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Biomedical subjects

Y Shirai

Publications and source records attributed to Y Shirai.

288 records · Page 16Linked to original sources
PubMedDate not supplied

Radiographic evaluation of the Hill-Sachs lesion in patients with recurrent anterior shoulder instability.

The Hill-Sachs lesion is an important bony sign of previous anterior shoulder dislocation and instability. Using orthographic projection, we evaluated the Hill-Sachs lesion in 30 shoulders in 27 patients with recurrent anterior shoulder instability. This produced a clear and undistorted view of the posterolateral notch. For orthographic imaging, the patient was placed supine with the arm in 135 degrees of flexion and 15 degrees of internal rotation. The x-ray beam was angled vertically through the humeral head. The width and depth of the posterolateral notches were measured on the orthographic radiographs. The average posterolateral notch depths were 3.9 +/- 0.9 mm in the dislocation group and 2.1 +/- 1.0 mm in the subluxation group. A shallow Hill-Sachs lesion was indicative of a greater degree of anterior instability of the shoulder.

Adolescent↗
PubMedDate not supplied

Calcification in mucinous cholangiocellular carcinoma.

Calcification is rarely seen in cholangiocellular carcinoma. We herein report the case of a 53 year-old man with calcification in a cholangiocellular carcinoma. Because imaging studies had revealed coarse calcified foci, hepatolithiasis was suspected pre-operatively. The patient underwent a laparotomy in which intra-operative cholangioscopy revealed no gallstones but did reveal an unsuspected tumor with abundant mucin. A left hepatic lobectomy with resection of the extrahepatic bile duct was performed. The tumor histology was mucinous adenocarcinoma with calcification. In the English language literature, we found 9 cases of cholangiocellular carcinoma with macroscopic calcification. Six of these cases were mucinous adenocarcinomas. Roentgenologic examination revealed coarse calcification in 7 cases and fine calcification in 2 cases. Clinicians should note that cholangiocellular carcinoma, especially the mucinous variant, may be accompanied by coarse calcification.

Adenocarcinoma, Mucinous↗
PubMedDate not supplied

Intra-operative color Doppler ultrasonography for assessing splenic blood supply during spleen-preserving distal pancreatectomy: a case report.

A 67 year-old Japanese woman presented with a cystic tumorous lesion, measuring 5 cm in diameter, in the tail of the pancreas. She underwent a spleen-preserving distal pancreatectomy (SPDP), in which the splenic artery and vein were divided because they were involved in scar formation around the lesion. Intra-operative color Doppler ultrasonography (CDUS) confirmed that splenic circulation via collaterals (short gastric and left gastroepiploic vessels) was preserved throughout the salvaged spleen. Histology of the resected specimen showed localized pancreatitis with a pseudocyst without neoplastic tissue. The patient's post-operative course was uneventful with no evidence of splenic failure and she was discharged 20 days after the operation. A literature review suggests that SPDP without preserving the splenic artery and vein may result in failure of the preserved spleen due to inadvertent injury to the remaining collaterals. Based on the experience of our case, we think that intra-operative CDUS is useful for assessing splenic circulation after SPDP with division of the splenic artery and vein.

Aged↗
PubMedDate not supplied

Gestational hyperlipidemic pancreatitis without non-gestational hyperlipidemia.

A 27 year-old pregnant woman was referred to our department with nausea, abdominal pain, and hypertriglyceridemia (5500 mg/dl). A diagnosis of acute gestational hyperlipidemic pancreatitis was made. She had no history of nongestational hyperlipidemia. Subsequently, she underwent pancreatic drainage and Caesarean section. Our experience suggests that gestational hyperlipidemic pancreatitis may occur in pregnant women without nongestational hyperlipidemia. Intensive monitoring of serum lipid levels is mandatory when managing pregnant women who develop or show gestational worsening of hypertriglyceridemia.

Acute Disease↗
PubMedDate not supplied

Impact of bactibilia on the development of postoperative abdominal septic complications in patients with malignant biliary obstruction.

This study was intended to clarify the role of bile bacteria in the development of postoperative septic complications in patients with malignant biliary obstruction. A total of 116 patients with malignant biliary obstruction underwent surgical intervention after biliary decompression. The relation between contaminated ductal bile and postoperative abdominal septic complications was analyzed retrospectively. Such complications developed in 49 patients (42%). Bile-contaminated operations (n = 93) resulted in a higher incidence of septic complications than non-bile-contaminated operations (n = 23; P = 0.009). Patients with pre-operative positive bile culture had a higher incidence of septic complications than those with negative bile culture (P = 0.06). There was a positive correlation between the presence of pre-operative cholangitis and the occurrence of septic complications (P = 0.007). Bacteria found in pre-operative ductal bile were also detected in infected sites of 80% of patients with septic complications. Intra-operative contamination from infected ductal bile plays a critical role in the development of postoperative abdominal septic complications.

Bile↗
PubMedDate not supplied

Asymptomatic adenomyoma of the common hepatic duct discovered during a medical checkup: report of a case.

Although adenomyoma of the gallbladder is not so rare, adenomyoma arising in the bile duct is extremely rare. We herein report a case of partial biliary obstruction due to adenomyoma of the common hepatic duct. A 64-year-old woman was referred to the 1st Department of Surgery, Niigata University School of Medicine for surgical intervention, in whom a biliary stricture in the common hepatic duct was discovered incidentally during a medical check-up for hyperamylasemia in an affiliated hospital. She was asymptomatic without jaundice. Based on her past history of abdominal contusion, the insidious presentation and the smooth biliary stricture on cholangiography, a diagnosis of benign biliary stricture secondary to blunt abdominal trauma was made. A suspicion of malignancy, however, could not be ruled out. Subsequently, she underwent a resection of the extrahepatic bile duct with lymph node dissection in the hepatoduodenal ligament. The patient's postoperative course was uneventful. She was discharged 18 days after the operation. Histology of the resected specimen confirmed the diagnosis of adenomyoma in the common hepatic duct. Clinicians should note to avoid overlooking or misdiagnosing that adenomyoma is a cause of biliary obstruction, although extremely rare.

Adenoma↗
PubMedDate not supplied

Pharmacological properties of YM-15430-1, a 1,4-dihydropyridine derivative with beta 1-adrenoceptor-blocking activity.

The pharmacological properties of YM-15430-1 and its stereoisomers (YM-15430-2, YM-15430-3 and YM-15430-4) were evaluated in in vitro experiments. In the rabbit isolated aorta, all compounds antagonized the CaCl2-induced contraction with a negative logarithm of the dissociation constant in calcium antagonism of 8.51, 7.13, 8.68 and 7.16, respectively. In the rat isolated right atrium, YM-15430-1 produced a competitive antagonism of the isoprenaline-induced tachycardia with a pA2 value of 7.59. YM-15430-2, YM-15430-3 and YM-15430-4 also antagonized the isoprenaline-induced tachycardia, with pA2 values of 7.91, 7.09 and 6.24, respectively. Because it was the most active of the 4 stereoisomers, YM-15430-1 was particularly studied. YM-15430-1 showed an about 100-fold greater selectivity for beta 1- than for beta 2-adrenoceptors, and had no intrinsic sympathomimetic activity. These results suggest that YM-15430-1 is a hybrid compound which combines calcium entry-blocking and selective beta 1-adrenoceptor-blocking activities in one molecule.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Potassium channel-opening and vasorelaxant profiles of a novel compound YM099 in rat isolated portal vein and rabbit isolated aorta.

The potassium channel-opening and vasorelaxant profiles of YM099, a newly synthesized benzoxadiazol derivative K channel opener, were evaluated in vitro. In the rat isolated portal vein, YM099 and a benzopyran derivative K channel opener levcromakalim concentration-dependently inhibited the frequency of spontaneous rhythmic contractions, with IC50 values of 104 and 38 nM, respectively. In the rabbit isolated aorta, YM099 (10(-7)-3 x 10(-5) M) and levcromakalim (10(-7)-3 x 10(-5) M) also concentration-dependently relaxed the contractions induced by 20 mM KCl, but they were ineffective against the contractions induced by 50 mM KCl. These effects of YM099 and levcromakalim were competitively antagonized by a K channel blocker glibenclamide (10(-7)-3 x 10(-6) M). In the rabbit isolated aorta, YM099 (3 x 10(-8)-3 x 10(-6) M), but not the calcium antagonist nifedipine (10(-8)-3 x 10(-6) M), relaxed the contractions induced by norepinephrine (10(-6) M) or prostaglandin F2 alpha (3 x 10(-6) M). These vasorelaxant effects of YM099 were also antagonized by glibenclamide. In conclusion, YM099 is a potent vascular smooth muscle-relaxant agent and possesses a vasorelaxant effect different from that of nifedipine. These effects of YM099 may be mediated, like those of levcromakalim, by the opening of glibenclamide-sensitive K channels.

Animals↗
PubMedDate not supplied

Pancreaticoduodenectomy for gallbladder cancer with peripancreatic nodal metastases.

The prognosis of patients with advanced gallbladder carcinoma remains dismal. In the English language literature, we found only one 5-year survivor with peripancreatic lymph node metastases. We herein report a patient with marked peripancreatic nodal metastases, who has exhibited the longest survival (6 years) without recurrence after a pancreaticoduodenectomy combined with extended cholecystectomy. This outcome suggests that pancreaticoduodenectomy may be effective for clearance of peripancreatic nodal metastases from gallbladder cancer.

Carcinoma↗
PubMedDate not supplied

Intraluminal duodenal diverticulum with malposition of the ampulla of Vater.

Intraluminal duodenal diverticulum is a rare congenital anomaly, sometimes associated with malposition of the ampulla of Vater. When the diverticulum is excised, the position of the ampulla should be determined carefully to avoid injury to pancreaticobiliary ducts. We report two patients with symptomatic intraluminal duodenal diverticulum and malposition of the ampulla. The ampulla was located on the rim of the diverticulum in one patient; in the others, the ampullary site was the posterior wall of the duodenum. Both patients underwent successful excision of the diverticulum without ductal injuries. As we have been unable to find any case with an ampullary location on the anterior wall of the duodenum, anterior duodenotomy followed by identification of the ampulla must precede excision of the diverticulum in order to avoid pancreaticobiliary ductal injuries.

Adult↗
PubMedDate not supplied

Cholangitis after endoscopic biliary drainage for hilar lesions.

BACKGROUND/AIMS: Cholangitis is a morbid complication following endoscopic biliary drainage. This study was undertaken to determine the subgroup of patients more likely to develop cholangitis after endoscopic drainage and to determine how to manage this complication. METHODOLOGY: Although we have used transhepatic biliary drainage as the procedure of choice for relieving obstructive jaundice, we recently encountered ten patients who underwent endoscopic drainage before referral. RESULTS: Three patients with a hilar obstruction developed cholangitis and cholangiolytic liver abscesses after endoscopic drainage, while seven with a distal obstruction did not develop cholangitis following drainage. Thus, the incidence of cholangitis in patients with a hilar obstruction (100%) was significantly higher than that (0%) in patients with a distal obstruction (p = 0.008). Cholangitis in the three patients was managed with percutaneous drainage without mortality, although this procedure was technically difficult because of the presence of collapsed intrahepatic bile ducts following the endoscopic drainage. CONCLUSIONS: Hilar lesions present a higher risk of cholangitis after endoscopic biliary drainage than distal lesions. Hence, percutaneous, rather than endoscopic, drainage is indicated for such lesions. Percutaneous drainage is the procedure of choice for the management of cholangitis after endoscopic drainage.

Aged↗
PubMedDate not supplied

Incidence of anomalous union of the pancreaticobiliary ductal system in biliary cancer.

BACKGROUND/AIMS: This study was intended to clarify the incidence of anomalous union of the pancreaticobiliary ductal system (AUPBD) in patients with biliary cancer. METHODOLOGY: Cholangiopancreatograms of 106 Japanese patients with biliary cancer were investigated for this study. The study included 58 patients with gallbladder cancer and 48 patients with cholangiocarcinoma. AUPBD was defined radiologically as the common bile duct joining the main pancreatic duct above the narrow distal segment. AUPBD was classified into two types: P-C union, the main pancreatic duct entering the common bile duct; and C-P union, the common bile duct entering the main pancreatic duct. RESULTS: Overall 10 patients (9.4%) had AUPBD, of whom all had gallbladder cancer and no gallstones. Nine of these patients showed P-C union and one patient had C-P union. The incidence of AUPBD in gallbladder cancer (10/58, 17.2%) was significantly higher (p = 0.0018) than that in cholangiocarcinoma (0/48, 0%). Among patients with gallbladder cancer, the mean age of those with AUPBD (56 years old) was significantly lower (p = 0.02) than that of those without AUPBD (65 years old). CONCLUSIONS: The incidence of AUPBD in gallbladder cancer is significantly higher than that in cholangiocarcinoma. AUPBD, especially the P-C union, may thus promote the development of acalculous gallbladder cancer.

Adenocarcinoma↗
PubMedDate not supplied

Complete remission after radiotherapy for recurrent rectal cancer.

Although the efficacy of radiotherapy for the palliation of recurrent or inoperable cancer has been proven, it results in complete tumor remission only rarely. We report a case of pelvic recurrence in which complete histological remission followed radiotherapy. A 68-year-old man developed a small pelvic recurrence near the rectal stump 8 months after a Hartmann procedure for rectal cancer. Histologic examination of the biopsy specimens revealed adenocarcinoma consistent with the primary tumor. He received radiotherapy to the whole pelvis, with a total dose of 39.4 Gy administered in 22 fractions over 4 weeks, with a continuous infusion of 5-fluorouracil as a radiosensitizer. After regression of the tumor was confirmed, resection of the pelvic recurrence was performed. Histologic examination of the resected specimen revealed no tumor. Thirty-six months after the second operation, the patient was alive with no evidence of disease. The experience of our case and a review of the literature suggests that small pelvic recurrences may be more responsive to radiotherapy than larger ones.

Adenocarcinoma↗
PubMedDate not supplied

Laparoscopic cholecystectomy may disseminate gallbladder carcinoma.

Laparoscopic cancer surgery has been reported to facilitate tumor dissemination. In our experience with 158 laparoscopic cholecystectomies, we encountered 2 cases (1.3%) of unsuspected gallbladder cancer. We report these 2 cases to illustrate the disadvantages of laparoscopic tumor resection. In Case 1, a 60-year-old woman with symptomatic cholecystolithiasis underwent a laparoscopic cholecystectomy revealing an unsuspected gallbladder cancer (pT2). Five months later, localized peritoneal carcinomatosis developed in the right subphrenic space, and she died from disseminated disease 19 months postoperatively. Laparoscopic manipulation may have caused the unusual, localized seeding. In Case 2, laparoscopic cholecystectomy was initiated for a polypoid lesion of the gallbladder in a 69-year-old man. When laparoscopy revealed a concomitant cancer (pT3), resection was converted to an open radical cholecystectomy. He remains alive without evidence of disease 31 months postoperatively. Conversion to open surgery may have contributed to the favorable outcome. The contrast between the 2 cases suggests that laparoscopic cholecystectomy should be converted to open surgery whenever malignancy is suspected. Surgeons should note that laparoscopic resection may disseminate cancer.

Adenocarcinoma↗
PubMedDate not supplied

Gallbladder cancer with intratumoral anechoic foci: a mimic of adenomyomatosis.

We report a case of advanced gallbladder cancer in a 58-year-old man. On ultrasonography, there were anechoic foci within the tumor. Although anechoic foci within a thickened gallbladder wall usually represent intramural diverticula (dilated Rokitansky-Aschoff sinuses) of adenomyomatosis, cystically dilated cancerous glands were the etiology of these foci in this case. Thus, gallbladder cancer may also have anechoic foci within the tumor.

Adenocarcinoma↗
PubMedDate not supplied

Left-sided gallbladder on the basis of a right-sided round ligament.

Left-sided gallbladder, a rare congenital anomaly, is defined as a gallbladder located to the left of the round ligament. A 42 year-old female underwent a cholecystectomy for gallstone disease. At laparotomy, we found that the round ligament was located to the right of its normal position and was continuous with the right anterior branch of the portal vein. Though normally situated, the gallbladder was therefore, on the left side of the anomalously right-sided round ligament, fulfilling the definition of a left-sided gallbladder. This case indicates that a third type of left-sided gallbladder may occur in addition to the other forms: one resulting from a right-sided round ligament, in addition to the "true" left-sided gallbladder and the variety seen in situs inversus.

Adult↗
PubMedDate not supplied

Ischemic biliary stricture due to lymph node dissection in the hepatoduodenal ligament.

We report on 2 cases of ischemic biliary stricture after radical lymphadenectomy in the hepatoduodenal ligament with skeletonization of the extrahepatic bile ducts for malignant diseases. In both cases, histologic examination of the subsequently resected biliary strictures revealed evidence of ischemia. Skeletonization of the bile ducts may result in ischemia and stricture formation. In patients who require thorough dissection of the hepatoduodenal lymph nodes, bile duct resection should be considered.

Aged↗