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Biomedical subjects

M Makuuchi

Publications and source records attributed to M Makuuchi.

At least 415 records · Page 23Linked to original sources
PubMed1990

CT of hilar cholangiocarcinoma: late contrast enhancement in six patients.

Hilar cholangiocarcinoma usually appears on CT scans as a low-density or isodense mass that abruptly obstructs converging dilated bile ducts. In four of six patients with histopathologically proved hilar cholangiocarcinoma who had late enhanced CT 8-15 min after dynamic CT, the lesion was seen as a high-density mass instead of the low-density lesion seen earlier on unenhanced and dynamic CT scans. The other two patients had ring enhancement with evidence of a thickened wall of the bile duct both on early and late enhanced CT scans. In the first four patients, carcinoma invaded the neighboring hepatic parenchyma and produced a mass, whereas in the last two, carcinoma was localized in the wall of the bile duct. Histopathologically, all lesions consisted of adenocarcinoma associated with a dense fibrotic tissue. As late enhanced CT shows hilar cholangiocarcinoma as a high-density mass, the exact location of the tumor and its relation to neighboring vessels can be determined, especially in relatively small tumors, and differentiation from sclerosing cholangitis is possible.

Adenoma, Bile Duct↗
PubMed1990

The diagnosis of small hepatocellular carcinomas: efficacy of various imaging procedures in 100 patients.

The efficacy of various imaging procedures used for the diagnosis of small hepatocellular carcinomas (HCCs) (lesions no larger than 3 cm in diameter) was evaluated in a retrospective study of 100 patients. Seven patients with hepatic adenomatous hyperplastic nodules containing HCC foci were also assessed. In 89 patients, the lesion was initially detected during follow-up of chronic liver disease. In 21 patients, it was first diagnosed on the basis of elevated serum alpha-fetoprotein; in the remaining 79 it was diagnosed incidentally with imaging procedures. The overall sensitivities of sonography (84%), CT (84%), and angiography (81%) were compared with those of arterial angiographic CT (82%), portal angiographic CT (91%), lipiodol CT (93%), and intraoperative sonography (96%). The differences in sensitivity between angiography and lipiodol CT (p less than .05) and between intraoperative sonography and the other studies (p less than .01) were statistically significant. In 22 lesions smaller than 1 cm, the sensitivities of lipiodol CT and intraoperative sonography were high (83% and 86%, respectively). Adenomatous hyperplasias containing HCC foci were frequently detected by arterial angiographic CT and intraoperative sonography. These results show that sonography or CT and alpha-fetoprotein are useful in detecting small HCCs in screening programs of patients with chronic liver disease. Lipiodol CT and intraoperative sonography are necessary in patients who are candidates for surgery.

Adult↗
PubMed1990

Early diagnosis of hepatocellular carcinoma.

We describe the results of our study on the early detection of the development of hepatocellular carcinoma among patients with chronic liver disease. Over a period of 18 years, 33 patients were diagnosed as having hepatocellular carcinoma. From 1970 to 1978, we used serum alpha-fetoprotein determination, liver palpation, and radionuclide liver scans. In addition to alpha-fetoprotein determination, computed tomography and ultrasonography were introduced in 1979. However, we did not have any general guidelines for the use of these imaging modalities. From 1984 onwards, ultrasonography and serum alpha-fetoprotein determination have been performed every three months and computed tomography every year in patients whose right hepatic lobe had atrophied due to liver cirrhosis. On the basis of this screening program, 50% of the detected hepatocellular carcinoma (9/18) were found to be smaller than 1.9 cm in diameter, and tumor resection was performed in 11 out of 18 patients (61%).

Adult↗
PubMed1990

Serious chemical sclerosing cholangitis associated with hepatic arterial 5FU and MMC chemotherapy.

A case of iatrogenic sclerosing cholangitis secondary to hepatic intra-arterial 5-fluorouracil (5FU) and Mitomycin C (MMC) chemotherapy is described. When any unexplained elevation of liver function results in alkaline phosphatase and bilirubin level, chemotherapy should be discontinued, and further examination carried out using ultrasonography, transhepatic cholangiography and endoscopic retrograde cholangio-pancreatography (ERCP). Although percutaneous transhepatic biliary drainage has been effective in some cases, in our case, the clinical course was irreversible and the patient died of hepatic failure and gastrointestinal bleeding. When clinical signs of hepatic dysfunction occur in the absence of tumor progression, iatrogenic sclerosing cholangitis must be suspected.

Adult↗
PubMed1990

Resection after intraarterial chemotherapy of a hepatoblastoma originating in the caudate lobe.

A rare case of hepatoblastoma originating in the caudate lobe was treated successfully with intraarterial chemotherapy followed by extensive lobectomy of the left side of the liver. Imaging modalities demonstrated a solitary huge tumor, initially inoperable, occupying almost the entire liver in a 4-month-old female infant. Transcatheter intrahepatic arterial chemotherapy with 10 mg doxorubicin, 20 mg cisplatin, and 3 ml Lipiodol, repeated twice at a 1-month interval, led to a remarkable reduction in tumor size and thereby made it resectable. The volume ratio between the intact hepatic parenchyma and the tumor changed from 1:1.70 to 1:0.13, as assessed by serial computed tomography scans, and the patient's initial alpha-fetoprotein level of 223,210 ng/ml declined to 53 ng/ml. The present case is the first in the literature, to our knowledge, of a resected hepatoblastoma in the caudate lobe. Clinical details of the tumor and surgical issues are discussed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

[An operated case of multiple well-differentiated hepatocellular carcinomas and adenomatous hyperplasia].

A 66-year-old male with non-A, non-B liver cirrhosis underwent an operation for a partial resection of the S8 area. Intraoperative ultrasound (US) examination of the entire liver revealed 10 space-occupying lesions (SOLs), and a biopsy of 5 out of the 10 SOLs showed 3 hepatocellular carcinomas (HCCs), adenomatous hyperplasia (AH), and an atypical AH (AAH). In a resected specimen that including 4 SOLs that had been detected by operative US, 6 early HCCs, an HCC of the Edmondson grade I + II, and 2 AAHs were found. All tumors were less than 2 cm and were not encapsulated.

Aged↗
PubMed1990

Solitary adrenal metastasis from hepatocellular carcinoma: a case report of simultaneous successful resections.

The case is presented of a 64-year-old male with a left adrenal mass and multiple liver lesions. Preoperative image work-ups included ultrasonography, computed tomography, selective liver and adrenal angiographies, and magnetic resonance imaging. Serial serum alpha-fetoprotein monitoring and the adrenal hormone profile were within the normal ranges. A left adrenalectomy and a right lobectomy of the liver were performed, and the pathology revealed hepatocellular carcinoma with left adrenal metastasis. The clinical significance of the present case, together with the diagnosis and management of the disease is discussed.

Adrenal Gland Neoplasms↗
PubMed1990

Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report.

Extensive liver resection for hilar bile duct carcinoma with jaundice has high morbidity and mortality rates because of postoperative liver failure. To minimize postoperative liver dysfunction, a portal venous branch was embolized before surgery to induce atrophy of the lobe to be resected and hypertrophy of the contralateral lobe in 14 patients with hilar bile duct carcinoma. Bile was drained before surgery in 11 patients with jaundice. Portal embolization did not produce major side effects, and moderate increases of serum transaminase activity or bilirubin returned to baseline values within 1 week. Hepatectomy with bile duct resection and lymphadenectomy was performed 6 to 41 days after embolization, at which time the embolized lobe was atrophied in 12 of the patients. Extended right or left lobectomy or left trisegmentectomy (10, 3, and 1 cases, respectively) with biliointestinal reconstruction was performed. One patient with jaundice and suppurative cholangitis died 30 days after hepatectomy. Another patient died 3 months after surgery of aggravated hepatitis. After surgery, no bile leakage occurred and hyperbilirubinemia was usually moderate and reversible.

Aged↗
PubMed1989

Clinical and radiologic assessments of the results of hepatectomy for small hepatocellular carcinoma and therapeutic arterial embolization for postoperative recurrence.

To study the prognostic significance of the state of the residual liver after hepatectomy for small hepatocellular carcinoma (s-HCC) no larger than 5 cm in diameter, 123 patients were followed for periods from 9 months to 9 years and 1 month. The following results were obtained: (1) recurrence occurred in the residual liver in 58 patients (54.2%) after an average of 14.9 months from hepatectomy; (2) at recurrence diagnosed by imaging, 12 of 48 recurrent patients showed negative alpha-fetoprotein; (3) computed tomography (CT) had a high sensitivity (71.4%) in detecting recurrence; (4) 5-year survivals for all patients (n = 123) who had hepatectomy, and for those without recurrence (n = 49) or with recurrence (n = 58) were 19.1%, 48.9%, and 11.0%, respectively; and (5) survivals for the patients who developed recurrence and who did and did not receive embolization treatment (n = 32, 23, respectively) were 70.3% and 37.1% at 1 year, 45.0% and 0% at 3 years, and 14.9% and 0% at 5 years, respectively. It is important to recognize that the patient who has undergone surgery even for s-HCC should be followed as a super high-risk patient at regular intervals using CT. Therapeutic embolization for recurrent patients improved the survival after recurrence.

Adult↗
PubMed1989

Evaluation of the prognosis for small hepatocellular carcinoma based on tumor volume doubling time. A preliminary report.

The relationship of tumor volume doubling time to length of patient survival was investigated for 15 patients with small hepatocellular carcinoma smaller than 4.5 cm in diameter. The mean tumor volume doubling time of these 15 nodules was 102 +/- 77 days (mean +/- SD; range 41 to 305 days) before the initiation of a specific treatment for cancer. These doubling times tended to correlate with mitotic indexes of the tumors and the patients could be divided into two groups according to the therapeutic modalities used. Patients in Group A received systemic chemotherapy without response or nonspecific treatments for cancer. In this group, there was a positive correlation between tumor volume doubling time and survival length (r = 0.8812; P less than 0.025). Patients in Group B either received hepatectomy after transarterial embolization or systemic chemotherapy or received hepatectomy alone. In this group, early death occurred in patients who had shorter tumor volume doubling times. Three surgically treated patients in Group B were evaluated as having survived for a significantly long period as assessed from their tumor volume doubling times. These results indicate that tumor volume doubling time is one of the determining factors of survival length in patients with hepatocellular carcinoma, and, therefore, can be used in the evaluation of therapeutic efficacy.

Aged↗
PubMed1989

Multicentric independent development of hepatocellular carcinoma revealed by analysis of hepatitis B virus integration pattern.

Two separate nodular lesions of hepatocellular carcinoma (HCC) were surgically removed from a patient with positive serum hepatitis B surface antigen. Southern blot analysis of DNA from the two separate HCC lesions showed different restriction patterns of integrated hepatitis B virus DNA, indicating their independent origins. The two lesions were composed mainly of poorly differentiated HCC; however, well-differentiated HCC was also observed in the periphery of the lesions. This histological finding is consistent with the multistep and independent development of HCC in each site of the liver.

Aged↗
PubMed1989

Clinical significance of 99mTc-N-pyridoxyl-5-methyltryptophan (99mTc-PMT) in the diagnosis of intrahepatic masses.

Hepatobiliary scintigraphy with 99mTc-N-pyridoxyl-5-methyltryptophan (99mTc-PMT) was carried out on 48 patients with intrahepatic masses, 44 with hepatocellular carcinoma and one each of hepatocellular adenoma, focal nodular hyperplasia, cholangiocellular carcinoma, and adenoid cystic carcinoma. Scans were performed twice, early scan (30 min post i.v.) and delayed scan (2.5 h post i.v.), and the delayed scan was used for assessing the accumulation of 99mTc-PMT in the intrahepatic masses. In the hepatocellular carcinoma group, based on individual patients, 17 out of 44 (38.6%) showed accumulation of 99mTc-PMT in various degrees; and based on individual masses, accumulation was noted in 21 out of 55 masses (38.2%). However, only the cases which had not received transarterial infusion of anti-cancer drugs (TAI) and/or blocking agents (TAE) were taken into consideration, 9 out of 18 patients (50%) and 12 out of 25 masses (48.0%) were found capable of picking up 99mTc-PMT. A case of hepatocellular adenoma showed a strong accumulation of 99mTc-PMT in the mass which was depicted as a defect on the 99mTc-colloid scan and did not show a significant accumulation of 67Ga. In a case of focal nodular hyperplasia, there were two space-occupying lesions (SOLs), one of which showed a clear-cut defect on the 99mTc-colloid scan and the other which showed only a distorted uptake pattern. However, both masses were strongly positive with 99mTc-PMT. 99mTc-PMT scintigraphy is useful in connection with 99mTc-colloid scan and sometimes with 67Ga-citrate in the diagnosis of intrahepatic masses originating from hepatocytes.

Adenoma, Bile Duct↗
PubMed1989

Hepatocellular and cholangiocellular carcinoma, double cancer of the liver: report of two cases resected synchronously and metachronously.

Double primary liver cancer, i.e., hepatocellular carcinoma (HCC) and cholangiocellular carcinoma (CCC), was detected by ultrasound (US) during the follow-up of chronic liver disease, and was safely resected in two patients, one synchronously and the other metachronously. On admission, laboratory data were normal except for slightly abnormal liver function tests. One patient (case 1) had a 5.1-cm white firm CCC with several small daughter lesions around it which was enhanced late in computed tomography, and a 2.1-cm well-circumscribed HCC with a pseudocapsule; the two were situated very close to one another in the right posterior segment of the liver. Another patient (case 2) had a small 1.5-cm CCC in the anterior superior area, and 6 yr after the first resection, alpha-fetoprotein gradually increased and a 4-cm HCC was detected anew and resected; the preoperative diagnosis made by US and ethiadol-computed tomography was correct. The histopathological diagnosis of the noncancerous portion was chronic active hepatitis in both cases. However, it changed to precirrhosis in case 2 during the follow-up.

Adenoma, Bile Duct↗
PubMed1989

[Cultivation of human tumor infiltrating lymphocytes for use in adoptive immunotherapy].

We have developed a method of in vitro stimulation of TIL and PBL using immobilized anti CD3 antibody instead of autologous tumors. After this treatment, proliferation of T cells was greatly enhanced. Separated TILs were cultured by OKT3 coated 96 well culture plate for about one week with 10% human serum and 1,000U/ml of rIL-2 supplemented RPMI-1640 medium, and then transferred to plain vessels. TIL increased in number by more than 5,000-fold after 3 weeks. PBLs obtained from 10 ml of peripheral blood were cultured in OKT3-coated culture flask (75 cm2) with 10 ml of medium for about one week, and then in plain flasks and finally expanded by culture in gas-permeable culture bags. PBL proliferated by more than 1,000-fold after 2 weeks. TIL or PBL cultured by this method contained over 90% activated T cells positive for the Leu4 marker, and HLA-DR. About 60% of these were CD8-positive and about 40% were CD4-positive. Only a small number of Leu 11-positive cells were detected in every case.

Antibodies↗
PubMed1989

[Hepatocellular carcinoma treated with a curative segmentectomy five years after complete remission of acute myeloblastic leukemia].

Acute myeloblastic leukemia (AML) was diagnosed in a 54-year-old male who had been known to carry a chronic hepatitis B surface antigen (HBsAg) from June, 1983. Prompt remission was achieved with combination chemotherapy of BHAC-DMP. Follow-up maintenance and an intensification of this chemotherapy had been given for five years. He was readmitted to our hospital in March, 1988 because a mass was detected in the right lobe of the liver by ultrasonography. His serum alpha fetoprotein (AFP) level was found to be 180.1 ng/ml, and was diagnosed as having a hepatocellular carcinoma though there was no evidence of liver cirrhosis. A curative right hepatectomy was performed in May, 1988 after transcatheter arterial embolization and portal embolization. After resection of the tumor, the AFP level decreased to 10.7 ng/ml and no HbsAg was detected in the serum.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

[The role of splenectomy in patients with hepatocellular carcinoma and hypersplenism as an aid to hepatectomy].

To evaluate the clinical value of splenectomy for hepatic resection, a total of 20 patients with hepatocellular carcinoma and hypersplenism were examined focusing on a change of total serum bilirubin values after surgery. Both hepatectomy and splenectomy were simultaneously performed in 12 patients, and in 8 patients as a staged operation. Postoperatively, a significant depression of bilirubin values was observed in a group with the preoperative values between 1.0mg/dl and 2.0mg/ml. Three factors (bilirubin, albumin and prothrombin time) in clinical stage were improved just after splenectomy with a statistical significance (p less than 0.05) in a group received staged operation. In 7 out of 8 patients, clinical stages were getting better as one or two stages prior to the hepatectomies. Therefore, we recommend the addition of splenectomy to hepatectomy in the patients whose hyperbilirubinemia are assumed to be correlated with coexisting hypersplenism.

Adult↗
PubMed1989

Poor prognoses following left hepatic trisegmentectomies for cancer.

Five patients with hepatocellular carcinoma, and one with a gallbladder cancer with liver metastases, underwent left hepatic trisegmentectomy with, in four cases, resection of the left caudate lobe. A bleeding peptic ulcer and an anaphylactic shock due to a drug allergy caused two hospital deaths. A third major complication was a prolonged bile leakage which healed spontaneously. One patient who died in hospital had not undergone a radical resection, and all four patients surviving the procedure eventually died with recurrent local (and sometimes also distant) tumors between 3.5 and 11 months after resection. The results appear to give relatively few indications for left trisegmentectomy in the treatment of these tumors.

Adult↗