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Biomedical subjects

K Tokui

Publications and source records attributed to K Tokui.

At least 19 recordsLinked to original sources
PubMed2000

Multiendoscope-assisted treatment for blue rubber bleb nevus syndrome.

Blue rubber bleb nevus syndrome is characterized by gastrointestinal and cutaneous hemangiomas and gastrointestinal bleeding causing anemia. We report a unique case of this syndrome in an adult woman. It was associated with congenital heart disease, for which the patient underwent surgery at 12 months of age, and cutaneous hemangiomas, for which surgery was performed later in childhood. Gastrointestinal bleeding was diagnosed and treated when she was 21 years of age after a workup for iron deficiency anemia. Successful total resection of all gastrointestinal hemangiomas was performed by minimally invasive surgery with gastric, small intestinal, and colonic fiberscopy and laparoscopy. The postoperative course was uneventful. The patient could walk the day after surgery, and she was discharged from the hospital 14 days after surgery. Our experience and findings given in other reports suggest that total resection of hemangiomas should be the final goal and that minimal skin incision is preferable for this benign disease, with multiendoscope-assisted treatment to ensure that any hemangiomas remaining in the gastrointestinal tract are not overlooked.

Adult↗
PubMed2000

Laparoscopic hepatic surgery guided by hookwire localization.

Due to recent improvements in radiographic technique, computed tomography (CT) occasionally delineates small hepatocellular carcinomas (HCCs) that are invisible with sonography. However, surgery has not been a viable option for these lesions because of the absence of tumor localization. We describe a new technique of preoperative tumor localization using a hookwire to guide laparoscopic surgery for such HCCs. A 68-year-old man with HCC had tumor recurrence after chemoembolization. Two recurrent lesions, 10 mm or less in diameter, located in segment III were demonstrated; not by sonography but by Lipiodol CT. We successfully placed a hookwire into the tumor through a 21-gauge needle under the guidance of CT. The hookwire instrument provided the only clue of tumor location at laparoscopy. The liver around the hookwire was thoroughly coagulated. The postoperative course was uneventful, and the tumor was completely ablated. Preoperative CT-guided hookwire placement is useful to localize and to laparoscopically treat small hepatic lesions.

Aged↗
PubMed2000

Painless lithotripsy by flashlamp-excited dye laser for impacted biliary stones: an experimental and clinical study.

OBJECTIVE: To find out the appropriate dye laser output and frequency for each kind of stone experimentally, and to use flashlamp-excited dye laser for impacted biliary stones. DESIGN: Prospective study. SETTING: University hospital, Japan. SUBJECTS: 12 patients undergoing lithotripsy for both intrahepatic and extrahepatic impacted biliary stones. MAIN OUTCOME MEASURES: Appropriate dye laser output and frequency, histological changes in the bile duct wall, and outcome. RESULTS: Stones were pulverised, and required a median 155 pulses (range 80-205) at 40 mJ for bilirubin stones and 355 pulses (range 205-405) at 50 mJ for cholesterol stones. At the standard energies used, the laser caused only superficial damage to the serosa of the common bile duct. It was successful in fragmenting 133/135 stones (99%), and in addition pulverised 125/135 stones (93%). No patients complained of pain during laser lithotripsy even under local anaesthesia. All patients were discharged from the hospital after an uneventful recovery, and no recurrent stones have been found at outpatient follow-up ranging between 2 and 85 months. CONCLUSION: Flashlamp-excited dye laser with a small choledochoscope seems to be safe and painless way of treating biliary stones, even if they are impacted in the peripheral biliary tree and patients are at high risk.

Aged↗
PubMed2000

CT-guided treatment of ultrasonically invisible hepatocellular carcinoma.

New techniques of CT-guided management were introduced to ablate ultrasonically invisible hepatocellular carcinomas. In six patients with HCC, a total of six nodules (8-30 mm in diameter) were treated under the guidance of CT. These lesions were not visualized by sonography but were visualized as Lipiodol spots on CT after chemoembolization. Tumor localization was successful in all patients without difficulty, using a thin needle or hookwire under the guidance of CT. Two patients underwent subsequent hepatic resection and/or microwave coagulation therapy (MCT) through a small incision after hookwire placement. Four patients received percutaneous MCT (n = 2) or ethanol injection (PEI) (n = 2) at the time of localization. The postoperative CT with contrast enhancement indicated that tumor ablation was complete in four of the five nodules treated with MCT or PEI. However, in one nodule (30 mm in diameter) treated with PEI, tumor ablation was not complete. There were no complications. There has been no local tumor recurrence 6-46 months after treatment in any of the patients. In conclusion, these CT-guided procedures were effective in treating ultrasonically invisible hepatocellular carcinomas that otherwise would have remained untreated.

Aged↗
PubMed1999

Diffusion-weighted magnetic resonance imaging: detection of ischemic injury 39 minutes after onset in a stroke patient.

A neurologist witnessed the in-hospital onset of an ischemic stroke in a 71-year-old right-handed male who suddenly developed global aphasia and right hemiplegia. Diffusion-weighted magnetic resonance imaging (DWI) 39 minutes after the ictus demonstrated high signals in the left internal carotid artery territory. T1- and T2-weighted images failed to detect this change. Magnetic resonance angiography showed occlusions in branches of the left anterior and middle cerebral arteries and an atheromatous stenotic lesion in the ipsilateral proximal internal carotid artery. The patient was treated with intravenous heparin and low molecular dextran solution. Repeated magnetic resonance imagings identified an infarction slightly smaller than the abnormality demonstrated by the initial DWI. DWI detects hyperacute ischemic injury within 1 hour of symptom onset in human ischemic stroke.

Aged↗
PubMed1999

A case of recurrent hepatocellular carcinoma treated with laparoscopic microwave coagulation therapy after minimally invasive hepatic surgery.

A case of hepatocellular carcinoma (HCC) in which the patient repeatedly underwent minimally invasive hepatic procedures is reported. The patient was a 71-year-old man who underwent transthoracic microwave coagulation therapy (MCT) for initial HCC nodules in segment VIII and subsequent laparoscopic MCT for small intrahepatic recurrent nodules in the left hepatic lobe. At this writing, the patient was alive and well without tumor recurrence 29 months after the initial surgery. Minimally invasive hepatic surgery alleviates perihepatic adhesion and allows subsequent laparoscopic surgery in the case of intrahepatic HCC recurrence.

Aged↗
PubMed1999

Laparoscope-assisted minimally invasive treatment for choledochal cyst.

The principle of treatment of choledochal cysts is total cyst excision with hepaticojejunostomy because of the high rate of associated malignancy of the biliary system. The authors used a minimally invasive laparoscopic procedure to treat a patient with nonmalignant choledochal cyst. Although a large median laparotomy is usually used for cyst excision and hepaticoenterostomy, laparoscope-assisted total cystectomy and hepaticojejunostomy were performed with minimal skin incision. To avoid gas embolism during dissection around the hepatic hilus the surgical procedure was divided into two stages: CO2 insufflation and abdominal lifting without pneumoperitoneum. This combination of procedures was as safe and technically adequate as conventional surgery. No abnormalities were observed in liver function, and the patient could sit up in bed the first day postoperatively. Thirteen days after surgery, he was discharged from the hospital uneventfully.

Adult↗
PubMed1998

Retinal arteriovenous shunt at the arteriovenous crossing.

OBJECTIVE: The purpose of the study was to demonstrate that the arteriovenous shunt at the arteriovenous crossing could occur in major retinal vascular diseases other than Takayasu disease. DESIGN: Clinical review of consecutive case series. PARTICIPANTS: The authors studied 1885 eyes with retinal vascular diseases such as diabetic retinopathy, branch retinal vein occlusion, central retinal vein occlusion, central retinal artery occlusion, Leber's miliary aneurysms, Eales disease, Behçet disease, and systemic lupus erythematosus retinopathy. INTERVENTION: Fluorescein fundus angiography using a wide-field fundus camera (60 degrees) was performed. MAIN OUTCOME MEASURES: Dye transit from artery to vein through sequential angiography. RESULTS: The arteriovenous shunt at the arteriovenous crossing was found in 8 eyes with proliferative diabetic retinopathy, 27 eyes with branch retinal vein occlusion in the chronic stage, 2 eyes with central retinal vein occlusion, 2 eyes with central retinal artery occlusion, and 2 eyes with miliary aneurysms. The arteriovenous shunt was formed by a direct inflow from artery to vein, showing vasodilation and hyperpermeability, followed by obliteration peripheral to the shunts. The pattern of initial inflow was classified into axial flow and laminar flow, and the inflow became wider and more rapid in the advanced stage. CONCLUSIONS: These findings indicate that the arteriovenous shunt at the arteriovenous crossing is not a unique phenomenon in Takayasu disease but rather is a basic pattern of retinal vascular reaction pathologic states.

Adult↗
PubMed1996

Identification of the interstitial cells of Cajal.

Observation of whole mount stretch preparations using the zinc-iodide-osmic acid method reveals a wide variety of interstitial cells in different tissue layers of the guinea-pig small intestine. And a subsequent electron-microscopic examination and survey of references makes clear that the interstitial cells of Cajal (ICC) depicted in original drawings of Cajal are heterogeneous and correspond to different types of interstitial cells. The myenteric ICC are characterized by long dichotomous branching processes which constitute cellular networks independent from the nerve plexus and form many gap junctions at their tips. Their ultrastructure is similar to that of fibroblasts and they have no basal lamina. The myenteric ICC show strong immunoreactivity for vimentin and the c-kit receptor, and probably correspond to the intestinal pacemaker cells. Within the circular muscle layer, ICC are represented by the cells that are closely associated with fine nerve bundles. The ICC have various shapes, ranging from bipolar to stellate, depending on the running pattern of the nerve fibers that they are associated with. They show fibroblast-like ultrastructure and have no basal lamina. They form gap junctions with smooth muscle cells and are immunoreactive for vimentin. On the other hand, ICC associated with the deep muscular plexus described in the guinea-pig by Cajal could not be clearly identified. However, it is suggested that the ICC in this location may correspond to glycogen-rich cells possessing a basal lamina. Although they show a fairly well-developed rough endoplasmic reticulum, Golgi apparatus and immunoreactivity for vimentin, ICC of the deep muscular plexus are probably specialized smooth muscle cells in nature.

Animals↗
PubMed1994

Progressive reorganization of the myenteric plexus during one year following reanastomosis of the ileum of the guinea pig.

The enteric nervous system appears to play a pivotal role in the functional recovery of the gastrointestinal tract after partial resection and reanastomosis, but the structural changes following surgery are not fully understood. The present study was designed to clarify the processes of myenteric plexus regeneration up to one year after transection and reanastomosis of the ileum of the guinea pig. The following techniques were used: nicotinamide adenine dinucleotide (NADH) diaphorase histochemistry, immunostaining of neuron-specific enolase (NSE) in whole-mount preparations, and transmission electron microscopy. Two months after transection and reanastomosis, myenteric ganglion cells with NADH diaphorase reactions were scarce in the center of the lesion, and were less numerous in adjacent areas (3 mm in width) than in the control ileum. In the areas adjacent to the lesion, a few large extraganglionic neurons that did not completely compensate for the loss of ganglion neurons were observed. The remaining ileum showed no changes in NADH diaphorase staining pattern at this stage. Two to 12 months after transection and reanastomosis, ectopic large neurons gradually increased in number not only in the areas adjacent to the lesion but also in part of the remaining ileum, up to 10 cm from the lesion. Concomitantly, large ganglion neurons decreased in number in these areas. In other ileal regions (more than 10 cm distant from the site of transection), no obvious changes in NADH diaphorase staining were noted throughout the observation period. The outgrowth of NSE-containing nerve fibers from the severed stumps was seen two weeks after transection. Six weeks later, numerous bundles of fine nerve fibers with NSE were shown to interconnect the oral and anal cut ends of the myenteric plexus, but they exhibited no subsequent alterations. Transmission electron microscopy revealed that regenerating nerve fiber bundles appeared initially among irregularly arranged smooth muscle cells eight weeks after the operation, as expected from light-microscopic observations. These findings suggest that myenteric ganglion cell bodies, unlike myenteric nerve fibers, require a longer term of reconstruction than previously believed after transection and reanastomosis of the ileum of the guinea pig.

Animals↗
PubMed1977

Rapid and sensitive, colorimetric determination of the anomers of D-glucose with D-glucose oxidase, peroxidase, and mutarotase.

A modification, utilising mutarotase, of an enzymic, colorimetric system for determining D-glucose with D-glucose oxidase, peroxidase, and ABTS was satisfactory for the assay of the anomers of D-glucose in aqueous solution. The time required for a single assay is approximately 10 min, and the lower limit is 0.4 microgram of D-glucose. The method is applicable to the anomer analysis of D-glucose released by enzymic hydrolysis of D-glucosides.

Carbohydrate Epimerases↗
PubMedDate not supplied

A minimally invasive approach to rectal cancer--sacrolaparoscopic approach.

BACKGROUND/AIMS: To investigate the feasibility of a technique with minimal skin incision, while retaining a rate of cure and safety equivalent to conventional rectal amputation, by making use of the advantages of laparoscopic procedures, we performed a minimally invasive laparoscopic rectal amputation. METHODOLOGY: Six patients suffering from rectal cancer with cardiac and/or respiratory disorders underwent laparoscope-assisted rectal amputation. The procedure was performed in three steps: 1) sacral approach, 2) laparoscope-assisted abdominal approach under CO2 insufflation, and 3) extracorporeal resection of the inferior mesenteric artery (IMA) and stoma making without CO2 insufflation. RESULTS: Intra-operative cardiopulmonary functions were maintained within normal range during CO2 insufflation. Although all patients had severe respiratory or cardiac disorder or diabetes mellitus, no complications were observed during and after surgery. The post-operative course was uneventful for our patients, each of whom could eat on the first post-operative day and walk on the third post-operative day. All patients were discharged from the hospital uneventfully. CONCLUSIONS: Laparoscope-assisted rectal amputation is technically feasible, adequate tumor excision can be achieved with it and post-operative recovery is improved. Sacrolaparoscopic rectal amputation appears to be a safe alternative procedure for patients with rectal cancer and even with severe cardiopulmonary disorders.

Aged↗
PubMedDate not supplied

Generalized intraperitoneal seeding of hepatocellular carcinoma after microwave coagulation therapy: a case report.

We first describe a case of generalized intraperitoneal seeding of hepatocellular carcinoma (HCC) after microwave coagulation therapy (MCT). A 61 year-old man underwent operative MCT for an exophytic HCC, 60 mm in diameter, in segment IV of his cirrhotic liver. Despite successful tumor ablation, the serum alpha-fetoprotein levels continuously rose after MCT. Five months later, radiographic examinations delineated several perihepatic masses with hypervascularity, and the patient presented with constipation. At the second laparotomy, there were numerous small peritoneal metastases involving the entire peritoneal cavity and slightly bloody ascites. An omental mass, 50 mm in diameter, involved the transverse colon. Most of these intraabdominal masses were removed together with the involved colon. Histologically, the initial tumor was a moderately differentiated HCC, and the peritoneal masses were poorly differentiated HCCs. The patient died of rapid tumor progression and bleeding 2 months later. In conclusion, we should be aware of the possible occurrence of peritoneal seeding after MCT for HCC. Every effort should be made to prevent this serious complication, particularly in cases of superficial, large, and less differentiated HCCs.

Carcinoma, Hepatocellular↗