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Biomedical subjects

K Nishimine

Publications and source records attributed to K Nishimine.

36 records · Page 2Linked to original sources

[Evaluation of a biliary endoprosthesis using expandable metallic stents].

A biliary endoprosthesis constructed of Gianturco self-expanding metallic stents was placed in twenty-nine patients with obstructive jaundice, 27 malignant and 2 benign. All endoprostheses were placed successfully. External drainage catheters were removed in twenty-seven patients. At the follow-up, ranging from two to 59 weeks, the 30 day mortality rate was 7.4%. Twenty-eight patients had obvious clinical improvement with relief of jaundice. Seven patients experienced recurrent jaundice. In two of these patients, the obstruction was relieved by additional metallic stents. The expandable metallic biliary endoprosthesis is suggested as an effective treatment for biliary obstruction.

Adult↗

[Treatment with expandable metallic stent for arterial occlusive disease].

Gianturco expandable metallic stents were used in 4 cases with ASO of the iliac artery after PTA for the purpose of the prevention of restenosis. The insertion of stent was succeeded in all 4 cases, and the improvement of clinical symptoms and elevation of ankle pressure index were observed. Follow-up over 3 to 8 months revealed no occlusion and migration of stent. Expandable metallic stent was suggested to be contributable to the treatment of arterial occlusive disease.

Arterial Occlusive Diseases↗

[An experimental and clinical study of thin-slice high-resolution CT for lung detail].

The clinical usefulness of thin-slice high-resolution CT in the diagnosis of the chest was assessed by (1) experiments using a phantom and an inflated fixed lung (Heitzman's method), (2) evaluation of the CT delineativity of the bronchi and major fissure and (3) clinical examination of patients with diffuse pulmonary diseases. 1) In a phantom experiment using catheters, 10 mm-thick slice scan showed the 6 catheters as a single faint line. By 1.5 mm-thick slice scan, the catheters were defined as 6 separate lines. The profile images suggested that 1.5 mm-thick slice scan enables delineation of more minute details of structures. 2) In an experiment using an inflated fixed lung, 1.5 mm-thick slice scan produced more informative images that resembled macroscopic or soft X-ray images. 3) By 1.5 mm-thick slice scan, the subsegmental bronchi of both the right and left lobes were identified in most cases, while identification was possible in only half the cases by 10 mm-thick slice scan. 4) By 10 mm-thick slice scan, the sub-subsegmental bronchi were not identified in most cases. However, identification was possible in approximately half the cases by 1.5 mm-thick slice scan. 5) By 1.5 mm-thick slice scan, the major fissure was delineated as a linear shadow in most cases. It was hardly recognizable by 10 mm-thick slice scan. 6) In diffuse pulmonary diseases, 1.5 mm-thick slice scan allowed more minute visualization of the patho-morphological changes compared to 10 mm-thick slice scan. 7) Thin-slice high-resolution CT is thus expected to contribute to pathological analysis and more accurate diagnosis of pulmonary diseases.

Humans↗

[Ultrasonic detectability of multiple small hepatic nodules].

We analyzed the ultrasonic detectability of multiple daughter nodules accompanied by 18 hepatocellular carcinomas and multiple small nodules in 11 metastatic liver tumors identified by infusion hepatic angiography. In the cases of hepatocellular carcinoma, ultrasonic detectability of daughter nodules was remarkably limited. If any daughter nodules are detected by US, there is the great possibility that many other daughter nodules are undetected. However, US is effective in detecting small nodules in the metastatic liver tumor.

Carcinoma, Hepatocellular↗

[Non-vascular interventional radiology expandable metallic biliary endoprosthesis and afterloading intracavitary irradiation for malignant biliary obstruction].

Biliary endoprostheses (EMBE) using expandable metallic stents or intracavitary irradiation with remote afterloading (RALS) were carried out in eighteen patients with malignant biliary obstruction. There were 11 patients with bile duct cancer, 3 patients with gallbladder cancer, 2 patients with pancreas cancer and 2 patients with metastatic gastric cancer. The favourable results were obtained. Placement of stents was successful in all 17 cases in which the EMBE was conducted, and in all cases but one, the duct was cleared. At the follow-up of 2 to 59 weeks, all stents maintained patency and there were no severe complications, although only one patient had jaundice due to obstruction at the stented duct 4 months after EMBE. In nine cases, intracavitary irradiation with RALS was performed using a newly developed 14 Fr applicator. The bile duct walls at the irradiation site were smooth and expansion of the constricted area was seen. These results indicate that the combined use of EMBE and intracavitary irradiation with RALS could form a new part of treatment of malignant tumors of the bile duct in which radical surgery is not possible.

Bile Duct Neoplasms↗

Transcatheter hepatic segmental arterial embolization using lipiodol mixed with an anticancer drug and Gelfoam particles for hepatocellular carcinoma.

Transcatheter hepatic segmental arterial chemoembolization using Lipiodol mixed with an anticancer drug followed by the injection of Gelfoam particles, introduced into the tumor-bearing hepatic segment as the target area (segmental Lipiodol-TAE), was carried out in 54 patients with hepatocellular carcinoma (HCC), 7 of whom were later resected. In 5 of the resected 7 cases, complete necrosis was histologically verified. No death due to HCC was encountered in 47 nonoperated cases, and better therapeutic results were obtained with segmental Lipiodol-TAE. It was concluded that this technique does not adversely affect normal tissues, and it does reinforce the effect of TAE.

Carcinoma, Hepatocellular↗

Segmental embolotherapy for hepatic cancer: keys to success.

Transcatheter chemoembolization using Lipiodol (Lp) mixed with chemotherapeutic agents followed by Gelfoam particle injection only to the tumor-bearing hepatic segment (segmental Lp transcatheter hepatic artery embolization) (TAE) was applied to more than 100 patients with hepatocellular carcinoma and metastatic liver cancer. For segmental Lp-TAE, knowledge of the variations of intrahepatic arterial anatomy is important. Furthermore, the catheters and guidewires, volume of Lp, kinds and dose of chemotherapy, preparation of the mixture of Lp and chemotherapy (Lp-emulsion), method of injection of Lp-emulsion and Gelfoam particles, as well as the follow-up computed tomography examination are key items to the success of the procedure and are reviewed.

Antineoplastic Agents↗

Crossover approach with a J-shaped sheath for angioplasty of iliofemoral artery stenoses and occlusions.

Thirty patients with atherosclerotic stenoses or occlusions of iliofemoral arteries were treated from the contralateral approach using a newly designed J-shaped sheath. Seven patients with stenoses and one with an occlusion were successfully dilated with balloon angioplasty. Twenty-two patients with occlusions were treated with urokinase infusion, 16 of whom received coaxial infusion with the J-shaped sheath and catheter. Complete thrombolysis was achieved in 18 patients. The treatment success rate was 100% in the stenotic group and 83% in the occlusion group. Initially, J-shaped sheaths were useful for treatment of iliofemoral artery lesions from the contralateral femoral artery.

Angioplasty, Balloon↗

Combined transjugular intrahepatic portosystemic shunt and segmental Lipiodol hepatic artery embolization for the treatment of esophagogastric varices and hepatocellular carcinoma in patients with cirrhosis: preliminary report.

PURPOSE: To evaluate the feasibility of combining placement of a transjugular intrahepatic portosystemic shunt (TIPS) and transcatheter hepatic segmental artery chemoembolization with Lipiodol (Seg-Lp-TAE) in patients with cirrhosis, esophagogastric varices, and hepatocellular carcinoma (HCC). METHODS: Five patients with bleeding or large, high-flow esophagogastric varices and HCC were treated by TIPS and Seg-Lp-TAE. RESULTS: The mean portosystemic pressure gradient decreased from 20.8 cm H2O to 7.8 cm H2O after TIPS. The direct portogram and endoscopic examination revealed reduction of varices. At 6 months, one shunt had functionally occluded and could not be reopened; the other TIPS remained functional. Follow-up CT and the changes of alpha fetoprotein indicated effective therapy of Seg-Lp-TAE for HCC. Four patients are in stabile clinical condition at 9, 6, 1, and 1 months after the combined therapy; one died after 14 months due to decompensated liver cirrhosis. CONCLUSION: The combined therapy of TIPS and Seg-Lp-TAE will become a new interventional approach for patients with HCC and esophagogastric varices.

Aged↗

Experimental TIPS with spiral Z-stents in swine with and without induced portal hypertension.

PURPOSE: To assess the suitability of spiral Z-stents for transjugular intrahepatic portosystemic shunt (TIPS) and the influence of portal hypertension on shunt patency in young swine. METHODS: TIPS were established using spiral Z-stents in 14 domestic swine. In 7 animals, the portal venous pressure was normal; in the other 7, acute portal hypertension was induced by embolization of portal vein branches. Follow-up portal venography and histologic evaluations were done from 1 hr to 12 weeks after TIPS. RESULTS: Follow-up transhepatic portal venograms showed progressive narrowing of the shunt, most prominent in the midportion of the tract. Ingrowth of liver parenchyma between the stent wires found after 3 weeks led to progressive shunt narrowing and shunt occlusion by 12 weeks. A pseudointima grew rapidly inside the stent, peaked in thickness around 4 weeks, and decreased later. Acutely created portal hypertension rapidly returned to normal and there was no difference in TIPS patency between the two groups of animals. CONCLUSION: Although the spiral Z-stent can be used as a device for creation of TIPS in patients with cirrhotic livers, it is associated with extensive liver ingrowth in swine that leads to rapid shunt occlusion. Portal hypertension was only transient in this model.

Animals↗

Segmental transcatheter hepatic artery chemoembolization with iodized oil for hepatocellular carcinoma: antitumor effect and influence on normal tissue.

PURPOSE: Segmental transcatheter arterial embolization (TAE) with use of iodized oil mixed with an anticancer drug, followed by injection of gelatin sponge particles, was undertaken to evaluate its antitumor effect and its influence on normal tissue in patients with hepatocellular carcinoma (HCC). PATIENTS AND METHODS: Histologic findings in 12 patients who underwent hepatectomy after segmental TAE were compared with findings on plain radiographs and computed tomographic (CT) scans. Visualization of the portal veins contiguous to the tumor on radiographs and the pattern of iodized oil accumulation in the tumor and vicinity on CT scans after TAE were assessed. RESULTS: Complete necrosis of the tumor was achieved in 10 cases (83%), while complete necrosis of daughter nodules and capsular invasion was observed histologically in eight of these 10 patients (80%). The degree of tumor necrosis correlated with the pattern of iodized oil accumulation in and near the tumor. Partial necrosis of normal tissue near the tumor correlated with accumulation of iodized oil. CONCLUSION: Segmental TAE may be an excellent therapeutic method for treatment of HCC that is localized in one or a few segmental or subsegmental regions.

Aged↗

Bile duct injury as a major cause of stenosis and occlusion in transjugular intrahepatic portosystemic shunts: comparative histopathologic analysis in humans and swine.

PURPOSE: A comparative histologic analysis of human and swine transjugular intrahepatic portosystemic shunts (TIPS) was performed to investigate factors limiting TIPS patency and to further develop an animal model for TIPS. MATERIALS AND METHODS: Twenty-one human and 13 porcine shunts were evaluated by means of gross inspection, histologic evaluation, and electron microscopy. RESULTS: Severe stenosis (> 75% narrowing) or occlusion was detected with portal venography in nine of the 21 human shunts (48%) and in 10 of 13 porcine shunts (77%). Gross or histologic evidence of a substantial biliary fistula was observed in seven of nine porcine shunts and in seven of eight human shunts with severe parenchymal tract stenosis or occlusion. No evidence of substantial bile duct injury was identified in the 13 human shunts or two swine shunts with patent, nonstenotic parenchymal tracts (P < .01, Fisher exact). Histologic findings in porcine shunts mimicked human tissue responses, including a metaplastic proliferation of bile duct epithelium at sites of bile duct transection. CONCLUSION: Bile duct transection and bile leak are significantly associated with TIPS parenchymal tract abnormalities in patients and swine. TIPS in swine created with the Wallstent faithfully reproduce gross morphologic and histologic changes observed in patients.

Animals↗

Afterloading intracavitary irradiation and expanding stent for malignant biliary obstruction.

A double lumen catheter was developed as an applicator for the remote afterloading (RALS) of 60Co source for the intracavitary irradiation of an obstructed common bile duct caused by carcinoma of the gallbladder. This was followed by the placement of nylon-covered expandable metallic stents to maintain patency. This combination effectively provided palliation.

Brachytherapy↗