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Biomedical subjects

K Suruga

Publications and source records attributed to K Suruga.

At least 37 records · Page 2Linked to original sources
PubMed1992

The future role of hepatic portoenterostomy as treatment of biliary atresia.

According to our recent study, 38 of 93 patients (40.9%) who underwent portoenterostomy at Juntendo University Hospital between 1977 and 1986 survived for more than 5 years. In order to learn the future improvement of the prognosis of biliary atresia patients who undergo portoenterostomy, we investigated the relationship between the prognosis of biliary atresia patients and the age and the histological changes of liver at the time of surgery. Twenty-seven of 30 patients (90%) who survived for more than 5 years with no jaundice and no findings of liver cirrhosis had a mild degree of liver fibrosis (F1 or F2) and a mild degree of degeneration of intrahepatic bile ducts (B1 or B2) at the time of surgery, in spite of the difference of size of intrahepatic bile ducts at the porta hepatis. On the other hand, all 8 patients who showed severe liver fibrosis (F3) and severe degeneration of intrahepatic bile ducts (B3) did not survive for more than 5 years. Accordingly, we can expect promising prognoses in patients who undergo refined portoenterostomy procedures and receive proper postoperative treatment before they have severe histological changes of liver. The portoenterostomy will still play an important role as treatment of biliary atresia in the future.

Bile Ducts, Intrahepatic↗
PubMed1990

A study on more than 20 years of postoperative follow-up in pediatric surgical cases.

There have been very few postoperative follow-up studies from the aspect of philosophical anthropology in the field of pediatric surgery. Fifty patients who underwent surgery either during the neonatal period or infancy and have been receiving medical treatment or consultation for more than 20 years in Juntendo University Hospital and Katsunan Hospital, were investigated from the aspect of philosophical anthropology. During adolescence or young adulthood, 52% of the patients were suffering from their medical problems. Forty percent of patients were bullied by their peers during their elementary school age due to various medical problems. As patients became adolescents or young adults, 20% of them started to feel that others were prejudiced against them or they were discriminated against when going to school or looking for a job. About 30% of patients who were of elementary school age and of adolescent or adult age, were introverted and short-tempered. Eighteen percent of the patients who were of elementary school age and adolescent or young adult age, were not satisfied with their family, particularly their parents, because of their medical problems. When patients became adults, 40% were not satisfied with their own society, particularly with others in their working place. More than 80% of patients who were of preschool age were shielded from their medical problems by their parents. As they became older, their parents were not always able to cover up their medical problems, but understanding school teachers and their elders were able to shield some of patients from social ridicule. By learning the results of this study, it is important for pediatric surgeons to minimize postoperative medical problems, giving proper surgery and postoperative care. Pediatric surgeons should become very supportive medical doctors to patients who suffer from postoperative medical problems.

Adaptation, Psychological↗
PubMed1985

A study of patients with long-term bile flow after hepatic portoenterostomy for biliary atresia.

Thirty-five cases of biliary atresia that demonstrated the creation of internal fistula between intrahepatic bile ducts at the portahepatis and intestine and showed long-term bile flow after our hepatic portoenterostomy were investigated from various aspects. These 35 cases were divided into Group A cases, in which jaundice disappeared within three months after surgery, and Group B cases, in which persistent jaundice was seen more than three months after surgery. (1) Severe liver fibrosis and degeneration of intrahepatic bile ducts were more often seen in Group B cases than in Group A cases. (2) The age at the time of surgery and the size of intrahepatic bile ducts at the portahepatis did not have much influence on the operative results in those 35 cases. (3) Measurement of the amount of bile flow and bile acid excretion obtained from Suruga II enterostomy is useful for evaluating the postoperative results of biliary atresia patients. (4) Reoperation that includes curettage and rehepatic portoenterostomy, and serious postoperative ascending cholangitis were each closely related to postoperative persistent jaundice.

Bile↗
PubMed1985

New operative technique for Hirschsprung's disease.

A new technique for definitive surgery in Hirschsprung's disease is described. After transection of the rectum at 2 cm above the peritoneal reflection, the distal rectum is incised laterally on both sides in a longitudinal direction half way to the anus. The mucosal lining of the anterior rectum is partially removed. The posterior portion of the rectum is divided into two flaps by sagittal incision up to the mucocutaneous junction of the anus, which are then reflected and everted through the anus. The proximal colon is then pulled through, exteriorizing 5 cm of ganglionic colon. The exteriorized colon is resected two weeks later. Nine cases were operated upon by this technique. The postoperative results were satisfactory in all cases.

Colon↗
PubMed1985

[Transfer of antibiotics into the liver tissue of infants with hepatic dysfunction].

Transfer of antibiotic (cefmetazole, CMZ) into the liver tissues of the infant with hepatic dysfunction, 6 cases of congenital biliary atresia, 4 cases of congenital bile duct dilatation, 1 case of congenital biliary hypoplasia, hepatic hemangioma and umbilical hernia with congenital heart disease is reported here. CMZ level in the liver tissues with hepatic dysfunction shows extremely low. Our study revealed that poor transfer of CMZ into the liver tissues might be a main cause of the poor excretion of CMZ into the bile in case of jaundiced infant.

Adolescent↗
PubMed1985

Hepaticportoenterostomy as surgical therapy for biliary atresia.

The Kasai I and Suruga I procedures are the most commonly reported surgical procedures used for the correction of biliary atresia. Clinical results are similar for these two procedures, but the Suruga I procedure is associated with a lower incidence of death due to ascending cholangitis. Postoperative care is an important consideration in choosing between these two procedures. The hepaticportocholecystostomy is associated with a decreased incidence of ascending cholangitis, however, it is only an option for a select group of patients. For all procedures mentioned, the level of transection of the bile duct remnant is crucial and pathologic confirmation of patency of the bile duct is helpful.

Bile Ducts↗
PubMed1984

Choledochopancreatic elongated common channel disorders.

A choledochopancreatic end-to-side ductal anastomosis was successfully performed in 40 puppies as an experimental animal model of choledochopancreatic elongated common channel disorders. Follow-up periods were up to 1 year after surgery. Fusiform dilatation was developed in all puppies. The dilatation was completed within 1 week after surgery and did not increase its size after that. Also, all puppies developed pancreatic juice reflux into the bile duct. As for the etiology of the dilatation of the bile duct, temporary stricture of anastomosis was a more important factor than the pancreatic juice reflux in our models. In the biliopancreatic juice, we found no significant change of bile acid analysis between the control and our operated puppies, but almost all pancreatic enzyme activities were elevated. Bile acid was considered to play an important role in the activation of pancreatic enzymes. Epithelial hyperplasia was the only significant pathological change in the bile duct wall. Definite chronic pancreatitis developed in one puppy 16 months after surgery and was considered to be caused by the reflux of bile into the pancreatic duct. The action of biliopancreatic juice to both the bile duct and to the pancreas was mild and chronic.

Animals↗
PubMed1984

Experimental study of the pathogenesis of choledochal cyst and pancreatitis, with special reference to the role of bile acids and pancreatic enzymes in the anomalous choledocho-pancreatico ductal junction.

To investigate the mechanisms initiating pancreatic enzyme activation followed by the development of a choledochal cyst and/or pancreatitis under anomalous choledocho-pancreatic ductal junction (ACPDJ), choledocho-pancreatic end-to-side ductal anastomosis was successfully performed in 40 puppies as an experimental model of ACPDJ. As a result, reflux of pancreatic juice into the common bile duct readily and continuously occurred, and all pancreatic enzymes in bile obtained from the common bile duct were activated. Total bile acids increased about 2 months after surgery, and the ratio of taurodeoxycholic acid to total bile acids increased within the first months after surgery. Various degrees of common bile duct dilatation developed in all puppies within 7 to 10 days after the surgery, and no further dilatation occurred in the subsequent period. Histological change in the pancreatic duct was less prominent than that in the common bile duct, but histologically proved chronic pancreatitis was found in three of 23 sacrificed dogs, in which there was strong evidence of free and massive regurgitation of the bile-pancreatic juice mixture between the bile and the pancreatic duct systems. These findings in this experimental study constitute the first step to prove that ACPDJ, which is often found in patients with choledochal cyst, is an important etiologic factor not only for choledochal cyst but also for pancreatitis, and bile acids play an important role in the mechanism of pancreatic enzyme activation under the condition of ACPDJ.

Animals↗
PubMed1984

[Postoperative evaluation of renal function from the aspect of urinary concentration of cefmetazole in infants and children with vesicoureteral reflux and hydronephrosis. I].

The urinary excretion of cefmetazole (CMZ) which was administered intravenously from both kidneys (affected side and normal side) was studied separately after surgery in 11 infants and children (10 cases of vesicoureteral reflux (VUR) and 1 case of hydronephrosis due to pelviureteric obstruction). In kidneys with VUR of grade IIb to III degree, urinary concentration of CMZ showed rather higher than that we expected from their creatinine clearance. On the contrary in kidneys with VUR of grade IV degree and hydronephrosis, urinary concentration of CMZ showed rather lower compared to their creatinine clearance.

Age Factors↗
PubMed1984

[The correlation between the biliary excretion of cefmetazole and the bile acid metabolism in postoperative patients with biliary atresia].

The correlation between the biliary excretion of cefmetazole (CMZ) and the bile acid metabolism was studied in 17 postoperative children with congenital biliary atresia. B (total bile acid value in bile)/S (total bile acid value in serum) ratio is the best indicator in order to evaluate the postoperative condition of the liver in patients with biliary atresia at this time, that is, the B/S ratio is lower, the condition of the liver is deteriorated. The biliary excretion of CMZ was closely correlated to the B/S ratio, that is, the B/S ratio is lower, the biliary excretion of CMZ is discussed.

Age Factors↗
PubMed1984

A study on hepatic portoenterostomy for the treatment of atresia of the biliary tract.

The results of our investigation have shown the crucial points of hepatic portoenterostomy used by us which is different from Kasai's portoenterostomy. First, the dissection of the rudimentary extrahepatic bile duct should be performed under magnification. Second, the transection of the rudimentary extrahepatic bile duct should be done using the microsurgical technique. Third, histologic verification of patency of the rudimentary extrahepatic bile ducts with frozen section during the operation should be carried out and the transection should be repeated under microsurgical control until the patency of the intrahepatic bile ducts at the porta hepatis area is confirmed. Fourth, the opening of the jejunal loop should be anastomosed quite close to the cut edge of the rudimentary extrahepatic bile duct at the porta hepatis by removing the mucosa of the posterior aspect of the jejunal opening. Fifth, the Suruga II procedure has been extremely successful in decreasing the incidence of postoperative ascending cholangitis and in preventing death in those infants who have postoperative ascending cholangitis develop. Sixth, if bile flow ceases postoperatively in spite of the forementioned technical refinements, then the curettage procedure should be carried out to the anastomotic site at the porta hepatis in order to resume bile flow.

Biliary Tract↗
PubMed1983

Antibiotic excretion into the bile after hepatic-portojejunostomy in biliary atresia.

Antibiotic excretion into the bile was studied using LMOX and CMZ in 16 postoperative cases of biliary atresia patients who had had hepatic portoenterostomy with Suruga II type enterostomy with the following results: Group I: Excellent excretion which was almost the same as that seen with adult patients; Group IIa: Good or poor excretion, depending on the amount of bile flow and liver function; Group IIb: Very poor excretion; Group III: Good excretion but depending on the amount of bile flow and liver function. As the total bile acid level in bile showed a higher level, the biliary excretion of antibiotics was greater. Our study indicates that antibiotic excretion into the bile in infants is closely related to the condition of the liver function and the biliary passages.

Bile↗
PubMed1983

Experimental study of the pathogenesis of infantile obstructive cholangiopathy and its clinical evaluation.

1,4-phenylenediisothiocyanate was given to five groups of rats of different developmental stages (97 in all), and the changes in the hepatobiliary system were compared histopathologically. Three groups of rats given the drug after birth showed dilatation of the extrahepatic bile ducts with inflammation. Two groups given the drug during the fetal period or added after birth showed stenotic or atretic extrahepatic bile ducts due to thickening and fibrosis of the wall. This experimental model suggests that differences in the pathologic features of infantile obstructive cholangiopathy (biliary atresia, neonatal hepatitis, and bile duct dilatation) may be the result of various developmental stages in the pathogenic process. After the experiment, 11 cases of correctable type biliary atresia were compared to 24 cases of noncorrectable type in various aspects. It is suggested that the correctable type may have suffered pathogenic process later in the developmental stages than noncorrectable type.

Animals↗
PubMed1983

[Cefotiam excretion into the bile after radical operation of congenital biliary atresia].

Twelve infants having undergone extrahepatic cholangiojejunostomy (SURUGA'S procedure II) after portal hepaticojejunostomy as a radical operation for congenital biliary atresia received prophylactic cefotiam (CTM) against biliary tract infection, 50 mg/kg by intravenous drip in 1 hour, followed by serial determinations of bile and serum CTM levels. The patients were evaluated as to degree of CTM excretion into the bile, by classification into 4 groups according to success or failure in establishing the anastomosis, bile outflow and persistence of jaundice. Patients with an established anastomosis, satisfactory bile flow and no longer jaundice showed high biliary antibiotic concentrations whereas lower biliary antibiotic levels were seen in those with failure in anastomosis, poor bile flow and persistent jaundice. In both cases, nevertheless, the antibiotic concentration in bile sufficiently exceeded the MIC80 values of CTM against principal bacterial pathogens causative of biliary tract infections, thus demonstrating clinical significance of the use of CTM for this purpose. The antibiotic excretion into the bile improved with normalization of liver function in an infant displaying satisfactory bile outflow from an early postoperative stage. The bile and serum CTM assay data obtained by the agar well method showed a high degree of correlation with those by high performance liquid chromatography.

Bacterial Infections↗
PubMed1983

[Cefmetazole excretion into the bile after hepatic portojejunostomy in congenital bile duct atresia].

Antibiotics excretion into the bile was studied using CMZ which was administered by drip infusion in 12 postoperative cases of congenital bile duct atresia patients who had hepatic portojejunostomy with SURUGA II type enterostomy with the following results. Group I (correctable type children, with good bile flow, no jaundice): Excellent excretion was almost the same as that seen in adult patients. Group IIa (uncorrectable type children, with good bile flow, no jaundice): Excretion was poor but good depending on the amount of bile flow and liver function. Group IIb (uncorrectable type children, with poor bile flow, jaundice): Excretion was very poor. Group III (uncorrectable type infants, with good flow, no jaundice): Excretion was good depending on the amount of bile flow and liver function. Our study indicates that antibiotics excretion into the bile in children is closely related to the condition of the hepatic function and biliary passage.

Age Factors↗