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Biomedical subjects

Y Mamada

Publications and source records attributed to Y Mamada.

At least 19 recordsLinked to original sources
PubMed2005

Splenic artery embolization before laparoscopic splenectomy in children.

BACKGROUND: This study assessed the safety and utility of preoperative splenic artery embolization before laparoscopic splenectomy in children. METHODS: Five young girls with a mean age of 13.2 years underwent laparoscopic splenectomies at the authors' institution from August 1998 to April 2003. Three of the patients had idiopathic thrombocytopenic purpura, and two had hereditary spherocytosis. Preoperative splenic artery embolization was performed the day before the surgery in all cases. The laparoscopic splenectomy was performed using traditional laparoscopic procedures and standard laparoscopic instruments with the patient in the right semilateral position. RESULTS: The mean spleen weight was 252.6 g, and the mean length was 11.6 cm. All the patients reported postembolic pain, but not to a level unmanageable by intravascular narcotics. There were no severe complications in the splenic artery embolization. The laparoscopic splenectomies were completed in a mean of 211 min, with a mean estimated blood loss of 9 ml. None of the operations required conversion to traditional open laparotomy, and none of the patients died or experienced operative complications. CONCLUSION: The authors concluded that splenic artery embolization is safe and useful as an adjuvant procedure performed before elective laparoscopic splenectomy in children.

Adolescent↗
PubMed2003

Hand-assisted laparoscopic hepatectomy after partial splenic embolization.

The case of a patient with hepatocellular carcinoma and thrombocytopenia secondary to liver cirrhosis who underwent successful hand-assisted laparoscopic hepatectomy after partial splenic embolization is described. A 67-year-old man with severe liver cirrhosis was admitted for treatment of hepatocellular carcinoma. His early phase of hepatic angiography showed two hypervascular tumors in segment 6. The patients liver function was poor, with the indocyanine green retention at 15 min of 49.5%, a total serum bilirubin concentration of 2.0 mg/dl, an albumin concentration of 2.8 g/dl, and an hyaluronic acid concentration of 649 ng/ml. The platelet count was 3.0 x 10(4)/microl secondary to hypersplenism. Partial splenic embolization decreased the splenic volume by 50% preoperatively. At 2 months later, the platelet count was 6.0 x 10(4)/microl, and hand-assisted laparoscopic partial hepatectomy was performed uneventfully. The patients postoperative course was unremarkable, and he was discharged on postoperative day 12.

Aged↗
PubMed2001

Acute cholecystitis caused by a cholesterol polyp.

A 39-year-old man hospitalized with upper abdominal pain had been found to have a 3mm polyp in the body of the gallbladder 3 years previously. Laboratory tests on admission showed mild liver dysfunction. Ultrasonography depicted a dilated gallbladder with increased wall thickness; the polyp could no longer be seen. Computed tomography with drip infusion cholangiography again showed a dilated gallbladder, and also stenosis of the distal cystic duct. The resected specimen obtained by laparoscopic cholecystectomy showed disappearance of the polyp from the body of the gallbladder. A cholesterol stone was incarcerated in the cystic duct, representing an impacted detached cholesterol polyp causing acute cholecystitis. Spontaneous detachment of a cholesterol polyp from the gallbladder mucosa, then, can result in acute cholecystitis.

Acute Disease↗
PubMed2001

Celiac artery aneurysm: a case evaluated preoperatively with three-dimensional computed tomographic angiography.

In a 63-year-old woman computed tomography (CT) incidentally detected a celiac artery aneurysm approximately 3 cm in diameter. While conventional angiography suggested that the splenic artery and common hepatic artery arose from the celiac artery aneurysm, three-dimensional CT angiography indicated that the aneurysm involved only the mid portion of the celiac artery. Considering the risk of eventual aneurysm rupture, surgery was performed. Aneurysmectomy and devascularization of hepatic, splenic, and celiac arteries were carried out following complete cross-clamping of the celiac artery. The distal segment of the celiac artery was directly anastomosed to the proximal segment in an end-to-end fashion. Histologically, the aneurysm wall showed atheromatous changes. Contrast-enhanced abdominal CT confirmed complete removal of the celiac artery aneurysm, and postoperative angiography confirmed good arterial flow. The patient recovered uneventfully after surgery, with normalization of transiently abnormal hepatic function parameters. In this case of celiac artery aneurysm, three-dimensional CT angiography was found to be valuable in determining the relationships of the aneurysms to important arterial branches.

Aneurysm↗
PubMed2001

Liver cell adenoma in a 26-year-old man.

This is a report of a case of liver cell adenoma (LCA) in a 26-year-old man with no prior history of liver disease or glycogen storage disease and no record of hormonal therapy. He was found to have an asymptomatic hepatic mass during a routine medical examination. The physical findings were unremarkable, and the results of routine laboratory studies were all within normal limits. Selective hepatic arteriography showed a hypervascular mass within the right lobe of the liver. Despite the radiological examination, the nature of the mass was unknown, and preoperative biopsy was unadvisable because of the risk of bleeding. Because of the difficulty of determining the malignancy of the hepatic tumor preoperatively, elective laparotomy for diagnosis and hepatectomy as treatment appeared to be the best available approach. Pathological examination of the surgical specimen resulted in a diagnosis of LCA. A review of the literature revealed that LCA unassociated with the use of oral contraceptives is rare.

Adenoma, Liver Cell↗
PubMed2001

Spontaneous disappearance of a hepatic cyst.

The spontaneous disappearance of a hepatic cyst is described. A 62-year-old woman presented with symptoms of general fatigue in August 1992. Her past medical history was significant for chronic hepatitis, which was diagnosed in 1990 but not treated. Initial laboratory tests revealed mild liver dysfunction with a positive serologic test for hepatitis C. In August 1992, ultrasonography and computed tomography disclosed a cystic lesion along the middle hepatic vein in the right anterior segment of the liver, which was 40 mm in diameter. Repeat radiologic studies in June 1994 demonstrated that the size of the cyst was unchanged. In May 1995, the cyst was only 25 mm in diameter, and it continued to decrease in size thereafter, to 10 mm in September 1995 and 7 mm in September 1996. No hepatic cyst was visualized in December 1996, though the region in which the cyst existed was hyperechoic. Laboratory data were essentially unchanged from August 1992 to December 1996. Clinically the patient remained asymptomatic.

Cysts↗
PubMed2000

Reconstruction of the vena cava with the peritoneum.

BACKGROUND: Reconstruction of the vena cava with an autologous vein requires extra incisions. Prosthetic material is associated with an increased risk of infection. We therefore created an animal model of vena cava reconstruction using the peritoneum. METHODS: A 2.5 x 2.5 cm piece of peritoneum was resected from 7 pigs weighing 30 to 40 kg. An oval window (long axis: 1.5 cm) was made in the infrarenal vena cava. This was repaired with the peritoneal patch fixed in alcohol. RESULTS: In 2 animals sacrificed at 5 hours, there was no evidence of thrombosis, but there was fibrin clot on the patches. Two animals sacrificed on day 8 exhibited excellent patency of the vena cava. Complete endothelialization of the patch was noted at day 15. At 6 weeks, the vena cava was healed. No infections or other problems were noted. CONCLUSIONS: The peritoneum is an accessible and safe substitute for reconstruction of the vena cava.

Animals↗
PubMed1997

Indication of chemoembolization therapy without gelatin sponge for hepatocellular carcinoma.

This study evaluated the effect of chemoembolization (C-LIP) consisting of ethiodized oil (Lipiodol Ultra Fluid; André Guerbet, Aulnay-sous-Bois, France) and epirubicin, without gelatin sponge on hepatocellular carcinoma (HCC), administered by hepatic arterial infusion. We analyzed the cases from two points of view: the local recurrence rate for hypervascular solitary small HCC (tumor size: < or =3 cm in diameter) and the cumulative survival rate for advanced HCC (stage VI according to the criteria of Liver Cancer Group of Japan) following C-LIP therapy. The C-LIP also was compared with transcather arterial embolization (TAE; C-LIP followed by gelatin sponge) and percutaneous ethanol injection therapy (PEIT). In the small HCC cases, the recurrence rate at 1 year after C-LIP was 77% (10 of 13 patients), while the local recurrence rate was 46% (six of 13 patients) at 6 months and 61% (eight of 13 patients) at 1 year. The local recurrence rate at 1 year was 29% (four of 14 patients) after TAE and 20% (three of 15 patients) after PEIT. These results showed that the effect of local anticancer therapy by C-LIP was not as potent as that of TAE or PEIT. In advanced HCC cases, the cumulative survival rate for 13 patients treated by C-LIP was 72% at 6 months, 36% at 1 year, and 14% at 2 years. However, the survival rates for 13 patients at 6 months, 1 year, and 2 years after TAE were 46%, 23%, and 8%, respectively. There was no difference between the C-LIP patients and TAE patients with regard to the pretreatment liver function. Three patients died within 2 months after the initial TAE. These deaths were mainly due to damage to the noncancerous liver parenchyma. Therapy with C-LIP alone was not appropriate for hypervascular solitary small HCCs, and additional treatment was necessary. We think C-LIP therapy should be selected instead of TAE for advanced HCCs to avoid severe parenchymal damage.

Aged↗
PubMed1995

[Clinical evaluation of endoscopic variceal ligation (EVL) using an intensive ligation method].

Endoscopic variceal ligation using an intensive ligation method, or intensive EVL, as we call it, was performed in 17 cases of esophageal varices, from August 1993 to November 1994. Intensive EVL involves making as many ligations as possible from just above the esophago-gastric junction at every session for the complete eradication of varices (F0 and negative Red color sign). Our success rate for the complete eradication of varices was 82.4% (14 out of 17 cases) with the mean number of sessions at 2.2 +/- 0.5 times. The total number of rubber bands used was 20.2 +/- 8.4, with 14.1 +/- 6.0 being used in the initial session alone. The rate of recurrence in complete eradicated cases was 50% (7 out of 14 cases) and the period to recurrence was 6.3 +/- 0.7 months. Although EVL using the intensive ligation method is useful for complete eradication of varices, a high incidence of recurrence in the short term is a concern. We conclude therefore that it is difficult to achieve long term complete eradication of varices with EVL alone, and that additional therapy is needed for long term control.

Adult↗
PubMed1989

[Management of bleeding esophageal varices--efficacy of emergency embolization therapy].

To increase durability for long term control of bleeding, additional treatment has to be performed. Since Oct. 1979, various embolizations that is percutaneous transhepatic obliteration (PTO), splenic artery embolization (SAE) and left gastric artery embolization (LGE) were introduced as conservative treatments, and have been used singly or concomitantly. Embolization has been employed in order to avoid the high risk of emergency operation. Complete hemostasis and prolonged efficacy could be obtained by introducing various embolizations. No emergency operation has been performed since all of these embolizations were introduced in Jan. 1983. The rates of hemostasis (100%), one month survival (90%), 1 year incidence of rebleeding (6.7%), 1 year survival (75.5%) and 3 year survival (62.5%) of emergency cases which received combined embolizations were better than the results of the cases which received emergency operation or endoscopic sclerotherapy alone. Moreover, the patients with gastric varices, including bleeding gastric varices treated with various combined embolizations, showed results of diminished varices in 78.9% of the patients. Thus to increase durability for long term control of bleeding, embolization should be combined according to the patient's hemodynamics, which may result in its extended application.

Embolization, Therapeutic↗
PubMedDate not supplied

New techniques: splenic artery embolization followed by intraarterial infusion chemotherapy for the treatment of pancreatic cancer.

We present a new intraarterial infusion chemotherapy technique for the treatment of inoperable cancer in the body and tail of the pancreas. The spleen was embolized at its hilum with coils to infuse an anti-tumor agent selectively into the pancreatic parenchyma and a catheter was placed into the splenic artery and connected to the reservoir. 99mTc-macroaggregated albumin+diethylenetriaminepenta-acetic acid (MAA+DTPA) was injected into the reservoir and the body and tail of the pancreas were visualized on the image. For inoperable cancer in the body and tail of the pancreas, splenic artery embolization followed by the placement of a catheter into the splenic artery can deliver a highly concentrated anti-tumor agent to the tumor.

Antineoplastic Combined Chemotherapy Protocols↗