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Biomedical subjects

S Yamazaki

Publications and source records attributed to S Yamazaki.

755 records · Page 42Linked to original sources
PubMedDate not supplied

Restrictive versus liberal blood transfusion policy for hepatectomies in cirrhotic patients.

To evaluate the worth of intra- and postoperative blood transfusion in cirrhotic patients undergoing resection for hepatocellular carcinoma, we compared 13 patients receiving transfusions and 14 matched contemporary patients who did not receive blood. Preoperative hematological and biochemical parameters, the type and extent of liver resection, and the mean blood loss (862 and 870 ml) were similar in the 2 groups. The total volume of intra- and postoperative blood transfused ranged from 400 to 1,800 ml (mean, 1,223 ml) in the patients receiving transfusions. During various postoperative time intervals, the mean values of hematocrit, hemoglobin, serum total bilirubin, and lactic dehydrogenase activity were significantly higher in the patients who were transfused compared to those who were not. Mean serum transaminase activities were similar in the 2 groups at the same times. The mean hematocrit values decreased from 36.8% preoperatively to a postoperative minimum of 27.0% in the transfused group, and from 39.9% to 26.1% in the nontransfused group. Our experience and theoretical reasons have led us to withhold blood transfusion until the hematocrit values fall below 30% during hepatectomy and below 20% in the postoperative period (or unless circulatory instability cannot be corrected otherwise). Fresh frozen plasma is preferred for volume substitution and, if blood has to be given, only up to 60-70% of estimated losses should be replaced by fresh blood.

Adult↗
PubMedDate not supplied

Ultrasonically guided cholangiography and bile drainage.

Ultrasonically guided percutaneous transhepatic cholangiography (UG-PTC), bile drainage (UG-PTBD) and gallbladder drainage procedure (UG-PTGBD), developed by us, were performed in 47, 183 and 36 patients, respectively. In 47 patients UG-PTC was successfully performed 51 times without complications. By UG-PTBD 220 intubations were carried out successfully and four attempts failed (1.8%). The main complication was that the catheter slipped out from the bile duct. It was experienced 27 times (12.3%) in 23 patients (12.4%) from two to 47 days after intubation. UG-PTGBD was successfully performed 36 times. Bleeding from the catheter was experienced in four patients. However, other complications such as cholascos were not experienced. Due to the development of ultrasonic diagnosis and the UG-PTBD procedure, the indications for percutaneous transhepatic cholangiography (PTC) are now limited. For differentiation of jaundice, ultrasonic examination takes over from PTC. For preparation of PTBD, thin needle cholangiography is no longer necessary because UG-PTBD is a single-step procedure without the need for cholangiography. Therefore, the indication for PTC is limited to patients with partial dilatation of intrahepatic bile ducts without jaundice, for example when only the left hepatic duct is dilated due to hepatolithiasis.

Bile↗
PubMedDate not supplied

Chronic subdural hematoma, as an initial manifestation of glutaric aciduria type-1.

A 10-month-old male with glutaric aciduria type-1 (GA-1) is reported. This patient showed frequent partial motor seizures, irritability, and involuntary movements, including oral dyskinesia at the age of 3 months. On admission, magnetic resonance (MR) scanning revealed a chronic subdural hematoma and widening of the bilateral insular cisterns. Urine organic acid analysis showed marked excretion of glutaric acid, 3-hydroxy glutaric acid and glutaconic acid, suggesting GA-1. Removal of the subdural hematoma was effective for the irritability but not for the extrapyramidal signs. This is the first report of a subdural hematoma as an initial symptom in a patient with GA-1. However, the complication of subdural fluid collection in GA-1 is not rare. To our knowledge, of 29 patients with GA-1 who underwent computed tomographic or MR scans, 5 had subdural fluid collection. Disproportional hypoplasia of the temporal lobes may be a suggestive etiology of subdural fluid collection/chronic subdural hematoma.

Amino Acid Metabolism, Inborn Errors↗
PubMedDate not supplied

A study of the evolution of coxsackievirus A24 variant in Ghana by viral RNA fingerprinting analysis.

An epidemic of acute haemorrhagic conjunctivitis (AHC) caused by coxsackievirus A24 variant (CA24v) was reported in Accra, Ghana in May 1987. We studied 7 of the viral strains collected from May to November, 1987, by RNA genome fingerprinting. Pairwise comparisons of the oligonucleotide maps showed that genetic similarity among them ranged from between 60.0 to 84.7%. Using base sequence variations deduced from genetic similarity among the isolates, isolation time of the strains and the rate of nucleotide substitution (estimated in a previous paper, Miyamura et al., 1990), we calculated divergence times and constructed a phylogenetic tree. This tree indicated that all the 7 strains had diverged from each other from 11 to 26 months before the AHC epidemic in Accra. CA24v may have been introduced into the country or the neighbouring area, at least, more than two years earlier, i.e. in the early half of 1985.

Adult↗
PubMedDate not supplied

CT of nodular hyperplasia of the liver in non-Hodgkin lymphoma.

During follow-up of non-Hodgkin lymphoma in a 60-year-old man, multiple hepatic small lesions were incidentally found by sonography. Dynamic CT disclosed enhancing masses in both the right and left lobes and faint arterioportal shunting in the left lobe of the liver. These findings were confirmed by angiography. Portal hypertension was, however, not present. Exploratory laparotomy revealed nodular regenerative hyperplasia of the liver. The nontumorous liver was normal.

Humans↗
PubMedDate not supplied

Focal nodular hyperplasia of the liver: arterial angio-CT and microangiography.

To differentiate focal nodular hyperplasia (FNH) from other hepatic tumors, especially hepatocellular carcinoma, we evaluated the hemodynamics of histologically proved FNH in three patients, two by arterial angio-CT and one by microangiography of the resected specimen. These studies demonstrated the centrifugal blood supply of FNH (early filling of central tumor vessels radiating to periphery, and lobulated tumor stains with central low density area in the late phase), which could not be demonstrated by dynamic CT or hepatic angiography. Arterial angio-CT is useful as a further study, when differential diagnosis of FNH is uncertain by other imaging techniques.

Adolescent↗
PubMedDate not supplied

Abnormal prothrombin: evaluation as a tumour marker and localization in tissues of patients with hepatocellular carcinoma.

In this study, the diagnostic significance of PIVKA-II concentrations in various liver diseases was evaluated, and the use of PIVKA-II as a tumour marker for hepatocellular carcinoma (HCC) was discussed. Also, the location of abnormal prothrombin (PIVKA-II) production in HCC by indirect immunoperoxidase staining was examined. There was a good correlation between plasma and serum PIVKA-II concentrations, indicating that serum samples are adequate for PIVKA-II measurements. Fifty-four of 97 (55.7%) patients with HCC, one of 10 (10%) patients with metastatic liver cancer and two of 47 (4.3%) patients with liver cirrhosis had positive serum PIVKA-II concentrations. Positive serum PIVKA-II concentrations were found more frequently in patients with HCC than in any other liver disease (P < 0.01). Of the 97 patients with HCC, 54 (55.7%) were PIVKA-II positive, 76.3% had serum concentrations of either PIVKA-II or alpha-fetoprotein, indicating the usefulness of both tumour markers in the diagnosis of HCC. Using frozen sections of tissue specimens obtained at autopsy or during surgery, the localization of PIVKA-II was examined by indirect immunoperoxidase staining with specific anti-PIVKA-II antibodies. Tissues from 12 of 22 patients with HCC had positive PIVKA-II indirect immunoperoxidase staining only in the cancer cells. Cells with greater atypia tended to have stronger cytoplasmic staining. No specific staining was observed in non-cancerous cells. These findings suggest that PIVKA-II is synthesized specifically in hepatic cancer cells.

Adult↗
PubMedDate not supplied

Quantitation of c-erbB-2 gene amplification in breast cancer tissue by competitive PCR.

Controversy exists regarding the relationship of the degree of c-erbB-2 amplification to other prognostic factors in breast cancer. To determine the degree of amplification of c-erbB-2 exactly, a sensitive and quantitative method is required. We have developed a competitive PCR method to quantitatively determine the amplification of the c-erbB-2 oncogene. Using this method, we evaluated DNA from 27 breast cancer tissue specimens and DNA from peripheral blood leukocytes from a normal individual. Regarding the relationship between the degree of c-erbB-2 amplification and clinicopathological factors, we found a greater degree of amplification of the c-erbB-2 oncogene in estrogen receptor- negative or progesterone receptor-negative specimens than in positive ones and in lymph node metastasis-positive specimens than in negative specimens, in stages II, III, and IV of disease compared with stage I disease, and in samples with positive lymphatic vessel invasion than with no lymphatic vessel invasion. Generally, these factors were seen in the group of patients who had a bad prognosis. By univariate analysis and multivariate analysis, reverse correlation was observed between amplification of c-erbB-2 and overall survival. Regarding disease-free survival, these relationships were observed only with univariate analysis in our group of patients.

Adult↗
PubMedDate not supplied

Dermal mucinosis and musculoskeletal symptoms simulating polymyositis as a presenting sign of hypothyroidism.

A case of dermal mucinosis and musculoskeletal symptoms simulating polymyositis as a presenting sign of hypothyroidism is presented. The patient presented muscle weakness and edema of the face including the eyelids. Laboratory examination revealed elevated creatinine phosphokinase, decreased free-T4, decreased free-T3, elevated TSH, positive anti-microsome antibody and positive anti-TSH receptor antibody. The skin biopsy specimen revealed swelling of the collagen bundles with the bundles splitting up into individual fibers, with some blue threads and granules of mucin interspersed. Alucian blue stain demonstrated vast amounts of mucin throughout the whole dermis, which was completely removed on incubation with Streptomyces hyaluronidase. The patient was diagnosed as having hypothyroidism due to Hashimoto's disease with possible polymyositis complications. After two months of thyroid hormone replacement therapy, she was euthyroidic and discharged. These results indicate that our case was a rare case of severe generalized myxoedema due to hypothyroidism of Hashimoto's disease simulating the musculoskeletal symptoms of polymyositis.

Aged↗
PubMedDate not supplied

Hepatic resection with and without surgical margins for hepatocellular carcinoma in patients with impaired liver function.

BACKGROUND/AIMS: The significance of a surgical margin for hepatic resection of hepatocellular carcinoma (HCC) in patients with impaired liver function was evaluated. METHODOLOGY: Sixty-eight patients, each with a solitary HCC, who had not received any prior treatments were divided into 2 groups, according to surgical margin: Group A included 25 patients who underwent resection with no margin (although the tumor was not exposed) and Group B included 43 patients with a sufficient surgical margin (mean distance: 9 mm). There were no significant differences in clinicopathologic variables between the 2 groups. The rate of stump recurrence, survival and recurrence-free survival were analyzed. RESULTS: Among the 38 patients who had cancer recurrence after a median follow-up of 58 months, 9 (Group A, n=4; Group B, n=5) (24%) had recurrent lesions at the stump. The surgical margin was not a significant factor related to survival or recurrence, irrespective of cirrhosis, capsule formation, cancer spread, or tumor size. CONCLUSIONS: Our results indicated that the HCC-free surgical margin is unlikely to be related to the survival of patients with impaired liver function unless the tumor is exposed on the raw liver surface.

Adult↗
PubMedDate not supplied

Anti-influenza virus activity of a lignin fraction from cone of Pinus parviflora Sieb. et Zucc.

When mice were inoculated intranasally or intracerebrally with lethal doses of influenza virus A/WSN/33, most died within 12 days. However, the infectivity of virus that had been preincubated with a lignin prepared from cones of Pinus parviflora Sieb. et Zucc. (PC-Fr. VI) was significantly reduced. Intraperitoneal or oral administration of PC-Fr. VI, prior to virus inoculation, slightly increased the survival ratio of the infected mice. Experiments using radiolabeled PC-Fr. VI revealed that this fraction effectively binds to virions as well as to cultured cells. These data suggest that PC-Fr. VI either inactivates the virus or induces the anti-viral state in cells by binding to virions or cells.

Administration, Oral↗
PubMedDate not supplied

[Hepatectomy for hepatocarcinoma on a cirrhotic liver: decision plans and principles of perioperative resuscitation. Experience with 204 cases].

Among more than 450 hepatectomies performed in the National Cancer Center Hospital of Tokyo from the beginning of 1977 to the end of 1986, 204 were performed for excision of an hepatocarcinoma on cirrhotic liver. The post-operative mortality (determined until the exit of the patient out of the hospital) was 7.8%. It was rather high at the beginning (20% of the first 30 cases) and progressively decreased with experience, to be only 2.8% of the last 70 cases. According to this experience the authors recommend a decisional diagram which appreciate the quantity of functional liver parenchyma which must be resected (depending on the tumor's characteristics) and the quantity of functional liver parenchyma which can be resected without major operative risk (depending on the gravity of the cirrhosis). They expose their attitude with oesophageal varix, the operative techniques and the peri-operative cares they have trained to decrease dramatically the post-operative complications.

Adult↗
PubMedDate not supplied

MRI of pulmonary sequestration with hemorrhage.

We present a case of hemorrhage into an intralobar pulmonary sequestration in which magnetic resonance imaging (MRI) clearly demonstrated a mass of high signal intensity on both T1- and T2-weighted images, indicative of hemorrhage.

Bronchopulmonary Sequestration↗
PubMedDate not supplied

Intrahepatic cholangiocarcinoma presenting intrabile duct tumor growth: report of a case.

A case of intrahepatic cholangiocarcinoma with intrabile duct tumor growth is presented. A 70-year-old female with prolonged obstructive jaundice and cholangitis was diagnosed with a mass lesion in the left lobe of the liver accompanied by an intrabile duct component which caused hilar bile duct obstruction. Percutaneous transhepatic biliary drainage (PTBD) was performed via three routes with intensive care of the drainage catheters over a 2-month period to alleviate jaundice and cholangitis. Extended left hepatic lobectomy with combined resection of extrahepatic bile duct and regional lymph nodes were carried out curatively. Macroscopically, a tumor formed a 8 x 6 cm mass with a scalloped margin in the left lobe and had an intraductal component with a round smooth surface protruding from the lumen of the left hepatic duct into the common bile duct. The histologic type of the tumor was well differentiated tubular adenocarcinoma. The intraluminal tumor grew expansively without invasion to the bile duct wall. The postoperative course was uneventful and the patient has remained in good health without recurrence for 1 year and 3 months since surgery. This case report discusses a rare extension pattern in ICC and the management of malignant hilar obstruction during radical surgery.

Aged↗