Biomedical subjects
Publications and source records attributed to Y Shoji.
A thread holding ring, originally developed for valve replacement surgery and now commercially available, was successfully employed when performing ileoanal or coloanal anastomosis in 34 patients. The use of this instrument for ileoanal or coloanal anastomosis shortened the operation time and resulted in a decreased rate of complications related to the anastomosis.
The incidence of postoperative hyperamylasaemia was evaluated in 70 patients who underwent staged restorative proctocolectomy. On the 14th postoperative day, 27 of 70 patients after total colectomy showed hyperamylasaemia, and the serum amylase returned to normal on the 30th postoperative day. Three out of 37 after ileoanal anastomosis and 8 out of 70 after stoma closure showed elevation of serum amylase postoperatively. Total colectomy might have a possible role in the postoperative increase of serum amylase. None of these patients had any obvious clinical evidence of postoperative pancreatitis. In 7 patients showing significant elevation of serum amylase levels (over 1000 IU), this was due predominantly to the pancreatic isoenzyme. This transitory elevation of serum amylase did not seem to be altered by the administration of therapeutic agents for pancreatitis. These observations suggest that postoperative hyperamylasaemia without clinical evidence of pancreatitis is very common after total colectomy, and that postoperative hyperamylasaemia itself does not necessarily require treatment.
We report a case of malignant histiocytosis of the intestine (MHI) in which clinical and small bowel barium examination led to an initial diagnosis of Crohn's disease. The patient's symptoms and radiologic features improved dramatically with steroid therapy, and the patient remained free of severe symptoms for five years; at this stage, massive rectal bleeding occurred and segmental ileal resection was performed. Pathology findings of the resected specimen revealed nonspecific ulceration of the ileum. The correct diagnosis, MHI, became apparent six months after surgical intervention, on the appearance of multiple lymphadenopathy.
We investigated the daily life and opinions of patients after total proctocolectomy and ileal J-pouch-anal anastomosis. Eighty patients answered a questionnaire, completed Cattell's anxiety scale, and recorded bowel function for one month. Both colitis and polyposis patients defecated five times daily, had 1.6 episodes of nocturnal motions weekly, and soiled twice weekly. However, colitis patients were more satisfied with their bowel function and surgical outcome than were polyposis patients. This difference had a close relationship to the personality factors of ego strength and frustration. All patients with either disease who defecated less than three times daily, had no nocturnal motions, and had no soiling showed normal ego strength and frustration and were completely satisfied with their bowel status and operation. In contrast, patients defecating more than seven times daily or more than once per week nocturnally and soiling more than four times weekly had high frustration and were dissatisfied. Thus, satisfaction with surgery correlated not only with the objective outcome but also with personality and lifestyle.
Physicians treating patients with ulcerative colitis are confronted with the difficult task of deciding whether medical or surgical treatment is best for their patients. There are no definitive criteria to indicate when medical therapy should be exchanged for definitive surgery. Even in patients who respond well to glucocorticoid treatment, the side effects of these drugs may necessitate surgery. We reviewed the steroid complications of our operative cases retrospectively. Although ulcerative colitis was usually in remission, severe steroid complications were no longer tolerable and definitive surgery was required. We also reviewed the literature regarding the adverse effects of steroid. Because of advances in sphincter-preserving surgery, re-evaluation of the treatment of ulcerative colitis is necessary. Although conservative treatment remains the first choice, tolerance of irreversible side effects (especially in children) no longer seems to be justified. In such patients, early definitive surgery may offer more than it appears to sacrifice.
To investigate whether Crohn's disease has two different clinical forms, a relatively aggressive perforating type and a more indolent nonperforating type, we compared the concentrations of lipocortin and prostaglandin E2 (PGE2) in the inflamed mucosa of 12 patients with strictly controlled Crohn's disease with those found in histologically normal mucosa of control subjects. The inflamed mucosa obtained from eight patients with nonperforating Crohn's disease did not react with antilipocortin antibody on immune blot analysis. In contrast, the inflamed mucosa from four patients with perforating Crohn's disease, as well as that obtained from histologically normal controls, contained lipocortins. In addition, higher concentrations of intramucosal ileal and colonic PGE2 were found in patients with nonperforating Crohn's disease (902 +/- 454 pg/wet weight [WW] mg and 1,268 +/- 567 pg/WW mg, respectively) compared with normal controls (90.2 +/- 43.1 pg/WW mg and 173 +/- 76.5 pg/WW mg, respectively) (p less than 0.01). The difference in intramucosal ileal and colonic PGE2 levels between patients with perforating Crohn's disease (109.6 +/- 16.7 pg/WW mg and 252 +/- 34.4 pg/WW mg, respectively) and normal controls was not significant. These findings indicate that there may be two distinct patterns of Crohn's disease that differ in the amount of lipocortin present in the intestinal mucosa.
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CAR bacillus propagated successfully in an artificial medium, and the number of CAR bacillus was about 30 times the original number after 8 days of cultivation. The medium consisted of Eagle's minimum essential medium supplemented with 10% fetal calf serum and 20% hamster tracheal organ culture soup. By intranasal inoculation to mice, two strains of the CAR bacillus passaged 5 and 6 times in this artificial medium produced the same lung lesions as natural CAR bacillus infection.
Protein kinase C (PKC) activity was measured in the inflamed colonic mucosa of 24 patients with ulcerative colitis and in the normal colonic mucosa of 10 patients with other benign diseases. The particulate fraction activity in ulcerative colitis mucosa was significantly increased compared with that of normal mucosa (320 +/- 47 versus 200 +/- 30 pmol/min/mg protein; p less than 0.05). Inflamed ulcerative colitis mucosa also showed significantly increased total PKC activity in the particulate fractions compared with normal mucosa (147 +/- 26 versus 37 +/- 8 pmol/min/mg tissue; p less than 0.05). Mucosal samples from ulcerative colitis patients were divided into 12 with mild and 12 with severe inflammation by histologic examination. The particulate PKC activity of severely inflamed mucosa was significantly lower than that of mildly inflamed mucosa (p less than 0.05). These results indicate that colonic inflammation in ulcerative colitis may be associated with altered cellular PKC activity.
BACKGROUND: This study included 16 patients without complications, eight patients with ulcerative colitis, and eight patients with familial adenomatous polyposis. All patients underwent colectomy, mucosal proctectomy, and ileoanal anastomosis in the jackknife position with complete removal of the rectoanal columnar mucosa above the dentate line (IAA) through the anus. METHODS: The patients were divided into two groups: eight patients with the rectal cuff about 7 cm from the dentate line, "the medium-cuff group," and eight patients who underwent resection of the rectal stump above the levator, leaving a cuff of 2 cm, "the minimum-cuff group." RESULTS: In the medium-cuff group the percent recovery of maximum resting pressure and maximum squeeze pressure 12 months after IAA were not significantly decreased, the rectoanal inhibitory reflex recovered in 87.5% of patients, and all patients regained continence. In the minimum-cuff group, however, the percent recovery for both pressures remained significantly reduced, the reflex never recovered, and only 25% of the patients were continent after 12 months (p less than 0.05). There was no significant difference in capacity or distensibility of the ileal pouch between the groups. CONCLUSIONS: These results indicate that the medium-cuff method was associated with a superior functional result compared with the minimum-cuff method in the early postoperative period and the cuff in the lower rectum connected with the visceral nerves should be preserved to achieve better bowel function in the patient undergoing IAA. The initial mucosectomy through the anus in the prone jackknife position is useful for this purpose.
Beta-lactams are well known to have potent convulsant activity. Imipenem, the first carbapenem antibiotic introduced in the clinical field, has been reported to induce convulsions. The neurochemical mechanism of the convulsions induced by carbapenems and cephalosporins were studied. Intraventricular injection of cefazolin, cephaloridine and imipenem, and of panipenem (a new carbapenem), induced convulsions in a dose-dependent manner in mice. They inhibited the receptor binding of gamma-aminobutyric acid (GABA), an inhibitory transmitter in the mammalian central nervous system. These in-vitro and in-vivo results suggest that carbapenems and cephalosporins might induce convulsions through the inhibition of GABA receptor binding when they are accumulated in the central nervous system.
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This study attempted to determine the mechanism of anal canal motility after ileoanal anastomosis with the use of alpha-, beta- and muscarinic receptor agents. Forty-five patients, 19 +/- 2 months after operation (mean plus or minus S.E.M.) and 48 control volunteers were studied. Anal manometry indicated no difference in maximum resting pressure and squeeze pressure between the patients and the normal controls. Greater amplitude and less frequent anal canal slow waves were a particular characteristic during the postoperative period. Phentolamine (alpha-blocker) exhibited a stimulatory effect on anal resting tone in the normal rectum, while propranolol (beta-blocker) and atropine (muscarinic blocker) had no effect. However, alpha-, beta- and muscarinic receptors all had stimulatory effects on postoperative anal tone. The muscarinic receptor had dominant effects on the reduction in anal canal slow wave frequency after ileoanal anastomosis. Our results indicated that neorectum after ileoanal anastomosis had hybrid characteristics of both rectum and ileum. Through analysis of receptor-related motor function, we may be able to improve our understanding of dyscontinence after ileoanal anastomosis.
BACKGROUND: There has recently been increasing interest in coloanal reconstruction after proctectomy for low rectal carcinoma. We describe here our pilot experience with seven patients undergoing modified anoabdominal resection of the rectum and a colonic J-pouch anal anastomosis. METHODS: The procedure varied according to the extent of internal anal sphincter (IAS) resection (type a, partial resection of the upper IAS; type b, circumferential resection of the upper IAS; type c, partial preservation of the lower IAS; and type d, total resection of the IAS). RESULTS: None of the patients had incontinence, but preservation of the lower half of the IAS (types a and b) showed functional superiority over more extensive IAS resection (types c and d). Only patients who underwent types c and d resection needed medications to reduce stool frequency. CONCLUSIONS: Our results suggest that the lower half of the IAS has a more important role than the upper half in the control of defecation. Total resection of the IAS did not sacrifice continence, but preservation of at least the lower IAS resulted in a better quality of life. Careful patient selection is needed when considering the use of these procedures for tumors in the lowest part of the rectum.
Between 1986 and 1990, 69 patients underwent surgery either for thoracic aneurysm (27 patients) or aortic dissection (42 patients). Sixty one patients (88%) survived and 8 patients (12%) died after surgery. Main determinants of deaths in 4 patients with true arch aneurysm were bleeding from the sites of aortic clamping or anastomosis and intraoperative severe LOS. Three patients with acute type A dissection died from bleeding due to clamp injury or myocardial ischemia. The cause of death in the patient with chronic type B dissection was associated with brain damage due to hypoxia developed during left heart bypass. Postoperative cardiac, pulmonary, hepatic and renal functions were analyzed in the operative survivors. Cardiac functions were maintained well in all patients except two patients with chronic type A dissection. Four patients, one with true arch aneurysm, 2 with chronic type A and one with chronic type B dissection, required tracheostomy. The mean of maximum total serum bilirubin exceeded 4 mg/dl in the patients with true arch aneurysm, acute and chronic type A dissection. The level of serum creatinine showed slight increase in all patients but prophylactic peritoneal dialysis was performed in one patient with chronic type A dissection. In conclusion, the cause of deaths in most patients with thoracic aneurysm was due to inappropriate operative techniques and circulatory supports during surgery. Without the complication described above, the patients could tolerate surgery well.
Between 1986 and 1990, 24 patients with Stanford type A dissection (acute; 14, chronic; 10) underwent surgery through median sternotomy. The patients were divided into two groups by a duration of postoperative ICU stay for respiratory care. Six patients in the long-period group stayed in ICU for more than 15 days and 18 patients in the short-period group stayed for less than 15 days after surgery. Acuity of disease, age, sex, operation time, pump time, aortic clamp time, lowest esophageal temperature, amount of blood transfusion, arch manipulation for cerebral perfusion with or without arch reconstruction, occurrence of phrenic nerve palsy and other postoperative complications, postoperative cardiac, hepatic and renal functions were compared between two groups. Conclusions are as follows: 1) Arch manipulation for cerebral perfusion with or without arch reconstruction, phrenic nerve palsy, other complications (pericardial and pleural fluid accumulation, recurrent nerve palsy, postoperative bleeding and coronary spasm) and high serum creatinine level were main factors for prolonged postoperative ICU stay for respiratory care and 2) arch manipulation in the patients with chronic type A aortic dissection induced high incidence of phrenic nerve palsy.
Localized giant pseudopolyposis is a rare complication in patients with ulcerative colitis which progresses to a huge intramural polypoid mass. Our case described here is a 30-yr-old female with chronic ulcerative colitis who developed localized giant pseudopolyposis with unexpected infiltrating adenocarcinoma. This case is one of an unusual form of cancer presentation in ulcerative colitis, and it indicates that we should be aware of the possibility of occult adenocarcinoma inside a large pseudopolyposis with no superficial dysplasia.
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