[Ultrasonic diagnosis of gastrointestinal diseases].
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Acute Disease↗
Biomedical subjects
Y Bandai
Publications and source records attributed to Y Bandai.
[Ultrasound-guided needle biopsy].
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Biopsy, Needle↗
The inferior right hepatic vein: ultrasonic demonstration.
The inferior right hepatic vein (IRHV) was demonstrated sonographically in 27 out of 269 patients (10%). It was shown to be thicker than the right hepatic vein in 8 (3%). In 2 patients, two accessory right hepatic veins were demonstrated, with one being the IRHV and the other the middle right hepatic vein. Delineation of the IRHV is significant in hepatectomy, detection of tumor thrombus in hepatocellular carcinoma, Budd-Chiari syndrome, and dilatation of the intrahepatic bile ducts.
Bile Ducts, Intrahepatic↗
Ultrasonic characteristics of the small hepatocellular carcinoma.
Fifty five small hepatocellular carcinoma less than 5 cm in diameter among 41 patients were examined by linear arrayed electronic scanning system with 3.5 MHz transducer. Characteristics of the sonogram were enhanced posterior echoes of the tumor, mosaic pattern of internal echoes, halo and lateral shadows. These findings are appeared in 69%, 64%, 35% and 22% of tumors respectively. Among 45 tumors from 2.1 cm to 5 cm in diameter, these findings are appeared in 81%, 73%, 40% and 24% respectively. Among 10 tumors less than 2 cm in diameter, these characteristics were rare and these minimal hepatocellular carcinomas were demonstrated as a simple low echo area. Fifty tumors in 39 patients were resected. Lobulation of the hepatocellular carcinoma on the cut surface of the resected specimen and mosaic pattern on the sonogram are closely connected with each other. Thin fibrous capsule of the hepatocellular carcinoma corresponded to halo and lateral shadows. Posterior echo enhancement was due to the softness of the hepatocellular carcinoma. By those four characteristics, hepatocellular carcinoma can be differentiated from hemangioma and metastatic liver tumor.
Carcinoma, Hepatocellular↗
Ultrasonographic diagnosis and drainage in noncalculous acute cholecystitis following surgery.
Postoperative acute cholecystitis is not so rare complication especially in postgastrectomy patients. Ultrasonic examination is the most suitable means of identifying postoperative acute cholecystitis. 24 patients were diagnosed as postoperative acute chlecystitis mainly by ultrasonic examination. The majority of cases recovered only by conservative treatment. Clinically severe cases are particularly indicated for ultrasonically guided percutaneous transhepatic gallbladder drainage. Moreover, patient with postoperative acute cholecystitis are considered to require follow-up studies after recovery.
Adult↗
Treatment of intrahepatic lithiasis using the choledochofiberscope.
Our experience with choledochoscopic extraction of intrahepatic calculi in eleven cases is presented. In three cases, the intrahepatic bile duct containing multiple stones was punctured under the guidance of ultrasonography, and the stones were removed choledochoscopically through the percutaneous transhepatic cholangial drainage (PTCD) tract which was dilated with catheters of increasing diameter. In nine cases, the removal of intrahepatic stones was attempted choledochoscopically through the T-tube tract or the jejunostomy. This procedure was successful in six of the nine cases. The advantage of the choledochoscopic removal through the PTCD tract compared with that through the T-tube tract is discussed, and an illustrative case is presented.
Adult↗
Sonographic differentiation between the umbilical portion of the left portal vein and intrahepatic bile ducts.
The method of differentiating between the portal vein and the bile ducts by means of their intrahepatic portions was studied. The left branch of the portal vein courses horizontally as the transverse portion, then veers anteriorly at an acute angle to make the umbilical portion. This characteristic form was demonstrated in all normal controls and 95% of the jaundiced patients studied. The left hepatic duct does not curve anteriorly at an acute angle, but branches off to the lateral segment running superior to the umbilical portion. This anatomic relationship and characteristic form of the umbilical portion were useful in differentiating the portal vein and the bile ducts.
Bile Ducts, Intrahepatic↗
Ultrasonically guided percutaneous transhepatic cholangiography and percutaneous pancreatography.
Ultrasonically guided percutaneous transhepatic cholangiography and percutaneous pancreatography were successfully performed in a patient with periampullary carcinoma. The entire biliary tree, including the dilated pancreatic duct, was visualized on both occasions. The techniques used are described, and the clinical significance of ultrasound as a guide in percutaneous puncture is discussed.
Aged↗
Ultrasonically guided percutaneous transhepatic bile drainage: a single-step procedure without cholangiography.
Percutaneous transhepatic bile drainage under real-time ultrasonic guidance was performed in 16 patients (21 procedures) without cholangiography. All bile ducts were successfully intubated. Merits of ultrasonically guided percutaneous transhepatic bile drainage are (a) the fact that only a single step is involved, without thin-needle cholangiography; (b) no contrast medium is injected; (c) the left-sided approach permits longer intubation; and (d) irradiation is not employed.
Bile↗
Sugiura procedure for management of variceal bleeding in Japan.
During the last three decades the Sugiura procedure and other nonshunting operations have been widely performed as the operations of choice for bleeding esophageal varices in Japan. The Sugiura procedure (University of Tokyo method), a transthoracoabdominal esophageal transection, consists in paraesophageal devascularization, esophageal transection and reanastomosis, splenectomy, and pyloroplasty. The results have been satisfactory with low operative mortality and low rebleeding rate. The prognosis of the patients after this operation depended on the liver function at the time of operation but not on whether operation was done as an emergency, elective, or prophylactic measure. Although the Sugiura procedure has recently been performed in more selected cases with an advance in endoscopic injection sclerotherapy, this procedure remains the ultimate direct operation for portal hypertension in Japan.
Adolescent↗
Changes in splanchnic blood flow and cardiovascular effects following peritoneal insufflation of carbon dioxide.
Laparoscopic surgery has rapidly become a popular and widely used technique. Although this procedure has been shown to be generally safe, cardiovascular derangement related to carbon dioxide pneumoperitoneum has been reported. There are few data available on the relationship between systemic and regional hemodynamics in cases of pneumoperitoneum. Changes in splanchnic blood flow and cardiovascular effects following a moderate increase of intraabdominal pressure (IAP) to 16 mmHg during a 3-h period were analyzed in six anesthetized dogs. After insufflation, cardiac output and blood flow in the superior mesenteric artery and portal vein decreased progressively and returned to the preinsufflation values following deflation. Hepatic arterial blood flow did not change significantly, perhaps due to compensatory mechanisms for maintenance of hepatic blood flow. Mechanical compression of the splanchnic capillary beds due to the elevated IAP may possibly reflect the increase in systemic vascular resistance causing the decrease in cardiac output. To prevent this impairment, intermittent decompression of gas during surgical laparoscopy is recommended.
Animals↗
Ultrasonically guided cholangiography and bile drainage.
Ultrasonically guided percutaneous transhepatic cholangiography (UG-PTC), bile drainage (UG-PTBD) and gallbladder drainage procedure (UG-PTGBD), developed by us, were performed in 47, 183 and 36 patients, respectively. In 47 patients UG-PTC was successfully performed 51 times without complications. By UG-PTBD 220 intubations were carried out successfully and four attempts failed (1.8%). The main complication was that the catheter slipped out from the bile duct. It was experienced 27 times (12.3%) in 23 patients (12.4%) from two to 47 days after intubation. UG-PTGBD was successfully performed 36 times. Bleeding from the catheter was experienced in four patients. However, other complications such as cholascos were not experienced. Due to the development of ultrasonic diagnosis and the UG-PTBD procedure, the indications for percutaneous transhepatic cholangiography (PTC) are now limited. For differentiation of jaundice, ultrasonic examination takes over from PTC. For preparation of PTBD, thin needle cholangiography is no longer necessary because UG-PTBD is a single-step procedure without the need for cholangiography. Therefore, the indication for PTC is limited to patients with partial dilatation of intrahepatic bile ducts without jaundice, for example when only the left hepatic duct is dilated due to hepatolithiasis.
Bile↗
Surgical management for adrenal gland metastasis of hepatocellular carcinoma.
BACKGROUND/AIMS: Although the adrenal gland is one of the common sites for metastasis from hepatocellular carcinoma, the significance of adrenalectomy for treatment of metastatic hepatocellular carcinoma still remains unclear. METHODOLOGY: Analysis of 4 patients with adrenal metastasis from among 390 patients with hepatocellular carcinoma admitted to our department between October 1994 and December 1997, and a review of 79 cases reported between 1984 and 1997, were performed. RESULTS: Four patients with adrenal metastasis, right in 2 and left in 2, underwent surgical treatment. Three of the patients developed tumor thrombi in the renal vein or inferior vena cava. Diagnosis of adrenal metastasis was made by ultrasonography or computed tomography scan, following an increase in serum tumor markers. Adrenalectomy with removal of the venous tumor thrombi was performed successfully. Three patients died of recurrence within 1 year, and one patient died due to other causes showing no recurrence at autopsy. The literature review revealed the left-sided metastases were significantly larger than the right-sided ones (p < 0.01). There was no significant difference in the survival periods between left and right metastasis, or between patients who underwent adrenalectomy and those treated by other means (p > 0.05). CONCLUSIONS: The rationality of surgical treatment for adrenal metastasis from hepatocellular carcinoma still remains controversial. However, we believe that adrenalectomy would be a safe procedure and increases the chance of survival for patients.
Adrenal Gland Neoplasms↗
Proximal bile duct stricture caused by a pancreatic pseudocyst: intra-operative placement of a metallic stent.
A 61 year-old man presented with a proximal bile duct stricture caused by a pancreatic pseudocyst, which is of rare occurrence. Although it could not be determined pre-operatively whether the lesion was caused by cholangiocarcinoma or inflammatory disease, a laparotomy revealed that the proximal extrahepatic bile duct was surrounded and constricted by a pancreatic pseudocyst extending into the hepatoduodenal ligament. Since the stricture was not relieved only by removing the contents of the pseudocyst and surgical biliary diversion was considered too difficult, a self-expandable metallic stent was placed intra-operatively, at the strictured site, under ultrasonic guidance, via the transhepatic approach. The post-operative course of the patient was uneventful, and he remains well 22 months after the operation. The intra-operative placement of a metallic stent into the biliary tract can be an alternative option in the relief of biliary obstruction.
Cholangiopancreatography, Endoscopic Retrograde↗
Rate of bilirubin decrease as a risk predictor in hepato-biliary-pancreatic surgery.
BACKGROUND/AIMS: Although percutaneous transhepatic biliary drainage is widely performed for jaundice reduction, the clinical significance and mechanism responsible for delayed decrease of the bilirubin level remains unclarified. METHODOLOGY: The rate of bilirubin decrease was estimated in 104 consecutive patients who underwent drainage. Morbidity and mortality after major and minor operations for hepato-biliary-pancreatic diseases in groups showing slow and rapid bilirubin decrease were estimated. The risk factors for slow bilirubin decrease were also examined by uni- and multivariate analyses. RESULTS: A statistically significant difference between the slow and rapid bilirubin decrease groups was found only in the morbidity rates of major surgery (73% vs 28%, p < 0.05). Univariate analysis showed that the longer interval from onset of jaundice to drainage, the use of multiple catheters for jaundice reduction, and advanced age were significant risk factors for slow bilirubin decrease. These factors were found to be independent by multivariate analysis (p < 0.05) CONCLUSIONS: A slow rate of jaundice reduction is a predictor of high risk in major surgery. It can be attributed to 3 factors; longer term of undrained jaundice, multiple biliary drainage, and age. Careful post-operative management is required when major surgery is scheduled for patients with these risk-predictive factors.
Adult↗
Biliary stricture due to mucosal hyperplasia of the common bile duct: a case report.
A 71-year-old man with a tumorous lesion of the common bile duct is presented. Although histological examination of tumor biopsy specimens taken at the time of duodenoscopy or percutaneous transhepatic choledochoscopy showed mucosal hyperplasia, cancer could not be ruled out; therefore, the patient underwent pancreatoduodenectomy. However, histology showed nodular mucosal hyperplasia and an ectopic pancreas adjacent to the papilla of Vater, which was suspected to have contributed to the development of the lesion by stimulating the mucosa of the papilla and the distal common bile duct.
Aged↗
Extended right trisegmentectomy for hilar bile duct carcinoma.
Extended right trisegmentectomy with total caudate lobectomy, extrahepatic bile duct resection and lymphadenectomy was performed for a 54-year-old man, who was diagnosed as type IV hilar bile duct carcinoma. After division of the right portal vein and all the portal venous branches to the caudate lobe and the left medial segment, the left hepatic artery and its branches to the segment II and III were dissected from the corresponding bile ducts to about 1 cm beyond the left margin of the umbilical portion of the left portal vein, where the lateral segmental bile ducts were divided after transection of the hepatic parenchyma. All bile duct margins were free from cancer microscopically. To our knowledge this is the first report of extended right trisegmentectomy for hilar bile duct carcinoma, in which the bile ducts of the left lateral segment are divided at the left side of the umbilical portion of the left portal vein. This technique facilitates making the intrahepatic bile duct stumps free from cancer. However, its impact on long-term survival remains to be determined.
Bile Duct Neoplasms↗