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Biomedical subjects

J Shikata

Publications and source records attributed to J Shikata.

At least 19 recordsLinked to original sources
PubMed1992

Extensive en bloc resection of regionally recurrent carcinoma of the rectum.

To remove regionally recurrent cancer of the rectum completely, more radical extensive resections were attempted than the conventional ones in 35 patients. Twenty-two patients underwent total pelvic exenteration. In 23, sacral resection was done, combined with other procedures including excision of the entire circumference of the lower pelvic ring. There were two hospital deaths. Delayed wound healing was seen in ten. Preoperative severe pain was alleviated in 18. Also, perineal ulcer, vaginal bleeding, bloody stools, and tenesmus disappeared. Of the four 5-year survivors (estimated rate, 23%), only one was disease-free. A second recurrence was seen in 27 patients, of whom 23 had regional failure. It was concluded that so-called local recurrence is a lesion more widespread than indicated by imaging and biopsy. Therefore, even the most radical resection rarely can cure this disease. However, such a surgical procedure can afford more effective palliation than other treatments and may prolong life in selected patients significantly.

Adenocarcinoma↗
PubMed1992

Villous component as a marker for synchronous and metachronous colorectal adenomas.

To determine whether patients with colorectal adenomas containing a villous component (+vc group) have a higher incidence of synchronous or metachronous colorectal adenomas, 527 consecutive cases of completely removed colorectal adenoma were used. Synchronous adenomas were detected in 22.6 percent and 19.0 percent of the patients in the +vc and -vc groups, respectively. In the analysis of metachronous adenomas, 164 patients who had been followed for 1 to 11 years (mean, 3.31 years) were included. The cumulative adenoma-free rate according to Kaplan-Meier tended to be lower in the +vc group, the difference being statistically significant 1.0 to 1.2 years after treatment of the initial adenoma and the two curves being different based on the generalized Wilcoxon test. The numbers of newly detected adenomas annually were 1.76 and 0.86, and their annual incidences were 1.09 and 0.59 times, in the +vc and -vc groups, respectively. These results suggest the importance of the villous component as a predictor of metachronous colorectal adenomas.

Adenoma↗
PubMed1992

Posterior decompression and stabilization for multiple metastatic tumors of the spine.

Although the value of surgical decompression and stabilization for solitary spinal metastasis is well documented, indication for surgery for advanced multiple metastatic tumors of the spine is controversial. In this study, the clinical effect of posterior decompression and stabilization was investigated in 11 patients with advanced multiple spinal metastases with unfavorable conditions. Mean blood loss during surgery was 3000 g. Disseminated intravascular coagulation occurred in three patients. Neurologic improvement was observed in nine patients. There was no neurologic deterioration due to surgery in any patients. A measure of pain relief was obtained in all patients. However, the postoperative longevity was short and the patients died 2.5 months (on average) after operation, except in cases of breast cancer. The effect of the posterior surgery on multiple spinal metastases depended on primary diseases. In cases of short life expectancy, the effect of the surgery was limited only to the short duration of neurologic improvement, pain relief, and ease of nursing care while confronted with grave surgical morbidity. In cases of long life expectancy with tumors like breast cancer, however, posterior decompression and stabilization were expected to exert long-term therapeutic effect. Therefore, the posterior surgery for multiple spinal metastases is cautiously indicated considering the nature of the primary tumor.

Adult↗
PubMed1992

[Decision analysis in therapeutic strategies for small bowel obstructions].

Clinical decision analysis was applied in therapeutic decision-making regarding small bowel obstructions. For strangulation obstruction, the three strategies of immediate surgery, observation of clinical course, and decision according to ultrasonographic findings were analyzed. When mortality rate, morbidity rate, or duration of hospital stay was used as the utility value, decision on the basis of ultrasonographic findings was selected as the most effective strategy, while the strategy of immediate surgery was selected when the rate of intestinal necrosis was used as the utility value. For adhesive obstructions, the three strategies of immediate surgery, conservative treatment with long tube decompression, and long tube decompression with enteroclysis (infusion contrast radiography) were analyzed. The strategy of enteroclysis was selected when morbidity rate and duration of hospital stay were used as utility values, while immediate surgery was selected when recurrence rate of adhesive obstruction was used as the utility value. For obstruction caused by intraabdominal recurrent cancer, operative treatment and conservative treatment were analyzed. The strategy of surgery was selected when rate of obstruction resolved and number of months of survival were used as utility values. Clinical decision analysis is valuable in quantitatively assessing individual variables affecting therapeutic decision-making.

Decision Support Techniques↗
PubMed1992

Relationship of cholecystectomy and detachment of the common bile duct to chronic bile duct dilation.

A combination of a cholecystectomy and detachment of the supportive tissue surrounding the extrahepatic bile duct results in chronic bile duct dilation. To clarify whether this cholangiectasis is due to the detachment of the surrounding tissue or to the cholecystectomy, we have studied 4 groups of adult mongrel dogs, i.e., a control group given a sham operation (n = 20), a group given cholecystectomy (n = 20), a group that had the surrounding tissue detached from the bile duct (n = 20), and a group given both a cholecystectomy and detachment of the surrounding tissue (n = 29). On examination by cholangiography at 1, 2, 3, and 4 weeks after the initial laparotomy, no significant cholangiectasis was found in dogs subjected to either cholecystectomy alone or to detachment of the surrounding tissue alone. In contrast, in dogs subjected to a cholecystectomy combined with detachment of the bile duct, the bile duct gradually dilated, resulting in significant cholangiectasis at 4 weeks. However, the intrabiliary pressure, the residual pressure, and the actual resistance value, which are indices of a passage disturbance in the sphincter of Oddi, were normal in all 4 groups. It is therefore concluded that both the extirpation of the gallbladder, and the lack of supportive tissue surrounding the bile duct were responsible for the resulting cholangiectasis.

Animals↗
PubMed1992

Surgical treatment of giant-cell tumors of the spine.

Three cases of relatively uncommon giant-cell tumors in the third cervical and first thoracic vertebra and the sacrum were treated surgically by radical resection and reconstruction. The tumor in the third cervical vertebra was treated by incomplete excision and anterior arthrodesis at a local hospital without pre- or postoperative radiotherapy. A recurrence was noted after four months, however, and an emergency operation was performed for severe quadriplegia. After posterior decompression, the tumor was resected by the lateral approach, and an autograft was performed. The tumor in the first thoracic vertebra was removed simultaneously by the anterior, posterior, and lateral approaches, and reconstruction was performed. The sacral tumor, which was radioresistant, was totally excised, and reconstruction was performed. Using these treatments, excellent results have been recorded after follow-up intervals of 1.5, three, and six years. Because of advancements in preoperative imaging techniques and better surgical techniques, radical resection is the recommended treatment for giant-cell tumors located in the spine.

Adult↗
PubMed1992

Bone-fibrin mixture in spinal surgery.

When bone grafting is performed adjacent to the spinal cord, instability of the grafted bone can result in compression of the spinal cord. To prevent this complication, fibrin sealant was mixed with the fine fragments of autogeneic bone, and the resultant pastelike mixture was used as a graft material. Operative procedures performed were posterolateral fusion (11 cases), anterior fusion (seven cases), and grafting into the bone defect (one case). After solidification of fibrin sealant, the autogeneic bone grafts were found to be firmly fixed in place, resulting in good bony fusion, and there were none of the neurologic symptoms associated with graft instability. No neurotoxicity was observed in any of these patients. Fibrin sealant was found to be an effective material for spinal surgery.

Adult↗
PubMed1991

Choledochoscopy during biliary surgery for reducing the risk of overlooked stones.

Although cholangiography is routinely performed during biliary surgery to ensure the removal of all stones, it is not always successful. Some investigators have claimed that intraoperative choledochoscopy is more effective in detecting all stones, although reports on the efficacy of this method have been contradictory. Furthermore, no study has systematically examined either of these procedures in terms of the actual incidence of overlooked stones. Thus, to evaluate the merits of intraoperative cholangiography as opposed to choledochoscopy, we studied the incidence of overlooked bile duct stones after surgery. We investigated 126 patients who had undergone surgery during which choledocholithotomy was performed within the past 10 years; 117 of these cases involved common bile duct stones and 22, intrahepatic stones. After the exclusion of 13 subjects whose stones were deliberately left for postoperative treatment due to severe complications, 126 patients were finally analyzed. Overlooked stones were found postoperatively in 13 (10%) of these 126 subjects, including 11 (14%) of 63 patients who had been inspected by intraoperative cholangiography alone and 2 (3%) of 63 who had undergone both choledochoscopy and cholangiography during surgery. Therefore, the incidence of overlooked stones proved to be significantly lower in those who had undergone choledochoscopy combined with cholangiography (P less than 0.01). Our results suggest the value of combining choledochoscopy with cholangiography during surgery for reducing the risk of overlooked bile duct stones.

Bile Duct Diseases↗
PubMed1991

Analysis and prevention of spinal column deformity following cervical laminectomy. I. Pathogenetic analysis of postlaminectomy deformities.

Postlaminectomy deformities were simulated in the cervical or cervicothoracic spine by the use of a displacement incremental method based on finite-element analysis combined with composite material and spanning element theory. The simulation analyses revealed that the primary cause of postlaminectomy deformity was the resection of one or more spinous processes and/or posterior ligaments (ie, ligamenta flava, supraspinous, and interspinous ligaments). After their removal, the tensile stresses that were preoperatively distributed through the posterior ligaments were transferred to the facets. This led to an imbalance of the stresses on the spinal bodies, causing deformity. The gravitational center of the head determined whether the deformity would develop as a kyphosis or increasing lordosis. As the elastic modulus of the soft tissue composites (eg, end plates, ligaments, and facets) increased, a kyphotic deformity changed gradually from swan-neck deformity, to extreme kyphotic deformity with a large curvature, and finally to a straightening deformity. Progressive kyphotic deformity is found only in children.

Adult↗
PubMed1991

[Problems with topical therapies for extensive squamous cell carcinoma of the buttocks].

In patients in whom cancer originating from a bed-sore has advanced to a stage where radical treatment is impossible, topical treatment with ointment, or systemic anti-cancer chemotherapy, is usually applied. We recently attempted treatment of extensive squamous cell carcinoma of the buttocks, for which radical treatment was impossible, by chemotherapy using a reservoir for intraarterial injection. This therapy involved intraarterial injection of bleomycin and 5-FU, together with topical treatment with 5-FU ointment. We describe the problems encountered with this therapy, e.g., measures against fever after intraarterial injection, management of the affected area, evacuation, possibility and limits of radiation therapy, and assessment of its efficacy.

Administration, Topical↗
PubMed1991

[A case report of spontaneous pneumothorax in Marfan's syndrome and an immunohistochemical study of type I collagen in lung tissue].

A 19-year-old male was admitted to Teikyo University Hospital because of dyspnea. The chest film revealed pneumothorax of the right side. The patient was tall and thin, with long tapered extremities. The lens showed ectopia lentis. Echography of the heart showed dilatation of the aorta. A diagnosis of Marfan's syndrome was established on the basis of characteristic skeletal, ocular and cardiovascular findings. At thoracotomy, several bullae were removed by wedge resection. Collagen type distribution in the lung was investigated by an indirect immunohistochemical study using type-special antibody of type I collagen. There were no significant differences in collagen type I in the lung between Marfan's syndrome and control. This suggests that type I collagen in Marfan's syndrome cannot be distinguished from normal collagen I by indirect immunochemical study.

Adult↗
PubMed1991

[A case of adenoma of the nipple with breast cancer].

Adenoma of the nipple is an uncommon lesion which can be mistaken clinically for Paget's disease and pathologically be misinterpreted as an adenocarcinoma. We recently experienced a case of very rare adenoma of the left nipple with left breast cancer. The patient was a 42-year-old, married woman with a firm, partially erosive lump measuring 12 X 12mm in her left nipple and with a left breast lump. Biopsy revealed the breast lump invasive ductal carcinoma and lump of the nipple was adenoma. Modified radical mastectomy was carried out. It is important to bear this rare lesion in mind and perform a thorough examination before making a diagnosis of a lump in the nipple.

Adenoma↗
PubMed1991

Long-term outcome of massive small bowel resection.

The long-term outcome for seven patients 4-17 yr (mean 7.1 yr) after massive small bowel resection, leaving 5-160 cm (mean 86.4) of small bowel, was reviewed. Their mean age at the final enterectomy was 40 yr. Adaptation to foodstuffs and the effects of physiologic alterations and complicating diseases on their return to work were emphasized. More than 3.5 yr after surgery, the patients had adapted to many kinds of foodstuffs, but dietary fat could not be tolerated by three patients. Six patients returned to work an average of 2.7 yr after surgery, but four were obliged to discontinue their work because of rehospitalization for long-term complications. In addition, their working hours were limited, and they could not engage in heavy physical work, owing to physiologic alterations, such as a reduced metabolic state, after massive enterectomy.

Adult↗
PubMed1991

[Dumbbell type tumor of a nerve root treated surgically by vertical curvilinear approach].

A 42-year-old man was admitted for further examination of an abnormal shadow on the posterior mediastinum which was incidentally detected by a routine chest X-ray. Myelography followed by computerized tomographic scanning (CT) revealed that a dumbbell shaped tumor had developed in the paravertebral area adjacent to the vertebral canal through an intervertebral foramen. A vertical curvilinear incision centered at T-6 was made with the patient in a prone position. Total laminectomy or T-5 and T-6 and resection of the left 6th rib provided sufficiently wide exposure for a one-stage resection of the tumor. The dumbbell shaped tumor originated from the root of 6th spinal nerve but did not extend to the spinal cord. The extirpated tumor was diagnosed histologically as schwannoma. Because tumor location had been determined preoperatively by CT scanning after myelography, it was possible to perform complete extirpation of the tumor while avoiding the complications of laminectomy and unnecessary thoracotomy.

Adult↗
PubMed1990

[A clinicopathological study on carcinoembryonic antigen in breast cancer].

The production of carcinoembryonic antigen (CEA) by human breast cancer tissue has been studied in relation to the prognosis of 60 patients with breast cancer who were classified in Clinical Stage of UICC I, II and III, and who were treated by radical mastectomy. Tissue CEA was studied in primary tumors using an immunoperoxidase (PAP) method. The obtained results were as followings: 1) Patients who had CEA-negative tumors had significantly higher 10-year survival rates. 2) The positive staining rate of CEA rises as Clinical Stage and metastatic status of lymph nodes advanced. 3) There were significant correlations between staining rate of CEA and classification of histological type and differentiation. 4) There were significant correlations between staining rate of CEA and lymphoid infiltration around main tumor and Sinus Histiocytosis in regional lymph nodes. 5) These results suggest that immunohistological assessment of CEA in breast cancer tissue may provide more precise prognostic information.

Adult↗