Search PubMed⌕ Search

Biomedical subjects

K Shimada

Publications and source records attributed to K Shimada.

At least 1,783 records · Page 99Linked to original sources
PubMedDate not supplied

Hepatic resection with and without surgical margins for hepatocellular carcinoma in patients with impaired liver function.

BACKGROUND/AIMS: The significance of a surgical margin for hepatic resection of hepatocellular carcinoma (HCC) in patients with impaired liver function was evaluated. METHODOLOGY: Sixty-eight patients, each with a solitary HCC, who had not received any prior treatments were divided into 2 groups, according to surgical margin: Group A included 25 patients who underwent resection with no margin (although the tumor was not exposed) and Group B included 43 patients with a sufficient surgical margin (mean distance: 9 mm). There were no significant differences in clinicopathologic variables between the 2 groups. The rate of stump recurrence, survival and recurrence-free survival were analyzed. RESULTS: Among the 38 patients who had cancer recurrence after a median follow-up of 58 months, 9 (Group A, n=4; Group B, n=5) (24%) had recurrent lesions at the stump. The surgical margin was not a significant factor related to survival or recurrence, irrespective of cirrhosis, capsule formation, cancer spread, or tumor size. CONCLUSIONS: Our results indicated that the HCC-free surgical margin is unlikely to be related to the survival of patients with impaired liver function unless the tumor is exposed on the raw liver surface.

Adult↗
PubMedDate not supplied

Should the bile duct be preserved or removed in radical surgery for gallbladder cancer?

BACKGROUND/AIMS: It is unclear whether resection of the extrahepatic bile duct in radical surgery for gallbladder cancer should be performed when direct infiltration into the hepatoduodenal ligament is absent. METHODOLOGY: The results of radical surgery with or without bile duct resection were compared in 55 patients with gallbladder cancer without direct extension to the hepatoduodenal ligament. Lymph node dissection and combined resection of involved organs were carried out according to the extent of the tumor. RESULTS: Nodal involvement was present in 43% of patients with tumors more advanced than pT1. Survival rates were similar between patients with or without bile duct resection in stages I-III, while significantly better survival was observed with bile duct resection in stage IV. CONCLUSIONS: Considering the adverse effect of bilioenteric anastomosis, preservation of the extrahepatic bile duct is recommended in radical surgery for gallbladder cancer when the tumor is less advanced than stage IV and does not extend to the hepatoduodenal ligament.

Adult↗
PubMedDate not supplied

Resection of liver metastases after pancreatoduodenectomy: report of seven cases.

There has been no English report of a long survivor after hepatectomy for metastasis from periampullary malignancies, who had previously undergone pancreatoduodenectomy (PD) for primary disease. Herein, we report 7 patients of liver metastases who underwent 8 hepatectomies after PD for peri-ampullary malignancies. One patient whose liver metastasis was neuroendocrine tumor, survived 2 years and 6 months without recurrence after hepatectomy. Another patient who had 2 hepatectomies for metastasis from duodenal leiomyosarcoma survived for 3 years and 20 days after the first hepatectomy. Procedure of hepatectomy comprised 4 limited resections (including 1 second hepatectomy) and 4 lobectomies at the first resection. Hepatic inflow clamp was used in 6 out of 8 hepatectomies and 4 out of 8 hepatectomies did not require allogeneic blood transfusion. Bacterial contamination of the drained discharge from the cut surface of the liver, mostly representative of enteric organisms, was identified in all but 2 patients who were not examined. Subphrenic abscesses developed in 2 patients after removal of the drains. Thus, prophylactic use of abdominal drain is indispensable after hepatectomy for the patients with bilioenteric anastomosis.

Adult↗
PubMedDate not supplied

Primary hepatic carcinoid tumors confirmed with long-term follow-up after resection.

Primary carcinoid tumor of the liver is very rare. Only 30 cases have been reported in the English literature. However, most of those cases were diagnosed only on the basis of diagnostic imaging and surgical exploration, their follow-up periods being up to 5 years. Considering the slow progression of the tumor, long-term follow-up is required to exclude occult extrahepatic primaries which may manifest afterwards, and to determine the clinical course of this disease. We experienced 3 patients with primary hepatic carcinoid tumors who underwent total resections. They all survived more than 7 years and were clinically confirmed as hepatic primary by failing to detect other primaries during their courses. One patient is disease-free for more than 7 years after resection. The other 2 were found to have recurrence in the remnant liver; 1 underwent transcatheter arterial embolization several times and is alive more than 4 years after recurrence, and the other underwent 2 more operations and survived 8 years after the 1st recurrence. Surgery might offer a possible chance of cure for primary hepatic carcinoid tumor, and transcatheter arterial embolization might be a good treatment option when an unresectable disease is confined to the liver.

Adult↗
PubMedDate not supplied

Thoracoabdominal approaches versus inverted T incision for posterior segmentectomy in hepatocellular carcinoma.

BACKGROUND/AIMS: The purpose of the present study was to clarify the indications for a thoracoabdominal right oblique approach and an inverted L incision in posterior segmentectomy of the liver for hepatocellular carcinoma. METHODOLOGY: Forty-six patients with hepatocellular carcinoma who underwent posterior segmentectomy with thoracotomy were divided into 2 groups according to the incision: thoracoabdominal right oblique incision (group A, n = 17) and inverted L incision (group B, n = 29). The perioperative factors of the patients in the 2 groups were compared retrospectively. RESULTS: No significant differences were found in the preoperative factors between the groups. However, a longer operation time (P = 0.01) and more blood loss (P = 0.02) were noted in group B. Although there was no significant difference between the groups in the overall morbidity rate (P = 0.36), a higher rate of pleural effusion was recognized in group A (P = 0.01). CONCLUSIONS: Thoracoabdominal right oblique incision may be suitable for use as an approach for posterior segmentectomy when manipulation of the left lobe is not required.

Adult↗
PubMedDate not supplied

Hilar cholangiocarcinoma evaluated by three-dimensional CT cholangiography and rotating cine cholangiography.

BACKGROUND/AIMS: To evaluate the usefulness of three-dimensional cholangiography and rotating cine cholangiography in depicting the anatomy of the hilar bile duct and tumor extension, and in planning surgical procedures for hilar cholangiocarcinomas. METHODOLOGY: Five patients with hilar cholangiocarcinoma and obstructive jaundice who underwent percutaneous transhepatic biliary drainage followed by resection were serially examined by cine cholangiography and three-dimensional cholangiography which were reconstructed from a helical computed tomography scan. Tumor extension to the bile ducts was prospectively diagnosed and the resection margin was planned using both cine and three-dimensional cholangiograms. The histological evaluation of the resected specimens were compared with preoperative findings of cholangiograms. RESULTS: The three-dimensional cholangiograms from vertical projection demonstrated the bile duct anatomy with excellent image quality. To assess tumor invasion to the intrahepatic bile ducts, cine cholangiograms from lateral and oblique projections were necessary. Selection of the surgical procedure was influenced by preoperative evaluations of the lesion on both three-dimensional and cine cholangiograms. Histologically, the resected margin was free from tumor in all cases. CONCLUSIONS: Three-dimensional and cine cholangiography allowed accurate assessment of the biliary system in patients with hilar cholangiocarcinoma, which was helpful for planning the surgical procedure.

Aged↗
PubMedDate not supplied

Complete drainage of pancreatic juice from the cut edge of the pancreas after subtotal left-side pancreatectomy.

The management of the cut stump after a subtotal left-side pancreatectomy is sometimes difficult compared with that after distal pancreatic resection, which is performed at or to the left of the superior mesenteric vein. This report describes a simple and effective drainage method of leaking pancreatic juice from the cut stump after subtotal left-side pancreatectomy for pancreatic adenocarcinoma located in the body and tail. Since July 20, 1994, we have applied this method to 12 patients with carcinoma of the body and tail of the pancreas other than the present case and as yet have never experienced serious postoperative complications.

Adenocarcinoma↗
PubMedDate not supplied

Phase 1/11 study of bi-weekly irinotecan plus cisplatin in the treatment of advanced gastric cancer.

OBJECTIVES: To conduct a phase I/II study of irinotecan with cisplatin to establish a recommended dose, and assess the safety, efficacy and feasibility of this regimen in unresectable advanced or recurrent gastric cancer. PATIENTS AND METHODS: In the phase I portion of the study, patients received a fixed dose of cisplatin (30 mg/m2) with escalating doses of irinotecan, ranging from 30 mg/m2 to 70 mg/m2, on days 1 and 15. In the phase II portion of the study, 40 patients were evaluated for response and safety at the recommended dose. RESULTS: Eighteen patients were enrolled in the phase I study. Dose-limiting toxicity (diarrhea and neutropenia) appeared at the irinotecan dose of 70 mg/m2. Therefore, the recommended irinotecan dose was 60 mg/m2. In the phase II study, 40 patients received cisplatin (30 mg/m2) plus irinotecan (60 mg/m2). Twenty-five out of 40 patients had received prior chemotherapy. The median number of cycles was 3.5. The response rate was 32.5% (13/40) overall, and 53.3% (8/15) in patients without prior chemotherapy. The median time to tumor progression (TTP) was 162 days. The median survival time was 288 days. Four patients (10%) developed grade 4 neutropenia and 3 patients (7.5%) developed grade 4 anemia. The only observed non-hematological toxicity at grade 3 or higher was diarrhea, seen in 2.5% (1/40) of the patients. CONCLUSION: Bi-weekly administration of irinotecan and cisplatin is safe and active for the management of unresectable advanced or recurrent gastric cancer.

Adult↗
PubMedDate not supplied

Dissociation of neurological deficits in spinal decompression illness.

Functional differentiation is found in the spinal cord. A unique set of neurological deficits follows a multi-focal injury. Clinically, sensory and motor disturbance present independently, often resulting in sensory and motor deficit dissociation. This study examined 103 spinal decompression illness (DCI) cases. The neurological deficit dissociation was classified as follows: 1) Cases with sensory impairment only, or motor dysfunction alone, were tagged as having "dissociation" (44 cases); when a case was with both sensory and motor dysfunction, the spinal level of the sensory impairment was determined and was matched with the spinal segments responsible for the motor dysfunction; 2) If the two spinal areas did not match (i.e. with no regional overlap), they were tagged as having "dissociation" for each motor dysfunction (32 cases). In total, dissociation was present in 76 out of 103 cases. We concluded that clinical neurological deficit dissociation is frequently observed in spinal DCI.

Adolescent↗
PubMedDate not supplied

Diagnosis of Pneumocystis carinii pneumonia by 5S ribosomal DNA amplification.

The polymerase chain reaction technique was used to detect Pneumocystis carinii by amplifying the P. carinii 5S ribosomal DNA. The efficacy and specificity of this diagnostic method is reported. Analysis of patients' sputa indicate that the method can be used on these samples for the diagnosis of P. carinii pneumonia.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Segmentectomy under echographic control on cirrhotic liver].

Hepatectomy for liver cell carcinoma in cirrhosis patients requires peroperative echographic control. Basel on their experience at the National Cancer Center Hospital in Tokyo (more than 500 hepatectomies of cirrhosis livers), the authors describe the advantages of peroperative echography and surgical techniques of various segmentectomy procedures.

Carcinoma↗
PubMedDate not supplied

Effects of long-term treatment with low doses of carteolol on cardiovascular regulatory functions in elderly patients with mild hypertension.

Circulatory autonomic functions and resting and exercise hemodynamics were studied before and six months after daily administration of 5 mg of carteolol in seven elderly patients with mild hypertension. Blood pressure was reduced in all but one patient. In maximal exercise tests, blood pressure and heart rate responses were significantly attenuated after carteolol treatment, without reduction in exercise capacity. Cardiac index at rest was not affected. Cardiac parasympathetic activity, baroreflex function, and plasma catecholamine, renin, aldosterone, atrial natriuretic peptide, and vasopressin levels did not change during treatment. The results suggest that long-term use of low doses of carteolol may reduce blood pressure without affecting circulatory regulatory functions, even in elderly patients with mild hypertension.

Aged↗
PubMedDate not supplied

Exfoliative cytology of a primary adenocarcinoma of the renal pelvis. A case report.

The cytologic features of a primary adenocarcinoma of the renal pelvis in a 64-year-old woman are reported. Cytologic examination of voided urine revealed an ordinary papillary pattern, characterized by clumping of cells with nuclear overlapping, eccentric position of nuclei and cytoplasmic vacuolization due to mucus production. Leukocytes and micro-organisms were also present. Multiple lesions of papillary adenocarcinoma were subsequently found in the right renal pelvis and ureter. The histogenesis of the primary adenocarcinoma seemed to be closely related to columnar-cell metaplasia of lining of the renal pelvis of this patient, who had previously been treated for tuberculosis of the urinary bladder.

Adenocarcinoma↗