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Biomedical subjects

M Makuuchi

Publications and source records attributed to M Makuuchi.

At least 379 records · Page 21Linked to original sources
PubMed1992

Living related liver transplantation.

Liver transplantation from a brain death donor has not yet been accepted in Japan. The only alternative method at present is transplantation from a living donor. After the first successful living related liver transplantation was performed by Strong in Brisbane, Australia, Japanese hepatic and transplant surgeons also began to perform such operations. As of February 1991, 16 living related liver transplantations had already been performed in Japan, mainly for children with biliary atresia. Five of these patients subsequently died, however, our patient has survived more than 1 year, and she is presently leading a normal school life. The most important issue regarding living related liver transplantation is to ensure the donor's safety. For this purpose, we conducted a preoperative banking of the donor's own blood and plasma. In addition, a selective vascular occlusion was carried out to reduce blood loss during the resection of the liver. Intraoperative color Doppler ultrasonography was introduced for evaluating the circulation of the graft. By using this modality, the following three points were able to be accurately estimated in order to obtain optimal graft perfusion: 1) The most suitable position for the graft to be fixed to the abdominal wall, 2) whether or not the abdominal wall could be closed and 3) the indication for a ligation of the collateral veins to form a porto-systemic shunt. Thanks to these procedures, living related liver transplantations have now become an acceptable transplant method, however, a transplantation from a cadaver that is brain dead but still has a beating heart is still absolutely necessary for adult recipients. Therefore, in the future, both methods should be performed.

Animals↗
PubMed1992

Benign tumors of the liver resected because of a diagnosis of malignancy.

Thirty-two benign hepatic lesions, which were resected because of a diagnosis of malignancy, were reviewed to demonstrate the characteristics of the problem and to consider the best course of management. The preoperative diagnoses included 21 hepatocellular carcinomas, six metastases and five others. As the final diagnosis, hemangioma and focal nodular hyperplasia were the two major lesions mimicking malignancy, accounting for seven and six patients, respectively. Four of seven hemangiomas were atypical, with a considerable amount of fibrosis. Focal nodular hyperplasia and adenoma were misdiagnosed as hepatocellular carcinoma among other malignancies. Two instances each of necrotic tissue and hemangioma were diagnosed as metastatic carcinoma. The lesions that were studied had main features, including a diameter of less than 4 centimeters in 23 patients, evident discrepancy among the roentgenologic diagnoses in 25 patients and no rapid increase in size in 28 patients. Four of nine needle biopsies performed gave false-positive results and did not always provide adequate information. It was concluded that 15 of the 32 patients, who satisfied the aforementioned three criteria, could have been observed more carefully. However, in the other 17 patients, surgical intervention was considered justified because of an indication of a higher likelihood of a real malignancy.

Adenoma↗
PubMed1992

Surgical treatment of intrahepatic cholangiocarcinoma: four patients surviving more than five years.

BACKGROUND: To find the rational surgical strategy for the treatment of intrahepatic cholangiocarcinoma (ICC), clinical features of ICC were studied in 20 patients who underwent hepatic resection in the National Cancer Center Hospital from 1980 to 1990. METHODS: According to the morphologic pattern, we classified the ICCs into two subcategories, mass-forming and infiltrating, which correlated with their biologic behavior. RESULTS: Of 10 patients who underwent hepatectomy for mass-forming ICC, three survived more than 5 years without recurrence. The 1-, 3-, and 5-year survival rates were 59.3%, 44.4%, and 44.4%, respectively. Of 10 patients who underwent hepatectomy for infiltrating ICC, one survived more than 5 years without recurrence. The 1-, 3-, and 5-year survival rates were 72.0%, 27.0%, and 27.0%, respectively. The pathologic findings and recurrences indicated that the salient feature of the mass-forming type was its tendency for intrahepatic metastasis especially near a main lesion, and of the infiltrating type was the infiltrative spread via Glisson's capsule and hilar lymph nodal metastasis. CONCLUSIONS: An anatomic and extensive liver resection should be performed for mass-forming ICC, whereas a hepatectomy with excision of the extrahepatic bile duct and hilar lymph nodal dissection is recommended for infiltrating ICC.

Adenoma, Bile Duct↗
PubMed1992

Resection of a large liver cell adenoma originating in the caudate lobe.

A rare case is reported of a large liver cell adenoma originating in the caudate lobe of the liver in a 38-year-old women with no history of liver cirrhosis or use of oral contraceptives: Caudate lobectomy of the liver is described. Passing tapes around the inferior vena cava was useful for controlling the bleeding from a torn short hepatic vein. This resection of a large hepatocellular adenoma originating in the caudate lobe is to our knowledge only the second case to be reported in the English literature.

Adult↗
PubMed1992

Clinical application of peroperative ultrasonography in liver surgery.

This communication outlines the findings at peroperative ultrasonography in patients who had resectional liver surgery because of primary hepatocellular carcinoma. Peroperative ultrasonography revealed the accurate location of the tumor, its relation with locoregional vascular structures, presence of tumor metastases and tumor thrombus. Additionally, ultrasonography provided useful guidance for tumor resection by making possible tumor staining via echo-guided puncture of the feeding vessel of the tumor.

Carcinoma, Hepatocellular↗
PubMed1992

A retrospective comparative study of reconstructive methods following pancreaticoduodenectomy--pancreaticojejunostomy vs. pancreaticogastrostomy.

Reconstructive methods following pancreaticoduodenectomy in our department are discussed and evaluated in this study. Between January 1980 and November 1990 fifty-two consecutive patients underwent pancreaticoduodenectomy because of pancreas head disease. Thirty-one patients underwent pancreaticojejunostomy and twenty-one had pancreaticogastrostomy as reconstructive procedures. Mortality rate was 6% in pancreaticojejunstomy versus zero in pancreaticogastrostomy. Six patients had leakage from the pancreaticojejunostomy, but only one patient had necrosis of the gastric stump and leakage from the pancreaticogastrostomy. This case had previous distal gastrectomy done for gastric ulcer. The residual stomach might not have been large enough, and the blood supply of the gastric stump might not have been adequate for pancreaticogastrostomy. Except for this case, none was observed with leakage from the pancreatic anastomosis in the pancreaticogastrostomy group. No statistical significance in operating time or blood loss was observed between the two methods. The pancreaticogastrostomy cases without complications had significantly less loss of body weight than those with pancreaticojejunostomy at the date of discharge (p < 0.05). It is concluded that pancreaticogastrostomy is the safer reconstructive method following pancreaticoduodenectomy, although it may not be indicated in patients with prior gastrectomy.

Adult↗
PubMed1992

Surgical management of biliary cystadenocarcinoma.

Four patients, one woman and three men, with biliary cystadenocarcinoma were surgically treated during a 7-year period. The mean age was 58 years. Symptoms prior to admission were mild, and blood tests including liver function tests, CEA and AFP were for the most part within the normal range. Surgery followed diagnostic work-up including US, ERCP, CT, angiography and MRI. Radical surgery was accomplished in three patients by extended left lobectomy in two and extended right lobectomy in one patient, respectively, in this latter patient preceded by therapeutic embolization of the right portal branch prior to resection, while the fourth patient had a palliative resection. Histological examination revealed papillary adenocarcinoma with mucin production within the cyst. The size of the cyst (maximum diameter) varied between 4.5 and 24 (mean 12) cm. The postoperative course was uneventful in all patients. Two patients are alive with no sign of recurrence 5 and 53 months after surgery, while two patients died after 26 and 75 months, respectively. Thus, radical resection of this rare kind of malignant hepatic tumor seems to offer a chance of long-time survival.

Aged↗
PubMed1992

Partial liver transplantation from living related donors.

Living related liver transplantation was performed in five cases between June 1989 and July 1991 at Shinshu University Hospital. All of the donors were fathers of the patients and blood type was identical in each case. All of them were discharged from the hospital 2 weeks after hepatectomy without any complications. They started to work 2 months after surgery. Four recipients are surviving but one died. Three are enjoying daily life 17 months after LT in case 1, 5 months after LT in case 4, and 4 months after LT in case 5. Case 2 is still in the hospital 14 months after LT. Advantages of LRLT we noted were (1) cases can be performed totally electively and allow full preparation for the family and the transplant team, (2) primary graft nonfunction has not been observed to date, and (3) 38 patients received the chance of liver transplantation in their own country, which under current legislation would not otherwise have been possible. Disadvantages of LRLT were (1) partial hepatectomy was performed in healthy persons, and (2) retransplantation is difficult.

Biliary Atresia↗
PubMed1992

[Effects of preoperative transcatheter portal embolization (TPE) on prevention of hepatic failure after massive hepatectomy].

Effects of TPE on prevention of hepatic failure after massive hepatectomy were studied experimentally using dogs. A 70% or 85% hepatectomy (Hx) was performed two weeks after TPE. All of the 70%Hx groups with(+)/without(-) TPE were alive for over two weeks after hepatectomy. While all of the 85%Hx group without TPE died, eight of ten in the 85%Hx group with TPE survived. Without TPE, total bilirubin levels in sera were elevated markedly in the 85%Hx group and moderately in the 70%Hx group after hepatectomy. The levels of escaped enzymes in sera, such as GOT or GPT, were also elevated remarkably in the TPE(-) groups. Although the levels of these enzymes were also high in the 85%Hx.TPE(+) group, these values were as same as those of 70%Hx.TPE(-) group. In the 85%Hx.TPE(-) group, critical diminution of functional hepatic cell mass and severe portal hypertension occurred after hepatectomy and coagulopathy and death followed to these phenomena. TPE might prevent the onset of these critical phenomena, and diminish the damage caused by massive hepatectomy. These results suggest that TPE is useful for prevention of postoperative hepatic failure so that we could perform massive hepatectomy safely, and extend the operative indication.

Alanine Transaminase↗
PubMed1992

Gangliocytic paraganglioma of the papilla of Vater with regional lymph node metastasis.

We report a case of duodenal gangliocytic paraganglioma (GP) in a 47-yr-old man. The GP arose in the second portion of the duodenum and was shown by histological examination to consist of epithelioid cells, spindle cells, and ganglion-like cells. Although most of the reported cases of GP have been regarded as benign, in the present case we found that a lymph node in the peripancreatic region contained a metastatic tumor. This is believed to be the third documented case of GP showing regional lymph node metastasis. The metastatic tumor consisted of only epithelioid cells, without spindle cells or ganglion-like cells, supporting the hypothesis that only epithelioid cells have malignant potential.

Ampulla of Vater↗
PubMed1991

Distribution and therapeutic effect of intraarterially transferred tumor-infiltrating lymphocytes in hepatic malignancies. A preliminary report.

Indium-111-labeled tumor-infiltrating lymphocytes (111In-TIL) were transferred as an intrahepatic arterial bolus to determine their in vivo distribution in patients with hepatic malignancies. In the in vitro culture system, TIL were expanded upon simultaneous stimulation by recombinant interleukin-2 (rIL-2) and immobilized anti-CD3 monoclonal antibody. This double activation led not only to a larger cell yield, but also to a significantly more dominant subpopulation with CD4+ phenotype than occurred with activation by rIL-2 alone. Accumulations of 111In-TIL in the liver were identified by scintigraphy in all of three patients, corresponding to the tumor localization by computed tomography. Such accumulation had persisted for at least 48 hours after infusion. After intraarterial chemoimmunotherapy that included TIL, two of three patients achieved a partial therapeutic response. The authors conclude that their method of culture and transfer can facilitate the accumulation of TIL at tumor sites, which may augment the antitumor effects of adoptive immunotherapy.

Adenocarcinoma↗
PubMed1991

Angiographic management of massive hemobilia due to iatrogenic trauma.

Ten patients with massive hemobilia in shock or preshock status were treated with angiography. The hemobilia had been induced by iatrogenic trauma: biliary drainage in seven patients, and surgery, liver biopsy, and angiography in one patient each. Angiography was performed on all patients. Embolization was performed in nine, and in the one remaining patient, spasm of the right anterior hepatic artery and catheter manipulation injured the intima and obliterated the artery. In seven patients with hepatic artery pseudoaneurysm, gelfoam particles were injected in five, however, extravasation could not be prevented in four of these patients. Permanent embolic materials were added and complete hemostatis was obtained. Hemobilia never recurred in any patient. Emergency embolization should be considered as the initial treatment of choice for hemobilia and when pseudoaneurysms are discovered, they should be obliterated by permanent embolic materials. Moreover, tumor thrombus in the portal vein is not a contraindication for this procedure.

Aged↗
PubMed1991

Intraperitoneal hemorrhage from hepatocellular carcinoma: emergency chemoembolization or embolization.

From 1982 to 1990, 38 patients with intraperitoneal hemorrhage from hepatocellular carcinoma (HCC) underwent treatment with emergency embolization with or without anticancer drug and iodized oil. Before emergency embolization, 24 patients had a serum total bilirubin value of 3.0 mg/dL or less (group A) and 14 patients had hyperbilirubinemia, with a serum bilirubin level greater than 3.0 mg/dL (group B). Successful hemostasis was achieved in all patients. The mean length of survival was 165 days in group A and 13 days in group B. A significant correlation (P less than .00003) between serum bilirubin level and prognosis was obtained. While tumor thrombus in the portal vein made the prognosis poor, there was no significant difference in prognosis between groups with and without tumor thrombus (P = .145). Emergency embolization is an effective treatment in patients with intraperitoneal hemorrhage from HCC. The prognosis for patients with HCC depends on the serum bilirubin level before embolization.

Adult↗
PubMed1991

Results of hepatectomy for hepatocellular carcinoma at the National Cancer Center Hospital.

The number of hepatectomies has increased greatly in recent years. Surgery for hepatocellular carcinoma (HCC) in the normal liver has not increased. However, the increase in numbers of hepatectomies for HCC associated with liver cirrhosis is remarkable. More than 80% of our hepatectomy cases were cirrhotic and about 80% of these cirrhotic cases had HCCs 5cm or less in diameter. The operative mortality rate has improved in the latter half of this series, from 10.1% (9/89) to 1.5% (5/338), in spite of an increase in cases with poor liver function. This corresponds to a decrease in the mean value of the annual operative blood loss. The survival rates after hepatectomy for all cases (n = 378) were 40.6% +/- 6.6 (% +/- SE) for 5 year and 22.7% +/- 5.3 for 10 year at the end of 1988. A difference of the 5-year survival rate between the patients operated on before 1981 (n = 78, 25.6% +/- 4.9) and after 1982 (n = 300, 46.1% +/- 4.8) was observed (p less than 0.05). Because the cancer-free survival rates of the patients operated on in the two periods, before 1981 and after 1982, were almost the same, the recent improvement of the survival rates seems to be due to a prolongation of survival time after recurrence.

Carcinoma, Hepatocellular↗