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T Tokuhara

Publications and source records attributed to T Tokuhara.

28 records · Page 2Linked to original sources
PubMed1994

[Three operated cases of epiphrenic esophageal diverticulum].

Three cases of epiphrenic esophageal diverticulum, treated successfully by surgery, were reported. Case 1 was a 71-year-old female associated with gastroesophageal reflux and esophageal dysmotility. Case 2 was a 40-year-old female associated with gastroesophageal reflux but no esophageal dysmotility. Case 3 was a 51-year-old male who showed no abnormality in esophageal pH and manometry, and esophageal scintigraphy. Resection of the diverticulum was performed in three cases and Belsey's fundoplication was added in case 1 and 2. In the patients with epiphrenic diverticulum, concomitant esophageal dysfunction can be the cause of the diverticulum and symptom. It is essential in deciding the surgical procedure to evaluate the esophageal function in the patients with epiphrenic esophageal diverticulum.

Adult↗
PubMed1994

[Function of the upper esophageal sphincter after denervation of recurrent laryngeal nerves and intramural nerves of the cervical esophagus in dogs].

The upper esophageal sphincter prevents reflux into the pharynx. If it functions improperly, aspiration pneumonia can result. We studied the functioning of the sphincter in unanesthetized dogs after denervation under anesthesia of the recurrent laryngeal nerves. The pressure of the sphincter at rest was measured by manometry with a transducer that measured pressure around the tip of a catheter. Then the pressure in response to inflation of a balloon to the diameter of 1.5, 2.0 and 2.5 cm at 5 and 10 cm aboral to the sphincter was measured. Next, the pressure during perfusion of 0.1 N HCl or NaOH 10 cm aboral to the sphincter was measured. These studies were done first in 10 dogs that had undergone only gastrostomy for measurements (controls). Measurements were repeated after the left recurrent laryngeal nerve in the controls was cut (L group), after the right recurrent laryngeal nerve in the L group was cut (B group), and after transection of the esophagus 7 cm aboral to the sphincter in the B group (T group). The differences in the pressure at rest were not significant. In each group, balloon inflation to any diameter tested and at either position made the pressure rise above that at rest. This pressure in the L, B, and T groups, however, was significantly lower than in the controls. When the balloon was inflated to 2.5 cm when it was 10 cm aboral to the sphincter, the pressure in the T group was significantly lower than in the B group. When HCl or NaOH were perfused, the pressure increased gradually in the controls, but not in the other groups. In conclusion, although recurrent laryngeal nerves did not affect the function of the sphincter at rest, they were the afferent routes of the contraction by the sphincter as a reflex following distension or chemical stimulation of the esophagus. The intramural nerve network of the cervical esophagus may be another reflex route of contraction of the upper esophageal sphincter.

Animals↗
PubMed1993

Effect of adrenoceptor agonists on striated muscle strips of the canine oesophagus.

1. Acute psychological stress, which could be related to the release of a large amount of catecholamines, may cause oesophageal motility disorders. Therefore, the aim of our study was to elucidate the influence of adrenoceptor agonists on the striated muscle portion of the oesophagus by use of isolated strips from dogs. 2. Contractions were evoked in isolated striated muscle strips by electrical field stimulation (1 pulse min-1, 1 ms/pulse, submaximal voltage). The effects induced by administration of adrenoceptor agonists alone or in the presence of antagonists were tested to determine the nature of the adrenoceptors on this muscle preparation. 3. The administration of both the natural adrenoceptor agonists, adrenaline and noradrenaline, and the synthetic beta-adrenoceptor agonists, isoprenaline (beta 1 + beta 2), dobutamine (beta 1) or ritodrine (beta 2), enhanced the amplitude of the contractions induced by electrical stimulation in a concentration-dependent manner. The maximum responses were 82.6 (adrenaline), 66.2 (noradrenaline), 86.2 (isoprenaline), 34.6 (dobutamine) and 80.8% (ritodrine). The EC20 values obtained were respectively 2 nM, 0.2 microM, 0.91 nM, 3 microM and 80 nM. The administration of the alpha 1-adrenoceptor agonist, phenylephrine, also enhanced the contractile response in a concentration-dependent manner (EC20 value = 0.3 microM) and the maximum response was 64.6%, but the administration of the alpha 2-adrenoceptor agonist, clonidine, did not influence the contractile response. These data suggest the involvement of beta 2- and possibly alpha 1-adrenoceptors in the responses of these adrenoceptor agonists. 4 The selective P2-adrenoceptor antagonist ICI 118551 (3-100nM) shifted the concentration-effect curves for noradrenaline, phenylephrine and ritodrine to the right in a concentration-dependent manner.ICI 118551 (3 nM) also shifted the concentration-effect curves for adrenaline and isoprenaline to the right, but increasing the concentration of ICI 118551 did not cause any further antagonist activity until a concentration of 100 nM, when a further rightward shift was obtained.5. The selective alpha 1-adrenoceptor antagonist, prazosin (30-300 nM), did not affect the increased contractile responses induced by adrenaline, noradrenaline, phenylephrine, isoprenaline or ritodrine.6. In conclusion, it appears that beta2-adrenoceptors are present in the striated muscle portion of the canine oesophagus, where they mediate an enhancement of contractile responses evoked by electrical stimulation. The alpha l-agonist, phenylephrine, appears to interact with beta2-adrenoceptors on this preparation.beta 3-Adrenoceptors have already been demonstrated in smooth muscle from various parts of the gastrointestinal tract, and our study does not exclude the possibility that there is an additional population of beta 3-receptors in the canine striated muscle part of the oesophagus.

Adrenergic alpha-Agonists↗
PubMed1992

[Clinical study on responses of the upper esophageal sphincter after subtotal esophagectomy for esophageal cancer].

Responses of the upper esophageal sphincter (UES) to distention of the esophageal wall by use of a balloon catheter were measured in 30 patients after subtotal esophagectomy for esophageal cancer and 33 volunteers with unrelated disorders (control group). Patients were divided into extended dissection group and non-extended dissection group according to the width of lymph node dissection, or palsy group and non-palsy group according to recurrent-laryngeal nerve palsy. The resting upper esophageal sphincter pressure (UESP) and the upper esophageal sphincter contraction (UESC) following UES induced by swallowing were measured after esophageal distention. Neither of UESP nor UESC without distention was significantly different among each group. But those of the extended dissection group and palsy group after esophageal distention were significantly lower values than those of control group. These findings suggest that responses of the UES to distention of esophageal wall are decreased, thus protection against aspiration is probably decreased.

Adult↗
PubMed1991

[Usefulness of Roux-Y type bypass operation using pedicled jejunum in unresectable esophageal cancer].

Twelve patients underwent bypass operation for unresectable esophageal cancer in our department in recent 5 years were reviewed. A group of 8 patients who had Roux-Y type bypass operation using pedicled jejunum was compared with a group of 4 patients who had bypass operation using gastric roll. 1) The anastomotic leakage was found in one patients in each group of patients. 2) The operating time and amount of bleeding were significantly less in the patients being used the jejunal pedicle than in the patients being used the gastric roll. 3) No significant difference was found in the possibility of oral uptake and discharge from hospital and postoperative survival period between these two groups. The bypass operation for unresectable esophageal cancer is a riskful operation. But, we found that the Roux-Y type bypass operation using the pedicled jejumun was a safe and uninvasive procedure for a patient with high risk.

Aged↗
PubMed1989

[Traumatic diaphragmatic hernia].

Five cases of traumatic diaphragmatic hernia were reported and 495 cases reported in Japan were reviewed. Analysis of cases of hernia following blunt trauma in the present study provided a simple classification of fissure of the diaphragm, i.e., "tension type (indirect type)" and "impact type (direct type)". In the former type, the fissure occurs in the central tendon or its vicinity in the diaphragm as a result of distortion of the bony thorax without direct force on the diaphragm, while in the latter type, the fissure occurs in the diaphragm close to the struck bony thorax as a result of blunt force on the bony thorax to which the diaphragm is attached.

Adult↗
PubMedDate not supplied

Perforated duodenal diverticulum: report of two cases.

Duodenal diverticula may be complicated by diverticulitis, perforation, hemorrhage, pancreatitis, or biliary obstruction. Two cases of perforated duodenal diverticulum are reported. Both patients were elderly females. Computed tomography of the abdomen showed retroperitoneal air around the duodenum in the first case, and an enterolith in a duodenal diverticulum and a retroperitoneal abscess in the second case. Laparotomy and diverticulectomy with two-layer closure of the duodenum was performed in the first case. The second patient was treated conservatively with antibiotics, percutaneous abscess drainage, and endoscopic lithotomy. Both recovered well. Computed tomography is useful in the diagnosis of a perforated duodenal diverticulum. Although surgical intervention is the standard treatment, conservative therapy is also an option. Duodenal enteroliths are rare but may cause perforation of a diverticulum or biliary obstruction. The duodenal blind loop created by a Billroth II gastrectomy provides a static environment for the formation of enteroliths in duodenal diverticula.

Abdominal Abscess↗