Biomedical subjects

Shinji Hirai

Publications and source records attributed to Shinji Hirai.

26 records · Page 2Linked to original sources

PubMed2003

[Basic policy towards patient's violation of drug control law].

All medical workers have a duty to protect a patient's privacy by law. Civil servants have a duty to prosecute anyone if a crime has been committed and others have the right to prosecute. When medical workers find their patient using illegal drugs, they are in a situation where any possible action they take is either a breach of one of the duties or an abandonment of the right to prosecute. Any worker in this situation should choose to do what will greater benefit society. Medical workers should avoid prosecuting a patient for illegal drug use, so that drug users can seek help. At the same time medical workers should try to put the patient in a situation where the patient's drug use in the future can be treated by the criminal justice system.

Attitude of Health Personnel↗

PubMed2003

Systemic inflammatory response syndrome after cardiac surgery under cardiopulmonary bypass.

OBJECTIVE: This prospective study was designed to elucidate the duration of systemic inflammatory response syndrome (SIRS) and the mechanisms that lead to the protraction of SIRS in patients who are operated on under cardiopulmonary bypass (CPB). METHODS: The duration of SIRS in 13 patients with SIRS was studied. Two groups were divided according to the duration to investigate the meaning of the duration of SIRS. The perioperative parameters which significantly correlated with the duration of SIRS, including the kinetics of cytokines and white blood cells (WBC) counts were investigated. RESULTS: In patients with SIRS extending for a period greater than 12 hours (group A), the duration of CPB, interleukin-6 (IL-6), interleukin-8 (IL-8) and WBC count after aortic declamping were significantly longer and higher than those in patients with SIRS lasting less than 12 hours (group B). The duration of SIRS significantly correlated with the highest level of IL-6 (r=0.724, p=0.0038) and the duration of CPB (r=0.626, p=0.0201). CONCLUSIONS: These results suggest that the duration of CPB and cytokinemia, with high IL-6 levels, during this short time frame until just after cardiac surgery might play an important role in the development of the SIRS.

Adult↗

PubMed2002

Gigantic thymolipoma.

A 48-year-old woman with an abnormal shadow in chest radiography during an annual physical examination was found by chest computed tomography to have a large fatty mass lesion found to be diagnosed as a gigantic lipoma. Histopathological diagnosis was found to be benign thymolipoma consisting of mature fatty tissue and hyperplastic thymic tissue structures with Hassall,s corpuscles. Although the diagnosis is supported by imaging studies that demonstrate fat and soft tissue within the tumor, variations occur in computed tomography appearance. We suggest that surgical excision be considered when a gigantic intrathoracic lipomatous mass is in scanning as in this case.

Female↗

PubMed2002

Retroperitoneal lymphangioma with a duodenal lesion in an adult.

A multilocular-cystic and cavernous, retroperitoneal tumor was found in a 40-year-old man whose past medical history was unremarkable. On admission, he complained of a large and still growing intra-abdominal mass associated with dull pain and a low-grade fever. Laboratory findings revealed leukocytosis and C-reactive protein elevation, compatible with inflammation of the tumor. Percutaneous aspiration of the tumor was performed under transabdominal ultrasonographic guidance, and continuous drainage of fluid from within the tumor ameliorated his symptoms. From preoperative examinations, including radiological imaging, fluid aspiration, and endoscopy with biopsy, a diagnosis of retroperitoneal lymphangioma was made. Laparotomy revealed extensive adhesions between the tumor and both the duodenum and the pancreatic head. A pancreaticoduodenectomy was therefore performed. At 3-year follow-up, there was no sign of recurrence. Retroperitoneal lymphangioma is an uncommon disorder, and the cavernous type is extremely rare. The duodenal lesion was an important feature of the present case, and endoscopic biopsy of this lesion facilitated precise preoperative diagnosis of retroperitoneal lymphangioma.

Adult↗

PubMed2002

Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma.

OBJECT: Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study is to evaluate the efficacy and role of gamma knife radiosurgery (GKS) in the management of residual or recurrent nonfunctioning pituitary adenomas. METHODS: A review was conducted of the data obtained in 42 patients who underwent adjuvant GKS at the University of Pittsburgh between 1987 and 2001. Prior treatments included transsphenoidal resection, craniotomy and resection, or conventional radiotherapy. Endocrinological, ophthalmological, and radiological responses were evaluated. The duration of follow-up review varied from 6 to 102 months (mean 31.2 months). Fifteen patients were observed for more than 40 months. The mean radiation dose to the tumor margin was 16 Gy. Conformal radiosurgery planning was used to restrict the dose to the optic nerve and chiasm. Tumor control after GKS was achieved in 100% of patients with microadenomas and 97% of patients with macroadenomas. Gamma knife radiosurgery was equally effective in controlling adenomas with cavernous sinus invasion and suprasellar extension. No patient developed a new endocrinological deficiency following GKS. One patient's tumor enlarged with an associated decline in visual function. Another patient experienced a deterioration of visual fields despite a decrease in tumor size. CONCLUSIONS: Gamma knife radiosurgery can achieve tumor control in virtually all residual or recurrent nonfunctioning pituitary adenomas. Dose sparing facilitates tumor management even when the adenoma is close to the optic apparatus or invades the cavernous sinus.

Adenoma↗

PubMed2002

Successful emergency repair of blunt right atrial rupture after a traffic accident.

A 53-year-old man crashed his motorcycle into a vehicle and was transported to our hospital by ambulance after about 30 min. Echocardiography revealed cardiac tamponade. Pericardiocentesis was immediately performed using a 5 Fr catheter via the subxiphoid approach and the results suggested cardiac injury. Surgery was commenced via median sternotomy about 2.5 hours after the accident. Patients with cardiac rupture who reach hospital alive can be saved by rapid transport, early detection, and early surgery. In particular, rapid echocardiography and pericardiocentesis via the subxiphoid approach under ultrasonic guidance are easy and helpful methods of making a diagnosis and achieving hemodynamic improvement prior to surgical intervention.

Accidents, Traffic↗

PubMed2002

Spontaneous and isolated dissection of the main trunk of the superior mesenteric artery.

A 42-year-old man was admitted to another hospital complaining of acute abdominal pain that was induced by eating. Abdominal computed tomography and selective angiography revealed an intimal flap separating true and false lumens that was located 3 cm from the origin of the superior mesenteric artery (SMA). Emergency surgery was performed because of the sudden recurrence of diffuse abdominal pain after eating and abdominal aorta-SMA bypass grafting was done using a radial artery graft. Postoperative angiography revealed that the graft showed good patency. The postoperative course was uneventful and abdominal pain no longer occurred after eating. This excellent result was achieved by early diagnosis using CT scanning and angiography plus an aggressive surgical repair with a radial artery bypass graft for isolated dissection of the superior mesenteric artery.

Adult↗

PubMed2002

Spontaneous and isolated dissection of the external iliac artery: a case report.

Spontaneous and isolated dissection of the limb arteries without involvement of the aorta is extremely rare. We present a 36-year-old male who has 95% tapering stenosis and dissection of the left external iliac artery with abrupt onset with total thrombosis in the false lumen until the level of the inguinal ligament. We also suggest that endovascular stent graft placement is a useful treatment for isolated arterial dissections prior to operation in consideration of the technical ease and safety of guiding intravascular ultrasound like in this case.

Adult↗