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Biomedical subjects

T Seo

Publications and source records attributed to T Seo.

At least 73 records · Page 4Linked to original sources
PubMed1996

Anatomy and etiology of extrahepatic portal vein obstruction in children leading to bleeding esophageal varices.

BACKGROUND: The cause of extrahepatic portal vein obstruction in childhood is unknown. We investigated the anatomical features of extra hepatic portal vein obstruction to clarify its cause. STUDY DESIGN: We studied portal venous anatomy in 10 patients with extrahepatic portal vein obstruction without hepatic disturbances ranging in age from 1 to 7 years (mean age, 4.2 years) using ultrasonography, portal venography, cholangio-computed tomography, and magnetic resonance imaging. RESULTS: The extrahepatic portal vein was not obliterated, but it crossed over the common bile duct from the left to the right side at the cranial level of the pancreas and ran in a cranial direction along the right side of the common bile duct or coiled itself around the bile duct. Thus, the extrahepatic portal vein formed a tortuous eta-shape. CONCLUSIONS: The portal vein was not obstructed in patients with extrahepatic portal vein obstruction but formed a characteristic eta-shape by coiling itself around the common bile duct, suggesting that extrahepatic portal vein obstruction has an embryological cause.

Bile Ducts, Extrahepatic↗
PubMed1995

Pancreaticobiliary maljunction without choledochal cysts in infants and children: clinical features and surgical therapy.

Pancreaticobiliary maljunction (PBM) usually is associated with choledochal cyst. PBM without dilatation of the common bile duct is rare in infants and children. This rare type of the anomaly may lead to the development of malignancy of the bile duct in later life. The authors report the clinical presentation and surgical treatment of seven pediatric patients with PBM. Symptoms and signs included repeated episodes of abdominal pain (7 of 7), nausea and vomiting (6 of 7), intermittent jaundice (3 of 7), and acholic stools (2 of 7). Some patients presented with high levels of serum and urinary amylase. These symptoms and signs might have been related to the temporary obstruction of bile flow in the common channel, where endoscopic retrograde cholangiopancreaticography (ERCP) disclosed a protein plug in four of the patients. The common bile duct proximal to the junction of the main pancreatic duct was excised, and a Roux-en-Y hepaticojejunostomy reconstruction was performed. To prevent iatrogenic injury of the main pancreatic duct, repeat cholangiography was performed with the aid of radiopaque silver clips placed on the line of dissection to evaluate the distance between the site of dissection and the main pancreatic duct. All patients have been free of symptoms since the surgery. PBM without dilatation of the common bile duct can be detected more frequently if ERCP is performed on every patient who has repeated episodes of abdominal pain refractory to conventional therapy. Complete excision of the common bile duct and gallbladder followed by hepaticojejunostomy is recommended for PBM, while the goals of decreasing the high risk of carcinoma of the bile duct and preventing recurrent symptoms.

Anastomosis, Roux-en-Y↗
PubMed1995

Rectal irrigations for the prevention of postoperative enterocolitis in Hirschsprung's disease.

The purpose of this clinical trial was to examine the role of rectal irrigations in the prevention of postoperative enterocolitis in children with Hirschsprung's disease. Over the past 22 years 177 children had surgical treatment for Hirschsprung's disease at a single pediatric hospital. Five children have died of other causes. Of the remaining 172 patients, follow-up clinical information was obtained from 135 (78%). In 1989, all of the children undergoing surgical reconstruction for Hirschsprung's disease were placed on routine postoperative rectal irrigations with normal saline. The parents were instructed in the irrigation technique before leaving the hospital. Irrigations were started 1 to 2 weeks postoperatively and were performed two times a day for 3 months, then once a day for an additional 3 months. There were no complications from the irrigations themselves. A previous report from the authors' institution has documented five sudden deaths over the past 22 years from fulminant postoperative enterocolitis. These five children all had an unremarkable postoperative recovery, then developed a rapidly progressive diarrheal illness. All of these deaths occurred before the institution of routine postoperative irrigations. Of the 135 patients in this review, 40 had the postoperative rectal irrigations. The remaining 95 children serve as historical controls. Data analysis showed that 34 of the 95 children in the nonirrigation cohort developed postoperative enterocolitis compared with 3 of 40 in the rectal irrigation cohort; P < .001 using Fisher's exact test. In the authors' experience, routine postoperative rectal irrigations have significantly decreased the incidence and severity of enterocolitis in children after surgical correction of Hirschsprung's disease.

Child↗
PubMed1995

Gastrointestinal function after surgical correction of Hirschsprung's disease: long-term follow-up in 135 patients.

This study is a retrospective review of all children treated for Hirschsprung's disease over the past 22 years at a single pediatric institution. During this time 177 patients had definitive surgical reconstruction. Five children died of causes unrelated to Hirschsprung's disease, and five children died from enterocolitis after an uneventful postoperative course. Clinical follow-up information was obtained from 135 (78%). Demographic data includes the following: sex ratio 74% male, 26% female; current mean age 9.9 years; mean length of follow-up 7.9 years (range, 3 months to 21.5 years). Mean age at surgical reconstruction was 1.6 years. Definitive surgical procedures included endorectal pull-through (Soave), 21%; modified Duhamel, 67%; extended side-to-side ileocolic anastomosis, 8%; rectal myomectomy, 4%. Transition zone was within rectum or rectosigmoid region in 86%. Overall, 32% (43/135) report difficulty with fecal soiling, and 12.6% (17/135) identify this as a severe problem. These numbers include patients with trisomy 21 and total colonic aganglionosis. Severe fecal soiling was reported in 7.1% (2/28) after an endorectal pull-through, and in 12.1% (11/91) after the modified Duhamel. The difference in incidence of soiling after these two procedures is not statistically significant. However, 40% (4/10) of the patients after the long side-to-side anastomosis for total colonic aganglionosis report severe problems with fecal soiling (P = .03). Surgical reconstruction for Hirschsprung's disease provides near-normal gastrointestinal function for the majority of children, but long-term follow-up shows significant residual problems with soiling in 12.6% of the patients. This is consistent with reported experience worldwide.

Adolescent↗
PubMed1995

Development of an isolated perfusion circuit with double bypass using automatic blood pumps.

Isolated perfusion of the liver is a useful and promising therapeutic method for various hepatic diseases. However, conventional techniques using a roller pump require a large priming volume and cannot run at the low flow rate without complications. These disadvantages do not allow the use of conventional techniques in smaller pediatric patients. The authors solved these problems successfully for the first time by using unique sac-type air-driven automatic blood pumps with an oxygenator primed with a blood volume of 65 ml in the total circuit. The usefulness of these blood pumps for liver perfusion was evaluated in small animals weighing 3.5-6.0 kg. A hepatic perfusion circuit was established between the portal vein and the inferior vena cava. The blood pumps worked well without any trouble, and stable flow could be maintained. No hepatocellular damage or anaerobiosis of the liver was observed at a hepatic perfusion flow rate of 20 ml/min/kg. Isolated liver perfusion using these blood pumps can be applied in infants and young children.

Analysis of Variance↗
PubMed1995

Congenital stenosis of the intrahepatic bile duct associated with choledochal cysts.

BACKGROUND: There are few studies that report on stenosis of the intrahepatic bile ducts associated with choledochal cysts. We investigated the presence and clinical significance of stenosis of the intrahepatic bile ducts associated with choledochal cysts. STUDY DESIGN: We examined intrahepatic bile ducts in patients with choledochal cysts using cholangiography (93 patients), endoscopy and direct observation during surgery (19 patients), and histologic examination (12 patients). RESULTS: Stenosis of the intrahepatic bile duct was present in 75 (80.6 percent) of 93 patients with choledochal cysts. Endoscopic and direct observation detected membranous stenosis, which consisted of a diaphragm, in 11 of 19 patients. Septal stenosis, which consisted of a bridge-like septum, was present in eight of 19 patients. Stenoses consisted of mucosal and fibromuscular layers. Intrahepatic calculi developed in eight patients with stenosis following resection of the choledochal cysts. CONCLUSIONS: Membranous or septal stenosis of the intrahepatic bile duct is a characteristic feature of choledochal cysts. Our findings suggest that these stenoses should be treated surgically because of the risk of intrahepatic calculi.

Adolescent↗
PubMed1995

Spontaneous perforation of choledochal cyst.

BACKGROUND: Spontaneous perforation of the common bile duct in children is very rare and its etiology is unknown. We describe herein five patients treated for the spontaneous perforation of choledochal cyst and suggest the important factors leading to perforation. STUDY DESIGN: All patients were initially treated with T-tube drainage through the perforated site. Cholangiography through the T tube was performed intraoperatively and the important factors leading to perforation were examined. Furthermore, histological examination of the perforated wall of the common bile duct was performed. RESULTS: Cholangiography through a T tube revealed the presence of a pancreaticobiliary junction malformation and filling defects (protein plugs) in the common channel in all patients. Postoperatively, the T tube was gently irrigated with a physiological salt solution until the free flow of bile into the duodenum was established. Histological examination showed that the wall near the perforation was covered with a granulation tissue that was present only at the limited area. CONCLUSIONS: Perforation of the common bile duct was related to the abrupt increase in intraluminal pressure due to obstruction by protein plugs at the common channel.

Anastomosis, Roux-en-Y↗
PubMed1995

[A left-handed patient with disturbance of manipulating objects].

We reported a left-handed patient with the disturbance of manipulating objects and the object pantomime. The patient was a 72-year-old man, admitted to Osaka Medical College Hospital complaint of the difficulty of object manipulation. The patient was alert, well oriented and attentive. On neurological examination the patient revealed grasp reflex in his left hand. On neuropsychological examination the patient spoke fluently, but his verbal comprehension was slightly disturbed. He could name popular objects only 9 out of 20 objects. On praxis examination he could pantomime the socially accustomed movements by command visually pantomime. He did not reveal buccofacial apraxia and constructional apraxia. However, the patient could not manipulate both single and pleural objects actually and pantomime without objects. On MRI the lesion was found in both frontal lobe, right medial frontal lobe and right temporal lobe. SPECT findings demonstrated that the bilateral parietal lobes were preserved and we speculated that the right supplementary motor area was assumed to be a crucial lesion for manipulating objects in the patient.

Aged↗
PubMed1994

Torsion of an accessory spleen presenting as an acute abdomen with an inflammatory mass. US, CT, and MRI findings.

Torsion of an accessory spleen is extremely rare. Only seven cases in children have been reported in the literature. This entity should be considered in the differential diagnosis of acute abdomen associated with an intraperitoneal inflammatory mass. This report describes a 10-year-old boy with severe abdominal pain and a mass that was found to be due to infarction of an accessory spleen that had twisted on its pedicle. Magnetic resonance imaging taken at two different times was helpful in detecting an inflammatory mass, while ultrasonography and computed tomography indicated only the presence of an intraperitoneal mass.

Abdomen, Acute↗
PubMed1994

Echocardiographic findings in 104 professional cyclists with follow-up study.

To assess the effect of long-term athletic training on the heart, 104 professional cyclists and 40 sedentary controls (69 younger cyclists and 26 controls aged 20 to 39 and 35 older cyclists and 14 controls aged 40 to 60) were examined by using M-mode and pulsed Doppler echocardiography. Cyclists had larger and more hypertrophied left ventricle than did controls (p < 0.001) and had normal percentages of fractional shortening (%FS). The ratio of left ventricular late-to-early diastolic peak filling velocity (A/R) of younger cyclists was normal, but the A/R of older cyclists was larger than that of controls (p < 0.001). Of the 104 cyclists, 95 continued cycling and were reexamined 2 years later; 9 of 40 older cyclists retired and were reexamined 20 +/- 8 months after retirement. During the follow-up period for the active cyclists, left ventricular dilatation, hypertrophy, and %FS of both younger and older cyclists and the A/R of younger cyclists did not change. However, the A/R of older cyclists increased (p < 0.01). For the nine retired cyclists, left ventricular dimension decreased (p < 0.001), left ventricular wall thickness and %FS did not change, and A/R increased (p < 0.05) after retirement. We concluded that (1) cyclists had large and hypertrophied left ventricles with normal systolic function, and (2) some cyclists with long-term athletic training may have partly irreversible left ventricular hypertrophy with impaired left ventricular diastolic filling.

Adult↗
PubMed1994

Bilateral adrenal neuroblastoma.

Two cases of bilateral adrenal neuroblastoma in infants are reported. The first patient presented with abdominal distension due to metastatic hepatomegaly and the second patient was found because of elevated urinary VMA by VMA mass-screening system. Both were under one year of age and were classified as stage IVs neuroblastoma. In each case unilateral adrenalectomy was performed and the contra-lateral adrenal tumor was observed. The remaining tumors slowly decreased in size and clinical progress was good. A review of published cases of bilateral adrenal neuroblastoma suggests that the characteristics of this disease are age less than 1 year, stage IVs, and good prognosis.

Adrenal Gland Neoplasms↗
PubMed1994

New neonatal extracorporeal membrane oxygenation circuit with a self-regulating blood pump.

BACKGROUND: Because a roller pump used in a conventional extracorporeal membrane oxygenation (ECMO) circuit with a roller pump cannot change the output automatically according to the venous return, ECMO management requires considerable personnel to prevent serious mechanical complications. An automatic blood pump will make ECMO less laborious and safer. METHODS: Takagi's self-regulating blood pump was modified for neonatal ECMO. The new ECMO circuit was tested in a simulation circuit, in puppies, and in two neonates clinically. Self-regulation of the pump was studied in response to various hemodynamic conditions. RESULTS: The priming volume including a membrane lung and a heat exchanger was about 90 ml. The maximum flow was 700 ml/min in the simulation circuit, 101 ml/min/kg in puppies, and 113 and 135 ml/min/kg in two newborns, respectively. ECMO flow was self-regulating and stable in response to hemodynamic changes. The blood pumps remained functional for more than 400 hours in puppies and 67 and 149 hours in the two newborns, respectively. CONCLUSIONS: The new automatic ECMO circuit is more reliable and requires less personnel than a conventional ECMO circuit.

Animals↗
PubMed1993

First clinical application of an automatic VA-ECMO system using artificial hearts as a blood pump.

A new extracorporeal membrane oxygenation (ECMO) circuit using air-driven artificial hearts as a blood pump was first applied on a newborn with congenital diaphragmatic hernia. ECMO was continued for 67 hours 36 minutes with no mechanical trouble. Since the artificial hearts changed their output automatically in proportion to venous return and did not generate excessive negative and excessive positive pressure, the automatic ECMO circuit could be handled safely by a small number of less-skilled staff.

Extracorporeal Membrane Oxygenation↗
PubMed1993

Usefulness of serum CA125 measurement for monitoring pericardial effusion.

To investigate the clinical significance of carbohydrate antigen 125 (CA125), an antigen related to ovarian cancer, in patients with pericardial effusion, we examined the relationship between serum levels of CA125 and the presence or severity of pericardial effusion. Fifty-seven patients (25 with heart failure, 22 with pericardial metastasis, 4 with hypothyroidism, 4 with renal failure, and 2 with other diseases) in whom pericardial effusion was confirmed by echocardiography or autopsy, were used as subjects. Thirty-seven of these patients (65%) tested positive for CA125 in the serum. Of these, no significant differences in serum levels of CA125 were found between patients with benign and those with malignant underlying diseases or between those with, or without, pericarditis. However, CA125 values were higher in the patients with larger pericardial effusions and the serum level decreased when the pericardial effusion reduced. In some cases, the serum level normalized before the effusion resolved. Pericardial drainage was performed on 6 patients with cardiac tamponade. Four of these 6 patients had high serum CA125 levels and recurrent pericardial effusion. The other 2 patients had normal serum CA125 levels and no recurrence of effusion. An immunohistological study showed that a positive stain of pericardial tissues reacting to CA125 antibodies correlated to higher serum and pericardial fluid levels of CA125 than the levels of groups staining negative to the antibody. These results suggest that CA125 can be useful in assessing the status and clinical course of this disease.

Aged↗
PubMed1993

[A case involving coronary dissection caused after PTCA that was observed with intravascular echocardiography].

We encountered a case that was observed on coronary angiography (CAG) during coronary dissection after coronary angioplasty (PTCA) in which the dissected cavity disappeared on CAG but thrombolytic obstruction in the dissected cavity could be observed by intravascular echocardiography (IVUS). A 67-year-old woman was admitted with a diagnosis of acute myocardial infarction with ST elevation when experiencing chest pain. PTCR was performed for obstruction of the left circumflex artery (LCX) and the stenosis was improved to 90 percent. One month later PTCA was performed on an obstruction lesion in LCX and the feature of the dissected section at the same site was observed by CAG after PTCA. CAG showed that the dissected cavity had disappeared a year and a half later, but IVUS indicated thrombolytic obstruction in the dissected cavity.

Aged↗