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Biomedical subjects

M Makuuchi

Publications and source records attributed to M Makuuchi.

At least 307 records · Page 17Linked to original sources
PubMed1996

[Surgical treatment of small hepatocellular carcinoma].

Two hundred thirty-five patients with small hepato-cellular carcinomas (HCCs) (mixed hepatocellular and cholangiocellular carcinoma included) measuring no more than 3 cm in diameter treated by surgical resection between 1980 and 1990 were reviewed retrospectively. Ninety-nine percent of the patients also had chronic hepatitis and 73% were diagnosed histologically as having liver cirrhosis. The operative and hospital mortality rates were 0.4% and 1.3%, respectively. The number of tumors, intrahepatic metastasis and vascular invasion were significant prognostic factors. Overall the 1-,3-and 5-year survival rates (operative deaths included) were 93.2%, 72. 7%, and 49.7%, and those of 144 patients treated in the late 80s (1986-1990) were 93.6%, 76.3%, and 52. 1%, respectively. These results were appreciably better than those for percutaneous ethanol injection therapy (PEIT) and transcatheter arterial embolization therapy (TAE) reported previously. In particular, the survival of the patient with single tumor demonstrated a clear advantage of surgery. The selection of treatment modalities is discussed, and our present standard strategy for surgical treatment is described.

Carcinoma, Hepatocellular↗
PubMed1996

Laparoscopic closure for perforation of the sigmoid colon by endoscopic linear stapler.

Immediate open surgery has been recommended for the management of perforation during colonoscopic examination. Laparoscopic closure for perforation of the sigmoid colon caused by diagnostic colonoscopy is described. The perforation site was identified in the antimesenteric border of the sigmoid colon by laparoscopic survey, and four ports were inserted in the lower abdomen. The margin of the perforation was lifted by two graspers, and the defect was completely closed using an endoscopic linear stapler. The patient recovered quickly without any associated complications. Postoperative barium enema showed no stenosis or leakage. This method is less invasive and allows earlier recovery of patients with colonic perforation.

Aged↗
PubMed1996

Recurrence of hepatocellular carcinoma after surgery.

A total of 386 patients who underwent complete resection of hepatocellular carcinoma over an 8-year period were assessed retrospectively for tumour recurrence. Some 219 (56.7 per cent) of the patients developed recurrence. Patients with a greater degree of cirrhosis showed a longer interval to recurrence; the median (range) interval until recurrence was 7.9 (1.8-84.2) months in patients with a normal liver, 13.4 (2.0-79.5) months in those with chronic hepatitis and 16.7 (1.5-73.1) months in those with cirrhosis. Intrahepatic recurrence was observed more frequently in either the same (26.4 per cent) or the adjacent (24.8 per cent) Healey segment than in the lobe contralateral to the primary tumour (17.8 per cent). The presence of portal venous invasion and/or intrahepatic metastasis, underlying liver cirrhosis and perioperative blood transfusion were determined to be independent predictors of recurrence by multivariate analysis. Because intrahepatic spread of hepatocellular carcinoma occurs in a segment-by-segment manner, surgeons should use an anatomically wide resection within the hepatic functional reserve.

Adult↗
PubMed1996

[Pancreas and islet transplantations].

Pancreas transplantation has been established as a treatment option for type I diabetes mellitus with one-year patients survival rate of 91% and one-year graft survival rate of 71%. Simultaneous pancreas and kidney transplantation with the bladder-drainage technique is most frequently performed. The bladder drainage technique makes amylase activity measurement in the urine as well as urine cytology possible, which facilitate a diagnosis of acute rejection. Combination treatment with cyclosporine, azatioprine, steroid and anti-lymphocyte globulin is usually employed for immunosuppression. In addition, FK506 in now available and expected to contribute to better graft survival. In contrast, islet transplantation has not yet achieved satisfactory results. Although a large number of islets can now be obtained from one pancreas, they are not sufficient for stabilizing a diabetic condition and multiple donors are still required. Xeno-transplantation may resolve the problem. Both pancreas and islet transplantation will achieve better results with further advance of transplant techniques including immunosuppressive treatment and diagnostic methods for acute rejection.

Anastomosis, Surgical↗
PubMed1996

Intraoperative ultrasonography and other techniques for segmental resections.

Intraoperative ultrasonography is an indispensable tool for liver surgery, and ultrasonically guided techniques have opened the way to new hepatectomy procedures, namely, segmental and subsegmental resections, thereby allowing minor but systematic resection in patients with poor hepatic function.

Carcinoma, Hepatocellular↗
PubMed1995

Prevention of hepatic artery thrombosis in pediatric liver transplantation.

Hepatic artery thrombosis after orthotopic liver transplantation is a serious complication, especially in children. We report our experience with intensive anticoagulant therapy during and after living-related liver transplantation in pediatric recipients. Twenty-four patients between 5 months and 15 years of age were studied. The mean diameter of the anastomosed hepatic arteries was 2.7 mm. The anticoagulant therapy consisted of low-molecular-weight heparin, antithrombin III concentrates, prostaglandin E1, fresh frozen plasma, and a protease inhibitor. The profiles of the coagulation and fibrinolytic systems were monitored by measuring several parameters, including plasma levels of thrombin-antithrombin III complex, antithrombin III, plasmin-alpha 2 plasmin inhibitor complex, fibrin degradation product D-dimer, tissue type-plasminogen activator, and plasminogen activator inhibitor-1. Acceleration of the coagulation system and delayed recovery of the fibrinolytic system were observed during the early postoperative days. The plasma level of antithrombin III activity was maintained within the normal range by the administration of antithrombin III concentrates. None of the recipients developed hepatic artery thrombosis. Children have been reported to be at a greater risk of developing hepatic artery thrombosis than adults due to the small diameters of their hepatic arteries and the postoperative hypercoagulable state. We believe that the intensive anticoagulation therapy described in this study, the main concept of which is the early correction of imbalance between the coagulant and anticoagulant systems, could become a model for the prevention of hepatic artery thrombosis in pediatric liver transplantation patients.

Adolescent↗
PubMed1995

Outcome of extended right hepatectomy after biliary drainage in hilar bile duct cancer.

OBJECTIVE: Evaluation of extended right hepatectomy (ERH) after biliary drainage in patients with hilar bile duct cancer. DESIGN: Case series. SETTING: University hospital. PATIENTS: Extended right hepatectomy was performed in 25 patients, and 12 underwent other surgical procedures. INTERVENTIONS: Among the 25 patients, 16 had obstructive jaundice. After biliary drainage, 11 had no biliary stasis in both lobes and five had undrained biliary trees in the right lobe. MAIN OUTCOME MEASURES: Long-term disease-free survival, presence or absence of undrained biliary trees in each lobe, rate of decrease in serum total bilirubin levels, and future remnant liver (left lobe) volume. RESULTS: Patients who underwent ERH had significantly longer disease-free survival than patients who underwent other procedures. There were no hospital deaths and no significant differences in morbidity between patients with and without prior jaundice. Patients with an undrained biliary tree in the right lobe had a larger future remnant liver volume, a slower rate of decrease in serum total bilirubin levels after biliary drainage, and a more rapid return of the postoperative serum total bilirubin level to the normal range than patients without biliary stasis in both lobes. CONCLUSIONS: Extended right hepatectomy can be performed safely even in patients showing a very slow decrease in the serum total bilirubin level after biliary drainage, caused by the presence of an undrained biliary tree in the right lobe with no biliary stasis in the left lobe, which induces compensatory hypertrophy of the left lobe. Extended right hepatectomy is a suitable surgical choice for achieving long-term survival in patients with hilar bile duct cancer.

Adult↗
PubMed1995

Healing process of sutureless choledochojejunostomy in an experimental model.

The healing characteristics and morphological features of sutureless choledochojejunostomy were investigated in a rat experimental model. The common bile duct of 34 conditioned Wistar rats was exposed, divided transversely and a choledochojejunostomy constructed with only a vinyl chloride tube positioned between the common duct and jejunum. The animals were killed 4, 12 and 52 weeks after surgery. Cholangiographic evaluation of the anastomosis in all three groups showed wide openings with dilatation of the extrahepatic bile duct. Microscopic examination of the anastomosis showed hyperplastic changes of the bile duct epithelium. The epithelial defect was completely covered with proliferative epithelium 12 weeks after operation. At long-term follow-up of 52 weeks there were no biliary strictures after the sutureless technique. This surgical approach may be useful for patients in whom sutured anastomosis of the bile duct might lead to stricture, such as those with a normal thin-walled bile duct.

Alanine Transaminase↗
PubMed1995

Successful left trisegmentectomy for ruptured hepatoblastoma using intraoperative transarterial embolization.

Although surgical treatment with resection for spontaneous rupture of hepatoblastoma into the free abdominal cavity is difficult in small children, it may be the only treatment available. The authors describe a 16-month-old girl who showed a progressive decrease in hematocrit and no response to blood transfusion, after spontaneous rupture of a large hepatoblastoma that extended to the pubic bone. Percutaneous transcatheter arterial embolization could not be performed because selective catheterization was impossible. Therefore, emergency surgery was conducted. After intraoperative transcatheter arterial embolization (IOTAE) to control hemorrhage, left trisegmentectomy was performed. The patient then underwent chemotherapy, followed by autologous bone marrow transplantation. The hemorrhage from the ruptured tumor was completely arrested by IOTAE, and the postoperative course was uneventful. Hepatic resection after IOTAE, followed by chemotherapy and bone marrow transplantation, represents a promising treatment for ruptured hepatoblastoma.

Angiography↗
PubMed1995

Criteria for safe hepatic resection.

BACKGROUND: To lower morbidity after hepatic resection, the authors examined the influence of predictor variables including: age, sex, preoperative risk factors, serum total bilirubin level, plasma retention rate of indocyanine green at 15 minutes, underlying liver disease, operative blood loss, operation time, amount of whole blood transfused, vascular occlusion time, surgical procedure employed, and extent of hepatic resection. PATIENTS AND METHODS: Between January 1990 and December 1992, 172 patients underwent hepatic resection based on our own criteria for hepatectomy, including the presence or absence of ascites, serum total bilirubin level, and the plasma retention rate of indocyanine green at 15 minutes in patients with chronic liver disease. The morbidity rate was 37.2%, and the hospital and operative mortality rates were 2.3% and 0.6%. RESULTS: The multiple logistic model revealed that the risk of morbidity was increased by longer operation time, major hepatic resection, and preoperative cardiovascular disease. CONCLUSIONS: Shortening the operation time without increasing operative blood loss and further modalities for making major hepatectomy safer are future problems to be addressed.

Adult↗