Biomedical subjects

Naoki Hashimoto

Publications and source records attributed to Naoki Hashimoto.

24 records · Page 2Linked to original sources

PubMedDate not supplied

Comparison of the functional and morphological changes in the pancreatic remnant between pylorus-preserving pancreatoduodenectomy and pancreatoduodenectomy.

BACKGROUND/AIMS: Pylorus-preserving pancreatoduodenectomy preserves the secretion of gastrointestinal hormones from the distal stomach and duodenum, whereas after pancreatoduodenectomy they are no longer secreted. It has been suggested that some gastrointestinal hormones exert a trophic effect on the pancreas, although this effect has not been documented in man. It was postulated that the ablation of gastrointestinal hormones, such as gastrin by pancreatoduodenectomy is an important cause of postoperative pancreatic atrophy and, since pylorus-preserving pancreatoduodenectomy preserves the secretion of these hormones, it would be more effective than pancreatoduodenectomy for the maintenance of postoperative pancreatic function. METHODOLOGY: We measured postoperative pancreatic function, parenchymal thickness of pancreas and the release of gastrin in patients who underwent pancreatoduodenectomy or pylorus-preserving pancreatoduodenectomy who had survived > 1 year without tumor recurrence. RESULTS: After pylorus-preserving pancreatoduodenectomy, exocrine pancreatic function, parenchymal thickness of pancreas and gastrin release were significantly greater than after pancreatoduodenectomy. CONCLUSIONS: We concluded that postoperative atrophy of the distal pancreas after pancreatoduodenectomy occurs, in part because of resections of the duodenum and distal stomach, which is the source of trophic stimuli, gastrin.

Ampulla of Vater↗

PubMedDate not supplied

The effects of a bradykinin B2 receptor antagonist in extended liver resection with ischemia in dogs.

BACKGROUND/AIMS: In liver surgery, total clamping of the portal triad (Pringle's procedure) is commonly used, and sometimes causes liver failure. This study evaluated the effects of a bradykinin B2 receptor antagonist, FR173657 (FR), on ischemia-reperfusion injury during liver resection in dogs. METHODOLOGY: Experimental animals were divided into two groups. In the FR group (n=6), FR (100 nmol/kg/hr) was administered continuously via the portal vein from 30 min before the onset of ischemia until 2 hr after reperfusion. In the control group (n=6), vehicle was injected in the same manner. The right portal pedicle was clamped for 60 min, while the left portal branch was left patent to avoid portal congestion. Following reperfusion, the non-ischemic lobes were resected, and remnant liver function was evaluated. RESULTS: AST and ALT were significantly (p<0.05) lower in the FR group than in the control group. Hepatic tissue blood flow 30 min after reperfusion was significantly (p<0.05) higher in the FR group than in the control group. Histological tissue damage was mild, and polymorphonuclear neutrophil infiltration was significantly (p<0.05) reduced in the FR group compared with the control group. CONCLUSIONS: A bradykinin B2 receptor antagonist ameliorated the ischemia-reperfusion injury caused by Pringle's procedure during extended liver resection.

Analysis of Variance↗

PubMedDate not supplied

Arterial hemorrhage by pseudoaneurysms following pancreatoduodenectomy.

Experienced centers report reduced operative mortality after pancreatoduodenectomy for cancer, but significant complications continue to occur in as many as 25% of patients. Anastomotic disruption leads to sepsis in the pancreatic bed where major vascular structures have been exposed by regional lymphadenectomy, creating a setting for arterial erosion or ligature slough and massive hemorrhage. Dehiscence of the pancreatojejunostomy is a particular risk. We presented one patient with arterial hemorrhage from visceral artery pseudoaneurysm after pancreatoduodenectomy, who had had sentinel bleeding from the abdominal drains or gastrointestinal tract. Sentinel bleeding after pancreatoduodenectomy indicates local sepsis and probable anastomotic dehiscence. Recognition of its significance and prompt response may prevent exsanguination.

Adenocarcinoma↗

PubMedDate not supplied

Hepatobiliary scintigraphy after biliary reconstruction-Roux Y and RY-DJ.

BACKGROUND/AIMS: Reconstruction of extrahepatic biliary tract with benign lesion still has some unsettled problems, such as postoperative cholangitis. This study was conducted to compare bile through the remnant alimentary tract in patients undergoing Roux-Y-duodenojejunal anastomosis (RY-DJ) which was designed for decompressing the jejunal limb of R-Y and for allowing an inflow of bile into the duodenum, and those undergoing Roux-Y choledochojejunostomy (R-Y), using hepatobiliary scintigraphy. METHODOLOGY: Five normal human volunteers and 20 patients underwent R-Y (n=14), RY-DJ (n=6), using hepatobiliary scintigraphy. RESULTS: Postoperative cholangitis developed in 2 patients (14%) with R-Y and none with RY-DJ. Hepatobiliary scintigraphy showed prominent stasis of 99mTc in the proximal jejunum loop of the patients who underwent R-Y, which was not found in the upper jejunum of the patients with RY-DJ. The time taken before visualization of 99mTc at the upper jejunum in the patient who underwent R-Y (65 +/- 5 min) was significantly longer than that in the healthy control (40 +/- 5 min). On the other hand, the time taken before visualization of 99mTc at the upper jejunum in RY-DJ (45 +/- 5 min) was similar to that of healthy controls. CONCLUSIONS: These data suggested that this new method (RY-DJ) for reconstructing the extrahepatic biliary tract was more physiological with less postoperative complications than R-Y.

Anastomosis, Roux-en-Y↗

PubMedDate not supplied

Effect of distal splenorenal shunt plus splenopancreatic disconnection on glucose and amino acid metabolism.

BACKGROUND/AIMS: The Warren-Zeppa distal selective splenorenal shunt (DSRS) is aimed at decompressing esophageal varices by a distal splenorenal shunt, at the same time ligaturing left gastric, gastroepiploic and umbilical veins. In the long-term follow-up the loss of shunt selectivity was observed in several cases. Therefore, Inokuti and Warren reported splenopancreatic disconnection (SPD) to prevent splenic collaterals from stealing portal venous blood. METHODOLOGY: This report presents metabolic data (K-glucose, IRI in iv-GTT, Fischer ratio) of 10 cirrhotic patients operated with DSRS plus SPD. RESULTS: K-glucose of iv-GTT was improved from 2.3 +/- 0.2 to 2.5 +/- 0.2. Fischer ratio was also improved from 1.58 to 2.0 after the operation. IRI behavior tends to be lower after operation as a result of devascularlization of the collateral circulation by the selective shunt. CONCLUSIONS: From these results it seems that DSRS+SPD has favorable effects on glucose and amino acid metabolism.

Amino Acids↗

PubMedDate not supplied

Hepatobiliary imaging after pancreaticoduodenectomy--a comparative study on Billroth I and Billroth II reconstruction.

BACKGROUND/AIMS: This study was conducted to compare the passage of bile through the remnant alimentary tract following pancreaticoduodenectomy in patients undergoing Billroth I (Imanaga) and Billroth II (Child) reconstructions, using biliary scintigraphy. METHODOLOGY: Seven normal human volunteers and 18 patients underwent Child's operation (n=10), or Imanaga's operation (n=8) using hepatobiliary scintigraphy. RESULTS: In patients who underwent Child's operation (n=10), hepatobiliary scintigraphy showed a prominent stasis of bile tracer in the proximal jejunal loop and a significant time delay occurred at the upper jejunum. The time taken before visualization of 99mTc at the upper jejunum in the patient who underwent Child (65 +/- 5 min) was significantly longer than that in the healthy controls. On the other hand, in the patients who underwent Imanaga's operation (n=8) no bile stasis in the proximal jejunal loop was found and the time taken before visualization of 99mTc of the upper jejunum was similar to that of healthy controls (n=7). Continuous stasis of bile in the proximal loop in patients who undergo Child's operation can therefore cause reflux cholangitis and absorptive disturbances postoperatively in the long term. CONCLUSIONS: The results of this study suggest that Imanaga's reconstruction is a more physiological procedure than Child's reconstruction following pancreaticoduodenectomy.

Adult↗