Biomedical subjects

K Kajiyama

Publications and source records attributed to K Kajiyama.

115 records · Page 7Linked to original sources

PubMedDate not supplied

Early recurrence after surgery of hepatocellular carcinoma.

BACKGROUND/AIMS: In 231 patients with hepatocellular carcinoma who underwent liver resection from 1986 to 1992 to determine the significance of alpha-fetoprotein (AFP) levels. MATERIALS AND METHODS: There were 13 patients (5.6 per cent) with early recurrence within six months after hepatectomy. RESULTS: Preoperative serum alpha-fetoprotein (AFP) levels were significantly higher in patients with early recurrence (p < 0.01). Postoperative histological examination revealed that there were significant correlations between patients with early recurrence and intrahepatic metastasis (p < 0.01), and portal vein infiltration (p < 0.01). There were significant correlations between patients with early recurrence and preoperative diagnosis of intrahepatic metastasis (p < 0.01), however, preoperative diagnosis of portal vein infiltration could not be detected enough. Eight (73%) of 11 patients with over 1000 ng/ml of AFP and preoperative diagnosis of intrahepatic metastasis had early recurrence (p < 0.01). CONCLUSIONS: We found that patients of hepatocellular carcinoma with over 1000 ng/ml of AFP and preoperative diagnosis of intrahepatic metastasis are the most important factors in the preoperative clinical data linked to early recurrence type of HCC after hepatectomy.

Aged↗

PubMedDate not supplied

A primary adenosquamous carcinoma of the liver with an elevated level of serum squamous cell carcinoma related antigen.

A case of primary adenosquamous carcinoma of the liver with an elevated level of serum squamous cell carcinoma related antigen is herein reported. Various hypotheses on the pathogenesis of adenosquamous carcinoma of the liver have been set forth previously, however there is still no widely accepted theory because of the absence of any sufficient evidence. The postoperative transition of serum squamous cell carcinoma related antigen and the immunohistochemical findings using anti-involucrin antigen in this case support the hypothesis that the squamous cell carcinoma component arises as a result of the metaplastic transformation of adenocarcinoma cells.

Aged↗

PubMedDate not supplied

Small hepatic nodules surrounding hepatocellular carcinoma.

BACKGROUND/AIMS: We investigated whether or not small hepatic nodules surrounding the main hepatocellular carcinoma were malignant, while also analyzing the role of intraoperative ultrasonography in detecting these small nodules. MATERIALS AND METHODS: Thirty-three small hepatic nodules near the main tumor in 17 patients were retrospectively studied. They were first detected either during or after the operation using intraoperative ultrasonography and/or after examining a cross-section of the resected specimen. RESULTS: Twenty-six of the 33 small nodules were shown to be malignant when studied histologically (79%). The reliability of intraoperative ultrasonography was higher than 80 per cent for detecting nodules measuring more than 5 mm in diameter. However, it was only 25 per cent reliable with smaller nodules measuring less than or equal to 5 mm. CONCLUSIONS: These results suggest that most small hepatic nodules with hepatocellular carcinoma should be considered to be malignant. In addition, smaller nodules measuring less than 5 mm in size can hardly be detected by intraoperative ultrasonography.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Indicative value of carcinoembryonic antigen (CEA) for liver recurrence following curative resection of stage II and III gastric cancer.

BACKGROUND/AIMS: We investigated the role of preoperative and serial postoperative serum CEA levels in advanced gastric cancer patients with curative operation. MATERIALS AND METHODS: Preoperative and serum postoperative CEA levels were measured in 115 patients with Stage II and III gastric cancer and who underwent curative gastric resection. RESULTS: The 5-year survival rates of patients with high preoperative CEA levels (> 5 ng/ml) were poorer than in case of low preoperative CEA levels (< 5 ng/ml) in both stage II (P < 0.05) and stage III (P < 0.01) gastric cancer. When the site of the recurrence was diagnosed in 47 patients with less than a 5-year survival, a high level of preoperative CEA was more likely to be associated with a liver metastasis (13/18, 72.2%) than with peritoneal dissemination (4/15, 26.7%) (P < 0.05). In the course of serial measurements of postoperative levels of CEA, CEA increased in patients with liver metastasis, and CEA levels began to elevate 3.2 months before clinical detection, while, little change of postoperative serum CEA levels was noted in patients with peritoneal dissemination. CONCLUSIONS: We propose that the preoperative and serial postoperative assays of serum CEA level are predictive for liver metastasis in patients with stage II and III gastric cancer and treated by curative gastric resection.

Bone Neoplasms↗

PubMedDate not supplied

The characteristics of hepatocellular carcinoma with a high level of serum lactic dehydrogenase: a case report.

Hepatocellular carcinoma (HCC) remains one of the most important malignancies in Japan (1, 2). Lactic dehydrogenase (LDH), which is a glycolyticenzyme, and exists in various types of human tissue and neoplasms, has also been reported to demonstrate a high level (especially LDH 5) in the serum of patients with HCC (3-10). We herein report the findings of a 68-year-old male patient with hepatocellular carcinoma (HCC), whose serum lactic dehydrogenase (LDH) level more closely correlated with the clinical course than the alpha-feto-protein level (AFP). Both the AFP and LDH levels were high before the operation (AFP 1402 ng/ml; LDH 638 IU/L) (LDH1 11%; LDH2 24%; LDH3 34%; LDH4 19%; LDH5 12%). The levels of the serum LDH and AFP one week after the right hepatic lobectomy both decreased to 423 IU/L and 331 ng/ml, respectively. In addition, the LDH isozyme pattern returned to normal. Six weeks after the operation, the serum LDH increased to 3504 IU/L, however, the AFP levels remained low at 43.4 ng/ml, and the CT findings demonstrated multiple recurrent nodules in the whole remnant liver. At eighty-one days after the operation, the patient died due to a rupture of the recurrent HCC. Immunohistochemical observations were performed using the peroxidase labeled streptavidin-biotin technique with slight modifications and using two monoclonal antibodies for AFP and for Ki-67. Most portions of the primary tumor consisted of poorly to undifferentiated HCC. The portion of undifferentiated HCC did not stain for AFP antibody, but the portion of poorly differentiated HCC stained positively for it. It was thus speculated that LDH was mainly produced in the portion of undifferentiated HCC. In addition the undifferentiated HCC were strongly positive for Ki-67, while, in contrast, the poorly HCC was only weakly positive for Ki-67. Based on the above findings, HCC with a high serum level of LDH appears to show both a rapid growth and highly malignant tumors.

Aged↗

PubMedDate not supplied

Virus-associated hemophagocytic syndrome after hepatic resection: a case report.

Virus-associated hemophagocytic syndrome (VAHS) is associated with a systemic viral infection and is mainly observed in immunosuppressed adult patients. This rare disease is characterized by symptoms which include a high fever, pancytopenia, and splenomegaly and sometimes results in a fatal outcome. However, thus far, little has been reported on VAHS in general surgical patients. We herein report this rare complication which occurred in a patient with hepatocellular carcinoma, as well as chronic hepatitis C, after a hepatic resection. A 66-year-old man with chronic hepatitis C and recurrent hepatocellular carcinoma underwent a repeat hepatic resection without any blood transfusions. In the early postoperative period, he recovered uneventfully. However, he suddenly began to suffer from a high fever (38.4 degrees C) and severe pancytopenia 8 days after surgery. Activated macrophages, which phagocytosed erythrocytes, were identified by a cytological study of the bone marrow. The patient was therefore treated with methylprednisolone pulse therapy 13 days after surgery. On the day following the initial administration of methylprednisolone, his clinical condition drastically improved. Fortunately, with methylprednisolone therapy, our patient recovered from acute, severe pancytopenia. In general surgery, it is often difficult for surgeons to use steroids due to their negative side effects. However, when symptoms such as fever, general fatigue and pancytopenia are observed, even in posthepatectomy patients with hepatocellular carcinoma and hepatitis, a bone marrow aspiration should be performed as soon as possible, and when VAHS is suspected, steroid pulse therapy should be the first treatment of choice. This rare but sometimes fatal complication should thus be taken into consideration in the postoperative management of hepatectomized patients with chronic hepatitis C.

Aged↗

PubMedDate not supplied

Heterotopic gastric mucosa in a gallbladder with an anomalous union of the pancreatobiliary duct: a case report.

A 25 year-old woman experienced a sudden onset of epigastralgia with nausea, and consulted our hospital. Because the abdominal pain did not subside with medication, she was hospitalized. On physical examination she had a slight tenderness of the right upper abdominal quadrant. Laboratory studies disclosed increases in the serum alkaline phosphatase, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and serum amylase levels. Abdominal ultrasonography, computed tomography, and endoscopic retrograde cholangiopancreatography revealed choledocholithiasis and a pancreatic duct which originated from the common bile duct. A common bile duct stone was removed with a basket catheter after an endoscopic sphincterotomy was performed. Since an anomalous union of a pancreatobiliary duct is a high risk factor of gallbladder cancer, laparoscopic cholecystectomy was perfomed. The post-operative course was uneventful and she was discharged on the twentieth post-operative day. In a microscopical examination of the resected specimen, a pyloric type gastric mucosa was clearly evident in the submucosa, while the remaining gallbladder demonstrated chronic cholecystitis. Some cases of heterotopic gastric mucosa in the gallbladder come from metaplasia, and metaplasia is also one of the most important factors in the carcinogenesis of gallbladder cancer. In conclusion, the present case is the first report of gastric mucosa with an anomalous union of the pancreatobiliary duct. Heterotopic gastric mucosa in the gallbladder may be one of the causes of gallbladder cancer, and close attention should, therefore, be paid to any occurrence of heterotopic gastric mucosa in this region.

Adult↗