BACKGROUND/AIMS: The cytoprotective effects of prostaglandin E1 on livers suffering from ischemia/reperfusion injury in the clinical setting are unproved. These effects were examined, focusing on inflammatory cytokine and nitric oxide metabolism. METHODS: Twenty-four cirrhotic patients with hepatocellular carcinoma undergoing subsegmentectomy under ischemia induced only by Pringle's maneuver were divided into two groups (patients given prostaglandin E1 by injection and untreated controls) and postoperative results were compared. Peripheral blood was taken perioperatively and the plasma aminotransferase, cytokines and nitrate/nitrite levels of the two groups were compared. Two liver specimens were taken from each patient, one before ischemia and the other after hepatectomy, and the levels of inducible nitric oxide synthase and cytokine mRNAs and proteins were analyzed. RESULTS: Although no apparent differences were recognized in postoperative complications or duration of postoperative hospital stay between the groups, the perioperative plasma aminotransferase level was significantly lower in the prostaglandin E1 group. Significant differences were also seen in interleukin-6 and nitrate plasma levels during the observation period and the interleukin-6 protein levels in the liver supernatants after hepatectomy in the two groups. In contrast, no significant differences were apparent between the interleukin-1 beta and tumor necrosis factor-alpha plasma levels of the two groups. The corrected fluorescence activities of interleukin-6 and inducible nitric oxide synthase mRNAs in the liver after hepatectomy correlated significantly. No interleukin-1 beta or tumor necrosis factor-alpha mRNAs or proteins were detected. CONCLUSIONS: Prostaglandin E1 exerted hepatoprotective effects on livers suffering from ischemia/reperfusion injury, and interleukin-6 might play an important role in these effects.

Aged↗

PubMed1998

History of intraoperative ultrasound.

Intraoperative ultrasound (IOUS) using A-mode or non-real-time B-mode imaging started in the 1960s; however, it was not widely accepted mainly because of difficulty in image interpretation. In the late 1970s, IOUS became one of the topics in the surgical communities upon the introduction of high-frequency real-time B-mode ultrasound. Special probes for operative use were developed. In the 1980s, all over the world the use of IOUS spread to a variety of surgical fields, such as hepatobiliary pancreatic surgery, neurosurgery, and cardiovascular surgery. IOUS changed hepatic surgery dramatically because IOUS was the only modality that was capable of delineating and examining the interior of the liver during surgery. After 1990, color Doppler imaging and laparoscopic ultrasound were incorporated into IOUS. Currently, IOUS is considered an indispensable operative procedure for intraoperative decision-making and guidance of surgical procedures. For better surgical practice, education of surgeons in the use of ultrasound is the most important issue.

Australia↗

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

Two-staged pancreatoduodenectomy with external drainage of pancreatic juice and omental graft technique.

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Aged↗

PubMed1998

Efficacy of a bioreactor filled with porcine hepatocytes immobilized on nonwoven fabric for ex vivo direct hemoperfusion treatment of liver failure in pigs.

We developed a new bioreactor for a bioartificial liver filled with porcine hepatocytes immobilized on polyester nonwoven fabric (NWF) and in our previous study showed that this NWF bioreactor has promising in vitro efficiency. In the present study, we investigated the efficacy of the NWF bioreactor in a direct hemoperfusion experiment conducted to treat pigs with liver failure. Porcine hepatocytes were isolated from the whole liver of a Sangen strain pig. They were immobilized in a 200 ml column containing NWF via perfusion in a closed circuit for 24 h to prepare a NWF bioreactor. The following day an operative liver failure model was produced by creating a portocaval shunt and ligating the entire hepatoduodenal ligament in the porta hepatis. Perfusion treatment was initiated 4 h after operative induction of liver failure and continued for about 1 h. The pigs which underwent perfusion treatment showed significant improvements in survival and blood data, including ammonia, total bile acid, glucose, and prothrombin time, attributed to significant improvements in the post- as compared to the prebioreactor levels in the perfused blood of the treated pigs. These beneficial effects of the NWF bioreactor were based on its excellent composition which allows the accommodation of adequate numbers of hepatocytes and direct contact between hepatocytes and perfused blood.

Ammonia↗

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

Serous cystadenoma of the pancreas with invasive growth: benign or malignant?

We describe a case of serous cystadenoma, that invaded a lymph node and adipose tissue. Preoperatively, the cystic lesion of the pancreas was diagnosed as a serous cystadenoma and subsequently the patient, a 71-yr-old woman, underwent distal pancreatectomy with splenectomy. Macroscopically, a greyish white, externally lobulated and partly ovoid tumor, measuring 12 x 8.5 x 5 cm, occupied the pancreatic body and tail extensively. In cross-section, multiple nodules were observed, which measured from 0.5 to 3 cm in diameter, were separated by hyalinized fibrous septa and were filled with numerous microcysts. Light microscopic findings were consistent with those for serous cystadenoma. At the splenic hilus, the tumor was found to have invaded the lymph node and adipose tissue. Based on the clinicopathological features of the six reported cases, including the present case (which behaved in a malignant fashion in terms of pathological findings of invasion or metastasis), serous cystadenoma should be regarded as having the potential for malignant growth.

Adipose Tissue↗

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↗

PubMed1998

Hepatic resection for hepatocellular carcinoma -- Japanese experience.

In the past 20 years, thanks to the early detection of hepatocellular carcinomas (HCCs), good perioperative care, the evaluation of functional liver reserve, preoperative portal embolization and the improvement in surgical techniques such as intraoperative ultrasonography, the surgical resection of HCC has become very safe. We have performed 367 hepatectomies on 352 patients since 1990 with a surgical mortality, hospital mortality, blood transfusion rate and 5-year survival rate of 0.27, 0.82, and less than 10 and 47.4%, respectively. Our standard method for selecting surgical procedures and perioperative care resulting in low blood transfusion rates and almost no mortality are described. Since 1990, ethanol injection for HCC ablation has been extensively used in Europe and Japan, but results are poorer than with surgical intervention. Therefore, in patients with small HCCs and good liver function, the first choice treatment should not be ethanol injection, but surgical resection.

Aged↗