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Biomedical subjects

K Yanaga

Publications and source records attributed to K Yanaga.

136 records · Page 8Linked to original sources
PubMedDate not supplied

A refined method of trans-thoracoabdominal hepatectomy for cirrhotic patients with hepatocellular carcinoma.

A hepatectomy in cirrhotic patients with hepatocellular carcinoma, located in either the posterior or superior part of the right lobe, inevitably requires a forced mobilization of the right lobe. Such a forced procedure causes a decreased hepatic blood flow resulting in postoperative morbidity and mortality, as well as an increased risk of the intrahepatic dissemination of cancer cells during the operation. We have thus refined the method of trans-thoracoabdominal hepatectomy to minimize those demerits of conventional transabdominal hepatectomies. The main characteristics of our refinements are as follows; (1) an optimal incision for the best short-cut to the hepatocellular carcinoma is determined by a three-dimensional imaging of either helical computed tomography and/or magnetic resonance imaging before operation; (2) a complete view of the operative field is obtained by the pertinent use of rotating the operation table, on which the patient is placed in a left semi-lateral position; (3) this method is suitable for resecting a tumor located in the posterior segment such as a posterior segmentectomy. This refined method is considered to decrease the postoperative morbidity including post-operative hepatic dysfunction and is also useful for cirrhotic patients with hepatocellular carcinoma.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

Early recurrence after surgery of hepatocellular carcinoma.

BACKGROUND/AIMS: In 231 patients with hepatocellular carcinoma who underwent liver resection from 1986 to 1992 to determine the significance of alpha-fetoprotein (AFP) levels. MATERIALS AND METHODS: There were 13 patients (5.6 per cent) with early recurrence within six months after hepatectomy. RESULTS: Preoperative serum alpha-fetoprotein (AFP) levels were significantly higher in patients with early recurrence (p < 0.01). Postoperative histological examination revealed that there were significant correlations between patients with early recurrence and intrahepatic metastasis (p < 0.01), and portal vein infiltration (p < 0.01). There were significant correlations between patients with early recurrence and preoperative diagnosis of intrahepatic metastasis (p < 0.01), however, preoperative diagnosis of portal vein infiltration could not be detected enough. Eight (73%) of 11 patients with over 1000 ng/ml of AFP and preoperative diagnosis of intrahepatic metastasis had early recurrence (p < 0.01). CONCLUSIONS: We found that patients of hepatocellular carcinoma with over 1000 ng/ml of AFP and preoperative diagnosis of intrahepatic metastasis are the most important factors in the preoperative clinical data linked to early recurrence type of HCC after hepatectomy.

Aged↗
PubMedDate not supplied

Serum hyaluronic acid as a reliable parameter of allograft viability in porcine liver transplantation.

BACKGROUND/AIMS: Hyaluronic acid is an endogenous glycosaminoglycan which is selectively degraded by hepatic sinusoidal endothelial cells. We evaluated the significance of serum hyaluronic acid clearance as an early indicator of allograft viability in porcine liver transplantation. MATERIALS AND METHODS: According to the survival period, animals were divided into two groups: Group I (n = 8) for survival equal or over four days and Group II (n = 5) for survival less than four days. Serial serum hyaluronic acid concentrations were measured before and after reperfusion in the recipient. RESULTS: In both groups, serum hyaluronic acid levels during the anhepatic period increased rapidly 9-fold from the preoperative value due to the absence of clearance by hepatic endothelial cells. In Group I, serum hyaluronic acid peaked at 15 min postreperfusion and decreased thereafter. In contrast, Group II failed to show clearance of hyaluronic acid after reperfusion. The serum hyaluronic acid value 120 min after reperfusion was 1,029 +/- 357 micrograms/L in Group I, and 1,856 +/- 263 micrograms/L in Group II (p < 0.01). Conventional parameters of liver function such as aspartate transaminase, lactic dehydrogenase, ammonia, lactate, and total bile acids were comparable between the two groups. CONCLUSIONS: The clearance of the serum hyaluronic acid reflects hepatic sinusoidal endothelial cell function and is a reliable and early marker of hepatic allograft viability.

Animals↗
PubMedDate not supplied

Nutritional support after hepatic resection: a randomized prospective study.

BACKGROUND: A consensus as to whether hypertonic dextrose should be given to patients with chronic liver diseases such as cirrhosis or chronic hepatitis after major hepatectomy has not been reached, mostly because metabolism in the remnant liver switches from utilization of blood glucose to utilization predominantly of fatty acid as an energy source. We investigated whether nutritional support would have beneficial effects for such patients. PATIENTS AND METHODS: Among 19 patients, 10 were given peripheral dextrose (10 kcal/kg/day) for seven days following hepatectomy and the other 9 were given hypertonic glucose. Twenty and 30 kcal/kg/day was the average non-protein caloric intake, including free oral intake during the first one week following hepatectomy, respectively. RESULTS: The groups were comparable with regard to laboratory data and operative stress. There were no untoward effects related to this support. In patients given nutritional support, retinol binding protein and prealbumin improved (p < 0.05 and p < 0.05, respectively), urinary 3-methylhistidine excretion decreased (p < 0.01) and the nitrogen balance normalized earlier (p < 0.05), as compared to findings with the conventional method. CONCLUSION: The remnant liver can utilize dextrose and nutritional support improves the nutritional status and may even preserve muscle protein mass.

Amino Acids, Branched-Chain↗
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

The fate of non-absorbable suture in growing vascular anastomoses in liver transplantation.

BACKGROUND/AIMS: Anastomotic stricture of the portal vein is an uncommon complication of orthotopic liver transplantation for which the etiology is unclear. In the present study, we evaluated the fate of continuous anastomosis by non-absorbable suture material in growing vessels after orthotopic liver transplantation in pigs. MATERIALS AND METHODS: A pig which had undergone orthotopic liver transplantation 54 months earlier was autopsied and inspected for vascular growth and their anastomotic patency. RESULTS: The pig weighed 270 kg (1,080%) at 54 months after orthotopic liver transplantation. The liver was normal in appearance and weighed 4,100 g (770%). All the vessels anastomosed were patent. However, luminal stenosis of the portal vein was identified at the anastomosis site, where intraluminal protrusion of the anastomosis was prominent. The inability of the suture material to grow longer than its full length along with the growth of the portal vein was suggested to be the main cause of the stenosis. CONCLUSION: We conclude that the use of non-absorbable sutures could cause late vascular anastomotic stricture in pediatric orthotopic liver transplantation.

Absorption↗
PubMedDate not supplied

Early detection of recurrent hepatocellular carcinoma.

BACKGROUND/AIMS: Early detection and treatment of recurrent hepatocellular carcinoma (HCC) are keys to patient survival after hepatic resection. In attempts at early detection, we make use of the alpha-fetoprotein (AFP) test every month and abdominal ultrasound (US) and computed tomography (CT) are carried out every three months after hepatectomy. The objective of the present study was to evaluate the most appropriate interval for follow-up re-examinations after resection for HCC. PATIENTS AND METHODS: Eighty-five patients with recurrent HCC were divided into two groups according to the state of the tumor when recurrence was detected: Group I (n = 70); tumor size < or = 2.0 cm, and group II (n = 15); tumor size > or = 2.1 cm. Clinicopathological comparisons were made between the two groups. RESULTS: AFP positivity in group I was significantly lower than group II at the time of recurrence. Rates of extrahepatic intra-abdominal recurrences, i.e. recurrence at the surgical stump and in the abdominal cavity and lymph nodes around the liver, were more frequent in group II than in group I (47% vs 4%; p < 0.001). The average tumor size was larger in 10 patients with extrahepatic intra-abdominal recurrence than in 75 patients with intrahepatic recurrence (3.4 +/- 2.0 vs 1.6 +/- 0.6 cm; p < 0.0001). There was a statistically significant difference regarding the histological grade of initial HCC between the two patterns of recurrence. CONCLUSIONS: Measurements of AFP were seen to have limited value for detecting recurrence, at an early stage. Close postoperative follow-up, including bedside US in the outpatient clinic, should be carried out when the initial HCC is histologically less differentiated HCC.

Abdomen↗
PubMedDate not supplied

Giant gastric varices after a left gastric venous caval shunt operation for esophageal varices: a case report.

A Japanese woman, who had undergone a left gastric venous caval shunt operation for esophageal varices 17 years earlier, was admitted to our hospital because of bleeding from giant gastric varices. An angiographic examination revealed a stealing of the portal blood flow to the inferior vena cava through both a dilated right gastroepiploic vein and a right gastric vein via the left gastric venous caval shunt. The gastric varices disappeared after obliterating both the feeding and drainage vessels by means of intervention radiology. We thus, consider the occlusion of both the afferent and efferent vessels to be an effective treatment for gastric varices.

Adult↗