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Biomedical subjects

T Hebiguchi

Publications and source records attributed to T Hebiguchi.

At least 19 recordsLinked to original sources
PubMed2001

Biliary atresia with hyperandrogenic amenorrhea.

The etiology of hyperandrogenic amenorrhea in a patient with biliary atresia successfully treated by a Kasai operation was unclear. Delayed puberty and menarche were evident at 16 years of age. Investigations showed no luteinizing hormone (LH)-follicle-stimulating hormone surge. A LH-releasing hormone provocative test showed a normal response. Peripheral aromatization of androgens appeared to function normally. Free testosterone (T) was normal, however, plasma levels of sex-hormone-binding globulin and total T were high. After menarche at 18 years of age, anovulatory menstrual cycles continued. A combination of estrogen and progesterone therapy was effective. A possible explanation may be that metabolic clearance of T is reduced in the presence of liver cirrhosis and a portosystemic shunt.

Amenorrhea↗
PubMed2001

Extremely short small bowel induces focal tubulointerstitial fibrosis.

BACKGROUND: Arginine becomes an essential amino acid after massive resection of the small bowel as a result of decreased biosynthesis of citrulline in the remaining small bowel. It is also reported that nitric oxide (NO) is synthesized from l-arginine by NO synthase (NOS), and NO is involved in the regulation of blood flow in the kidney. The authors observed a patient with an extremely short small bowel, showing focal tubulointerstitial fibrosis. The experiment was designed to clarify whether massive small bowel resection (SBR) produces focal tubulointerstitial fibrosis in the kidney. METHODS: An experimental study was performed using 4-week-old rats with 90% proximal SBR either with or without arginine supplementation for 6 weeks after surgery. RESULTS: In rats without arginine supplementation, low plasma levels of citrulline and arginine increased urinary excretion of orotate, and focal tubulointerstitial fibrosis was observed 6 weeks after 90% SBR. The data from plasma amino acid chromatography and increased excretion of urinary orotate suggested the presence of arginine deficiency. The kidney pathology was similar to that of our patient. Rats with arginine supplementation after 90% SBR and pair-fed control rats without 90% SBR showed almost normal glomeruli and tubulointerstitium. CONCLUSIONS: Experimental study strongly suggests that arginine deficiency causes focal tubulointerstitial fibrosis in the kidney after massive SBR.

Animals↗
PubMed2000

Z-shaped skin incision applying Kraissl's lines for an axillary thoracotomy.

A Z-shaped skin incision applying Kraissl's lines for a thoracotomy is presented herein. The center of the Z-shape is located on the intercostal space of the thoracotomy. Parallel Z-shaped lines are described on circular Kraissl's lines in the axillary region. The oblique cross-line of the Z-shape is drawn from the dorsal edge of the cranial line to the anterior edge of the caudal line. The angle of the triangular skin flaps is adjusted to 30 degrees or greater in order to keep good microcirculation. The incision gives good exposure for the operative fields and results in a cosmetically satisfactory scar.

Axilla↗
PubMed2000

Biliary atresia with hyperandrogenic amenorrhea: case report.

The etiology of hyperandrogenic amenorrhea in a 16 year-old girl after a successful Kasai operation for biliary atresia was unclear. Delayed puberty and menarche were observed. There was no luteinizing hormone-follicular stimulating hormone surge. A provocative luteinizing hormone-releasing hormone test showed a normal response. Peripheral aromatization of androgens appeared to function normally. However, plasma levels of sex hormone-binding globulin and total testosterone were high and the free testosterone level was normal. The anovulatory menstrual cycle continued after menarche at 18 years of age. A combination of estrogen and progesterone therapy was effective. The etiology might be associated with delayed metabolic clearance of testosterone accompanied by the compensatory cirrhosis and portosystemic shunt.

Adolescent↗
PubMed2000

Wing-shaped end-to-end anastomosis for the treatment of high jejunal atresia.

Six infants with jejunal atresia, one infant with ileal atresia, and one infant with colonic atresia were managed by a newly developed wing-shaped end-to-end anastomosis. The technique was accomplished by anastomosing the tip of the dilated proximal bowel to the diminutive distal bowel, which had been divided into two parts, including the mesentery. The completed anastomosis resembled extended wings, and this technique was therefore named wing-shaped anastomosis. This technique for anastomosis is effective in preventing functional obstruction because no axial deviation between the proximal and distal anastomotic bowels exists, and the mucosal absorptive surface is completely preserved.

Anastomosis, Surgical↗
PubMed1999

The position and size of radiological nephrogram in Japanese preschool children.

The early detection of retroperitoneal masses in children, such as neuroblastoma, Wilm's tumor, hydronephrosis and cystic renal diseases, has a great clinical importance for the improvement of their prognosis. The kidney is often affected in its size or position by these lesions, and occasionally allows clinicians to find a clue to reach the correct diagnosis before the patient become symptomatic. Since we had no clinically available nomogram on the position and the size of the kidney in Japanese children, we measured the size and position of the kidneys on plain abdominal x-rays in 347 Japanese children in preschool years with a special attention to their relationship with the spine. As a result, the nomogram showed age dependent growth of the kidneys keeping almost the same ratio with the spine, while the distance between the upper pole of the kidney and the spine remained less than 10 mm in all age groups. Our nomogram may be useful not only for picking up the malposition of the kidneys but also for the follow up of the patients with chronic renal diseases affecting the growth of the kidneys.

Aging↗
PubMed1998

Surgical indications for neonatal ovarian cysts.

Ante- or neonatal ovarian cysts can be often diagnosed by routine ultrasonography. Small simple ovarian cysts, which can be followed with serial ultrasonography, usually resolve spontaneously. Large simple cysts and complicated cysts should undergo surgical treatment to reduce the potential for serious complications. Seventeen ovarian cysts were experienced between 1983 and 1997. Sixteen cases underwent surgical treatment at less than 1 month of age according to our protocols. In this report, we reviewed these cases for clinical presentation, ultrasound data, management, intraoperative findings, complications, and outcome. At operation, nine of them showed torsion, and seven of them showed necrotic changes. Only five of them was considered to fall into torsion by preoperative ultrasonography. In five cases whose blood flow could not improve after reduction of torsion, salpingo-oophorectomy was performed. We consider that small simple ovarian cysts under 4 cm in diameter can be observed carefully with serial ultrasonography. But, not only complicated ovarian cysts and simple cysts over 5 cm in diameter, but smaller cysts showing no decrease in size should be considered for surgical indication to rescue the ovarian tissue.

Female↗
PubMed1997

The effect of arginine supplementation on growth hormone release and intestinal mucosal growth after massive small bowel resection in growing rats.

Four-week-old male Sprague-Dawley rats underwent a 90% small bowel resection. From the fourth day after surgery, they were divided into group 1 and 2, and pair-fed by elemental diets (0.8 kcal/mL, 50 mL/day) with L-arginine (n = 10) or L-glycine (n = 11) as an isonitrogenous and isoenergetic supplement for 3 weeks. They were compared with each other 3 weeks after surgery. A statistical analysis was performed using the unpaired Student's t test and the one-way factorial analysis of variance (ANOVA) using Bonferroni/Dunn multiple comparison test. A Pvalue of < .05 was considered significant. There were no significant differences between the two groups in food intake, body weight, tail length, residual ileal length, and plasma IGF-I level. However, the mean height of ileal villi in group 1 showed higher than that in group 2 (P < .01). Growth hormone-releasing hormone (GHRH) provocative tests (1 microg per rat, intravenously) showed the more significant elevation of growth hormone IGH) secretion in the arginine supplement group than that of glycine supplement group at 5 minutes (P < .05). There were no significant differences between basal levels of plasma rat GH in both groups. It is suggested that arginine has a possible significant role of GH secretion and intestinal mucosal growth after massive small bowel resection.

Animals↗
PubMed1997

Experience with treatment of three pairs of conjoined twins.

Three pairs of female conjoined twins--a xiphoomphalopagus, a pygopagus, and a thoracopagus--were encountered during the past 10 years. Surgical separation was successful in the xiphopagus, and both twins survived. Separation was also successful in the pygopagus, but only one of the twins survived; the twin that died had sustained cerebral hemorrhage before the operation. Both of the twins in the thoracopagus died before surgery could be performed, due to sepsis and heart failure, 44 days after birth. Separation surgery of conjoined twins is often successful with a high survival rate of both twins unless vital organs such as the brain or the heart are fused. However, unlike other operations, separation surgery entails ethical considerations pertaining to matters such as the distribution of organs in addition to surgical considerations. Furthermore, separation of conjoined twins is certain to cause various degrees of anatomical as well as functional disorders associated with the surgical procedure, and provision for the postoperative care for these disorders is indispensable.

Abdominal Muscles↗
PubMed1997

[Therapeutic strategy and clinical outcome in congenital diaphragmatic hernia].

Congenital diaphragmatic hernia (CDH) continues to carry a high mortality rate 40%-60% mainly due to severe pulmonary hypoplasia. At our institute, thirty-seven neonates were treated for CDH diagnosed within the first 24 hours of life. Eleven of thirty-seven patients died and the mortality rate was 30%. Deaths in ten patients were due to severe pulmonary hypoplasia. The other one patient died from barotrauma at three months of age. All twenty-six patients who responded to ventilatory management and pharmacological therapies underwent surgical repair of CDH and all except one survived. Eight of eleven patients who did not respond to treatment also underwent surgery, but all died. These cases were all treated fufore ECMO introduction. Two of the other three in whom ECMO support was instituted died postoperatively. Among the parameters PH < 7, PaO2 < 60, PaCO2 > 60, AaDO2 > or = 600 and OI > or = 40 recorded on admission and examined retrospectively, OI > or = 40 was the most reliable as a predictor for poor outcome (sensitivity: 100%, specificity: 81%) and probably entry criteria for ECMO. The mean lung/body weight ratio of nonsurviving neonatal cases was as low as 0.49 +/- 0.18% while at least 1% is the critical value for survival. To salvage the CDH patient with severe pulmonary hypoplasia, surgical intervention before birth is inevitably necessary based on accurate prenatal diagnosis and established surgical techniques.

Animals↗
PubMed1993

Mental and intellectual development of neonatal surgical children in a long-term follow-up.

The mental and intellectual development of 75 children aged 6 to 10 years who had undergone operations during their neonatal period was estimated using the WISC-R intelligence test and the Bender-Gestalt test (BGT). WISC-R test results correlated with patients' total surgical stress scores, number of operations, and total duration of hospitalization. A tendency for verbal IQ deficiency was observed in many patients. BGT results correlated with the number of operations and total period of hospitalization. Patients with anorectal anomalies were apparently affected more than those with other diseases. An accumulation of therapeutic stresses relating to operations and hospitalizations during childhood extending through the neonatal period may affect subsequent mental and intellectual development.

Age Factors↗
PubMed1993

Immunoelectron microscopic study on IgA, secretory component and complement component C3 in the liver of children undergoing total parenteral nutrition through neonatal period.

To study the mechanism of the intrahepatic cholestasis observed during total parenteral nutrition (TPN) in neonates, we examined the localization of IgA, secretory component (SC) and complement component C3 (C3) in the liver in 4 patients by light and electron microscopic immunohistochemistry. In the patients who received TPN for 1 month, IgA- and SC-positive cholestasis was limited to bile canaliculi, but the integrity of both the canalicular wall and intercellular tight junction was maintained. These findings suggest that obstruction in the biliary tract develops at the canalis of Hering, causing reflux of IgA and SC into the bile canaliculi. When the duration of TPN extended beyond 6 months, the cholestasis in bile canaliculi progressed further, and degeneration of hepatocytes became more marked. Bile retained in hepatocytes occasionally contained IgA and SC. IgA- and SC-positive cholestasis also developed in the interlobular bile ducts, where no cholestasis had been observed 1 month after the beginning of TPN. SC production and SC-mediated transport of IgA, which are important functions of bile duct epithelial cells in the local immune mechanism, were impaired in association with the injury of those cells. C3 was localized not only in the hepatocellular organelles where C3 is normally observed, but also in the lumen of dilated bile canaliculi, suggesting that C3 is released from hepatocytes into bile in neonates receiving TPN and that C3 may be involved in some local immune mechanism of biliary system.

Complement C3↗
PubMed1989

On-line plasma exchange for sepsis in neonates and infants.

The present study was designed to assess the effectiveness of on-line plasma exchange (on-line P.E.) between septic infants and healthy adults using septic puppies. The plasma separation system consisted of a membrane plasma separator and a plasma treatment system, KM-9027 (Kurarey Co.) equipped with small 2 channel blood and plasma pumps. 5 X 10(9) CFU/ml/kg of E. coli with endotoxin was injected intravenously into 22 puppies and they were divided into 4 groups, namely untreated group (n = 7), on-line P.E. group (n = 5), P.E. group (n = 5), sham group (n = 5). In the on-line P.E. group, about 80 ml/kg of plasma in septic puppy was replaced during 2 hr with fresh plasma simultaneously obtained from healthy adult dog. As the results, 4 of 5 survived in the on-line P.E. group and 1 of 5 survived in the P.E. group, while all other puppies died within 24 hr. In the P.E. group and on-line P.E. group, mean blood pressure and urinary output were significantly improved (p less than 0.05) by the treatment. The numbers of E. coli and endotoxin concentration in the blood were reduced significantly (p less than 0.05) only in the treatment with on-line P.E. opsonic activity recovered significantly (p less than 0.05) in P.E. group. This system appears to be effective and applicable for sepsis in infants and neonates.

Age Factors↗
PubMed1989

Pathology of anomalous junction of the pancreaticobiliary ductal system: mutagenicity of the contents of the biliary tract and nuclear atypia of the biliary epithelium.

Congenital biliary dilatation is frequently complicated by biliary tract cancer, and anomalous junction of the pancreaticobiliary ductal system, a major factor constituting the pathology of this disease, is considered to be important as a background for carcinogenesis in the biliary tract. To clarify the mechanism of carcinogenesis in the biliary tract under the circumstance of anomalous junction, we evaluated the mutagenicity of the contents of the biliary tract in patients with congenital biliary dilatation and analyzed the nuclear atypia of the biliary epithelium by fluorocytometry. A mutagenicity test using Bacillus subtilis showed positive results in 6 of 12 patients. Since mutagenicity correlates well with carcinogenicity, these results suggest the necessity of separation surgery between the bile and pancreatic ducts in patients with anomalous junction regardless of the presence or absence of biliary dilatation. On the other hand, DNA histograms of the nuclei of gallbladder epithelial cells produced by fluorocytometry in 4 patients revealed a high incidence of polyploid DNA in 2 patients with marked hypertrophic changes. These patients were also positive for mutagenicity of the contents of the biliary tract, suggesting that mutagens are involved in the atypia at the cellular and nuclear levels.

Adolescent↗
PubMed1985

The effects of total parenteral nutrition on gastrointestinal growth and development.

Total parenteral nutrition (TPN) is vital for the nutritional support of infants with disorders of the gastrointestinal tract that prevent adequate enteral intake. Studies in adult rodents maintained on TPN have demonstrated intestinal atrophy and decreased activity of the brush border enzymes of the small bowel mucosa. We studied the effects of TPN during the phase of rapid intestinal growth and development in piglets. Matched groups of three 6-week-old weaned piglet littermates received a glucose (45 g/kg/d), amino acid (8 g/kg/d), and fat (2.5 g/kg/d) solution intravenously (IV) or by gastrostomy (GF), or were given hog chow (Chow) at an equivalent caloric value for three weeks. No differences were noted in the mean weight gain (13-15 g/kg/d), total serum protein (4.5-4.8 g/dL), BUN (9-12 mg/dL), or Hct (25% to 30%). The IV and GF animals, compared to the Chow animals, had decreased growth of the stomach, small bowel, and pancreas with decreased small bowel mucosal disaccharidase activity. The IV group, compared to Day 0 animal measurements, had decreased small bowel length and weight and pancreatic weight. Histology of the proximal small bowel mucosa in the IV animals showed decreased mucosal depth, villus height, crypt depth, and epithelial cell number from the crypt base to the midvillus. These findings suggest that stomach, small bowel, and pancreatic growth are dependent on the route of administration and/or the composition of the diet, the small bowel mucosa and the pancreas atrophies in young piglets maintained on TPN, the activity of some intestinal brush border disaccharidases are decreased in the small bowel in piglets maintained on either an intravenous or an intragastric infusion of a TPN solution.

Animals↗