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Kunihide IZAWA, Makoto SASAKI, Tsutomu TOMIOKA, Takashi KANEMATSU
1994 Volume 8 Issue 3 Pages
197-203
Published: June 25, 1994
Released on J-STAGE: November 13, 2012
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Formerly, standard hepatobiliary functional reserve of each hepatic lobe before hepatectomy has not proved to be of substantive prognostic value in patient having invasion of cancer to the hilar ducts and undergoing biliary decompression for obstructive jaundice. To evaluate usefulness of ICG Bmax in hepatectomy bigger than lateral segmentectomy, the 13 hepatectomized patients who underwent unilobar or bilobar biliary decompression as a result of hilar carcinoma were studied. Correlations between ICG Bmax values and other blood chemistry values were evaluated. Two of the three patients with ICG Bmax values of remaining hepatic lobe below 0 were died of liver failure. The remaining one had complications such as intractable pleural effusion and prolonged hyperbilirubinaemia. In the seven patients with complications ICG Bmax values showed below 0.5. The morbidity in seven patients with ICG Bmax values between 0 and 0.5 was 57 %. In patients showing ICG Bmax values below 0, hepatectomy bigger than segmentectomy is contraindicated despite intensive postoperative care. The present study showed that the ICG Bmax test may be a useful and reliable indicator of prognosis in hepatectomy after biliary decompression for obstructive jaundice as a result of hilar carcinoma.
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Hitoshi HARA, Hiroshi ISOZAKI, Sinsho MORITA, Takashi ISHIBASHI, Masak ...
1994 Volume 8 Issue 3 Pages
204-208
Published: June 25, 1994
Released on J-STAGE: November 13, 2012
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Cholecystectomy for gallbladder stones has been increasingly performed using laparoscopy instead of laparotomy. However, this technique sometimes causes injury to the biliary tract during operation.
We evaluated the incidence of abnormal arrangement of the cystic duct, its diagnostic method, and the incidence of injury to the biliary tract during operation in 489 patients with gallbladder stones or polyps (421 treated by cholecystectomy after laparotomy and 68 treated by cholecystectomy under laparoscopic guidance) during the past 8-year period. 1) Abnormal arrangement of the cystic duct was observed in 26 patients (5.3%). 2) As the diagnostic method, direct cholangiography by ERC was useful. 3) The incidence of injury to the biliary duct during operation was significantly higher in the patients with abnormal arrangement of the cystic duct (7.7%) than in those with the normal cystic duct (1.9%).
Preoperative confirmation of the presence or absence of abnormal arrangement of the cystic duct is important in preventing injury to the biliary tract during cholecystectomy. We perform preoperative ERC and intraoperative cholagiography to confirm the absence of injury in the biliary tract in all patients undergoing cholecystectomy under laparoscopy.
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Hiroki KANNO, Naoki YAMANAKA, Eizo OKAMOTO
1994 Volume 8 Issue 3 Pages
209-214
Published: June 25, 1994
Released on J-STAGE: November 13, 2012
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To investigate the mechanism of pancreatic hypersecretion and pancreatico-trophic effect associated with obstructive jaundice, three types of experimental model were designed in rats as follows: obstructive jaundice (OJ), choledocho-caval fistula(CCF), and 70% choledocho-caval fistula (70% CCF). In the OJ model, the hypersecretion of pancreatic juice and an increase in pancreas weight were demonstrated. The CCF model showed hyperbilirubinemia, hyper bile -acidemia and hyper secre-nemia as did the OJ model. Although the liver injury was minimal in this model, not likely in the OJ model, hypersecretion of the pancreatic juice and the increase in the pancreas weight were observed similarly to the OJ model. These results were also obtained in the 70% CCF model, associating with hyper bile-acidemia but not with hyperbilirubinemia and hyper secretinemia. Those findings lead us a conclusion that the pancreatic hypersecretion and pancreaticotrophic effect associating with obstructive jaundice is mainly caused by hyper bile-acidemia.
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pathomorphological and immunohistological study of Chromogranin A positive tumor cells
Toshiaki KUNIMURA, Toshio MOROHOSHI, Kenichi FUNO, Mikio KANDA
1994 Volume 8 Issue 3 Pages
215-222
Published: June 25, 1994
Released on J-STAGE: November 13, 2012
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54 cases of biliary tract carcinomas (10 cases of papilla Vater carcinoma,21 cases of common bile duct carcinoma,23 cases of gall bladder carcinoma) were examined morphologically and immunohistologically, to detect the neuroendocrine differentiation of the tumor cells. Neuroendocrine cells (NE cells) were demonstrated in 43% (23 cases) evaluated by chromogranin A (CGA)immunoreactivity, and were predominantly in papilla Vater and gall bladder carcinoma.
Histologically, NE cells were seen in significantly higher incidence in well differentiated adenocarcinoma than in moderate or poorly differentiated cases. But no mitotic figure was seen in NE cells, and mitotic index of the tumor seemed to decrease according to the frequence of NE cells. These findings suggest the non agressive features of NE cells. Overexpression of p53 were seen in 26% (12 cases), and were in significally higher incidence in cases of gall bladder carcinoma with NE cells.
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Hideki MORIYA
1994 Volume 8 Issue 3 Pages
223-230
Published: June 25, 1994
Released on J-STAGE: November 13, 2012
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Intermediate filament (Cytokeratin), a kind of cytoskeleton, that play an important role in cell stability and intracellular organization. We studied change of hepatic cytokeratin in obstructive jaundice before and after biliary drainage.
Using liver biopsy specimens obtained before and after biliary drainage in 17 obstructive jaundiced patients were studied hepatic cytokeratin by immunohistochemistry compared with change of microorganellas.
Hepatic cytokeratin in prolonged jaundice were not improved by biliary drainage. The cellular and lobular distribution of cytokeratin in obstructive jaundice were reflected changes of microorganellas.
This study is suggested that make possible to estimate the effect of biliary drainage by observe the change of hepatic cytokeratin at biliary drainage.
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Relation for pathologic factors and prognosis
Motomi YOSHIDA
1994 Volume 8 Issue 3 Pages
231-237
Published: June 25, 1994
Released on J-STAGE: November 13, 2012
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This study was aimed to clarify whether DNA ploidy patterns could be one of prognosis -regulating factors in gallbladder cancer invading to subserosal layer (ss cancer). In sixty patients with ss cancer DNA ploidy patterns were analyzed using the method of Flow cytometry. The relation between pathologic factors, prognosis and DNA ploidy patterns was examined. As the result,23s peciment (s38%) were aneuploid aynd 37s peciment (s62%) were diploidy N. o significant relation could be recognized between DNA ploidy patterns and pathologic factors. Five year survival rate of aneuploid cases was 18%, wheares that of diploid cases was 72%. The patients with diploidy survived significantly longer than those with aneuploidy in ss cancers (p<0.05).
These results concluded that DNA ploidy patterns could be assigned one of prognosis-regulating factors and those were independent from pathologic factors in ss cancer.
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Hiroyuki TODA
1994 Volume 8 Issue 3 Pages
238-246
Published: June 25, 1994
Released on J-STAGE: November 13, 2012
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DNA ploidy pattern was analyzed by flow cytometry in 54 patients with lower bile duct carcinoma. In order to determine the biological characteristics of lower bile duct carcinoma from the viewpoint of DNA ploidy pattern, the relationship between DNA ploidy pattern and histopathological factors and prognosis, was studied. Regarding the relationship between DNA ploidy pattern and histopathological factors, pancreas invasion, lymphatic vessel invasion, perineural invasion, duodenal invasion and lymph node metastasis of aneuploid patients were more frequent than those of diploid patients, although there were no significant differences in frequency. Five-year survival rate of aneuploid patients was significantly lower than that of diploid patients(p<0.01). However, DNA ploidy pattern was not an independent prognostic factor by Cox's proportional hazard model. On the other hand, eleven of thirteen patients with survival of more than 5 years had diploid tumors. DNA ploidy pattern appears to be one of the prognostic factors in lower bile duct carcinoma.
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Yutaka SHIMADA
1994 Volume 8 Issue 3 Pages
247-255
Published: June 25, 1994
Released on J-STAGE: November 13, 2012
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Crystallographic analyses by powder X-ray diffractometry were carried out on 107 cases of black pigment gallstones. In calcium carbonate containing group, three polymorphs were noticed; they were calcite, aragonite and vaterite, and calcite was dominant. Black pigment gallstones were classified into calcium carbonate (C)-, calcium carbonated +calcium phosphate (CP)-, calcium phosphate (P) -and no calcium salts (N) group according to inorganic calcium salts.
Chemical analyses were carried out on 95 cases of black pigment gallstones and the results were compared among these groups. Calcium and phosphate levels were statistically significant between each group. Cu, Fe, Zn levels showed an increasing tendency in group P or N, and Mg and Mn levels were statistically high in group CP and P. These differences of metal elements level suggested the characteristics of each group, especially Mg and Mn levels were thought to be related to calcium phosphate component.
On X-ray diffractometry, some peak similar with that of calcium bilirubinate stones was found at low angle area, suggesting the relationship with black pigment itself.
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Seiji MIURA, Yuji HORIGUCHI, Hideo IMAI, Bon SEKOGUCHI, Hirohisa OGAWA ...
1994 Volume 8 Issue 3 Pages
256-263
Published: June 25, 1994
Released on J-STAGE: November 13, 2012
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In order to establish the appropriate criteria of ESWL to Japanese patients, we reevaluated the efficacy of ESWL according to various factors of the stone. Respect to the stone number, the group of 2 or less in number showed satisfactory stone-free rate, although the stone size did not affect the stone-free rate, Ultrasonical types of the stones were the most sensitive factor for predicting freedom of stones; the stone-free rate was estimated at 100% and 60% in type I a, b and type I c plus type IIa, respectively. Calcification of the stones was not an excluding criteria, since the estimated stone-free rate of calcified stones with a thin rim or laminated rim reached to 83% after 20 months.
We, therefore, proposed a new criteria for the patient selection: 1) history of biliary pain,2) one or two stones in number,3) types I or IIa of ultrasonographic classification,4) non-calcified stones or calcified stones with a thin rim or a laminated rim, and 5) gallbladder visualization on oral cholecystogram. When this criteria was adopted for the selection of patients, about 29% of the outpatient with gallbladder stones was indicated for ESWL and the cumulative stone-free rate was estimated at 91%.
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Tsutomu TOMIOKA, Yoshito IKEMATSU, Masahiro YAMAMICHI, Yoshitsugu TAJI ...
1994 Volume 8 Issue 3 Pages
264-271
Published: June 25, 1994
Released on J-STAGE: November 13, 2012
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In the once-a-year mass screening survey at Naru city since 1971, an analysis of the data from 1985 to 1991 especially for biliary diseases has been conducted. The total number of the subjects receiving the mass screening was 5,210 with an average of 744 yearly in the period. Twenty-seven subjects were detected having a cancer; inculding 13 cases of gastric cancer,4 of breast cancer, and 4 of colorectal cancer. Ultrasonographic examination of the biliary tract detected 40 cases of cholecystolithiasis,27 of cholesterol polyp and 14 of intrahepaticlithiasis and others.
No biliary carcinoma was detected, however, five patients died of biliary carcinoma during the same period.
In the meantime, disease-bearing people who need some medical treatment have been significantly decreasing during the same period compared to those in the initial period immediately after the screeing started. It can be thought that the screening greatly contributed to the decreasing, but also considered that poses a new problem. That is, when the mass screening is conducted in the same area for a long period, appropriate strategy for people who do not receive the screening and establishment of some cost-effective system would be necessary.
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Keiji HANADA, Masaki ITOH, Masataka HIRAOKA, Kiyomu FUJII, Hideo OHISH ...
1994 Volume 8 Issue 3 Pages
272-276
Published: June 25, 1994
Released on J-STAGE: November 13, 2012
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A 61-year-old woman was admitted because of vomiting and abdominal pain. Abdominal plain X-ray, US, and CT showed pneumobilia, ileus, and a stone in left lower abdominal region.
Percutaneous transhepatic cholangiography showed the fistula between gallbladder and duodenum. num. Laparotomy was performed, and a 25×30 mm stone was found in the jejunum (270cm oral side from the ileum end). The jejunum, was completely obstructed by the stone. Cholecystectomy and closure of the fistula were performed. The stone consisted of 81% cholesterol and 19% bilirubin.
In this paper, the importance of abdpminal plain X-ray and US to diagnose gallstone ilens preoperatively was discussed.
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Tetsuya KANEKO, Akimasa NAKAO, Soichiro INOUE, Akio HARADA, Toshiaki N ...
1994 Volume 8 Issue 3 Pages
277-282
Published: June 25, 1994
Released on J-STAGE: November 13, 2012
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A 57-year-old man was admitted to our hospital for advancec gallbladder cancer. A tumor has invaded the liver deeply from the left medial segment to the right lobe. It also invaded the hepatic hilum, so percutaneous transhepatic bile duct drainage was perfomed. Abdominal angiography revealed encasement at the first-ordered branch of the right hepatic artery. Percutaneous transhepatic portography showed slight compression of the portal venous trunk below the bifurcation. In order to prepare for massive resection of the liver, percutaneous transhepatic embolization of the right portal venous branch was done. At operation, intraportal ultrasonography (IPUS) revealed destruction of the echogenic band of the portal venous wall, and a diagnosis of portal venous invasion of the tumor was made. Based on this IPUS finding, extened right hepatic lobectomy with combined resection of the portal vein was performed. Histological examination confirmed the portal venous invasion. Its ability to distinguish between portal vein compression and invasion makes IPUS an effective aid in formulating operative strategy.
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Kenji YOKOI, Kazuyuki KAWAKAMI, Yukirnitsu KAWAURA
1994 Volume 8 Issue 3 Pages
283-286
Published: June 25, 1994
Released on J-STAGE: November 13, 2012
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A case of mucin productive bile duct adenoma with obstructive jaundice is described. A 82 years old man complaining of general malaise and icterus admitted to our hospital. Dilated left intrahepatic bile duct and no definite mass was showed by abdominal ulttasonography and computed tomography. Endocopic retrograde cholangiopancreatography showed clear-shaped filling defect in the common bile duct and the almost total filling defect in the left intrahepatic bile duct. Diagnosis was tumor of left intrahepatic bile duct. A left hepatectomy was performed. There was much mucin in the common bile duct and localised thickness of the wall of the left intrahepatic bile duct. Pathological examination of the localised thickness of the wall revealed a bile duct adenoma. This case is interesting from the view point of showing obstructive jaundice.
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Youichi HOKAZE, Masami MATUMOTO, Norie UMEMOTO, Toshiya NAKATANI, Masa ...
1994 Volume 8 Issue 3 Pages
287-291
Published: June 25, 1994
Released on J-STAGE: November 13, 2012
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A 27-year-female was admitted to our hospital because abdominal US showed dilatation of common bile duct. ERCP revealed dilatated common bile duct that was connected to the main pancreatic duct at 2.5 cm distal portion from the orfice of papilla Vater. Because the main pancreatic duct was short and smooth in pancreaticography from papilla Vater, pancreaticography from accessory papilla was done. This study disclosed that dorsal pancreatic duct had no connection with ventral pancreatic duct, and a diagnosis of pancreas divisum associated with pancreatobiliary mal-union was made. Co-existence of both anomalies has been rarely reported. We conclude that a care should be paid for the association of pancreas divisum in a case with pancreatobiliary mal-union.
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Hideki FUJII, Fumiko ICHIHARA, Makoto SUDOU, Tsutomu TAKAZAWA, [in Jap ...
1994 Volume 8 Issue 3 Pages
292-298
Published: June 25, 1994
Released on J-STAGE: November 13, 2012
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A case of unresectable common bile duct cancer involving the portal vein and with wide spread of lyinphnode metastasis was dealt with FPM (5-FU; 5-fluorouracil, THP: pirarubicin, MMC; mitomycin-c) treatment. The case was a 53-year old female who was admitted to the hospital with an obstructive jaundice and right flank pain. After 4 cycles of the treatment, the metastatic lymphonode completely disappeared and the symptoms diminished. THP was used instead of adriamycin (ADR) and toxicities such as gastrointestinal disorders including anorexia, nausea and vomiting and alopecia and cardiotoxicity which were seen very often in ADR were not observed. But, severe leukopenia was noted and it was overcome with granulocyte colony stimulating factor (G-CSF). In this case, the efficacy of FPM tratment to the primary lesion was not clear, be cause of the difficulty of elucidation of the primary site by diagnostic image. However, FPM treatment was effective to the advanced bile duct cancer.
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