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Biomedical subjects

M Makuuchi

Publications and source records attributed to M Makuuchi.

At least 19 recordsLinked to original sources
PubMed1998

Hypertension, hypertriglyceridemia, and impaired endothelium-dependent vascular relaxation in mice lacking insulin receptor substrate-1.

Insulin resistance is often associated with atherosclerotic diseases in subjects with obesity and impaired glucose tolerance. This study examined the effects of insulin resistance on coronary risk factors in IRS-1 deficient mice, a nonobese animal model of insulin resistance. Blood pressure and plasma triglyceride levels were significantly higher in IRS-1 deficient mice than in normal mice. Impaired endothelium-dependent vascular relaxation was also observed in IRS-1 deficient mice. Furthermore, lipoprotein lipase activity was lower than in normal mice, suggesting impaired lipolysis to be involved in the increase in plasma triglyceride levels under insulin-resistant conditions. Thus, insulin resistance plays an important role in the clustering of coronary risk factors which may accelerate the progression of atherosclerosis in subjects with insulin resistance.

Animals↗
PubMed1998

Risk factors for hyperamylasemia after hepatectomy using the Pringle maneuver: randomized analysis of surgical parameters.

OBJECTIVES: To determine whether the increased portal venous pressure caused by use of the Pringle maneuver contributes to inducing posthepatectomy hyperamylasemia and, subsequently, to evaluate risk factors for its development. DESIGN: Randomized study. SETTING: University hospital. PATIENTS: Forty patients who were going to undergo hepatectomy were assigned prospectively to either a superior mesenteric artery clamp (n=20) or a nonclamp (n=20) group by the random-block method. INTERVENTIONS: The Pringle maneuver was used during hepatectomy, and in the superior mesenteric artery clamp group the superior mesenteric arteries were clamped simultaneously. MAIN OUTCOME MEASURES: Amylase activity, isozyme, and creatinine levels in the blood and urine samples were measured before and after surgery, and the amylase creatinine clearance ratio was estimated. RESULTS: The serum amylase activity levels of the superior mesenteric artery clamp and nonclamp groups did not differ significantly during the 7 postoperative days. The serum amylase activity levels exceeded 250 U/L in 14 patients (group 1) and remained below this level in 26 (group 2). The salivary-type isozyme levels of group 1 increased significantly compared with those of group 2, and the levels of group 2 remained normal. The total amount of amylase excreted in the urine samples of group 1 patients also increased significantly, with the salivary-type isozyme predominating. All the mean amylase creatinine clearance ratios before and after surgery remained normal. The mode chi2 of the logistic model including the indocyanine green retention rate at 15 minutes and the ratio of the resected liver weight to the whole liver volume showed a significantly increased risk (P=.01). CONCLUSION: It is not the increased portal venous pressure caused by use of the Pringle maneuver but the liver function and the extent of liver resection that are considered risk factors for inducing posthepatectomy salivary-type hyperamylasemia.

Aged↗
PubMed1998

[Pancreas carcinoid with extensive liver metastasis--simultaneous excision].

This case report describes an unusually large islet cell tumour of the pancreas presenting clinically with extensive metastases in the liver. The patient involved was a 55-year-old woman. The leading symptom was severe, hardly tractable diarrhoea. Histological examination including immunohistochemistry and measurements of the proliferation index revealed a probable malignant Vipoma of low grade. It was treated by simultaneous R0 resection of the tumour masses; the postoperative course was unremarkable. This outcome is seen as a strong argument in favour of a radical surgical approach even if there is significant metastatic disease in the liver. The advantage of intraoperative ultrasound is discussed along with aspects of tumour classification and alternative therapeutic modalities.

Female↗
PubMed1998

Increase in natural killer cell activity following living-related liver transplantation.

We monitored the serial changes of natural killer cell (NK) activity in eight recipients of living-related liver transplantation. The HLA types of all eight patients were haplotypically identical with those of their donors. Tacrolimus and methylprednisolone were used for immunosuppression. The NK activity before transplantation was 24.1 +/- 20.2% which is surprisingly low when compared with the value for normal individuals (67.7 +/- 13.2%, P < 0.01) or a liver dysfunction group (49.4 +/- 21.9%, P < 0.05). Serial changes in NK activity revealed a minimum of 6.1 +/- 3.6% 1 week after transplantation, gradually increasing to 49.2 +/- 12.5% at 2 months after transplantation. These results suggest that the diseased liver might play an important role in the suppression of NK activity.

Adolescent↗
PubMed1998

Increased nitric oxide production in the liver in the perioperative period of partial hepatectomy with Pringle's maneuver.

BACKGROUND/AIMS: There is no evidence that nitric oxide is produced in the liver during ischemia/reperfusion injury. This study examined the production of nitric oxide and inducible nitric oxide synthase in patients undergoing partial hepatectomy. METHODS: Twenty patients undergoing partial hepatectomy with only Pringle's maneuver were included. Peripheral blood was taken 1 day before the operation, during the operation (just after laparotomy and the first and last Pringle's maneuver) and 1 and 3 days after the operation, for measurement of plasma nitrate/nitrite, endotoxin and cytokine levels. Blood was also sampled from hepatic veins after Pringle's maneuver. Two liver specimens were taken from each patient, one before ischemia and one after partial hepatectomy, for the detection of inducible nitric oxide synthase. RESULTS: Average nitrate reached a maximum (33.5+/-3.4 micromol/l) after the final clamp (hepatic venous level). The increase in nitrate level during the operation correlated with the total duration of clamping. Endotoxin and interleukin-6 levels increased in a similar manner to nitrate levels, but tumor necrosis factor-alpha and interleukin-1 beta levels did not. In liver specimens taken after partial hepatectomy from patients, inducible nitric oxide synthase mRNA and protein were detected. CONCLUSIONS: Nitric oxide was produced in livers during ischemia/reperfusion injury and inducible nitric oxide synthase was involved in nitric oxide production.

Adult↗
PubMed1998

Anastomotic aneurysms after surgical treatment of Takayasu's arteritis: a 40-year experience.

PURPOSE: To evaluate the clinical characteristics of anastomotic aneurysms that develop in surgically treated patients with Takayasu's arteritis. METHODS: Among 103 patients with Takayasu's arteritis treated surgically over 40 years, 91 patients with 259 anastomoses (allowing for exclusion of 12 operative deaths) participated in follow-up study from 1 month to 37.3 years with a mean value +/- SEM of 17.3 +/- 1.1 years with a follow-up completion rate of 93% at 30 years. The clinical characteristics of anastomotic aneurysms were clarified, and the influences of several factors (sites of anastomoses, occlusive or aneurysmal disease, suture material, preoperative systemic inflammation, and administration of corticosteroids) on formation of anastomotic aneurysms were analyzed by means of life-table method and Cox regression analysis. RESULTS: Twenty-two uninfected anastomotic aneurysms were found among 14 patients (22 of 259 anastomoses, 8.5%). The interval between the previous operation and diagnosis varied from 1.6 to 30 years with a mean value +/- SEM of 9.8 +/- 1.8 years. The cumulative incidence of anastomotic aneurysm at 20 years was 12.0%. Systemic inflammation or steroid administration had little influence on formation of anastomotic aneurysm. Instead, anastomotic aneurysm tended to occur after operations for aneurysmal lesions. CONCLUSIONS: Anastomotic aneurysm can occur anytime after operations for Takayasu's arteritis. The development of anastomotic aneurysm is not influenced by any factor specific to this disease except the presence of an aneurysmal lesion.

Adolescent↗
PubMed1998

Rhabdomyosarcoma of the diaphragm: report of an adult case.

Diaphragmatic tumors, whether benign or malignant, may not generally reveal any symptoms in the early phase and may be found accidentally. During a pre-employment physical examination, a 20-year-old woman was found to have an abnormal shadow on the left diaphragm. An X-ray film, computed tomography and ultrasonography showed a giant mass on the left side, to the rear of the heart. She underwent surgery via a left thoraco-abdominal approach. The lesion was found to arise from the left diaphragm, and multiple disseminated lesions were scattered in the left thoracic cavity. Histological examination showed many large, oxyphilic rhabdoid cells between diffusely proliferating, spindle-shaped cells, and the tumor was subsequently diagnosed as a pleomorphic rhabdomyosarcoma of the diaphragm, of which the location and histological type were very rare. Despite adjuvant therapy, chest X-ray and CT revealed increasing tumor growth in the left cavity and she died one year after surgery.

Adult↗
PubMed1998

Living related liver transplantation in adults.

OBJECTIVE: To evaluate the outcome of living related liver transplantation (LRLT) in adult patients and to assess graft size disparity and graft regeneration. SUMMARY BACKGROUND DATA: Although LRLT has been accepted as an optional life-saving procedure for pediatric patients with end-stage liver disease, the feasibility of LRLT for adult patients has not been reported with reference to a clinical series. METHODS: Adult-to-adult LRLT was performed using whole left lobar grafts in 13 patients (5 with primary biliary cirrhosis, 6 with familial amyloid polyneuropathy, 1 with biliary atresia, and 1 with citrullinemia). The 13 donors comprised 5 husbands, 3 sons, 2 sisters, 2 fathers, and 1 mother. The ratio of the graft volume to standard liver volume (GV/SV ratio) was calculated for use as a parameter of graft size disparity. RESULTS: Although the liver graft was markedly small for size (GV/SV ratio 32%-59% at the time of LRLT), none of the 13 patients developed postoperative liver failure. Eleven of the patients are still alive and well with satisfactory graft function 2 to 35 months after LRLT. Graft liver volume increased rapidly after LRLT and approximated the standard liver volume with time. CONCLUSIONS: Our LRLT program for adult patients has produced good results. LRLT in adults can be indicated for selected donor-recipient combinations.

Adult↗
PubMed1998

Problems in the diagnosis and treatment of a so-called mucin-producing tumor of the pancreas.

Reports of a so-called "mucin-producing tumor of the pancreas" are increasing worldwide. Although the clinicopathologic features and therapeutic strategies of this tumor have been enthusiastically investigated, there are still many unanswered questions regarding this ailment. In this study, problems in the diagnosis and treatment of mucin-producing tumor were analyzed, based on the 259 reported cases of this tumor. The overall 5-year survival rate for resected cases is 83%, which is much higher than that for ordinary duct cell carcinoma (17.3%). However, the 5-year survival rate for carcinoma cases with infiltration into other organs is 28%, which is much lower than those for carcinoma cases without infiltration (86%) and carcinoma cases with infiltration that remained within the pancreatic parenchyma (74%). These results demonstrate that patients with this tumor have a poor prognosis if the tumor infiltrates other organs. In addition, when the spread of the tumor is >6 cm, the prognosis is significantly worse than when the tumor has a spread of <6 cm. The significance of using the presence of K-ras mutation in the pancreatic juice for diagnosis of this tumor and problems of duodenum-preserving pancreatic head resection are discussed.

Adenocarcinoma, Mucinous↗
PubMed1998

Tibioperoneal bypass for popliteal arterial occlusion.

OBJECTIVE: To clarify the clinical features of chronic arterial occlusive disease in which the main lesion occurs in the popliteal artery (OPA). EXPERIMENTAL DESIGN: This was a retrospective study with a follow-up of 1 to 163 months. SETTING: A department of surgery in a university hospital. PATIENTS: Fifty-six patient who underwent tibioperoneal bypasses: 31 patients with OPA, and 25 with an extensive occlusive lesion from the femoral to popliteal artery (OFPA). INTERVENTION: All bypasses were performed using reversed saphenous veins under tourniquet ischemia. MEASUREMENTS: The background of the patients and the surgical results, including long-term patency and postoperative arteriographic findings. RESULTS: Buerger's disease occurred most commonly in the OPA group (49%) and arteriosclerosis obliterans occurred most commonly in the OFPA group (64%). The 3-year primary and secondary cumulative patency rates of the grafts for OPA were 72% and 85% respectively, and were comparable with those of OFPA. Arteriographic analyses carried out in the follow-up period revealed no occlusive progression in the inflow artery. CONCLUSIONS: Popliteal-distal bypass is a reliable procedure in selected patients with OPA.

Adult↗
PubMed1998

Continuous hemodiafiltration during aortic arch aneurysm repair in chronic renal failure patient.

We report the successful repair of a distal aortic arch aneurysm in a patient with chronic renal failure following aneurysmectomy for a ruptured abdominal aorta. Perioperative use (during and up to 47 hrs after the operation) of continuous hemodiafiltration was useful for controlling fluid balance and uremia without any complicating hemodynamic instability. However, this should be restricted to the first two or three days after the operation, since it poses risk of significant thrombocytopenia.

Aortic Aneurysm, Thoracic↗
PubMed1998

[Systematic resection for hepatocellular carcinoma].

We have performed systematic subsegmentectomy in patients with hepatocellular carcinoma complicated mainly by cirrhosis. Such small anatomical resections have become possible due to the introduction of intraoperative ultrasonography and of vascular occlusion techniques. As a result of our clinical experience involving 163 cases, it has been clarified that subsegmentectomy is a safe procedure (operative mortality rate, 0.6%) and results in a favorable long-term outcome (5-year survival rate, 51%). In the resected specimens, microscopic cancer spread was recognized frequently (portal venous invasion, 41%; intrahepatic metastasis, 31%). Subsegmentectomy is therefore the first procedure of choice in patients who have small hepatocellular carcinoma and chronic hepatitis or cirrhosis.

Aged↗
PubMed1998

[Different strategies for treatment of hepatocellular carcinoma in the west and in the east].

In most of the cases, hepatocellular carcinoma (HCC) develops in the setting of cirrhosis associated with hepatitis B or C infection. Thus, cirrhotic patients constitute the population at risk for HCC. This has prompted the screening of cirrhotic patients for HCC and this policy has facilitated the detection of HCC at an early and/or asymptomatic phase when potentially effective treatments are available. However, it must be stressed that the prognosis of the patients with HCC is determined not only by the stage of the HCC, but also by the functional status of the underlying liver. In such a situation in Japan, systematic subsegmentectomy using intraoperative ultrasound, trancathether arterial embolization (TAE), and percutaneous ethanol injection (PEI) were developed to treat HCC patients with cirrhosis. On the other hand in the West, liver transplantation is the therapeutic modality for small HCC with cirrhosis while small HCCs are treated mainly by PEI. However, the lack of controlled trials for the most therapeutic options in our country precludes knowing if their antitumoral effect is associated with an improved survival. In summary, the treatment of patients with HCC remains a clinical challenge with several areas to be investigated through carefully designed prospective randomized controlled trials. Ideally, this clinical research will provide us with solid therapeutic options that unequivocally improve the survival of the patients with HCC. Application of living-related liver transplantation for carefully selected adult patients with small HCC will be necessary in Japan.

Carcinoma, Hepatocellular↗
PubMed1997

Urgent living-related liver transplantation using a graft with multiple intrahepatic arterioportal fistulae.

BACKGROUND: We describe the case of a man with intrahepatic arterioportal fistulae located in the left lobe, whose left lateral segment was transplanted into his son who was suffering from severe acute hepatitis B. METHODS: A male infant with severe acute hepatitis B was considered to be a candidate for liver transplantation. The father was willing to be the donor. Preoperative evaluation of the donor revealed intrahepatic arterioportal fistulae, however, duplex ultrasonography showed normograde portal blood flow. A living-related liver transplantation was performed. RESULTS: The postoperative course for both the donor and recipient was uneventful. The recipient is free of recurrent hepatitis B and has normograde portal blood flow. CONCLUSIONS: The present case suggests that there may be a symptomless population with intrahepatic arterioportal fistulae, which cause various degrees of disruption of the portal blood flow. Duplex ultrasonography might be helpful in the evaluation of candidates for liver donation.

Adult↗