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Biomedical subjects

M Higashijima

Publications and source records attributed to M Higashijima.

15 recordsLinked to original sources
PubMed2000

[A case of percutaneous and transpapillary placements of expandable metallic stents in a patient with cholangiocarcinoma at the hilum of the liver].

A 76-year-old woman was admitted with obstructive jaundice. US and MR cholangiopancreatography (MRCP) revealed an inoperative cholangiocarcinoma, 3 cm in diameter at the hilum of the liver, the obstruction of the hepatic duct bifurcation and the separation of bilateral hepatic bile ducts. Percutaneous transhepatic biliary drainage (PTBD) was performed from bilateral hepatic bile ducts. The right PTBD tube was spontaneously extubated. We could not succeed in performing internal biliary drainage across the hilar malignant stricture from a left hepatic bile duct, because of bad angulation. Transpapillary insertion into the common bile duct (CBD) was extremely difficult due to the collapse of the CBD. Endoscopic sphincterotomy (EST) after precutting method was performed. Although we performed the ballooned dilatation of malignant stricture and the insertion of a self-expandable metallic stent (EMS) into a right hepatic bile duct transpapillary. After dilatation of the hilar malignant stricture by the initial EMS, we inserted a guidewire into the CBD through the wire mesh of a stent from the left PTBD tube. We could insert the second EMS from a left hepatic bile duct to the CBD transhepatically, using a dilator and a dilating balloon. Finally, we performed the ballooned dilatation from bilateral hepatic bile ducts to the CBD transpapillary. She was discharged after bilateral internal biliary drainages, successfully.

Aged↗
PubMed1999

Successful treatment of cytomegalovirus colitis with ganciclovir in a patient with adult T cell leukemia lymphoma: case report.

An 84-year-old patient with adult T cell leukemia lymphoma (ATLL) developed diarrhea on day 5 of chemotherapy and was diagnosed with cytomegalovirus (CMV) colitis. Sigmoidoscopy revealed multiple superficial erosions surrounded by a flare. Computed tomography (CT) and ultrasonogram of the abdomen revealed marked thickening of the colonic mucosa. There were 186 CMV antigen-positive leukocytes per 31,000 white blood cells (WBC). A colonic biopsy specimen showed typical CMV nuclear inclusions. Immunohistological study of the specimen was positive for CMV antigen. Administration of ganciclovir (DHPG) 500 mg/day for 14 days improved the diarrhea and other symptoms. On day 30 of the chemotherapy, the patient developed diarrhea again but was diagnosed with pseudomembranous colitis instead of CMV colitis. At that time, CMV antigenemia and a histologic study for CMV were negative. The stool was positive for Clostridium difficile toxin antigen. ATLL patients are believed to be immunocompromised hosts and often develop opportunistic infections such as CMV infection. Most suffer from CMV pneumonia at the end of their course of therapy. Few gastrointestinal (GI) CMV infections are seen in ATLL patients and details of CMV colitis have never been reported. When an ATLL patient develops diarrhea that barely responds to conventional therapy, CMV colitis and pseudomembranous colitis should be listed in the differential diagnosis.

Aged↗
PubMed1999

[An extremely elderly patient with choledocholithiasis and many complications].

It was very difficult to treat a 90-year-old woman for choledocholithiasis with acute obstructive suppurative cholangitis, gallbladder perforation, and a pool of bile in the right perirenal spase. Extracorporeal shockwave lithotripsy (ESWL) was performed after emergency percutaneous transhepatic biliary drainage (PTBD), but we could not perform lithotripsy successfully because of large and hard stones. Although Endoscopic sphincterotomy (EST) was performed using an ultratome by rendezvous method. Lithotripsy was finally successful, after three times endoscopic mechanical lithotripsy (EML) and procedure using an endotriptor for basket impaction. It is very important in advanced aged patients that endoscopic treatment should be performed step by step.

Aged↗
PubMed1997

[An elderly case of post-bulbar Dieulafoy's ulcer].

The case is a 79-year-old man who came to our hospital with melena as chief complaint. Emergency endoscopy showed spurting bleeding from a small ulcer. We diagnosed as Post-Bulbar Dieulafoy's ulcer and performed hemostatic procedure with hemostatic clips. The forth endoscopy (7 days after admission) showed fresh clot and oozing bleeding after the third hemostatic clipping. Although we performed hemostatic procedure with the injection therapy of hypertonic saline epinephrine solution (HSE). The effective hemostatic procedure is discussed with reference to some related literature.

Aged↗
PubMed1996

[A case of endocrine cell carcinoma in the duodenal bulb].

A 73-year-old man was admitted to our hospital due to weight loss and melena. Roentgenograms and endoscopy showed a Borrmann type 2 tumor occupying the entire duodenal bulb. Histological findings of the lesion (H-E stain) showed poorly differentiated adenocarcinoma. Almost the entire specimen showed positive staining granules for Grimelius stain. Ultrastructurally, remarkable endocrine granules covered a layer of the limited membrane (membrane-bound granule) in the tumor cell. We diagnosed endocrine cell carcinoma. Since it was difficult to operate due to age and invasion to the fundus of the gall-bladder and the pancreatic head, we treated this case by chemotherapy.

Adenocarcinoma↗
PubMed1996

[Surgical treatment of secondary chronic colonic pseudo-obstruction].

A 74-year-old woman was admitted to the hospital because of constipation and marked abdominal distension. She had become to be bedridden after cerebral infarction 10 years previously, and was tabescent due to vomiting. A left hemicolectomy and colostomy were performed because conservative therapy seemed to be ineffective. The postoperative course was good and her nutritional status improved.

Aged↗
PubMed1995

[A case of Lemmel's syndrome caused by a large diverticular enterolith at the peripapillary portion of the duodenum].

A 93-year-old woman admitted because of epigastralgia. Cholelithiasis, obstructive jaundice, acute suppurative cholangitis and acute pancreatitis were diagnosed on blood chemistry and ultrasonography on admission. We performed emergency PTCD. A calculus 4 cm in diameter was detected at the papilla of Vater and marked dilatation of the common bile duct and pancreatic duct. ESWL was performed because of her age and because endoscopical operation seemed to be difficult. After lithotripsy, PTC and endoscopy demonstrated a diverticulum at the peripapillary portion of the duodenum. Based on analysis of PTC result before and after ESWL, we diagnosed this case as Lemmel's syndrome (obstructive jaundice, acute suppurative cholangitis and acute pancreatitis) caused by a large diverticular enterolith at the peripapillary portion of the duodenum. ESWL treatment of aged patient with an enterolith is safe.

Acute Disease↗
PubMed1993

[Three cases of acquired megacolon in the elderly].

As the number of the elderly in society increase, cases of abnormal bowel habit in the aged have also increased. This report describes 3 cases of acquired megacolon in the elderly. Case 1, a 71-year-old female, complained of constipation and developed megacolon after an attack of cerebral infarction. Case 2, a 82-year-old male, developed megacolon while receiving psychoactive medication. Case 3, a 69-year-old male who complained of constipation for a long time and rapidly developed megacolon was diagnosed as idiopathic megacolon.

Aged↗
PubMed1993

[A case of early duodenal cancer resected by endoscopic polypectomy in the elderly].

Early duodenal cancer has been detected with increasing frequency of endoscopy and the advent of an aging society. Aged patients, however, are often inoperable because of complications due to various underlying diseases. The authors report a case of early duodenal cancer curatively operated by endoscopic polypectomy and refer to related cases in the literature.

Adenocarcinoma↗
PubMed1993

[A case of pancreatic pseudocyst with intracystic hemorrhage and repeated gastrointestinal bleeding].

The case is a 83-year-old woman who came to our hospital with melena and epigastralgia as chief complaints, presenting pre-shock state with high serum amylase value. ERP revealed diffuse dilatation of pancreatic duct and cyst of the accessory pancreatic duct. Endoscopy showed hemorrhage of the accessory papilla. A diagnosis of chronic pancreatitis and hemosuccus pancreaticus was made. Because of the patient's advanced age, conservative treatment (total parenchymal nutrition, transfusion, hemostatics, etc.) were prescribed. The patient succumbed due to heart failure 15 months later. This case of gastrointestinal bleeding from a pancreatic pseudocyst due to neighboring arterial rupture is discussed with reference to some related literature.

Aged↗
PubMed1992

[Upper gastrointestinal bleeding in the elderly].

Due to increasing number of the elderly, cases of hematemesis and melena in the aged have been increasing. The authors evaluated 69 such cases over 60 years old in whom emergency endoscopy of the upper digestive tract was carried out because of hematemesis and melena. Twenty cases are diagnosed as gastric ulcer (29%), 12 cases as esophageal ulcer and esophageal erosion (17.4%), 9 as duodenal ulcer (13.0%), 7 as gastric cancer (10.1%), 6 as Mallory-Weiss syndrome (8.7%), 6 as esophageal and gastric varices (8.7%), 4 as acute hemorrhagic gastritis (5.8%), 3 as Dieulafoy's ulcer (4.3%), and one case each of chronic pancreatitis (hemosuccus pancreaticus) and hemorrhage due to gastric angiodysplasia (1.4%). Of these cases, blood transfusion was performed in 46 cases (66.7%), and shock occurred in 27 cases (39.1%). The endoscopical hemostatic procedure was effective for detection of underlying diseases in the aged. Surgery was often impossible because of the rapid deterioration of the systemic condition due to the hemorrhage of the digestive tract.

Aged↗
PubMed1991

[Efficacy and safety of percutaneous endoscopic gastrostomy in the elderly].

Percutaneous endoscopic gastrostomy (PEG) was performed in 32 patients with nasogastric feeding (NGF) or total parenteral nutrition (TPN), who were unable to swallow. Our cases of PEG included 10 with dementia, 8 with cerebral infarction, 8 with cerebral bleeding, 3 with gastric cancer, and others. TPN was performed after PEG for a short time. Because of the combination of TPN and PEG, there was no mortality or major complication related to the procedure. Minor complications included subcutaneous abscess and TPN catheter fever. PEG can be safely and rapidly performed. Furthermore, painless life, better cosmetic features and physical condition can be obtained with this procedure. The majority of the patients are able to return home after PEG. PEG can improve the quality of life of the patients who cannot swallow but have an intact gut.

Abscess↗
PubMed1987

Studies on lipoprotein and adrenal steroidogenesis: I. Roles of low density lipoprotein- and high density lipoprotein-cholesterol in steroid production in cultured human adrenocortical cells.

The roles of human low density lipoprotein (LDL)- cholesterol and high density lipoprotein (HDL)- cholesterol on adrenal steroidogenesis were investigated using cultured human adult and fetal adrenocortical cells and the findings were then compared to those obtained with bovine adrenocortical cells. The secretion of cortisol in both human and bovine adrenocortical cells was dose-dependently increased by the administration of LDL- or HDL-cholesterol in the presence of adrenocorticotropin (ACTH). LDL-cholesterol was utilized to a greater extent than HDL-cholesterol in both human and bovine adrenal steroidogenesis in the presence of ACTH. Exogenous lipoprotein-derived cholesterol was less utilized in human adrenal steroidogenesis than in bovine adrenal steroidogenesis, compared to the endogenous cholesterol. An increase in the secretion of cortisol and dehydroepi androsterone sulfate (DHEA-S) continued for the 5-day culture period, in the presence of lipoprotein cholesterol and ACTH in both human adult and fetal adrenocortical cells. The secretion of aldosterone increased on the first day of the culture period, then gradually decreased for the 5-day culture period in human adult adrenocortical cells, but not in human fetal adrenocortical cells in the presence of lipoprotein cholesterol and ACTH. These findings demonstrate that exogenous cholesterol utilized in the biosynthesis of steroids is mainly from LDL-cholesterol in both human adult and fetal adrenals and bovine adrenal and the proportion of cholesterol synthesized de novo is significantly larger in the human adult adrenal than in the bovine adrenal.

Adrenal Cortex↗
PubMed1987

Studies on lipoprotein and adrenal steroidogenesis: II. Utilization of low density lipoprotein- and high density lipoprotein-cholesterol for steroid production in functioning human adrenocortical adenoma cells in culture.

We examined the utilization of human low density lipoprotein (LDL)- and high density lipoprotein (HDL)-cholesterol for steroid production in primary monolayer culture cells from adenomas of primary aldosteronism and Cushing's syndrome and an adrenal of nodular hyperplasia of Cushing's syndrome. We compared the data obtained with findings in the case of cultured normal human adrenocortical cells. In the presence of 10(-7) M adrenocorticotropin (ACTH), the addition of either LDL or HDL to the culture medium at a cholesterol concentration of 100 micrograms/ml led to a significant increase in the daily secretion rates of cortisol, dehydroepiandrosterone sulfate (DHEA-S) and aldosterone in the adenoma and nodular hyperplasia cells, as in the normal cells. Although LDL greatly increased the secretion of steroid hormones, no significant difference in steroid secretion following the treatments with LDL and HDL were observed in these cultured cells. The contribution of endogenous cholesterol to steroid production was also high, thereby indicating that the neoplastic transformation did not have untoward effects. Cells from adenomas of primary aldosteronism secreted not only aldosterone, but also cortisol and DHEA-S. The daily secretion rates of these steroids were markedly increased when ACTH was added to the medium. With prolonged exposure to ACTH, however, the rate of aldosterone secretion showed a gradual decrease with the incubation time. This decrease might be due to the impaired conversion of corticosterone to 18-hydroxycorticosterone. In case of adenomas in patients with Cushing's syndrome, the secretion of steroid hormones varied in quantity and quality, depending on the type of plasma cortisol response to the rapid ACTH test in vivo, thereby suggesting that the adrenocortical adenoma of Cushing's syndrome might be divided into two subtypes. These results indicate that human functioning adrenocortical adenoma cells utilize plasma lipoproteins as a source of cholesterol for steroidogenesis during the prolonged stimulation of steroid secretion.

Adenoma↗