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↗

PubMedDate not supplied

General rules for recording endoscopic findings of esophagogastric varices (1991). Japanese Society for Portal Hypertension.

The general rules made in 1980 for recording endoscopic findings of esophageal varices have widely been used in Japan and in other countries. However, since the development of endoscopic sclerotherapy and other modalities of endoscopic treatment, these 1980 rules were found to be insufficient for recording mucosal changes after treatment. The general rules as revised in 1991 recognize mucosal changes such as erosion, ulcer, scar, thrombosed varices, and bleeding signs. These new 1991 rules, which seem useful for recording initial evaluation of gastroesophageal varices and for describing mucosal changes after sclerotherapy as well, are described here.

Esophageal and Gastric Varices↗

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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↗

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Present status of sclerotherapy and surgical treatment for esophageal varices in Japan. Japanese Research Society for Portal Hypertension and Japanese Research Society for Sclerotherapy of Esophageal Varices.

A nationwide survey on the treatment for esophageal varices was performed in 1990 jointly by the Japanese Research Society for Portal Hypertension and the Japanese Research Society for Sclerotherapy of Esophageal Varices to clarify the present status and strategy of this treatment in Japan. A total of 12,675 cases, including 4,159 cases of nonshunting procedures and 7,612 cases of sclerotherapy, were collected from 101 institutions. The number of patients had greatly increased in the first half of the 1980s. With regard to the therapeutic strategy, surgical procedures were not recommended in either emergency or prophylactic cases in terms of the timing of the operation, or in Child C cases in terms of the degree of hepatic insufficiency. Endoscopic injection sclerotherapy became the leading method of treatment and in 1988 only 16% of 1,528 cases were treated by surgical procedures. The strategy for the same group of patients differed between medical and surgical institutions. With regard to sclerotherapy, repeated intravariceal injection and combined intra- and paravariceal injection were the two main techniques and 10-year cumulative survival rates were 62.8% in Child A cases, 47.7% in Child B cases, and 13.2% in Child C cases. With regard to surgical procedures, 10-year survival rates were 50.6% in esophageal transection, 42.5% in gastric transection, 53.1% in cardiectomy, and 43.0% in selective shunt procedures. We are quite convinced that this report will prove useful in determining the future strategy for treating esophageal varices.

Esophageal and Gastric Varices↗

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An automated plasma collector with innovative membrane and cassette-like disposable set.

Explore the source record for details and available documents.

Blood Component Removal↗

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Pharmacodynamics of FUT-175 anticoagulant in adsorbent plasma perfusion.

FUT, a new synthetic protease inhibitor, has been used recently in hemodialysis as an anticoagulant in patients with bleeding tendencies. As some new adsorbents require alternatives to heparin because of their strong adsorbing capacity for heparin, plasma perfusion with FUT anticoagulation was pharmacodynamically investigated. Blood was pumped from a dog (QB = 50-70 ml/min) into a plasma separator. The separated plasma (QP = 10-20 ml/min) passed through an adsorbent column and was reinfused into the blood that had passed through the plasma separator. FUT was continuously infused, at a flow rate of 50 mg/hr, into the blood as it left the dog and entered the extracorporeal circuit. Blood and plasma samples were taken as it exited the dog (S1), before and after the adsorbent column (S2, S3), and before reinfusion into the dog (S4). Except for that done with a charcoal-column, adsorbent plasma perfusion went well and the dog tolerated the procedure. FUT levels in S2, S3, and S4 provided anticoagulation. However, as the FUT levels in S1 remained negligible, the dog's coagulation time was within normal limits. In conclusion, FUT was pharmacodynamically proven to be a safe and reasonable anticoagulant for adsorbents that adsorb large amounts of heparin and for patients with bleeding tendencies.

Animals↗

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Esmarch's bandage technique in distal bypass surgery.

Esmarch's rubber bandage technique has been applied to 49 distal bypass surgeries in 46 patients during the past ten years. The primary and secondary patency rates at 5 years after femoro-tibial bypass surgery were 82% and 92%, respectively. This technique has the following advantages: (1) it minimizes surgical injury of the arterial wall because there is less dissection around the anastomotic site; (2) it decreases scar formation in the anastomotic area after surgery; (3) it maintains abundant muscular blood flow by preserving small branches to muscles, and (4) it provides a bloodless surgical field and easy handling for fine sutures without using vascular clamps. We consider that the avoidance of long circumferential dissection of the artery may play an important role in improving long-term patency in distal bypass surgery.

Adult↗

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Basic studies on a new material for inducing antitumor immune cells.

Recently, adoptive immunotherapy for cancer with lymphokine activated killer (LAK) cells has been widely used experimentally. The therapy has several problems, including difficulty in handling, sterilization, and time consumption. To solve these problems, new materials able to induce antitumor immune cells were investigated. Pokeweed mitogen (PWM) and PWM-conjugated materials (CMC-1) could induce strong killer cells by short-term stimulation of human peripheral blood lymphocytes (PBL). The induced killer cells showed a wide killing spectrum in vitro against human tumor cell lines (MKK-1, PRMI4788, NBT-2, ZR-7530, H-1, Hela, KB, HMV-1, PC-10, C-1). Human PBL stimulated for a short time by CMC-1 also showed a tumoricidal effect on tumor bearing (MKN-1, MKN-45) nude mice. These results suggest that CMC-1 may solve the problems with currently used LAK therapy and may provide easily applicable extracorporeal immunotherapy for cancer.

Cell Line↗

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Carotid artery pseudoaneurysm following internal jugular vein cannulation.

A case of right common carotid artery pseudoaneurysm following internal jugular vein cannulation is reported. The aneurysm appeared three days after removal of the catheter, which had been in the right internal jugular vein for three weeks. There was a pin-hole communication between the common carotid artery and the pseudoaneurysm, which was successfully obliterated by surgery. Carotid pseudoaneurysm formation is a rare complication of internal jugular vein cannulation, and there has been no report of its formation after apparently successful jugular vein cannulation. This complication is difficult to predict, and careful observation after removal of the catheter is mandatory.

Aged↗

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Disseminated intravascular coagulation caused by abdominal aortic aneurysm.

A 71-year-old male with disseminated intravascular coagulation (DIC) caused by abdominal aortic aneurysm was successfully treated surgically. He had aortic regurgitation, an old myocardial infarction, and nephrotic syndrome. The infrarenal part of the inferior vena cava, which was on the left side of the aneurysm, was temporarily transected during the surgical procedure. Preoperative heparin therapy was insufficient, but infusion of blood components during the operation and minimal dissection of the aneurysm were effective in controlling intraoperative hemorrhage. Hypofibrinogenemia and thrombocytopenia were normalized immediately after operation, and hemorrhagic diathesis was completely cured. In this case, the definitive treatment of DIC caused by an abdominal aortic aneurysm war removal of the lesion and the infusion of coagulation factors during the operation was effective in minimizing blood loss.

Aged↗

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Extracorporeal methods of liver failure treatment.

A combination of plasma exchange and dialysis, the procedure of which is easily and safely performed by our hepatic assist system, composed of a membrane plasma separator, blood and plasma pumps, hemodialyzer and controller. This may be a practical and reliable method for hepatic support at the present time, however, the results are not so satisfactory. In order to improve our system, a surfactant-free polyolefine membrane plasma separator has been developed and evaluated to be better than conventional ones in both efficiency and biocompatibility. And also, a new module of IONEX, completely saturated with heparin, has been developed as a safe and an efficient adsorbent, which selectively adsorb bilirubin and bile acids.

Acute Disease↗

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Therapeutic efficacy and toxicity of sequential methotrexate and 5-fluorouracil in gastric cancer.

The therapeutic efficacy and toxicity of sequential methotrexate and 5-fluorouracil in 64 inoperable gastric cancer patients are reported. An intermediate-dose treatment was given to 48 patients, and a low-dose treatment to 16 patients. In the intermediate-dose treatment, leukopenia was observed in 11 patients, nausea and vomiting in six patients and diarrhea and stomatitis in two patients each. In the low-dose treatment, no patient developed toxic symptoms of grade 3 or 4. All 9 responders had adenocarcinoma of the poorly differentiated type and the response rate in patients who belonged to this type was 32.1%.

Adult↗

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Perianastomotic findings in canine endothelial cell seeded grafts at 3 months.

Endothelial cell seeding is one of the methods commonly used to prepare an antithrombogenic surface for small caliber vascular prostheses. In this study, we investigated the perianastomotic tissue reaction of seeded grafts, using a canine model. Eight dogs were used to harvest endothelial cells (ECs) enzymatically from their external jugular veins, with one dog being excluded because of infection. ECs were cultured and seeded, using a rotation method, onto a small caliber prosthesis woven with ultrafine polyester fibers. Each graft was implanted into the carotid artery of its cell donor dog, with another implanted contralaterally as a non seeded control. Two of seven seeded grafts were patent at 3 months, while all controls were occluded. Histologic examination revealed a continuous lining of ECs in the patent grafts, but thickening of the intima at the anastomoses was also observed. The occluded seeded grafts had organized hard thrombi and thick fibrosis at the perianastomotic area, however, with few thrombi in the midportion. These observations suggest that the investigation of a small caliber prosthesis with the ultimate aim of producing better patency should focus not only on antithrombogenicity of the surface of the lumen, but also on the perianastomotic biologic reaction.

Animals↗

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Hemodynamic analysis of findings in patients with portal hypertension: multicenter analysis in Japan. Japan Portal Hypertension Study Group.

BACKGROUND/AIMS: A multicenter study was done to assess the pathophysiology of malcirculation with portal hypertension. PATIENTS AND METHODS: Patients were admitted to 48 different institutes from 1990 to 1992. RESULTS: Portal venous pressure was 345.9 +/- 72.1 mmH2O in patients with portal hypertension. In patients with liver cirrhosis, the diameter of the splenic artery, of the proper hepatic artery, of the left gastric artery and of the splenic vein was significantly larger (p<0.05) than seen in the controls without portal hypertension. In patients with idiopathic portal hypertension, the diameter of the splenic artery and of the vein was significantly larger (p<0.05) and that of the proper hepatic artery was significantly smaller (p<0.05) than seen in the cirrhotic patients. In the cirrhotic patients, blood flow volume was significantly larger (p<0.05) in the splenic vein. In patient with idiopathic portal hypertension, blood flow volume in the portal vein and splenic vein were significantly larger (p<0.05) and that of superior mesenteric vein showed an increasing tendency to enlarge. CONCLUSION: This study shows that a hyperdynamic state is present in patient with portal hypertension.

Case-Control Studies↗