Search PubMed⌕ Search

Biomedical subjects

M Makuuchi

Publications and source records attributed to M Makuuchi.

At least 343 records · Page 19Linked to original sources
PubMed1994

An isolated, complete resection of the caudate lobe, including the paracaval portion, for hepatocellular carcinoma.

An isolated resection of the entire caudate lobe, including the paracaval portion, was performed in a 68-year-old man with hepatocellular carcinoma complicated by chronic hepatitis. Precise resection of the paracaval portion, which surrounds the right side of the inferior vena cava, is difficult because of its deep location and the lack of superficial landmarks indicating its margins. Using a counterstaining technique to define the right margin and the transhepatic anterior approach to access the ventral border, the paracaval portion, with the spigelian lobe and the caudate process, was completely resected without sacrificing the other part of the liver. The whole procedure was performed without blood transfusion, and the postoperative course of the patient was uneventful. This procedure would add a new option for surgical management of hepatic malignancies originating in the caudate lobe of the compromised liver.

Aged↗
PubMed1994

Changes in serum amylase level following hepatic resection in chronic liver disease.

OBJECTIVE: Factors that were likely to cause hyperamylasemia following hepatic resection were studied. DESIGN: Case-comparison study. SETTING: Institutional practice. PATIENTS: Seventy-one patients who underwent hepatic resection because of primary or secondary liver tumors and other benign disease, and who had no history of pancreatitis, were divided into four groups. Patients were divided into groups according to the presence or absence of underlying liver disease and the vascular occlusion methods used during hepatic resection (Pringle maneuver or the hemihepatic vascular occlusion technique). The Pringle maneuver was chosen for patients in whom the duration of liver parenchymal transection was expected to be short and/or the hepatic hilum had severe adhesion precluding the safe dissection of the hepatic artery and portal vein. MAIN OUTCOME MEASURES: Serum amylase levels were measured on the preoperative day and on postoperative days 1, 2, 4, 6, 7, 10, and 14. Preoperative liver function, operative blood loss, operative time, and vascular occlusion time were examined. RESULTS: Patients with chronic liver disease (CLD group) had high serum amylase levels during the preoperative and postoperative periods. Patients in the CLD group who underwent the Pringle maneuver (Pringle-L group) had significantly elevated postoperative serum amylase levels in comparison with their preoperative serum amylase levels. Pancreatitis developed in two patients in the Pringle-L group--one of them died. CONCLUSION: These results strongly suggest that prolonged complete occlusion of the portal vein for hepatectomy in patients with chronic liver disease has a serious influence on postoperative serum amylase levels.

Adult↗
PubMed1994

Effect of platelet-activating factor on cold-preserved liver grafts.

Platelet-activating factor (PAF) may play an important role in graft injury in liver transplantation. Livers excised from male Wistar rats were preserved in University of Wisconsin solution for 6 h and then perfused with Krebs-Henseleit solution containing vehicle (bovine serum albumin) or PAF. Impairment of parenchymal cells was assessed by reference to tissue adenosine triphosphate levels, oxygen consumption and alanine aminotransferase activity in the effluent. The effect on non-parenchymal cells was evaluated by measurement of purine nucleoside phosphorylase and alanine aminotransferase levels in the effluent. Administration of as little as 1.0 ng kg-1 PAF caused a significant decrease in adenosine 5'-triphosphate concentration and oxygen consumption (P < 0.05), although non-parenchymal cell injury was not affected. PAF can therefore cause liver graft dysfunction with hepatocytes as the main target, even in the absence of microcirculatory disturbance secondary to interaction between blood cells and endothelial cells.

Adenosine↗
PubMed1994

Liver injury following normothermic ischemia in steatotic rat liver.

The influence of normothermic ischemia on steatotic liver was compared with that on healthy liver in rats. Steatotic liver was induced with 4 wk of a choline-deficient diet. We used a procedure of subcutaneous spleen transposition to develop portosystemic collaterals to avoid splanchnic stasis during total hepatic vascular occlusion. One-week survival rates after 30, 45, and 60 min of normothermic ischemia were 75%, 20% and 0% in the steatotic liver group and 100%, 90% and 70% in the control group, respectively. Significantly poor restoration of energy metabolism was observed in the steatotic liver group. After 1 hr of reflow following 45 and 60 min of ischemia, ATP was restored to 74% and 50%, respectively, of the preischemic level in healthy liver but to only 44% and 27% respectively, in steatotic liver. Microscopically, focal hemorrhage, disruption of the sinusoidal microvasculature and occasional spotty necrosis of hepatocytes were demonstrated after 1 hr of reflow following ischemia in steatotic liver, but no significant changes were evident in healthy liver. This microcirculatory alteration seems to be responsible for the loss of organ viability in steatotic liver. We suggest that steatotic liver is more vulnerable than healthy liver to normothermic ischemia in the rat.

Adenine Nucleotides↗
PubMed1994

Effects of preoperative chemotherapy on DNA ploidy patterns, cell cycle, and histological findings in gastric and colonic cancer patients.

The effects of preoperative chemotherapy on gastric and colonic cancers have yet to be evaluated fully. In this study, its effects were assessed by studying DNA ploidy patterns, cell cycles, and histological findings in such patients. Thirty-nine patients with gastric or colonic cancer were given preoperative chemotherapy with UFT (an admixture of tegafur and uracil). Biopsy specimens for analysis were obtained before chemotherapy through a gastroscope or colonoscope and after chemotherapy from resected tumors. The DNA ploidy patterns and cell cycles were evaluated using a flow cytometer and the tissues were examined histologically. The DNA ploidy pattern was diploid (D) in 12 gastric and 13 colonic cancer patients and aneuploid (A) in 10 and 4 patients, respectively. After chemotherapy, the pattern changed in nine gastric (A-->D: 7, D-->A: 2) and six colonic cancer patients (A-->D: 3, D-->A: 3) and was unchanged in the remaining patients. Cell cyclic analysis showed decreased G1- and increased S-phase fractions in 10 of 12 patients with gastric and 6 of 10 patients with colonic cancer. Histologically, decreased tumor cellularity, increased fibrosis, and/or cytological changes were observed in both cancers after chemotherapy. Gastric and colonic cancers in which the DNA ploidy pattern changed from aneuploid to diploid, G1- decreased and S-phase increased, and/or histological changes were observed, were considered to have responded to preoperative UFT administration.

Adult↗
PubMed1994

Effects of peritoneal insufflation on hepatic and renal blood flow.

The effects of peritoneal insufflation with carbon dioxide on hepatic and renal blood flow have not been reported hitherto. We evaluated these effects in a porcine model of abdominal laparoscopic surgery. Seven anesthetized pigs underwent peritoneal insufflation in a step-wise manner to create intraabdominal pressures of 6, 12, 18 and 24 mmHg, and changes in the arterial and venous pressure, arterial blood gases, and hepatic and renal blood flow were monitored. Both the hepatic and renal blood flow decreased as the intraabdominal pressure increased. Therefore, in order to carry out laparoscopic abdominal surgery safely in patients with hepatic or renal impairment, low intraabdominal pressures or noninsufflating techniques are recommended.

Animals↗
PubMed1994

Effect of granulocyte colony-stimulating factor on neutropenia in liver transplant recipients with hypersplenism.

The authors present details of their initial experience with use of recombinant human granulocyte colony-stimulating factor (rhG-CSF) for preventing neutropenia caused by hypersplenism, and, possibly, for reducing the risk of postoperative infections in pediatric liver transplant recipients. Seven patients with end-stage liver disease, three of whom had severe hypersplenism, underwent living related liver transplantation (LRLT). The rhG-CSF was administered to the latter three patients. Peripheral neutrophil counts decreased immediately after reperfusion (to 1500 +/- 300/microL) in the three patients, and returned to normal with use of rhG-CSF 3 to 10 days after transplantation. The dosage was adjusted to maintain peripheral leukocyte and granulocyte counts above 5,000/microL and 2,000/microL, respectively. This initial clinical trial showed that rhG-CSF administration restores the leukocyte counts of patients who have hypersplenism, without any significant adverse effects, and that rhG-CSF holds promise for reducing the risk of infections after liver transplantation.

Child↗
PubMed1994

Second-stage pancreatojejunostomy following pancreatoduodenectomy in high-risk patients.

Tube pancreatostomy for complete external drainage of pancreatic juice following pancreatoduodenectomy and a subsequent second-stage pancreatojejunostomy were carried out in four high-risk patients without morbidity. This procedure avoids the fatal outcome associated with pancreatojejunal anastomotic leakage following pancreatoduodenectomy in emergency and high-risk cases.

Adult↗
PubMed1994

[Changes in serum h-HGF levels after living-related liver transplantation].

It is well known that prognosis is very poor in patients with severe hepatic insufficiency such as congenital biliary atresia and fulminant hepatitis. The liver transplantation is only effective therapy for these patients and living-related liver transplantation is becoming popular in Japan. We observed the changes in serum human hepatocyte growth factor (h-HGF) levels of the recipients during the operation in 3 cases of congenital atresis and one of fulminant hepatitis. Serum h-HGF values in these patients reached the maximal levels (5-10-fold compared to the base line values) at the phase of portal or hepatic artery anastomosis during the operation. These observations suggest that the increase of h-HGF in the recipient is derived from the following three origins. (1) Wash outed h-HGF from the liver of the donor. (2) Induced h-HGF from other organs than the liver of the recipient. (3) The decreased catabolism of h-HGF in recipient due to total hepatectomy.

Adolescent↗
PubMed1994

Radical operation after portal embolization for tumor of hilar bile duct.

The clinical outcomes of patients with carcinoma of the proximal bile duct who underwent portal embolization of the right lobe followed by right extended lobectomy with (n = 3) and without (n = 9) pancreatoduodenectomy, are described. Preoperative embolization of the portal venous branch of the right hepatic lobe, which was performed with the intent of preventing postoperative hepatic failure, induced a significant increase in the volume of the future remnant liver (left lobe) (from 437 +/- 88 to 544 +/- 97 milliliters, p < 0.01). No patients died in the hospital after the resectional operation. One patient, who had poorly differentiated adenocarcinoma, died as a result of tumor recurrence 12 months after operation, and in another patient, distant lymph node metastases were found. The remaining ten patients are alive and well with no signs of recurrence. The three who underwent hepatopancreatoduodenectomy are leading a normal life 14, 21 and 22 months postoperatively.

Adult↗
PubMed1994

Arterial ketone body ratio in liver surgery.

To evaluate the relevance of the hypothesis that the arterial ketone body ratio (acetoacetate/beta-hydroxybutyrate) can reflect the liver mitochondrial redox potential, we investigated the influence of ketone body metabolism in peripheral tissues on the arterial ketone body ratio during conditions in which no ketone body was available to the systemic circulation: during total clamping of the hepatoduodenal ligament in 37 patients undergoing partial hepatectomy and during the anhepatic phase in 14 liver transplant recipients. Changes in both the arterial acetoacetate and beta-hydroxybutyrate concentrations and arterial ketone body ratio varied markedly from patient to patient after clamping. Among 20 patients with hepatocellular carcinoma and associated chronic liver disease, arterial ketone body ratio 15 min after clamping was higher in 11 and lower in 9 than that before clamping. Of the remaining 17 patients with other types of tumor, arterial ketone body ratio was increased in 10 and decreased in 7 after clamping. Similar changes were observed in 14 recipients during the anhepatic phase of liver transplantation. Arterial ketone body ratio was increased in 7 recipients during the anhepatic phase compared with that at laparotomy, whereas it was lowered in the remaining 7. These results indicate that each of the two types of ketone body is metabolized in extrahepatic tissues to a different extent, varying among individual patients and disease conditions. We conclude that arterial ketone body ratio does not solely reflect the ratio of the amounts of acetoacetate to beta-hydroxybutyrate produced by the liver. This may make it difficult to use arterial ketone body ratio as an accurate parameter representing the redox state in liver mitochondria.

3-Hydroxybutyric Acid↗
PubMed1994

Perioperative blood transfusion promotes recurrence of hepatocellular carcinoma after hepatectomy.

BACKGROUND: Recent advances in liver surgery have reduced operative blood loss drastically, and in more than one half of the patients in our hospital, the liver resection can be accomplished without blood transfusion. METHODS: Two hundred fifty-two patients who underwent complete resection for hepatocellular carcinoma (HCC) were evaluated to assess the effect of perioperative blood transfusion on the recurrence of carcinoma. RESULTS: Carcinoma recurred in 55 (74.3%) of the 74 patients who received a transfusion, but in only 89 (50%) of the 178 patients who did not receive a transfusion (p = 0.0001). This effect was significant even when only a small amount of blood was transfused (p = 0.0001). Based on multivariate analysis, perioperative blood transfusion was a significant predictor for accelerated recurrence (p = 0.003), as were tumor invasiveness (vascular invasion or intrahepatic metastasis) (p = 0.0008) and background liver cirrhosis (p = 0.04). The recurrence-promoting effect of blood transfusion was markedly significant when the patient had either noninvasive HCC (p = 0.0005) or a cirrhotic liver (p < 0.0001). CONCLUSIONS: These results strongly suggest that perioperative blood transfusion substantially promotes the recurrence of HCC after hepatectomy. This effect must be considered and added to the risks of perioperative blood transfusion when formulating a surgical strategy for HCC.

Adult↗
PubMed1994

Intraoperative increment of platelet-activating factor in clinical liver transplantation.

Recent studies have shown that platelet-activating factor (PAF) is involved in ischemia/reperfusion injury to the liver. We therefore examined changes in PAF in recipients during liver transplantation. The level of PAF increased after portal venous reperfusion, except in one case where veno-venous bypass was applied. A marked elevation was noted in another case where portal congestion occurred due to outflow block, followed by prolonged graft dysfunction. These results suggest that elevation of the PAF level is related to portal congestion, and that PAF might be involved in postoperative liver graft dysfunction.

Adolescent↗
PubMed1994

Benign stricture of the intrahepatic bile duct with arterial involvement.

The absence of arterial change is one of the definitive findings of benign bile duct stricture. Here we report on a patient with a stricture of the intrahepatic bile duct with arterial involvement. Histological examination of the resected specimen revealed fibrous replacement of arterial media, with no evidence of malignancy.

Bile Duct Diseases↗
PubMed1994

Resection for multiple metastatic liver tumors after portal embolization.

BACKGROUND: Five patients with bilateral multiple liver metastases (3 to 12 lesions) from colorectal cancer who underwent extensive liver resection after portal embolization are described. METHODS: Portal embolization of the right portal branch was performed 9 days to 8 months before hepatic resection. The location and number of metastases were determined by intraoperative ultrasonography at the time of liver resection to accomplish complete resection of the tumors. Extended right lobectomy was carried out in four patients, two of whom underwent additional wedge resection of nodules located in the left lateral segment. The other patient underwent right lobectomy associated with local resection of the tumor in the left lobe. RESULTS: The postoperative course in the five patients was uneventful, with no serious complication or liver dysfunction. Although one patient died of recurrence 28 months after liver resection, the remaining four patients were alive and free of cancer between 36 and 74 months after hepatectomy. CONCLUSIONS: The presence of bilateral multiple (four or more) metastatic liver lesions from colorectal cancer is not considered a contraindication for hepatic resection if thorough examination of the liver is performed with intraoperative ultrasonography and the surgical risk is minimal. Portal embolization appears effective for increasing the safety of hepatectomy for patients with small metastases who require major right-sided resection combined with wedge resection of the left lobe.

Adult↗
PubMed1994

Radiological study of idiopathic Budd-Chiari syndrome complicated by hepatocellular carcinoma. A report of four cases.

During an 11-yr period (1979-1989), we have experienced five patients with idiopathic Budd-Chiari syndrome (BCS), four (80%) of whom had associated hepatocellular carcinoma (HCC). In contrast, the incidence of BCS complicated by HCC was 0.7% of a total of 556 patients who underwent surgery for HCC or were autopsied. Hepatitis B virus-related antigen or antibody was positive in one patient each. Four of our five patients were asymptomatic and were initially diagnosed by ultrasonography (n = 3) or computed tomography (n = 1). The hepatic parenchyma histopathological findings were cirrhosis and fibrosis in one each. Infection of hepatitis B virus rather than BCS was speculated as a causative factor for HCC in two patients. Membranous obstruction with spotty calcification, intrahepatic bizarre communicating vessels, and the dilated anterior longitudinal veins in spinal canal were recognized in three patients. Three patients had two HCCs which were similar in size and arose from the right and left hepatic lobe, separately, suggesting multicentricity of HCC. Both percutaneous transluminal angioplasty with Gruntzig balloon catheters for the obstruction of the inferior vena cava and hepatic arterial embolization for HCC(s) were performed in three patients. These patients survived 29.3 months on average after the diagnosis of BCS complicated by HCC(s). The opened IVC was confirmed to be patent on an average of 26.3 months after the first angioplasty.

Adult↗