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51.
Masao Tanaka Hiroyuki Konomi Hiroaki Matsunaga Kazunori Yokohata Naruhiro Utsunomiya Torahiko Takeda 《Journal of Hepato-Biliary-Pancreatic Surgery》1997,4(1):16-19
Technical improvements, such as mechanical lithotripsy, stenting or nasobiliary drainage, and wire-guided cannulation, have reduced the risk of complications in endoscopic sphincterotomy. To determine the extent of this reduction in risk, we assessed the medical records of 1352 patients with common bile duct stones in whom the procedure was conducted. Complications examined were: acute cholangitis and pancreatitis. Stone clearance was achieved in 1256 patients (92.8%), with an overall morbidity rate of 7.7% and a mortality rate of 0.15%. One hundred and forty-two patients had stones with a diameter greater than 20mm; 97 of these patients did not undergo lithotripsy. Cholangitis occurred in 10 of these 97 patients (10.3%), whereas, in the 45 patients who underwent lithotripsy, there were no cases of cholangitis (P=0.02). Stone removal was not immediately accomplished or attempted in 396 patients. In 82 of these patients in whom a stent or a nasobiliary drain was placed in the common bile duct, the incidence of cholangitis was 1.2%, significantly less (P=0.045) than the incidence of 6.4% in the other 314 patients given no stenting or nasobiliary drain. To overcome difficult cannulation, precut sphincterotomy was conducted in 134 patients and wireguided sphincterotomy, a recently introduced procedure, was conducted in 55 patients. When the precutting technique was used, the incidence of acute pancreatitis was significantly higher (8/134; 6.0%) than that in the patients in whom the standard procedure was conducted, i.e., neither the precut technique nor wire-guided ES was used (23/1218; 1.9%) (P=0.008). There were no cases of pancreatitis in the 55 patients in whom wire-guided sphincterotomy was performed, although the difference was not statistically significant because of the small number of patients (P=0.06). Based on these findings, we conclude that improved technologies have led to a significant reduction of complications in endoscopic sphincterotomy. 相似文献
52.
Atsuhiro Yoshida Asami Takeda Katsushi Koyama Yasuhiro Ohtsuka Kunio Morozumi Tadashi Oikawa 《Clinical and experimental nephrology》1997,1(4):292-296
Kimura's disease is a rare disorder that involves regional lymph nodes and the major salivary glands, which become infiltrated
by eosinophils and lymphocytes. Renal lesions associated with Kimura's disease are rare. We describe the case of a 60-year-old
Japanese woman who first noted a nodular mass in a salivary gland. As the nodule grew, nephrotic syndrome and heart failure
developed. A biopsy of the nodule revealed Kimura's disease, and surgical excision was performed. After the operation, the
heart failure and nephrotic syndrome, which were diagnosed as minimal change disease on renal biopsy, improved rapidly without
steroid therapy. Four months later, the nephrotic syndrome recurred without recurrence of Kimura's disease. The patient showed
marked improvement during prednisolone therapy (40 mg/d) and was in complete remission 4 weeks after the initiation of steroid
therapy. This case shows that surgical excision and prednisolone therapy are useful for nephrotic syndrome associated with
Kimura's disease. 相似文献
53.
Takeda Atsushi Kikuchi Akio Matsuzaki-Kobayashi Michiko Sugeno Naoto Itoyama Yasuto 《Journal of neurology》2007,254(4):IV2-IV7
Journal of Neurology - Olfactory dysfunction in Parkinson's disease (PD) has been described for more than thirty years and known as one of the commonest non-motor symptoms in PD. Recently, it... 相似文献
54.
Masahito Minakawa Kenji Takahashi Norihiro Kondo Masaharu Hatakeyama Toshihiko Kuga Ikuo Fukuda 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2003,51(11):582-587
Objective: Reoperative coronary bypass grafting is at high risk. Particularly in redo cases where the patent graft is running near
the midline of the sternum, the graft may be exposed to injury by a median sternotomy and subsequent dissection. Whereas,
off-pump bypass grafting from the left axillary artery or descending thoracic artery by a left thoracotomy approach is safe
for preventing graft damage.Methods: From March 1998 to February 2002, we performed off-pump coronary artery bypass grafting by a left thoracotomy approach in
9 patients. The left axillary artery was used as the inflow vessel in 4 cases, and the descending thoracic, aorta in 5.Results: The radial artery was anastomosed proximally to the axillary artery in 4 cases and the descending thoracic aorta in one
case. The saphenous vein graft was anastomosed, proximally to the descending thoracic aorta in 4 cases. Transdiaphragmatic
minimally invasive bypass grafting for the right coronary artery was simultaneously performed in 3 cases. Postoperative cardiac
events were ventricular arrhythmia in 6 cases and supraventricular arrhythmia in 3 cases. There was no damage to the patent
grafts. Postoperative coronary angiography performed, in 8 cases revealed all the grafts to be patent without stenosis. Cardiac
symptoms were not found after the operation in any of the cases.Conclusions: These procedures can prevent the injury to patent grafts caused by a median sternotomy, and will be one of the useful strategies
for reoperative off-pump coronary artery bypass grafting. 相似文献
55.
A focal cerebral ischemic model was produced by occlusion of the intracranial main cerebral artery with a silicone cylinder in normotensive (NTR) and spontaneously hypertensive rats (SHR). Main cerebral artery could be successfully occluded in approximately 90%. The most frequent embolized site was the distal part of the internal cerebral artery (ICb) and less frequently the horizontal segment of the anterior cerebral artery (Al). Mortality rate of NTR with ICb occlusion (NTR-ICb) was 43% at 72 hours after embolization and that of SHR with ICb occlusion (SHR-ICb) was 67% at 24 hours after embolization. NTR-ICb showed neurological signs (i.e. circling movement, hemiparesis, poor response to pain stimuli) and histologically, showed infarction in the deep cerebral structures (i.e. thalamus, hypothalamus, hippocampus, and internal capsule) accompanied with mild disruption of blood-brain barrier (BBB). SHR-ICb showed more serious neurological signs and more severe cerebral infarction in the deep cerebral structures with severe disruption of BBB. In SHR-ICb, ischemic cerebral edema was more prominent which may deteriorate symptoms and pathological findings compared to NTR-ICb. This embolization model is proposed to be useful for studying the pathophysiology of focal cerebral ischemia, especially, early ischemic edema. 相似文献
56.
57.
Kenji Yoshimi Masatoshi Takeda Tsuyoshi Nishimura Takashi Kudo Yu Nakamura Kunitoshi Tada Nobuyoshi Iwata 《Brain research》1991,560(1-2):149-158
Changes in MAP2 and clathrin immunoreactivity were studied in gerbil hippocampus after transient cerebral ischemia. MAP2 immuno-reactivity decreased significantly by 1 h in the subiculum-CA1 and CA2 areas which correspond to reactive change, while no decrease was observed in CA1 until day 4. Before the initiation of delayed neuronal death, MAP2 immunoreactivity was not changed in CA1. On the other hand clathrin immunoreactivity increased in the pyramidal cell layer of CA1 by 3 h after ischemia and remained high for 2 days. Clathrin immunoreactivity in the pyramidal cell layer of CA1 diminished after delayed neuronal death. The transient change of clathrin was noted especially in CA1 in the period prior to delayed neuronal death. These results imply an abnormal change in clathrin turnover after ischemia, which may participate in the pathogenesis of delayed neuronal death. 相似文献
58.
Dual effects of 5-hydroxytryptamine on the release of gamma-aminobutyric acid from myenteric neurones of the guinea-pig ileum.
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The effects of 5-hydroxytryptamine (5-HT) on the release of gamma-aminobutyric acid (GABA) were examined in the longitudinal muscle-myenteric plexus (LM-MP) preparation of guinea-pig ileum. 5-HT increased the spontaneous release and inhibited the electrically-evoked release of [3H]-GABA. The 5-HT-evoked release was Ca2+-dependent and tetrodotoxin-sensitive, and was antagonized by (3 alpha-tropanyl)-1H-indole-3-carboxylic acid ester (ICS 205-930), but not by methysergide and ketanserin. The inhibitory effect of 5-HT was antagonized by methysergide, but not by ketanserin and ICS 205-930. 8-Hydroxy-2-(di-n-propylamino)tetralin mimicked the inhibitory effect of 5-HT. Thus, 5-HT may exert an excitatory effect on the enteric GABAergic neurone via the 5-HT3 receptor and an inhibitory effect via the 5-HT1A receptor. 相似文献
59.
K. Miyashita I. Morioka T. Tanabe H. Iwata S. Takeda 《International archives of occupational and environmental health》1992,64(5):347-351
Summary To study the effects of construction machinery operation on subjective symptoms, a questionnaire survey was caried out among construction machinery operators by a self-reporting method. Subjects were 184 power shovel operators, 127 bulldozer operators, 44 forklift operators as operator groups, and 44 office workers as a control. Their ages were in a range of 30–49 years. The questionnaire contained 20 symptoms referring to fatigue, digestive problems, and upper or lower limbs or back problems. The prevalence rate and symptom characteristics were examined. The dominant symptoms of the operator groups were stiff shoulder, low back pain, and stomack symptoms. The prevalence rate of low back pain was significantly different between forklift operators and controls. No significant differences were found in the symptoms of upper limbs and fingers between operator groups and controls. The prevalence of Raynaud's phenomenon was 0.5%–2.3% in the operator groups and 2.3% in the control group. 相似文献
60.
Effect of extradural analgesia on the paradoxical arousal response of the electroencephalogram 总被引:2,自引:0,他引:2
Despite widespread recognition of the potential role of the processed
electroencephalogram (pEEG) as a monitor of depth of anaesthesia, few
studies have examined the effects of surgical stimuli on the intraoperative
pEEG. Two groups of gynaecological patients (n = 10 in each group), with or
without pre-incisional extradural analgesia, undergoing gynaecological
laparotomy under nitrous oxide and isoflurane anaesthesia were monitored
with routine haemodynamic observations and pEEG. Patients who received
pre-incisional extradural analgesia showed no significant changes in pEEG
variables during surgery (mean spectral edge frequency 95 percentile
(SEF95) 13.3 (SD 1.4) Hz), whereas in all patients without pre-incisional
extradural analgesia, a significant decrease in SEF95 was noted (6.5 (1.1)
Hz after incision compared with a pre-incisional value of 12.5 (1.4) Hz)
together with an increase in arterial pressure (paradoxical response). In
the latter group, SEF95 and arterial pressure returned to pre-incisional
values after extradural analgesia was established during operation. During
emergence from anaesthesia, both groups showed a significant increase in
SEF95 (25.7 (1.4) Hz). This study suggests that intraoperative pEEG arousal
response was different from changes detected when anaesthesia was
terminated at the end of surgery. Surgical stimuli in the absence of
adequate analgesia induced a paradoxical arousal response.
相似文献