1
|
Matsubara S, Imai K, Murayama K, Higashizawa T. Severe liver dysfunction during nausea and vomiting of pregnancy: folic acid supplement as a suggested culprit. J OBSTET GYNAECOL 2012; 32:701-2. [PMID: 22943726 DOI: 10.3109/01443615.2012.698332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- S Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
| | | | | | | |
Collapse
|
2
|
Yamamoto H, Sekine Y, Higashizawa T, Kihira K, Kaneko Y, Hosoya Y, Ido K, Saito K, Sugano K. Successful en bloc resection of a large superficial gastric cancer by using sodium hyaluronate and electrocautery incision forceps. Gastrointest Endosc 2001; 54:629-32. [PMID: 11677485 DOI: 10.1067/mge.2001.118643] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The advisability of endoscopic mucosal resection (EMR) for treatment of large superficial gastric cancers has been challenged. For more reliable en bloc resection, a new method of EMR was developed that uses a viscous substance, sodium hyaluronate, and two newly designed devices. METHODS A large superficial gastric cancer was treated with this new EMR technique. Sodium hyaluronate was injected into the submucosa and mucosal incisions were made with a needle-knife. The newly developed incision forceps and flat-ended transparent hood were used for submucosal incisions. RESULTS The large cancer was successfully resected endoscopically as a single piece of mucosa 6 cm in diameter without complication. Histopathologic evaluation of the specimen confirmed that the resection was curative. CONCLUSIONS EMR with sodium hyaluronate along with two new devices may be a reliable method for en bloc resection of large superficial gastric lesions.
Collapse
Affiliation(s)
- H Yamamoto
- Department of Gastroenterology, Jichi Medical School, Tochigi, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Abstract
A case of symptomatic duodenal duplication cyst is reported. The patient underwent endoscopic partial resection of the cystic wall using the O-ring ligation kit. After resection, the abdominal pain disappeared. Endoscopic partial resection is useful for diagnosis and treatment of duodenal duplication cyst.
Collapse
Affiliation(s)
- S Wada
- Dept. of Gastroenterology, Jichi Medical School, Tochigi, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Higashizawa T, Koga Y. Effect of infraorbital nerve block under general anesthesia on consumption of isoflurane and postoperative pain in endoscopic endonasal maxillary sinus surgery. J Anesth 2001; 15:136-8. [PMID: 14566510 DOI: 10.1007/s005400170014] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE The efficacy of infraorbital nerve block in reducing isoflurane consumption and postoperative pain was evaluated in patients undergoing endoscopic endonasal maxillary sinus surgery (ESS) under general anesthesia. METHODS Fifty patients were randomly allocated to either the block group (n =15) or the nonblock group (n = 25). After the establishment of general anesthesia with isoflurane, nitrous oxide, and oxygen, the patients received infraorbital nerve block with 1.0 ml of either 0.5% bupivacaine (block group) or normal saline (nonblock group) administered into the soft tissue in front of the infraorbital foramen. Systolic blood pressure during anesthesia and surgery was maintained at 85-90 mmHg by adjusting the inspiratory concentration of isoflurane, and its consumption was evaluated in both groups. Pain intensity at 15 min after the end of anesthesia was also evaluated on a five-point pain scale. RESULTS The consumption of isoflurane under a fresh gas flow of 6 l.min(-1) was 17.3 +/- 6.5 ml.kg(-1).h(-1) (mean +/- SD) in the block group and 27.4 +/- 9.4 ml.kg(-1).h(-1) in the nonblock group during surgery ( P < 0.001). Nicardipine was required during surgery less frequently in the block group than in the nonblock group ( P < 0.01). Postoperative pain intensity was lower in the block group than in the nonblock group ( P < 0.01). CONCLUSION General anesthesia combined with infraorbital nerve block is effective in reducing the consumption of isoflurane and postoperative pain intensity in ESS.
Collapse
Affiliation(s)
- T Higashizawa
- Department of Anesthesia, Sakai Hospital in Research Institute of Basic-Clinical Medicine, Kinki University, 2-7-1 Harayama-dai, Sakai 590-0132, Japan
| | | |
Collapse
|
5
|
Higashizawa T, Tamada K, Tomiyama T, Wada S, Ohashi A, Satoh Y, Gotoh Y, Ido K, Sugano K. Looping technique for transpapillary selective biopsy of the left hepatic duct. J Gastroenterol 2001; 36:492-4. [PMID: 11480794 DOI: 10.1007/s005350170073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Because biopsy forceps tend to turn towards the right hepatic duct during endoscopic retrograde cholangiopancreatography (ERCP), selective access to the left hepatic duct is difficult. METHODS In this study, we managed to insert biopsy forceps selectively into the left hepatic duct, by using a looping technique, in three patients. Biopsy forceps were inserted into the right hepatic duct by the conventional method. The elevator of the endoscope was kept down, and the shaft of the biopsy forceps was then advanced to the duodenal cavity until it formed a loop between the endoscope and the papilla. During the procedure, the tip of the forceps was kept at the hepatic hilus. RESULTS In this condition, we were able to slowly rotate the tip of the forceps and direct the forceps towards the left. Sufficient material from the left hepatic duct was obtained in all patients. CONCLUSIONS The looping technique was useful for selective access to the left hepatic duct.
Collapse
Affiliation(s)
- T Higashizawa
- Department of Gastroenterology, Jichi Medical School, Tochigi, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Gotoh Y, Tamada K, Tomiyama T, Wada S, Ohashi A, Satoh Y, Higashizawa T, Miyata T, Ido K, Sugano K. A new method for deep cannulation of the bile duct by straightening the pancreatic duct. Gastrointest Endosc 2001; 53:820-2. [PMID: 11375604 DOI: 10.1067/mge.2001.113387] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Y Gotoh
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
|
8
|
Higashizawa T, Yuasa H, Koga Y. [Appearance of angry backfiring C-nociceptor (ABC) syndrome-like pain disorder in cross-side of one-side spinal anesthesia]. Masui 2001; 50:507-8. [PMID: 11424465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
ABC (angry backfiring C-nociceptor) syndrome-like pain disorder categorized in sympathetic independent pain appeared after amputation during spinal anesthesia. A 69-year-old female who had undergone amputation of the right leg below knee 5 months before, received amputation of the left leg below knee this time because of diabetic neuropathy and gangrene of her both legs. There were no complications in her right leg after the former amputation. Spinal anesthesia was maintained in the left one-side by hyperbaric local anesthetic. After changing the body position from left lateral to supine, the left leg was completely anesthetized and the right leg was incompletely anesthetized with only loss of cold sensation. In this state, she had pain in her right leg, and this pain was relieved by intravenous lidocaine administration. It was indicated that this type of pain was caused by the presence of ABC syndrome probably after right leg amputation.
Collapse
Affiliation(s)
- T Higashizawa
- Department of Anesthesia, Sakai Hospital in Research Institute of Basic-Clinical Medicine, Kinki University, Sakai 590-0132
| | | | | |
Collapse
|
9
|
Ohashi A, Tamada K, Tomiyama T, Wada S, Higashizawa T, Gotoh Y, Satoh Y, Miyata T, Tano S, Ido K, Sugano K. Epinephrine irrigation for the prevention of pancreatic damage after endoscopic balloon sphincteroplasty. J Gastroenterol Hepatol 2001; 16:568-71. [PMID: 11350556 DOI: 10.1046/j.1440-1746.2001.02483.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM Endoscopic balloon sphincteroplasty (EBS) is an alternative to sphincterotomy for the treatment of bile duct stones. The purpose of this study was to determine if epinephrine irrigation of the papilla can prevent the pancreatic damage associated with EBS. METHODS A total of 173 patients with bile duct stones were treated by EBS. After conventional endoscopic retrograde cholangiography, EBS was performed by using a biliary dilatation catheter (balloon diameter: 8 mm). The duct was then cleared by using Dormia baskets or retrieval balloon catheters. Mechanical lithotripsy was performed before extraction when the stones were greater than 8 mm in diameter. In 81 patients, the dilated orifice was irrigated with 40-120 mL (50 +/- 37 mL) of 1:1,000,000 epinephrine (epinephrine group). In the remaining 92 patients, epinephrine irrigation was not performed (control group). Acute pancreatitis was defined by a serum amylase concentration fivefold greater than the upper limits of normal in association with abdominal pain. RESULTS After EBS, serum amylase concentrations were significantly increased in both groups. However, the degree of hyperamylasemia was less in the epinephrine group than in the control group (617 +/- 611 vs 1037 +/- 1491 IU/L, P < 0.05). The incidence of pancreatitis was lower in the epinephrine group than in the control group (1.2 vs 7.6%, P < 0.05). CONCLUSIONS Epinephrine irrigation is a simple and useful method to prevent post-EBS pancreatic damage and pancreatitis.
Collapse
Affiliation(s)
- A Ohashi
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Tamada K, Tomiyama T, Ohashi A, Wada S, Satoh Y, Higashizawa T, Gotoh Y, Ido K, Sugano K. Intraductal ultrasonography for evaluating the patency of biliary metallic stents: correlation with cholangioscopic findings. Abdom Imaging 2001; 26:210-4. [PMID: 11178703 DOI: 10.1007/s002610000125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This is the first study to correlate intraductal ultrasonography (IDUS) with cholangioscopy in evaluating the patency of biliary metallic stents. METHODS The findings of IDUS (probe 2.0 mm in diameter and 20-MHz frequency) through a percutaneous transhepatic (n = 24) or transpapillary (n = 2) approach were retrospectively reviewed without other information. Criteria for IDUS are as follows: type 1, the inside of the stent is free; type 2, the inner edge is smooth; type 3, the inner edge is irregular; type 4, the inside of the stent is totally occupied; type 5, the solid echo is connected to the outside mass; type 2+D, a hypoechoic line is seen between the bile duct wall and the inside solid component and the inner edge of the bile duct wall is smooth; type 3+D, an irregular hypoechoic line is seen between the bile duct wall and the inside solid component. RESULTS In the control group (n = 11), IDUS showed type 1 (n = 9) or type 2 (n = 2). In the occluded group (n = 15), when IDUS showed type 3 or 5, the patients (n = 5) required additional stents (n = 3), microwave coagulation of the tumor (n = 1), or transient external drainage (n = 1). When IDUS showed type 4 (n = 5), after washing, the findings changed to type 2+D (n = 4). When IDUS after washing showed a smooth inner edge (type 2+D), the patients were treated without additional stents more frequently than the other groups (eight of nine vs. two of six), a significant distinction (p < 0.05). CONCLUSION IDUS is useful in assessing the patency of metallic stents. When the inside of the stent is totally occupied, however, examination after washing is necessary.
Collapse
Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi 329-0498, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Tamada K, Wada S, Tomiyama T, Ohashi A, Satoh Y, Miyata T, Higashizawa T, Gotoh Y, Ido K, Sugano K. Percutaneous recanalization of the bile duct along an endoscopic naso-biliary catheter. J Gastroenterol 2001; 35:622-6. [PMID: 10955601 DOI: 10.1007/s005350070062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Percutaneous recanalization of the bile duct is essential for placing biliary stents and carrying out other interventions. This prospective study was performed to establish safe approaches for percutaneous recanalization of the bile duct when it had previously resulted in failure. Between July 1995 and July 1999, percutaneous recanalization of the bile duct was attempted in 58 patients with a malignant biliary stenosis. When recanalization failed, an endoscopic naso-biliary drainage (ENBD) catheter was placed across the stenosis. The procedure was again attempted along the ENBD catheter. In the period of the study, four patients underwent successful recanalization after ENBD, although attempts prior to ENBD had been unsuccessful. As a result, the success rate of recanalization in the period was 100% (58/58). When recanalization fails, the use of an ENBD catheter may provide access to the biliary tree, and the biliary stenosis can be recanalized safely.
Collapse
Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Tochigi, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
BACKGROUND Deep insertion of an enteroscope by use of a push technique is difficult. A new method of enteroscopy was developed, a double-balloon method, to improve the access to the small intestine. METHODS The new method uses 2 balloons, one attached to the tip of the endoscope and another at the distal end of an overtube. By using these balloons to grip the intestinal wall, the endoscope can be inserted further without forming redundant loops in the small intestine. This method was tried with a standard upper endoscope in 3 patients and with a longer enteroscope in 1 patient. RESULTS Despite its short length the upper endoscope was successfully inserted as far as 30 to 50 cm beyond the ligament of Treitz in the 3 patients. In the fourth patient the longer enteroscope was successfully inserted beyond the ileo-cecal valve. CONCLUSIONS The double-balloon method facilitates endoscopic access to the small intestine.
Collapse
Affiliation(s)
- H Yamamoto
- Department of Gastroenterology, Jichi Medical School, Tochigi, Japan
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Tamada K, Ohashi A, Tomiyama T, Wada S, Satoh Y, Higashizawa T, Ido K, Sugano K. Comparison of intraductal ultrasonography with percutaneous transhepatic cholangioscopy for the identification of residual bile duct stones during lithotripsy. J Gastroenterol Hepatol 2001; 16:100-3. [PMID: 11206304 DOI: 10.1046/j.1440-1746.2001.02384.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND An imaging modality that can be used to identity small stones after a biliary lithotripsy is required. Intraductal ultrasonography was evaluated by using percutaneous transhepatic cholangioscopy as the gold standard. METHODS Lithotripsy, under percutaneous transhepatic cholangioscopy guidance, was performed in 20 patients. A thin-caliber ultrasonic probe (2.0 mm in diameter and 20 MHz frequency) was inserted into the bile duct through the percutaneous tract after lithotripsy, and residual stones were identified. This was followed by percutaneous transhepatic cholangioscopy. RESULTS In the extrahepatic bile ducts, intraductal ultrasonography provided images of all the stones demonstrated on cholangioscopy (n = 11). The sensitivity was superior to that of cholangiography (P < 0.005). However, in the intrahepatic bile ducts, intraductal ultrasonography only visualized the stones located in the cannulated lobe. Extrahepatic stones smaller than 5.0 mm in diameter or in a common hepatic duct larger than 15.0 mm in diameter were missed by cholangiography, but were visualized by the use of intraductal ultrasonography (P < 0.05). CONCLUSIONS Intraductal ultrasonography is equivalent to cholangioscopy in the extrahepatic bile ducts. Cholangiography and intraductal ultrasonography should be used in combination to image intrahepatic and extrahepatic stones.
Collapse
Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
BACKGROUND Transpapillary procurement of bile duct biopsy specimens is an effective diagnostic technique in cases of biliary structure. The utility of new ropeway-type bile duct biopsy forceps with a side slit for a guidewire was investigated in this study. METHODS The 12 patients in this study had bile duct cancer (n = 3), cancer of the head of the pancreas (n = 4), gallbladder cancer (n = 1), and benign bile duct stenosis (n = 4). After endoscopic retrograde cholangiography, a guidewire was placed in the bile duct across the stenosis. The new forceps (1.8-mm diameter clamshell-type biopsy forceps without needle) was then introduced through the intact papilla along the guidewire. RESULTS In all patients, sufficient tissue for histopathologic evaluation was obtained without complication. In one patient, biopsy specimens were selectively obtained of the left hepatic duct, which was impossible with conventional forceps. In another patient, histologic examination of specimens obtained by using this new forceps showed adenocarcinoma, whereas specimens obtained with a conventional forceps did not contain adenocarcinoma. However, in another patient, biopsy specimens obtained with a conventional forceps contained adenocarcinoma that was not evident in specimens obtained with the new forceps. Dislodgement of the guidewire during procurement of biopsy specimens occurred in 1 patient. In the other 11 patients, an endoscopic biliary drain was inserted over the guidewire. CONCLUSION The new ropeway-type biopsy forceps is useful for selectively obtaining biopsy specimens of the bile duct. With this system, access for subsequent endoscopic biliary drainage is maintained.
Collapse
Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Tamada K, Tomiyama T, Wada S, Ohashi A, Satoh Y, Higashizawa T, Gotoh Y, Ido K, Sugano K. Hyperechoic lines as a sonographic confirmatory sign during percutaneous transhepatic biliary drainage. Abdom Imaging 2001; 26:39-42. [PMID: 11116358 DOI: 10.1007/s002610000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND In ultrasonically guided percutaneous transhepatic biliary drainage, we often can recognize hyperechoic lines at the tip of the needle when the duct is penetrated successfully. We evaluated the frequency of this phenomenon and analyzed whether it was a useful sign for confirming successful bile duct puncture. METHODS In 65 patients with biliary tract diseases, 84 catheters were placed in the course of 108 attempts at puncture. Results of puncture and the presence of hyperechoic lines were investigated prospectively. RESULTS When the ultrasonographic findings showed hyperechoic lines, successful puncture was significantly more frequent than when the findings did not show hyperechoic lines (53/55, 96%, vs. 31/59, 53%; p < 0.0001). When we judged the hyperechoic lines as the sign of successful puncture, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 63%, 93%, 96%, 48%, and 71%, respectively. CONCLUSION Hyperechoic lines are a useful confirmatory sign of successful puncture. However, absence of these lines was not invariably associated with unsuccessful puncture.
Collapse
Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi 329-0498, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Tamada K, Tomiyama T, Ohashi A, Wada S, Miyata T, Satoh Y, Higashizawa T, Gotoh Y, Ido K, Sugano K. Access for percutaneous transhepatic cholangioscopy in patients with nondilated bile ducts using nasobiliary catheter cholangiography and oblique fluoroscopy. Gastrointest Endosc 2000; 52:765-9. [PMID: 11115914 DOI: 10.1067/mge.2000.109807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Percutaneous transhepatic biliary drainage is required for percutaneous transhepatic cholangioscopy. However, puncture of nondilated bile ducts under ultrasonographic guidance is difficult. METHODS In 10 patients with no ultrasonographic evidence of intrahepatic bile duct dilatation, percutaneous transhepatic biliary drainage was performed under fluoroscopic guidance using cholangiography obtained via a nasobiliary drainage catheter. Direct puncture was performed by means of a left ventral approach using oblique C-arm fluoroscopy. RESULTS Bile duct puncture was successful in all patients. There were no procedure-related complications. Subsequent cholangioscopy was successful in all patients. CONCLUSIONS Direct puncture using nasobiliary drainage cholangiography and oblique fluoroscopy is a useful method when cholangioscopy is necessary in patients with nondilated bile ducts.
Collapse
Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Tamada K, Tomiyama T, Wada S, Ohashi A, Satoh Y, Higashizawa T, Miyata T, Ido K, Sugano K. Catheter dislodgement of percutaneous transhepatic biliary drainage: identification of role of puncture sites and catheter sheath. Abdom Imaging 2000; 25:587-91. [PMID: 11029089 DOI: 10.1007/s002610000047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To identify the appropriate puncture points in the bile duct to avoid catheter dislodgement. METHODS Percutaneous transhepatic biliary drainage catheters (n = 300) were placed in 242 patients. The frequency of dislodgement (complete dislodgement or bending of the catheter) was prospectively investigated. The puncture site of the bile duct was classified on the ultrasonographic findings as follows: Main-B3, main branch of the lateral inferior segment; peripheral-B3, peripheral branch of the lateral inferior segment; B2, lateral superior segment; left hepatic duct, proximal portion of the left hepatic duct; B8, anterior superior segment; B5, anterior inferior segment; B5 + 8, main bile duct of the anterior segment; B6, bile duct of posterior inferior segment; and right hepatic duct, proximal portion of the right hepatic duct. RESULTS When a catheter without an outer sheath was used, catheter dislodgement in peripheral-B3 (2/11, 18%) was more common than in main-B3 (0/32, 0%; p < 0.05). In B5, catheter dislodgement (6/12, 50%) was more frequent than in B8 (3/20, 15%; p < 0.05) and in B6 (0/14, 0%; p < 0.005). When a catheter with an outer sheath was used, catheter dislodgement (2/207, 1%) was rare. CONCLUSION Drainage from B5 and peripheral-B3 is associated with a high risk of dislodgement of the catheter. A catheter with an outer sheath was useful to prevent catheter dislodgement.
Collapse
Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi 329-0498, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Yamamoto H, Koiwai H, Yube T, Isoda N, Sato Y, Sekine Y, Higashizawa T, Utsunomiya K, Ido K, Sugano K. A successful single-step endoscopic resection of a 40 millimeter flat-elevated tumor in the rectum: endoscopic mucosal resection using sodium hyaluronate. Gastrointest Endosc 1999; 50:701-4. [PMID: 10536333 DOI: 10.1016/s0016-5107(99)80026-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- H Yamamoto
- Department of Gastroenterology, Jichi Medical School, Tochigi, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
BACKGROUND Saline-assisted endoscopic mucosal resection is an established therapeutic method. However, it is sometimes difficult to maintain a desired level of tissue elevation after injection of saline. Therefore we decided to use a mucinous substance such as sodium hyaluronate instead of saline. METHODS Two resected porcine stomachs and five dogs were used for the study. The elevations, made by submucosal injections of sodium hyaluronate, were compared with those produced with normal saline. Sodium hyaluronate-assisted mucosal resections were compared with the saline-assisted resections. RESULTS Mucosal elevations created by submucosal injections of sodium hyaluronate remained for a longer time with a clearer margin compared to those made by saline injection. Endoscopic mucosal resections were performed safely with the assistance of sodium hyaluronate. CONCLUSIONS Use of sodium hyaluronate instead of saline for endoscopic mucosal resection could make the procedure easier and more reliable.
Collapse
Affiliation(s)
- H Yamamoto
- Department of Gastroenterology, Jichi Medical School, Tochigi, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Yuasa H, Higashizawa T, Shiokawa Y, Tanaka T, Koga Y. [Spinal anesthesia for a patient with long-term SMON]. Masui 1999; 48:79-80. [PMID: 10036897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
SMON (subacute myelo-optico-neuropathy) may result from clioquinol neurotoxicity. An 81-year-old woman underwent internal fixation for left intertrochanteric fracture. She had been diagnosed as having SMON twenty years previously. Sensory examination revealed paresthesia and decreased deep sensation in the lower extremity. A recent neuropathological report shows that in long-term SMON of about fifteen years, degeneration is located from the medulla oblongata to T5-6. We performed spinal anesthesia of which the level of analgesia was below T5-6 in the present case. The level of anesthesia was determined by the pinprick test, and was recognized as below T10. Postoperatively, both the sensory level of analgesia and vital signs remained stable. There was no worsening of neurological findings after spinal anesthesia, including the postoperative period. In conclusion, spinal anesthesia which was limited to below the level of degeneration could be applied in a case of long-term SMON.
Collapse
Affiliation(s)
- H Yuasa
- Department of Anesthesiology, Wakakusa Daiichi Hospital, Higashiosaka
| | | | | | | | | |
Collapse
|
21
|
Morita H, Higashizawa T, Yuasa H, Hiramatsu K, Koga Y. [Evaluation of preincisional mexiletine administration to alleviate postoperative pain]. Masui 1998; 47:1311-4. [PMID: 9852693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Mexiletine, an antiarrhythmic agent, was preincisionally administered intravenously for the purpose of reducing postoperative pain. Twenty-eight female patients for mastectomy were studied. The patients were divided into three groups. Group 1 received no mexiletine. Group 2 received bolus administration of mexiletine 1 mg.kg-1 with additional continuous administration of 1 mg.kg-1.hr-1 for 75 minutes. Group 3 received bolus administration of mexiletine 2 mg.kg-1. The requirement of butorphanol as a postoperative analgesic within 1 hour after mastectomy in Group 3 was significantly lower than that in Group 1 (P < 0.05), but butorphanol requirement in Group 2 was not significantly lower than that in Group 1. Plasma mexiletine concentration was slightly higher in Group 3 (1.7 micrograms.ml-1) than that in Group 2 (1.0 microgram.ml-1) immediately after the intravenous mexiletine administration, although there was no significant difference. The results indicate that mexiletine 2 mg.kg-1 as preoperative bolus administration maintains its plasma concentration above 1.7 micrograms.ml-1, and is clinically effective for reducing the postoperative pain after mastectomy.
Collapse
Affiliation(s)
- H Morita
- Department of Anesthesiology, Kinki University School of Medicine, Osakasayama
| | | | | | | | | |
Collapse
|
22
|
Sakai T, Konishi A, Nishiyama T, Higashizawa T, Bito H. [A comparison of the grade of laryngeal visualisation;--the McCoy compared with the Macintosh and the Miller blade in adults]. Masui 1998; 47:998-1001. [PMID: 9753969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Effectiveness in visualization of the vocal cord during orotracheal intubation with McCoy (McC) compared with Macintosh (Min) and Miller (Mil) blades were investigated. After an institutional review board approval, 117 patients for elective surgery under general anesthesia requiring tracheal intubation were investigated. Five board certified anesthesiologists tried to visualize the vocal cord of a patient three times with the three different types of laryngoscope. Total of 351 intubation attempts were studied. The view obtained at laryngoscopy with each of the three blades was recorded as follows. Grade 1. If most of the glottis is visible. Grade 2. If only the posterior extremity of the glottis is visible. Grade 3. If no part of the glottis can be seen. Grade 4. If not even the epiglottis can be exposed. Eight-two Grade 1 views were obtained with McC, 72 with Mil and 47 with Min, respectively. Thirty-three Grade 2 views were obtained with McC, 36 with Min and 24 with Mil. Two Grade 3 views with McC, 34 with Min and 14 with Mil were obtained. Seven Grade 4 views were obtained with Mil. The grades of laryngeal visualization with McC were significantly lower than those with Min and Mil.
Collapse
Affiliation(s)
- T Sakai
- Department of Anesthesiology, University of Hirosaki School of Medicine
| | | | | | | | | |
Collapse
|
23
|
Nishiyama T, Higashizawa T, Bito H, Konishi A, Sakai T. [Which laryngoscope is the most stressful in laryngoscopy; Macintosh, Miller, or McCoy?]. Masui 1997; 46:1519-24. [PMID: 9404140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Stress responses during laryngoscopy were compared among the situations using three different laryngoscopes, Macintosh (curved standard blade), Miller (straight blade), or McCoy (levering). Blood pressure, heart rate (in 58 patients) and plasma concentration of catecholamines (in 29 patients) were measured before, during and after laryngoscopy without tracheal intubation. Systolic blood pressure after laryngoscopy was significantly higher in the Miller group than in other two groups. Plasma epinephrine concentrations after laryngoscopy in the McCoy group were lower than other two groups. Heart rate and plasma norepinephrine concentration were not different among the three groups. These results suggest that the stress response during laryngoscopy without intubation is the biggest in using the Miller laryngoscope and the smallest in using the McCoy laryngoscope.
Collapse
Affiliation(s)
- T Nishiyama
- Department of Anesthesiology, University of Tokyo Faculty of Medicine
| | | | | | | | | |
Collapse
|
24
|
Higashizawa T, Bito H, Nishiyama T, Sakai T, Konishi A. [Assessment of the practice of endotracheal intubation by levering Laryngoscope in teaching of undergraduate medical students]. Masui 1997; 46:1255-8. [PMID: 9311221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Twenty-nine inexperienced medical students tried to intubate endotracheal tubes using both levering laryngoscope (McCoy laryngoscope) and Macintosh laryngoscope in adult mannikin the Cormack and Lehane Grade 2. The number of successful intubations by McCoy type was close to those by Macintosh type. Improvement in time necessary from insertion of the laryngoscope to confirmation of placement of the endotracheal tube McCoy type was also close to that by Macintosh type. But the grade of handling difficulty of McCoy type was significantly higher than that of Macintosh type, because Macintosh type was simpler to handle than McCoy type. It was suggested that Macintosh laryngoscope was more useful than McCoy laryngoscope for teaching of inexperienced medical students.
Collapse
Affiliation(s)
- T Higashizawa
- Department of Anesthesiology, Kinki University School of Medicine, Osaka-Sayama
| | | | | | | | | |
Collapse
|
25
|
Konishi A, Sakai T, Nishiyama T, Higashizawa T, Bito H. [Cervical spine movement during orotracheal intubation using the McCoy laryngoscope compared with the Macintosh and the Miller laryngoscopes]. Masui 1997; 46:124-7. [PMID: 9028096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The movement of cervical spine during orotracheal intubation was compared using the McCoy, Macintosh or Miller laryngoscope blade. Twenty ASA 1-2 patients requiring tracheal intubation were studied. Following induction of anesthesia and obtaining muscle relaxation, the cross-table lateral X-ray was taken before and during laryngoscopy using three types of laryngoscopes. Degree of cervical spine movement was evaluated by measuring the distance between the spinous processes of C1 and the occiput, and the amount of displacement of C1 and C5 against C3 by tracing on each films. The results indicated that delta C1-occiput was larger and delta C1 + C5 smaller with the McCoy laryngoscope compared with the others. The use of the McCoy laryngoscope results in less cervical spine movement during laryngoscopy and therefore should be of particular benefit in the presence of cervical spine instability as well as in the normal patients.
Collapse
Affiliation(s)
- A Konishi
- Department of Anesthesia, Shin Tokyo Hospital, Matsudo
| | | | | | | | | |
Collapse
|
26
|
Higa K, Manabe H, Sato S, Higashizawa T, Dan K. Effect of vidarabine and acyclovir on acute herpetic pain treated with sympathetic nerve block. Pain 1990. [DOI: 10.1016/0304-3959(90)92256-p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
27
|
Takahashi H, Nakano K, Adachi Y, Aoki N, Hajiro K, Yamamoto T, Higashizawa T, Chikugo T, Suzuki T. Multiple nonfunctional pancreatic islet cell tumor in multiple endocrine neoplasia type I. A case report. Acta Pathol Jpn 1988; 38:667-82. [PMID: 2905567 DOI: 10.1111/j.1440-1827.1988.tb02339.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A case of multiple nonfunctional pancreatic islet cell tumor in multiple endocrine neoplasia type I (MEN I) is reported. The patient was a 41-year-old woman who had a past history of thyroid cancer (papillary carcinoma) and hyperparathyroidism due to parathyroid adenoma. Later, a nonfunctional pituitary tumor and five nonfunctional pancreatic tumors were found simultaneously and the patient was finally diagnosed as having MEN I. Following surgical enucleation, the pancreatic tumors were histopathologically diagnosed as benign islet cell tumors. One of them (tumor 3) exhibited a solid nodular pattern while the others showed gyriform patterns. They were divided histochemically and immunohistochemically into three types: two (tumors 1 and 2) produced a single hormone (glucagon), one (tumor 3) produced five (insulin, glucagon, somatostatin, gastrin and pancreatic polypeptide) and the remaining two (tumors 4 and 5) produced two (glucagon and pancreatic polypeptide). Electron microscopically, three types of endosecretory granules were found in the tumor cells of tumor 3 but only one type was found in tumor 4. However, in the tumor 4 extract, glucagon, pancreatic polypeptide, C-peptide, somatostatin, vasoactive intestinal peptide and growth hormone releasing factor were detected by radioimmunoassay. These findings suggest that these pancreatic tumors were both multicellular and multihormonal.
Collapse
Affiliation(s)
- H Takahashi
- Second Department of Internal Medicine, Kinki University School of Medicine, Osakasayama, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Okamoto K, Yamamoto K, Morita N, Ohta Y, Chikugo T, Higashizawa T, Suzuki T. Establishment and use of the M strain of stroke-prone spontaneously hypertensive rat. J Hypertens Suppl 1986; 4:S21-4. [PMID: 3465899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
An inbred strain of stroke-prone spontaneously hypertensive rat, the M-SHRSP, was established by brother-sister breeding of selected SHRSP for 24 generations while administering apresoline. Compared with SHRSP, the M-SHRSP shows an earlier rise in blood pressure, plasma renin activity (PRA) and cerebrospinal fluid (CSF) pressure, and somewhat changed cerebrovascular lesions. Crosses and back-crosses, using M-SHRSP, Wistar-Kyoto rats (WKY), spontaneously hypercholesterolaemic (SHC) rats and their hybrids produced colonies with various blood pressure levels and hypercholesterolaemia. Continued successive selective brother-sister breeding of M-SHRSP and SHC hybrids produced a colony with severe hypertension and marked hypercholesterolaemia. Streptozotocin diabetes was induced in an M-SHRSP and SHC hybrid (TC), from which diabetic TC was successively bred to the fifth generation. While each generation was hypertensive and showed a decrease in islet B-cells, symptoms of lasting glycosuria were first observed in the fourth generation among those given a high alpha-corn starch (75.7%) diet.
Collapse
|