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Biomedical subjects

K Uesaka

Publications and source records attributed to K Uesaka.

At least 55 records · Page 3Linked to original sources
PubMed1996

Gastric stump carcinoma after partial gastrectomy for benign gastric lesion: what is feasible as standard surgical treatment?

METHOD: Clinicopathological features and prognostic factors were evaluated in 26 cases of stump carcinoma, operated on in the recent 20 years, in search of the standard surgical treatment. BACKGROUND: Stump carcinoma usually emerges more than 20 years after the initial gastrectomy and is often not diagnosed in the early clinical stage, resulting in a significantly low incidence of curative resection compared with primary gastric carcinoma. RESULTS: No improvement in the survival curves for stump carcinoma was observed between the past two decades. Nodal metastases were frequently found within the first tier nodes, and no 5-year survivor was found among the patients with nodal metastasis beyond pN1. CONCLUSIONS: Subtotal gastrectomy might suffice for the treatment of stomal cancer, and most patients might not benefit from extensive lymphadenectomy.

Carcinoma↗
PubMed1996

Changes in hepatic lobar function after right portal vein embolization. An appraisal by biliary indocyanine green excretion.

OBJECTIVE: The changes in the functional capacity of the hepatic lobe after right portal vein embolization (RPE) were investigated in patients with complete obstruction of the hepatic hilus who had undergone multiple percutaneous transhepatic biliary drainage catheterizations. METHODS: After injection of 0.5 mg/kg of indocyanine green (ICG), bile draining from each hepatic lobe was collected separately for 6 hours. Biliary ICG excretion in each hepatic lobe was estimated and compared with hepatic lobar volume measured by computed tomographic volumetry before and an average of 11 days after RPE. RESULTS: Right portal vein embolization produced a significant increase in bile volume and biliary ICG concentration in the left lobe, resulting in a significant increase in ICG excretion in the left lobe. The percentage of ICG excretion in the left lobe to the whole-liver excretion showed a mean increase of 20.1%, which was statistically significant. In contrast, the percentage of left lobar volume to the total liver volume increased by only 8.3%. CONCLUSIONS: Measurement of biliary ICG excretion is useful for estimating changes of hepatic lobar function and has revealed that within 11 days RPE enhances functional capacity in the left lobe compared with volume gain without affecting total liver function.

Adult↗
PubMed1996

Postoperative staging of gastric carcinoma. A comparison between the UICC stage classification and the 12th edition of the Japanese General Rules for Gastric Cancer Study.

BACKGROUND: The feasibility of the latest edition of the Japanese General Rules for Gastric Cancer Study (GRGCS) is evaluated by comparison with the TNM system. METHODS: In a 5-year period from 1985 to 1989, 978 patients with gastric cancer underwent laparotomies at the Dept. of Gastroenterological Surgery, Aichi Centre Centre, Japan. All the patients have now been followed up for 5 years or until death. These patients were retrospectively classified into appropriate clinical stages and residual tumour status on the basis of the GRGCS and the 4th edition of the TNM classification by the UICC, and survival curves for various stages and subgroups were evaluated. RESULTS: The GRGCS classification provided useful information by splitting UICC stage IV into stages IVa and IVb, and R0 into curabilities A and B, both subgroups showing significant differences in the survival curves. CONCLUSIONS: The new edition of the GRGCS can be recommended as a useful staging manual for gastric cancer.

Follow-Up Studies↗
PubMed1996

Gastric remnant carcinoma after partial gastrectomy for benign and malignant gastric lesions.

BACKGROUND: A retrospective study was designed to evaluate the clinicopathologic characteristics and prognosis of gastric stump carcinoma (GSC) after gastrectomy for gastric adenocarcinoma. STUDY DESIGN: A comparison of the clinicopathologic features was made between 12 cases of GSC and 27 cases of remnant carcinoma (RC) following gastrectomy for adenocarcinoma. The various factors influencing survival of both groups of patients were evaluated separately and by multivariate analysis. RESULTS: Gastric stump carcinoma emerges late after initial gastrectomy and has a significant tendency toward lymph node metastasis. No difference was observed between the survival curves for patients with GSC or RC after gastrectomy for malignancy. Serosal invasion was the factor most affecting survival. CONCLUSIONS: Early diagnosis is most important for management of the disease, and only patients with T2 staged GSC according to the Union Internationale Contre le Cancer classification system might benefit from extensive lymphadenectomies.

Adenocarcinoma↗
PubMed1996

The prognostic value of preoperative serum levels of CEA and CA19-9 in patients with gastric cancer.

OBJECTIVES: The clinical significance of preoperative serum levels of tumor markers CEA and CA19-9 was evaluated in gastric cancer patients. METHODS: Serum levels of CEA and CA19-9 were measured in 663 patients with gastric cancer who underwent laparotomies over a recent 4-yr period (1990-1993). The correlations between the serum levels of tumor markers and several clinicopathological factors were evaluated by univariate analysis. The significance of the tumor markers as prognostic factors was assessed by multivariate analysis. RESULTS: The positivity rates of CEA and CA19-9 were 16.6% and 16.0%, respectively. The positivity of CEA correlated well with the sex of the patients, hepatic, peritoneal, and nodal metastases and the depths of tumors, but it correlated weakly with a tumor's histological type. The positivity of CA19-9 correlated well with various forms of metastases, depths, and tumor size. A significant in prognosis was observed between patients positive and negative for CA19-9 among those undergoing R0 resection. Multivariate analysis also revealed that serum CA19-9 was better than CEA as a prognostic factor. CONCLUSIONS: CA19-9 in the preoperative sera is a good prognostic factor in gastric cancer patients, although tumor markers continue to have only limited diagnostic usefulness.

Biomarkers, Tumor↗
PubMed1996

Visualization of routes of lymphatic drainage of the gallbladder with a carbon particle suspension.

BACKGROUND: Although carcinoma of the gallbladder frequently spreads lymphatically, few reports exist about the evaluation of routes of lymphatic drainage of the gallbladder by vital staining. The purpose of this study was to visualize drainage routes and the extent of lymphatic flow from the gallbladder by using vital staining with a carbon particle suspension (CH40). STUDY DESIGN: In 20 patients, 0.3 to 0.5 mL of carbon particle suspension was injected into first station nodes for the gallbladder, the cystic node or pericholedochal node, intraoperatively. After a Kocher maneuver was performed, lymph nodes and lymphatic vessels blackened by the stain were visualized macroscopically. RESULTS: Lymphatic pathways from the gallbladder were classified into three routes: right, left, and hilar. The right route, which ran along the common bile duct to the superior retropancreaticoduodenal node or the retroportal node and reached the para-aortic nodes, was stained in 95 percent of patients. The left route, which traveled toward lymph nodes medial to the hepatoduodenal ligament through the posterior aspect of the head of the pancreas, was stained in less than 50 percent of patients. Among lymph nodes along the left route, the posterior common hepatic node was most frequently stained (45 percent). The hilar route, which ascended toward the hepatic hilus, was stained in 20 percent of patients. CONCLUSIONS: These data demonstrate that the right route is a main pathway of lymphatic drainage from the gallbladder, while the left and hilar routes are branch lines. The para-aortic nodes, regarded as final regional nodes for the gallbladder, should be removed during radical surgery for advanced carcinoma of the gallbladder. Drainage along the hilar route may cause metastasis to the liver.

Carbon↗
PubMed1996

Surgical treatment of Borrmann type IV gastric carcinoma: relevance of lymphadenectomy in improving survival.

BACKGROUND: Borrmann type IV gastric carcinoma carries a poor prognosis, even if curatively resected. The benefit of a lymphadenectomy is unknown. STUDY DESIGN: A retrospective study was designed to evaluate whether improvements have been made in the treatment of type IV gastric carcinoma over the past decade. The 345 patients with type IV carcinoma who underwent laparotomy within a recent 16-year period were split into two groups: one group of patients who underwent laparotomy between 1977 and 1985, and the other between 1986 and 1992. Survival data were compared between these two groups and prognostic factors for type IV gastric carcinoma were assessed by multivariate analysis. RESULTS: A significant difference in survival was observed between the groups, both of which underwent curative resection, despite a lack of difference in background factors. The improvement was more prominent among patients with nodal metastases and insignificant among patients without nodal metastases. Multivariate analysis identified nodal metastasis as a major independent prognostic factor. CONCLUSIONS: An improvement in outcome was presumably achieved through extended lymphadenectomy. However, the survival rate remains unsatisfactory, and further advances in the treatment of this disease are needed.

Adenocarcinoma↗
PubMed1995

Incidence, diagnosis and significance of multiple gastric cancer.

Of 2790 patients with gastric cancer undergoing surgery between January 1978 and December 1993, 160 (with 356 neoplastic lesions) had synchronous multiple cancer. Of these lesions 271 (76 percent) were early cancers. Only 85 (53 percent) of the 160 patients were diagnosed before operation as having multiple cancer; 69 further patients (43 percent) were diagnosed during the course of the operation. Small flat (IIb) and depressed (IIc) type lesions had a propensity to be missed before operation. The incidence of multiple cancer was relatively low, indicating that several microscopic lesions might have been overlooked in this series. There has, however, only been one patient (1 percent) with subsequent cancer of the gastric remnant of 126 with multiple cancer and postoperative gastric remnants over the past 16 years. This might be because of co-resection of unrecognized lesions by distal gastrectomy in 68 percent of the patients. Alternatively some microscopic cancers might not invariably be destined to grow into clinically significant lesions over 10 or more years.

Female↗
PubMed1995

Right or left trisegment portal vein embolization before hepatic trisegmentectomy for hilar bile duct carcinoma.

BACKGROUND: Percutaneous transhepatic embolization of the right portal vein plus the left medial portal branch (R3-PE) and the left portal vein plus the right anterior portal branch (L3-PE) is not well described. METHODS: Four patients with far advanced carcinoma of the hepatic hilus underwent R3-PE (n = 1) or L3-PE (n = 3) as preoperative management for right hepatic trisegmentectomy or left hepatic trisegmentectomy. The portal vein embolization was performed with the ipsilateral approach through the right anterior portal branch. RESULTS: In all patients the embolizations were successful without complications. Volumetric study with computed tomography showed sufficient hypertrophy of the nonembolized hepatic segments. Three of the four patients eventually underwent trisegmentectomy. The postoperative courses in two of the patients were uneventful. The remaining patient suffered from posthepatectomy liver failure but recovered. CONCLUSIONS: R3-PE or L3-PE is advisable as preoperative management for trisegmentectomy and appears effective for increasing the safety of the operation. This embolization is achievable only through the ipsilateral approach.

Adult↗
PubMed1995

Changes in hepatic lobe volume in biliary tract cancer patients after right portal vein embolization.

Changes in lobar volume of the liver and in total hepatic function were studied in 19 patients with biliary tract cancer who underwent right portal vein embolization as preoperative management for extensive liver resection. Computed tomography (CT) was performed to estimate liver volume before and approximately 11 days after embolization. An indocyanine green (ICG) test was performed before and 11 to 13 days after embolization. The calculated volume of the right lobe decreased from 761 +/- 181 cm3 to 625 +/- 110 cm3 11 days after embolization (P < .0001), whereas the volume of the left lobe increased from 420 +/- 94 cm3 to 555 +/- 110 cm3 (P < .0001). Thus, portal embolization produced a gain in left lobe volume of 136 +/- 62 cm3 and an almost equivalent loss in right lobe volume. The hypertrophy ratio of the left lobe, expressed as percentage of postembolization volume of the left lobe to preembolization size, of the 5 patients with diabetes mellitus (DM) was lower than that of the 14 patients without diabetes (116.7 +/- 6.3% vs. 140.4 +/- 18.4%; P < .005). The ICG disappearance rate in 16 patients improved from 0.163 +/- 0.034 to 0.177 +/- 0.027 (P < .05). The improvement was especially evident in 9 of 14 post-jaundice patients, although the rate decreased slightly in 2 patients without jaundice. We conclude that right portal vein embolization can produce a compensatory hypertrophy of the left lobe within 11 days without seriously affecting hepatic function. In diabetic patients, however, a longer interval between embolization and operation may be needed to achieve sufficient hypertrophy of the left lobe.

Adult↗
PubMed1994

End colostomy using stapling device.

Our experiences concerning the end colostomy using the stapling method are reported. The anvil which has been inserted to the proximal end of the colon and purse string suture with the skin is engaged the anvil shaft, and then, is fired. This operative procedure is simple, safe and convenient, and we can expect a uniform and satisfactory outcome. We applied this technique on 6 cases and have had no postoperative complications.

Adult↗
PubMed1990

Characterization of an antigen defined by monoclonal antibody KMO1.

We have isolated an antigen defined by the monoclonal antibody KMO1 from tissue culture supernatant as a glycoprotein and from cancer cells as a glycolipid. The antigenic determinant was a carbohydrate. Antibody KMO1 inhibited the binding activity of 19-9 to CA19-9, but 19-9 antibody did not inhibited the binding activity of KMO1 to KMO1 antigen. The glycolipid antigen of KMO1 was a monosialoganglioside and was separated into 3 components on thin layer chromatography. The 19-9 antibody reacted with one of the components. These results suggest that the KMO1 antigen is similar to but not identical to CA19-9.

Animals↗
PubMed1989

Osteoclast-like giant cell tumor of the pancreas associated with cystadenocarcinoma.

Osteoclast-like giant cell tumor is a very rare type of pancreatic malignancy, and no more than 20 cases have been reported in the English literatures. A case of this tumor associated with cystadenocarcinoma is reported. This giant cell is undistinguishable on light microscopy from osteoclast of bone and correct diagnosis of this unusual tumor is important because of its relatively poor prognosis.

Adult↗
PubMed1989

Cholescintigraphic observation of the sphincter of Oddi motor activity in patients with gallstone.

In 36 cases with gallstones, biliary scintigraphy was performed before and after operation to prepare the time-activity curve in the juxta-papillary duodenum. This curve showed different patterns depending on the conditions of disease, and seemed to represent on aspect of the sphincter of Oddi phasic activity, in view of the exerted effect of caerulein administration. This method is useful as a non-invasive one for the diagnosis of dynamic function of the sphincter of Oddi.

Ampulla of Vater↗
PubMed1989

Hepatic artery embolization for inoperable hepatocellular carcinoma; prognosis and risk factors.

During a 7-year period in our hospital, 69 patients with inoperable hepatocellular carcinoma (HCC) underwent 111 courses of transcatheter hepatic artery embolization (TAE) and/or chemoinfusion with lipiodol. Patient survival was 0.5-37 months following therapy and the factors affecting prognosis were evaluated. Survival rates at 1, 2 and 3 years after TAE were 53%, 24% and 15%, respectively. Survival rates at 1, 2 and 3 years in relation to tumor size were 100%, 100% and 100% in 5 patients (tumor size less than 2 cm in diameter), 81%, 33% and 16% in 23 patients (2.1-5.0 cm), and 35%, 9% and 0% in 41 patients (greater than 5.1 cm). An analysis of prognostic factors showed that the size of the main tumor significantly influenced the prognosis following TAE (P less than 0.01), whereas the frequency of TAE, intrahepatic metastasis and the degree of liver dysfunction showed a slight correlation (P less than 0.1). These results suggest that TAE has a significant potential for becoming the first choice of treatment for patients with small multiple HCCs (less than 2 cm), provided that neither severe hepatic dysfunction nor a tumor thrombus in the main portal vein is present.

Adult↗