Search PubMed⌕ Search

Biomedical subjects

M Makuuchi

Publications and source records attributed to M Makuuchi.

At least 397 records · Page 22Linked to original sources
PubMed1991

Thickening at the root of the superior mesenteric artery on sonography: evidence of vascular involvement in patients with cancer of the pancreas.

Thickening of the root of the superior mesenteric artery (SMA) was studied by using preoperative sonography in 23 patients with pancreatic cancer and in 10 healthy control subjects. Of the 23 with cancer, 11 had neoplastic involvement of the SMA and 12 did not. Prominent thickening of the area around the SMA with (six patients) or without (five patients) decreased echogenicity compared with the adjacent retropancreatic connective tissue was observed in patients with involvement of the SMA, a finding called the "cuff sign." Mean thickness of the periarterial area in the cancer patients with and without involvement of the SMA and in control subjects were 8.5 mm, 4.0 mm, and 2.9 mm, respectively. With an upper limit of normal of 7.0 mm for the thickness of the SMA, the sensitivity, specificity, and overall accuracy of this sign in the evaluation of involvement of the SMA were 91%, 100%, and 96%, respectively. Decreased echogenicity of the periarterial area was not observed in patients without involvement of the SMA or in control subjects. Our results show that sonographic evidence of periarterial thickening of the root of the SMA (cuff sign), especially with decreased echogenicity, is a reliable finding of tumor infiltration of the SMA in patients with pancreatic carcinoma.

Adult↗
PubMed1991

Extrahepatic division of the right hepatic vein in hepatectomy.

Extrahepatic division of the right hepatic vein, after division of the inferior vena cava ligament and, if necessary, of the adrenal gland, was performed during 87 liver resections, and the results compared with those of intraparenchymal division of the right hepatic vein in 32 similar hepatectomies. The selection of the method reflected the surgeon's preference, and was unrelated to the weight of the resected specimen. The incidences of injury to the adrenal gland, inferior vena cava and short hepatic veins were comparable with the two methods, 28 versus 26%, but massive bleeding occurred in 13 vs. 6%, and the mean operative bleeding was 3.8 vs. 1.8 liters (p less than 0.01) during intrahepatic and extrahepatic dissection, respectively. Tumors close to the junction of the right hepatic vein with the inferior vena cava cannot be removed radically with intraparenchymal division of the right hepatic vein. For these reasons, we prefer extrahepatic right hepatic vein division, which was technically possible in 75 of the 84 cases in whom it was attempted.

Adrenal Glands↗
PubMed1991

New possibilities for major liver surgery in patients with Klatskin tumors or primary hepatocellular carcinoma--an old problem revisited.

An impaired liver function secondary to liver disease is considered a contra-indication for extensive liver resection because of the risk of liver failure. Selective embolization of the portal branch corresponding to the part of the liver that is considered for resection, carried out three to four weeks before surgery, reportedly induced atrophy of the embolized part of the liver with hypertrophy of the nonembolized part. This policy showed satisfactory early results in 46 patients who had extended liver resection. One patient with severe cholangitis died in the first 30 days. Seven patients had minor complications, which responded well to conservative management (subphrenic abscesses 3, wound infections 3, pulmonary infection 1). Selective portal embolization was well tolerated and was associated with temporary mild side effects. Liver functions before and after embolization returned to pre-embolization values. The present results support the policy of selective portal embolization in patients with impaired liver function in whom extensive liver resection is necessary. Embolization is a promising ancillary preoperative alternative.

Adenoma, Bile Duct↗
PubMed1991

Identification of the intersegmental or subsegmental plane in the liver with a surgical clip.

In patients with hepatocellular carcinoma and liver cirrhosis, complete removal of the portal unit containing the tumor is indicated because of portal invasion. Systematic subsegmentectomy achieves this goal in theory; however, the margin of the subsegment or segment in the liver parenchyma is unclear. To visualize the margin of the portal unit in the liver, we have invented a new method in which the portal pedicle is clasped and dye is injected. With this method, staining of the portal unit persists even after resection is complete, and the margin of the portal unit within the parenchyma is easily followed during transection.

Carcinoma, Hepatocellular↗
PubMed1991

A hepatoblastoma originating in the caudate lobe radically resected with the inferior vena cava.

Complete resection of a rare hepatoblastoma in the caudate lobe, involving the inferior vena cava (IVC), is reported. After systemic chemotherapy, a 5-year-old child underwent exploratory laparotomy at another hospital, but resection was not attempted because the tumor in the caudate lobe had extensively invaded the retrohepatic IVC. However, because not only the lack of distant metastases but also the establishment of extrahepatic collaterals were confirmed by imaging, we thought it was possible to radically resect the tumor. We successfully performed an extended left hepatic lobectomy including total excision of the caudate lobe and the involved portion of the IVC. Although we did not reconstruct the IVC, no clinical manifestations arising from caval congestion were seen. The serum alpha-fetoprotein value declined below the normal limit. Our experience with this case has introduced a radical resectability for hepatic malignancy in the caudate lobe, even if it has extended into the IVC.

Carcinoma, Hepatocellular↗
PubMed1991

A new method for mapping hepatic subsegment: counterstaining identification technique.

Hepatic subsegmentectomy requires identification of the borders of tumor-bearing subsegment, usually achieved by injecting dye into the portal veins feeding the domain. We describe an alternative technique for performing systematic subsegmentectomy in patients with cirrhosis and hepatocellular carcinoma, in whom hepatic arterial and portal venous embolizations were already performed as a preoperative adjuvant. Under ultrasonic guidance, each of the neighboring portal units is sequentially stained, thus defining the avascular subsegment to be resected as the nonstaining area. This allows the subsegment to be totally resected. This counterstaining identification technique can be used for all subsegments undergoing complete embolization and for other situations in which the usual staining method is impossible because of the presence of arterioportal shunting or portal tumor thrombus.

Carcinoma, Hepatocellular↗
PubMed1991

The value of ultrasonography for hepatic surgery.

Ultrasonography plays an important role in the early detection of hepatocellular carcinoma. Ultrasonography detected 53% of 287 patients with small (less than or equal to 5 cm) hepatocellular carcinomas. Among 486 patients with hepatocellular carcinomas, sensitivities of intra-operative ultrasonography in detecting 451 small primary hepatocellular carcinoma nodules, intrahepatic metastasis in 330 patients with small hepatocellular carcinoma and 63 tumor thrombi were 98, 48 and 67%, respectively. The sensitivity of intra-operative ultrasonography in detecting small primary tumors was 10% better than ultrasonography, computed tomography, and angiography. The sensitivity of intra-operative ultrasonography in intrahepatic metastasis and tumor thrombus was two to three times better than pre-operative examination. Intra-operative ultrasonography was useful in detecting nonpalpable tumors and in guiding the transection of the liver, biopsy, and cryosurgery. Moreover, intra-operative ultrasonography made possible new hepatectomy procedures: systematic subsegmentectomy and hepatectomies which preserve the inferior right hepatic vein. Systematic subsegmentectomy guided by intra-operative ultrasonography resulted in better survival rates than the limited resection in patients with small hepatocellular carcinoma two years after hepatectomy; by the sixth year, this difference was significant (p less than 0.05). Ultrasonography and intra-operative ultrasonography are indispensable in the early detection, accurate diagnosis, operative guidance and postoperative care of hepatocellular carcinoma.

Carcinoma, Hepatocellular↗
PubMed1991

Adjuvant hepatic intra-arterial chemotherapy after potentially curative hepatectomy for liver metastases from colorectal cancer: a pilot study.

The site most at risk of recurrence after hepatectomy is the remaining liver. Therefore a study was conducted of the use of hepatic intra-arterial and oral chemotherapy for colorectal metastases to prevent intrahepatic recurrence. Our regimen consisted of intra-arterial 5-fluorouracil (5-FU), mitomycin C (MMC) and oral 1-hexylcarbamoyl-5-fluorouracil (HCFU). Sixteen patients were treated. Median total dose of 5-FU was 8.1 g, MMC was 43 mg, and HCFU was 54 g, respectively. Median follow-up period was 21 months. The recurrence rate of the remaining liver was 31%. With respect to the number of hepatic metastases, there was no recurrence in patients with a single deposit. On the other hand, the intrahepatic recurrence rate of patients with multiple deposits was 45%. Of six patients with more than five hepatic deposits, however, only one patient had developed recurrent disease in the liver. Chemical sclerosing cholangitis (19%) was the most serious complication. Consequently, we propose that a prospective randomized trial should be carried out to establish the effects of this type of adjuvant chemotherapy to reduce possible recurrences in the remaining liver.

Adult↗
PubMed1991

Primary lymphoma of the common bile duct.

Primary lymphoma of the common bile duct is an extremely rare disease. Only two detailed case reports have been published in the literature. In the present paper, a 68-year-old female with obstructive jaundice and a primary lymphoma of the common bile duct, which was resected, is described in detail because of the rarity of the lesion in the literature. The cholangiogram demonstrated stricture of the common bile duct. The findings at angiography and computed tomography were non-specific, but a hypo-echoic mass filling the lumen of the bile duct was demonstrated by ultrasonography. Subtotal resection of the common bile duct and cholecystectomy was performed as the method of choice, although the frozen section examination was not definitive. The final histological diagnosis was malignant lymphoma of the diffuse, small cleaved cell type. There was no metastasis to dissected regional lymph nodes. External irradiation was effective when recurrent tumors were found six months later. However, the patient developed generalized disease one year after resection. Although combination chemotherapy was effective this time for her lymphadenopathy, she died of pneumonia one year and four months after surgery. It can be postulated that ultrasound would be useful in diagnosing this rare entity, and that adjunctive radiotherapy after resection would be preferable to prevent progression of the disease.

Aged↗
PubMed1991

[Effects of various forms of gastric surgery on gut hormones and pancreatic secretions].

Effects of various forms of gastric surgery on gut hormones and pancreatic secretions were examined using canine models. These operative procedures included simple laparotomy (group A; n = 13), truncal vagotomy with pyloroplasty (B; n = 17), selective proximal vagotomy (C; n = 17), proximal gastrectomy with pyloroplasty (D; n = 6), proximal gastrectomy with truncal vagotomy and pyloroplasty (E; n = 7), and distal gastrectomy (F; n = 19). The mean fasting serum gastrin and secretin levels (pg/ml) were 71.0, 82.5 in A, 94.0, 97.7 in B, 62.1, 108.1 in C, 58.2, 123.0 in D, 91.2, 138.6 in E, and 50.9, 74.5 in F, respectively. The mean value of plasma pancreatic glucagon (pg/ml) showed 73.6, 109.9, 106.8, 47.2, 37.8, and 74.5 in each of the six groups. Significant correlations were observed between values of serum lipase and those of serum gastrin as well as between the amount of pancreatic secretions and serum secretin levels. Pancreatic secretions were decreased markedly in group F and moderately in B. Basal tissue blood flow measured by hydrogen clearance method was low in D, E, and F when compared with that in A.

Animals↗
PubMed1991

[Preoperative portal embolization increases safety of hepatectomy].

Postoperative liver failure following major hepatectomy is a frightened complication. In order to increase safety of major hepatectomy, a study evaluating preoperative portal embolization (PE) was performed. Between 1983 and 1990, PE was performed in 71 patients (41 with hepatocellular carcinoma (HCC), 8 with other liver tumors, and 22 with biliary carcinoma), in 63 cases to the main branch, prior to hepatectomy. Out of these 63 patients 42 (extended) hemihepatectomies were performed. For comparison 77 patients with the same extent of hepatectomy, but without PE, were studied. Liver volume was evaluated by CT examination. Portal venous pressure was elevated by 73 mmH2O just after embolization of the main portal branch. However, no complications were associated to the PE procedure except for temporary elevation of transaminases. Volume of the unembolized lobe increased by 8.8% in average following PE. Prominent volume gain was observed in the patients with prior arterial embolization and long observation period. In patients with PE prior to major hepatectomy, postoperative bilirubin values were significantly lower (p less than 0.01). In the group with PE, no fulminant liver failure was seen and no operative mortality was encountered, as compared to 11.7% (9/77) in the control group. Preoperatively performed PE was a safe procedure decreasing postoperative liver failure and mortality.

Adult↗
PubMed1990

Malignant transformation of adenomatous hyperplasia to hepatocellular carcinoma.

To clarify the course of adenomatous hyperplasia (AH) of the liver, 17 patients with 20 biopsy-proven AH nodules were followed clinically for 1-5 years. At the initial biopsy the mean nodular diameter was 10 (SD 4) mm and the relative cellularity [( mean cellularity of AH divided by mean parenchymal cellularity] x 100) 141 (27). The criteria for diagnosis of malignant transformation of AH were both a doubling of nodular volume and changes on imaging. Between 6 and 50 months after biopsy, 9 of the 18 nodules which could still be accurately identified met the criteria for transformation; histological proof of hepatocellular carcinoma (HCC) was obtained later for 7 of these 9 nodules. The product of diameter and cellularity (transformation index) was the strongest predictor of the time to transformation. 9 AH nodules did not undergo transformation--7 did not meet one or both criteria and 2 became undetectable by imaging. Because of the high risk of malignant transformation, it can be concluded that AH is an absolute precursor of HCC. It should therefore be treated as a potential malignant disorder.

Adenocarcinoma↗