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Biomedical subjects

M Makuuchi

Publications and source records attributed to M Makuuchi.

At least 361 records · Page 20Linked to original sources
PubMed1993

Changes in the cardiovascular and respiratory systems during laparoscopic cholecystectomy.

The effects of peritoneal insufflation on the cardiovascular and respiratory systems were investigated in eight patients who underwent laparoscopic cholecystectomy. During the operation, intraabdominal pressure was maintained at a constant 12 mm Hg with carbon dioxide. The cardiac index had increased significantly at 20 and 40 min after the start of insufflation (3.6 +/- 0.6, 3.9 +/- 0.8 mL/min, respectively) and after evacuation (4.2 +/- 0.6 mL/min) compared with the control value (3.2 +/- 0.6 mL/min). Mean arterial pressure was significantly increased at 20 min after the start of insufflation (94.6 +/- 11.2 mm Hg) relative to the control value (79.9 +/- 11.1 mm Hg) and remained high after evacuation (101.5 +/- 11.9 mm Hg). Central and femoral venous pressure rose significantly during the operation from baseline values (12 +/- 6 and 4 +/- 4 mm Hg, respectively) to 18 +/- 10 and 11 +/- 6 mm Hg, respectively, at 20 min, and to 18 +/- 10 and 19 +/- 8 mm Hg, respectively, at 40 min after the start of insufflation. These parameters returned to control levels immediately after evacuation. Dynamic lung compliance decreased by 25% as a result of the elevated intraabdominal pressure. These findings demonstrate that some cardiopulmonary changes occur even at an intraabdominal pressure of 12 mm Hg, which up to now has been considered a safe level.

Carbon Dioxide↗
PubMed1993

Intraportal US with 20-MHz and 30-MHz scanning catheters. Work in progress.

Intraportal ultrasonography (US) with scanning catheters was attempted in nine patients with various biliary tract diseases, to evaluate the portal venous system for tumor invasion. Intraportal US was performed successfully in seven patients. Intraportal US scans were compared with images obtained with arterial portography, direct portography, and intraoperative US. Intraportal and intraoperative US revealed cancer invasion into the wall of the portal venous trunk in two patients. Negative findings for cancer invasion with intraportal US were verified with intraoperative US and laparoscopic examination in five cases. Arterial portography was unable to delineate the fine portal venous wall configuration in six of the seven patients, and direct portographic images were not fully diagnostic of tumor invasion in three cases. The improved detection of tumor invasion to the portal venous system with intraportal US was helpful in determining the appropriate treatment for biliary tract disease in these patients.

Adult↗
PubMed1993

Response of early-stage hepatocellular carcinoma and borderline lesions to therapeutic arterial embolization.

OBJECTIVE: In Japan, borderline lesions and early-stage hepatocellular carcinoma (HCC) are now histopathologically divided into two subgroups; one includes adenomatous hyperplasia and atypical adenomatous hyperplasia, and the other includes early HCC and early advanced HCC. In order to evaluate the efficacy of transcatheter arterial embolization for treating such lesions, histopathologic studies were done after embolization and resection in 27 patients. MATERIALS AND METHODS: The lesions consisted of two adenomatous hyperplasias, one atypical adenomatous hyperplasia, 22 early HCCs, and 13 early advanced HCCs. All patients had chronic liver diseases in nontumorous parenchyma in addition to HCC. For transcatheter arterial embolization, one of the following embolizing materials was used: iodized oil (Lipiodol) alone (n = 4), an emulsion of doxorubicin in Lipiodol (n = 8), and the same emulsion followed by gelatin sponge particles (n = 15). RESULTS: The frequencies of tumor stain on the angiogram and retention of Lipiodol within the tumor were 84% and 94% in overt HCC, 23% and 69% in early advanced HCC, and 9% and 9% in early HCC, respectively. The average size of overt HCC was significantly (p < .01) larger than that of early advanced HCC and early HCC. The amount of necrosis induced by embolization relative to the size of the mass was 56% on average in overt HCCs, 14% in early advanced HCCs, and 0% in early HCCs, atypical adenomatous hyperplasias, and adenomatous hyperplasias. Significant differences (p < .01) in mean necrosis rate were seen between overt HCCs and early advanced HCCs, between early advanced HCCs and early HCCs, and between overt HCCs and early HCCs. The frequency of Lipiodol retention correlated with mean necrosis rate for tumor. With reference to therapeutic techniques, only for the overt HCCs was a significant difference (p < .01) in the mean necrosis rate found between the group that received the emulsion of doxorubicin in Lipiodol and the group that received the emulsion and then particles of gelatin. CONCLUSION: This study suggests that transcatheter arterial embolization has limited efficacy for treating early-stage HCC and borderline lesions compared with its efficacy for treating overt HCC.

Aged↗
PubMed1993

A new method for determining cellular ATP content in hepatocytes.

We have developed a new ATP assay for hepatocytes which is simple, rapid and highly sensitive. ATP determination using luciferin-luciferase was performed on hepatocytes separated by perfusion of the liver with collagenase. There was a close correlation between the ATP content of hepatocytes and viable cell numbers. The ATP content of dead cells which were determined by trypan blue dye exclusion test had less than one per cent of levels of viable cells. ATP contents of isolated hepatocytes in Minimum Essential Medium was 6.8 +/- 0.6 x 10(-15) mol/cell at 2 hours after excision of the liver and showed no significant difference compared with that determined at 6 hours. This method was performed to evaluate changes in the cellular ATP content of hepatocytes after partial hepatectomy in rats and transcatheter portal embolization (TPE) in dogs. The ATP content in rat hepatocytes showed a remarkable increase after hepatectomy, with a peak value of 19.1 +/- 1.7 x 10(-15) mol/cell at 24 hours post-surgery. On the other hand, marked atrophy in the embolized lobes and compensatory hypertrophy in the non-embolized lobes were found following TPE in dogs. Cellular ATP content in the non-embolized lobes showed its highest level of 8.7 +/- 2.9 x 10(-15) mol/cell on the third day after TPE, but in the embolized lobes decreased immediately after TPE with significant differences compared with the non-embolized lobes (p < 0.05). Our method may also be applicable to the evaluation of other adenosine phosphate by use of converting enzymes for ATP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMed1993

Preoperative measurement of segmental liver volume of donors for living related liver transplantation.

Segmental liver volume determination by computed tomographic scan was carried out preoperatively in nine donors for living related liver transplantation. The calculated volume was compared with the graft size actually obtained by three types of donor hepatectomy. The volume of the left lateral segment (175 to 241 ml) and the left lobe (310 to 490 ml) varied markedly among the donors. The ratio of the left lobar to total liver volume also showed a wide range of values (23.2% to 35.9%). The value of the left lobar volume did not correlate positively with the donor's body weight, suggesting that graft size cannot be predicted only on the basis of the donor's body size. Segmental graft liver volume was estimated by use of computed tomographic scan, with acceptable accuracy on comparison with the graft volume actually obtained. In living related liver transplantation, the type of donor hepatectomy should be selected on the basis of the segmental liver volume of the donor in addition to the recipient's body size so that liver failure can be prevented in recipients and the donor's safety can be assured as far as possible.

Adolescent↗
PubMed1993

[Intrahepatic cholangiocarcinoma: proposal of new macroscopic classification].

From the analysis of 19 resected intrahepatic cholangiocarcinoma (ICC) from 1980 to 1991 in the National Cancer Center Hospital, we classified them into three subcategories, mass-forming ICC, infiltrating ICC and papillary ICC, according to the morphologic pattern. Mass-forming ICC, which made an apparent mass lesion in the liver, showed a spread based on the intrahepatic metastasis with a frequent remnant hepatic recurrence. Infiltrating ICC caused a stricture or an obstruction of intrahepatic bile duct with a spread along the Glisson's capsule without forming a mass in the liver and yielded no remnant liver recurrence except for a local recurrence in the patient with positive surgical margin. Intraductal papillary ICC, which appeared a special type of ICC, developed a papillary projection into the ductal lumen. Three patients of mass-forming ICC and one of papillary ICC survived more than 5 years. The different biologic behaviour should be considered when formulating an operative procedure for each type of ICC.

Adult↗
PubMed1993

Personal experience of right anterior segmentectomy (segments V and VIII) for hepatic malignancies.

BACKGROUND: Right anterior segmentectomy is the most difficult type of hepatic resection to perform and is reported only rarely. For patients with tumors limited to the anterior segment but complicated by mild liver dysfunction, this is the only type of hepatectomy that can be tolerated. This article described personal experience with this operation in 17 patients with liver malignancies. METHODS: Fourteen patients had hepatocellular carcinoma, one had cholangiocellular carcinoma, and two had metastases, one from rectal and the other from gastric carcinoma. Except in one case of dense adhesion of the hepatoduodenal ligament, hemihepatic vascular occlusion was used. Both the right and middle hepatic veins were fully exposed in 14 patients. RESULTS: The average operation time was 412 minutes and the average blood loss was 1482 ml. There was one operative death as a result of pneumonia and liver failure. Another patient had prolonged bile leakage with right pleural effusion and bleeding gastric erosions. The cumulative 1- and 5-year survival rates were 88% and 47%, respectively. CONCLUSIONS: The results of this experience indicate that in selected patients with hepatic malignancies this procedure is safe and compatible with improved survival. This may be the first report to describe the clinical features and operative technique in a series of patients treated by right anterior segmentectomy.

Aged↗
PubMed1993

Hepatocellular carcinoma with portal tumor thrombus: analysis of factors determining prognosis.

For 104 consecutive patients with hepatocellular carcinoma (HCC) with portal tumor thrombus (PTT) seen in the past nine years, prognostic factors were analyzed retrospectively using Cox's multivariate analysis. There was a significant difference in survival rate with hepatic functional reserve (Child classification, P = 0.005), type of treatment (surgical vs non-surgical treatment, P = 0.009) and PTT grade (P = 0.04). The survival rates for patients with Child's A (n 49) or Child's B (n 55) were 60.8 vs 20.0% at one year, 41.6 vs 9.1% at two years and 35.4 vs 5.5% at three years. The survival rates of patients with surgical (n 32) and non-surgical (n 72) therapy were 71.7 vs 25.0% at one year, 58.5 vs 9.4% at two years and 53.6 vs 4.7% at three years. Among patients with PTT grades in the third or lower order branch (Vp1, n 29), the second order branch (Vp2, n 32) and the first or portal vein trunk (Vp3, n 43), the one-year, two-year and three-year survival rates were 61.6, 43.8 and 20.9%; 47.1, 27.5 and 6.2% and 42.8, 27.5 and 0%, respectively. When analysis was focused on 32 patients with Child's A and PTT (Vp1 plus Vp2) with respect to treatment, the survival rates in the surgical (n 22) and nonsurgical (n 10) groups were 86.1 vs 70.0% at one year, 71.5 vs 30.0% at two years and 64.3 vs 20.0% at three years (P < 0.05), respectively. In HCC patients with PTT, surgery seems to be indicated where hepatic function is well preserved and the PTT is localized in a peripheral portal branch.

Adult↗
PubMed1993

Long-term results after resection of hepatocellular carcinoma: experience of 480 cases.

The long-term outcome in 480 patients with primary hepatocellular carcinoma (HCC) who underwent hepatic resection between 1980 and 1990 was investigated. Overall 5- and 10-year survival rates were 44.1% and 17.8%, respectively, with a hospital mortality rate of 3.1%. The survival of patients who underwent curative resection was better than that of patients treated with noncurative resection. Tumor invasiveness, defined by the presence of vascular invasion and/or intrahepatic metastases, was a major prognostic factor for early recurrence in the patients treated with curative resection. The effect of tumor size and number on prognosis was attributable to a strong correlation with tumor invasiveness. One-third of patients with multiple lesions were considered to have multicentric disease, and their prognosis was better than that of patients with invasive lesions. The width of the resection margin did not affect the prognosis. An unfavorable effect of associated liver disease, especially cirrhosis, was prominent in the later period. A beneficial effect of anatomically systematic resection was apparent in non-cirrhotic patients with non-invasive HCC.

Adolescent↗
PubMed1993

Repeat hepatic resection for recurrent hepatocellular carcinoma.

During the last 12 years, hepatic resection was carried out on 268 patients with a diagnosis of hepatocellular carcinoma. Of these, 78% developed tumor recurrence in the remaining liver within 5 years. The indications for repeat hepatectomy were evaluated in the same way as for the first operation. Eighteen second hepatic resections and six third hepatic resections were performed 4 to 63 months after the first hepatectomy, with no operative deaths. The cumulative survival rate of these 24 patients was 87.1% at 3 years, 87.1% at 5 years and 72.6% at 7 years after the first hepatic resection, respectively. The present results show that repeat hepatectomy can be safely indicated for recurrent tumors in patients whose liver functional status has been relatively stable since the first hepatic resection.

Adult↗
PubMed1993

Donor hepatectomy for living related partial liver transplantation.

BACKGROUND: An essential prerequisite for living related partial liver transplantation is to perform donor hepatectomy with minimal risk while preserving graft viability. This article describes a safe method of donor hepatectomy that was used for five patients who underwent living related liver transplantation. METHODS: Liver parenchymal transection was performed by the selective vascular occlusion technique in four patients, and interruption of the blood supply to the left medial segment was carried out along the right side of the umbilical portion before parenchymal division in the other patient. RESULTS: These procedures resulted in insignificant intraoperative blood loss, for which no banked blood or blood derivatives were transfused. The postoperative course for each of the five donors was uneventful, and excellent graft viability was verified by the fact that the five recipients showed a good immediate postoperative course without marked increases in the serum activities of liver enzymes. CONCLUSIONS: We believe that the operative risk of living related donor hepatectomy is minimal if it is performed by experienced liver surgeons with the present procedures.

Adult↗
PubMed1992

Liver regeneration in recipients and donors after transplantation.

Reduced-size liver grafts from related donors may not be of an optimal size for adequate function in the recipient. Therefore, liver-graft regeneration is clinically important. We evaluated liver regeneration by liver-volume determinations with serial computed tomography scans in four recipients (aged 9 months to 12 years) and their donors (all fathers of the recipients) after living-related liver transplantation. Standard liver volume was calculated from the recipient's body-surface area. In each recipient, the size of the transplanted liver tended to converge to the standard liver volume with time, regardless of whether initial liver-graft volume was smaller or larger than standard liver volume. In addition, transplanted liver in the recipient regenerated much faster than remnant liver in the donor, even though both consisted of the same hepatocytes, which suggests that regeneration is regulated mainly by factors other than the hepatocytes themselves.

Adult↗
PubMed1992

A clinical and radiologic study of primary liver cancer associated with extrahepatic primary cancer.

In a consecutive series of 393 patients with excised and pathologically proven primary liver cancer (PLC)--including 374 hepatocellular carcinomas (HCC), nine cholangiocellular carcinomas (CCC), and ten mixed type of HCC and CCC--33 patients (8.4%) had one or two other malignancies in the extrahepatic organ(s). Of these, 29 had double cancers and four, triple cancers. This was synchronous in 11 patients, metachronous in 20 (including 18 with double cancers and two with triple cancers) and synchronous and metachronous in two with triple cancers. Metachronous cancer was found in 21 patients 1 year before hepatectomy for PLC and in three patients, 1 year after hepatectomy. The median age of PLC patients with multiple primary cancer (MPC) was 63.6 +/- 6.9 years; this was significantly greater than that of PLC patients without MPC (P less than 0.01). The associated cancer was gastric cancer in 11 patients (29.7%), colorectal cancer in six, pharyngeal cancer in four, and other cancers in ten different organs in 16. Thirteen of 22 patients had a history of blood transfusion. The incidence of liver cirrhosis in PLC associated with MPC (57.6%) was significantly lower than that without MPC (82.8%, P less than 0.01). The differential diagnosis of PLC from liver metastasis was possible retrospectively in 78.6% using sonograms, 79.3% using computed tomograms, and 91.3% using angiograms. The survival rates of patients with PLC with (n = 33) and without (n = 299) MPC who had undergone hepatectomy were 97.0% and 85.4% at 1 year, 55.5% and 59.5% at 3 years, and 40.5% and 40.1% at 5 years, respectively. There was no significant difference between the survival rates of those who underwent operations for PLC and extrahepatic primary cancer(s) synchronously and metachronously.

Adenoma, Bile Duct↗
PubMed1992

Postresection recurrence of hepatocellular carcinoma treated by arterial embolization: analysis of prognostic factors.

Of 270 consecutive patients with hepatocellular carcinoma who underwent surgery, 50 who had recurrence and were subsequently treated with transcatheter arterial embolization were analyzed. The longest interval between surgery and recurrence in the 50 patients who underwent transcatheter arterial embolization was 7 yr. Recurrence was initially found in the remnant liver in all patients but one; extrahepatic metastases were detected in 13 patients (26%) during follow-up. A "multiple" type was the most common (64%) hepatic recurrence pattern on angiography, followed by the "solitary" (16%) and "tumor thrombus" (12%) patterns. Hepatic recurrence was most frequently found in the ipsilateral lobe (48%) relative to the site of the primary hepatocellular carcinoma. Multivariate analysis of the factors affecting survival after transcatheter arterial embolization indicated that recurrence pattern (p = 0.025) and distant metastases (p = 0.011) were significant. Of 13 patients with distant metastases, 11 had the "multiple" pattern of hepatic recurrence. Survival rates for all 50 patients after initial surgery and after transcatheter arterial embolization were 90% and 64%, respectively, at 1 yr; 52% and 24%, respectively, at 3 yr; and 27% and 5%, respectively, at 5 yr. On analysis of survival rates after transcatheter arterial embolization in 37 patients with recurrence only in the liver and of the response of recurrent hepatocellular carcinoma to transcatheter arterial embolization, a significant difference was noted between those with "partial response" and "progressive disease" (p less than 0.05) and between those with "no change" and "progressive disease" (p less than 0.05).

Adult↗