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Biomedical subjects

Y Kawarada

Publications and source records attributed to Y Kawarada.

At least 163 records · Page 9Linked to original sources
PubMed1984

Blunt injury of duodenum with avulsion of papilla of Vater--report of a case.

In a 52-year-old man, there was a complete separation of the duodenum with avulsion of the papilla of Vater from the head of the pancreas due to blunt abdominal trauma. He was successfully treated by an anastomosis of the ampulla to the jejunum of a Roux-en Y limb, after removal of the entire duodenum and partial gastrectomy, followed by gastrojejunostomy of the Billroth II-type, instead of pancreaticoduodenectomy. The patient is well at 15 months after this surgery.

Ampulla of Vater↗
PubMed1984

Cholangiocellular carcinoma of the liver.

Of the 118 patients with primary liver cancer treated in our clinic during a 6 year 7 month period, 11 patients had cholangiocellular carcinoma of the liver. Ten (90.9 percent) of the 11 patients underwent surgery, and 9 (90 percent) had major hepatic resection with no operative deaths. Seven were still alive at the time of the study 2 months to 4 years 1 month after surgery. Three patients died from recurrence 9 months, 11 months, and 1 year 4 months after surgery. The 1 and 3 year actuarial survival rates after hepatic resection were excellent (85.7 and 61.2 percent, respectively) compared with the 1 and 3 year rates of 58.8 and 0 percent in the Japanese series. Even though the cholangiocellular carcinomas in our 11 patients were in the advanced stages, good results were obtained by hepatic resection. If they were detected at a much earlier time, an even more remarkable survival rate could be expected.

Adenoma, Bile Duct↗
PubMed1984

Surgical treatment of giant hemangioma of the liver.

During a 5 year period, we treated 5 patients with giant hemangioma of the liver. There were 4 women and 1 man who ranged in age from 34 to 51 years with an average age of 43.8 years. The symptoms were an abdominal mass with Kasabach-Merritt syndrome in 2 patients, an uncomfortable sensation in the upper abdomen in two patients, and pain in the right upper quadrant in one patient. All five patients underwent surgical treatment with a successful outcome. Three of the patients underwent hepatic lobectomy, one patient underwent left lateral segmentectomy with ligation of the right hepatic artery, and one patient had ligation of the left hepatic artery with radiation. In two of the patients, Kasabach-Merritt syndrome was cured promptly after hepatic lobectomy. We believe that a symptomatic giant hemangioma within one lobe should be treated by hepatectomy, but if it involves both lobes, ligation of the hepatic artery, with or without radiation, should be considered.

Adult↗
PubMed1983

[Indication for hepatic resection, with special reference to functional reserve of the liver].

Liver failure is a major cause of death after hepatectomy in cirrhosis. Therefore, an accurate indication for hepatectomy should be estimated preoperatively. By using multiple regression analysis of liver function, we could accurately select any one of five possibilities in hepatic surgery: 1) trisegmentectomy , 2) lobectomy, 3) segmentectomy, 4) partial hepatectomy, and 5) no surgery, without severe postoperative complications. Furthermore, the functional reserve of the remnant liver after hepatectomy should be estimated preoperatively. We measured ICG Rmax of the remnant liver, from both the effective liver volume rate obtained by the uptake of radioisotope on a liver scan and ICG Rmax of the whole liver. If it is above 0.4 mg/kg/min, any type of hepatic resection may by possible. On postoperative management, it is also important to estimate function of the reticuloendothelial system, blood clotting mechanism, and cardio-pulmonary and renal function. ICG Rmax per unit liver volume in the remnant liver after proposed hepatectomy can be calculated preoperatively from volume of the remnant liver on CT scan and ICG Rmax of the remnant liver. If it is above 0.8 microgram/kg/min/cm3, regeneration and function of the remnant liver will remain good without any late postoperative complications after hepatectomy.

Follow-Up Studies↗
PubMed1983

Angiomyolipoma of the liver.

The case of a 59-year-old woman with angiomyolipoma who was diagnosed by CT appearance and attenuation values before surgery is reported. The patient underwent a right hepatic lobectomy and has been well for 2 years and 7 months since surgery. The present paper may be the first report of angiomyolipoma of the liver diagnosed by CT scan before surgery and successfully treated by hepatic resection.

Female↗
PubMed1982

Carbohydrate metabolism and endocrine function in the pancreas remnant after major pancreatic resection.

Changes in glucose tolerance, in secretion of pancreatic hormones and in the islets of the pancreas were investigated after major resection of the pancreas in dogs to elucidate the pathophysiologic features of carbohydrate metabolism and the difference in the amount of insulin required in diabetes after total and partial pancreatectomy. In diabetes after 90 percent or more pancreatectomy, both insulin secretion and the function of the anti-insulin system decreased, associated with degeneration of the islet B, A, and D cells. The required insulin amount was similar to that needed after total pancreatectomy. Diabetes developed more than 6 weeks after 70 to 90 percent pancreatectomy, and insulin secretion decreased but the function of the anti-insulin system was accentuated with an increase in plasma glucagon levels, associated with degeneration in B cells but not in A and D cells. The amount of insulin required was 3 to 4 times greater than that needed after total pancreatectomy.

Animals↗
PubMed1980

Gastrectomy in siblings with Christmas disease (hemophilia B).

Gastrointestinal hemorrhage is regarded as one of the commonest clinical manifestations of classic hemophilia and Christmas disease. Although major surgery is usually avoided in such cases, recently we had 2 cases of Christmas disease in siblings who had undergone a successful gastrectomy and concomitant administration of a concentrated preparation of factor IX. In addition, findings in 7 other Japanese patients with hemophilia who underwent gastrectomy are discussed.

Blood Transfusion↗
PubMed1979

Preoperative estimation of operative risk in liver surgery, with special reference to functional reserve of the remnant liver following major hepatic resection.

Hepatic functional reserve was evaluated in 76 patients with known liver, biliary tract or pancreas diseases using kinetic analysis of removal of indocyanine green (ICG) with special reference to maximal removal rate (Rmax). In surgery other than hepatectomy, if ICG Rmax is below 0.4 mg/kg/min the operative risk should be considered high. In hepatic surgery, even if ICG Rmax is above 0.4 mg/kg/min the operative risk was high and it should be required to be above 1.0 mg/kg/min for extended lobectomy or hepatectomy. Furthermore, prior to hepatectomy the functional reserve of the remnant liver was estimated from an effective liver volume rate, calculated from the rate of uptake of radioisotope as measured by on-line computer system, and ICG Rmax. The functional reserve of the remnant liver was compared with the operative results, such as morbidity or mortality for each patient. When ICG Rmax of the remnant liver was below 0.4 mg/kg/min the prognosis was poor in hepatic surgery, because of there were three postoperative death and seven complications such as ascites or liver failure in the ten cases. On the other hand, when above 0.4 mg/kg/min, the prognosis was good without any postoperative death or complications in the twelve cases of hepatic surgery, as the completely same results for general surgery, in which it is as well when ICG Rmax of whole liver is above 0.4 mg/kg/min.

Carcinoma, Hepatocellular↗
PubMed1979

Resectability and functional reserve of the liver with obstructive jaundice in dogs.

Fifty-five dogs were used to evaluate the resectability of the liver with obstructive jaundice. Cholecystectomy and ligation of the distal common bile duct were used to produce obstructive jaundice. It was found that 40 per cent of the liver with obstructive jaundice was resectable with biliary decompression 2 weeks after ligation. At 1 week after induction of obstructive jaundice, 70 per cent hepatectomy with biliary decompression may be tolerated with careful postoperative management. From serum chemical studies it was found that if the serum albumin level was below 2.0 g/dl, 60 per cent of the dogs died after 40 per cent hepatectomy and all died after 70 per cent hepatectomy. From the standpoint of hepatic functional reserve 40 per cent hepatectomy is successful if the maximal removal rate of indocyanine green is above 0.14 mg/kg/min. Hepatic functional reserve is reliable for predicting the risk of hepatectomy, and it correlates well with the rate of hepatic regeneration after hepatectomy.

Animals↗
PubMed1978

Pathophysiology and management of acute gastric mucosal hemorrhage.

Unlike hemorrhage from peptic ulcer, surgical management for hemorrhage from stress ulcer is not necessarily successful on many occasions. Thus, the most important thing one can try is to prevent the development of this condition. Forty eight patients admitted to the Shock and Trauma Unit, Hahnemann Medical College and Hospital, who had a primary diagnosis of shock were divided into three groups: group 1 received the standard shock regimen plus large dose steroid therapy repeated every four hours for 36 hours; group 2 received the standard shock regimen plus small dose steroid therapy repeated every four hours for 96 hours; group 3 received the standard shock regimen without the addition of steroids. There was a 57.9 per cent incidence of acute gastric ulceration in those shock patients not treated with steroids (group 3) compared with 33.3 per cent incidence of gastric ulceration in group 2 and 5.9 per cent incidence in group 1. The use of pharmacologic doses of steroids early in the shock state for period of less than 36 hours seems to reduce the incidence of gastric ulceration and hemorrhage in low flow states associated with septic, cardiogenic and hemorrhagic shock.

Acute Disease↗
PubMed1976

Staging laparotomy for Hodgkin's disease.

We reviewed 39 patients with untreated Hodgkin's disease who underwent staging laparotomy and such cases in the English literature over the past two-and-a-half years. In the group of institutions in our compilation, the accuracies of clinically positive and negative judgments of liver involvement were 28 per cent and 95.4 per cent respectively, while in our institution the accuracies were 100 per cent and 95 percent respectively. The accuracies of the clinically positive and negative determinations of splenic involvement were 61.2 per cent and 67.3 per cent respectively after histological examination, whereas we had accuracies of 100 per cent and 74 per cent respectively. The accuracies of the clinically positive and negative determination of lymph nodes were 72.1 per cent and 86.7 per cent respectively, whereas the results were 70.6 per cent and 100 per cent respectively in our 39 cases. The percentage of complications was 10 per cent and the mortality rate was 0.9 per cent among 719 staging laparotomies. The common complications were atelectasis, pneumonia, wound infection and dehiscence, abscess, intestinal obstruction and thrombocytosis. We think more aggressive staging laparotomy should be performed for Hodgkin's disease under one surgeon or one surgical team.

Adolescent↗