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Biomedical subjects

T Miyano

Publications and source records attributed to T Miyano.

At least 109 records · Page 6Linked to original sources
PubMed1996

Lingual thyroglossal duct cyst: a unique surgical approach.

Thyroglossal duct cyst (TGDC) is one of the more common causes of a pediatric neck mass. Lingual TGDC, which is located at the base of the tongue, is an unusual variant. Because of the oral pharyngeal location, lingual TGDC may cause dysphagia and respiratory distress. Previous investigators have advocated the use of a formal Sistrunk procedure for lingual TGDC. Herein the authors describe three children with a lingual TGDC in whom marsupialization of the cyst was performed, without excision. The follow-up period ranges from 2 to 5 years, and there has been no recurrence. Because of the low morbidity and high success rate associated with this approach, the authors recommend it for the treatment of lingual TGDC.

Humans↗
PubMed1996

Sibling occurrence of biliary atresia and biliary dilatation.

Familial occurrence of extrahepatic biliary atresia (EHBA) or biliary dilatation has been reported; however, the genetic influences on these disorders are still obscure. The authors previously reported the occurrence of biliary dilatation and EHBA in sisters, which is extremely rare. Recently, a similar pair of sisters was treated; one had pancreaticobiliary maljunction with minimal dilatation of the common bile duct, and the other also had EHBA. The authors' investigations suggest that there may be common etiologic factors for EHBA and biliary dilatation, such as pancreaticobiliary maljunction; however, other factors are required to complete the process and cause biliary atresia.

Bile Ducts↗
PubMed1996

Lack of intestinal pacemaker (C-KIT-positive) cells in infantile hypertrophic pyloric stenosis.

The pathogenesis of infantile hypertrophic pyloric stenosis (IHPS) is not well understood. Recent studies have shown that the protonocogene c-kit is essential for the development or maintenance of autonomic gut motility, and also show that the c-kit gene protein product (C-KIT) positive cells in the mammalian gut are responsible for intestinal pacemaker activity. This study examines cells in the pyloric muscles of 23 patients (16 with IHPS, 7 controls) for the presence of the C-KIT (C-KIT+), using immunohistochemical techniques with antihuman C-KIT sera. In the controls, many C-KIT immunoreactive (IR+) cells were observed in the muscle layers. The myenteric plexuses were demarcated by a moderate number of C-KIT-IR+ cells. However, in the IHPS patients, C-KIT-IR were either absent or significantly reduced. No C-KIT-IR+ cells were found around the myenteric plexuses. These findings suggest that a lack of c-kit expression (as an indicator of intestinal pacemaker activity) in the hypertrophic pyloric smooth muscles may be an important factor in the pathogenesis of IHPS.

Biological Clocks↗
PubMed1996

Localization of intestinal pacemaker cells and synapses in the muscle layers of a patient with colonic hypoganglionosis.

Bowel dysmotility in association with hypoganglionosis remains unexplained. The proto-oncogene c-kit encodes a transmembrane tyrosine kinase receptor, and the c-kit protein-product (C-KIT) positive cells in the mammalian gut are responsible for intestinal pacemaker activity. The authors examined the localization of intestinal pacemaker cells in the muscle layers of a patient with colonic hypoganglionosis, using an antihuman C-KIT serum. In the normoganglionic ileum, many C-KIT immunoreactivity positive (C-KIT-IR+) cells were present in the muscle layers. In contrast, there were no C-KIT-IR+ cells in the muscle layers of the hypoganglionic colon. These findings suggest that a lack of c-kit expression may be responsible for the autonomic gut dysmotility in hypoganglionic bowels.

Colon↗
PubMed1996

Hepaticoenterostomy after excision of choledochal cyst in children: a 30-year experience with 180 cases.

In the long-term follow-up of patients with choledochal cyst, postoperative ascending cholangitis and/or stone formation in the intrahepatic bile ducts (IHBD) owing to anastomotic stricture present serious problems. To prevent the formation of anastomotic strictures, some surgeons recently have performed hepaticoenterostomy at the hepatic hilum, with a wide stoma, in all patients with choledochal cyst. The authors of the present study review the surgical procedures performed on a total of 180 children with choledochal cyst and discuss the treatment of choice, with special reference to the types of hepaticoenterostomy. The medical records and radiographs of all patients treated for choledochal cyst between January 1964 and December 1993 at the authors' institutions were reviewed. A total of 180 patients (mean age at time of surgery, 4.3 years) had follow-up for a mean of 11.1 years; 174 of them had cyst excision and hepaticoenterostomy, and six had cystoenterostomy. Of the 174 patients who underwent cyst excision, 171 had a conventional hepaticoenterostomy; two had an intrahepatic cystoenterostomy, and one had a hepaticoenterostomy at the hepatic hilum. IHBD stones with or without cholangitis developed postoperatively in four (2.3%) of the 171 patients who had conventional hepaticoenterostomy. The age at time hepaticoenterostomy of these four patients was 12, 7, 16, and 6 years. Postoperative IHBD stone formation and cholangitis were not found in 121 patients under 5 years of age. The authors recommend conventional hepaticoenterostomy as the treatment of choice for children with choledochal cyst. Hepaticoenterostomy at the hepatic hilum is indicated in only selected cases.

Adolescent↗
PubMed1996

Pancreaticobiliary maljunction associated with nondilatation or minimal dilatation of the common bile duct in children: diagnosis and treatment.

It is known that the etiology of congenital biliary dilatation (CBD) is closely associated with pancreaticobiliary maljunction (PBMJ). Treatment of CBD today is primary excision of the cyst followed by hepaticoenterostomy. However, PBMJ without dilatation of the biliary tract has recently been reported and its treatment is still controversial. In adults, simple cholecystectomy without biliary reconstruction is often performed, because it usually presents as an anomaly of the gallbladder. Over 30 years, we have encountered 8 patients with PBMJ without dilatation of the common bile duct in 180 pediatric cases of CBD. The presenting symptoms of these patients were those of pancreatitis i.e. abdominal pain associated with elevation of serum amylase levels. Five cases presented with jaundice or a history of pale colored stools. Endoscopic retrograde cholangiopancreatography was performed to confirm the diagnosis. Five (62.5%) of these 8 patients were found to have dilatation of the common channel, which was seen in 50 (29%) of the 172 other cases with biliary tract dilatation. Three cases (37.5%) had proven protein plugs or debris at the level of the common channel, and this was observed in 28 (16%) of the 172 other cases. It is strongly suggested that the manifestation of clinical symptoms in these patients results from stasis or obstruction at the level of the common channel. In children who present with recurrent pancreatitis, PBMJ must be suspected even if the common bile duct appears to be normal. It is difficult to resolve these anomalies without operative repair. The authors consider that radical treatment of PBMJ is required in these children to prevent serious long-term complications.

Abdominal Pain↗
PubMed1996

Specific acceptance of fetal bowel allograft in mice after combined treatment with anti-intercellular adhesion molecule-1 and leukocyte function-associated antigen-1 antibodies.

OBJECTIVE: The aim of this study was to see whether tolerance could be induced by simultaneous administration of monoclonal antibodies (MoAbs) to intercellular adhesion molecule-1 (ICAM-1) and leukocyte function-associated antigen-1 (LFA-1) after transplantation of fetal small bowel between fully incompatible mice strains. METHODS: Fetal small bowel from either BALB/c (H-2d) or C3H/He (H-2k) mice was transplanted into the space between the peritoneum and rectus abdominis of adult C3H/He recipient mice. Syngeneic (n = 6) and two allogeneic transplant groups were made. In one of the allogeneic groups (n = 8), no immunosuppressant was given. In the other allogeneic group (n = 13), both anti-LFA-1 and anti-ICAM-1 MoAbs (50 micrograms each/mouse/day) were given intraperitoneally after transplantation for the first 4 weeks. In the syngeneic and untreated allogeneic groups, all mice were killed 4 weeks after transplantation. In the treated allogeneic group, eight mice were killed 6 weeks after cessation of the MoAb treatment. At the time the mice were killed, the bowel graft as well as the recipient spleen were taken for histologic analysis and cytotoxic T-lymphocyte (CTL) assay, respectively. Each mouse in the remaining treated five mice was transplanted with BALB/c and C57BL/6 (as third-party) full-thickness skin simultaneously 8 weeks after cessation of the MoAb treatment. RESULTS: All grafts in the syngeneic group survived with normally developing villi, whereas all grafts in the untreated allogeneic group disappeared. In the treated allogeneic group, all allografts developed normal mucosa without any sign of rejection. Splenocytes from the recipient mice in the untreated allogeneic group showed increased CTL induction against donor-type alloantigen (p < 0.005), compared with that in the syngeneic group. Suppressed CTL induction against donor-type alloantigen was observed in the treated allografted recipient (p < 0.001), whereas CTL induction against third-party alloantigen was intact (p = NS). Third-party skin graft was normally rejected within 10 days, whereas donor-type skin graft was accepted in all mice tested. CONCLUSIONS: Specific tolerance for fetal bowel allografts could be induced by a relatively short-term treatment with anti-ICAM-1 and anti-LFA-1 MoAbs. This mode of immunointervention could perhaps be applied to humans undergoing small-bowel transplantation.

Animals↗
PubMed1996

Masked ureteral duplication with ectopic ureter detected by magnetic resonance imaging.

The usefulness of magnetic resonance imaging (MRI) in the detection of a masked duplex kidney system is described. A 9 year old girl was admitted to our hospital for urinary incontinence. She was found to possess an ectopic ureter associated with complete ureteral duplication. She had been evaluated for incontinence at several hospitals, but neither ultrasound sonography nor intravenous pyelography detected any abnormalities. Only cystoscopic examination and MRI detected the anomalies. Partial nephroureterectomy resolved the patient's incontinence. MRI is useful for the detection of ureteral duplication and should be used on cases in which this condition is suspected, prior to performing invasive procedures.

Child↗
PubMed1996

[Surgical strategy for the treatment of congenital biliary dilatation based on the location of intrahepatic bile duct dilatation].

Congenital biliary dilatation used to be regarded as having a good prognosis. However, some recent long-term follow-up studies have shown there to be quite a high incidence of postoperative intrahepatic bile duct (IHBD) stone formation. In most of the cases in whom IHBD stones form, the IHBD were found to be dilated as the time of initial surgery. Therefore, preoperative evaluation of IHBD dilatation using various imaging studies is extremely important. Surgically, in cases involving structure of the common hepatic duct (CHD) with dilatation above the structure, resection of the stricture and a wide hepaticointestinal anastomosis are strongly recommended. In cases where there is a stricture of the CHD or of the first branch of the IHBD, a reconstructive technique should be applied to dilate the stricture. Patients who have a structure and cystic dilatation of the IHBD above the second branch should be carefully followed-up postoperatively. Partial liver resection to remove the cyst may be required at the time of initial operation or at a later stage.

Bile Ducts, Intrahepatic↗
PubMed1995

Inhibitory action of hypoxanthine on meiotic resumption of denuded pig follicular oocytes in vitro.

The present study was conducted to investigate the direct action of hypoxanthine, which has been reported to be present in pig follicular fluid, on spontaneous meiotic resumption of pig denuded oocytes in vitro. No oocytes, which were surrounded by a cumulus and some membrana granulosa cells directly adjacent to it from healthy antral follicles, underwent germinal vesicle breakdown (GVBD) when they were cultured in serum-supplemented 199 with or without 4 mM hypoxanthine. On the other hand, 81% of denuded oocytes prepared from such cumulus-oocyte-granulosa cell complexes showed GVBD after 24 h of culture. Hypoxanthine inhibited significantly this spontaneous resumption of meiosis in denuded oocytes. The inhibitory action of hypoxanthine was dose dependent at concentrations of 1-6 mM and was reversible following subsequent culture of the oocytes in hypoxanthine-free medium. However, premature chromosome condensation was observed in oocytes cultured in hypoxanthine-supplemented medium, and the oocytes released from the influence of hypoxanthine completed GVBD and reached the second metaphase slightly faster than those freshly isolated from the follicle. These results suggest that hypoxanthine inhibits spontaneous meiotic resumption of pig oocytes in vitro. However, the inhibitory action of hypoxanthine does not prevent all events involved in GVBD from occurring.

Animals↗
PubMed1995

Abnormal contralateral kidney in unilateral multicystic dysplastic kidney disease.

We performed a retrospective study of infants with unilateral multicystic dysplastic kidney (MCDK) in order to investigate the associated urological abnormalities. We examined the records of seven patients, in five of whom a diagnosis had been made prenatally using ultrasonography. Our investigation focused on the associated urological abnormalities, particularly on the contralateral side, and the results of voiding cystourethrography (VCUG). Four of the seven patients (57%) had urological abnormalities other than MCDK: three exhibited vesicoureteral reflux (VUR) of the contralateral side including one patient who also had an ipsilateral ectopic ureter, and the fourth patient had a ureterocele of the ipsilateral side. The results indicate that contralateral VUR, was the most common abnormality associated with MCDK. Two infants had high-grade VUR and underwent anti-reflux surgery soon after the diagnosis. Both have remained free of recurrent urinary tract infection.

Female↗
PubMed1995

A lack of intestinal pacemaker (c-kit) in aganglionic bowel of patients with Hirschsprung's disease.

Recent experimental studies in mice have shown that the proto-oncogene c-kit plays a key role in the development of a component of the pacemaker system that is required for generation of autonomic gut motility. These studies further suggest that interaction of the c-kit receptor and its ligand (stem cell factor, SCF) is critical for the development of the enteric nervous system. The authors investigated the presence of c-kit-positive (c-kit+) cells as well as the expression of SCF in bowel from 12 patients with Hirschsprung's disease (HD), 4 patients with total colonic aganglionosis (TCA), 2 patients with extensive aganglionosis (EA) and 14 controls. Our methods involved the use of immunohistochemistry with antihuman c-kit sera and antihuman SCF sera. A few c-kit+ cells were found in the muscle layers of aganglionic bowels from HD, TCA and EA, in contrast to many c-kit+ cells in ganglionic bowel segments from control, HD, and TCA patients. Expression of SCF was identified in the muscle layers as well as in myenteric plexus of ganglionic bowel, in contrast to its absence in the muscle layers of aganglionic bowel specimens. A lack of c-kit and SCF might be of significance for autonomic gut dysmotility in aganglionic bowel segments of patients with HD and allied disorders such as chronic idiopathic intestinal pseudo-obstruction.

Cell Adhesion Molecules↗
PubMed1995

Choledochal cysts: special emphasis on the usefulness of intraoperative endoscopy.

Long-term complications after excisional surgery for choledochal cyst include stone formation within the intrahepatic bile duct (IHBD) and within the intrapancreatic portion of the bile duct (IPBD). The authors reviewed 180 patients with choledochal cysts (137 women) seen during a 30-year period and report their recent experience with intraoperative cyst endoscopy. Primary cyst excision with hepaticoenterostomy was performed in 150 cases, and a secondary cyst excision, after various lesser drainage procedures, in 24. Six children were treated early in the series with a cyst enterostomy. The mean age and follow-up period were 4.3 and 9.4 years, respectively. At surgery, dilatation of the IHBD was identified in 96 patients, and protein plugs or stones were observed in 31 common pancreaticobiliary channels. Fifty-five common channels were noted to be dilated. Hepaticojejunostomy was performed in 123 patients without intraoperative endoscopy. Late stone formation occurred within the IHBD in 4 of these cases and within residual segments of intrapancreatic cyst in 2 (mean age and follow-up period were 4.9 and 13.0 years, respectively). Intraoperative endoscopy was performed in 51 patients (mean age and follow-up period 3.6 and 4.3 years), and stone formation has not been observed in any patients in this group. Intraoperative cyst endoscopy is recommended as a valuable adjunct to choledochal cyst excision.

Adolescent↗
PubMed1995

Degeneration of intrahepatic bile duct with lymphocyte infiltration into biliary epithelial cells in biliary atresia.

Degenerative changes of intrahepatic bile ducts with lymphocytic infiltration into portal areas have been recognized as the characteristic histopathologic features in the liver with biliary atresia (BA). Occasionally, lymphocytic infiltration into biliary ductal epithelium was noted and has been thought to be mostly the result of nonspecific chronic inflammation. However, this histological presentation looks quite similar to that of acute graft-versus-host disease (GVHD) after bone marrow transplantation (BMT) or acute cellular rejection (ACR) after orthotopic liver transplantation (OLTx). According to this histological similarity, we presumed that the degeneration of intrahepatic bile ducts (DIBD) might have developed with lymphocytic infiltration into biliary epithelial cells (LIBE) as some part of an immunologic reaction, and focused on the DIBD with LIBE in the patients with BA. Liver specimens obtained from 31 patients with BA at the time of primary Kasai operation and 3 patients at the time of reoperation were reviewed histologically, and investigated DIBD with LIBE. Nine patients with choledochal cyst (CBD) and 5 patients with neonatal hepatitis (NH) were added to this study as a control population. All patients with BA presented with DIBD with LIBE. On the other hand, only 2 patients with CBD presented with DIBD with LIBE, and no patients with NH presented with DIBD with LIBE. The DIBD with LIBE is not limited to patients with BA, but it seems to be much more serious in this group. These findings may suggest that some sort of immunologic factors contribute to the persistent DIBD in the patients with BA.(ABSTRACT TRUNCATED AT 250 WORDS)

Bile Ducts, Intrahepatic↗
PubMed1995

Prevention of fetal bowel allograft rejection by combined treatment with anti-ICAM-1 and anti-LFA-1 antibodies.

Prevention and treatment of allograft rejection remain the major issues in clinical small bowel transplantation. New strategies for manipulating immune responses using more powerful immunosuppressive agents continue to be evaluated. The fetal small bowel from BALB/c (H-2d) or C3H/He (H-2k) mice was transplanted into the space between the peritoneum and rectus abdominis of adult C3H/He (H-2k) recipient mice. Syngeneic (n = 6) and allogeneic transplant groups were made. In the allogeneic group, the recipient mice were subdivided into three groups, depending on the duration of combined treatment with anti-LFA-1 and anti-ICAM-1 monoclonal antibodies (MAbs): untreated (n = 10), 7-day course (n = 10), and 4-week course (n = 14). A dose of 50 micrograms/mouse/d each of both MAbs was given intraperitoneally, immediately after transplantation and on the consecutive days. All mice were killed 4 weeks after transplantation, and the graft as well as the recipient spleen were taken for histological examination, graft survival ratio, mixed lymphocyte reaction (MLR) assay and cytotoxic T lymphocyte (CTL) assay. All grafts in the syngeneic group survived with normal villi, whereas all grafts in the allogeneic group without treatment disappeared within 4 weeks. All grafts in the allogeneic group with a 7-day course of MAb treatment showed marked disruption of the mucosa with massive cellular infiltration. However, in the allogeneic group treated for 4 weeks, all allografts had adequate growth and demonstrated normal villi with minimal cellular infiltration. Splenocytes from allografted recipient mice without MAb treatment showed markedly increased MLR and CTL activity, compared with the activity seen in the syngeneic MLR and CTL.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Quantitative analysis of neuronal innervation in the aganglionic bowel of patients with Hirschsprung's disease.

Although there is marked proliferation of nerve fibers in the aganglionic bowel of patients with Hirschsprung's disease (HD), controversy exists as to whether these fibers terminate in the cells of the bowel wall. This study quantitates biochemically the synaptic vesicle proteins and neurofilaments in the aganglionic bowel of HD patients. The bowel specimens obtained from 12 patients with HD (mean age, 4.6 months) and nine age-matched controls were analyzed by Western blot analysis using monoclonal antibody 171B5 against the synaptic vesicle 38,000-d protein (SVP38), and the specific band obtained was quantitated by densitometry. Similarly, using monoclonal antibody NF70K for detecting the 70,000-d component of neurofilament (NF70), nerve fibers were quantitated. In the aganglionic HD bowel, the quantity of SVP38, representing a proportion of synapses, was significantly lower than that in the normoganglionic bowel (P < .001). The quantity of NF70, representing a proportion of nerve fibers, was significantly greater than that in the normoganglionic bowel (P < .05). These findings suggest that the nerve fibers in the aganglionic bowel of HD patients have much less developed connections with the cells of the bowel wall, indicating overall poor innervation, despite marked proliferation of the nerve fibers.

Blotting, Western↗