Biomedical subjects

K Shimada

Publications and source records attributed to K Shimada.

1,794 records · Page 100Linked to original sources

PubMedDate not supplied

Functional and histopathologic studies of primate pulmonary allografts preserved for 24 hours with a form of modified extracellular solution.

BACKGROUND: The purpose of this investigation was to evaluate the efficacy of a solution (Ep4) for long-term hypothermic pulmonary allograft preservation in a primate model using both functional and histopathologic criteria. METHODS: Twenty-seven Japanese monkeys were divided into donor group and three study groups. The animals in group I underwent acute left lung transplantation (n = 5). Group II consisted of animals which received left pulmonary allografts preserved for 24 hours by simple hypothermic immersion in Ep4 solution (n = 6). The temporary contralateral (right) pulmonary artery occlusion test was performed immediately after transplantation and on postoperative day 7 to assess lung function in the allografts. This test was also performed in the control group (group III, n = 5). The recipient animals in groups I and II were also subjected to serial open lung biopsies and bronchoscopic assessments after transplantation. RESULTS: Temporary right pulmonary artery occlusion did not show any significant differences in gas exchange capacity and pulmonary hemodynamics between groups I and II. Histopathologic examination did not show significant differences in the pulmonary allografts between groups I and II for a period of 4 weeks after transplantation. Serial bronchoscopic and histologic examinations also showed no significant differences in bronchial healing between these two groups. CONCLUSIONS: Long-term hypothermic pulmonary allograft preservation with Ep4 solution does not impair pulmonary function immediately after transplantation. The results of this study indicate that extracellular electrolyte composition solutions such as Ep4 should be subjected to clinical trials.

Animals↗

PubMedDate not supplied

Function-preserving segmentectomy of the cirrhotic liver.

BACKGROUND/AIMS: A cirrhotic case of hepatocellular carcinoma (HCC) complicating portal vein tumor thrombi which underwent posterior segmentectomy with anterior portal venoplasty is reported. MATERIALS AND METHODS: The HCC originated in the right posterior segment and grew intraluminally up to the right portal vein, and the laboratory data indicated a presence of severe cirrhosis. The operative procedure undertaken consisted of internal shunting of the portal blood stream by mesentero-umbilical bypass, resection of the posterior segment and the anterior portal venous root, and reconstruction of the anterior portal branch by patch grafting. RESULTS: This operation produced no distinct complications, and it was defined pathologically as being curative. CONCLUSION: The case here introduces rationale of this modified hepatic segmentectomy in view of functional preservation of the residual cirrhotic liver.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Adenosquamous carcinoma with different morphologic and histologic components arising from the intrahepatic bile duct: report of a case.

A very rare form of adenosquamous carcinoma arising from the intrahepatic bile duct which had diverse morphologic and histologic components is presented. A 77-year-old female complained of relapsing febrile attack accompanied by upper abdominal pain. From the imaging studies, which revealed an atrophic left lobe with dilated intrahepatic bile duct, cholangiocarcinoma constricting the orifice of B3 was considered the most likely diagnosis. Surgery, which included resection of the left hepatic and caudate lobes with lymph node dissection, revealed an atrophic lateral segment indicating recurrent inflammation. Pathologic examination revealed a combined tumor composed of papillary squamous cell carcinoma arising at the orifice of the lateral inferior segmental bile duct and intramucosal adenocarcinoma spreading distal to the polypoid tumor. Two different components were connected with a thin stalk, but there was no apparent transitional zone. Contrary to ordinary mass-forming adenosquamous carcinoma in the liver, which is reported to pursue a very rapid, fatal course, our patient made an uneventful recovery and has remained in good health without recurrence for 2 years and 3 months since surgery.

Aged↗

PubMedDate not supplied

Intrahepatic cholangiocarcinoma presenting intrabile duct tumor growth: report of a case.

A case of intrahepatic cholangiocarcinoma with intrabile duct tumor growth is presented. A 70-year-old female with prolonged obstructive jaundice and cholangitis was diagnosed with a mass lesion in the left lobe of the liver accompanied by an intrabile duct component which caused hilar bile duct obstruction. Percutaneous transhepatic biliary drainage (PTBD) was performed via three routes with intensive care of the drainage catheters over a 2-month period to alleviate jaundice and cholangitis. Extended left hepatic lobectomy with combined resection of extrahepatic bile duct and regional lymph nodes were carried out curatively. Macroscopically, a tumor formed a 8 x 6 cm mass with a scalloped margin in the left lobe and had an intraductal component with a round smooth surface protruding from the lumen of the left hepatic duct into the common bile duct. The histologic type of the tumor was well differentiated tubular adenocarcinoma. The intraluminal tumor grew expansively without invasion to the bile duct wall. The postoperative course was uneventful and the patient has remained in good health without recurrence for 1 year and 3 months since surgery. This case report discusses a rare extension pattern in ICC and the management of malignant hilar obstruction during radical surgery.

Aged↗

PubMedDate not supplied

CT evaluation of small polypoid lesions of the gallbladder.

BACKGROUND/AIMS: The ability of CT to differentiate small polypoid lesions of the gallbladder was evaluated. MATERIAL AND METHODS: CT followed by cholecystectomy was performed in 20 patients with small polypoid lesions (< or = 20mm) of the gallbladder measured by preoperative ultrasonography. Detectability of the lesions on both unenhanced and enhanced CT, and the configuration and density of the polypoid lesions on enhanced CT were evaluated in comparison with histopathology. RESULTS: Unenhanced CT detected 8 of 20 polypoid lesions (40%), whereas enhanced CT detected all lesions. All the cholesterol polyp (n = 9) and hyperplastic polyp (n = 2) were not detected on unenhanced CT. Configurations of the polypoid lesions were classified into three types; pedunculated, sessile, and mass forming type. All of cholesterol polyp and hyperplastic polyp were demonstrated as pedunculated type, and adenomyomatosis (n = 2) as mass forming type in all lesions, respectively. Two of adenoma were seen as pedunculated type in one and as mass forming type in the other. Adenocarcinoma (n = 5) was depicted as sessile type in four lesions and as pedunculated type in one. The density of the lesions compared with the liver parenchyma on enhanced CT was not specific. CONCLUSIONS: The configuration of polypoid lesions depicted on enhanced CT and visualization of them on unenhanced CT are helpful in differentiating neoplastic lesions which should be resected from other benign lesions.

Adenocarcinoma↗

PubMedDate not supplied

Influence of alcohol abuse on recurrence after curative resection of hepatocellular carcinoma.

BACKGROUND/AIM: We studied the influence of alcohol abuse (ethanol intake > 80 gm/day for > 5 yr.) on recurrence in 81 patients with hepatocellular carcinoma who had undergone curative hepatic resection. Twenty-nine patients were positive for alcohol abuse [AA(+)] and 52 were not [AA(-)]. RESULTS: Recurrence of carcinoma within 2 and 27 postoperative months was observed in 45 (55.6%) of the 81 patients. The median disease-recurrence time was 12.0 mo in the AA(+) group and 24.1 mo in the AA(-) group (p<0.01). The patterns of recurrence were classified into the following 4 types: single-nodular type (intrahepatic single nodule); multi-nodular type (intrahepatic multiple nodules); whole liver type (diffuse recurrence over the whole remnant liver); and extrahepatic type (extrahepatic recurrence alone). Five (29.4%) of the 17 patients with recurrence in the AA(+) group demonstrated the whole liver type, compared with only 2(7.1%) of the 28 patients in the AA(-) group (p<0.05). CONCLUSION: Patients with alcohol abuse should be followed up particularly closely, even if they have received curative surgery, since alcohol abuse is strongly related to postoperative recurrence.

Alcoholism↗

PubMedDate not supplied

The prognosis of patients with hepatocellular carcinoma of multicentric origin.

BACKGROUND/AIMS: The characteristics of patients with multicentric hepatocellular carcinoma (HCC) differ from those of patients with intrahepatic metastatic HCC. However, there are few reports regarding the long-term results in patients with HCC of multicentric occurrence. The purpose of this study was to clarify the prognosis of a group of patients with multicentric HCCs. MATERIALS AND METHODS: We evaluated the outcome in 28 patients with multiple hepatocellular carcinoma (HCC) suggestive of multicentric occurrence, all of whom underwent hepatic resection. The disease-free survival, recurrence pattern and survival were analyzed in the two subgroups of 12 patients with single advanced HCC (AdHCC) nodule and an early HCC (eHCC) or early advanced HCC (eAdHCC) nodule [Group A] and 16 patients with two AdHCC lesions [Group B]. These data were also compared with those of 58 patients with solitary AdHCC [Group C]. RESULTS: Both the disease-free survival and survival periods for Groups A and C were significantly longer than those for Group B, while no significant difference was seen between Group A and C. No significant differences among the three groups were recognized in the incidence of various types of recurrence pattern. CONCLUSIONS: The long-term results in patients with multicentric HCC apparently vary depending on the pathological condition at the time of operation. Among patients with multicentric HCC, those with AdHCC combined with an eHCC or eAdHCC are likely to show improved prognosis as a result of hepatic resection.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Hepatectomy for metastatic renal cell carcinoma.

The experience with hepatectomy for metastatic renal cell carcinoma (RCC) has been very rarely reported, because multiple organ metastases ordinarily coexist when hepatic metastases are found out. Three patients who underwent hepatectomy for metastatic RCC are presented here. Radical nephrectomy was performed for the primary renal lesions in all the patients, and their hepatic metastases were resected simultaneously in one of them with a solitary tumor, and about one month later in two of them with multiple (3 and 6) tumors. These operations produced no distinct complications. The patients with 1 and 3 hepatic metastatic lesions survived without tumor recurrence for 12 and 21 months, respectively, while the patient with 6 hepatic metastatic lesions had tumor-free interval of only 2 months and died 10 months after hepatectomy due to lung metastasis. Hepatectomy may be the only promising treatment for hepatic metastases from RCC, but the indication for surgery should be evaluated according to the number of hepatic metastases.

Carcinoma, Renal Cell↗

PubMedDate not supplied

Helical CT of the abdomen after pancreaticoduodenectomy: usefulness for detecting postoperative complications.

BACKGROUND/AIMS: Helical (spiral) computed tomography (CT) decreases scanning time and respiratory motion artifact. These characteristics are convenient for the evaluation of postoperative intra-abdominal conditions. We investigated the usefulness of helical CT in detecting complications after pancreaticoduodenectomy. MATERIAL AND METHODS: Helical CT scans were carried out in 21 patients with symptoms suggesting postoperative complications after pancreaticoduodenectomy. Twenty-one patients who underwent pancreaticoduodenectomy were examined postoperatively by helical CT scans. Findings were correlated with the subsequent clinical course. RESULTS: Abnormal findings were detected by helical CT scan in 16 (76%) of 21 patients. These included 13 patients with fluid collection, 7-with localized liver infarction, 5 with intra-abdominal abscess, 3 with pleural effusion or ascites, and 2 with pseudoaneurysms or wound abscesses. Liver infarctions were found in 7 of 10 patients who underwent combined resection of the portal and/or superior mesenteric veins, but not in any of 11 patients without combined vascular resection. CONCLUSIONS: Helical CT was useful in evaluating intra-abdominal conditions and detecting complications after pancreaticoduodenectomy.

Adult↗

PubMedDate not supplied

Comparison between thoracoabdominal and abdominal approaches in occurrence of pleural effusion after liver cancer surgery.

BACKGROUND/AIMS: Pleural effusion is a complication occasionally encountered in hepatic surgery. The production of pleural effusion was compared between thoracoabdominal and abdominal approach for hepatic surgery of hepatocellular carcinoma. METHODOLOGY: All the 98 patients undergoing liver resection for hepatocellular carcinoma at the National Cancer Center Hospital from May 1992 to March 1994 were included into the study, of those 70 were by the thoracoabdominal and 28 by the standard abdominal approach. Comparisons were made in regard to the rate of pleural effusion, the rate of postoperative thoracentesis, the number of postoperative thoracentesis procedures per patient, the total volume of pleural effusion obtained by thoracentesis per patient, and the duration of pleural effusion. RESULTS: Forty-three percent of patients treated with the abdominal approach in contrast to 73% of patients treated with the thoracoabdominal approach developed pleural effusion (p < 0.01). Seven percent of the patients treated with the abdominal approach in contrast to 17% of the patients treated by the thoraco-abdominal approach required thoracentesis. The number of thoracentesis required for the abdominal approach was 1, for the thoracoabdominal approach was 3 (p < 0.02). The bile leakage rate was 17% for thoracoabdominal versus 33% for abdominal approach. CONCLUSIONS: Due to frequent pleural effusion, the thoracoabdominal approach should not be used for every liver operation. However, when treatment to the neck of the right hepatic vein is necessary, the thoracoabdominal approach might be recommended because of the easy access to the operating field and the reduced rate of bile leakage.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Preoperative portal embolization.

Excess parenchymal loss associated with hepatectomy is the leading risk factor/for liver failure especially in patients with impaired hepatic function. Selective portal embolization (PE) before hepatectomy is aimed to induce an atrophy of the embolized lobe to be resected, with a compensatory hypertrophy of the/counterlobe to be preserved. We performed PE followed by hepatectomy in 58 patients with hepatocellular carcinoma (HCC, n. = 44) or metastatic liver tumour (MLT, n. = 14). All the patients well tolerated PE, and hepatic functional data returned to the baseline levels within a week. The left lobe volume increased by about 10% after the right PE. Hepatectomy procedures undertaken comprised right or extended right lobectomy (n. = 39), central bisegmentectomy (n. = 3), extended segmentectomy (n. = 12), and limited resection (n. = 4). The 25 of HCC patients underwent right-sided lobectomy despite a presence of hepatic functional impairment, and the 3 of MLT patients under went right lobectomy with additional resection of the left lobe. As a whole, the operative morbidity and mortality rates were 15.5% and 1.7%, respectively (one patient died of liver failure). The 5-year over all survival rates were 46.8% in HCC patients and 38.0% in MLT patients, respectively. Preoperative PE therefore can be an ancillary procedure for patients, despite with hepatic dysfunction or with bilobar tumours, who may need extensive hepatectomy.

Embolization, Therapeutic↗

PubMedDate not supplied

A case with small cell carcinoma of the esophagus: measurement of tumor markers, including pro-gastrin-releasing peptide.

Small cell carcinoma of the esophagus is a rare clinical entity and the accumulation of information is necessary to clarify its clinical behavior. We report a 69-year-old Japanese man with this rare disease with systemic metastases, including liver, bone and lymphnodes. The patient was treated with systemic chemotherapy consisting of 300 mg/m2 of carboplatin on day 1, and 80 mg/m2 of etoposide on days 1, 2 and 3. Although transient relief of subjective symptoms was obtained, the disease showed systemic progress, and the patient died on day 25 of chemotherapy. During the clinical course of the disease, serum pro-gastrin-releasing peptide (proGRP) decreased upon systemic chemotherapy from elevated level (54.6 pg/ml) to normal range (19.2 pg/ml). Further study is warranted to examine whether measurement of serum proGRP may yield valuable information on the diagnosis and monitoring activities of esophageal small cell carcinoma.

Aged↗