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Biomedical subjects

Y Nimura

Publications and source records attributed to Y Nimura.

At least 37 records · Page 2Linked to original sources
PubMed1992

[A case of intrahepatic cholesterol stone complicated with atrophy of the anterior superior ventral and anterior superior lateral subsegments (S8ab) of the liver].

A 61-year-old male patient with intrahepatic cholesterol stone is reported. Stones were detected in the anterior superior lateral subsegment (S8ab) of the right lobe with bile duct stenosis, the lateral anterior segment (S3) of the left lobe, and the left caudate lobe (S11). Partial hepatectomy including S8ab, S3 and S11 was performed to remove all stones. Atrophy of S8ab was diagnosed by CT, and PTP clarified the patency of the subsegmental portal vein (P8ab). This is a rare case with cholesterol intrahepatic stone with regional bile duct stenosis and subsegmental atrophy of S8ab of the liver.

Atrophy↗
PubMed1991

Combined portal vein and liver resection for carcinoma of the biliary tract.

Twenty-nine patients with advanced carcinoma of the bile duct or gallbladder underwent combined portal vein and liver resection. Segmental excision of the portal vein was performed in 16 cases and wedge resection of the vessel wall in 13. The operative mortality rate was 17 per cent. The median survival for the 24 patients who left hospital was 19.8 months. Actuarial survival rates at 1, 3 and 5 years for all 29 patients were 48 per cent, 29 per cent, and 6 per cent respectively, whereas the median survival for 46 patients with unresectable carcinoma was 3 months and the 1 and 3-year actuarial survival rates were 13 per cent and zero respectively. This difference in survival times between patients undergoing hepatectomy with portal vein resection and those with unresectable carcinoma were statistically significant (P less than 0.01). Combined portal vein and liver resection is recommended as a reasonable surgical approach in selected patients with advanced carcinoma of the biliary tract.

Adult↗
PubMed1991

Percutaneous transhepatic manometry of sphincter of Oddi.

A nonoperative examination of the function of the sphincter of Oddi, involving percutaneous transhepatic manometry via the percutaneous transhepatic biliary drainage tract, was developed and clinically applied in 23 patients with biliary disease. Long-term recording of sphincter of Oddi motility, which was impossible using conventional intraoperative or endoscopic manometry, was made possible by means of this method and revealed various changes of sphincter of Oddi motility. The mean recording time was 131.33 +/- 9.77 min. The frequency of contractions of the sphincter of Oddi in basal fasting conditions varied from 0 to 13/min and high-frequency contractions (frequency 9.49 +/- 0.35/min, duration 5.77 +/- 0.54 min) were observed in 12 patients on a total of 19 occasions. In five patients, high-frequency contractions were observed twice during one session of continuous recording and the interval between burst contractions was 85.4 +/- 13.3 min. Long-term continuous recording is advantageous for the evaluation of the function of the sphincter of Oddi and short-term manometry may not be representative of overall sphincter of Oddi motility.

Adult↗
PubMed1991

Aberrant pancreas is not susceptible to alcoholic pancreatitis.

Three cases of chronic alcoholic pancreatitis associated with aberrant pancreas are reported. All three patients underwent laparotomy, and an aberrant pancreas was found in the jejunum of each of the three patients. Microscopic examination of the aberrant pancreas did not show any changes suggestive of chronic pancreatitis, despite severe chronic pancreatitis in the main pancreas.

Adult↗
PubMed1991

Induction of DNA replication and cell growth in rat liver by obstructive jaundice.

Obstructive jaundice, produced by ligating the common bile duct, induced a transient DNA replication followed by cell proliferation in rat liver. At 48 h after the operation, DNA polymerase alpha activity started to increase and reached its maximum level (more than twice the control) at day 4. At day 7, the enzyme level had decreased to the control level. Pulse-labeling experiment using radioactive thymidine showed that the rate of DNA synthesis increased approximately 2.5-fold in the same pattern as that of DNA polymerase alpha. The mitotic index in hepatocytes also increased 10-fold at day 4 and then decreased. The proliferation of liver cells induced by obstructive jaundice mimics the regeneration of partially hepatectomized liver, although the response was slightly delayed and the proliferation was transient.

Alanine Transaminase↗
PubMed1991

Purification and characterization of calcium-calmodulin kinase II from human parathyroid glands.

Calmodulin has been identified in parathyroid cells and is thought to play an important role in the production or secretion of parathyroid hormone. However, a detailed investigation of calmodulin-binding proteins in parathyroid glands has not been conducted. In this study, we attempted to determine the presence of calmodulin-binding protein in human parathyroid adenoma by affinity chromatography. The eluted protein from a calmodulin-coupled Sepharose 4B column with EGTA was analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis which revealed a major protein band of Mr 50,000. A Ca2+/calmodulin-dependent protein kinase activity was detected at the protein peak using dephosphorylated casein as a substrate. The 50 kDa band was identified as calcium/calmodulin-dependent protein kinase II (CaM-kinase II) by immunoblotting. The substrate specificity, pH dependency and affinity for calmodulin of this enzyme were identical to those of CaM-kinase II from rat brain. Also, the kinase activity was sensitive to KN-62, a specific inhibitor of CaM-kinase II. In total, 0.48 mg of this kinase was purified from 3 g human parathyroid adenoma.

Calcium-Calmodulin-Dependent Protein Kinases↗
PubMed1991

Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract.

Twenty-four patients with advanced carcinoma of the gallbladder and/or the bile duct underwent hepatopancreatoduodenectomy, that is, en bloc hepatic resection with pancreatoduodenectomy. They included 14 cases of gallbladder carcinoma, nine cases of bile duct carcinoma, and one case of double cancer of the gallbladder and the bile duct. Eleven kinds of hepatic lobectomy or segmentectomy with pancreatoduodenectomy were carried out, and the caudate lobe was also removed en bloc from 17 patients with carcinoma involving the hepatic hilus. Combined resection of the portal vein was performed in 11 patients, of the inferior vena cava in 2, and of the colon in 5, patients. Forty-four postoperative complications occurred in 22 patients (91.7%). The operative mortality rate was 12.5% (3/24). The median survival and the 2-year survival rate were 7.0 months and 17.9% for all 24 patients, including 3 operative deaths, or 11.0 months and 20.4% for 21 patients surviving hepatopancreatoduodenectomy, and 12.4 months and 20.8% for all 14 patients with gallbladder carcinoma, and 5.2 months and 14.8% for all 9 patients with bile duct carcinoma. The longest survivor died of recurrent tumors at 5 years and 7 months. Hepatopancreatoduodenectomy offered not only an unexpectedly long survival period, but also unexpected morbidity in some cases.

Adenoma, Bile Duct↗
PubMed1991

A case of early asymptomatic carcinoma of the hepatic hilus.

We describe a 54-year-old asymptomatic male with carcinoma of the hepatic hilus. Elevated serum transaminases were detected during the annual medical examination. The diagnosis was confirmed by ultrasonography (US), computed tomography (CT), percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP). Curative surgery, which included right hepatic lobectomy with total caudate lobectomy, was performed. The resected specimen revealed a localized tumor in the right anterosuperior dorsal intrahepatic bile duct branch. The histological diagnosis was moderately differentiated tubular adenocarcinoma. The patient's postoperative recovery was smooth and he has remained in good health for 15 months after surgery without any signs of recurrence. This case report discusses the early diagnosis and rational surgical treatment for carcinoma of the hepatic hilus.

Adenoma, Bile Duct↗
PubMed1991

[A prospective trial of the mass survey for pancreatic cancer using serum markers and ultrasonography].

We designed a prospective trial of the mass survey for pancreatic disease, especially pancreatic cancer in consecutive 2576 subjects undergoing periodical health examination during 1989. In order to detect abnormality of the pancreas we measured serum amylase, elastase-1 and SPan-1 as serum markers and used ultrasonography (US). When abnormal elevation of serum markers or abnormal findings of US were obtained at the first screening, re-examination or further examination using ERCP, CT and endoscopic US were performed. Frequencies of elevated amylase, elastase-1 or SPan-1 were 0.9%, 3.4% or 1.7%, respectively. However, no pancreatic diseases were detected among the cases of elevated serum markers after subsequent further examination. Frequency of abnormal US findings of pancreas were 2.3% (59/2576), including dilatation of main pancreatic duct, cystic lesion, space occupying lesion and calcification. Subsequent further examinations on subjects with abnormal US revealed 8 cases of pancreatic diseases including one small pancreatic cancer. US may be an efficient tool of mass survey for pancreatic cancer in the health examination at present.

Adult↗
PubMed1991

[A clinicopathological study on the proximal border of bile duct carcinoma].

We studied the clinicopathological characteristics of the proximal border of bile duct cancer among 46 cases. In both the superficial and the superficially spreading type, cancer was located within the mucosa and the mucous membrane at its verge was more hypertrophic than the proximal noncancerous mucosa, but they didn't differ from each other in thickness at the fibromuscular and Glisson's fibrous layer. In bile duct cancer without superficial spread, on the other hand, the tumor involve the fibromuscular or Glisson's fibrous layer and fibromuscular or Glisson's fibrous layer at their verge was more hypertrophic than the proximal noncancerous bile duct, which resulted in the narrowing bile duct at the lesion. Percutaneous transhepatic cholangioscopy (PTCS) facilitates the preoperative diagnosis of the extent of the bile duct cancer, which shows a granular change of the mucosa and tumor vessels. The wall irregularity and narrowing of the bile duct demonstrated by the selective cholangiography are also referred to its extent.

Adenocarcinoma↗
PubMed1991

Enhancement of rat liver mitochondrial function by portal branch ligation secures subsequent extended hepatectomy.

We have examined the effects of portal branch ligation on liver mitochondrial function and on subsequent extended hepatectomy in rat. In the occluded lobes, mitochondrial function was depressed immediately after the ligation. In the unoccluded lobes, mitochondrial function was enhanced and reached the maximum two days after the ligation. This enhancement was associated with increases in the enzymic activities and subunit amounts of the energy-transducing complexes, and with increase in mitochondrial DNA content. The ligation improved both survival rate and mitochondrial redox state monitored by the ratio of acetoacetate to beta-hydroxybutyrate after hepatectomy. These results suggest that the enhancement of mitochondrial function by portal branch ligation fills the energy demand for liver regeneration.

Animals↗
PubMed1991

Deleted mitochondrial DNA in the skeletal muscle of aged individuals.

Human mitochondrial DNA deletions occur mainly in the major region between the origins of replication of the heavy and light strands both in mitochondrial myopathy and in the ageing process. To determine whether deletions in the minor region also contribute to the ageing process, we analyzed a 3,610-basepair deletion (nucleotide position 1,837-5,447, from the 16S rRNA gene to the ND2 gene) in the skeletal muscle from individuals of various ages. The direct repeated sequence at each boundary of the deletion was identified as 5'-CCCC-3'. This minor-region deletion was detected in one of five individuals of the sixth decade, two of five in the seventh decade, and all of five in the eighth decade, but not in individuals below age 60. These results indicate that age-related accumulation of mtDNA deletions occurs not only in the major region but also in the minor region.

Adolescent↗
PubMed1991

[Coagula tamponade as a complication of open heart surgery: the clinical significance and diagnostic value of transesophageal echocardiography].

The pathogenesis of low cardiac output failure (LOF) immediately after open heart surgery was studied in 41 patients with LOF and 15 control patients without LOF using echocardiography. In 35 patients, transesophageal echocardiography was also performed. Left ventricular (LV) contraction was impaired in 28 of the 41 LOF patients, in whom LV fractional shortening was less than 25%. In the other 13 LOF patients, however, it was greater than 25%. In 12 of these 13 patients, transesophageal echocardiography revealed that accumulating pericardial coagula were localized in the right side of the heart, deforming the right atrial and ventricular chambers. The LV end-diastolic diameter was significantly less than the control, indicating that the pericardial coagula disrupted the distension of the heart. Emergent coagulotomy was performed in 5 patients, and hemodynamic conditions were improved. In spite of "cardiac tamponade", the wall motion and pressure tracings of the right atrium and right ventricle in these patients differed from those in fluid tamponade. Therefore, this condition should be designated "coagula tamponade." In the other 22 patients in whom transesophageal echocardiography was employed, no coagula were observed. Since pericardial coagula can hardly be detected by transthoracic echocardiography, transesophageal echocardiography is indispensable for diagnosing pericardial coagula noted immediately after open heart surgery.

Adult↗
PubMed1991

[Human heart recovery during weaning from a left ventricular assist system: time course and outcome prediction].

To investigate the time course of recovery of a failing heart using the left ventricular assist system (LVAS) and to predict the outcome of weaning from the LVAS, 14 patients with a failing heart were studied. Among them, 5 had recovered and survived for more than 2 weeks after weaning from the LVAS (recovered group), while 9 could not be weaned or died within 2 weeks after weaning (unrecovered group). All patients were gradually weaned from the LVAS with adequate support for systemic circulation for 3 days. In the recovered group, indices of systolic time intervals (STIs) showed improvement within a week. However, improvement of STIs was slow reaching a plateau around the 10th day in the unrecovered group. On weaning from the LVAS, aortic systolic pressure and ejection time were regulated by the patients' own hearts and were nearly the same between the 2 groups. However, left atrial pressure was significantly higher in the unrecovered group than in the recovered group. These hemodynamic features were first present on the 7th day. Therefore, hemodynamic data on the 7th assistant day can be a reliable factor in predicting the possibility of successful weaning from the LVAS and recovery in patients with a failing heart.

Adult↗
PubMed1991

[Management of cholangitis complicated in biliary carcinoma with hilar bile duct stenosis].

We reviewed 60 cases of biliary carcinoma with hilar bile duct stenosis which had received percutaneous transhepatic cholangio-drainage (PTCD). Of the 60 cases, nine were complicated with acute cholangitis (AC) and three with segmental acute obstructive suppurative cholangitis (S-AOSC). The incidence of cholangitis was 20%. Six patients with AC and three with S-AOSC underwent hepatic resection for carcinoma. As to preoperative management for cholangitis in these 9 cases, conservative chemotherapy was effective in only 2 cases, and additional PTCD or segmental introduction of the drainage catheter under PTCS were useful in 5 cases. The remaining 2 cases with S-AOSC needed urgent hepatic resection including suppurative hepatic segments after various interventional treatments. No significant difference was found in resectability, morbidity and mortality between the cholangitis group and non-cholangitis group. In conclusion, it is emphasized that postoperative outcome of biliary carcinoma with cholangitis will be improved by adequate PTCD and/or urgent hepatic resection.

Acute Disease↗
PubMed1991

[Efficacy of transesophageal echocardiography immediately after open heart surgery: diagnosis of coagula tamponade].

Massive pericardial coagula were detected by transesophageal echocardiography in some patients with low cardiac output failure immediately after open heart surgery. Characteristically, the coagula were localized anterior to the right atrium and right ventricle in all patients. The coagula could not be detected by transthoracic echocardiography. Despite of low output, absence of wall motion abnormality of the left ventricle, tachycardia, elevated atrial pressure and small left ventricular cavity lead to diagnose cardiac tamponade by pericardial coagula. Neither the right atrial nor the right ventricular wall showed collapsing motion except the area with pericardial effusion. Massive coagula in the anterior mediastinum produced similar clinical manifestation, but could be differentiated from pericardial coagula by echographic identification of the anterior pericardium. Pericardial coagula were also observed in patients with superior vena cava syndrome, but low right atrial pressure differentiated it from coagula tamponade. In all of the present patients, usual transthoracic echocardiography did not offer any sufficient images for diagnosing pericardial coagula. Transesophageal echocardiography was indispensable for detecting pericardial coagula soon after open heart surgery.

Adult↗