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Biomedical subjects

T Tsunoda

Publications and source records attributed to T Tsunoda.

At least 271 records · Page 15Linked to original sources
PubMed1986

Collective review of small carcinomas of the pancreas.

To determine problems involved in the treatment and diagnosis of pancreatic cancer, a collective study of small carcinoma of the pancreas (2 cm or less in diameter) was performed. One hundred six cases were collected and analyzed. The results were as follows: In small carcinoma of the pancreas, the resectability rate was 99.0% and the operative mortality rate was 4%. Only 44% of the patients belonged to Stage I, and 14% belonged to Stage III or IV. Lymph node involvement, capsular invasion, retroperitoneal invasion, and vascular invasion were found in 30, 20, 12, and 9% of the patients, respectively. The postoperative cumulative 5-year survival rate was 30.3%, and that of Stage I was 37.0%. A small-sized tumor of the pancreas is not always an early carcinoma, but a tumor in Stage I may be regarded as an early carcinoma. Percutaneous transhepatic cholangiography and endoscopic retrograde cholangiopancreatography were the main diagnostic indicators in cases with and without jaundice, respectively. There was no specific single serum test for detecting small pancreatic cancer.

Adult↗
PubMed1985

Surgical treatment for carcinoma of the extrahepatic bile duct.

Eighty-six patients with primary extrahepatic bile duct carcinoma operated on in the Second Department of Surgery at Nagasaki University Hospital during a recent 13.5-year period were reviewed. The patients were divided into five groups depending upon the site of the tumor. The operative mortality, resectability, postoperative survival period, and five-year survival rate in each group were studied. The lower third group had the highest resectability, lowest operative mortality and longest post operative survival period. The hepatic duct, the upper third and the extended groups, however, showed extremely poor results. The pathological features of these three groups are discussed here and an operative procedure for resection of the tumor is proposed. We emphasize that the development of methods of early diagnosis is necessary, and recommend aggressive surgical treatment for tumors of the hepatic duct, upper third, and extended groups.

Adolescent↗
PubMed1985

Long-term results of surgical treatment for intrahepatic stones.

One hundred and nineteen patients with intrahepatic stones treated surgically in Nagasaki University Hospital from 1969 to 1984 were reviewed. The patients were divided into four types according to location of the stones and the presence or absence of stenotic lesions and/or localized dilatation of the intrahepatic bile ducts. Types I and II patients were treated with choledocholithotomy or choledochojejunostomy, while type III patients underwent hepatic resection and type IV patients were treated by partial hepatic resection with bilioenteric anastomosis, including extended hepatico-choledochojejunostomy. The majority of operative or early deaths belonged to type IV and residual stones were present in almost all patients. The long-term results for the 88 patients revealed that the rate of improvement was 100 per cent for type I, 87 per cent for type II, 83 per cent for type III and 84 per cent for type IV. In type IV, the most excellent results (92 per cent) were obtained by extended hepaticocholedochojejunostomy, especially with hepatectomy. It is suggested that extended hepaticocholedochojejunostomy with partial hepatic resection is a reasonable procedure for treating patients with type IV intrahepatic stones.

Adolescent↗
PubMed1985

[Surgical results of severe acute pancreatitis with special consideration of the severity of pancreatitis].

The surgical treatment of acute pancreatitis remains controversial. Since 1975, we have treated 70 patients with acute pancreatitis. In 36 with severe acute pancreatitis who were not responding adequately to medical intensive treatments, mobilization and drainage of pancreatic exudate from pancreatic bed and retroperitoneal cavity (M-D procedure) were carried out. Thirty-six operative cases were classified into 8 edematous, 7 hemorrhagic, and 21 necrotizing. Edematous pancreatitis showed a tendency of early development of severe symptoms such as enzymatic encephalopathy. Eight of 36 patients who underwent M-D procedure died (22.2 percent), but the rate became 13.8 percent after excluding 3 who died of unrelated causes. Postoperative complications were most frequently encountered in the patients with gallstone pancreatitis. Obstruction of the alimentary tract due to pancreatic or peripancreatic abscess was most serious late complication. Six of the eight were required reoperations and three of them died of further complications which were developed after reoperations. The rate of curability of M-D procedure was 84.8 percent. These data suggest that M-D procedure is highly effective in the treatment of early case of severe acute pancreatitis.

Acute Disease↗
PubMed1984

Results of mobilization and drainage of the pancreas for acute pancreatitis.

The surgical treatment of acute pancreatitis remains controversial. Since 1969, we treated 60 patients with acute pancreatitis. In 34 with severe acute pancreatitis who were not responding adequately to intensive medical care, surgical intervention was made by mobilization of the pancreas from retroperitoneal tissue and drainage of the pancreatic bed (M-D procedure). Thirty-four operative cases were classified into 7 edematous, 7 hemorrhagic, and 20 necrotizing. Macroscopic findings of the pancreas did not correlate either to the severity of the acute pancreatitis or to the mortality rate. Eight of 34 who underwent M-D procedure died (23 per cent), but the rate became 14.7 per cent after excluding 3 who died of unrelated causes. These data suggest that the M-D procedure is highly effective in the treatment of early cases of severe acute pancreatitis. There was an associated marked reduction in the mortality rate with the prophylactic use of broad spectrum antibiotics. With M-D procedure, there was a low incidence of late sequelae of pancreatic or peripancreatic abscess.

Acute Disease↗
PubMed1984

[Intrapulmonary reactions of workers exposed to dust and ozone].

Forty-one dust-and-ozone-exposed and 37 nonexposed workers, belonging to the Research and Development Division of a photo-copier manufacturing industry, were examined to assess the effect of the exposure to carbon, iron and resin dust and ozone in the air of the work environment by means of questionnaires on their physical condition, smoking habits and exposure history by interview, chest X-rays, testing of ventilatory functions, transcutaneous PO2 (tcPO2) test and H2O2-induced hemolysis test. The following results were obtained. Respirable dust concentrations in the air of the work place were 0.1-1.0 mg/m3, total dust concentrations 0.2-2.0 mg/m3, and ozone concentrations 0.004-0.06 ppm (0.008-0.12 mg/m3). According to the Japanese Classification of Radiographs of Pneumoconioses, the exposed workers showed a higher rate of profusion 0/1 and over, and category 1 and over (1/0 and over) than the nonexposed workers. Ventilatory function testing revealed no difference between exposed workers and nonexposed workers, but small airway narrowing was suspected in smoking workers in comparison with nonsmoking workers. Transcutaneous PO2 showed no difference between exposed and nonexposed workers, between smoking and nonsmoking workers, and between any of the paired six combinations out of the four groups of workers, i.e., nonsmoking and nonexposed, nonsmoking and exposed, smoking and nonexposed, and smoking and exposed. It was estimated by H2O2-induced hemolysis test that smoking and/or dust exposure, especially long-term exposure, gave rise to aggravation of fragility of the erythrocyte membrane by lipid peroxidation with ozone or active oxygen produced by the reaction of dust and alveolar macrophages. The questionnaire was considered indispensable to ascertain the workers' exposure history. No worker in this work environment showed clinical signs indicating a need for medical care or home response. There results may indicate that in resolving the pathogenesis of pneumoconiosis further studies will be required on the prevalence rate of profusion 0/1 and over (or category 1 and over) under low concentrations of dust exposure and on the intrapulmonary reactions induced by low doses of dust exposure.

Adult↗
PubMed1984

[Morphological studies on the pathogenesis and treatment of hepatolithiasis].

Review of 108 patients with hepatolithiasis showed a recent increase of primary intrahepatic gallstones. 55 per cent of cases with hepatolithiasis had their gallstones in the left intrahepatic bile ducts. Clinicopathological study on the resected hepatic specimens of 33 patients revealed numerous intrahepatic periductal glandular formations. Periductal glandular formations were classified into the intramural and extramural glands. The mucous substances which might had been released from the periductal glands seemed to play a role in the formation of stones in combination with bilirubin pigments, cholesterin, bacterial organisms, cellular debris and other bile component. Intrahepatic gallstones and extramural glands were seen in the intrahepatic segment and area ducts. The defunctionalized atrophic hepatic lobe or segment should be resected in order to remove the calculi completely and to prevent the recurrence.

Adolescent↗
PubMed1983

[Evaluation of the lipid and glucose metabolism on the apancreatic status with insulin supplement and with pancreatic autotransplantation].

To evaluate the effect of pancreatic fragments transplantation on glucose and lipid metabolism in the apancreatic status, 22 healthy mongrel dogs were totally pancreatectomized and then divided into three groups, (1) 5 dogs without any supplement , (2) 5 dogs with insulin replacement, and (3) 12 dogs with additional pancreatic fragments transplantation. In these three groups, changes in fasting plasma sugar, triglyceride, total cholesterol, phospholipid and lipoprotein fractions were studied. Stability of serum glucose levels were compared between the dogs with insulin replacement and those with transplantation by using glucose infusion and insulin test. Without insulin replacement or transplantation, apancreatic dogs showed high serum glucose levels immediately after total pancreatectomy. With pancreatic transplantation, serum glucose levels and lipids were well controlled within normal limits for a long time period after the operation. However, in the dogs with insulin replacement, serum glucose levels and lipids were remarkably unstable in fasting period and also showed easily tendencies to become hypoglycemic status by insulin test and diabetic ketoacidosis by glucose infusion test as compared with those in the transplanted dogs.

Animals↗
PubMed1982

Reoperative surgery in cholelithiasis.

From 1965 to 1980, reoperations for residual or recurrent stones were performed on 78 out of 962 Japanese patients with cholelithiasis. The majority of patients who required reoperation had intrahepatic stones. Most of the causes of reoperation were residual stones due to incomplete removal or the non-detection of intrahepatic stones at the previous surgery. Very careful examination of the intrahepatic biliary trees should be done in patients with biliary tract diseases, because in many, the first operation was done during their youth. To remove the intrahepatic calculi completely, hepatic lobectomy should be considered as a final procedure. The causes of reoperation of common duct stones were residual in 60 per cent and recurrent in 40 per cent. Definitive surgery should be done at the first or at least the second operation to avoid irreversible hepatic disorders which have untoward effects on the prognosis. It is important not only to remove the stones but also to relieve the bile stasis in the biliary tract.

Aged↗