Biomedical subjects

Yasuhiko Umehara

Publications and source records attributed to Yasuhiko Umehara.

5 recordsLinked to original sources

PubMed2005

Features and management of bile leaks after laparoscopic cholecystectomy.

BACKGROUND/PURPOSE: Leakage of bile is one of the troublesome complications after laparoscopic cholecystectomy. METHODS: The present study reviewed our experience with this complication, in order to analyze its characteristics and proper management. RESULTS: Postoperative bile leaks occurred in 23 of 1365 patients (1.7%) undergoing laparoscopic cholecystectomy from July 1990 to May 2002, with the policy of routine operative cholangiography and routine drainage of the gallbladder bed. These patients could be divided into four types. In type 1 (17 patients), bile leakage stopped spontaneously within 3 days (subclinical group). In type 2 (3 patients), the leak continued for longer than 3 days but was controlled by an endoscopic nasobiliary drainage (ENBD tube; minor-leakage group). In type 3 (2 patients), bile leakage continued for longer than 3 days and required open repair (major-leakage group). In type 4 (1 patient), bile leakage started several days after surgery (delayed-leakage group). CONCLUSIONS: It is thought that better understanding of these four types of bile leakage should help in the proper management of this complication.

Bile↗

PubMed2005

Periodic measurement of serum carcinoembryonic antigen and carbohydrate antigen 15-3 levels as postoperative surveillance after breast cancer surgery.

PURPOSE: Breast cancer surveillance guidelines do not recommend routine tumor marker testing after surgery, despite which it is still widely performed in Japan. We investigated the clinical utility of postoperative tumor marker testing in a series of Japanese patients, in view of the fact that all the studies to date have been non-Japanese. METHODS: We retrospectively analyzed the lead time by periodic measurements of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 15-3 (CA15-3) in 233 patients who underwent breast cancer surgery. Both tumor marker levels were measured every 3 months for the first 5 years, every 6 months for the next 5 years, then annually. Physical examination and chest X-ray were routinely done at the same time, and bone or computed tomographic scans were done if the tumor marker levels were elevated or clinical symptoms appeared. RESULTS: In patients with recurrent disease, the mean lead times were -333.9 days for CEA and -210.6 days for CA15-3, respectively. Elevated tumor marker levels were found much later than recurrence. CONCLUSION: Our results support the American Society of Clinical Oncology guidelines. Thus, the serial testing of tumor marker levels after breast cancer surgery may not be as beneficial as thought in Japan.

Adult↗

PubMed2005

Long-term survival after report resection of pulmonary metastases from hepatocellular carcinoma: report of two cases.

Hepatocellular carcinoma (HCC) is often treated most effectively by resection. Although improved surgical procedures and perioperative care have made hepatic resection safe, the prognosis of patients with HCC is still poor because of the high incidence of postoperative recurrence. The most common site of extrahepatic recurrence is the lung. However, because of its multiplicity and concurrent recurrence in the liver remnant, resection of pulmonary metastases form HCC is rarely beneficial. We report two cases of long-term survival after repeated pulmonary resection of metastasis from HCC. At the time of this report the two patients were free of disease, 110 months and 107 months, respectively, after their initial hepatectomy. These case reports show that pulmonary metastases from HCC can be successfully resected in selected patients.

Adult↗

PubMed2003

Elective laparoscopy for small bowel obstruction.

We performed elective laparoscopic adhesiolysis in 21 patients with small bowel obstruction. The procedure was completely laparoscopic or laparoscopy assisted in 17 patients, but 4 patients required full laparotomy due to internal hernia in 2, perforation of the small bowel associated with dense adhesions in 1, and carcinoma of the cecum in 1. In patients with a laparoscopic or laparoscopy-assisted procedure, the mean operating time, mean time until the return of bowel function, and mean postoperative stay were 94 minutes, 3.3 days, and 9.9 days, respectively. During follow-up for 14 to 44 months, 3 patients developed recurrent obstruction, 1 patient suffered from catheter-induced thrombosis, and 1 patient died from lung cancer. Elective laparoscopy can be performed safely and effectively in selected patients with intermittent small bowel obstruction.

Adult↗

PubMed1999

Gastric carcinoma resembling submucosal tumor.

Acase of stomach carcinoma showing features of submucosal tumor is reported. The patient was a 50-year-old man presenting with hematemesis. Endoscopic examination was performed and revealed a submucosal tumor-like lesion with central ulceration in the fornix of the stomach. The biopsy specimen from this lesion showed poorly differentiated adenocarcinoma, and surgery was performed. The tumor, measuring 3.5 x 2.7 cm in size, invaded to the muscularis propria with proliferation of the interstitial connective tissue and lymphoid follicles consisting mainly of B lymphocytes in the submucosal layer. In situ hybridization of tumor tissue for Epstein-Barr virus (EBV)-encoded small RNA1 as target revealed negative results. In stomach carcinoma simulating submucosal tumor, as in this patient, preoperative diagnosis is important to plan treatment strategies.

Journal Article↗