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Biomedical subjects

T Todani

Publications and source records attributed to T Todani.

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

Changes in splenic volume after partial splenic embolization in children.

AIM: The authors studied changes in splenic volume after partial splenic embolization (PSE) in children who had thrombocytopenia caused by splenomegaly. MATERIALS AND METHODS: Five children with hypersplenism (ages of 1, 6, 7, 10, and 14 years) underwent PSE. The follow-up period ranged from 1 month to 8 years 9 months. Whole and infarcted splenic volumes were measured from computed tomography images obtained before and after PSE. RESULTS: Within 2 weeks after PSE, the whole splenic volume increased to 110% to 140% of the pre-PSE volume. The infarcted area disappeared 3 to 4 months after PSE, and the whole splenic volume decreased markedly. The decreased volume tended to be stable during the follow-up period. The splenic enlargement before PSE ranged from 7.2 to 14.2 times the standard splenic volume for a corresponding body weight. The splenic volume did not become normal after PSE; it remained between 2 and 7 times larger than standard. Platelet counts stayed above 10 x 10(4) /mm3 when the splenic volume reduced to 2 times the standard volume. CONCLUSION: The first 4 weeks after PSE is the most dangerous period for the development of splenic capsule. The infarcted parenchyma is absorbed 3 to 4 months after PSE, and the whole splenic volume is reduced. Thereafter, the splenic volume is stable for several years. Reembolization is not likely to be necessary in the majority of patients who have had splenic embolization with an infarction rate of > or = 80%.

Adolescent↗
PubMed1996

[Cancer arising in choledochal cyst and management].

Biliary cancer develops in 20-30% of the patients with choledochal cyst and pancreatobiliary malunion. Some bile acid fractions and refluxed pancreatic enxymes into the bile duct is probably responsible for carcinogenesis. Cancer often develops in the extrahepatic bile duct and gallbladder, and rarely in the intrahepatic duct. In cystic dilatation, cancer often occurs in the common bile duct, while in diffuse or non-dilated type it occurs in the gallbladder. Cancer usually occurs in younger patients than does biliary cancer in general population, and the average age is in the 40s. The risk of malignancy in cysts with internal drainage is higher than that in primary cysts, and early removal of the retained cyst should be performed as quickly as possible. Although the prognosis of biliary cancer is usually dismal, aggressive procedures are recently gaining better results than that by conventional methods. The prevention of cancer is the procedure of choice by early excision. Removal of the whole extrahepatic bile duct is necessary, even in case of malunion with no biliary dilatation. Cancer rarely arises in the intrahepatic duct after excisional surgery, due to long standing biliary stricture. Wide anastomosis with ductoplasty should be essential. Cancer also occurs in the remnant duct. Excision of the distal duct in the pancreas is also necessary.

Bile Duct Neoplasms↗
PubMed1995

Peritoneal lavage versus drainage for perforated appendicitis in children.

A total of 231 children with acute appendicitis were treated at our hospitals during the 10 years between 1984 and 1993, 53 of whom had a perforated appendix. These 53 patients were randomly assigned to two groups at the time of surgery according to the different procedures performed. Thus, 29 children were managed by appendectomy followed by peritoneal lavage using a large amount of saline, and intravenous antibiotic therapy consisting of aminoglycoside and cephem (lavage group), while the other 24 children were treated by appendectomy with silicon tube drainage and the same systemic antibiotic therapy (drainage group). The mean length of hospitalization, and the mean durations of fever and the need for fasting after laparotomy in the lavage group were significantly less than those in the drainage group: 10.1 versus 18.8 days, 2.8 versus 7.7 days, and 1.8 versus 3.5 days, respectively. The operation wounds healed well in the lavage group due to the fact that there was no drain. Wound infections occurred in two children from the lavage group and six from the drainage group. Intra-abdominal abscesses occurred in two children from the drainage group. Accordingly, peritoneal lavage appears to be superior to intraperitoneal tube drainage for the management of perforated appendicitis in children.

Adolescent↗
PubMed1995

Biliary complications after excisional procedure for choledochal cyst.

During the last 25 years, from 1969 to 1994, the authors treated 97 choledochal cysts by surgical excision. Biliary reconstruction consisted of 67 hepaticoduodenostomies and 30 hepaticojejunostomies. The common hepatic duct was the site of anastomosis in 9 of the duodenostomies and 13 of the jejunostomies and of the bifurcation of the hepatic ducts in 58 duodenostomies and 17 jejunostomies. Reoperation was required in 10 cases because of recurrent cholangitis with intrahepatic gallstones. Biliary strictures were responsible for the cholangitis in 9 children with anastomoses at the level of the common hepatic duct and in 1 with an anastomosis at the level of the bifurcation. These results suggest that biliary complications develop because of anastomotic stricture or primary ductal stricture, and may be minimised by the creation of a wide anastomosis, which is best accomplished at the hepatic hilum.

Adolescent↗
PubMed1995

Alveolar rhabdomyosarcoma of the lung in a child.

The case of a 22-month-old boy with alveolar rhabdomyosarcoma of the lung is presented. Brain metastasis and recurrence of the right pulmonary hilum and parietal pleura developed 6, 11, and 24 months (respectively) after tumor resection. Chemotherapy and radiotherapy were effective. Neuron-specific enolase was very helpful in detecting metastasis and disease recurrence. Primary pulmonary rhabdomyosarcoma can be divided into two groups: tumor in the normal lung, and tumor in cystic lesions of the lung.

Biomarkers, Tumor↗
PubMed1995

Does hyperamylasemia in choledochal cyst indicate true pancreatitis? An experimental study.

Patients with choledochal cyst often have repeated attacks of abdominal pain accompanied by hyperamylasemia, and they may be diagnosed as having acute pancreatitis. However, the attacks generally tend to subside in a short period by conservative treatment, and evidence of pancreatitis is rarely observed at the time of surgery. Choledochal cyst is commonly associated with pancreatobiliary maljunction, and high concentrations of pancreatic enzymes in bile are usually observed. When the bile duct pressure increases due to obstructive cholangitis, pancreatic enzymes in bile may regurgitate into the blood stream. Cholangiovenous reflux of amylase might cause hyperamylasemia. In order to investigate the mechanism of hyperamylasemia by cholangiovenous reflux, canine pancreatic juice or bile from a patient with choledochal cyst was injected into the obstructed common bile duct in dogs. The pancreatic enzymes in bile could readily enter into the blood stream at the pressure level of 15 mmHg or more in the bile duct. The peak amylase level in the thoracic lymph was observed to be more than 4 times higher than that in the blood serum, and the lymph flow during 30 minutes increased significantly from 8.1 to 20.4 ml at the bile duct pressure level of 20 mmHg. The reflux of amylase in bile into the blood stream via both the hepatic vein and thoracic duct might result in hyperamylasemia in the patients with choledochal cyst.

Acute Disease↗
PubMed1995

Characteristics of choledochal cysts in neonates and early infants.

Thirty-six infants with choledochal cyst consisting of 28 babies less than 12 months of age and 8 between 13 and 24 months of age, were analyzed. Characteristics of cases were as follows: (1) they were usually of the cystic type, (2) a huge abdominal mass and jaundice with alcoholic stool were typically found, (3) no symptom suggesting acute pancreatitis was observed, (4) amylase levels in bile were usually low, despite the presence of pancreatobiliary malunion, while other pancreatic enzymes in bile commonly showed a high concentration, and (5) primary cyst excision and biliary reconstruction was the treatment of choice, and could be safely performed with favorable outcomes even in babies less than 1 year of age.

Amylases↗
PubMed1994

The effects of feeding and secretin administration on the pancreaticoduodenal papilla of conscious dogs.

The aim of this study was to define the functional role of the pancreaticoduodenal papilla (PDP) in the regulation of pancreatic outflow into the duodenum in response to feeding and secretin administration in conscious dogs. The canine model we developed allowed for measurement of the pancreatic ductal pressure and pancreatic outflow simultaneously in a physiological state without interfering with the flow of pancreatic juice via the intact sphincter of the duodenal papilla. Feeding increased the pancreatic outflow from 2.8 +/- 0.2 to 13.4 +/- 1.3 ml/15 min with a slight increase in the pancreatic ductal pressure from 8.5 +/- 0.6 to 13.7 +/- 1.4 cmH2O. The administration of secretin increased the pancreatic outflow from 2.8 +/- 0.2 to 12.7 +/- 1.0 ml/15 min without increasing the pancreatic ductal pressure. The viscosity of the pancreatic juice increased during exposure to food, but decreased following food intake and secretin administration, after which the PDP seemed to dilate by about 40% of the fasting value. The results suggest that PDP changes its opening to maintain the pancreatic ductal pressure below a certain level, even if pancreatic secretion into the pancreatic duct increases due to food intake and secretin administration.

Ampulla of Vater↗
PubMed1993

Ischemic jejunal stricture developing after diabetic coma in a girl: a case report.

A 15-year-old girl with ischemic stricture of the jejunum, probably due to microangiopathy caused by diabetes mellitus is presented. Laparotomy revealed two circular strictures in the proximal jejunum, and histology showed ischemic enteritis with ulceration, granulation with microvascular proliferation, inflammatory cell infiltration, marked fibrosis, and hemosiderin deposition. Uncontrolled diabetes mellitus often causes ketoacidosis, increased blood viscosity and platelet aggregation, dehydration in addition to hyperglycemia, and occasionally results in occlusive or non-occlusive vascular disease of the intestine. Ischemic stricture of the bowel in the diabetic state is probably related to moderate ischemia resulting in ulceration and scar formation in the intestine.

Adolescent↗
PubMed1990

Pseudopancreatitis in choledochal cyst in children: intraoperative study of amylase levels in the serum.

A case of acute necrotizing pancreatitis in association with choledochal cyst is presented. Pancreatitis associated with choledochal cyst is probably caused by a biliary reflux into the pancreatic duct via a pancreatobiliary malunion, as the intraductal pressure of the cyst exceeds that of the pancreatic duct. Ampullar stenosis due to gallstones or inflammatory changes may increase the intraductal pressure. Bile with activated pancreatic enzymes refluxes into the pancreatic duct, and possibly results in acute pancreatitis. However, patients with choledochal cyst presenting with recurrent bouts of abdominal pain, vomiting, and fever have often been diagnosed as having acute pancreatitis because of hyperamylasemia, despite no evidence of pancreatitis at the time of surgery. At the time of bouts, they also show a slight elevation of serum bilirubin, and an increase in the degree of the choledochal dilatation that are possibly caused by biliary obstruction, not ampullar obstruction, due to suppurative cholangitis. The term "fictitious pancreatitis" or "pseudopancreatitis" in choledochal cyst appears to be appropriate. This clinical study shows that amylase in the biliary tract has ready access to the blood stream, probably through a sinusoidal pathway by cholangiovenous reflux, and a lymphatic pathway, via the Disse's space and denuded cyst wall, provided the biliary ductal pressure is increased.

Abdominal Pain↗
PubMed1990

Endodermal sinus tumour of the posteroinferior mediastinum resembling dumbbell neuroblastoma in a child.

A male infant presenting with paraplegia due to intraspinal extension of an endodermal sinus tumour in the posteroinferior mediastinum is reported. Dumbbell tumours are usually observed in mediastinal neuroblastomas, and rarely in rhabdomyosarcomas of the chest wall. The present case demonstrates the clinical similarity of endodermal sinus tumours to neuroblastomas with extradural extension. Therefore, endodermal sinus tumours should be considered in the differential diagnosis of posterior mediastinal masses, because of the distinctly different treatment from that for other tumours.

Combined Modality Therapy↗
PubMed1990

Air reduction for intussusception in infancy and childhood: ultrasonographic diagnosis and management without X-ray exposure.

For the treatment of uncomplicated intussusception in infants and children, we attempted air reduction without x-ray study to avoid the genetic and carcinogenic effects of radiation. Intussusception could generally be diagnosed by ultrasonography in addition to the history and typical clinical signs without using a barium enema. The success of reduction could also be safely evaluated from the disappearance of both the characteristic sonographic target sign and the abdominal palpable mass, and improvement in the general condition 2 or 3 hours after completing this procedure. This simple, cheap and clean reduction method was applied to 127 patients under strict indications and sedation with diazepam. The successful reduction rate was high (90.6%) and equal to that by hydrostatic reduction. Accordingly, this procedure appears to be safely applicable to the management of uncomplicated intussusception in infancy and childhood.

Air Pressure↗
PubMed1988

Frantz's tumor: a papillary and cystic tumor of the pancreas in girls.

Four girls with Frantz's tumor, a papillary and cystic tumor of the pancreas, are studied and discussed in comparison with 112 cases in the literature, including 58 Japanese cases. The neoplasms occur predominantly in girls and young women. Up to recently, the tumors have possibly been misclassified as nonfunctioning islet cell tumor or carcinoma, acinar cell carcinoma, papillary cystadenocarcinoma, or pancreatoblastoma according to microscopic findings and frequently have been managed with aggressive surgery such as pancreatoduodenectomy. The tumors are well encapsulated and the cut surfaces show characteristically solid and hemorrhagic-necrotic patterns. Ultrasonography and CT scan are the most useful tools for the diagnosis. The neoplasms usually behave like a very low-grade malignancy, so that complete removal is the treatment of choice for the tumor arising anywhere in the pancreas. Immunochemical and electron microscopic studies can differentiate Frantz's tumor from other neoplasms and also suggest that the tumors originate from primordial cells or multipotential stem cells capable of differentiating into both exocrine and endocrine lines.

Adolescent↗
PubMed1988

Reoperation for congenital choledochal cyst.

A reoperation after excisional procedure was carried out in seven cases due to early or late postoperative complications. Of the 12 patients with early complications, four underwent relaparotomy due to anastomotic leakage and bleeding. Late complications were seen in nine patients with recurrent cholangitis caused by an anastomotic stricture, and three patients with intrahepatic involvement required a reoperation several years after the initial surgery. Recurrent cholangitis after biliary reconstruction mainly occurs due to an anastomotic stricture of the hepaticoenterostomy. There was no significant difference in the results between hepaticoduodenostomy and hepaticojejunostomy over a long follow-up period. A wide anastomotic stoma that permits free drainage of bile into the intestine is imperative to the prevention of cholangitis, and can be created by an incision extending along the lateral wall of both the hepatic ducts with a hepaticoenterostomy at the hilum. This procedure is obviously necessary in all patients with or without intrahepatic involvement. Carcinoma of the intrahepatic ducts and the retained distal choledochus have rarely developed in patients undergoing cyst excision followed by biliary reconstruction. Complete excision of the whole extrahepatic bile duct could prevent carcinoma arising in the distal choledochus, although it could not prevent carcinoma arising from the intrahepatic ducts. However, patients with carcinoma of the intrahepatic duct were reported to have had symptoms of biliary stricture for a long time since the cyst excision. Bile stagnation in the intrahepatic ducts is possibly responsible for the development of carcinoma. A wide anastomosis resulting in free drainage of bile appears to be essential to the prevention of carcinoma arising in the intrahepatic ducts after cyst excision.

Adenocarcinoma↗
PubMed1987

Carcinoma related to choledochal cysts with internal drainage operations.

Carcinoma arising in a choledochal cyst retained after enteric drainage is discussed in comparison with primary carcinoma. In our series, carcinoma developed in eight of 82 patients with choledochal cyst and three of the eight had secondary carcinoma occurring several years after enteric drainage. Forty-two similar instances and 235 instances of primary carcinoma have been reported in Japan. The mean age at detection of carcinoma in enteric drainage was 35 years old, 15 years less than that of primary carcinoma. The mean interval between drainage and detection of carcinoma was ten years. Carcinoma mainly arose from the retained cyst in drainage, while primary carcinoma developed in either the cyst or gallbladder. The prognosis was very poor. Almost all patients undergoing enteric drainage died soon after the detection of carcinoma. This is possibly due to the delay in diagnosis. Pancreatic juice can easily regurgitate into the choledochus through an anomalous junction of the pancreatobiliary ductal system, and enteric drainage causes pancreatic juice in the cyst to become activated due to the influx of intestinal juice. Therefore, inflammatory changes of the cyst are accelerated and probably result in carcinoma. Early excision of the choledocus should be recommended in patients with choledochal cyst retained after enteric drainage.

Adenoma, Bile Duct↗