Search PubMed⌕ Search

Biomedical subjects

Y Idezuki

Publications and source records attributed to Y Idezuki.

At least 55 records · Page 3Linked to original sources
PubMed1994

Role of laparoscopic cholecystectomy in treating gallbladder polyps.

Since the application of laparoscopic cholecystectomy (Lap C) to gallbladder polyps has not yet been fully evaluated, we performed Lap C on 26 patients with gallbladder polyps. Pathological examinations showed adenocarcinoma in three patients, adenoma in two, and cholesterol polyp in 21. Preoperative diagnoses of the cases with adenocarcinoma were a cholesterol polyp in one patient and an adenoma in two. Adenocarcinoma was confirmed to reside in the mucosa without any invasion of lymphatic ducts or small vessels in the three patients. This procedure was considered to be sufficient for this grade of cancer, and, therefore, no additional operations were performed. At present, our policy is to resect by Lap C a gallbladder polyp having a maximum size larger than 10 mm and a tendency to grow or presenting with suspicion of adenoma. When cancer is suspected by preoperative examinations, however, traditional surgery may be recommended.

Adenocarcinoma↗
PubMed1994

Morphometry of sinusoids and portal hypertension in non-alcoholic cirrhosis.

To examine whether structural changes in hepatocytes and/or sinusoidal areas contribute to the portal hypertensive state in non-alcoholic cirrhosis, a new method of morphometric analysis using a computer-aided color image analyzer was performed in 16 patients with non-alcoholic cirrhosis, which allowed quantitative evaluation of various morphometric parameters of sinusoids and hepatocytes. The sinusoidal pressure gradient was estimated theoretically with these and clearance parameters using Poiseulle's equation and compared with the hepatic venous pressure gradient measure by hepatic vein cannulation. A significant relationship was found between the hepatic venous pressure gradient and sinusoidal volumetric ratio (r = -0.598, p < 0.05), but not between mean hepatocyte volume and sinusoidal volumetric ratio (r = 0.416, NS), or the hepatic venous pressure gradient (r = 0.371, NS). The estimated sinusoidal pressure gradient showed a significant relationship with the hepatic venous pressure gradient (r = 0.637, p < 0.01). However, the absolute values of the former were much lower than those of the latter. Therefore, in non-alcoholic cirrhosis, although sinusoidal stenosis not caused by hepatocyte swelling may lead to increased vascular resistance, other factors must also play a significant role.

Aged↗
PubMed1994

Study of new prognostic factors of esophageal variceal rupture by use of image processing with a video endoscope.

BACKGROUND: We studied new prognostic factors of esophageal variceal rupture by analyzing electronic video images of esophageal varices in 30 patients with portal hypertension. METHODS: Fifteen of the patients were emergency or elective cases (bleeders), and the remaining 15 were prophylactic cases (nonbleeders). A comparison was made between the bleeders and nonbleeders in terms of endoscopic findings and the image processing data, especially variceal color tone and red color sign. RESULTS: Endoscopic findings based on the general rules prepared by the Japanese Research Society for Portal Hypertension showed no significant difference between the two groups. However, with regard to the image processing data, both the ratio of red signal and the ratio of value were significantly lower in bleeders than in nonbleeders. In addition, the area ratio of red color sign was significantly higher in the former than in the latter. A follow-up study of nonbleeders also indicated that image processing data were more reliable than traditional endoscopic rules. CONCLUSIONS: By adding these image processing data to the traditional general rules for recording endoscopic findings, it is possible to select patients with varices that have a higher risk of rupture.

Esophageal and Gastric Varices↗
PubMed1994

[Gallstones in liver cirrhosis].

The prevalence of gallstones in cirrhotic patients has been found to be higher than in the general population, by at least twofold. Of this increment, the majority of stones are of the pigment type in the gallbladder. The composition of black stone is unique because of the large fraction of unconjugated bilirubin, which is present as calcium bilirubinate or in an undefined polymeric form. There is little doubt that biliary surgery is hazardous in cirrhotic patients. Elective surgery for symptomatic Child A and B patients would normally be warranted. For Child C patients with life-threatened cholecystitis or cholangitis, every type of medical treatment should be attempted. After considering the bleeding tendency or ascites, percutaneous transhepatic gallbladder drainage or endoscopic sphincterotomy is considered to be one of the treatments.

Cholecystectomy↗
PubMed1993

A case of an aortocolic fistula occurring 27 years after aorto-femoral bypass surgery, treated successfully by surgical management.

The secondary aortoenteric fistula (AEF) is a rare but grave complication of aortic reconstructive surgery. We report herein a case of an aortocolic fistula which occurred 27 years after an aortofemoral bypass. A 69-year-old man was admitted to hospital following a sudden episode of melena. He had undergone aortofemoral bypass surgery with a prosthetic graft 27 years previously for occlusive disease of the right external iliac artery. Colonofiberscopy, CT scan, and angiography were performed, and an aortocolic fistula due to an aortic anastomotic pseudoaneurysm was diagnosed. The first-stage operation, being resection of the previously implanted graft, right hemicolectomy, and aortic stump closure were carried out with concomitant axillo-right femoral bypass. A femoro-femoral crossover bypass was performed in the second stage and the patients recovery followed uneventfully. This case constitutes the longest postoperative interval for an AEF recorded in the English literature.

Aged↗
PubMed1993

Management of gallstones in cirrhotic patients.

34 cirrhotic patients who underwent either cholecystectomy alone or in conjunction with common duct exploration were retrospectively reviewed. In Child A and B patients morbidity was low and there were no postoperative deaths. However, all patients who underwent additional cholecystectomy during the non-shunting operation for esophageal varices required blood transfusion. Cholecystectomy in Child C patients is frequently associated with considerable intraoperative bleeding and subsequent postoperative complications. In the 23 patients who were not operated upon for gallstones, no patients developed symptomatic biliary disease. Ultrasonographically, most of these gallstones were strongly suspected to be black stones. Elective surgical intervention for symptomatic Child A and B patients would normally be warranted, but hemorrhage and resulting complications due to additional cholecystectomy for asymptomatic gallstones during the non-shunting operation should be minimized. An additional cholecystectomy should be considered, provided such a cholecystectomy is thought to be easily performed judging from the degree of development of collateral circulation around the hepatoduodenal ligament and unless black stones are suspected ultrasonographically. For symptomatic gallstones in Child C patients every type of medical treatment should be attempted. After considering the bleeding tendency or ascites, percutaneous transhepatic gallbladder drainage is considered to be one of the safest treatments.

Adult↗
PubMed1993

Comparison between wedge and needle biopsies for evaluating the degree of cirrhosis.

To examine whether the biopsy method could affect histological evaluation, the volumetric ratio of human liver parenchyma was estimated in specimens from subcapsular and intralobar areas, and also in specimens obtained by needle biopsy (Tru-Cut needle). A new method of morphometric analysis was performed using a computer-aided color image analyzer. Eighteen cirrhotic, 7 fibrotic, and 4 normal liver biopsies were taken during hepatic resection and analyzed. The parenchymal cell volume ratio in the intralobar area was significantly correlated with that in the subcapsular area, and less significantly with needle biopsy samples (r = 0.844, p < 0.001; r = 0.577, p < 0.01, respectively). Both showed one-to-one correspondence. These results suggest that both wedged and needle biopsy samples are appropriate for assessing the degree of fibrosis or cirrhosis, although the sampling variability of the latter is greater than the former.

Adult↗
PubMed1993

Localized sclerosing cholangitis in the intrapancreatic bile duct. Report of a case.

A case of primary sclerosing cholangitis (PSC) localized in an isolated segment of the intrapancreatic bile duct was successfully treated by a pancreatico-duodenectomy. Although a progressively larger number of patients with PSC have recently been reported, there have been no other reports of a patient with this disease confined to the very distal part of the common bile duct. Since it is difficult to differentiate this rare disease from malignancy, surgical treatment as for a malignancy is sometimes required.

Bile Ducts↗
PubMed1993

Safe intraabdominal pressure of carbon dioxide pneumoperitoneum during laparoscopic surgery.

BACKGROUND: The deliberate induction of carbon dioxide pneumoperitoneum during laparoscopic surgery could be a possible source of cardiovascular collapse. The effects of elevated intraabdominal pressure (IAP) on systemic hemodynamics and splanchnic blood flow created by insufflation of carbon dioxide were examined in anesthetized dogs. METHODS: Stepwise increases in IAP of 8 (n = 7), 12 (n = 7), and 16 (n = 7) mm Hg were applied to determine the threshold pressure that had minimum influence on these hemodynamics. Hemodynamic parameters were measured at baseline and 1, 2, and 3 hours after the start of insufflation. RESULTS: At an IAP of 16 mm Hg, cardiac output was decreased significantly by 1 hour after the start of insufflation and became progressively lower during the procedure. Systemic vascular resistance was elevated significantly in parallel with the change in cardiac output. Although hepatic arterial blood flow was not decreased significantly, portal venous and superior mesenteric arterial blood flows were diminished significantly at 16 mm Hg, resulting in a decrease in total hepatic blood flow. No significant changes were observed in these parameters at 8 or 12 mm Hg. CONCLUSIONS: Based on these results, an IAP from 8 to 12 mm Hg is recommended for laparoscopic surgery, to avoid complications caused by hemodynamic derangements.

Abdomen↗
PubMed1992

False aneurysm as a late complication of division of a patent ductus arteriosus.

A 58-year-old male patient who had a huge false aneurysm as a late sequela of division of patent ductus arteriosus was surgically managed with success. It is noteworthy that 24 years had elapsed from the initial operation until recognition of the aneurysm. The pathogenesis and method of the surgical treatment are discussed.

Aortic Aneurysm↗
PubMed1992

Transection and devascularization procedures for bleeding from oesophagogastric varices.

Transection and devascularization procedures (Sugiura procedure and transabdominal transection of oesophagus and devascularization) had been the most popular modality of treatment for oesophagogastric varices until the 1970s but the trends of treatment for varices have changed drastically during the last decade. This is partly due to the recent development of endoscopic sclerotherapy and partly due to the patient's increasing demand for less invasive treatment. Recently most patients with oesophagogastric varices are treated initially by endoscopic sclerotherapy and surgical treatment is only called for after sclerotherapy has failed.

Esophageal and Gastric Varices↗
PubMed1992

Activities of thymidylate synthetase and thymidine kinase in gastric cancer.

In a previous clinical study, sequential methotrexate and 5-fluorouracil has shown improved efficacy for treating advanced gastric cancer of the poorly differentiated type. In this study, we investigated whether difference in the levels of thymidylate synthetase (TS) and thymidine kinase (TK) activities in gastric cancer tissue account for selectivity of the treatment. Activity of TS was higher in 19 cases of the poorly differentiated type than in 16 cases of the well differentiated type (P < 0.02), whereas TK activity was lower in the poorly differentiated type than in the well differentiated type (P < 0.01). Thus, the TS/TK ratio was significantly higher in poorly differentiated gastric cancers than in well differentiated cancers (P < 0.001). These results suggest that a greater dependence upon the de novo pathway of pyrimidine synthesis in poorly differentiated gastric carcinomas may enhance the efficacy of sequential methotrexate and 5-fluorouracil treatment.

Adenocarcinoma↗