Yorinori Hikasa

Treatment of cystic hygroma and lymphangioma with the use of bleomycin fat emulsion

Of the several types of treatment for cystic hygromas and lymphangiomas, surgical excision has been the preferred treatment. However, there is a high recurrence rate because lymphangiomas tend to infiltrate the surrounding tissues. Bleomycin in a microsphere‐in‐oil (S/O) emulsion was used in this study as a sclerosing agent for lymphangiomas. Experimental studies using domestic rabbits showed that the bleomycin emulsion caused more marked fibrotic changes at the injection site than other formulations, such as a blank emulsion and bleomycin solution. In clinical trials, 27 of 33 patients received bleomycin S/O emulsion injected directly into the tumors with satisfactory results. Histologic pictures of the clinically resected specimens confirmed the findings of the experimental studies. Comparative studies of treatments between bleomycin S/O emulsion and surgery indicated that injection therapy of bleomycin S/O emulsion would be more beneficial than surgical excisions.

Gallstones in Western Japan: Factors affecting the prevalence of intrahepatic gallstones

In a study from 40 hospitals in Western Japan between 1975 and 1978, intrahepatic gallstones were identified at the first biliary tract operation in 106 patients (a 3.03% prevalence). These were predominantly bilirubin stones. The occurrence rate for patients with intrahepatic stones was the same as for patients with bilirubin stones solely in the common bile duct suggesting the pathogenetic similarity of these two conditions. The prevalence of intrahepatic stones was 1.5% at urban and 4.97% at rural hospitals (P less than 0.005). Rural patients were significantly older than urban patients (P less than 0.005), but both groups showed an increasing prevalence with age. However, patients with intrahepatic stones were younger than those with bilirubin stones solely in the common bile duct, reflecting the increase likelihood that stones obstructing the biliary tree in this location would cause hepatic damage, pain, and, fever or the possibility that congenital anomalies of the bile ducts migt lead to stone formation at an earlier age. Among the 106 patients, only 12% had stones in the intrahepatic ducts alone. The majority of patients with both bilirubin and cholesterol intrahepatic stones had stones throughout the biliary tree simultaneously. The decreasing prevalence of bilirubin stones in Japan may be related to multiple factors including eradication of parasites and westernization of the diet.

Present features of gallstones in Japan: A collective review of 2,144 cases

A collective review of 2,144 patients operated on for cholelithiasis during the last twenty-two months has shown that younger Japanese adults have predominantly cholesterol stones in their gallbladders and that elderly persons still frequently have bilirubin stones not only in their gallbladders but also in their common bile ducts. Recent westernization of dietary habits in Japan is considered to be the most probable factor causing the increased incidence of cholesterol stones. The decreased incidence of bilirubin stones is considered to be caused by the decreased incidence of biliary infection and increased intake of proteins in food.

Analysis of conjugated bile acids in bile by high-pressure liquid chromatography

The major conjugated bile acids of man, including glycine and taurine conjugates, can be separated by high-pressure liquid chromatography (HPLC). The chromatographic column is 300 mm long with an internal diameter of 8.0 mm and is packed with Lichrosorb RP 18 (5 MICRONS). The mobile phase is methanol-water 75 : 25 (v/v) acidified to pH 2 with phosphoric acid. The eluent peaks are detected by a UV absorbance detector at a wavelength of 210 nm. The 10 conjugated bile acids are quantitatively analyzed on a single run of chromatography in less than 50 min. Deproteinization of biological samples is sufficient for the preparation of the analysis.

Stimulation of hepatic cholesterol biosynthesis by dietary glucose, and its relation to cholesterol gallstone formation in the hamster

Abstract The biosynthesis of cholesterol in the liver has been investigated in vitro with hamsters maintained on various dietary conditions. A fat-free and high-glucose diet has been reported to produce cholesterol gallstones at a high incidence, but no cholesterol gallstone is produced when dietary glucose is substituted with starch. After hamsters were fed on the fat-free and high-glucose diet for 28 days, the activity of cholesterol synthesis from acetate in the liver slices was about 4-fold that of the animals which were maintained on the fat-free and high-starch diet. The addition of ethyl linoleate to the high-glucose diet prevented the increase of synthetic activity of cholesterol as well as gallstone formation. Ethyl linoleate could not be replaced by ethyl palmitate. With mevalonate as a substrate, no marked difference in the cholesterol synthesis was observed between animals on the glucose diet and those on the starch diet. The results indicate a close correlation between the increased activity of cholesterol synthesis in the liver and the formation of cholesterol gallstones. The enhanced activity of cholesterol synthesis from acetate in animals on the glucose diet appears to be due to the increase of enzymic activities before mevalonate in the biosynthetic pathway of cholesterol.

Pathogenesis and treatment of pancreatitis due to essential fatty acid deficiency

SummaryPathogenesis of pancreatitis was studied in experimental animals and essential fatty acid deficiency was condemned as an etiological factor, since it caused pathological changes in permeability of cell membrane of the pancreatic acinar cells.Favorable effects of intravenous fat emulsion was clearly demonstrated in treatment for acute and chronic pancreatitis.

Surgical significance of dilatation of the common bile duct--with special reference to choledocholithiasis.

Diameter of the common bile duct was measured in 3,119 patients who underwent primary operation for gallstones, during the period from 1975 to 1978. Although dilatation of the common bile duct was most marked in patients with bilirubin stones in the bile duct alone, dilatation was also observed in patients with cholesterol stones in the gallbladder alone. Drip infusion cholangiograms of 84 healthy patients showed that the common bile duct dilated in parallel with aging. A review of patients with congenital choledochal cysts reported in the literature in Japan revealed that few had gallstones. Thus, it was difficult to determine whether common bile duct dilatation was the cause or result of gallstones, and it was suggested that the socalled drainage operation such as choledochoenterostomy should be done only under strict indications.

Recurrent common duct stones, with special reference to primary common duct stones.

SummaryA series of 1,358 cholelithic patients operated on at 32 affiliated hospitals during the last year and 492 patients operated on at authors’ hospital during the last 21 years were reviewed with special reference to the cases of recurrent common duct stones. Of the former series 15 patients and of the latter series 12 patients respectively were reoperated on for recurrent, but not for residual, common duct stones, and all of them had in the markedly dilated common duct bilirubin stones showing characteristics of stasis stone-primary in common duct. Two representative cases are presented briefly. Congenital hypotonia of the common duct and inflammatory choledochitis are condemned and bilioenterostomy is recommended for preventing stone recurrences.

Etiology of cholesterol gallstones.

SummaryFormation of pure cholesterol stones is initiated by an excessive intake of highly purified carbohydrates, a large intake of animal fats and a restricted intake of vegetable fibers.When the protein content of the lithogenic diet was reduced, mixed or combined stones were formed in golden hamsters. These experimentally, dietarily produced gallstones had compositions and fine structures similar to those of human gallstones.Some mentions were made on black stones which were found in the aged golden hamsters fed with lithogenic diets.

A case with large hepatoma which showed some interesting findings of the hemodynamics of the portal system after interposition mesocaval shunt.

リニア電子スキャンとパルスドップラー法を組み合わせたリニア電子スキャン・パルスドップラー複合血流計により,門脈などの深部血管の血流測定が可能となった.我々は,この方法による血流測定と門脈圧・肝静脈圧などを同時に測定し,肝臓を中心とした門脈の血行動態を定量的に把握するよう努めてきた.今回,肝癌の患者で,5年前に上腸間膜静脈・下大静脈H型吻合術を実施されていた患者に上述の検査を実施し,門脈血行動態上,興味ある以下の知見を得た.1)門脈本幹血流の逆流が認められたこと.2)シャントを介した圧較差ぶ6mmHg,血流が約3,000ml/minと計算され,同シャントの血管抵抗が非常に低値であると証明されたこと.さらに,3)肝癌による下大静脈圧排という血行動態の修飾により,類洞圧の低下がみられず,結果として類洞より肝静脈に灌流される血液が充分に存在していたと想像されたことであった.