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Biomedical subjects

M Ohgami

Publications and source records attributed to M Ohgami.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Laparoscopic surgery for early gastric cancer--its advantage and pitfall].

We have successfully treated 50 patients with early gastric cancer by using two different laparoscopic procedures since March 1992. which are laparoscopic wedge resection of the stomach using a lesion-lifting method (n = 33) and laparoscopic intragastric mucosal resection (n = 17). The indication is as follows; (A) mucosal cancer, (B) < 25 mm, if the lesion is protruded type, (C) < 15 mm and Ul(-), if the lesion is depressive type. The advantages of these methods are; 1) minimally invasiveness. 2) sufficient surgical margin, 3) feasibility of detailed histology, 4) feasibility of perigastric lymph node dissection. In contrast, there are several problems to be solved, which are; 1) preoperative diagnostic accuracy of the depth of cancer invasion, 2) possibility of reoperation because of sm invasion or lymphatic or venous invasion in final histology, 3) possibility of postoperative stenosis after laparoscopic intragastric mucosal resection for the lesion near the cardia, 4) incidence of metachronous multiple gastric cancer.

Adult↗
PubMed1997

Laparoscopic local excision of the cecum for cecal creeping tumor.

Laparoscopic surgery is now widely accepted because of its many benefits. We have successfully performed laparoscopic curative resection in 72 patients with colon cancer or polyps. Of these patients, seven with cecal creeping tumor underwent laparoscopic local cecum excision (cecectomy). The creeping tumor is often found in the rectum and cecum. It is extremely difficult to remove endoscopically because of its shape and size. In addition, the recurrence rate after endoscopic mucosal resection is high. Therefore, laparoscopic cecectomy was thought to be a suitable procedure for such cases. This procedure was performed intracorporeally by using an ENDO-GIA and was less invasive than the extracorporeal procedure. These tumors, which showed local cancer limited to the mucosa or tubular adenoma with severe dysplasia in pathological findings, were resected completely. All patients tolerated liquids 1 day postoperatively and were discharged within 5 days. Our experience suggests that laparoscopic cecectomy has the potential to be useful for cecal creeping tumors.

Adenocarcinoma↗
PubMed1997

[Laparoscopically assisted surgery for Crohn's disease].

PURPOSE: Surgical treatment is often required by patients with Crohn's disease who have intestinal stricture or fistula. Minimally invasive laparoscopic surgery appears to be useful in such patients. Eight cases of intestinal stricture and/or fistula treated by laparoscopic surgery are reported. METHODS: In 1997, laparoscopic surgery was attempted and successfully completed in 18 patients Crohn's disease presenting with intestinal stricture and/or fistula, following strict nutritional therapy. Of the 8 patients with a fistula, one had an gastrocdic fistula, one had an ileovesical fistula, two had an colic fistula and three had ileoileal fistulas. Ileovesical, ileorectal and gastrocolic fistulas were divided with an intracorponeal automatic stapling device. Fourteen patients underwent ileocecal resection and four underwent ileal resection with laparoscopic assistance. RESULTS: Postoperative pain was mild, oral intake was started an average of 1.4 days after operation. The patients were discharged an average of 8 days after operation. No complication was identified. CONCLUSION: If Crohn's disease is treated adequately with conservative therapy, laparoscopic surgery is relatively easy, even when there are adhesions and fistulas. Since the incision is extremely small with this method, postoperative adhesions are minimized. This procedure has the advantage of allowing repeated laparoscopic surgery with minimal morbidity. Minimal invasiveness and rapid return to normal activity may make laproscopic surgery the treatment of choice for patients with Crohn's disease who require surgical treatment.

Adolescent↗
PubMed1997

Laparoscopic adrenalectomy in asymptomatic pheochromocytoma.

A patient with asymptomatic pheochromocytoma associated with catecholamine hypersecretion but no hypertension was treated by right laparoscopic adrenalectomy. The 63-year-old male patient was referred to us for treatment of an incidentaloma. The diameter of the adrenal tumor was 50 mm, and the peripheral blood nonrepinephrine level was 1.12 ng/ml (normal level, 0.4 ng/ml). Blood pressure was normal. A flexible electron laparoscope was used for open laparoscopy, and four trocars were inserted. The retroperitoneum was incised to the right of the inferior vena cava, and the tumor was excised. During the operation, blood pressure rose transiently, and a blocker and nitroglycerin were administered. The tumor bled extremely easily. The duration of surgery was 3 hours and 20 minutes, and blood loss was 210 ml. The excised tumor was 55 mm in diameter. The patients's postoperative course was uneventful. If the size of asymptomatic pheochromocytoma is not large, and blood pressure and cardiac function are stable, laparoscopic adrenalectomy is indicated for this type of tumor as long as it is performed by experienced surgeons.

Adrenal Gland Neoplasms↗
PubMed1996

Laparoscopically assisted ileocecal resection for Crohn's disease associated with intestinal stenosis and ileovesical fistula.

We describe a 22-year-old man with Crohn's ileocolitis accompanied by intestinal stenosis and ileovesical fistula in whom laparoscopically-assisted surgery was successfully performed after thorough nutritional therapy. Laparoscopic procedures are characterized by minimal access and minimal invasion, features which can contribute to the early recovery of patients who undergo surgery. It is suggested that laparoscopic (or laparoscopically-assisted) surgery after strict nutritional therapy can be effective in the treatment of patients with Crohn's disease who have intestinal complications.

Adult↗
PubMed1996

Mixed germ-cell tumor of the brain. Pathologic study of six autopsy cases.

Intracranial mixed germ-cell tumors are rare. We describe the findings from six autopsies of patients with these tumors. The patients were all young at presentation (mean age, 16 years), and five of the six were male. Headache, vomiting, polyuria and diplopia were common symptoms. Radiographic evaluation demonstrated a mass on the midline of the brain. The patients were treated mainly with radiation, but survival (mean, 3.7 years) was not as long as predicted. At autopsy, the tumors occupied most of the ventricular spaces, and ranged from being well-circumscribed to invasive. All tumors contained both germinoma components and nongerminomatous germ-cell tumor components. Because the distribution of these components was not homogenous, at least two sections were necessary for the diagnosis. Immunoreactivity for placental alkaline phosphatase was found in all tumors. Immunostaining for human chorional gonadotropin, alpha-fetoprotein and carcinoembryonic antigen was usually associated with abnormally high serum levels of these tumors markers in life. A number of the cells in both kinds of tumor components expressed proliferating cell nuclear antigen, probably reflecting the intense malignant potential.

Adolescent↗
PubMed1996

Effects of steroids on the lung accumulation of neutrophil and monocyte in rabbits with endotoxemia.

STUDY OBJECTIVE: To determine the effects of steroids on the lung accumulation of polymorphonuclear leukocytes (PMNs) and monocytes in rabbits with endotoxemia. DESIGN: A prospective, randomized, controlled animal trial. SETTING: Surgical research laboratory, Keio University School of Medicine. SUBJECTS: Twenty-four female Japanese white rabbits. INTERVENTIONS: Rabbits with endotoxemia were pretreated with steroids sufficient to inhibit the production of tumor necrosis factor (TNF) and to prevent the fall of BP. MEASUREMENTS AND RESULTS: The circulating leukocyte counts and the leukocyte accumulation in the lung were evaluated. Endotoxin caused a rapid decrease in circulating PMNs and monocytes followed by an 8-fold greater accumulation of PMNs (p < 0.001) and a 6.5-fold greater accumulation of monocytes (p < 0.05). Steroids failed to inhibit this initial drop of PMNs and monocytes. However, steroids inhibited the PMN accumulation in the lung by 50% (p < 0.05), without inhibiting the monocyte accumulation in the lung. CONCLUSIONS: These findings suggest that the lung accumulation of PMNs is dependent on TNF or other inflammatory mediators that are inhibited by steroids while the lung accumulation of monocyte is not.

Animals↗
PubMed1996

[Laparoscopic surgery for early gastric cancer].

We have successfully treated 40 patients with early gastric cancer by using two different laparoscopic procedures since March 1992, which are laparoscopic wedge resection of the stomach using a lesion-lifting method (n = 25) and laparoscopic intragastric mucosal resection (n = 15). The indication is as follows; 1) mucosal cancer, 2) < 25 mm, if the lesion is protruded type, 3) < 15 mm and U1 (-), if the lesion is depressive type. All patients were discharged within 4-8 days uneventfully. The resected specimens were 66 +/- 16 mm and 48 +/- 8 mm in diameter respectively, and had a sufficient surgical margin horizontally (16 +/- 5 mm, 8 +/- 4 mm) and vertically. Histology revealed they were all curative surgeries except one case in whom an additional gastrectomy with lymph node dissection by laparotomy was required one month after surgery because lymphatic invasion had been revealed by pathology. In conclusion, these laparoscopic procedures are curative and minimally invasive treatment for early gastric cancer.

Adult↗
PubMed1996

[Laparoscopic curative surgery for early gastric cancer].

We have successfully treated 40 patients with early gastric cancer by using two different laparoscopic procedures since March 1992, which are laparoscopic wedge resection of the stomach using a lesion-lifting method (n = 25) and laparoscopic intragastric mucosal resection (n = 15). The indication is as follows; 1) mucosal cancer, 2) < 25 mm, if the lesion is protruded type, 3) < 15 mm and Ul(-), if the lesion is depressive type. All patients were discharged within 4-8 days uneventfully. The resected specimens were 66 +/- 16 mm and 48 +/- 8 mm in diameter respectively, and had a sufficient surgical margin horizontally (16 +/- 5 mm, 8 +/- 4 mm) and vertically. Histology revealed they were all curative surgeries except one case in whom an additional gastrectomy with lymph node dissection by lapalotomy was required one month after surgery because lymphatic invasion had been revealed by pathology. In conclusion, these laparoscopic procedures are curative and minimally invasive treatment for early gastric cancer.

Gastrectomy↗
PubMed1994

[A new video-assisted thoracoscopic surgical interruption of patent ductus arteriosus].

A new video-assisted thoracoscopic surgery was applied to patients with patent ductus arteriosus (PDA). After the ductus was carefully dissected and exposed, two or one titanium clips which were 11 mm in length were used to interrupt the ductus completely. Eight patients with PDA were successfully treated by the new technique between July 1992 and September 1993, which was the first successful series in Japan. Mean age was 4.3 years (range 1.7 approximately 6.7 years) and mean weight was 15.6 kg (range 10.0 approximately 24.0 kg). All patients had immediate complete PDA closure after the procedure which was proved to be successful by an esophageal stethoscope and color doppler echocardiogram. One patient had mild left recurrent laryngeal nerve dysfunction which was completely cured on 7th postoperative day. There were no other complications and the usual hospital stay was 4 or 5 days. No residual PDA shunt in all cases was revealed by color doppler echocardiogram during follow-up periods (range 3 approximately 12 months). The advantages of thoracoscopic surgery for PDA are: less postoperative pain and discomfort, early recovery and short hospital stay, and cosmetic preservation. Availability of smaller sized surgical instruments should allow this technique indicated for smaller children and premature infants.

Child↗
PubMed1994

[Thoracoscopic surgery for benign esophageal disease].

Two patients with benign esophageal disease were successfully treated by thoracoscopic surgery. First case was a 66 year old male with esophageal diverticulum, who had complained of progressive dysphasia. The esophagogram showed a giant epiphrenic diverticulum which was 8 cm in diameter. Entire procedure was performed thoracoscopically under general anesthesia, while left side univentilation was applied. A flexible videoelectronic thoracoscope was introduced into thoracic cavity at the 5th intercostal space, and 4 additional trocars were inserted. The pleura over the diverticulum was divided, and the diverticulum was fully dissected and exposed. A multifire endoscopic stapler, an Endo GIA, was applied to resect the diverticulum. For security, uninterrupted suture of muscular layer of the esophagus over the stapled line was performed. Second case was a 60 year old male with esophagobronchial fistura, who had complained of choking during liquid intake for 20 years. The bronchogram showed a communication between a esophageal diverticulum and a right B6 bronchus. The operation was performed thoracoscopically. A thoracoscope was introduced as mentioned above, and the esophagus and the peripheral lung around the fistura was dissected and fully exposed. The diverticulum was divided at its base using an Endo GIA, and the fistura was resected with lung parenchyma using also an Endo GIA. The postoperative courses of the both patients were uneventful. The patients started diet on the 4th and the second postoperative day respectively, and the symptoms had disappeared after surgery.

Aged↗
PubMed1993

[An innovative thoracoscopic surgery for patient ductus arteriosus--a Japanese first case report].

A five-year-old girl with patent ductus arteriosus (PDA) was successfully treated by thoracoscopic surgery, which was the first successful case in Japan. The operation was carried out under general anesthesia with usual endotracheal intubation. Short trocars were inserted through the left intercostal spaces to introduce a flexible video thoracoscope and adequate surgical instruments. After the ductus was carefully dissected and exposed, two titanium clips which were 11 mm in length were applied to interrupt the ductus completely. The continuous heart murmur of PDA was confirmed to disappear by an esophageal stethoscope. Postoperative course was uneventful and the patient was discharged on 6 postoperative day. No residual PDA shunt was revealed by doppler echocardiogram 8 months after surgery. The advantages of thoracoscopic surgery for PDA are: less postoperative pain and discomfort, early recovery and short hospital stay, and cosmetic preservation. Availability of smaller sized surgical instruments should allow this method indicated for smaller children or newborns with PDA.

Child, Preschool↗
PubMed1992

Late effects of endotoxin on the accumulation and function of monocytes in rabbit lungs.

Recent studies from our laboratory show that the lung contains a marginated pool of monocytes. The present study was designed to investigate monocyte accumulation in this pool 4 to 28 h after a single dose of endotoxin when the endotoxin had disappeared from the circulation. This was accomplished by administering a single intravenous dose of endotoxin (Escherichia coli, 50 micrograms/rabbit) to unanesthetized animals (n = 6) and saline to controls (n = 5) at time 0. Four hours after this dose of endotoxin, 111In-monocytes (93.5% pure) isolated from donors were injected intravenously, and, at 27 h, the rabbits were anesthetized and colloidal carbon (CC, 1 ml/kg body weight) was injected intraarterially to provide a phagocytic stimulus. The animals were sacrificed at 28 h, and the lungs were fixed in situ with glutaraldehyde. The data show that lungs from the endotoxin-treated rabbits contained 4.8 times more 111In-monocytes than controls, that 92% of these radiolabeled monocytes were in the alveolar capillaries, and that 72% of these labeled cells had phagocytosed CC. The histologic studies of unlabeled cells confirmed that this endotoxin treatment caused a 3-5-fold increase in unlabeled mononuclear cells and neutrophils (PMN) in the microvasculature and that many of the unlabeled monocytes in the endotoxin-treated group had also phagocytosed colloidal carbon. The behavior of the donor monocytes injected after the endotoxin had time to disappear from the circulation suggests that they accumulate in the lung in response to the indirect effects of endotoxin on endothelial cells.

Animals↗
PubMed1991

One-step isolation of neutrophils using an elutriator.

To simplify the isolation of neutrophils, we developed a one-step procedure using elutriation. The perfusate (0.2% gelatin and 0.1% glucose in phosphate buffered saline) was pumped through an elutriator rotor at 4 ml/min (25 degrees C) with the rotor speed at 2370 rpm. Twenty milliliters of anticoagulated porcine venous blood were mixed with 60 ml of perfusate and loaded into the elutriator chamber. The flow rate was increased by 2 ml/min increments and 100-ml fractions of effluent were collected at each increment. Concentrations of neutrophils and mononuclear cells were measured in each fraction, and the percentage of total neutrophils or mononuclear cells was plotted against flow rate. The optimal yield (46%) and purity (95.1%) of neutrophils (n = 8) was obtained in pooled fractions at flow rates greater than 20 ml/min. Neutrophils in this preparation were round, the granules were intact, and the nuclei were lobulated. In addition, the cells produced superoxide in the presence of phorbol myristate acetate and phagocytosed zymosan particles. These characteristics were similar to those of porcine neutrophils prepared by a conventional sedimentation method. The yield (43%) and purity (94%) of human neutrophils isolated using the elutriator method was similar to that for porcine cells. This one-step method provides a moderate yield of pure neutrophils that have retained their morphology and function.

Animals↗
PubMed1991

Monocyte kinetics in rabbits.

Previous studies of monocytes isolated from peripheral blood have suggested that the lung sequesters these cells and has an important role in monocyte kinetics. However, the lung also provides the first capillary bed encountered by these cells after intravenous injection. A major criticism of the previous reports is that the behavior of monocytes in the lung may be altered as a result of the isolation procedure. The present study addresses this question by comparing the distribution of isolated monocytes (87% pure) in various organs 10 min after they were injected into either the central venous or the arterial circulation. The data show that the extraction of monocytes on the first passage through the lung after intravenous injection was 86.5 +/- 1.5%. After the monocytes had circulated for 10 min, the lungs contained 35.5 +/- 2.5% of the cells after intravenous injection and 29.7 +/- 2.2% after intra-arterial injection (P greater than 0.05). The lung-to-blood recovery ratio after either intravenous or intra-arterial injection showed that the lung contained a marginating pool of monocytes that was five to seven times the size of the circulating pool. The retention of monocytes in a region of the lung was proportional to the regional erythrocyte transit time. The half-life of the radiolabeled monocytes in the circulation was approximately 25 h. We conclude that the lung contains a marginating pool of monocytes and speculate that they concentrate there in preparation for migration into the interstitium and air space of the lung.

Animals↗
PubMed1990

Indomethacin enhances histamine-induced pulmonary hemodynamic changes.

To determine the role of prostaglandins in porcine pulmonary hemodynamic changes caused by histamine, we compared responses to intravenous histamine with and without pre-treatment with the cyclo-oxygenase inhibitor, indomethacin. In anesthetized pigs, pulmonary artery pressure (Ppa), pulmonary arterial wedge pressure (Ppaw), left ventricular end diastolic pressure (Plved) and cardiac output (Q) were measured repeatedly for 30 minutes, following a 1 ml intrajugular injection of histamine 0.6 microM/kg (n = 6), the identical histamine dose after pre-treatment with indomethacin 5 mg/kg (n = 7), or normal saline (n = 5). Pulmonary arterial resistance (Ra) and pulmonary venous resistance (Rv) were calculated as (Ppa-Ppaw)/Q and (Ppaw-Plved)/Q respectively. Indomethacin pre-treatment caused 2-fold greater increases in Ra and Rv with histamine and more prolonged changes. We conclude that inhibition of a vasodilatory prostaglandin released from pulmonary endothelial cells results in unopposed pulmonary vasoconstriction, thereby augmenting pulmonary resistance changes due to histamine.

Animals↗
PubMed1990

Leukocyte and platelet margination within microvasculature of rabbit lungs.

These studies compare the behavior of radiolabeled neutrophils, monocytes, lymphocytes, and platelets during their first pass through the pulmonary circulation after a central venous injection and their distribution within the circulation 10 min later. Their first pass through the pulmonary circulation was compared with erythrocytes (RBCs) using the indicator-dilution technique, and their recovery within the circulation of the lung and other organs was determined at 10 min by counting the radioisotopes in each organ. The extraction of each cell relative to RBCs during the first pass through the lung correlated with cell size in that the neutrophils (volume 107-140 fl) showed 97.6 +/- 0.6% extraction, monocytes (volume 80-105 fl) showed 91.4 +/- 1.7% extraction, lymphocytes (volume 36-75 fl) showed 80.1 +/- 4.4% extraction, and platelets (volume 4-7 fl) showed 33.1 +/- 3.9% extraction. After 10 min of circulation, the proportion of injected cells remaining in the lung was similar for neutrophils and monocytes (27.4 +/- 1.8 vs. 31.4 +/- 1.6%) but lower for lymphocytes (18.6 +/- 2.9%) and platelets (3.1 +/- 0.5%). All of the leukocytes were found to have a substantial marginated pool within the lung, whereas the platelets did not. The exchange between the circulating and marginated pools of leukocytes in the lung was related to blood velocity, with the least retention occurring in lung regions with shortest RBC transit times. We conclude that cell size is a major factor determining the time that cells will be delayed by the pulmonary microvasculature.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗