Retrograde right hepatic trisegmentectomy.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
K Shirabe
Publications and source records attributed to K Shirabe.
Prognosis of recurrent hepatocellular carcinoma: a 10-year surgical experience in Japan.
BACKGROUND & AIMS: Little has been addressed on the characteristics and prognostic factors of recurrent hepatocellular carcinoma after undergoing a hepatic resection for primary hepatocellular carcinoma. The aim of this study was to clarify the aforementioned matters of recurrent hepatocellular carcinoma. METHODS: One hundred fifty-nine patients with recurrent hepatocellular carcinoma were studied retrospectively. Twenty-four clinicopathologic variables, including the period until recurrence (less than or more than 1 year), types of recurrence (intrahepatic nodular type, intrahepatic multiple type, and extrahepatic type), and types of treatment after recurrence (no treatment, lipiodolization, ethanol injection, or hepatectomy) were univariately and multivariately analyzed. RESULTS: The following three variables were finally selected as independent and prognostic indicators after recurrence: (1) period until recurrence, (2) type of recurrence, and (3) types of treatment after recurrence. CONCLUSIONS: The prognostic factors in patients with recurrent hepatocellular carcinoma were as follows: (1) period until recurrence, (2) types of recurrence, and (3) types of treatments received after recurrence. The establishment of a follow-up system, including an examination for extrahepatic recurrence, and the development of an effective method of adjuvant chemotherapy are required to obtain better treatment results.
Aged↗
Characteristics of hepatocellular carcinoma associated with extrahepatic primary malignancies in southern Japan.
OBJECTIVES: This study was conducted to clarify the characteristics of patients with extrahepatic primary cancers (EHPC) associated with hepatocellular carcinoma (HCC), as well as to investigate the influence of EHPC on both patient survival and disease-free survival after hepatic resection. METHODS: Forty-one of 463 patients who underwent hepatic resection were included. The clinicopathological factors, including survival, were compared between patients with and without EHPC. We also compared the same factors among the prehepatectomy, synchronous, and posthepatectomy groups. Different types of extrahepatic cancers were also investigated in detail. RESULTS: Gastric and colorectal cancers were the most common EHPC. No definite relationship was observed between HCC and other specific cancers such as B-cell lymphoproliferative disorders. There also were no differences in either the liver function tests, alpha-fetoprotein, or prognostic pathological indicators such as portal vein invasion and intrahepatic metastases. In addition, we found no difference in patient survival between the patients with and without EHPC. However, disease-free survival rates in patients with EHPC were significantly higher than in those without EHPC. Patients in the prehepatectomy group were older than those in the synchronous and posthepatectomy groups, and no positive hepatitis B surface antigen was found in the prehepatectomy group. Patient survival was significantly higher in the posthepatectomy group than in the prehepatectomy group; however, no significant difference in disease-free survival was found among the three groups. Only one patient died of EHPC. CONCLUSIONS: No specific clinicopathological factors were observed in patients with HCC associated with EHPC. Furthermore, EHPC had no adverse effect on either patient survival or disease-free survival after hepatic resection. The predominant cancer was gastric cancer, whereas the most frequent cause of death was HCC itself. Therefore, a strict follow-up of HCC--as well as screening for the most common cancers, such as gastric cancers in southern Japan--should be required for patients with HCC associated with EHPC.
Carcinoma, Hepatocellular↗
Transient kinetics of intracomplex electron transfer in the human cytochrome b5 reductase-cytochrome b5 system: NAD+ modulates protein-protein binding and electron transfer.
Transient kinetics of reduction and interprotein electron transfer in the human cytochrome b5 reductase-cytochrome b5 (b5R-b5) system was studied by laser flash photolysis in the presence of 5-deazariboflavin and EDTA at pH 7.0. Flash-induced reduction of the FAD cofactor of b5R by deazariboflavin semiquinone (in the absence of b5) occurred in a rapid second-order reaction (k2 = 3.1 x 10(8) M-1 s-1) and resulted in a neutral (blue) FAD semiquinone. The heme of cytochrome b5 (in the absence of b5R) was also rapidly reduced in this system with k2 = 3.1 x 10(8) M-1 s-1. When the two proteins were mixed at low ionic strength, a strong complex was formed. Although the heme of complexed b5 could be directly reduced by deazariboflavin semiquinone, the second-order rate constant was nearly an order of magnitude smaller than that of free b5 (k2 = 3.4 x 10(7) M-1 s-1). In contrast, access to the FAD of b5R by the external reductant was decreased by considerably more than an order of magnitude (k2 < 1 x 10(7) M-1 s-1). When an excess of b5R was titrated with small increments of b5 and then subjected to laser flash photolysis in the presence of deazariboflavin/EDTA, interprotein electron transfer from the b5R FAD semiquinone to the heme of b5 could be observed. At low ionic strength (I = 16 mM), the reaction showed saturation behavior with respect to the b5 concentration, with a limiting first-order rate constant for interprotein electron transfer k1 = 375 s-1, and a dissociation constant for protein-protein transient complex formation of approximately 1 microM. The observed rate constants for interprotein electron transfer decreased 23-fold when the ionic strength was increased to 1 M, indicating a plus-minus electrostatic interaction between the two proteins. Saturation kinetics were also observed at I = 56, 96, and 120 mM, with limiting first-order rate constants of 195, 155, and 63 s-1, respectively. In the presence of NAD+, the transient protein-protein complex was stabilized by approximately a factor of two, and limiting first-order rate constants of 360 s-1 were obtained at both I = 56 mM and I = 96 mM and 235 s-1 at I = 120 mM. Thus, NAD+ appears to stabilize as well as to optimize the protein-protein complex with respect to electron transfer. Another effect of NAD+ is to appreciably slow autoxidation and disproportionation of the FAD semiquinone.(ABSTRACT TRUNCATED AT 250 WORDS)
Cytochrome Reductases↗
A new approach for liver surgery. Transdiaphragmatic hepatectomy for cirrhotic patients with hepatocellular carcinoma.
OBJECTIVE: To clarify the efficacy of transdiaphragmatic hepatectomy. DESIGN: Transdiaphragmatic hepatectomy and transabdominal hepatectomy were retrospectively compared. SETTING: This technique is used in cirrhotic patients with hepatocellular carcinoma located near the diaphragm. PATIENTS: Thirty-six cirrhotic patients with hepatocellular carcinoma who underwent transdiaphragmatic (group 1 [n = 8]) or transabdominal (group 2 [n = 28]) hepatectomies between April 1985 and March 1993 were investigated. All patients underwent a partial hepatectomy for hepatocellular carcinoma less than 3 cm in diameter located in segment VII or VIII or near the confluence of the hepatic veins. MAIN OUTCOME MEASURE: Intraoperative and postoperative clinical parameters, including operative time, blood loss, and length of hospital stay. RESULTS: The mean +/- SD operative time was significantly shorter in group 1 (184 +/- 25 minutes) than in group 2 (270 +/- 79 minutes). The intraoperative blood loss was significantly smaller in group 1 (857 +/- 622 mL) than in group 2 (1318 +/- 926 mL). The rate of postoperative complications was lower in group 1 (13% [n = 1]) than in group 2 (43% [n = 12]). The postoperative hospital stay was significantly shorter in group 1 (16 +/- 5 days) than in group 2 (23 +/- 16 days). CONCLUSIONS: Transdiaphragmatic hepatectomy is a useful technique for cirrhotic patients with hepatocellular carcinoma located near the diaphragm.
Abdomen↗
Small hepatocellular carcinoma of single nodular type: a specific reference to its surrounding cancerous area undetected radiologically and macroscopically.
A total of 128 surgically resected small hepatocellular carcinomas, measuring less than or equal to 3 cm in diameter, were studied by both macroscopic and histologic examinations. In 95 single nodular-type tumors of the 128 lesions, eight tumors were associated with the cancerous areas of well differentiated hepatocellular carcinoma around the nodule. These surrounding cancerous areas went undetected by both the preoperative radiological examinations and the gross findings of resected specimens. Based on the immunohistochemical findings, the labeling index, both of the proliferating cell nuclear antigen (PCNA) and of the Ki-67 in the surrounding cancerous areas, were lower than that of the main nodules but higher than in the nontumorous liver parenchyma in seven of eight cases. These results suggest that the main nodule was generated from the surrounding cancerous area, supporting the hypothesis of a stepwise progression of HCC. Even if the tumor seems to be a small and single nodular type, it is recommended that its surrounding areas should be closely examined and the surgical cutting margin should be made more than 1.0 cm away from the main nodule at hepatic resection.
Carcinoma, Hepatocellular↗
Laparoscopic hepatic resection for hepatocellular carcinoma.
Despite recent progress in diagnostics for hepatocellular carcinoma, the rate of resectability remains low, mainly because of the advancement of the underlying liver disease. We report a case of a 54-year-old man with a hepatocellular carcinoma and poor liver function that was treated successfully with a laparoscopic hepatic resection. Laparoscopic hepatic resection is considered to be feasible with the aid of an ultrasonic dissector and a microwave coagulator; however, close attention should be paid to the development of air embolism and hepatic vein injury.
Carcinoma, Hepatocellular↗
Occurrence of intraperitoneal septic complications after hepatic resections between 1985 and 1990.
In this study, the risk factors related to intraperitoneal septic complications occurring after hepatectomy (IPSCH) as well as the effect of various perioperative variables on the outcome of IPSCH between 1985 and 1990 were analyzed. Twenty-one of 211 patients (10.0%) developed IPSCH. The findings in the patients with IPSCH were compared with those in 190 patients without IPSCH. The significant variables associated with the development of IPSCH included a high incidence of accompanying chronic renal failure (14.3% vs 2.1%), a larger blood loss during surgery (2,130 vs 1,340 ml) as well as a greater amount of intraoperative blood replacement (1,130 vs 570 ml), and a greater weight of the resected liver (367 vs 233 g). IPSCH occurred in 10 of 12 patients who had postoperative bile leakage. Eighteen patients (85.7%) with IPSCH were discharged from the hospital after non-operative management; however, the hospital death rate (14.3% vs 1.1%) was significantly higher in patients with IPSCH. This review suggests that the incidence of IPSCH has not decreased recently. Thus, to prevent IPSCH, at least following bile leakage, it is necessary to perform a careful division of the liver parenchyma followed by a bile leakage test, and when this complication occurs unexpectedly in patients who have a good functional reserve of the remnant liver, IPSCH can be effectively drained percutaneously under ultrasound guidance.
Abdominal Abscess↗
Lesser sac herniation through the greater omentum and gastro-pancreatic ligament: report of a case.
We report herein the case of a woman who developed a lesser sac hernia which was especially unusual in that the small bowel prolapsed through a defect in the greater omentum and was thereafter strangulated by a hole in the gastro-pancreatic ligament. The gastro-pancreatic ligament has never before been documented as causing an internal hernia. In our patient, a plain abdominal X-ray demonstrated as soft-tissue mass displacing the stomach to the left while abdominal computed tomography and ultrasonography showed a sac-like encapsulation of the small bowel loops between the liver and stomach. Careful evaluation of these radiographic findings allowed for the preoperative diagnosis of a lesser sac hernia to be made.
Adult↗
Risk factors for intrahepatic recurrence in human small hepatocellular carcinoma.
BACKGROUND/AIMS: Postoperative intrahepatic recurrence of human hepatocellular carcinoma is high. Recently, the relationship between proliferating cell activity in the cirrhotic liver and occurrence or recurrence of hepatocellular carcinoma has been reported. METHODS: One hundred two resected cases of small hepatocellular carcinoma of < 3 cm in diameter without venous invasion or intrahepatic metastasis were examined to ascertain the factors affecting postoperative intrahepatic recurrence. RESULTS: Cumulative intrahepatic recurrence rates at 1, 3, and 5 years after surgery were 12.0%, 57.2%, and 67.6%, respectively. The log-rank test indicated that serum albumin levels of < 3.7 g/dL, alanine aminotransferase levels of more than 54 IU/L, active inflammation in the nontumorous portion, and high proliferating cell nuclear antigen labeling index in the nontumorous portion (> 23.2%) were significant risk factors for recurrence. Tumor factors, including tumor size, histological grade, or alpha-fetoprotein level, were not significant risk factors. Cox's proportional hazard model identified that serum albumin level and alanine aminotransferase level were independently associated with intrahepatic recurrence after hepatectomy. CONCLUSIONS: This study suggests that the principal cause linked to either a recurrence or a second new growth of hepatocellular carcinoma in the remnant liver after hepatectomy was the state of the underlying liver parenchyma as well as other tumor factors per se.
Adult↗
Afferent loop syndrome due to scarring of a stomal ulcer following a Billroth II gastrectomy.
Explore the source record for details and available documents.
Afferent Loop Syndrome↗
High incidence of Haemophilus influenzae in nasopharyngeal secretions and middle ear effusions as detected by PCR.
PCR was used to detect Haemophilus influenzae in samples of nasopharyngeal secretion and middle ear effusion (MEE). Nasopharyngeal secretions were collected from 102 patients with otitis media with effusion and from 111 healthy subjects. Eighty samples of MEE were collected from patients with otitis media with effusion. A pair of primers was designed to amplify a DNA segment of the gene encoding P6 outer membrane protein of H. influenzae. The amplified PCR product was detected with an internal probe that hybridized specifically to the P6 DNA of H. influenzae. Samples of MEE and nasopharyngeal secretion were also examined by a conventional culture method. The incidence of P6 gene DNA in nasopharyngeal secretions detected by PCR was about two times higher than that of H. influenzae detected by the conventional culture. Culture-positive samples were all positive in the PCR test. In MEEs, the rate of detection of the P6 gene DNA target was about five times higher than that of H. influenzae detected by the culture method. All patients who had P6 gene DNA in MEEs were found to have the DNA in nasopharyngeal secretions. These findings suggest that the presence of H. influenzae in MEEs and in nasopharyngeal secretions is more common than previously reported.
Bacteriological Techniques↗
Alteration in levels of human hepatocyte growth factor following hepatectomy.
BACKGROUND: The clinical significance of changes in serum human hepatocyte growth factor (hHGF) in patients having hepatectomy remains unclear, partly because of various perioperative factors, such as underlying diseases and surgical procedures. STUDY DESIGN: Human hepatocyte growth factor was measured preoperatively and then on postoperative days 1, 3, 5, and 7. In 49 (79 percent) of 62 patients studied, serum hHGF increased postoperatively and peaked on postoperative day 1 or 3 (group 1), while in the other 13 patients (21 percent), it decreased on postoperative day 1 (group 2). RESULTS: The preoperative clinical parameters were comparable between the two groups except for indocyanine green retention rate at 15 minutes (16.6 compared with 23.4 percent; p < 0.05). Operative stress and histology of the nontumorous portion of the liver were also comparable between the two groups. Postoperatively, alanine aminotransferase was significantly higher in group 1 than in group 2 on postoperative days 1 and 3. Regeneration of the remnant liver one month after hepatectomy was significantly higher in group 1 than in group 2 (5 +/- 9 percent compared with -6 +/- 8 percent; p < 0.01). The incidence of postoperative hepatic failure was significantly higher in group 2 than in group 1 (15 compared with zero percent; p < 0.05). CONCLUSIONS: These observations led to the thesis that changes in serum hHGF levels after hepatectomy are an indicator of hepatic regeneration and also will serve as one factor to predict postoperative hepatic failure.
Adult↗
A comparison of the surgical results in patients with hepatitis B versus hepatitis C-related hepatocellular carcinoma.
To assess the differences in the surgical results between patients with hepatitis B- and hepatitis C-related hepatocellular carcinoma (HCC), the operative outcomes of 30 patients with hepatitis B surface antigen (HBsAg)-positive (the B-HCC group) and 96 patients with hepatitis C antibody (HCVAb)-positive (the C-HCC group), who had undergone hepatic resection from 1989 to 1993, were compared. The mean age of the patients in the C-HCC group was higher than that in the B-HCC group (61.7 years vs. 57.0 years, P < .05). The C-HCC group demonstrated both a greater decrease in liver function and a larger enhancement of inflammatory changes in the liver under a pathological examination (the current rate of active hepatitis: 69% vs. 27%, P < .001). There was also a higher incidence of total postoperative complications in the C-HCC group (60% vs. 37%, P < .05); however, regarding each individual complication, the rate was similar between the two groups. Two of the six patients with postoperative hepatic failure in the C-HCC group died. The mortality rate in the C-HCC group was 2%, but no operative death was encountered in the B-HCC group. The crude survival and the disease-free survival rates at 5 years were similar, 61.8% and 46.2% in the B-HCC group and 52.8% and 23.2% in the C-HCC group, respectively. The patterns of recurrence were also similar in both groups. The pathological features of HCC were similar between the two groups. In conclusion, the surgical results between the two groups were almost identical.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
A novel point mutation in a 3' splice site of the NADH-cytochrome b5 reductase gene results in immunologically undetectable enzyme and impaired NADH-dependent ascorbate regeneration in cultured fibroblasts of a patient with type II hereditary methemoglobinemia.
Hereditary methemoglobinemia with generalized deficiency of NADH-cytochrome b5 reductase (b5R) (type II) is a rare disease characterized by severe developmental abnormalities, which often lead to premature death. Although the molecular relationship between the symptoms of this condition and the enzyme deficit are not understood, it is thought that an important cause is the loss of the lipid metabolizing activities of the endoplasmic reticulum-located reductase. However, the functions of the form located on outer mitochondrial membranes have not been considered previously. In this study, we have analyzed the gene of an Italian patient and identified a novel G-->T transversion at the splice-acceptor site of the 9th exon, which results in the complete absence of immunologically detectable b5R in blood cells and skin fibroblasts. In cultured fibroblasts of the patient, NADH-dependent cytochrome c reductase, ferricyanide reductase, and semidehydroascorbate reductase activities were severely reduced. The latter activity is known to be due to b5R located on outer mitochondrial membranes. Thus, our results demonstrate that the reductase in its two membrane locations, endoplasmic reticulum and outer mitochondrial membranes, is the product of the same gene and suggest that a defect in ascorbate regeneration may contribute to the phenotype of hereditary methemoglobinemia of the generalized type.
Amino Acid Sequence↗
Elevation of hepatocyte growth factor levels in portal and hepatic veins immediately after hepatic resection in cirrhotic patients.
Explore the source record for details and available documents.
Hepatectomy↗
[Cytochrome b5 reductase].
Explore the source record for details and available documents.
Cytochrome Reductases↗
Beneficial effect of thromboxane A2 synthetase inhibitor on cold-stored rat liver.
Prostanoids such as prostacyclin and thromboxane A2 have recently been suggested to play important roles in cold ischemia/reperfusion injury. The purpose of this study was to investigate the effect of thromboxane A2 synthetase inhibitor (OKY-046) on cold-stored livers of the rat using an ex vivo perfusion system. Addition of OKY-046 to preservation solution and the perfusate of livers stored cold (4 degrees C) in lactated Ringer's solution resulted in significantly lower glutamic pyruvic transaminase release (3.01 +/- 0.86 IU/g liver vs. 1.79 +/- 1.08 IU/g liver at 120 min after perfusion; P < 0.05), reduced perfusate ammonia levels (8.51 +/- 2.51 micrograms/dl/g liver vs. 3.62 +/- 1.71 micrograms/dl/g liver at 60 min; P < 0.05 and thereafter), lower perfusate taurocholate levels (0.63 +/- 0.10 vs. 0.18 +/- 0.05 at 15 min; P < 0.01 and thereafter), perfusate hyaluronic acid clearance (0.934 +/- 0.132 vs. 0.76 +/- 0.127 at 30 min; P < 0.05 and thereafter), and a reduced number of trypan blue-positive sinusoidal lining cells (50.1 +/- 9.9%; vs. 17.4 +/- 7.0%; P < 0.01). Histologically, the liver preserved for 6 hr in simple cold lactated Ringer's solution exhibited interstitial edema, various degrees of hepatocyte swelling, and sinusoidal stenosis, as well as dilatation, while the livers treated with OKY-046 demonstrated much less hepatocyte swelling, and change in sinusoidal width was nearly absent. We conclude that OKY-046 reduces post-preservation reoxygenation injury by protecting sinusoidal endothelial cells and hepatocytes.
Alanine Transaminase↗