where patients had insignificant lesions, profile curves were normal in 10 (71%). In 62 components, where patients had arteriographically significant lesions, stress profile curves were abnormal in 57 (92%) compared with normal controls. Approximately, in half (28/62) components which had significant lesions, profile curves showed redistribution after 3 hr compared with normal redistribution curves. In three patients who underwent successful bypass graftings, the activity of each muscle component returned to a normal range.

Adult↗
PubMed1989

[A study of concomitant chronic pancreatitis in forty-one cases of adult congenital biliary dilatation].

Forty-one cases of adult congenital biliary dilatation (CBD) were studied for concomitant chronic pancreatitis. Of the 41 cases, 8 had had such previous operations as choledochojejunostomy or choledocho-duodenostomy without biliary diversion (reoperated cases) and the other 33 had not received previous operations (primary cases). All of the 36 cases whose type of pancreatico-biliary junction could be examined revealed anomalous pancreatico-biliary junction. Four cases (10%) of CBD (1 of the primary and 3 of the reoperated cases) were complicated by chronic pancreatitis. On examining the elapsed time between the first and the final operation of the reoperated cases, in the 5 cases whose periods were less than 13 years, none was complicated by chronic pancreatitis. On the contrary, in the 3 cases whose periods of time were more than 17 years, all were complicated by chronic pancreatitis. The results suggest that choledochoenterostomy without biliary diversion enhances pancreatic damage in cases with anomalous pancreatico-biliary junction.

Adolescent↗
PubMed1989

[Indication of femorotibial and femoroperoneal bypass for Buerger's disease].

Infrapopliteal bypass with autogenous vein graft was performed in twenty-three patients of thromboangiitis obliterans (Buerger's Disease) during the past 8 years. The outflow vessel of the graft had the direct connection with the pedal arch in 3 cases. In 20 cases the graft was anastomosed to the solitary tibial or peroneal segment, in which the occlusive lesion existed between the outflow vessel and pedal arch, or otherwise, the pedal arch was not opacified in the arteriogram. The length of the solitary tibial or peroneal segment of the successful cases ranged from 11.5 cm to 29.0 cm. The cumulative patency rates of the 23 bypass grafts at 3 months, 1 year, 3 years and 5 years were 86.7%, 77.3%, 77.3%, 77.3% respectively. This result is comparable to those of other authors. When the solitary tibial or peroneal artery is found out and is longer than 12 cm in the arteriogram of Buerger's Disease, we are going to perform bypass surgery to the vessel. If the foot is already necrotic, the amputation should be carried out several days or several weeks after the successful reconstructive surgery.

Adult↗
PubMed1988

Fate of the ischaemic limb in Buerger's disease.

The clinical course of 328 patients with Buerger's disease (thromboangiitis obliterans: TAO) was followed. Neither ischaemic ulcers nor gangrene occurred in 26 per cent of the patients. Almost all of the ulcers occurred in patients between 20 and 50 years of age, with a peak incidence between 40 and 45 years. The younger the patient at the onset of the disease, the later the first ulcer occurred, and the later the first ulcer occurred, the shorter the period in which ulceration may recur. Recurrent ulcers were observed in 45 per cent of the patients. The progression of symptoms was influenced by smoking, but this was not the only deleterious factor as there were patients with stable TAO unaffected by smoking. In the 30 patients over the age of 60 years, ulceration and gangrene were not observed. In all patients, the progression of symptoms was self-limited and recurrent ulcers occurred less frequently with ageing. The rate of major amputation was low (3.9 per cent) although minor digital amputations were sometimes required. The survival rate of patients with TAO was higher than that of patients with arteriosclerosis obliterans. The aim of treatment in patients with TAO is to make patients abstain from smoking to prevent ulceration and to shorten the period of healing of trophic lesions without major amputation, as ulceration and gangrene in T AO are limited to the most distal part of the limbs, and seems to have healing potential.

Adult↗
PubMed1988

Value of percutaneous transhepatic cholangioscopy (PTCS).

Since July 1975, percutaneous transhepatic biliary drainage (PTBD) has been performed in 533 cases, and since April 1977 we have developed percutaneous transhepatic cholangioscopy (PTCS) as a diagnostic and therapeutic endoscopical tool in 198 cases of malignant disease and 195 benign cases. After dilating the sinus tract of PTBD using a 15-Fr catheter about 2 weeks after PTBD, PTCS was carried out through the sinus tract. PTCS has diagnostic advantages: the lesion can be accurately diagnosed histologically and the extent of cancer in the biliary tract can be assessed by taking biopsy specimens before the operation. PTCS has been applied for cholangioscopic lithotripsy in 145 cases of gallstone disease. In 44 cases, the Nd-YAG laser and/or electrohydraulic shock wave has been used to break up the stones. The PTCS morbidity was 6% and mortality was 0.3%.

Biliary Tract Diseases↗
PubMed1988

Feedback regulation of basal pancreatic secretion in humans.

The effect of intrajejunal infusion of pancreatic juice on basal pancreatic secretion was studied in patients who had received pancreatoduodenectomy for pancreatic, biliary, or duodenal malignancy. Pure pancreatic juice was obtained through a drainage tube inserted into the main pancreatic duct. There was little fibrosis in the pancreatic remnant and daily pancreatic juice output was more than 200 ml. After intraluminal infusion of pancreatic juice, water, protein, bicarbonate, and enzyme outputs were decreased significantly by about 30%. Intraluminal trypsin also reduced pancreatic secretion. Trypsin inhibitor (aprotinin) suppressed the significant decrease caused by autopancreatic juice or trypsin solution. We conclude that basal pancreatic secretion in humans is under negative feedback control by intestinal pancreatic juice or tryptic activity.

Adult↗
PubMed1988

Postprandial celiac and superior mesenteric blood flows in conscious dogs.

Celiac and superior mesenteric arterial blood flows were measured simultaneously in conscious beagle dogs. The responses to food were completely different between the two arteries. Celiac flow increased quickly to 180-200% of the control 2 min after food but started to decline rapidly to preprandial levels, though greater than 90% of food was still in the stomach. It remained at preprandial levels over the next 1-6 h. Superior mesenteric flow increased gradually in 20-50 min (peak: 230%) and remained above the control levels for 3-6 h. The celiac response was inhibited by vagal block, hexamethonium, and gastric mucosal anesthesia by oxethazaine but not by atropine, phenoxybenzamine, or propranolol. Postprandial superior mesenteric hyperemia was blocked by mucosal anesthesia and was reduced by atropine by 80%. Ganglionic or adrenergic blockades were without effect. It is concluded that the celiac peak response to food is mediated by a nonadrenergic, noncholinergic vagal reflex in conscious dogs. Extrinsic nerves probably play little part in the postprandial increase of superior mesenteric flow.

Animals↗