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Biomedical subjects

K Takayasu

Publications and source records attributed to K Takayasu.

At least 109 records · Page 6Linked to original sources
PubMed1986

Clinical and radiologic features of hepatocellular carcinoma originating in the caudate lobe.

Five patients with hepatocellular carcinoma in the caudate lobe were evaluated. Computed tomography (CT) scan and/or angiography clearly demonstrated multiple intrahepatic metastases in four (80%), and tumor thrombi in the portal vein in two (40%), and in the inferior vena cava in one. Even though there was no recognizable lung metastasis, metastases were found in the orbita in one patient, and in the ribs and thoracic vertebrae in two patients. Four patients died after a mean period of 5.5 months from the initial diagnosis. The mechanism for early invasion into the vessels and multiple intrahepatic metastases of hepatocellular carcinoma arising from the caudate lobe is discussed.

Angiography↗
PubMed1986

Peripheral low-density area of hepatic tumors: CT-pathologic correlation.

To aid in the distinction between colorectal cancer metastasis to the liver and hepatocellular carcinoma, findings on computed tomographic (CT) scans taken more than 5 minutes after contrast material administration ("late-enhanced CT scans") and pathologic findings were compared. Late-enhanced CT scans of metastatic adenocarcinoma showed a peripheral low-density area (PLDA) that corresponded to viable tumor and a central high-density area that represented fibrous connective tissue. This phenomenon was recognized in 15 of 20 (75%) patients with metastatic adenocarcinoma and in one of 50 (2%) patients with hepatocellular carcinoma. Late-enhanced CT scans may be useful in distinguishing between metastatic nonmucinous colorectal cancer and hepatocellular carcinoma.

Adenocarcinoma↗
PubMed1986

Hepatic lobar atrophy following obstruction of the ipsilateral portal vein from hilar cholangiocarcinoma.

Gross deformity of the liver associated with hilar carcinoma is rare. In 17 patients with hilar cholangiocarcinoma and intrahepatic bile duct dilatation, the relationships between lobar or segmental atrophy, compensatory hypertrophy, and patency of portal vein branches were evaluated with computed tomography (CT) and angiography. All six patients with obstructed or narrowed portal veins (group A) had lobar or segmental atrophy on CT scans and angiograms. Compensatory hypertrophy was observed in the unaffected lobe with a patent portal vein in five. In contrast, neither hepatic atrophy nor hypertrophy was demonstrated in the other 11 patients with patent portal veins. All group A patients had differences in hepatic attenuation on CT scans or dense opacification during the hepatogram phase of angiography. Biliary decompression was optimized when the bile duct selected for percutaneous drainage paralleled a patent portal vein. Knowledge of radiologic findings will assist in determining the primary site along the bile duct from which carcinoma has arisen.

Adenoma, Bile Duct↗
PubMed1986

Atypical radiographic findings in hepatic cavernous hemangioma: correlation with histologic features.

Three cases of cavernous hemangioma of the liver having atypical imaging features are described. In the first case, an 11 x 10 cm hypervascular mass with a central hypovascular area supplied by many large tortuous vessels was demonstrated on angiography, CT, and sonography. The mass had a central cavity that contained fluid. In the second case there was a 2-cm isoechoic mass with a peripheral halo, despite the presence of typical features of hemangioma on angiography. The halo was shown histologically to be fibrous tissue surrounding the tumor. In the third case, a 6.5 x 4.3 cm mass exhibited slight peripheral enhancement on CT but was not detectable by angiography. Histologically, the tumor was hyalinized with only scattered small foci of hemangioma within it.

Adult↗
PubMed1986

Angiography of small hepatocellular carcinomas: analysis of 105 resected tumors.

One hundred five hepatocellular carcinomas less than 5 cm in diameter were resected in 75 patients. The tumors were studied with respect to their detection rate by angiography and their angiographic features. Angiography identified 86 (82%) of the 105 lesions, missing 19 (18%). The findings included tumor vessels (70%) and tumor staining (76%). Pathologic analysis of the 19 undetected lesions showed that 74% of them were smaller than 2 cm in diameter and that they were well-differentiated carcinomas. Forty percent of 100 lesions were in the anterosuperior subsegment of the right lobe.

Adult↗
PubMed1986

[A case of cholangiocarcinoma and dysgerminoma associated with Turner's syndrome].

A rare case of cholangiocarcinoma and dysgerminoma synchronously associated with Turner's syndrome was reported. A 53-year-old woman was admitted to our hospital on July 12, 1984 due to intrahepatic and left inguinal tumors. Physical examination revealed the typical characteristics of Turner's syndrome. The karyotype from myelocyte and fibrocyte culture was interpreted as 45, X. The resected intrahepatic tumor was cholangiocarcinoma that had invaded to the transverse mesocolon and the duodenum, while the inguinal lesion was dysgerminoma derived from a dysgenetic gonad. As far as we have been able to ascertain through our investigations of the literature on malignant disease in Turner's syndrome, the association of cholangiocarcinoma with Turner's syndrome has not been reported previously.

Adenoma, Bile Duct↗
PubMed1986

Necrosis of hepatocellular carcinoma as a result of subintimal injury incurred by hepatic angiography: report of two cases.

This report described two patients with hepatocellular carcinoma in whom angiographic procedure caused an inadvertent subintimal injury of the hepatic artery, resulting in tumor necrosis. In the first case of a 38-year-old male, complete obstruction of the common hepatic artery occurred on the initial angiography. It was followed by marked reduction of the tumor vessels on repeat angiography, and necrosis of about half of the tumor as confirmed by computed tomography. In the other 58-year-old female, severe subintimal injury occurred in the proper hepatic artery followed by obstruction of the feeding arteries. Subsequent computed tomography scan disclosed necrosis of the tumor. Both patients presented the postembolization syndrome that consisted of a transient fever and elevation of blood enzymes. When spontaneous regression or reduction of hepatocellular carcinoma is observed, special attention should be paid regarding whether or not hepatic angiography was performed and clinical symptoms followed it.

Adult↗
PubMed1985

Large spontaneous intrahepatic arterioportal fistula demonstrated by rapid sequential computed tomographic scan. Report of two cases.

A huge spontaneous intrahepatic arterioportal shunt with regurgitation through the portal vein trunk was demonstrated by computed tomography and confirmed by angiography in 2 patients with liver cirrhosis. Rapid sequential computed tomographic scanning was very useful in the diagnosis and follow-up after arterial embolization. Early visualization of the portal vein and increased attenuation in the ipsilateral lobe bearing the fistula were demonstrated in 1 case, and the same findings were also demonstrated by computed tomography and angiography in the other case.

Adult↗
PubMed1985

Portal hemodynamics in chronic portal-systemic encephalopathy. Angiographic study in seven cases.

A portal hemodynamic study was made in 7 consecutive patients with chronic portal-systemic encephalopathy by percutaneous transhepatic catheterization of the portal vein and injecting contrast medium into the superior mesenteric vein or by superior mesenteric arterial portography in comparison with patients without encephalopathy studied by percutaneous catheterization of these veins. All 7 patients had a large gastro-renal or spleno-renal shunt, and a large proportion of superior mesenteric venous blood was being shunted as estimated from the diameter of the portal and the collateral vein, whereas in nonencephalopathic patients in whom part of the superior mesenteric venous blood was shunting this diversion was much less (P less than 0.001). Only one of the chronic portal-systemic encephalopathic patients had esophageal varices, insignificant in size, and the incidence of esophageal varices was significantly less compared to the 12 nonencephalopathic control patients with portal hypertension who had either a gastro-renal or spleno-renal shunt (P less than 0.05). It is suggested that chronic portal-systemic encephalopathy is a result of a large collateral route shunting a large proportion of the superior mesenteric venous blood into systemic circulation, and that development of such collaterals precludes formation of large esophageal varices.

Ammonia↗
PubMed1985

Preoperative imaging of liver metastases. Comparison of angiography, CT scan, and ultrasonography.

Thirty-one patients with mostly colorectal cancer metastases to the liver had preoperative selective/superselective angiograms (24 cases), computed tomography (CT) [26 cases, mostly enhanced by contrast administered by a peripheral vein (9), the common hepatic artery (9), or the portal vein (5)], and ultrasonography (26 cases). Intraoperative ultrasonography and palpation and examination of the resected specimens revealed 113 tumors. CT detected almost half of the masses smaller than 1 cm, and ultrasonography and angiography about one-third of lesions 1-2 cm in size. Ultrasonography was less powerful for examination of the posterior segment of the liver. CT and ultrasonography placed the tumors into subsegments more accurately than did angiography. Almost 40% of the preoperative plans had to be changed: in two-thirds by extended resections and in one-third by a change from curative to palliative intent. Most changes were due to extrahepatic tumor growth, often within areas screened before surgery. The use of all three imaging modalities for liver metastases is recommended for preoperative planning.

Angiography↗
PubMed1985

Transhepatic obliteration of esophageal varices using stainless coils combined with hypertonic glucose and gelfoam.

A total of 63 patients with variceal bleeding were included in this study. Fifty-six attempts at percutaneous transhepatic variceal obliteration were made using stainless steel coils followed by 50% glucose and Gelfoam in 27 emergency cases, in whom bleeding did not stop by conventional medical treatment; and in 18 elective cases, in whom bleeding did stop by conventional medical treatment. The remaining 18 patients, whose bleeding was controlled by conventional medical treatment, were used as a control for the elective cases (conservative cases). The overall success rate was 93%. In 92% of the 37 acute bleeders, bleeding ceased as soon as the varices were obliterated. In emergency cases, the cumulative variceal rebleeding rate at 1, 2, 3, 6, 9, and 12 months after obliteration was 16%, 29%, 34%, 44%, 56%, and 56%, respectively. Its mortality within 1 month after the first bleeding was only 11%. In elective cases, the rebleeding rate at 1, 2, and 12 months was significantly lower; and the survival rate at 1 and 2 months was significantly higher compared with conservative cases. Follow-up portography in 10 active rebleeders and two nonrebleeders demonstrated new vessel formation in six, and recanalization of previously completely occluded varices in two. Complications included transient hemiparesis and partial stenosis of intrahepatic portal branches, but none was fatal. When compared with a conventional treatment, transhepatic variceal obliteration using steel coils followed by 50% glucose and Gelfoam proved to be an effective, safe emergency treatment for variceal hemorrhage. However, since the rebleeding rate was high, this procedure should be followed by an elective operation or other procedures for a lasting prevention of bleeding.

Embolization, Therapeutic↗
PubMed1985

Intrahepatic portal vein branches studied by percutaneous transhepatic portography.

Percutaneous transhepatic portography was performed in 31 patients. Based on the anterior and lateral images, the authors have concluded that the portal vascular system described in most anatomy textbooks does not correspond to the anterior portogram. A more practical nomenclature and order of branches are proposed, in which the first order includes the proximal portal vein branches; the second order includes the right anterior and posterior segmental branches, the umbilical portion of the left lobe, and most of the caudate veins; and the third order includes the peripheral (subsegmental) branches. The liver is divided accordingly into three main segments and one secondary segment (the caudate lobe), with each of the main segments being divided into two subsegments. The authors suggest that this new nomenclature will be helpful in both diagnosis and surgery.

Adult↗
PubMed1985

Intrahepatic venous collaterals forming via the inferior right hepatic vein in 3 patients with obstruction of the inferior vena cava.

When the inferior vena cava is obstructed, collateral veins enlarge, connecting with the inferior (accessory) right hepatic vein (IRHV) and thence through various hepatic veins to the right atrium. Three such cases are described. In one patient, most contrast material flowed into the IRHV and from there to the left hepatic vein. The second patient had several large collaterals arising from the IRHV and flowing into the right and middle hepatic veins, while the third patient demonstrated anastomoses between the IRHV and the middle hepatic vein. All of these hepatic venous shunts eventually drained into the right atrium. There were no clinical manifestations such as ascites, edema, or dilatation of the abdominal veins. Cavography alone or combined with computed tomography proved to be diagnostic in the assessment of these intrahepatic collaterals.

Collateral Circulation↗
PubMed1985

Esophageal varices: correlation of left gastric venography and endoscopy in patients with portal hypertension.

Selective left gastric venography was performed via percutaneous transheptic catheterization in 100 patients with portal hypertension to study hemodynamics and left gastric collaterals. Flow was hepatofugal in 81 patients, while 63 had varices supplied by the left gastric vein; azygos/hemiazygos collaterals were seen in 27 patients, gastrorenal shunts in 18, and other collaterals in 58. In 79 cases, enlarged, tortuous veins arising from thin parallel vessels at the esophagogastric junction on venography corresponded with varices on endoscopy in both size and course. Venography failed to show small varices which were seen endoscopically, whereas endoscopy often interpreted non-tortuous veins as varices. Using endoscopy as a reference, the sensitivity of venography for varices was 76%, specificity 100%, and accuracy 78%. There was a significant correlation between venographic demonstration of varices and previous hematemesis. Left gastric venography is necessary prior to embolization of varices and is also useful in their diagnosis as well as study of hemodynamics and assessment of bleeding risk.

Esophageal and Gastric Varices↗
PubMed1985

Bile duct necrosis: complication of transcatheter hepatic arterial embolization.

Bile duct necrosis because of transcatheter hepatic arterial embolization (THAE) in two patients with hepatocellular carcinoma is reported. Preoperative THAE was performed on 29 patients, and bile duct necrosis was experienced by two of the 29 (7%). In these two patients, gelatin (Gelfoam) powder was used as the embolus. Among the 24 whose embolus was clear, four were embolized with gelatin powder. Therefore, incidence of bile duct necrosis after THAE with gelatin powder was 50%. Because of the hazards of severe complications such as bile duct necrosis, we conclude that gelatin powder should not be used except for the THAE of no more than one segment of the liver.

Bile Ducts↗
PubMed1985

Gallbladder infarction after hepatic artery embolization.

Nineteen patients with hepatocellular carcinoma had transcatheter hepatic arterial embolization and subsequent hepatic resection with cholecystectomy. During the angiographic procedure, inadvertent embolization of the cystic artery occurred in 10 patients (53%). Subsequent histologic study of the gallbladder demonstrated necrotizing ulcerative cholecystitis in nine of the 10. All nine patients complained of right-upper-quadrant pain of varying degree after hepatic embolization, but none required special treatment or urgent laparotomy.

Aged↗