Biomedical subjects

M Yamashiro

Publications and source records attributed to M Yamashiro.

At least 37 records · Page 2Linked to original sources

PubMed1994

[Prognostic factors influencing survival after operations for gastric cancer in the elderly].

The prognostic factors influencing survival after operations for gastric cancer in the elderly were evaluated by Cox's proportional hazards model analysis. Data were obtained from 511 operations over a 10-year period, in patients with a mean age of 75.6 +/- 7.9 years. The significant prognostic factors of survival out of 47 examined risk factors were, in order of standardized coefficient values, (1) stage of cancer, (2) %IBW, (3) peritoneal dissemination (P-factor), (4) multiple non-gastric cancers, (5) postoperative hepatic injury and (6) postoperative cardiac complication. No other factors, including preoperative associated diseases and postoperative pulmonary complication (the major risk factor of operative death), were significant risk factors of survival. We conclude that by giving special postoperative attention to prevent hepatic injury and cardiac complication, the length of survival of elderly patients with gastric cancer will improve.

Aged↗

PubMed1994

[Postoperative delirium and abnormal behaviour related with preoperative quality of life in elderly patients].

Postoperative delirium and abnormal behavior were studied in 160 patients aged 60 and over with relation to their QOL assessed before surgical operation. QOL was assessed physically, psychologically, mentally and socially. Physical status was assessed with ability in daily life, seeing, hearing and severity of disease. Psychological condition (depression) was assessed by using GDS (Geriatric Depression Scale of Sheikh), Mentality (dementia) was assessed by using CDR (Clinical Dementia Rating) and HDS-R (Revised version of Hasegawa's dementia Scale). Sociality was assessed by social life and familial environment. Postoperatively 37.1% of males and 28.9% of females developed delirium and abnormal behaviour. Abnormal behaviour of demented patients was not defined as due to delirium or as dementia itself, so it was included in the classification "delirium and abnormal behaviour" because of the same aspect in terms of practical nursing care. The following factors were found to be statistically related to the occurrence of postoperative delirium and abnormal behaviour: disability in daily life, dementia, disturbance of hearing. Scores of HDS-R was closely related with the possibility of postoperative delirium and abnormal behaviour.

Activities of Daily Living↗

PubMed1993

[Gastric ulcer and patterns of distribution of intestinal metaplasia in the elderly].

Gastric ulcer was studied with regard to the relationship with patterns of distribution of intestinal metaplasia (IM). 882 stomachs of elderly patients, obtained from autopsies from 1987 to 1991 were examined histopathologically. There were 74 open gastric ulcers and 88 ulcer scars. Distribution of IM was classified into 7 types. Open ulcers and scars were found more often in type O (IM found in the entire lesser curvature which is the most common type in the elderly) than in other types. Open ulcers in type O were mostly shallow and located in the IM area. Many open ulcers in type A (IM involving the antrum) and type B (IM involving both the antrum and cardia) were deep and on the boundary zone between the IM area and the proper gastric mucosa area. Most of the deep scars that did occur in type O were in the IM area but in types B and A most of them were located on the boundary zone. Scars in type O probably developed on the boundary zone when they were open ulcers and removed in the IM area because of progression of the IM area. In some cases ulcers were at the boundary zone of IM involving the cardia and this finding was characteristic of elderly cases.

Aged↗

PubMed1993

[Thoracoscopic resection of pleural tumor].

A thoracoscopic operation was safely performed for a case of a intrathoracic tumor. The patient was a 68-year-old male who had been treated for bronchial asthma and recurrent pneumonia. The reason for a successful operation were one-lung-ventilation under general anesthesia, the thoracoscopic electrocautery, the thoracoscopic ultrasonic surgical aspiration system, and thoracoscopic hemoclips. Pathologically the tumor was a benign mesothelioma. The patient was discharged without complications. In the treatment of intrathoracic benign diseases, thoracoscopic surgery is thought to be particularly useful to patients who are at high-risk in conventional thoracic operations due to accompanying respiratory diseases, as well as to patients requiring incisions as small as possible.

Aged↗

PubMed1993

Clinicopathological characteristics of hepatic hilar bile duct carcinoma.

We reviewed thirty cases of hepatic hilar bile duct carcinoma found in 5,800 consecutive autopsy cases, mainly of the aged, and analysed their clinicopathological characteristics. Eleven cases had a record of tumor resection (8 men, 3 women, mean age 75.1 years). At operation, the gross type was mainly infiltrative in all eleven cases, and the stage was II, III or IV in as many as ten cases. Cholecystectomy and bile duct resection were performed in all cases except one in whom additional hepatic lobectomy was performed. In none of the cases was the operation curative. The main cause of non-curability was residual carcinoma on the surgical cut or ablated surface due to longitudinal or lateral cancerous interstitial spread. This was confirmed by the fact that local relapse of carcinoma, either in the hepatic hilus or hepatoduodenal ligament, was found in all the cases at autopsy. This fact also indicates the difficulty in achieving complete resection of carcinoma in this part. On the other hand, a relatively "benign" aspect of hepatic hilar bile duct carcinoma was suggested as follows: 1. Most of the cases were well-differentiated adenocarcinoma. 2. Although there was no case of curative resection, three out of of nine cases (excluding the cases of death during operation) survived more than two years. 3. Distant metastasis found at autopsy was relatively rare, being seen in four of these eleven cases. In the light of these data an operation, even though palliative, is considered to be justified.

Adenocarcinoma↗

PubMed1992

[Prognostic analysis for postoperative complications of abdominal surgery in the elderly].

In order to evaluate the prognostic importance of the conditions before abdominal surgery for patients over 60 years of age. Multivariate analyses of postoperative complications were performed in 634 patients (comprising 525 cases of elective abdominal surgery and 109 cases of emergency abdominal surgery). The Mortality rate was significantly higher (p < 0.01) in the emergency group (11.9%) and relatively low among the elective abdominal surgery group (3.8%). In the emergency group, 13 patients died, and MOF (multiple organ failure) was found to be the direct cause of death in 11 (85%). Although, the majority (75%) of emergency operations were for benign disorders, the remainder (25%) had malignant tumors. It is noteworthy that among 25% of cases, obstructions and perforations due to large bowel cancers were found to be 59% and 19%, respectively. In the elective surgery group, postoperative pulmonary and cardiovascular complications were found in 11.6% and 9.6%, respectively. Death due to cardiovascular problems in rare (5%), however, postoperative pneumonia was the cause of death in 70% of all of postoperative death. Risk factors affecting postoperative pulmonary complications were malnutrition, advanced age, male sex, malignant disease, dementia, cerebrovascular disorders, impaired pulmonary function tests. Surprisingly, the risk factors were identical, except for impaired pulmonary function, for postoperative MRSA pneumonia. In our study, postoperative pulmonary death was not associated with impaired pulmonary function, and it appears to be rather affected by the presence of cerebrovascular disorders and malnutritional state. A poor nutritional states (< 40 according to Onodera's nutritional index) was present in over 50% of patients with cerbrovascular disorders and low ADL.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗

PubMed1992

[Stomal stenosis following gastrectomy in the elderly].

Seven hundred and thirty seven patients over 65 years of age (mean 76 years) undergoing gastrectomies from 1979 to 1991 were reviewed to evaluate the cause of stomal stenosis in the early postoperative period. Fifty seven (7.7%) patients, 24 males (5.6%) and 33 females (10.6%), had overt stomal stenosis or obstruction documented by radiological and endoscopic findings. The incidence of stenosis in females was significantly higher than in males (p < 0.05). Complications developed in 19 (20.0%) of 95 patients after gastroduodenostomy (Billroth-I), 29 (6.2%) of 465 after gastrojejunostomy (Billroth-II and others) and 8 (5.0%) of 159 after esophagojejunostomy (total gastrectomy). The incidence of complications in the first was significantly higher than in the other two (p < 0.01). The cause of stomal stenosis was classified into three groups; (1) transient stenosis due to stomal edema in 21 patients, (2) intestinal obstruction immediately adjacent to the stoma (kinking, invagination and volvulus) in 22, (3) organic stenosis of pathological origin (stomal ulcer, anastomotic leakage and strangulation by the proliferated mesocolon) in 14. The period of recovery from postgastrectomy retention was different in each group. It was 20.7 (mean) +/- 7.7 (SD) days in group (1), 29.7 +/- 12.6 days in group (2) and 62.1 +/- 30.0 days in group (3). These mean periods were significantly different from each other (p < 0.01). Group (1) and most of group (2) responded well to conservative management consisting of decompression by nasogastric suction and parenteral feeding but a reoperation was necessary for only two patients in group (2). Half of group (3) was treated by endoscopic dilatation and one third by reoperation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1992

[Post operative upper gastrointestinal bleeding in the aged].

A 10-year experience with 2,441 patients over 65 years of age undergoing operations for non-upper gastrointestinal tracts was reviewed to evaluate both the incidence of postoperative upper gastrointestinal bleeding and the clinical risk factors associated with the complication. A total of 18 (0.7%, 7 males and 11 females) patients had overt postoperative upper gastrointestinal bleeding of non-variceal origin documented by endoscopic findings or blood transfusions. Of these, the complication developed in 10 (1.5%) of 646 patients after an operation for biliary or pancreatic disease, 1 (1.5%) of 64 for aneurysmal or obstructive arterial disease, 5 (1.1%) of 43 for colorectal cancer and 2 (0.3%) of 916 for hernia. The incidences of bleeding after an operation for obstructive jaundice (3.8%), for biliary or pancreatic malignancy (4.5%), and of unavoidable diversion colostomy for colorectal anastomosis (3.1%) were significantly higher than for non-jaundice (0.6%), for non-malignancy (1.1%) and of postoperative upper gastrointestinal bleeding in the present study. The origins of bleeding were gastric ulcer in 11, acute gastric mucosal lesion in 4, duodenal ulcer in 1 and other in 2. All cases of bleeding were treated and met success in hemostasis using H2-blockers. Of these, however, 5 patients died of multiple organ failure despite discontinued hemorrhage, prophylactic use of H2-blockers showed a decrease in occurrence of postoperative upper gastrointestinal bleeding in the present study.

Aged↗

PubMed1991

[Treatment of strongyloidiasis with mebendazole--long-term eradication and new trials].

We previously reported the short period cure rate of mebendazole (MBZ) treatment to strongyloidiasis. We are now reporting the long period cure rate of the treatment. The results were as follows: 1) The cure rate was 73.9% (17/23) in single use of MBZ (100 mg twice daily for 28 days). 2) The cure rate was 100.0% (22/22) in combination therapy (thiabendazole 500 mg three times a day for 5 days and after that, MBZ 100 mg twice daily for 9 days). Before we obtained the cure rate of 6 months after the treatment described above, we concluded that MBZ could be used for the treatment of strongyloides infection because of the lack of severe side effects and suitable intervals between courses would prevent liver injury. Thus, in this study, 47 patients were treated with 100 mg of MBZ twice a day for 5 days and this treatment was repeated 1, 3 and 4 weeks later on the same schedules (group 1). But because of liver injury, 13 patients were interrupted and moved to the 4th course (group 2). The following results were obtained: 1) Out of a total of 60 patients, the cure rate was 88.1% (52/59) after 2 courses, 92.3% (12/13) after 3 courses and 100.0% (46/46) after the 4 courses were finished. 2) Diarrhea (10.6%), arthralgia and lumbago (8.5%) were observed in group 1. No side effects were observed in group 2. 3) The incidence of liver injury occurred 48.9% (23/47) in group 1 and 30.8% (4/13) in group 2. 4) Positive rate of HTLV-I antibody was 40.0% (24/60).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

[A case of EEC (ectrodactyly, ectodermal dysplasia, and cleft lip) syndrome].

EEC syndrome is a rare congenital malformation characterized by ectrodactyly, ectodermal dysplasia, cleft lip and/or palate. We reported a case of EEC syndrome with cleft palate. The patient was a 15-month-old girl. She had split hands of the upper extremities, syndactyly and polydactyly of the right lower extremity, ectodermal dysplasia including sparse hair, enamel hypoplasia and cleft palate. The patient underwent palatoplasty at the age of 18 months.

Abnormalities, Multiple↗

PubMed1991

[Aortitis syndrome associated with aortic regurgitation and coronary ostial stenosis: a case of successful surgical treatment at the active stage].

A 24-year-old woman with aortic regurgitation and ostial stenosis of coronary artery due to aortitis syndrome was reported. She was admitted to the hospital with anterior chest pain. Retrograde aortogram showed aortic regurgitation and selective coronary angiogram revealed severe ostial stenosis. In spite of steroid therapy, chest pain was not controlled. In spite of the active stage, she underwent aorto-coronary bypass and aortic valve replacement. Intra-aortic balloon pumping (IABP) was necessary to wean from cardio-pulmonary bypass, but she recovered well and no complication was recognized after operation.

Adult↗

PubMed1991

[Mitral valve replacement in idiopathic hypereosinophilic syndrome].

Idiopathic hypereosinophilic syndrome (IHES) is a rare systemic manifestation of eosinophilia that may cause endocardial fibrosis and thrombus formation. We presented a 48-year-old man with rapid onset of intractable congestive heart failure during the course of chemotherapy for IHES. After the urgent operation, which included left ventricular thrombectomy and mitral valve replacement the patient was asymptomatic, but died 1 month after operation because of development of IHES. Atrioventricular valve replacement may be beneficial to selected patients with congestive heart failure associated with the cardiac process of the IHES and review of the literature led us to prefer porcine heterograft prostheses in patients with IHES.

Eosinophilia↗

PubMed1989

[Studies on pharmacological activity of the Japanese and European mistletoe].

The pharmacological actions such as analgesic effect, diuretic action, hypoglycemic activity and hypotensive action were studied on the methanol extract of the Japanese mistletoe and the European mistletoe. The both extracts showed the hypotensive action when administered intravenously to cat. The methanol extract of the Japanese mistletoe also showed a increase of K+ value in the urine when administered orally to rat.

Analgesics↗

PubMed1989

Simultaneous development of gallbladder and bile duct carcinomas with atypical epithelium intervention: a case report.

An 81-year-old woman, diagnosed as having a lower bile duct carcinoma by percutaneous transhepatic cholangiography and cytology of the bile after the onset of repeated nausea and fever around November, 1986, was given a pancreatoduodenectomy in February, 1987. From histological analyses of specimens taken at surgery, papillary adenocarcinoma of the lower bile duct was revealed with a massive amount of mucin in the cancerous gland lumens, the bile duct and the tubular adenocarcinoma retained in the mucosal layers of the gallbladder. Lying between these carcinoma sites was found atypical epithelia of a lesion borderline between benign and malignant (Group III). The patient's postoperative progress was fair, but she died suddenly of cerebral hemorrhage in July, 1988. No intraperitoneal or general carcinoma relapse was found at autopsy. This is one of the relatively rare cases of a simultaneous development of gallbladder and bile duct carcinomas and we found it of great interest that these carcinomas existed through an intermediate atypical epithelium.

Adenocarcinoma↗

PubMed1988