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S Isaji

Publications and source records attributed to S Isaji.

14 recordsLinked to original sources
PubMed1992

Role of bacterial infection in diet-induced acute pancreatitis in mice.

This study was performed to elucidate the role of bacterial infection in acute pancreatitis in young female mice fed a choline-deficient diet supplemented with 0.5% DL-ethionine (CDE diet). Mice were randomly classified into two groups: one had been fed CDE diet alone (nonantibiotic group), the other was fed a CDE diet with oral administration of antibiotics (antibiotic group). Survival rates at 96 and 144 h after introduction of the CDE diet were significantly improved in the antibiotic group, 25.0 and 19.4%, respectively, as compared with 3.6 and 0% in the nonantibiotic group (p, 0.05). Aerobic and anaerobic bacterial cultures of blood, ascites, spleen, and pancreas were taken from living mice 72 h after introduction of the CDE diet. Positive bacterial growth from one or more of the specimens occurred in 29.4% of the nonantibiotic group, and in 10.0% of the antibiotic group. Mice with pancreatic necrosis had a higher positive culture rate, 62.5% in the nonantibiotic group vs 20.0% in the antibiotic group. These results suggest that reduction of intestinal flora in mice inhibits secondary infection caused by bacterial translocation and improves survival in diet-induced hemorrhagic pancreatitis. We believe the development of bacterial infection of gut origin may be a factor influencing mortality in severe pancreatitis.

Acute Disease↗
PubMed1992

[Pathophysiology and management of patients with diabetes mellitus in gastrointestinal surgery, with special reference to hepatectomy and pancreaticoduodenectomy].

In the 235 patients with hepatectomy, 111 with pancreaticoduodenectomy (PD) and 547 with gastrectomy for the past 15 years and 5 months, we compared the incidence of postoperative complications between patients with diabetes mellitus (DM) and those without DM, and studied glucose metabolism and management of diabetic patients. DM was most frequently found at 27.7% in hepatectomy, especially 38.7% in cirrhotic patients, followed by 24.3% in PD and only 5.9% in gastrectomy. The incidence of postoperative complications was not different between DM and non-DM after gastrectomy and PD. It was significantly higher in DM than in non-DM after hepatectomy (38.5% vs. 11.8%), although there was no statistically significant difference in the cirrhotic patients with hepatectomy (34.9% vs. 23.5%). The studies on insulin metabolism preoperatively determined by oral glucose tolerance test and postoperative control of DM revealed that diabetic patients with hepatectomy, especially hepatogenous DM, had a significantly reduced insulin uptake in the liver and exogenous insulin resistance to glucose. After PD for diabetic patients, a long-term care of impaired pancreatic exocrine and endocrine functions was considered to be required, especially paying attention to lipid and zinc metabolism.

Diabetes Complications↗
PubMed1992

Effect of protease inhibitor FUT-175 on acute hemorrhagic pancreatitis in mice.

The effect of FUT-175, a new synthetic trypsin inhibitor, was evaluated in a lethal model of acute hemorrhagic pancreatitis induced by feeding mice a choline-deficient, ethionine-supplemented diet (CDE diet). When FUT-175 was given prophylactically at doses of 20 mg/kg body wt, the survival rate was significantly improved (p less than 0.05). The serum amylase concentration and trypsin activity in serum were also significantly diminished (p less than 0.05). Prophylactic administration of 5 mg/kg body wt of FUT-175 showed a statistically significant decrease in the serum trypsin activity, but it did not improve the survival rate. Therapeutic administration of FUT-175 showed no favorable effect. FUT-175 showed protective effects on the course of severe acute pancreatitis only when given prophylactically at the beginning of the pancreatitis induced by the CDE diet.

Acute Disease↗
PubMed1991

Surgery in acute pancreatitis. The Japanese experience.

Seventy-eight cases of severe acute pancreatitis were admitted to Mie University and its affiliated hospitals. These were subdivided into Group I (1976-1983) and Group II (1984-1989). The rate of early death was 34.8% in Group I and 9.3% in Group II. Among operated cases, peritoneal drainage alone was not effective with the worst mortality rate of 47.1%, especially in gallstone pancreatitis, with a 100% mortality rate. Early detection of infected necrosis or abscess using enhanced CT and subsequent drainage should be performed in cases of severe acute pancreatitis. A total 1182 cases of severe acute pancreatitis out of 12,309 cases of acute pancreatitis were collected in Japan by Saito et al., who belong to the Research Committee of Intractable Diseases of the Pancreas supported by the Japanese Ministry of Health and Welfare. Furthermore, 473 cases of severe acute pancreatitis in the Japanese literature reported from 1987 to 1990 were reviewed. Then, surgical indications and procedures were discussed. The incidence of necrosectomy has been increased to 10.3% from 3%, and biliary drainage procedure increased for severe acute pancreatitis. Indication of necrosectomy with or without open drainage method should be carefully evaluated in each institution.

Acute Disease↗
PubMed1991

Effect of insulin treatment on the regeneration of the remnant pancreas after major pancreatectomy in dogs.

The effect of exogenous insulin treatment on the pancreatic regeneration after major pancreatectomy was evaluated in dogs. More than 92% of the pancreas was removed near the duodenum with the main pancreatic duct left intact. All 26 dogs developed diabetes mellitus (DM) immediately after surgery, and these dogs were divided into two groups: insulin-treated group (n = 19) and noninsulin-treated group (n = 7). All seven dogs in the noninsulin-treated group died within seven weeks after surgery, whereas all dogs in the insulin-treated group survived until the twelfth week, except for six dogs sacrificed on the seventh week, and finally seven (53.8%) of 13 dogs recovered from DM. DNA and polyamine syntheses in the remnant pancreatic tissue at the third day increased more significantly in the insulin-treated group than in the noninsulin-treated group. Sigma IRI in IV-GTT was maintained more significantly in the insulin-treated group, and the regeneration rate at the seventh week was also significantly higher in the insulin-treated group than in the noninsulin treated group. Furthermore, the regeneration rate of the remnant pancreas at seventh week correlated well with DNA synthesis and ornithine decarboxylase activity on the third day. The exogenous insulin treatment after major pancreatectomy enhanced the proliferation of the remnant pancreas within the first week, and it maintained endogenous insulin secretion, promoting pancreatic regeneration.

Animals↗
PubMed1991

[Clinical and experimental studies on pancreatic functions and gastrointestinal hormones after major pancreatectomy].

The present study was undertaken to evaluate the changes of gastrointestinal hormones and pancreatic functions after major pancreatectomy in dogs and human. After more than 92% pancreatectomy in dogs, all dogs developed diabetes mellitus (DM). In these dogs, the remnant pancreas showed poor regeneration rate of 24.0% at 6 weeks, decreased sigma IRI in IV-GTT had not been recovered, pancreatic glucagon response was diminished, pancreatic exocrine function had been declined with increased plasma levels of secretin and CCK, and gastric secretion increased in spite of diminished gastrin response. After 74 to 92% pancreatectomy, 17.6% of dogs developed DM. The dogs with DM had poor pancreatic regeneration rate of 22.7% at 12 weeks, hypersecretion of glucagon and decreased gastric secretion with low plasma concentration of gastrin. On the other hand, in dogs without DM, pancreatic regeneration rate showed 42.7% at 12 weeks, insulin release and pancreatic exocrine function had been recovered well, and plasma CCK levels increased without changes of gastric secretion. In the clinical study, gastric secretion, CCK response and pancreatic endocrine and exocrine functions had been maintained better after pylorus preserving pancreaticoduodenectomy than after conventional pancreaticoduodenectomy.

Animals↗
PubMed1989

Liver abscesses.

Clinical suspicion of a liver abscess mandates an investigation of the liver for evidence of a liver abscess by radionuclide, ultrasound, or CT scan. Amebic abscesses have a lower mortality rate than pyogenic abscesses. Amebic and pyogenic abscesses can be distinguished on the basis of epidemiologic, clinical, and laboratory studies. The definitive studies for identifying amebic liver abscesses are hemagglutinin or gel diffusion studies. Amebic abscess of the liver may be complicated by extension to the lung, with pulmonary complications. Patients suspected to have amebic abscesses require metronidazole. Emetine or chloroquine may be added if there is no response or if the abscess recurs. Unless there is a failure of the amebic abscess to resolve or secondary infection occurs, there is seldom a need to aspirate or drain these abscesses. Pyogenic abscesses should be treated with broad-spectrum antibiotics to cover gram-negative aerobes and anaerobic organisms. All pyogenic abscesses larger than 1.5 cm in diameter should be aspirated, and the aspirate should be Gram stained and cultured. Percutaneous or surgical drainage should then be performed. Operative intervention is required in those patients with intra-abdominal pyogenic infections that are seeding the liver abscess. The marked reduction in the mortality rate of pyogenic liver abscess witnessed in this decade is multifaceted and attributable in part to earlier diagnosis, permitting definitive treatment in a timely fashion, as well as to improved intensive unit care, antibiotic management, and operative technique.

Adult↗
PubMed1989

Pancreatic resection for chronic pancreatitis.

Patients with chronic pancreatitis needing operative management include those with severe pain, those with complications of pancreatitis, or those in whom it is not possible to distinguish cancer of the pancreas from chronic pancreatitis. The use of endoscopic retrograde cholangiopancreatography, CT, and angiography to define the structural abnormalities has increased the surgeon's ability to select an operation matched to the patient's needs. A longitudinal pancreaticojejunostomy should be performed in patients whose ducts are dilated. When the head of the pancreas is enlarged and thickened, pancreaticoduodenectomy has been the traditional operation of choice. However, local resection with pyloric and duodenal preservation should now be considered an alternative that has a lower mortality rate and less likelihood of creating diabetes or exocrine insufficiency. Patients whose ducts are of insufficient caliber to permit longitudinal pancreaticojejunostomy are candidates for resection of the proximal or distal pancreas, depending on the site of disease or, alternatively, for the Beger or Warren procedure. Pain relief is achieved with surgery in about 80 per cent of patients with chronic pancreatitis. Many of the late deaths following operation for chronic pancreatitis are attributable, not to the operation, but to the effects of alcoholism. There is a need for surgeons to improve their observations and assessment of operative results.

Chronic Disease↗
PubMed1987

[Clinical study on the effect of 24-hour continuous intravenous infusion of CDDP in far-advanced and recurrent carcinoma of the gastrointestinal tract].

This clinical study was undertaken in order to evaluate the effect of CDDP on 43 patients with far-advanced or recurrent carcinoma of the gastrointestinal tract. For all these patients, CDDP at 100 mg/m2 had been administered by continuous intravenous infusion for 24 hours and repeated one to seven times at an interval of 3 to 4 weeks. The effect of this therapy was assessed according to the criteria of clinical evaluation of chemotherapy for solid cancers by Koyama and Saito. The response rate for both complete and partial response was 27.9% among all 43 patients, including 47.1% (8/17) for gastric cancer, 33.3% (1/3) for esophageal cancer, 25.0% (1/4) for hepatocellular carcinoma, 25.0% (1/4) for carcinoma of the gallbladder or bile duct, 20.0% (1/5) for pancreatic cancer and none (0/10) for colorectal cancer. In particular, a good response rate of 37.5% (3/8) was obtained for patients with recurrent tumor and one of 33.3% (6/18) for those with palliative resection of the primary tumor, which was much higher that the rate of 17.6% (3/17) for those without resection. As for the side effects of CDDP therapy, gastrointestinal symptoms were most frequently found in 78.3% of patients followed by bone marrow suppression in 15.2%, and abnormalities of hepatic and renal function in 4.3% and 4.3%, respectively. Consequently, 24-hour continuous intravenous infusion of CDDP was considered to be effective for far-advanced or recurrent carcinoma, especially in cases of gastric cancer.

Carcinoma, Hepatocellular↗
PubMed1985

[Evaluation of severity in acute pancreatitis].

Recently we reviewed 240 patients with acute pancreatitis admitted to our service and the affiliated hospitals for five years. Clinical symptoms and laboratory data of these cases were analyzed depending on their prognosis. The grades were divided into 3 groups by the mortality rates: Grade I with the mortality rate of less than 10%, Grade II 10-20%, and Grade III with greater than 20%. Clinical symptoms in Grade III were shock and neurological or dermatological symptoms. On the other hand, laboratory findings in Grade III were as follows; blood sugar was more than 200 mg/dl, LDH greater than or equal to 600 IU%, BUN greater than or equal to 40 mg/dl, serum Ca less than or equal to 7.5mg/dl, T.Bil. greater than or equal to 5.0 mg/dl, blood pressure less than or equal to 90 mmHg, and PaO2 less than or equal to 65 mmHg (room air). The degree of severity of acute pancreatitis was divided into 3 types, as follows: Mild; all belong to Grade I, or less than 2 positives of Grade II. Moderate; 3 to 4 positives of Grade II, or one positive of Grade III. Severe; 5 positives or more of Grade II, or 2 positives or more of Grade III. Our criteria with both clinical and laboratory findings are very useful for the evaluation of the severity and choice of treatment in acute pancreatitis.

Acute Disease↗
PubMedDate not supplied

Radical operations for carcinoma of the gallbladder: present status in Japan.

Based on the histological findings of 1,686 resected cases of gallbladder carcinoma and operative results collected from 172 major hospitals in Japan, the present status of radical operation was assessed with respect to the relationship between the depth of carcinoma invasion and the operative results. The depth of carcinoma invasion was classified into 5 groups, i.e., limited to the mucosal layer (m) in 11.9%, advanced to the proper muscle layer (pm) in 9.8%, extending to the subserosal layer (ss) in 29.6%, serosal involvement (se) in 21.8%, and carcinoma invading the adjacent organs (si) in 26.9%. Tumor extension, such as lymph node metastasis, invasion of lymphatic and venous vessels, and perineural infiltration, were observed more frequently in patients with ss, se, and si than in those with m and pm. The cumulative 5-year survival rates were 82.6% and 72.5% in patients with m and pm, which were significantly higher than 37.0%, 14.7%, and 7.5% in those with ss, se, and si, respectively. The choice of operative procedures should depend on the depth of carcinoma invasion. Cholecystectomy alone is done only in patients with tumor limited to the mucosa, and more radical procedures such as extended cholecystectomy should be performed in those with carcinoma invasion beyond the mucosa. Pancreatoduodenectomy is indicated in those with lymph node metastasis posterior to the head of the pancreas and with invasion to the duodenum. When the tumor directly invades the liver, major hepatic resection is recommended.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Treatment of chronic pancreatitis complicated by obstruction of the common bile duct or duodenum.

In patients with chronic pancreatitis, common bile duct obstruction is reported in 3.2-45.6% of patients; however, only 5-10% of all patients with chronic pancreatitis require operative decompression of the bile duct. The cause of the intrapancreatic stricture of the common bile duct may be either a fibrotic inflammatory restriction, or compression by a pseudocyst. Obstruction of the duodenum is much less common than common bile duct obstruction in chronic pancreatitis occurring in less than 1-2% of patients with chronic pancreatitis. Colonic obstruction secondary to pancreatitis is very infrequent. The intrapancreatic strictures of chronic pancreatitis are characteristically smooth and tapering on endoscopic retrograde cholangiopancreatography (ERCP), but in some patients, they may have a sharp cut-off and closely resemble the appearance of carcinoma of the pancreas invading the bile duct. The natural history of these intrapancreatic strictures is variable. They may progress and be associated with cholangitis, biliary cirrhosis, common duct stones, or may remain stable for years or regress. Prior pancreaticojejunostomy is not protective against the development of intrapancreatic biliary strictures which may follow in 5-30% of patients, with most authors reporting an incidence of less than 10%. Evaluation of alkaline phosphatase, bilirubin, the presence of jaundice, or the appearance of an intrapancreatic stricture on ERCP is not predictive of whether cholangitis or biliary cirrhosis may or may not develop. The incidence of cholangitis and biliary cirrhosis in patients with intrapancreatic stricture is 9.4% and 7.3%, respectively. Laennec's cirrhosis occurs in a similar number of patients. Operation is indicated in patients with intrapancreatic strictures of the common bile duct in association with chronic pancreatitis in patients developing cholangitis, biliary cirrhosis, common duct stones, progression of the stricture, persistent high elevations of alkaline phosphatase and/or bilirubin for over a month or inability to rule out cancer of the pancreas or periampullary region. The operation of choice is choledochoduodenostomy or Roux-en-Y choledochojejunostomy to bypass the obstructed intrapancreatic portion of the common bile duct. Persistent duodenal obstruction for over 3 or 4 weeks is an indication for gastrojejunostomy. Pain is not a feature of common bile duct obstruction in the absence of cholangitis. In the presence of pain associated with chronic pancreatitis, longitudinal pancreaticojejunostomy is the operation of choice combined with Roux-en-Y choledochojejunostomy. Some of the newer operations, e.g., the Beger and Frey procedures, may make the necessity of a separate operation for biliary decompression superfluous.

Chronic Disease↗