Biomedical subjects

K Shirabe

Publications and source records attributed to K Shirabe.

158 records · Page 9Linked to original sources

PubMedDate not supplied

Prognosis of well differentiated small hepatocellular carcinoma--is well differentiated hepatocellular carcinoma clinically early cancer?

BACKGROUND/AIMS: The purpose of this study is to examine whether or not well differentiated (w-d) hepatocellular carcinoma (HCC) is indeed clinically early cancer. MATERIALS AND METHODS: Seventy six patients with solitary small HCCs up to 3 cm in diameter, who underwent hepatectomy, were observed for at least 2 years for possible recurrence. These patients were divided into two groups: 10 patients with w-d HCCs (Edmondson and Steiner's grade I) and 66 patients with less differentiated (l-d) HCCs (Edmondson and Steiner's grade I-II, II-III, and III). RESULTS: The histological analysis revealed that w-d HCCs had lower incidences of fibrous capsule formation (P<0.01), when compared to l-d HCCs. There were no significant differences in the incidence of intrahepatic metastasis, or portal vein invasion. In a resected specimen of w-d HCC, barium sulfate and gelatin were injected into portal vein and a transparent specimen was made. The transparent specimen showed that the portal vein in the tumor seemed to be intact. Microscopically, cancer cell infiltration into the fibrous frame of the portal tract was present. There were no significant differences in the disease free survival between the two groups. An analysis of tumor volume doubling time in recurrent foci suggested that minute cancerous foci had been present at the time of operation. CONCLUSIONS: W-d HCCs were clinically demonstrated not to be early cancer, because there was no significant difference in disease free survival between the patients with w-d and l-d HCCs.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

A long-term surviving patient with hepatocellular carcinoma including lymphocytes infiltration--a clinicopathological study.

In patients with hepatocellular carcinoma, a diffuse lymphocyte infiltration into the tumor has been reported to be a favorable prognostic factor. Nevertheless, the mechanism of the lymphocyte infiltration is still unknown and HLA-DR antigen expression, which is the cause of lymphocyte infiltration, has never to our knowledge been previously reported in such cases. The patient in this case had hepatocellular carcinoma with a diffuse lymphocytes infiltration into the tumor and was able to survive for 6 yrs and 11 months without any cancer recurrence. The tissue was studied using histologic and immunohistologic methods. Microscopically, lymphocytes infiltrate along the trabeculae of cancer cells. Immunohistochemically, such infiltrated lymphocytes are mainly T lymphocytes. No lysozyme positive cells were seen in the tumor. HLA-DR antigen was diffusely and strongly expressed on the endothelial cells in the tumor, however its expression was minimal on the endothelial cells in the non-cancerous parenchyma. T lymphocytes infiltrated selectively towards the HLA-DR antigen of the endothelial cells in the tumor and the inflammatory infiltrate may thus be related to a distinct category of patients with a favorable prognosis.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Chemosensitivity in primary liver cancers: evaluation of the correlation between chemosensitivity and clinicopathological factors.

BACKGROUND/AIMS: The aim of this study is to investigate the correlation of the chemosensitivity of primary liver cancers and the clinicopathological factors. MATERIALS AND METHODS: The correlation of the chemosensitivity was investigated along with the associated clinicopathological factors, using 229 cases with hepatocellular carcinoma (HCC) and 8 with cholangiocellular carcinoma (CCC), ,who all underwent hepatic resection. Chemosensitivity was determined by a succinate dehydrogenase inhibition assay. RESULTS: The overall rate of chemosensitivity among the HCCs was as follows: 34.8% to adriamycin, 40.5% to mitomycin C, 38.2% to cisplatin, respectively, while the resistant rate to all drugs tested was 50.9%. The chemoresistant rate of the HCCs with hepatitis C tended to be higher (62%) than that of the HCCs with hepatitis B (50%). In the HCCs, there was no definite correlation between the chemosensitivity to each drug and the histological findings, while there seemed to be a positive correlation between the chemoresistant rate and the poor prognostic risk factors, such as vascular invasion and intrahepatic metastasis. In CCCs, the chemoresistant rate to all drugs tested was 77.7%, moreover, both the age and the CA 19-9 level in the chemosensitive group were significantly higher than those in the chemoresistant group. CONCLUSION: HCC with hepatitis C, as well as the higher degree of malignant potentials such as vascular invasion, intrahepatic metastasis and poor differentiation tended to be resistant to all 3 drugs tested. CCC was also highly resistant to all 3 drugs tested. For such resistant tumors, the drug-resistant mechanism urgently needs to be identified as soon as possible.

Adult↗

PubMedDate not supplied

Impaired systemic immunity and frequent infection in patients with Candida antigen after hepatectomy.

BACKGROUND/AIMS: Infection after hepatic resection constitutes a major cause of morbidity and mortality. We examined the role of Candida antigen in systemic immunity and the infectious complications after hepatectomy. MATERIAL AND METHODS: In 25 hepatectomized patients, the Candida antigen titers were measured by a latex agglutination test (CAND-TEC). In the patients with Candida antigen (n = 10; 40%) and those without (n = 15; 60%), multiple immunological parameters, including the total lymphocyte count, lymphocyte subpopulations, phytohemagglutinin (PHA) response, and natural killer (NK) activity, and the incidence of infectious complications were compared. RESULTS: In the preoperative and operative parameters, there were no significant differences between the two groups. In the postoperative immune parameters, a significant attenuation in the total lymphocyte number (p < 0.01) and NK activity (p < 0.01) was observed in the patients with Candida antigen, compared with the findings in patients without Candida antigen. A bacterial infection was identified in 5 of 10 patients (50.0%) with Candida antigen, and in 1 of 15 patients (6.7%) without Candida antigen (p < 0.05). In contrast, the Candida culture was negative for all patients. CONCLUSIONS: Both a profound attenuation of systemic immunity and frequent bacterial infections were observed in the hepatectomized patients with Candida antigen.

Adult↗

PubMedDate not supplied

A comparison of parenteral hyperalimentation and early enteral feeding regarding systemic immunity after major hepatic resection--the results of a randomized prospective study.

BACKGROUND/AIMS: To compare the nutritional efficacy, especially regarding the systemic immunity of early enteral (EEN) and total parenteral nutrition (TPN) in major hepatic resection. MATERIAL AND METHODS: A randomized, prospective controlled study was performed in the Second Department of Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan. Twenty-six patients who underwent a major hepatic resection were divided into 2 groups: EEN (n = 13), and TPN (n = 13). There was no significant difference between the two groups in regard to either clinical backgrounds, nutritional parameters. RESULTS: There was no significant difference in the nutritional parameters after hepatectomy, such as the serum levels of retinol binding protein, transierrin, pre-albumin, and 3-methylhistidine between the two groups. Among the immunologic parameters, NK activity and changes in the lymphocyte number, the PHA response and the NK activity, which was expressed as a percentage of the preoperative values, was significantly higher in the EEN group than in the TPN group (p < 0.05). The incidence of infectious complications in the TPN group was 4 of 13 patients (31%), although the same incidence in the EEN group was only 1 of 13 (8%). In one case of TPN, a bacterial strain of gut origin was isolated from the intra-abdominal abscess, which suggested that bacterial translocation occurred. CONCLUSION: No significant difference was observed in the nutritional parameters between the EEN and TPN groups. Early enteral feeding maintained immunocompetence, and thus such feeding possibly reduced the rate of infectious complications after major hepatic resection.

Aged↗

PubMedDate not supplied

Circulating intercellular adhesion molecule-1 in patients with hepatocellular carcinoma before and after hepatic resection.

BACKGROUND/AIMS: We recently demonstrated that an activated inflammation in a non-tumorous portion was a significant risk factor for recurrence in patients with small hepatocellular carcinoma. The purpose of this study is to provide further proof for this mechanism by explaining the relation ship between the post-operative hepatitis state and intrahepatic recurrence. PATIENTS AND METHODS: We used an enzyme-linked immunosorbent assay to detect cICAM-1 in the serum of 18 patients with hepatocellular carcinoma before and after hepatic resection. RESULTS: A complete surgical resection of the tumor masses did not result in a significant reduction of cICAM-1 levels. The levels of aminotransferase after hepatic resection in patients with an increased level of cICAM-1 in the post operative period (n = 7) were much higher than in patients with a decreased level of cICAM-1 (n = 11) (p < 0.05). The 1-, 2- and 3- year disease free survival rates in the former group were 42.9%, 14.3% and 0%, respectively, and those in the later group were 72.7%, 54.5% and 54.5%, respectively (p < 0.05). CONCLUSIONS: The enhancement of inflammation in the remnant liver tissue is related to intrahepatic recurrence after hepatic resection through adhesion molecules, such as cICAM-1.

Aged↗

PubMedDate not supplied

Right hepatic lobectomy in elderly patients with hepatocellular carcinoma.

BACKGROUND/AIMS: The outcome of hepatectomy in elderly patients with hepatocellular carcinoma have been reported, however neither the morphological nor functional hepatic regeneration in elderly patients have been fully investigated. MATERIALS AND METHODS: Fifty-six patients with hepatocellular carcinoma, who underwent a right hepatic lobectomy over an 8-year period, were classified into three groups according to their age; group 1 (n = 7), more than 70 years of age; group 2 (n = 40), patients from 50 to 69 years of age and group 3 (n = 9), under 50 years of age. There were no significant differences regarding backgrounds or intra-operative parameters among the three groups. The perioperative hepatic function, postoperative complications and the regeneration rate of the remnant left lobe at 1 month after operation were compared. RESULTS: No differences were found in the regeneration rate, however, the levels of the hepaplastin test and lecithin:cholesterol acyltransferase at 7 days after hepatectomy in group 1 (31.3%, 8.8 U) were significantly lower than those in groups 2 and 3 (37.4%, 18.4 U; 47.9%, 29.4 U, respectively). The incidence of hospital death due to hepatic failure in group 1 (42.9%) was also significantly higher than that of group 2 (5.0%) or group 3 (0%). CONCLUSION: The decline of postoperative protein synthesis regardless of the voluminal regeneration is a characteristic of the elderly. This phenomenon might thus be an important promoter of postoperative hepatic failure which remains unpredictable using any type of examination. Therefore, at this time, a major hepatectomy is not recommended as a viable treatment alternative in the elderly.

Adult↗

PubMedDate not supplied

Urinary excretion of prostaglandins and renal function after hepatic resection.

BACKGROUND/AIMS: The leading postoperative complication associated with hepatic resection is the accumulation of fluid in the abdominal cavity, which usually develops approximately one week after surgery. This study was undertaken to investigate the role of renal prostaglandins in modulating renal sodium and water retention in patients who underwent hepatic resection. METHODS: Urinary excretion of thromboxane B2 and 6-keto-prostaglandin F1 alpha as well as renal function were investigated serially in 7 patients with hepatocellular carcinoma who underwent hepatic resection. We administered 60 mg of OKY 046, a selective thromboxane A2 synthetase inhibitor, for 6 hours by continuous drip infusion from the commencement of surgery. RESULTS: Urinary sodium excretion was reduced from 165 mEq/day pre-operatively to 73 mEq/day on postoperative day 6 (p = 0.0181), however, there was no decline in urinary osmorality. OKY 046 administration inhibited intrarenal thromboxane A2 production, on the other hand, it significantly increased the production of intrarenal prostaglandin I2 (from 147 +/- 19 to 6339 +/- 1861 pg/mg creatinine, p = 0.0017) on the day of surgery. The level of thromboxane A2 was significantly increased to 2440 +/- 1099 pg/mg creatinine (p = 0.006, vs. pre-operative value), whereas the level of prostaglandin 12 was significantly reduced to 687 +/- 163 pg/mg creatinine (p = 0.0181, vs. the value on the day of surgery) on postoperative day 6. CONCLUSIONS: Urinary thromboxane A2 synthesis might contribute to sodium and water retention after hepatic resection. These results suggest that combined use of OKY 046 and diuretics prevent ascites formation after hepatic resection.

6-Ketoprostaglandin F1 alpha↗

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

Hepatic resection for icteric type hepatocellular carcinoma.

Icteric-type hepatocellular carcinoma, which initially presents as jaundice, is known to be rare. Furthermore, the number of such cases that undergo hepatic resection is also very small. The purpose of this study was to clarify the characteristics of icteric type hepatocellular carcinoma and discuss the efficacy of hepatic resection in this condition. Herein, we present five cases of icteric type hepatocellular carcinoma which were among a study of 438 patients who underwent hepatic resection. Most of these cases were in the advanced stages, and a high incidence of early death was recognized. However, two patients are doing well, without further recurrence (8 years and 7 months, and 13 months, respectively). It is important to consider icteric type hepatocellular carcinoma whenever a patient has a potential risk for hepatocellular carcinoma. In addition, it is also important to understand that in diagnosing icteric type HCC, sometimes neither choledocholithiasis nor cholangiocellular carcinoma can be clearly ruled out. Extensive examinations of the biliary tract, including percutaneous transhepatic cholangiography as well as endoscopic retrograde cholangiography are indicated for such patients when they exhibit either temporary cholangitis or jaundice, as well as when there is biliary dilatation within the liver. Furthermore, hepatic resection is also considered to be a viable alternative for such cases.

Adult↗

PubMedDate not supplied

The role of growth hormone, somatostatin and glucagon in hepatic resection.

BACKGROUND/AIMS: The aim of this study was to clarify the roles of growth hormone, somatostatin, and glucagon in vital reactions against surgical stress as well as in hepatic regeneration. METHODOLOGY: Eleven consecutive patients, who underwent hepatic resection, were included in this study. Changes in intrinsic hormones, specifically growth hormone, somatostatin, and glucagon, were investigated. Furthermore, a comparison was made between major (more than 2 segments) and minor (less than 1 segment) hepatectomies. RESULTS: Growth hormone was observed to increase four-fold during hepatectomy and thereafter remained at relatively high levels. Somatostatin reached its lowest level on postoperative day 1 and then returned to near the preoperative level on postoperative day 7, while glucagon gradually increased and reached a peak around postoperative day 3. The concentrations of both somatostatin and glucagon in the portal vein were higher than those in the peripheral vein. No significant differences between major and minor hepatectomies were found throughout the perioperative course. CONCLUSIONS: Growth hormone is considered to be a sensitive parameter in terms of surgical stress and can also act as a trigger as well as a promoter of hepatic regeneration, while a dissociation between somatostatin and glucagon in the early postoperative period indicates the promotion of hepatic regeneration. Furthermore, portal blood, which contains higher concentrations of these substances, plays an important role in regulating hepatic regeneration. However, the absence of a correlation between the extent of the hepatectomy and these parameters suggests that some other, as yet unidentified mechanism, may also be related to the regulation of hepatic regeneration.

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

Significance of the peroral phenolsulfonphthalein test in hepatic resection: a possible predictor of bacterial translocation.

BACKGROUND/AIMS: The aim of this study was to evaluate the perioperative changes in intestinal permeability by using the phenolsulfonphthalein (PSP) test and to also to clarify the significance of the peroral PSP test in hepatic resection. METHODOLOGY: Fifty patients, all of whom underwent hepatic resection, were prospectively studied. Postoperative complications occurred in 16 patients, and 10 of these complications were infectious. A peroral PSP test, which was scheduled before operation and on postoperative days 3, 7, and 14, was performed as follows: after the administration of 30 mg of PSP, a 24-hour urine was collected, and the urinary PSP was measured by colorimetric assay. The correlation between the preoperative PSP value and various clinical variables, such as perioperative changes in urinary PSP excretion, and the relationship between the postoperative PSP value and postoperative complications, were investigated. RESULTS: Preoperative urinary PSP excretion was found to increase in proportion to the degree of liver dysfunction. In contrast, urinary PSP excretion did not significantly change during the perioperative period. However, urinary PSP excretion on postoperative day 3 in patients with postoperative infectious complications (27.3%) was significantly greater than that in those without infectious complications (17.4%; p < 0.05). Furthermore, PSP excretion on postoperative day 3 in those with infectious complications was also significantly greater as compared to the preoperative level. The patients with a urinary PSP excretion level on postoperative day 3 of greater than 25%, exhibited infectious complications more frequently than patients with a level under 25% (60% versus 10.3%, respectively; p < 0.05). CONCLUSIONS: The peroral PSP test is thus suggested to be a possible predictor of bacterial translocation after hepatic resection.

Bacterial Infections↗

PubMedDate not supplied

A branched chain amino acid-enriched solution does not induce any beneficial effect on the postoperative intestinal functions.

BACKGROUND/AIMS: This study was conducted in order to clarify the significance of using a branched chain amino acid-enriched solution on surgical patients, especially regarding the postoperative nitrogen balance as well as such intestinal functions as permeability and immunity. METHODOLOGY: Eight patients were prospectively and randomly divided into 2 groups. Consisting of a control group (n = 4) who all received conventional postoperative hyperalimentation using the branched chain amino acid-enriched solution; and a high-dose group (n = 4), who received an additional amount of branched chain amino acid-enriched solution immediately after operation up until postoperative day 7. No significant differences were observed in the background variables between the two groups. RESULTS: The nitrogen balance in the high dose group from postoperative day 1 to day 4 was significantly better for all compared to those of the control group. The ratio of the branched-chain amino acids to aromatic amino acids at postoperative day 3 in the high dose group was significantly higher than that in the control group. The urinary 3-methylhistidine excretion in the high-dose group tended to be lower than that in the control group. However, regarding the intestinal functions, no significant differences between the two groups were observed regarding the lactulose-mannitol test, the rate of positive Candida antigen, and the serum level of secretary immunoglobulin A, or the serum activity of diamine oxidase. CONCLUSIONS: A high dose branched chain amino acid-enriched solution can improve immediately postoperative nitrogen balance and may also lead to the prevention of a breakdown in the skeletal muscles. However, no beneficial effects were observed in the postoperative intestinal functions, which play an important role in preventing bacterial translocation.

Aged↗