[Hepatolithiasis. Hepatectomy of hepatolithiasis].
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Biomedical subjects
Publications and source records attributed to F Hanyu.
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Primary lymphoma of the liver is an extremely rare entity; only eight cases have been reported in the literature. We treated a 34-year-old man with primary hepatic lymphoma by right hepatic lobectomy, including right hemicolectomy the nephrectomy. The histological diagnosis was a small cell diffuse histiocytic lymphoma. Details of this case plus that of others in the literature are described in this report.
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Twenty-eight cases of unresectable pancreatic carcinoma were treated with intraoperative radiotherapy (IOR) with or without postoperative radiotherapy (POR) from 1975 to 1982 at Tokyo Women's Medical College. The results were as follows. IOR was effective for pain relief, and the response rate was 93%. Twenty-five Gy of IOR, considering sequential POR, was a reasonable dose in about an 8 X 8 cm to 10 X 10 cm radiation field. Precise staging and marking of the tumor edge at operation were important for the treatment planning after IOR. Radiotherapy should be considered in the multimodal treatment of pancreatic carcinoma.
Though the resection rate of pancreatic carcinoma has become markedly higher since introduction of extensive operation in 1978, the prognosis is still poor, and a majority of resected cases die of tumor within one year after operation. It must be emphasized that the multidisciplinary treatment positively incorporating such new procedures as described below is now important to improve the therapeutic results of pancreatic carcinoma; providing a device for postoperative percutaneous intraarterial injection for resectable cases or performing local chemotherapy with MMC preparations of controlled release for non-resectable cases.
Morphological survey was performed in 140 liver specimens of hepatolithiasis which were collected from several pathological and surgical Departments in Japan. Among them there were 19 cases with unusual features suggestive of presumed lithogenic processes. They consisted of association of congenital dilatation of biliary tree (5 cases), association of stenosis or obstruction of biliary tree occurring prior to lithiasis (4 cases), association of anomalous communication between biliary tree (1 case), presence of serous glands simulating to pancreatic exocrine glands in biliary tree (1 case), association of non-biliary hepatic cirrhosis (4 cases), association of chronic ulcerative colitis (1 case), intrahepatic cholesterol stone (2 cases) and association of granulomatous cholangitis (1 case). Chronic proliferative cholangitis which is consistently seen in a common type of hepatolithiasis was found in about a half of these unusual cases and not in the remaining cases. Based on the observations of these unusual cases, the following suggestions were obtained: dilatation, bile stasis or cholangitis may be a lithogenic factor of hepatolithiasis, and chronic proliferative cholangitis associated with a numerous amount of mucinous glands is not always a prerequisite lesion and exerts a promoting and accelerating effect in hepatolithiasis.
In our hospital, we had experienced 3,036 cases of gallstones from January 1968 through December 1983, among which intrahepatic stone cases was 154, (5.1%). Intrahepatic stone formation is classified based on X-ray pictures, i.e., congenital intrahepatic cystic bile duct dilatation, for example, Caroli's disease. anomaly of the bile duct. acquired extrahepatic ductal stones. operation. Hepatectomy was performed in 49 of 154 intrahepatic ductal stone cases. We never experienced operative death. We should select operative methods, taking mode of formation into consideration. Hepatectomy for intrahepatic ductal stones was radical surgery and it shortened therapeutic period. Prognosis is good in 41 cases and poor in 6. In 2 among latter 6 cases, recurrence of stones was observed and in other 4 cases, residual stones and cholangitis were noticed. Two cases died, one due to hepatic abscess and the other another disease.
In cases of surgically proved pancreatic carcinoma, preoperative values of serum CEA, serum amylase and pancreozymin-secretin test (PST) were seen if they related to the macroscopic stages of the tumor determined by "General Rules for Surgical and Pathological Studies on Cancer of Pancreas" offered by Japanese Pancreatic Society in April 1982. Serum CEA was determined in 43 cases, serum amylase in 34 cases and PST was done in 28 cases. All of CEA, amylase and PST showed no statistically significant relationship to the stages of the carcinoma. This may suggest that these tests may not be a useful indicator of the stage of tumor.
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In order to know the degree of the destruction of peptide hormones in pancreatic tissue of autopsied material, the time courses of the degradation of pancreatic insulin, glucagon and hPP were studied using surgically operated pancreatic pieces kept at room or low temperature. Amounts of insulin, glucagon and hPP in pancreatic tissue were determined by radioimmunoassay. Insulin in the pancreas just after resection was 2.58 +/- 0.33 U/g (mean +/- SE). At 3 hrs it decreased to 66.4 +/- 3.8%, at 6 hrs, to 68.5 +/- 5.1% and at 12 hrs to 51.7 +/- 11.4% of the initial value in the tissues kept at room temperature (20-22 degrees C) When the tissues were kept at 4 degrees C, 90.7 +/- 3.9% of insulin at 3 hrs, 88.5 +/- 7.0% at 6 hrs, and 80.3 +/- 2.6% at 12 hrs were preserved. 81.3 +/- 13.9% of the initial hPP was present in the tissues after 6 hrs at room temperature, and it decreased to 20.7 +/- 5.7% after 12 hrs, whereas no significant decrease in hPP was found even after 12 hrs at low temperature. Glucagon content at starting point was 16.85 +/- 4.05 micrograms/g and at 3 hrs in the room temperature it fell to 7.46 +/- 3.53 micrograms/g (41.5 +/- 9.8%) and at 6 and 12 hrs only 14.4 +/- 4.1% and 5.8 +/- 4.2% were left, respectively. At low temperature, at 3 hrs 79.3 +/- 8.9%, at 6 hrs 62.2 +/- 14.7% and at 12 hrs 53.5 +/- 16.6% was preserved. These findings indicate that special consideration should be taken from the viewpoint of the destruction of hormones in pancreatic tissues obtained at autopsy.
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We devised a direct percutaneous transhepatic cholangial drainage under fluoroscopic control. The principle is as follows. After percutaneous transhepatic cholangiography, the three dimensional structure of intrahepatic bile ducts is projected to a two dimensional plane under fluoroscopy; the needle can then be introduced into the selected bile duct with accuracy. The technique can be used as a preoperative management of operations of patients with jaundice and also as a palliative management of advanced cancer without much complication.
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