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Biomedical subjects

K Hirohashi

Publications and source records attributed to K Hirohashi.

At least 19 recordsLinked to original sources
PubMed1992

[Preoperative percutaneous transhepatic portal vein embolization to extend the indications for hepatectomy and to increase the safety of extended hepatectomy for hepatocellular carcinoma].

The usefulness of preoperative percutaneous transhepatic portal vein embolization (PTPE) in extending the indications for hepatectomy and increasing the safety of extended hepatectomy for hepatocellular carcinoma was studied in 21 patients who underwent right hepatic lobectomy with PTPE of the right first portal branch (group E), in 15 such patients but without PTPE (group N), and in seven such patients who underwent PTPE at this location but could not undergo surgery (group U). The mean volume of the left lobe increased but the results of a 15-minute indocyanine green retention test were worsened 2 weeks after PTPE and again 4 weeks after hepatectomy, but these changes after hepatectomy were almost the same in groups E and N. The worsening of liver function and coagulation test results was less in group E than in group N. The mean prognosis score was better in group E two weeks after PTPE than before, but not in group U. The four patients in group E with high portal vein pressure (> or = 30 cmH2O) or a high prognosis score (> or = 50 points) after PTPE developed hepatic failure after surgery. Preoperative PTPE was useful in extending the indications for hepatectomy and increasing the safety of extended hepatectomy. Evaluation of the clinical course after PTPE was also useful when decisions about the operative method to be used were being made.

Aged↗
PubMed1991

[Preoperative portal vein embolization for hepatocellular carcinoma].

We performed preoperative portal vein embolization (PVE) for 71 patients with hepatocellular carcinoma (HCC), 59 of whom underwent hepatectomy about two weeks after PVE. The purpose of the PVE was usually to embolize the portal vein supplying the area to be resected. After PVE, the non-embolized part of the liver became hypertrophic and the embolized part of the liver became atrophic. Of the 22 patients who underwent right lobectomy after PVE of the right first branch of the portal vein, the mean results of a test of 15-minute indocyanine green retention after PVE increased significantly less than the mean for six patients who could not undergo right lobectomy after PVE of their right first branch. The extent of this increase and the liver volume of the left lobe 4 weeks after right lobectomy were higher in another 15 patients who did not undergo PVE than 22 patients who underwent PVE. PVE is useful as one preparation for hepatectomy of patients with HCC, because the embolized part of the liver was damaged by PVE, but mean liver function was compensated by the part of the liver that was not embolized and regenerated.

Carcinoma, Hepatocellular↗
PubMed1990

Clinical courses and treatment of splenic artery aneurysms--report of 3 cases and review of literatures in Japan.

We have treated three cases of splenic artery aneurysms recently, so we reported them with a review of 181 cases in Japan. All three cases are women and have characteristic clinical courses and pathogenesis in each to which we performed a reasonable operation so that they could be saved. First one is a ruptured case. So we performed ligation of the splenic artery from inside the aneurysm under 9 min.'s clamp of the aorta. Second one was pointed out the splenic artery aneurysm during admission for cholecystectomy, so we performed splenectomy and aneurysmectomy, and after that we reconstructed the splenic artery with end-to-end anastomosis. Third one suffered from splenomegaly and portal hypertension. We performed splenectomy with the aneurysm. From the clinical and pathological findings, we concluded that an aneurysm in our first case was associated with arterial dysplasia, second with hemodynamic changes in parous women, and third with portal hypertension. Aneurysms of the splenic artery have been rarely reported until recently, when developments in diagnostic procedures made their discovery easier. We have diagnosed splenic artery aneurysm in three patients preoperatively. The clinical symptoms and operative procedure was different in each case, and are reported here. We demonstrated the summary of our three cases of that at Table 1.

Aneurysm↗
PubMed1989

[Measurement of portal blood flow in man by a continuous local thermodilution method. III. Effects of dopamine on systemic and portal hemodynamics after hepatectomy].

We gave dopamine (3 micrograms/kg/min, 30 min) intravenously on the third day after hepatectomy to 19 patients, and studied the effects of the drug on systemic and portal hemodynamics. In another 42 patients, administration of dopamine at the same rate was started soon after hepatectomy and continued for about 2 weeks; the clinical results were evaluated. After hepatectomy, the systemic hemodynamics were hyperdynamic and the portal hemodynamics were hypodynamic. After 30 min of dopamine administration, the oxygen pressure in portal blood increased, and because portal blood flow also increased, the oxygen delivery to the liver increased. The mechanism involved an increased proportion of portal venous flow to cardiac output, and a decrease in the splanchnic resistance, not portal venous resistance. Probably, specific dopamine receptors played important role in the increase in the superior mesenteric arterial blood flow. Among 42 patients given small dosage of dopamine, the clinical symptoms of five of seven who had developed liver failure improved. None of the other 35 patients given dopamine preventively developed liver failure. Dopamine in small doses is useful for the management of liver failure after liver resection.

Adult↗
PubMed1988

Resection of hepatocellular carcinoma with obstructive jaundice caused by compression of the common hepatic duct.

We treated a patient with hepatocellular carcinoma in whom jaundice was caused by obstruction of the common hepatic duct because of compression by the tumor. Percutaneous transhepatic cholangiodrainage was performed preoperatively. The tumor was entirely in the medial segment of the liver, without invasion of the hepatic ducts, and medial segmentectomy was performed. As of the end of 1985, 58 cases of hepatocellular carcinoma complicated by extrahepatic obstructive jaundice have been reported in Japan. In only four was obstructive jaundice caused by extraluminal biliary compression. We review ten patients treated by liver resection.

Aged↗
PubMed1988

[Branching patterns of the intrahepatic portal vein and hepatic segments identified by percutaneous transhepatic portography].

We studied branching of the intrahepatic portal vein and hepatic segment by percutaneous transhepatic portograms in 237 patients with liver, biliary tract, or pancreatic disease. At the hilum, the pattern was normal in 74% of the patients. In the others, branching of the right posterior branch was trifurcated or independent. Caudate branches usually ramified from first-order branches, but sometimes ramified from the right posterior branch. The left portal branch divided into a laterodorsal branch (second-order) and umbilical portion, from which the lateroventral branch (third-order) and several medial branches (fourth-order) arose. It seems to be better to divide the left lobe into anterior segment (supplied by medial and a lateroventral branch) and posterior segments (supplied by a laterodorsal branch) than into the lateral and medial segments. The right anterior branch of 27% of the patients was bifurcated. In the others, there were six other patterns, with four or five fourth-order branches arising from this branch. The anterior segment should be considered having not two subsegments, but four or five small subsegments. Small branches divided off from the main trunk of the right posterior branch. In resection for hepatoma, each such branch can be thought of as one small subsegmental branch.

Adult↗
PubMed1986

[Resected hepatocellular carcinoma with macroglobulinemia--a case report].

A 54-year-old man had been diagnosed as having macroglobulinemia 10 years earlier; Ultrasonography and liver scintigraphy showed a space-occupying lesion in the right lobe of the liver; CT scan showed abnormal density in the same region. IgG was more than 7,000 mg/dl. The tumor was isolated, and liver function was good. On laparotomy, biopsy of the tumor and one of the enlarged lymph nodes in the hepatoduodenal ligament was undertaken. The diagnosis the from frozen tumor section was hepatocellular carcinoma; malignancy was not found in the lymph node. Right lobectomy was done. The patient left the hospital two months later after an uneventful recovery.

Carcinoma, Hepatocellular↗