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Biomedical subjects

G Naritomi

Publications and source records attributed to G Naritomi.

17 recordsLinked to original sources
PubMed2000

Manometric evidence of improved early gastric stasis by erythromycin after pylorus-preserving pancreatoduodenectomy.

Gastric stasis is a frequent complication of pylorus-preserving pancreatoduodenectomy (PPPD). We demonstrated that it might be attributable to delayed recovery of phase III activity of the gastric migrating motor complex due to low concentrations of plasma motilin caused by resection of the duodenum. Leucine 13-motilin is effective for treating gastric stasis, but it is not yet available for clinical use. Whether erythromycin would improve early gastric stasis after PPPD was tested clinically and by manometry. A manometric tube assembly and a gastrostomy tube were inserted in the stomach of 10 patients at PPPD for pressure recording from the gastric antrum and jejunum and for gastric juice drainage, respectively. After baseline recording, erythromycin 5 mg/kg was given intravenously on day 14 and saline as a placebo on day 17 every 4 hours four times a day. The daily volume of gastric juice output and the gastric motility index were measured. The mean period until the return of gastric phase III was 31 +/- 1 days. Erythromycin significantly increased the gastric motility index from 7.9 +/- 1.3 mmHg to 15.7 +/- 1.8 mmHg (p = 0.0005), whereas saline did not (7.2 +/- 1.6 mmHg to 6.5 +/- 1.2 mmHg; p = 0.21). Erythromycin significantly decreased the gastric juice output from 1,080 +/- 190 ml to 738 +/- 199 ml (p < 0.0001), but the saline injections did not (1,064 +/- 174 ml to 1,115 +/- 189 ml; p = 0.35). Erythromycin, a universally available motilin agonist, is a safe, effective, potent drug for the treatment of early gastric stasis after PPPD.

Aged↗
PubMed1998

Vector manometric study of the sphincter of Oddi in the dog: functional and morphological correlation.

The relationship between sphincter of Oddi pressure and the morphological structure of the sphincter was studied in eight dogs prepared with a duodenal cannula. Sphincter of Oddi manometry was performed in awake animals in three directions, ventral, left dorsal, and right dorsal, using a catheter with three radial side holes for recording at one level. The pressure in the ventral direction (26.6+/-1.06 mmHg) (mean+/-SEM) was significantly lower than that in the left and right dorsal directions (30.6+/-1.42 and 31.2+/-1.23 mmHg, respectively). This functional manometric difference in the three directions correlated closely with the morphological structure of the sphincter of Oddi; the sum of the thickness of the sphincter of Oddi muscle and duodenal proper muscle was greater on the dorsal than on the ventral side. To our knowledge, this is the first report of axial asymmetry in sphincter of Oddi pressure.

Analysis of Variance↗
PubMed1998

Effect of leucine 13-motilin (KW5139) on early gastric stasis after pylorus-preserving pancreatoduodenectomy.

OBJECTIVE: To test a hypothesis that exogenously administered motilin would improve early gastric stasis after pylorus-preserving pancreatoduodenectomy (PPPD). SUMMARY BACKGROUND DATA: Prolonged gastric stasis is a frequent complication after PPPD. We demonstrated that this might at least in part be attributable to delayed recovery of phase III activity of the gastric migrating motor complex due to low concentrations of plasma motilin caused by resection of the duodenum. METHODS: Ten patients with a mean age of 54 years (range, 33-70) who underwent PPPD were studied. An assembly of manometric tubes was placed in the gastric antrum and jejunum (neoduodenum) at surgery. A gastrostomy tube was added for drainage and volume measurements of the gastric juice. After baseline recording, saline as a placebo was given intravenously on day 14 and 0.5 microg/kg of KW5139 (leucine-13 motilin) was given on days 17 and 18 every 2 hours, 6 times a day. The daily volume of gastric juice output and a gastric motility index were measured. RESULTS: The mean period until the first appearance of phase III activity in the stomach was 41 +/- 2 days. The injection of saline did not change the gastric motility index (7.3 +/- 1.1 to 7.1 +/- 1.3 mmHg; p = 0.72). In contrast, motilin resulted in a significant increase in the gastric motility index (7.5 +/- 1.0 to 17.7 +/- 2.0 mmHg; p < 0.001). The saline injection produced no change in the daily gastric juice output (1175 +/- 140 to 1393 +/- 193 mL; p = 0.09). Motilin significantly decreased the gastric juice output (1387 +/- 157 to 934 +/- 142 mL; p = 0.01). CONCLUSIONS: These data indicate that KW5139 is a safe and effective prokinetic drug for the treatment of early gastric stasis after PPPD.

Adult↗
PubMed1997

Pancreatic tumor formed by infiltration of adult T-cell leukemia cells.

CONCLUSION: We have described a case of pancreatic tumor formed by adult T-cell leukemia (ATL) cell infiltration. BACKGROUND: The patient was diagnosed as chronic ATL hematologically with the findings of increased number of atypical lymphocytes, ATL cells in the peripheral blood, and positive human T-cell leukemia virus type I (HTLV-I) antibody in the serum. The pancreatic tumor was identified by ultrasonography and computed tomography as a diffusely swollen tumor from the body to the tail of the pancreas. Biopsy specimen confirmed the ATL cell infiltration into the pancreas immunohistochemically, and Southern blot analysis showed the integration of HTLV-I proviral DNA both in the pancreas and in the peripheral blood. RESULTS: The pancreatic tumor diminished spontaneously without chemotherapy when ATL cells in the peripheral blood disappeared by spontaneous regression.

Aged↗
PubMed1996

Multiseptate gallbladder: biliary manometry and scintigraphy.

A 30-year-old man with multiseptate gallbladder, a very rare congenital anomaly, is presented. His presenting symptom was epigastric pain. A hypoplastic gallbladder with multiple septa was demonstrated by ultrasonography and endoscopic retrograde cholangiography. An injection of cerulein reproduced pain, and simultaneous biliary manometry and scintigraphy showed impairment of gallbladder filling and emptying. Laparoscopic cholecystectomy resulted in complete relief of the pain. Biliary manometry and scintigraphy are useful to determine the operative indication in a symptomatic patient with this entity.

Adult↗
PubMed1996

Effects of intraduodenal air insufflation on sphincter of Oddi motility in conscious dogs.

To investigate effects of intraduodenal air insufflation on sphincter of Oddi motility, manometric recordings were obtained during fasting from the sphincter and duodenum in four conscious dogs with duodenal cannula. At 40% of the mean cycle length of the migrating motor complex predetermined from baseline recording, 160 ml of air was injected into the duodenum. In both the sphincter and duodenum, air insufflation produced premature phase III-like activity in seven of 20 experiments (35%) or nonspecific excitatory reaction in eight (40%). In the remaining five experiments (25%), the sphincter exhibited a transient inhibitory response, while the duodenum showed the nonspecific excitatory reaction. Basal pressure of the sphincter increased immediately after air insufflation in 90% of the 20 experiments. The mean basal pressure increased from 12.3 +/- 1.6 mm Hg to 22.4 +/- 2.1 mm Hg (P < 0.0001) and minimum basal pressure from 2.9 +/- 0.9 mm Hg to 4.7 +/- 0.8 mm Hg (P < 0.001). These results indicate that intraduodenal air insufflation does affect motility of the sphincter of Oddi and duodenum in conscious dogs.

Air↗
PubMed1996

Single oral dose of cisapride accelerates gastric antral emptying in healthy humans: an ultrasonographic study.

An ultrasonographic study of ten healthy volunteers was carried out to evaluate the effect of cisapride on gastric antral emptying. More than 1 week after the measurement of the baseline emptying rate, cisapride was given at a single oral dose of 5 mg 30 minutes before intake of a balanced liquid test meal (5 ml/kg body weight). To determine the time to half emptying (T1/2), an exponential curve was extrapolated for the elimination phase of the gastroantral sagittal cross-sectional area plotted against time. The T1/2 was reduced by 18.5% after cisapride, from 62.6 +/- 4.3 to 51.0 +/- 4.4 min (P = 0.0284). We conclude that a single oral dose of 5 mg of cisapride significantly accelerates the gastric antral emptying rate in healthy humans.

Administration, Oral↗
PubMed1996

Pancreatic head resection with and without preservation of the duodenum: different postoperative gastric motility.

BACKGROUND: Early gastric stasis is a unique complication of pylorus-preserving pancreatoduodenectomy. Because the duodenum proved to be important in the initiation and consolidation of phase III activity of the migrating motor complex of the stomach, the absence of the duodenum and hence gastric phase III may be a cause of gastric stasis. METHODS: Postoperative gastrointestinal motility was measured with a pneumohydraulic capillary infusion system in nine patients who had undergone pylorus-preserving pancreatoduodenectomy through an indwelling tube assembly placed at operation, and compared with that in six patients who had undergone duodenum-preserving pancreatic head resection. Plasma motilin concentrations were measured by radioimmunoassay. RESULTS: The mean period until the first occurrence of gastric phase III was significantly longer in patients who had undergone a pylorus-preserving pancreatoduodenectomy (40.6 +/- 4.6 days or more) than in patients who had undergone a duodenum-preserving pancreatic head resection (18.8 +/- 4.3 days; p < 0.05). On the day of the first observation of gastric phase III, the plasma concentration of motilin at proximal jejunal phase III in patients who underwent a pylorus-preserving pancreatoduodenectomy (50.2 +/- 9.8 pg/ml) was significantly lower than that at duodenal phase III in patients who underwent a duodenum-preserving pancreatic head resection (184.6 +/- 48.6 pg/ml; p < 0.05). CONCLUSIONS: Gastric stasis after a pylorus-preserving pancreatoduodenectomy may be in part attributable to the low concentration of plasma motilin caused by the resection of the duodenum.

Aged↗
PubMed1995

Reappraisal of safety of endoscopic sphincterotomy for common bile duct stones in the elderly.

BACKGROUND: Endoscopic sphincterotomy is the method of choice for elderly patients with common bile duct stones, even though these patients are poor operative risks. We undertook this study to analyze the operative risk factors for this age group. METHODS: We compared specific problems of 182 patients aged 80 years or older and 921 younger patients who underwent endoscopic sphincterotomy for common bile duct stones. RESULTS: Despite a higher frequency of periampullary diverticula in the elderly than in the younger patients (54% versus 36%, P < 0.001), the success rates of sphincterotomy were not different. The elderly patients required lithotripsy more often than did the younger ones (15% versus 4%, P < 0.001), and the necessity of stenting or nasobiliary drainage was greater in this group (9%) than in the younger group (5%, P < 0.05). This difference in the tactics between the older and younger groups was due to the greater number and size of stones, longer period of time for complete clearance of the common bile duct (13.5 versus 6.0 days, P < 0.01), and a greater percentage of patients with operative risks (55% versus 36%, P < 0.001). The elderly also had significantly greater overall morbidity compared with the younger patients (13% versus 7%, P < 0.005), frequency of acute cholangitis (8% versus 2%, P < 0.001), and mortality (1% versus 0%). CONCLUSION: These results suggest that frequent stenting or nasobiliary drainage to prevent cholangitis or prompt stone removal by lithotripsy would be necessary in this group of patients.

Adolescent↗
PubMed1994

Biliary motility. Changes in detailed characteristics correlated to duodenal migrating motor complex and effects of morphine and motilin in dogs.

The temporal relationship of biliary motility to the duodenal migrating motor complex and effects of morphine and motilin were studied in five dogs prepared with a duodenal cannula. Common bile duct, sphincter of Oddi, and duodenal manometry were performed awake. Sphincter of Oddi phasic contractions occurred even during the quiescent period of duodenal phase I and its activity increased from phase II to III. Minimum basal pressure of sphincter of Oddi and common bile duct pressure decreased from phase I to phase III. Both morphine and motilin induced premature phase III in the sphincter of Oddi and duodenum. Latencies of the effect were 0.2 min for morphine and 3.2 min for motilin (P < 0.01). After morphine, vigorous continuous contractions with high basal pressure occurred, being interrupted by brief and repeated inactive periods, similar to spontaneous phase III. Motilin-induced phase III appeared indistinguishable from spontaneous phase III. Although both agents induced phase III in the sphincter of Oddi, differences in the latency and contraction pattern suggest different mechanisms of action of these agents on the sphincter of Oddi.

Animals↗
PubMed1994

Multiseptate gallbladder as a cause of biliary pain.

A 45-yr-old Japanese woman with multiseptate gallbladder, a quite rare congenital anomaly, is presented. Her epigastric pain, with a 35-yr history, was relieved by cholecystectomy. The septa were present only at the neck portion of the gallbladder and were lined by mucosal epithelium containing a muscular layer continuous to the gallbladder wall. A review of 26 patients (including the present case) reported in the world literature revealed that only two of them had such partial involvement at the infundibulum of the gallbladder.

Biliary Tract Diseases↗
PubMed1993

Malignant duodenocolic fistula: report of a case and considerations for operative management.

Malignant duodenocolic fistula is a rare complication of gastrointestinal malignancy. We present herein the case of a 34-year-old female in whom a large duodenocolic fistula was caused by advanced transverse colonic carcinoma. Right hemicolectomy combined with pancreaticoduodenectomy enabled en bloc resection of the tumor, and the patient has been free of disease for 1 year and 8 months postoperatively. A review of the international literature, including 33 cases reported in Japan, indicates that if the disease is curable, the treatment of choice is right hemicolectomy with pancreaticoduodenectomy, whereas if it is not curable but locally resectable, the best palliation appears to be right hemicolectomy with partial duodenectomy to include the fistulous tract. Dehiscence of the duodenal wound closure associated with partial duodenectomy can be prevented by using the mucosal or serosal patch techniques with intestinal loops. These therapeutic principles are also applicable for colonic carcinoma which massively involves the duodenum without fistula formation.

Adenocarcinoma↗
PubMed1992

Intraoperative endoscopic electrohydraulic lithotripsy of pancreatic stones.

Two male patients with complications associated with chronic pancreatitis are described. In each patient, preoperative examinations revealed a large stone obstructing the main duct in the head of the pancreas. Lateral pancreaticojejunostomy was performed to relieve pain and prevent further attacks of pancreatitis. During each operation, the stone was fragmented under direct visual control with the use of a flexible choledochoscope and a contact electrohydraulic lithotriptor. The stone was removed and ductal flow through the head of the pancreas was reestablished. Our experience shows that endoscopic electrohydraulic lithotripsy facilitates operative removal of pancreatic stones deeply located in the head of the pancreas.

Adult↗
PubMed1992

[Clinical significance of endoscopic sphincterotomy compared with surgical common bile duct exploration and surgical sphincterotomy].

Records of 940 patients with endoscopic sphincterotomy (ES) and 100 patients with choledochotomy for stone removal were compared. Those with ES were characterized by older mean age (65.9 vs. 60.6, p < 0.001), similar frequency of operative risks (36% vs. 45%), and a less complication rate (8.2% vs. 53%, p < 0.001) as compared with the surgery group. Complications of ES included cholangitis, pancreatitis, bleeding, and basket impaction. One patient each with cholangitis and pancreatitis died, thus a mortality rate of 0.2%. Complications of choledochotomy occurred in 53 patients with no death. Most of them were associated with anesthesia, laparotomy, wound and immobilization. The complications of ES should decrease due to recent development of lithotripsy instruments and endoscopic stenting to prevent cholangitis. Follow-up of 74 patients 15-21 years after surgical sphincterotomy revealed recurrent stones in 3.5%, which was lower than a recurrence rate of 10.3% in 290 patients 5-14 years after ES. However, that rate may be an underestimate, because the follow-up was obtained in only 79% of those with surgical sphincterotomy as compared with 99% of ES. Ninety percent of those with recurrence after ES underwent endoscopic treatments again, whereas 10% had surgery. Easy repetition at the time of recurrence is one of major advantages of the endoscopic treatment.

Adolescent↗
PubMedDate not supplied

Comparison of routine and selective endoscopic retrograde cholangiography before laparoscopic cholecystectomy.

To evaluate the role of endoscopic retrograde cholangiography (ERC) before laparoscopic cholecystectomy, we compared the frequency of concomitant common bile duct stones, their clinical outcome, and the frequency of bile duct injury between a group of 128 patients with routine preoperative ERC (group A) and 1010 patients with selective ERC (group B). Overall, 48 patients (4.2%) had duct stones, but the predictive signs were absent in six of them (12.5%). The stones were demonstrated by ERC and removed by sphincterotomy in all 11 patients in group A. Of 37 patients in group B, 22 were diagnosed by selective ERC and underwent endoscopic removal. Of four patients whose stones were found by operative cholangiography, one had immediate open surgery, another passed a stone spontaneously, and the other two underwent postoperative sphincterotomy, which failed in one. The stones were not recognized until pain recurred in the remaining 11 patients. Sphincterotomy was successful in nine patients but failed in the other two. Thus postoperative sphincterotomy failed in 3 of 13 patients (23%), necessitating open surgery. Forty-two patients overall (3.7%) had aberrant biliary tract anatomy, which did not lead to bile duct injury in any of the patients. Morbidity of routine ERC (3.1%) was lower than that of selective ERC (7.4%) (p < 0.05). It should be noted that a certain proportion of duct stones may be missed by selective ERC, necessitating laparotomy when sphincterotomy fails. The routine use of preoperative ERC may be justified at institutions where the expertise is available, at least until laparoscopic lithotomy becomes easy.

Adult↗