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N Isoda

Publications and source records attributed to N Isoda.

At least 37 records · Page 2Linked to original sources
PubMed1996

Laparoscopic transcystic cholangioscopic lithotripsy for common bile duct stones during laparoscopic cholecystectomy.

BACKGROUND AND STUDY AIMS: Following the recent introduction of laparoscopic cholecystectomy (LC) for cholecystolithiasis, treatment of concomitant common bile duct (CBD) stones has been evaluated by using laparoscopic choledochotomy, a transcystic approach, or by means of endoscopic sphincterotomy (ES) before or after LC. PATIENTS AND METHODS: During laparoscopic cholecystectomy, we attempted lithotripsy of CBD stones using laparoscopic transcystic cholangioscopy with lithotripsy (LTCL), in 70 patients out of 950 laparoscopic cholecystectomies. Preparatory tests included laboratory values, ultrasound, and performance of endoscopic retrograde cholangiography (ERC) with placement of a nasobillary tube (without sphincterotomy). RESULTS: Introduction of the cholangioscope into the CBD was successful in 65 patients (92.9%) and CBD clearance was completely achieved by LTCL alone in 51 (78.5%). The overall success rate was therefore 73%. The remaining 19 cases required postoperative procedures such as extracorporeal shock-wave lithotripsy without ERC or ES (successful in all). The average hospital stay period was 9.4 days for patients in whom CBD clearance was achieved by LTCL alone. This period did not differ significantly from that of patients who underwent LC alone (8.4) days. The operation time was about 70 minutes longer for the LTCL group (total time 174 minutes on average) than for the LC group (107 minutes). We did not observe any series complications during or after LTCL (mean follow-up period: 34 months). CONCLUSION: LTCL in combination with LC allows shortening of the hospital stay and a swift return to work for patients with CBD stones. This procedure also preserves the function of the sphincter of Oddi, so that the longterm prognosis for patients is likely to be very good.

Adult↗
PubMed1995

Lower-extremity venous stasis during laparoscopic cholecystectomy as assessed using color Doppler ultrasound.

Lower-extremity venous stasis during laparoscopic cholecystectomy was evaluated in 16 patients by monitoring the blood velocity in the femoral vein and the femoral vein size (cross-sectional area) using color Doppler ultrasonography. The blood velocity in the femoral vein decreased significantly after the start of 10-mmHg abdominal insufflation in the supine position. When the patients were placed in a reverse Trendelenburg position during 10-mmHg insufflation, blood velocity in the femoral vein further decreased. However, velocity returned to the baseline after deflation. The cross-sectional area of the femoral vein was significantly elevated after the start of 10 mm Hg insufflation in the supine position. When patients were placed in the reverse Trendelenburg position during 10-mmHg insufflation, this parameter was further elevated, but returned to the baseline soon after deflation. These results indicate that femoral vein stasis during laparoscopic cholecystectomy can be minimized by reducing the pressure of abdominal insufflation and avoiding elevation of the patient's head as much as possible.

Blood Flow Velocity↗
PubMed1995

Femoral vein stasis during laparoscopic cholecystectomy: effects of graded elastic compression leg bandages in preventing thrombus formation.

Venous stasis of the legs during laparoscopic cholecystectomy was compared between patients without graded compression leg bandages (Group 1; n = 12) and patients with such bandages (Group 2; n = 12) by measuring mean blood flow velocity and cross-sectional area of the femoral vein using a color Doppler ultrasonography. In Group 1, when velocity and area were measured in the supine position, a significant decrease in velocity (p < .05) and a significant increase in area (p < .05) occurred after abdominal insufflation to 10 mm Hg. These changes were greater during abdominal insufflation in the reverse Trendelenburg position than during abdominal insufflation in the supine position. In Group 2, flow velocity was significantly higher (p < .05) before abdominal insufflation as compared with Group 1. After abdominal insufflation to 10 mm Hg and a postural change, velocity significantly decreased (p < .05) and area significantly increased (p < .05) in Group 2, similar to the results in Group 1. During abdominal insufflation at 5 mm Hg or lower, the use of the graded compression bandage was found to be useful for preventing femoral vein stasis. During abdominal insufflation at 10 mm Hg or in the reverse Trendelenburg position, the bandage did not prevent femoral vein stasis.

Bandages↗
PubMed1994

[Localized cardiac tamponade after aortic valve replacement: a case report].

We report a case of localized cardiac tamponade after aortic valve replacement. A 56-year-old man had an aortic valve replacement for his aortic valve steno-insufficiency. At 3-postoperative day, severe hypotension occurred, causing acute renal failure. There were no cardiomegaly, high central venous pressure, nor echo-free space. A mass shadow, appearing on chest X-ray at 37-postoperative day, was diagnosed as a localized tamponade by means of a computed tomography and a radioangiography at 38 postoperative day. After the spontaneous drainage of old bloody effusion from the partially opened wound in mid-line, his cardiac and renal failure improved rapidly. When the hematoma is localized, computed tomography is most diagnostic while conventional echo-cardiography often fails to show echo-free spaces.

Aortic Valve↗
PubMed1994

[Respiratory and circulatory changes under high intra-abdominal pressure].

In order to determine the safety limit of abdominal pressure, the influence of abdominal pressure on the respiratory and circulatory systems was examined by changing it from 0 to 50 mmHg in dogs with carbon dioxide insufflation. Total peripheral resistance increased slightly after pneumoperitoneum but increased rapidly when 30 mmHg was exceeded. Cardiac output tended to decrease with an abdominal pressure above 30 mmHg. Static compliance decreased in response to the abdominal pressure up to 20 mmHg but the decrease became rather gentle when 30 mmHg was exceeded. Peak inspiratory airway pressure increased in response to the increased abdominal pressure up to 30 mmHg followed by small fluctuations thereafter. These evidences indicate that an abdominal pressure below 15 mmHg is desirable for performing a peritoneoscopic operation safely because the biocompensatory system may be impaired when the pressure exceeds 30 mmHg.

Abdomen↗
PubMed1993

Introduction of a "safety zone" for the safety of laparoscopic cholecystectomy.

Anatomic variations of the biliary tract were found in 18 cases of 600 patients (3.0%) undergoing laparoscopic cholecystectomy. All bile duct anomalies were confirmed preoperatively by endoscopic retrograde cholangiography. In every case, the cystic duct and cystic artery were exposed in a "safety zone" near the gallbladder neck in Calot's triangle. Laparoscopic cholecystectomy was successfully performed on all 18 cases. Intraoperative cholangiography clearly demonstrated the anatomic variations in all cases, unequivocally identified the cystic duct, and confirmed the absence of bile duct injury. Preoperative endoscopic retrograde cholangiography and intraoperative cholangiography, which have been performed routinely in all patients, improve the safety of laparoscopic cholecystectomy. Moreover, the observance of the essential rule of "keep operating in the safety zone" protects against inadvertent complications, especially against bile duct injury during laparoscopic cholecystectomy. Laparoscopic cholecystectomy was thus successfully performed on all 600 cases in the present series, except for three cases, which were converted to open surgery (conversion rates, 0.5%), because of pin-hole bleeding on the portal vein in our first case of 600, and severe adhesion in two (46th and 302nd) cases.

Bile Ducts↗
PubMed1992

Prospective study of laparoscopic cholecystectomy in two hundred and fifty patients.

Two hundred and fifty consecutive patients (151 women, 99 men, age 49.3 years) with symptomatic gallstones as diagnosed on ultrasonography underwent elective laparoscopic cholecystectomy over a 12-month period. Preoperative intravenous cholangiography (IVC) and endoscopic retrograde cholangiography (ERC) were also performed in 203 and 200 patients, respectively. Laparoscopic cholecystectomy was successfully performed on 248 of the 250 patients (99.2%). Two patients required conversion to open cholecystectomy because of a pin hole injury to the portal vein in one case, and because of technical difficulties with the dissection due to severe adhesions in the other patient. Procedure time in the initial 100 cases decreased from an average of 216 minutes for the first ten cases to 87 minutes for the last 30 cases, including the time required for intraoperative cholangiography (IOC). Bile duct stones were found in 4 cases on IOC which were diagnosed by preoperative ultrasonography, IVC and ERC in 0, 2 and 3 cases respectively. An intraabdominal drain was inserted for two days in all cases. The mean hospital stay was 8.6 days (range 4 to 19 days) with no readmissions. No complications were seen at short-term follow-up one month after discharge. Although there was a significant learning period, the procedure was safe and effective and could be performed with minimal risk. The results show that physicians with experience in both endoscopy and laparoscopy are well qualified to perform laparoscopic cholecystectomy after appropriate training.

Cholangiography↗
PubMed1992

Preliminary experience using laparoscopic transcystic cholangioscopy for treatment of common bile duct stones.

Laparoscopic transcystic cholangioscopy (LTC) in combination with electrohydraulic lithotripsy may be an alternative treatment to ERCP and sphincterotomy in patients with both gallbladder and common bile duct stones undergoing laparoscopic cholecystectomy. Preliminary experience using LTC lithotripsy in 13 cases is reported. In 12 cases the stones were pushed out into the duodenum using the tip of the cholangioscope, in 8 of them stone disintegration via LTC lithotripsy also being required. In the remaining case the cholangioscope could not be inserted into the common bile duct via the cystic duct due to complete cystic duct obstruction. The average hospital stay was 9 days (range 6-16) in patients with LTC/lithotripsy, which did not differ significantly from 8.4 days (range, 4-19) (n = 330) in the group undergoing laparoscopic cholecystectomy alone. The patients usually resumed normal activity the day after discharge. LTC lithotripsy has the advantages over endoscopic sphincterotomy of a shorter treatment and preservation of a normal functioning sphincter of Oddi. Further technical improvements, especially the development of a cholangioscope for this purpose, are urgently required.

Adult↗
PubMed1992

[Laparoscopic cholecystectomy].

Two hundred and fifty consecutive patients with symptomatic gallstones underwent elective laparoscopic cholecystectomy over a ten month period. Out of 250 cases, 2 (0.8%) were converted to open cholecystectomy. One was due to bleeding, and the other being due to severe adhesion. The remaining 248 cases resulted in complete success without any complications or postoperative readmission. In this modality of laparoscopic cholecystectomy, there is an apparent learning experience which can be covered only by adequate training and experience. From an ethical point of view, however, training should not be undertaken at the expense of patients. With less experienced operators, the threshold of indication for laparoscopic cholecystectomy should be set high in order to secure the safety of the patients as well as the successful completion of the procedures.

Adult↗
PubMed1991

[Laparoscopic laser cholecystectomy: a prospective analysis of 70 initial cases].

Laparoscopic cholecystectomy using Nd-YAG laser was performed in 70 consecutive patients with preoperatively symptomatic gallstones. Sixty-eight patients had successful completion of the laparoscopic cholecystectomy. Mean hospital stay was 7.8 days (range: 4-12), and a diet as well as physical walking was tolerated in all 68 patients by the next day following the procedure. Mean operating time was 216 minutes in the initial 10 cases, which improved significantly to 87 minutes in the latest 28 cases. The difference of operative time did not influence any difference on the postoperative course. Nineteen of 68 patients (27.9%) required postoperative pain medication (pentazocine 15 mg, i.m.). Two patients required conversion to open cholecystectomy because of a pin hole injury on the portal vein by laser quartz in the first case, and difficult dissection due to severe adhesion in the 46th case. There is a definite learning curve in this new modality. Laparoscopic cholecystectomy is a safe and effective procedure, significantly improving the quality of life of the patients with gallstones.

Adult↗
PubMed1990

Two-dimensional polyacrylamide gel electrophoretic pattern of duodenal tumour proteins.

We investigated the protein pattern of a surgically resected tumour in a case where it was difficult to distinguish between duodenal and pancreatic cancer. The investigation was performed using two-dimensional polyacrylamide gel electrophoresis with silver staining. Samples of the duodenal tumour, normal duodenal mucosa and normal pancreatic tissue from the same patient were compared. Each gel had ca. 250-300 protein spots, and the tumour sample pattern more closely resembled that of normal duodenal mucosa than that of pancreatic tissue, suggesting that the tumour had arisen from duodenal mucosa. There were three proteins identified only in the tumour sample gel, and these may have been tumour-specific proteins.

Aged↗
PubMed1990

Esophageal carcinoma-associated proteins detected by two-dimensional polyacrylamide gel electrophoresis.

Patterns of proteins of five surgically resected esophageal carcinomas were studied by two-dimensional polyacrylamide gel electrophoresis with silver staining. The samples of normal esophageal mucosa and esophageal carcinoma from the same patient were compared. Each gel had ca. 300 protein spots and had a similar pattern of proteins. Four spots were observed in all of the esophageal carcinomas that were not present in any of the normal mucosae. The molecular weights and isoelectric points were 46,000 and 5.3, 46,000 and 5.2, 36,000 and 4.7 and 33,000 and 5.1, respectively. One spot was observed in all of the normal mucosae but not in any of the esophageal carcinomas. Its molecular weight and isoelectric point were 27,000 and 5.3, respectively.

Aged↗
PubMed1989

Histopathological study of corpora amylacea pulmonum.

In this paper, we present a rare disorder which is known as corpora amylacea pulmonum. X-ray CT scanning showed an abnormal focus of the lung as a solitary mass with high density and spicular features around the surface. The resected lung tissue was characterized by the appearance of round, concentrically laminated acellular bodies about 40-80 microns in diameter. The bodies were usually found lying free in the alveolar space and surrounded by the exudate alveolar macrophages or multinuclear giant cells. Some of these macrophages were in a state of progressive degeneration. The bodies showed an affinity for Congo red and exhibited partial birefringence. Moreover, all the bodies had a strong positivity for the PAS reaction and anti lysozyme antibodies. The exudate alveolar macrophages and multinuclear giant cells also displayed reactivity for PAS and lysozyme in a similar manner to that of the bodies. Electron microscopically the bodies were fundamentally composed of fibrillar elements, which bore some resemblance to amyloid fibrils and probably accounted for the partial affinity of the bodies for Congo red. These amyloid-like fibrils were also found in the cytoplasm of the macrophages. This suggested that the concentrically laminated bodies in corpora amylacea pulmonum might be formed by sequential aggregation, fusion, coalescence and compaction of degenerated alveolar macrophages.

Aged↗