Biomedical subjects

T Seo

Publications and source records attributed to T Seo.

At least 55 records · Page 3Linked to original sources

PubMed1997

Biochemical and morphological changes in the liver during isolated liver perfusion with double bypass using automatic blood pumps.

Isolated organ perfusion is used in clinical practice for chemotherapy in adults with malignant tumors. However, it has not been performed in children because of the size mismatch with the adult circuits. The authors have previously studied isolated liver perfusion in small animals using the self-regulating extracorporeal membrane oxygenation circuit. The present study was designed to investigate the biochemical and morphological changes in the liver during isolated liver perfusion with double bypass using automatic blood pumps. Isolated liver perfusion was performed with bypass between the hepatic and portal veins in seven weanling Yorkshire swine weighing 8.2 to 12.2 kg, at a flow rate of 20 mL/min/kg for up to 4 hours. Venous blood from the intestine and lower body was bypassed to the superior vena cava. As a result, perfusate glutamic pyruvic transaminase and lactate concentrations did not change during liver perfusion. On gross inspection, the surface of the liver was mottled. Microscopically, normal histology of the hepatic parenchyma and portal tract structures was preserved. Transmission electron microscopy showed no gross structural abnormalities in most of the hepatocytes for up to 4 hours. However, swelling of the mitochondria and smooth endoplasmic reticulum was seen occasionally in a very small number of the hepatocytes after more than 3 hours of perfusion. Glycogen granules decreased with time in some animals. Isolated liver perfusion at 20 mL/min/kg of perfusion flow can be performed safely for up to 4 hours with nearly intact hepatocellular function and morphology.

Alanine Transaminase↗

PubMed1997

A new hepatic portoenterostomy with division of the ligamentum venosum for treatment of biliary atresia: a preliminary report.

BACKGROUND/PURPOSE: Kasai's operation consists of transection of the fibrous portal cord including the bile duct remnant. However, it is difficult to transect the fibrous cord at the level of the posterior surface of the portal vein, because the portal vein is fixed at the porta hepatis. METHODS: The authors described a new hepatic portoenterostomy to transect the fibrous cord under an appropriate visual field by division of the ligamentum venosum (Arantius' canal). Between February and December 1996, six patients who had biliary atresia underwent this procedure. RESULTS: Jaundice resolved completely (TB < or = 1.0 mg/dL) in all six patients within 40 days. Postoperative cholangitis did not occur and good bile drainage was obtained. CONCLUSIONS: Using this procedure, the portal vein becomes fully mobile after dividing the ligamentum venosum, and the porta hepatis can be widely exposed. The fibrous cord of the porta hepatis can be easily dissected off posteriorly and laterally.

Biliary Atresia↗

PubMed1997

Unique spindle cells in the involved ileal segment of rats with congenital aganglionosis.

Protein gene product (PGP) 9.5 is a newly characterized brain-specific protein originally detected by high-resolution two-dimensional electrophoresis of soluble human brain proteins. Immunoreactivity for PGP9.5 was investigated in the small and large intestine of aganglionic mutant and control rats with light microscopy, electron microscopy, and confocal laser scanning microscopy. Immunoreactive spindle-shaped cells were seen in the inner circular muscle layer of the aganglionic ileal segment. The long axes of these spindle cells paralleled the inner circular muscle fibers. PGP9.5-positive spindle cells were positive for enteric actin, and some of them were also positive for vimentin, a relatively specific marker for the special smooth muscle (pacemaker cells). These cells may prove to be a maldeveloped microenvironment of aganglionic segment. However, it is necessary to investigate expression of PGP9.5 in embryonal tissue with an abnormal environment to test this hypothesis. This study showed PGP9.5-positive pacemaker cells in the aganglionic ileal segment in the first time.

Animals↗

PubMed1997

Obstructive jaundice, an unusual initial manifestation of intraabdominal non-Hodgkin's lymphoma in children: complications of percutaneous transhepatic cholangial drainage.

Obstructive jaundice is an unusual initial manifestation of non-Hodgkin's lymphoma in children. Two pediatric patients with primary intraabdominal non-Hodgkin's lymphoma causing obstructive jaundice are presented. Although percutaneous transhepatic cholangial drainage (PTCD) is frequently used to treat obstructive jaundice, there was no definite rule for management of PTCD during chemotherapy, which may rapidly resolve the obstruction. Biliary peritonitis occurred in both patients soon after removal of the PTCD tube after chemotherapy. It was speculated that secure formation of the fistula for PTCD was impaired because of chemotherapy for a considerably long period. The PTCD tube that was already placed for obstructive jaundice in a non-Hodgkin's lymphoma patient should be maintained during chemotherapy with great care for displacement of the tube. PTCD can result in complications, and is probably unnecessary when lymphoma has been diagnosed before PTCD.

Abdominal Neoplasms↗

PubMed1997

Splenectomy in biliary atresia patients with recurrent jaundice following partial splenic embolization.

Splenectomy was performed for three patients with biliary atresia because of re-exacerbation of their jaundice following treatment by partial splenic embolization (PSE). The subjects' red blood cell count and hemoglobin, serum level of hepatic enzymes (glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, gamma-glutamyl transpeptidase, alkaline phosphatase, and lactic dehydrogenase), and total bilirubin (TB) were evaluated both before and after splenectomy in order to analyze the effects of splenectomy on these patients. The TB decreased significantly within 3 months after splenectomy in all three patients (13.0 +/- 1.6 mg/100 ml to 5.4 +/- 0.3 mg/100 ml, p < 0.05). The red blood cell count and hemoglobin increased gradually. There was a statistically significant correlation between the TB and the red blood cell count, and/or concentration of hemoglobin. The hepatic enzymes after splenectomy were not significantly different from those before splenectomy. The change in TB following splenectomy was essentially similar to that following PSE. These results suggested that the postoperative improvement in jaundice following splenectomy may not be due to improved hepatic function but merely a reflection of decreased red blood cell turnover. Splenectomy is a useful palliative procedure for jaundice in patients with biliary atresia for whom PSE is no longer effective.

Biliary Atresia↗

PubMed1997

[Sensorineural hearing loss caused by middle ear surgery].

It is well known that sensorineural hearing loss rarely occurs after middle ear surgery. Five cases of postoperative sensorineural hearing loss were reviewed. These operations amounted to 0.9% of all middle ear operations in which the first author was involved. The causes of hearing loss were believed to be labyrinthitis through the fistula in cholesteatoma case 1, and acoustic trauma from the bone-cutting burr in cases 2 and 3. In cases 4 and 5 postoperative sensorineural hearing loss occurred several months after stapes surgery and the causes of hearing loss were unknown. On the basis of the available literature discussion focused on management of labyrinthine fistula, the acoustic effect of the bone-cutting burr and the possibility of sensorineural hearing loss caused by stapes surgery.

Aged↗

PubMed1997

[Indication for percutaneous transluminal coronary angioplasty based on quality of life of patients with angina pectoris].

The changes in quality of life (QOL) before and after percutaneous transluminal coronary angioplasty (PTCA) were investigated to establish criteria for determining whether patients with angina pectoris should undergo PTCA. The QOL was surveyed twice by self-completed questionnaire for QOL by Iida and Kohashi (QUIK) before and about 4 months after PTCA in 84 patients (mean age 62.8 +/- 10.1 years) with angina pectoris. High QUIK score reflects a poor QOL, of which the internal consistency was 0.86, demonstrating high reliability. The subjects were classified into three groups according to the changes of total QUIK score before and after PTCA (I: QOL improved 31.0%, II: QOL unchanged 48.8%, III: QOL worsened 20.2%). Age, gender, total QUIK score prior to PTCA, presence of anginal pain, complications extent and degree of coronary artery stenosis, and left ventricular ejection fraction were compared between the three groups. The total QUIK score prior to PTCA in the improved QOL group was higher than that in the worsened QOL group (11.6 vs 5.1, p < 0.01). Most patients showing a poor QOL prior to PTCA demonstrated an improvement in their QOL after PTCA. The number of patients with anginal pain prior to PTCA was high in the improved QOL group (35.8%, p < 0.05). Percutaneous transluminal coronary angioplasty might not aggravate QOL (12.1%, p = 0.1) in patients with single-vessel disease. In patients with multivessel disease, PTCA might not improve (35.3%) but also might aggravate QOL (25.5%). Multivariate analysis showed that PTCA improved QOL in male or sixty-ager patients and in patients with a total QUIK score of 10 or more prior to PTCA (p < 0.01). The total QUIK score, presence of anginal pain and extent of coronary artery stenosis prior to PTCA, gender and age are factors predicting QOL after PTCA. The adaptation of PTCA for those patients should be prudently and inclusively taken into consideration to extend their QOL.

Adult↗

PubMed1997

Anatomy of the round ligament in female infants and children with an inguinal hernia.

BACKGROUND: The ligament which runs along an inguinal hernia sac in females is believed to be the round ligament of the uterus. According to most standard textbooks, the round ligament of the uterus terminates at the labium majorum. This study examined the termination of the ligament. METHODS: The anatomy of the ligament was examined in 248 female children (aged 1 month to 11 years) with an inguinal hernia. The anterior wall of the hernia sac, consisting of the inner and outer membranes, was opened and the inner membrane of the sac was pulled up with forceps; the hernia sac was then separated from the surrounding tissue. The termination of the ligament was observed. RESULTS: The ligament did not end at the labium majorum but terminated in the hernia sac. The ligament was attached to the mid portion of the fallopian tube near the ovary. CONCLUSION: These findings suggest that the ligament which runs along the hernia sac is the suspensory ligament of the ovary.

Child↗

PubMed1997

Heparan sulfate proteoglycans mediate internalization and degradation of beta-VLDL and promote cholesterol accumulation by pigeon macrophages.

Pigeon and rabbit beta-migrating very low density lipoprotein (beta-VLDL) are similar in size and composition, yet rabbit beta-VLDL consistently stimulates greater cholesteryl ester accumulation in pigeon peritoneal macrophages than does pigeon beta-VLDL. The purpose of this study was to determine the mechanism of this difference. Pigeon beta-VLDL bound to both a high and low affinity site while rabbit beta-VLDL bound primarily to a low affinity site. The high affinity site had the characteristics of the LDL receptor. Most rabbit beta-VLDL and some pigeon beta-VLDL bound to the low affinity site that was not down-regulated by cholesterol loading. beta-VLDL binding to the low affinity site and subsequent internalization and degradation were mediated by cell surface heparan sulfate proteoglycans (HSPG). Evidence for this includes inhibition of binding and uptake by chlorate, which prevents sulfation of proteoglycans, and by treatment with heparinase but not chondroitinase ABC. beta-VLDL uptake was stimulated by lipoprotein lipase (LpL) and apolipoprotein E (apoE), both known to bind HSPGs. Uptake and degradation of beta-VLDL were not mediated by the LDL receptor or the alpha(2)MR/LRP. Thus, binding of beta-VLDL to low affinity, high capacity HSPG binding sites on pigeon macrophages appears to directly promote internalization and degradation and is largely responsible for the greater ability of rabbit beta-VLDL to stimulate cholesterol accumulation.

Animals↗

PubMed1997

Protein plugs cause symptoms in patients with choledochal cysts.

OBJECTIVES: Symptoms in patients with choledochal cysts are believed to be caused by pancreaticobiliary maljunction. However, this anomaly alone cannot explain the occurrence of symptoms. The aim of this study was to elucidate the etiology of the symptomatology in patients with choledochal cysts. METHODS: Clinical data and preoperative and operative cholangiopancreatography were reviewed in 55 consecutive patients with choledochal cysts seen between 1980 and 1996. RESULTS: The bile duct was significantly larger in the symptomatic phase than in the asymptomatic phase. External biliary drainage resulted in rapid resolution of symptoms in 11 patients. A radiolucent filling defect in the pancreaticobiliary duct was found in 22 patients (40.0%). The defects were in the common channel in 15 patients and near the common channel in 7 patients. Filling defects disappeared spontaneously or after irrigation in 19 patients. In three patients, the material in the common channel removed during surgery was fragile and consisted of more than 98% protein. CONCLUSION: The filling defects were protein plugs. The simultaneous occurrence of symptoms and signs may be explained by disturbances in bile and pancreatic secretory flow caused by a protein plug in the common channel.

Adolescent↗

PubMed1996

Manometric evaluation of gastrointestinal motility in children with chronic intestinal pseudo-obstruction syndrome.

Various causes of abnormal gastrointestinal motility may account for the symptoms of chronic intestinal pseudo-obstruction syndrome (CIIPS). Fasting gastrointestinal motility in humans is characterized by regular cyclic activity of the migrating motor complex (MMC), which may be used as an objective indicator of intestinal motility. The present study investigated MMC in five children with CIIPS (2 neurogenic and 3 nonneurogenic cases) using a perfused catheter system. The findings were compared with those for children with idiopathic constipation and Hirschsprung's disease. The gastrointestinal MMC was found to be abnormal with CIIPS, whereas it remained normal with idiopathic constipation and Hirschsprung's disease. The four CIIPS patients without any gastrointestinal MMC activity required total pareteral nutrition. There was significant improvement of intestinal motility over time in a patient with immaturity of ganglia, and there was gradual deterioration in a patient with hypoganglionosis. In conclusion, gastrointestinal motility studies provide objective diagnostic information in patients with intestinal dysmotility and can be used as an indicator of intestinal function during the treatment of CIIPS.

Adolescent↗

PubMed1996

Coronary arterial perfusion during venoarterial extracorporeal membrane oxygenation.

The effects of venoarterial extracorporeal membrane oxygenation on left ventricular performance have not been studied in detail. Coronary arterial flow obtained by direct measurement with an electromagnetic flowmeter and blood gas analysis from the aortic root were tabulated during venoarterial extracorporeal membrane oxygenation 14 puppies, and these parameters were evaluated with respect to changes in the venoarterial extracorporeal membrane oxygenation flow. Unique automatic blood pumps generating pulsatile flow were used for the venoarterial extracorporeal membrane oxygenation bypass. Coronary arterial flow decreased as the extracorporeal membrane oxygenation flow increased (106 +/- 26 ml/min per 100 gm of left ventricle at 20 ml x min(-1) x kg bypass flow to 71 +/- 17 ml/min per 100 gm of left ventricle at 100 ml x min(-1) x kg bypass flow, p < 0.01). There were no significant changes in the mean or diastolic pressures in the ascending aorta despite changes in the extracorporeal membrane oxygenation flow. Arterial oxygen tension in the ascending aorta was not increased even under high-flow venoarterial extracorporeal membrane oxygenation. This result indicates that oxygenated blood from the extracorporeal membrane oxygenation circuit does not pass in a retrograde fashion into the aortic root and thus does not perfuse the coronary arteries. The diastolic aortic pressure did not correlate with the changes in extracorporeal membrane oxygenation flow. The decrease in coronary arterial flow is therefore predominantly caused by increased coronary arterial resistance. Tension-time index, an indicator of myocardial oxygen consumption, did not decrease with venoarterial extracorporeal membrane oxygenation. In conclusion, high-flow venoarterial extracorporeal membrane oxygenation causes undesirable hemodynamic effects on the left ventricle.

Analysis of Variance↗

PubMed1996

Increased cell proliferation and transforming growth factor-alpha (TGF alpha) in the gall-bladder epithelium of patients with pancreaticobiliary maljunction.

Pancreaticobiliary maljunction is associated frequently with gall-bladder carcinoma. Although increased turnover of the gall-bladder epithelium in patients with pancreaticobiliary maljunction is thought to predispose to carcinogenesis, there is little data to confirm this hypothesis. In addition, no previously published study has addressed the process underlying cell proliferation. In this study, cell kinetics were first evaluated using two methods, proliferating cell nuclear antigen (PCNA) immunohistochemical staining and argyrophilic nucleolar organizer region (AgNOR) staining. Second, immunohistochemistry was used to investigate the expression of transforming growth factor-alpha (TGF alpha), a potential regulator of cell proliferation in the gall-bladder. The gall-bladders of 11 patients with pancreaticobiliary maljunction were studied, and 11 gall-bladders removed from patients during other surgery were used as controls. The number of PCNA-positive cells and the number of AgNOR per nucleus were significantly greater in the gall-bladders of patients with pancreaticobiliary maljunction than in the control gall-bladders. The expression of TGF alpha was also significantly greater in the gallbladders of patients with pancreaticobiliary maljunction than in the control gall-bladders. In conclusion, these results suggest that the increased TGF alpha expression induced by pancreaticobiliary maljunction promotes proliferation of the gall-bladder epithelium, which may lead to carcinogenesis.

Adolescent↗

PubMed1996

[Tympanoplasty on only hearing ears].

Tympanoplasty on only hearing ears was performed on 11 patients in Osaka University Hospital and Osaka Rosai Hospital during 1986 1994; this was 0.68% of all cases of middle ear surgery. The patients consisted of 5 with cholesteatoma, 5 with chronic otitis media and 1 with cholesterin granuloma. The mean age was 47.6 years (13-68 years) and the mean follow-up period was 2 years and 7 months (6 months-4 years). Postoperative hearing results was obtained in 9 patients (81.8%) according to the criteria of Otology Japan (1987), and all ears were dry at the final examination. Compared with the preoperative hearing level, postoperative hearing level showed improvement in 3 cases, not in 7 cases (within difference of 5 dB) and deterioration by 10-15 dB in 1 case. Although indications for surgery on only hearing ears are still controversial, we suggest the following: 1) patients with cholesteatoma should be operated on in the ordinary way; 2) patients with chronic otitis media should be operated on only by myringoplasty; 3) all patients must be operated on very carefully by skillful surgeons.

Adolescent↗

PubMed1996

Intrahepatic bile duct stenosis causing intrahepatic calculi formation following excision of a choledochal cyst.

BACKGROUND: Formation of intrahepatic calculi is one of the major late complications after excision of a choledochal cyst. There are few studies, however, that have examined this complication. Generally, an anastomotic stricture is believed to be the main cause of intrahepatic calculi. We report our experience with eight patients who had intrahepatic calculi after excision of a choledochal cyst. STUDY DESIGN: To determine what caused the intrahepatic calculi to form, seven patients underwent cholangioscopy and direct visual inspection during the operation, and one patient underwent percutaneous transhepatic cholangioscopy. Intrahepatic bile was cultured, and calculi were analyzed. RESULTS: Two types of stenoses (membranous and septal) were demonstrated near the hepatic hilum in all patients. Calculi were always located on the hepatic side of the stenoses. No anastomotic strictures were found in the region of the hepaticojejunostomy. The calculi contained mainly calcium bilirubinate. Escherichia coli and Klebsiella pneumoniae were cultured from the bile in all patients. CONCLUSIONS: Stenoses of the intrahepatic bile ducts were demonstrated in all eight patients. The stenoses were considered to be the primary cause of intrahepatic calculi formation after excision of the choledochal cysts.

Adolescent↗

PubMed1996

[Quantitative flow measurement of the vertebro-basilar circulation for positional vertigo by using 2D phase contrast technique].

Quantitative measurements of blood flow in the vertebral and basilar arteries were obtained by the 2D phase contrast (2D PC) technique. In phantom study, flow velocity measured with 2D PC correlated well with actual flow velocity. Sixty-six patients were neurologically normal and 20 had positional vertigo due to vertebrobasilar insufficiency (VBI). Mean velocities (MV) were measured by using a transverse plane in the vertebral arteries at the level of C3 and in the basilar arteries at the level of the sella floor. Volume flow rates (VFR) were calculated as the product of MV and the area of the arteries whose diameters were measured on the basis of pixel counting in the histogram of the signal intensity profile. In the normal group, MV of the left vertebral artery and MV and VFR of the basilar artery showed significant declines as age progressed. In the vertigo group, MV and VFR of the basilar artery were significantly lower than in the normal group. It is concluded that 2D PC technique appears to be fast and easy to handle without cardiac gating to assess blood flow in vessels surrounded by bone tissues.

Adult↗

PubMed1996

Complete excision of the intrapancreatic portion of choledochal cysts.

BACKGROUND: Cyst excision is the treatment for patients with choledochal cysts. In general, many authors recommend intramural dissection between the outer and inner layers of the cyst or partial excision leaving part of the cyst in the pancreas to avoid pancreatic injury. However, because there are few large series with long-term follow-up periods, it remains unclear how much of the intrapancreatic portion of the cyst should be resected and what resection technique should be used. STUDY DESIGN: During an 18-year period, 104 patients underwent excision of choledochal cysts at our hospitals. Twelve patients had partial excision of the cyst above the pancreas, and 17 had intramural dissection of the intrapancreatic portion. Seventy-five patients underwent complete excision of the intrapancreatic portion of the cyst by our new technique, in which the outer plane of the epicholedochal plexus is dissected, exposing the narrow distal segment connecting the cyst to the pancreatic duct. Our new technique was compared retrospectively with the other two techniques. RESULTS: With our technique, the intrapancreatic cyst could be excised completely in 75 patients without any complications. Blood loss was significantly decreased when our technique was used compared to intramural excision. A pancreatic fistula occurred after intramural excision in one patient, and pancreatic stones formed several years after partial excision and intramural excision in three patients who proved to have residual cystic material in the pancreas. CONCLUSIONS: Our operative technique is safe and effective for the complete excision of the intrapancreatic portion of a choledochal cyst.

Adult↗

PubMed1996

[Intravascular ultrasound in determining the end point of percutaneous transluminal coronary angioplasty].

Intravascular ultrasound (IVUS) imaging was used to measure internal luminal area immediately after percutaneous transluminal coronary angioplasty (PTCA) in 83 patients (59 males, 24 females, mean age 63 +/- 12 years) with angina pectoris to determine the need for additional intervention. The effectiveness of these interventions to prevent restenosis was also studied. Thirty-five patients (42%) with insufficient dilatation revealed an internal luminal area less than 5 mm2 or luminal stenosis greater than 60% as evaluated by IVUS imaging following the procedure. The luminal area increased from 4.5 +/- 1.1 to 7.9 +/- 2.8 mm2 and the percentage luminal stenosis improved from 66 +/- 9% to 54 +/- 9% in patients who underwent further dilatation with a larger size balloon, longer dilatation time, directional coronary atherectomy, or stenting. The insufficient dilatation group exhibited hard plaque and calcification more frequently than in the other group (48 patients, 58%) in whom sufficient dilatation of the target lesion was achieved. The incidence of restenosis in the sufficient dilatation group was 25%, compared to 33% of the patients receiving additional treatment after IVUS imaging and 42% in the 192 patients who underwent PTCA without IVUS imaging. IVUS imaging is a useful method for evaluation of complex luminal morphology to decrease the incidence of restenosis and for determination of the end point and the extent of dilatation required.

Aged↗