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Biomedical subjects

J Yanagihara

Publications and source records attributed to J Yanagihara.

52 records · Page 3Linked to original sources
PubMed1986

Comparison of results of anorectal manometry performed after surgery for anorectal malformations and repeated three years later.

Anorectal manometry was performed in 27 patients 2 to 16 years after surgical correction of anorectal malformations and again 3 years after the initial examination. Further clinical improvement from faecal incontinence to normal bowel habits was observed in 3 of 11 patients with high anomaly. All of these 3 patients received special physiotherapeutic training from 3 months to 1 year during the two examinations. At the second examination these 3 patients had an anorectal pressure difference of more than 10 cmH2O, which is almost normal, and one of the 3 patients had developed an anorectal reflex. These results suggest that the functioning puborectalis muscle, which had been left intact during surgery, might be reinforced by physiotherapeutic training.

Anal Canal↗
PubMed1986

Anorectal electromyography in the diagnosis of Hirschsprung's disease.

Anorectal electromyography using intraluminal electrodes was done in nine patients with Hirschsprung's disease and in nine control patients with chronic constipation. In chronic constipation, many bursts of spikes were seen in both the anal canal and the rectum corresponding to contractions of the external sphincter muscle. These were propagated from the anal canal to the rectum. In contrast, in Hirschsprung's disease few bursts of spikes were seen in the rectum, and they were not propagated from the anal canal to the rectum, even if they corresponded to contractions of the external sphincter muscle. Thus anorectal electromyography proved to be a useful screening test for Hirschsprung's disease. The bursts of spikes were analysed by a signal processor that provided more precise details for the diagnosis of Hirschsprung's disease.

Anal Canal↗
PubMed1986

Cholelithiasis in children with congenital spherocytosis.

Cholelithiasis was diagnosed in two children with congenital spherocytosis of 7 and 9 years of age. Surgery was performed at age 10 and 14, respectively. The presence of gallstones should be considered in patients with congenital spherocytosis even under the age of 10. Various radiologic methods and ultrasonography are useful in the diagnosis of cholelithiasis in children as well as in adults. Once the diagnosis of cholelithiasis is established the treatment of choice is cholecystectomy and splenectomy at the same operation. To perform both procedures an upper midline incision proved to be satisfactory.

Adolescent↗
PubMed1985

Objective assessment of anorectal function after sphincter reconstruction using the gluteus maximus muscle. Report of a case.

Sphincter reconstruction using the gluteus maximus muscle was attempted in a 9-year-old boy who had been incontinent following surgery for the high type of anorectal malformation. Anorectal function following this procedure was assessed by anorectal manometry, defecogram, and electromyography. Postoperative function improved from Kelly 1 (poor) to Kelly 3 (fair). Adequate anorectal pressure difference and good voluntary contraction were documented one year after surgery. A defecogram one month postoperatively showed the presence of an empty segment which had not been noted before. Tonic activity at rest, which had not been present before, was found both one month and one year after surgery. These results indicate that the gluteus maximus muscle maintains some function as a newly created anorectal sphincter. In the present study, the patient was examined periodically for one year after surgery. Further follow-up studies are necessary.

Anal Canal↗
PubMed1985

The effect of gastrin, secretin and prostaglandin F2 alpha on the lower esophageal sphincter of dogs after Nissen fundoplication.

The effect of gastrin, secretin and prostaglandin F2 alpha on the canine lower esophageal sphincter (LES) after Nissen fundoplication was investigated by esophageal manometry. The gastrin-stimulated LES pressure was significantly higher intraoperatively 2 and 4 weeks after operation than the preoperative stimulation pressure. On the other hand, the prostaglandin F2 alpha-stimulated LES pressure 2 weeks after operation did not differ significantly from the preoperative stimulation value. At 2 weeks after Nissen fundoplication the LES pressure before secretin injection was significantly higher than the preoperative value. However, the LES pressure after secretin injection did not differ significantly from the preoperative stimulation pressure. Therefore, it seems that exogenously administered gastrin, unlike prostaglandin F2 alpha, stimulates the antireflux mechanism after wrapping of the gastric fundus in the Nissen procedure. It was suggested that secretin reacts against the new muscular sphincter substitute created by wrapping of the gastric fundus in the Nissen procedure.

Animals↗
PubMed1985

Immunohistochemical investigations of gut hormones in the colon of patients with Hirschsprung's disease.

The distributions of gut hormones in the colon of Hirschsprung's disease were investigated by the peroxidase-antiperoxidase (PAP) immunohistochemical method. Three colonic segments (ganglionic, oligoganglionic, and aganglionic) were stained by the unlabeled antibody enzyme method. The immunoreactivity of vasoactive intestinal polypeptide (VIP) was found to be reduced in the oligoganglionic and aganglionic segments. Antisera to substance P and met-enkephalin demonstrated immunoreactive cells and fibers in the ganglionic segment, whereas these cells and fibers were almost completely absent in the oligoganglionic and aganglionic segments. A similar distribution was seen for the mucosal endocrine cells with somatostatin immunoreactivity. Antisera to neurotensin, motilin, bombesin, and cholecystokinin revealed no immunoreactivity in the normal colon or the three segments. The differences in these peptides between normal and impaired colonal segments may be one of the causes of colon constriction in Hirschsprung's disease.

Adult↗
PubMed1985

Postoperative continence assessed by electromyography of the external sphincter in anorectal malformations.

Voluntary faecal continence after corrective surgery for anorectal malformations was assessed via electromyography (EMG) of the external sphincter muscle in 20 patients with anorectal malformations. Six normal children served as controls. Function of the external sphincter in patients with high type anomaly was disturbed from the points of tonic activity, inflation reflex, and activity during further rectal filling. Patients with a positive inflation reflex, regardless of the type of anorectal malformation, had good Kelly scores. Phasic activity was observed in patients with high-type anomaly, and in normal subjects and patients with other types of anomaly. Therefore, patients with high-type anomaly may acquire compensatory voluntary anal continence through training.

Adolescent↗
PubMed1985

Cancer of the gallbladder in a 9-year-old girl.

Carcinoma of the gallbladder was found in a 9-year-old girl. The patient was transferred to our hospital because of an abdominal mass and right upper quadrant pain. X-ray cholecystography and ultrasonography were performed preoperatively. The ultrasonic scan showed a thickened wall and lack of contractility of the gallbladder. A laparotomy was performed under the diagnosis of chronic cholecystitis. At operation a peanut-sized nodule, in which adeno carcinoma was demonstrated by frozen section, was palpable at the neck of the gallbladder. Cholecystectomy was performed with T-tube drainage and postoperative chemotherapy was administered. The patient has had no evidence of tumour recurrence in 24 months of follow-up.

Adenocarcinoma↗
PubMed1985

Congenital short small bowel with malrotation in a neonate.

A 1-day-old male infant with congenital short small bowel was transferred to our hospital because of bilious vomiting and abdominal distension. An exploratory laparotomy performed at the age of 8 days revealed malrotation without any volvulus or stenosis of the small intestine, which was 45 cm long. There were no other anomalies except absence of the appendix. Postoperative nutritional support was by intravenous hyperalimentation and administration of elemental diet. However, parenteral nutrition was discontinued because of hyperbilirubinaemia. The patient died from marked emaciation at 2 months of age despite the administration of elemental diet. Therefore, careful total parenteral nutrition is the only management for successful therapy until the child's intestinal absorptive function develops.

Cecal Diseases↗
PubMed1985

[Assessment and achievement of postoperative continence in imperforate anus].

Functional results after surgical correction of anorectal malformations were assessed on a clinical basis following Kelly score, by manometric and radiologic studies. Sixty-five patients, older than 5 years, were personally interviewed and 51 of the 65 had manometric and radiologic studies to evaluate postoperative continence. Continent patients with high type lesions as well as those with low type lesions characteristically had a marked anorectal pressure difference and an acute anorectal angulation in the defecogram. On the other hand, in the patients with fair or poor results, neither a marked anorectal pressure difference nor anorectal angulation was found. These results indicate that achievement of continence in patients with a high type lesion treated by staged abdominoperineal rectoplasty depends upon bringing the terminal bowel down exactly within the sling of the puborectalis muscle.

Anus, Imperforate↗
PubMed1984

Antireflux mechanism in Nissen fundoplication--an experimental study.

The antireflux mechanism of the Nissen fundoplication was investigated in 15 mongrel dogs by esophageal manometry. Nissen fundoplication increased the lower esophageal resting pressure for 2 weeks after operation; however, by 4 weeks it had decreased to a level which did not differ significantly from the preoperative value. Thus, lower esophageal sphincter (LES) length, unlike LES pressure, was maintained for a long period. These results suggest that restoration of competence at the gastroesophageal junction after Nissen fundoplication depends on an adequate length of LES as well as increased LES pressure. The gastrin-stimulated LES pressure 1, 2 and 4 weeks after operation was significantly higher than the preoperative stimulation pressure. Therefore, it seems that the antireflux mechanism is associated not only with the mechanical aspect of the wrapping but also with creation of a new muscular sphincter substitute that reacts sufficiently to gastrin stimulation.

Animals↗
PubMed1984

Manometric study and prolonged pH monitoring of esophagus in patients with hiatus hernia before and after operation.

The pathophysiology of the lower esophagus in 18 patients with hiatus hernia and 15 normal controls was investigated by esophageal manometry and prolonged pH monitoring. Thirteen patients with symptoms of severe gastroesophageal reflux had lower than normal pressures at the gastroesophageal junction. In 5 patients without symptoms, the pressure was normal. Nine of the 13 patients were inadequately controlled by conservative measures and underwent Nissen or Dor-Nissen fundoplication. All were free of esophageal symptoms postoperatively. Fundoplication resulted in a significant increase in the lower esophageal pressure. Prolonged esophageal pH monitoring showed significant improvement in all indices. Hiatus hernia and gastroesophageal reflux are related etiologically. However, further observations are needed to explain the association between reflux esophagitis and hiatus hernia. Nissen and Dor-Nissen fundoplications restored competence to the gastroesophageal junction as judged by esophageal manometry and prolonged pH monitoring.

Adult↗
PubMed1983

Acetylcholinesterase activity in rectal mucosa and blood in the diagnosis of Hirschsprung's disease.

Histochemical and biochemical examinations of rectal biopsy specimens were performed in 13 patients with Hirschsprung's disease and in seven with idiopathic constipation and no megacolon. Serum and erythrocyte acetylcholinesterase (AchE) activity in these two groups was compared with that in 30 normal controls. AchE staining of rectal biopsy specimens proved to be a reliable and convenient diagnostic approach in patients with Hirschsprung's disease. Biochemical assay of AchE activity in rectal biopsy specimens was also of value in the diagnosis, however, there was an overlap between Hirschsprung's disease and idiopathic constipation. Erythrocyte AchE activity correlated well with AchE activity in rectal biopsy specimens. Therefore, assays of erythrocyte AchE activity provided useful additional information, especially in screening tests for Hirschsprung's disease.

Acetylcholinesterase↗
PubMed1983

Manometric assessment of anorectal pressures in Hirschsprung's disease after Rehbein's operation with and without anorectal myectomy.

Anorectal manometric studies were performed on 15 patients with Hirschsprung's disease before surgery, on eight patients after Rehbein's procedure and seven patients after Rehbein's procedure with anorectal myectomy. The results were compared with those of 45 normal subjects. High anal resting pressure as well as an absence of the anorectal reflex proved to be responsible for obstructive symptoms in Hirschsprung's disease. Out of eight patients treated according to Rehbein's procedure, new internal sphincter relaxation was found in two, and anal resting pressures were significantly higher than those of the normal controls or of the patients treated according to Rehbein's procedure plus anorectal myectomy. It was demonstrated that anorectal myectomy is a more definitive procedure to restore the anal resting pressure to normal. Good postoperative continence can be achieved not only by the new internal sphincter relaxation but also by good propulsive movement which can overcome the remaining functional obstruction.

Anal Canal↗
PubMed1980

Bleeding Meckel's diverticulum diagnosed with 99mTc-pertechnetate.

The diagnosis of bleeding Meckel's diverticulum in an 11 year old boy, an 8 year old girl and a 2 1/2 year old boy, was established preoperatively using 99mTc-pertechnetate. These abdominal scannings were of value in the management of patients with rectal bleeding after ruling out other disorders by hematologic tests, usual radiologic studies and endoscopic examinations. To reduce ambiguities, the scanning was performed with the child in a fasting state and a nasogastric tube was led into the stomach to minimize volume and flow of radioactive gastric juice into the intestinal tract. Based on our experiences and review of reported cases, applicability of the scanning in the management of patients with Meckel's diverticulum is discussed.

Child↗