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Biomedical subjects

M Makuuchi

Publications and source records attributed to M Makuuchi.

At least 325 records · Page 18Linked to original sources
PubMed1995

How should polypoid lesions of the gallbladder be treated in the era of laparoscopic cholecystectomy?

BACKGROUND: Definitive criteria for choosing the most appropriate treatment for each type of polypoid lesion of the gallbladder (PLG) have yet to be established. METHODS: The shapes, sizes, echo patterns, and echogenicities of PLGs that had been evaluated by means of ultrasonography in 72 patients who had undergone resective surgery were analyzed retrospectively to elucidate the ultrasonic characteristics of polypoid cancers and to establish criteria for selecting the most suitable treatment such as laparoscopic cholecystectomy for each type of PLG. RESULTS: Histologic examinations showed cholesterol polyps in 47 patients, adenomas in 8, cancers in 16, and an inflammatory polyp in 1. The diameters of 61% of the benign PLGs were less than 10 mm, whereas those of 88% of the cancers were more than 10 mm; 80% of the former were pedunculated and 56% of the latter were sessile. Seven of eight early-stage cancers had diameters less than 18 mm, whereas those of all eight more advanced cancers were greater than 18 mm. Five of the eight early-stage cancers were pedunculated, and six of the eight more advanced cancers were sessile. Cholecystectomy with or without full-thickness dissection were main surgical procedures used to resect benign PLGs and early-stage cancers, whereas cholecystectomy with partial liver resection was used for more advanced cancers. Laparoscopic cholecystectomy was performed in the recent 34 patients, four of whom had early-stage cancers. CONCLUSIONS: A PLG with a diameter of less than 18 mm is a potential early-stage cancer and therefore can be resected by laparoscopic cholecystectomy with full-thickness dissection. However, when cancer invades the subserosal layer or beyond, a second-look operation is necessary. A PLG with a diameter of greater than 18 mm may be an advanced cancer and should be removed by using cholecystectomy with partial liver resection or a more extended procedure with lymph node dissection.

Adenocarcinoma↗
PubMed1995

Appraisal of intraoperative ultrasonography during laparoscopic cholecystectomy.

BACKGROUND: The usefulness of intraoperative ultrasonography during laparoscopic cholecystectomy (LC) has yet to be evaluated fully. METHODS: In 50 patients who underwent LC, the intraoperative ultrasonography findings were compared with those of preoperative ultrasonography, intraoperative cholangiography, and histology, and then its usefulness for examining anatomic relationships in the hepatoduodenal ligament, detecting bile duct stones, diagnosing gallbladder polyps and abnormally thickened walls, and determining the propriety of LC was appraised. RESULTS: The preoperative ultrasonography diagnoses were gallstones in 38 patients, polyps in 10, and cancer and adenomyomatosis in one each. In four patients endoscopic retrograde cholangiography showed bile duct stones. In all 50 patients intraoperative ultrasonography was useful for examining the anatomic relationships between the bile duct and vessels, such as the portal vein and hepatic artery, and showing the presence or absence of bile duct stones. On the basis of the intraoperative ultrasonography findings, gallstones were diagnosed in 38 patients, in five of whom bile duct stones were shown clearly, cholesterol polyps in eight, early-stage cancer or adenoma in two, and adenomyomatosis in two, and subsequently LC was performed. Histologic diagnoses of cholesterol polyps were made in eight of ten patients with polyps, and intramucosal cancer and an inflammatory polyp in one each. In one patient with a preoperative diagnosis of cancer the apparently elevated flat lesion was found to be partial thickening of the gallbladder wall, which was diagnosed as adenomyomatosis, and LC was chosen as the operative procedure. CONCLUSIONS: Intraoperative ultrasonography during LC is useful for detecting bile duct stones, diagnosing gallbladder polyps and abnormally thickened walls, and deciding whether LC is adequate for resection of the gallbladder.

Adult↗
PubMed1995

Segmental occlusion of the pancreatic duct with prolamine to prevent fistula formation after distal pancreatectomy.

OBJECTIVE: The authors used prolamine (Ethibloc, Ethicon GmBH, Norderstedt, Germany) for segmental obstruction of the pancreatic duct to prevent pancreatic fistula development after distal pancreatectomy combined with total gastrectomy for gastric malignancies. SUMMARY BACKGROUND DATA: Although the initial clinical application of prolamine was pancreatic duct obstruction for patients with pancreatitis and undergoing pancreatic transplantation and pancreaticoduodenectomy for pancreatic cancer, there are no reports on prevention of pancreatic fistula formation after distal pancreatectomy. METHODS: Prolamine (0.2 mL) was injected into the distal segment of the main duct in the remaining pancreata of 51 patients. Small pancreatic ducts on the cut surface, from which prolamine extravasates, were closed by ligation, the main duct was ligated doubly, and the transected pancreatic margin was closed 15 minutes after phenylpropanolamine hydrochloride injection. RESULTS: No patient developed a pancreatic fistula or the complication of arterial bleeding due to prolonged infection. CONCLUSION: Segmental obstruction of the pancreatic duct with prolamine is useful for preventing pancreatic fistula development after distal pancreatectomy.

Amylases↗
PubMed1995

Phosphatidylinositol-3 kinase in fission yeast: a possible role in stress responses.

A DNA fragment coding for a part of a putative phosphatidylinositol 3 kinase was cloned from Schizosaccharomyces pombe by cross-hybridization with Saccharomyces cerevisiae VPS34 gene, a yeast homologue of mammalian PI-3 kinase. The clone contained an open reading frame of 797 amino acids but lacked the initiation codon, ATG. The predicted amino acid sequence was homologous to those of S. cerevisiae VPS34 and mammalian PI-3 kinase genes. Disruption of the gene resulted in extremely low levels of PI-3-P and higher levels of PI-4-P, supporting the idea that the gene codes for the PI-3 kinase of S. pombe. The disruptants harbored large vacuoles and were sensitive to stresses such as high temperature or high concentration of monovalent and divalent cations.

Amino Acid Sequence↗
PubMed1995

[Changes in coagulation parameters during the clinical courses of recipients of living-related partial liver transplantation].

We had rare opportunities to examine changes in fibrin degradation products (FDP)-D-dimer (DD), thrombin-antithrombin III complex (TAT), plasmin-alpha 2-plasmin inhibitor complex (PIC) and other coagulation parameters during the clinical courses of living-related partial liver transplantation (LRPLT). In seven out of eight recipients without severe rejection and/or disseminated intravascular coagulation (DIC), FDP-DD values reached their maximum at 5 to 10 days after transplantation, then gradually decreased. On the other hand, TAT values rose to the maximum at anhepatic or reperfusion phase of liver transplantation. These data represent hypercoagulation in consequence of tissue thromboplastin activation after extensive operation. Changes in PIC, tissue-type plasminogen activator, and plasminogen activator inhibitor-1 (PAI-1) in the clinical course of case 1 suggested that fibrinolysis was suppressed by relatively elevated level of PAI-1 around the operation, but thereafter was adversely accelerated by relatively lower levels of PAI-1. In comparison with patients with DIC, TAT was much higher but PIC was significantly lower in recipients of LRPLT. These findings indicated that marked hypercoagulation and mild to moderate hyperfibrinolysis occurred in recipients of LRPLT.

Antithrombin III↗
PubMed1995

[Clinical evaluation of sequential MTX/5-FU therapy for gastric cancer].

Sequential MTX/5-FU therapy was performed on 64 patients with unresectable or recurrent gastric cancer. The therapy was most effective in patients with poorly differentiated type gastric cancer. We adopted the intermediate (MTX: 100mg/m2, 5-FU: 800mg/m2) and low (MTX: 30mg/m2, 5-FU: 600 mg/m2) dose regimens. The latter was performed at the outpatient clinic every 2 weeks. This therapy was used for patients with Borrmann type 4 gastric cancer or advanced gastric cancer of poorly differentiated type as postoperative adjuvant chemotherapy. The response rate was 25% in 44 evaluable patients, and 33% in patients with poorly differentiated type cancer. As an adverse effect, leukopenia (grade 3, 4) was observed in 4 patients (9%). The 5-year cumulative survival rate of the sequential MTX/5-FU therapy group (52.6%) was much better than the conventional adjuvant chemotherapy group (32.1%) in patients who underwent curative resection with Borrmann type 4 gastric cancer. One patient survived more than 900 days after non-curative resection with peritoneal dissemination (P 3) after low dose therapy of sequential MTX/5-FU. For the patients who did not respond to the MTX/5-FU therapy, MTX/CDDP/LV/5-FU therapy was adopted. This protocol consisted of MTX (30 mg/m2 iv; day 1), CDDP (60 mg/m2 div; day 2 and day 9), Leucovorin (30 mg iv; day 2-9) and 5-FU (250 mg/m2 div; day 2-9). We also performed MTX/CDDP/LV/5-FU therapy for the treatment of differentiated type gastric cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Calculation of child and adult standard liver volume for liver transplantation.

Despite refinements in surgical techniques for liver transplantation, liver size disparity remains one of the most common problems in pediatric patients. Optimal liver graft size remains unknown and the volume of diseased liver in the recipient is not indicative of the volume (standard liver volume [LV]) optimal for the recipient's metabolic demands. To establish a formula for calculating the standard LV in the pediatric and adult populations for liver transplantation, whole LVs were measured using computed tomography (CT) in 96 patients (65 pediatric and 31 adolescent or adult subjects) with normal liver whose disease conditions did not seem to affect body weight (BW) or LV. In the 96 subjects, the ratio of estimated LV to BW decreased gradually as age increased until approximately 16 years, when it started to level off. On the other hand, there seemed to be a directly proportional relationship between the estimated LV in vivo and body surface area (BSA) (r = .981; r2 = .962; P < .0001) in the subjects as a whole, and the formula, LV (mL) = 706.2 x BSA (m2) + 2.4, was established from the measured data by simple regression analysis. Another predicting equation, LV (mL) = 2.223 x BW (kg)0.426 x body height (BH) (cm)0.682, was produced by multiple regression analysis (r2 = .969; P < .0001). Considering its simplicity of use, we adopted the first formula for predicting standard LV in an individual patient.

Adolescent↗
PubMed1995

Surgical therapy for hilar bile duct cancer.

Surgical treatments for hilar bile duct cancerare discussed in relation to the necessity for and most appropriate method of preoperative biliary drainage, desirable operative procedures for achieving long-term survival and the usefulness of portal venous branch embolization before extended hemihepatectomy. We believe that extended right hemihepatectomy can be performed safely after the volume of the remaining liver has been increased by portal embolization and the serum total bilirubin level has dropped to below 2.0 mg/dl. This procedure is a suitable surgical choice for achieving long-term survival in patients with hilar bile duct cancer.

Bile Duct Neoplasms↗