Biomedical subjects

T Takada

Publications and source records attributed to T Takada.

374 records · Page 21Linked to original sources

PubMedDate not supplied

The relationship between a subcutaneously placed afferent jejunal loop in a hepaticojejunostomy and postoperative cholangitis.

A subcutaneously placed afferent jejunl loop pexis, which is often performed during a hepaticojejunostomy, opens a route to the biliary tract, through which appropriate instruments can be passed should postoperative complications arise, requiring a choledochoscopy, the removal of calculi, and for the dilatation of the anastomotic site. From our clinical experience with such a pexis, however, postoperative cholangitis showing a transient fever with abdominal pain and liver dysfunction frequently develops. Further, in cases in which a subsequent dissection of this jejunal pexis was performed, there was a reduction in the incidence of cholangitis, which suggests a possible correlationship between such a pexis and cholangitis. In this investigation, bile stasis in jejunal loop has been studied, using hepatobiliary scintiscanning in examining 31 patients given a hepaticojejunostomy. Fourteen of these patients were also given a jejunal loop pexis, and 17 patients were without such a pexis. Bile stasis was found to be more frequent in the group given a jejunal loop pexis (p less than 0.001). Further, bile stasis was found in 90% of patients showing postoperative cholangitis whereas postoperative cholangitis was observed in 60% of patients with bile stasis (p less than 0.01). Thus, based on the data obtained, as well as our clinical experience, it would seem that a subcutaneously placed jejunal loop pexis should be avoided while performing a hepaticojejunostomy, unless the possibility of anastomotic stenosis and/or the retention of stones are strongly expected.

Anastomosis, Roux-en-Y↗

PubMedDate not supplied

CT score and the severity of acute pancreatitis.

The CT findings in 28 patients with acute pancreatitis were compared with the severity of the disease. The pancreatic image, which demonstrates the pancreatic lesion, was studied with respect to 9 items, and fluid accumulation showing the peripancreatic status with respect to 13 items. According to Forell's classification, the lesion was mild in 8 patients, moderate in 11, and severe in 9. The detection rates of abnormal pancreatic images and fluid accumulation increase with the advance in the severity of the disease. The mean CT score according to severity was 0.9 +/- 0.6 for mild pancreatitis, 7.2 +/- 4.5 for moderate pancreatitis, and 13.4 +/- 4.2 for severe pancreatitis. Significant differences were observed among the groups, suggesting that the CT score is useful for evaluating the severity of acute pancreatitis.

Acute Disease↗

PubMedDate not supplied

Effects of angiotensin converting enzyme inhibitor (SA-446) on regional hemodynamics in renal and spontaneously hypertensive rats.

The effects of an angiotensin converting enzyme inhibitor, SA-446, on regional hemodynamics were examined in conscious renal and spontaneously hypertensive rats (RHR, SHR) using the radioactive microsphere method. We observed the differences in regional hemodynamics between hypertensive rats and normotensive rats, as well as the differences between SHR and RHR. An i.v. administration of SA-446 at a dose of 1 mg/kg induced a considerable hypotension in both types of hypertensive rats and increased the flow rates in most organs, along with an increase of cardiac output. The systemic and regional hemodynamic changes due to SA-446 in SHR and RHR were not qualitatively different, but the organs in RHR responded to SA-446 with greater magnitude. SA-446 increased the flow rates in organs which originally had low flow rates, more than it increased those of normotensive control rats.

3-Mercaptopropionic Acid↗

PubMedDate not supplied

Ultrasonographic diagnosis of acute appendicitis in surgical indication.

The visualization rate and cross section width of the appendix were compared with the severity of appendicitis by using ultrasonography in 77 patients with acute appendicitis. An appendicitis echo was obtained in 100% of phlegmonous and gangrenous appendicitis cases in which emergency surgery was indicated, but in only 32% of catarrhal appendicitis cases in which conservative therapy was generally indicated. The cross section width of the appendix was 19.00 +/- 2.76 mm in gangrenous appendicitis, 15.22 +/- 3.73 mm in phlegmonous appendicitis and 9.50 +/- 1.76 mm in catarrhal appendicitis; i.e. the severer the inflammation the longer the diameter (p less than 0.01). A fluid echo, which suggests the existence of a complication, was observed in patients with gangrenous and phlegmonous appendicitis. The above facts suggest that ultrasonographic examination can be useful in assessing the severity of acute appendicitis.

Acute Disease↗

PubMedDate not supplied

Technique and management of percutaneous transhepatic cholangial drainage for treating an obstructive jaundice.

BACKGROUND/AIM: The authors report on the experience they have gained with regard to the techniques and management of percutaneous transhepatic cholangial drainage (PTCD) as a non-operative method for providing biliary drainage in treating 1,012 patients with obstructive jaundice. MATERIALS AND METHODS: The PTCD puncture for drainage was performed under fluoroscopic guidance for 603 patients between January 1968 and October, 1980, and under ultrasonic guidance for 409 patients between August, 1978 and July, 1994. RESULTS: The incidence of complications after the fluoroscopically-guided puncture was 6.0%, the early post-PTCD complications consisting of hemobilia(5 patients), shock due to an increased the intrabiliary pressure following an injection from the contrast material (12 patients), and shock due to a decrease in the intrabiliary pressure (13 patients), and the late complications consisting of bile peritonitis caused by catheter displacement (6 patients). In contrast, the incidence of post-PTCD complications after the ultrasonically-guided puncture amounted to only 0.7%, which was dramatically lower, and the only complication that occurred was a late complication due to PTCD-tube displacement. CONCLUSION: Thus, monitoring the PTCD-tube is important to complete recovery from the PTCD procedure.

Cholestasis↗

PubMedDate not supplied

Influence of endotoxemia on hepatic energy metabolism in rats with obstructive jaundice.

BACKGROUND/AIMS: A secondary insult in patients with obstructive jaundice can lead to multiple system organ failure. We evaluated the influence of endotoxin on hepatic energy metabolism and hepatic tissue blood flow in obstructive jaundiced rats. MATERIAL AND METHODS: Male Sprague-Dawley rats were divided into a control group, an endotoxin administration group, an obstructive jaundice group, and an obstructive jaundice with endotoxin administration group. To evaluate hepatic energy metabolism, we have measured arterial blood ketone body ratio, and arterial blood total ketone body concentration. Hepatic tissue blood flow was determined by laser Doppler velocimetry. RESULTS: In the endotoxin administration group, no change was observed in hepatic energy metabolism. However, the obstructive jaundice group was associated with decreased hepatic tissue blood flow shortly after the outset of jaundice, while no change was observed in hepatic energy metabolism until 3 weeks later. In the obstructive jaundice with endotoxin administration, a significant decrease in hepatic tissue blood flow and an increase in hepatic energy metabolism were measured. CONCLUSION: Endotoxin administration alone had no influence on hepatic energy metabolism, while endotoxin administration in the presence of obstructive jaundice results in a rapid decrease in hepatic energy metabolism. This occurred as a result of the secondary insult of endotoxin in the setting of decreased hepatic tissue blood flow caused by obstructive jaundice.

Animals↗

PubMedDate not supplied

Simultaneous hepatic resection with pancreato-duodenectomy for metastatic pancreatic head carcinoma: does it improve survival?

BACKGROUND/AIMS: To determine whether aggressive surgery, consisting of a simultaneous pancreatic and partial hepatic resection, for patients with an invasive metastatic ductal adenocarcinoma of the pancreatic head improves the postoperative outcome. MATERIALS AND METHODS: A total of 109 patients with adenocarcinoma of the pancreatic head were divided into two groups. Group 1 consisted of 33 patients with liver metastasis and Group 2 consisted of 76 patients without liver metastasis. Group 1 was further subdivided into 11 patients(Group 1-A) to aggressive surgery, consisting of pancreatoduodenectomy and partial liver resection, and 22 patients to palliative bypass surgery(group 1-B). Group 2 was subdivided into 37 patients to pancreatoduodenectomy(group 2-A), and 39 patients to bypass surgery(group 2-B). RESULTS: No significant statistical differences were seen in the outcomes between Group 1-A (median survival period: 6 months) and Group 1-B (median survival period: 4 months). Further, all Group 1-A patients died from multiple recurrent liver metastasis within a year. In addition, the outcomes of Group 1-A were significantly poorer than that of 2-A patients(median survival period: 24 months). CONCLUSION: Patients who underwent an aggressive simultaneous resection of primary and metastatic hepatic lesion did not exhibit any improvement. However, it is anticipated that these findings will provide insights into developing an effective adjuvant therapy to impede or destroy macroscopic/occult liver metastasis.

Adenocarcinoma↗

PubMedDate not supplied

Results of a pylorus-preserving pancreatoduodenectomy for pancreatic cancer: a comparison with results of the Whipple procedure.

BACKGROUND/AIMS: A pylorous-preserving pancreatoduodenectomy (PPPD) was performed in patients with an invasive ductal adenocarcinoma of the pancreatic head, but with no direct invasion to the duodenal bulb or pyloric ring and no perigastric lymph node metastasis. This study compares the results achieved by the Whipple procedure in patients with invasive ductal adenocarcinoma of the pancreatic head. METHODOLOGY: Over the past 14 years, we have treated 109 patients with an invasive ductal adenocarcinoma of the head of the pancreas, this number excluding low-grade malignancies such as intraductal papillary mucinous carcinoma or cystadenocarcinoma. The postoperative survival rate, level of postoperative social activity and changes in body weight were studied in 48 resected patients and compared with the results of those who underwent the Whipple procedure. RESULTS: In the resected patients, the 3-year survival rate was 20.8%, and the 5-year survival rate was 16.7%. All patients who underwent the bypass operation, however, had a survival rate of less than 2 years, hence the prognosis for resected patients was better (p < 0.01). Among the resected patients, the postoperative survival rate was better in those who underwent a curative resection than in those who underwent a non-curative resection (p < 0.01). No difference was observed in the postoperative survival rate of PPPD vs Whipple procedure patients. The level of postoperative resumption of social activity and changes in body weight were significantly better after the PPPD than after the Whipple operation. CONCLUSIONS: For patients with cancer of the pancreatic head, but with no direct invasion of the duodenal bulb or pyloric ring and no perigastric lymph node metastasis, a PPPD proved more effective than the Whipple operation. Further, as the prognosis was also better after curative resection, an extended lymphadenectomy in conjunction with the PPPD was also considered necessary to ensure a cancer-free state following resection.

Adenocarcinoma↗

PubMedDate not supplied

Effects of prolactin and estrogen on cell proliferation of the mouse liver induced by partial hepatectomy.

Estrogen or prolactin suppresses mouse hepatocellular tumorigenesis induced by carcinogens through inhibition of the growth of preneoplastic hepatocytes. In the present study, we investigated whether estrogen or prolactin inhibits proliferation of normal hepatocytes as well as preneoplastic hepatocytes in mice. The proliferation of mouse hepatocytes was induced by partial hepatectomy, and DNA synthesis of the liver was evaluated by measurement of 5-[125I]iododeoxyuridine ([125I]IdUrd) uptake/mg liver DNA after an injection of [125I]IdUrd into mice. For acute treatment with estrogen or prolactin, estradiol-17 beta (E2) (1 micrograms) or ovine prolactin (140 micrograms) was injected into ovariectomized mice twice a day from the day of partial hepatectomy. For chronic treatment with estrogen, ovariectomized mice received implants of E2 pellets containing 100 micrograms E2 40 days before partial hepatectomy, and for chronic treatment with prolactin, hyperprolactinemia was induced by pituitary graft under the renal capsule of ovariectomized mice 40 days before partial hepatectomy or by daily injections of perphenazine (150 micrograms/day) beginning 40 days before partial hepatectomy. The acute treatment with either estrogen or prolactin did not affect the hepatocyte proliferation induced by partial hepatectomy. Chronic hyperprolactinemia induced by the pituitary graft or by injections of perphenazine, and the chronic treatment with E2 pellets did not suppress either basal or partial hepatectomy-induced proliferation of hepatocytes. The present results show that acute and chronic treatments with estrogen or prolactin do not inhibit proliferation of mouse normal hepatocytes, and suggest that the effects of estrogen and prolactin on proliferation of mouse hepatocytes are different from those on proliferation of preneoplastic hepatocytes.

Animals↗

PubMedDate not supplied

The effects of omeprazole, a proton pump inhibitor, on early gastric stagnation after a pylorus-preserving pancreaticoduodenectomy: results of a randomized study.

BACKGROUND/AIMS: To determine the effects of Omeprazole, a proton pump inhibitor (PPI), on gastric stasis following a pylorus-preserving pancreatico-duodenectomy (PPPD) by means of a randomized trial of PPPD patients. METHODOLOGY: Forty-two PPPD patients were randomly divided into two groups: Group 1 (n=24) received a PPI through a jejunal tube after PPPD, whereas Group 2 (n=18), serving as controls, received a saline solution through a jejunal tube and no medication after a PPPD. The daily volume and total acidity of the gastric juice, aspirated via nasogastric tube, were measured each day for 7 days following PPPD. RESULTS: In Group 1 the mean daily aspirated volume of gastric juice was 160.2 ml, and the mean maximum volume was 222.8 ml on the first postoperative day. In Group 2, six patients were withdrawn from this study for therapy on the third or fourth postoperative day due to gastric bleeding and/or a large amount of excreted gastric juice (in excess of 2,000 ml). The mean daily aspirated volume of gastric juice in the remaining Group 2 patients was 787.4 ml, and the mean maximum volume was 1,039 ml on the third postoperative day. Gastric secretion was significantly lower in Group 1 (p<0.05). Further, the total acidity of the gastric juice was significantly lower in Group 1 than in Group 2 for each of the 7 postoperative days (p<0.05). CONCLUSIONS: These results indicate that postoperative administration of a PPI significantly suppresses the volume and acidity of the gastric juice after PPPD.

Aged↗

PubMedDate not supplied

An introduction to mucin-producing tumors of the pancreas: why they deserve more attention.

BACKGROUND/AIMS: Mucin-producing tumors of the pancreas are clinically characterized by dilatation of the major pancreatic duct due to pooled mucin, and by dilatation of the orifice of the duodenal papilla. The concept of mucin-producing tumors of the pancreas was proposed in 1982, but has undergone revision since then. METHODOLOGY: The present paper reviews the history, classification, and description of mucin-producing tumors of the pancreas. Problems relating to this type of tumor are also discussed. RESULTS: The clinical concept of mucin-producing tumors of the pancreas has affected studies of the pancreatic diseases in many areas. First, when recognition of pancreatic cancer with a relatively good prognosis commenced, this concept led to awareness of the necessity for a detailed examination of the pancreatic duct epitheliums in cases of suspected pancreatic carcinoma. Second, the concept made it easier to diagnose carcinoma in situ. Third, new classifications of cystic lesions of the pancreas were initiated. Fourth, a molecular biological view of the onset of pancreatic cancer was developed. Pathologically, this type of tumor is characterized by papillary growth of the epitheliums within the pancreatic duct, and it has been regarded as having a good prognosis. The term mucin-producing tumors of the pancreas now includes: intraductal papillary tumors which are non-invasive carcinomas or carcinoma in situ; duct-ectatic tumors, or mucinous cystic tumors; and, invasive carcinomas, derived from the former types. CONCLUSIONS: The definition of "mucin-producing tumor of the pancreas" has been undergoing revision. In the past, it has referred to pancreatic tumors with a good prognosis. It is now time to consider a more detailed classification.

Adenocarcinoma, Mucinous↗

PubMedDate not supplied

Surgery for mucin-producing pancreatic tumor.

BACKGROUND/AIMS: There is a diversity of mucin-producing tumors of the pancreas, including benign adenoma, malignant intraductal papillary carcinoma and invasive papillary carcinoma. However, there has been little discussion of appropriate techniques for surgically treating these tumors. METHODOLOGY: From August 1981 to December 1997, surgery was performed on 24 patients with mucin-producing pancreatic tumors (18 cases were malignant and 6 were benign). The surgical techniques which were used, the results of surgery, and the post-operative course of the patients are discussed. RESULTS: Surgical resection was possible in 23 patients and included: 4 cases of total pancreatectomy; 1 case of pancreaticoduodenectomy (Whipple's procedure); 1 case of Whipple's procedure with a transverse colectomy; 13 cases of pylorus-preserving pancreaticoduodenectomy (PPPD); 2 cases of duodenum-preserving pancreatic head resection (DPPHR); 1 case of resection of the posterior segment of the pancreas (posterior segmentectomy); and, 1 case of resection of the medial segment of the pancreas (medial segmentectomy). Surgical resection was also used for 17 (94.4%) of the 18 patients with malignant tumor. There were no fatalities during or immediately following surgery. One patient developed transient duodenal stenosis after DPPHR. The 5-year survival rate after surgical resection was 68.4% for the 17 patients with malignant tumor. Mucus leaked from the pancreatic duct into the operating field of 1 patient during pancreatectomy. This patient died 7 months after surgery from a tumor metastasis of the thoracic mediastinal lymph nodes and peritoneal seeding. This episode illustrates the high risk associated with leakage of pancreatic duct mucus into the operating field. The longest surviving patient, 13 years and 11 months after total pancreatectomy, has good health and shows no signs of recurrence. CONCLUSIONS: The prognosis for surgically resectable mucin-producing pancreatic tumors is better than that for invasive pancreatic duct carcinoma. When treating mucin-producing pancreatic tumors surgically, techniques which allow preservation of pancreatic and gastroenteric functions should be selected when possible. These techniques include PPPD, DPPHR and pancreatic segmentectomy. A total pancreatectomy should only be selected in cases where cancer has invaded the entire pancreas (especially when cancer has invaded the duct within the pancreatic head, through the tail). It may also be used when residual cancer cells have been detected by intra-operative pathological examination at the distal stump of the pancreas. During surgery with any technique, leakage of pancreatic duct mucus into the operating field must be avoided.

Adenocarcinoma, Mucinous↗

PubMedDate not supplied

Prospective randomized trial of 5-fluorouracil, doxorubicin, and mitomycin C for non-resectable pancreatic and biliary carcinoma: multicenter randomized trial.

BACKGROUND/AIMS: The efficacy of combination chemotherapy, which consists of fluorouracil, doxorubicin and mitomycin, was compared with that of palliative surgery-only in patients (control) having non-resectable pancreatic and biliary carcinomas in a multicenter randomized trial. METHODOLOGY: The patients were assigned to combination chemotherapy consisting of concomitant 5-fluorouracil 200 mg/m2, doxorubicin 15 mg/m2, and mitomycin 5 mg/m2 by intravenous administration. This combination chemotherapy was given concurrently as the initial dose within 1 week after palliative operation, and this regimen was repeated for at least 2 whole courses at 4-week intervals before the next course of therapy. Forty-two cases of this combination chemotherapy group and 41 of the control group were completely eligible for analysis. RESULTS: Regarding the overall 50% inhibition of tumor progression and that of gallbladder carcinoma, there were significantly better outcomes in the modified FAM therapy group. In this group, tumor reduction was achieved in 1 complete response (CR) and 2 partial response (PR) patients. With respect to the overall and differentiated survival times according to the tumor sites and the clinical efficacy, there was no difference between the groups. The most frequent adverse reactions were gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea; also noted was alopecia. CONCLUSIONS: Since this combination chemotherapy inhibited the tumor progression for significantly longer duration and, to a lesser extent, reduced the tumor size in non-resectable gallbladder carcinomas compared to a non-administrated chemotherapy group, this study will function as the basis for pursuing a more effective chemotherapy.

Adult↗

PubMedDate not supplied

Pancreatic duct patency after pancreaticogastrostomy: long-term follow-up study.

BACKGROUND/AIMS: To clarify whether the pancreatic duct remains patent during long-term follow-up of patients after pancreaticogastrostomy. In a previous study of pancreaticogastrostomy with post-operative follow up for 3 years after surgery, we found that the orifice of the pancreatic duct was difficult to detect in some patients because of swelling of the gastric mucosa. Previous studies have not examined pancreatic duct patency during long-term follow-up. METHODOLOGY: Between July 1985 and August 1989, 20 patients underwent a pylorus-preserving pancreaticoduodenectomy with reconstruction by pancreaticogastrostomy. Five of these patients were followed up post-operatively for more than 9 years to determine the patency of the pancreatic duct. All pancreatic anastomoses were performed by the telescopic method. RESULTS: All 5 patients were female, with a mean age of 65.4 years (range: 54-75). Median post-operative follow-up was 10.8 years (range: 9-12). The indications for surgery were carcinoma of the ampulla of Vater in 4 patients and chronic pancreatitis in 1 patient. Pancreatic duct patency was confirmed in 4 patients by gastroscopy and pancreatography. However, the anastomotic orifice could not be detected in the remaining patient because of complete coverage by the gastric mucosa. In this patient, pancreatic exocrine and endocrine function deteriorated with dilation of the distal pancreatic duct. The patient underwent a second operation involving dissociation of the pancreatico-gastric anastomosis and resection of about 1 cm of the fibrous, proximal portion of the pancreas. Reconstruction was performed with a Roux-en-Y pancreaticojejunostomy and a mucosa-to-mucosa anastomosis. CONCLUSIONS: Although pancreaticogastrostomy has been applied as a safe and straightforward method for reconstruction after pancreaticoduodenectomy, anastomotic stenosis is a potential late complication of this approach.

Aged↗