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Biomedical subjects

M Makuuchi

Publications and source records attributed to M Makuuchi.

At least 451 records · Page 25Linked to original sources
PubMed1986

Angiography of small hepatocellular carcinomas: analysis of 105 resected tumors.

One hundred five hepatocellular carcinomas less than 5 cm in diameter were resected in 75 patients. The tumors were studied with respect to their detection rate by angiography and their angiographic features. Angiography identified 86 (82%) of the 105 lesions, missing 19 (18%). The findings included tumor vessels (70%) and tumor staining (76%). Pathologic analysis of the 19 undetected lesions showed that 74% of them were smaller than 2 cm in diameter and that they were well-differentiated carcinomas. Forty percent of 100 lesions were in the anterosuperior subsegment of the right lobe.

Adult↗
PubMed1986

[A case of cholangiocarcinoma and dysgerminoma associated with Turner's syndrome].

A rare case of cholangiocarcinoma and dysgerminoma synchronously associated with Turner's syndrome was reported. A 53-year-old woman was admitted to our hospital on July 12, 1984 due to intrahepatic and left inguinal tumors. Physical examination revealed the typical characteristics of Turner's syndrome. The karyotype from myelocyte and fibrocyte culture was interpreted as 45, X. The resected intrahepatic tumor was cholangiocarcinoma that had invaded to the transverse mesocolon and the duodenum, while the inguinal lesion was dysgerminoma derived from a dysgenetic gonad. As far as we have been able to ascertain through our investigations of the literature on malignant disease in Turner's syndrome, the association of cholangiocarcinoma with Turner's syndrome has not been reported previously.

Adenoma, Bile Duct↗
PubMed1986

Necrosis of hepatocellular carcinoma as a result of subintimal injury incurred by hepatic angiography: report of two cases.

This report described two patients with hepatocellular carcinoma in whom angiographic procedure caused an inadvertent subintimal injury of the hepatic artery, resulting in tumor necrosis. In the first case of a 38-year-old male, complete obstruction of the common hepatic artery occurred on the initial angiography. It was followed by marked reduction of the tumor vessels on repeat angiography, and necrosis of about half of the tumor as confirmed by computed tomography. In the other 58-year-old female, severe subintimal injury occurred in the proper hepatic artery followed by obstruction of the feeding arteries. Subsequent computed tomography scan disclosed necrosis of the tumor. Both patients presented the postembolization syndrome that consisted of a transient fever and elevation of blood enzymes. When spontaneous regression or reduction of hepatocellular carcinoma is observed, special attention should be paid regarding whether or not hepatic angiography was performed and clinical symptoms followed it.

Adult↗
PubMed1986

[Surgical treatment of hepatocellular carcinoma].

The result of surgical treatment for hepatocellular carcinoma in National Cancer Center Hospital is reported. Almost 80% of the cases in this series are cirrhotic. The cases were divided into two groups according to the period when hepatectomy was done, as the first half, [A], was from 1974 till 1981 when the treatment was only surgical removal and the latter half, [B], was from 1982 till the end of March, 1986 when pre- and post-operative embolization was combined with hepatectomy. The operative mortality rate was 10.1% (9/89) for [A] and 2.2% (3/121) for [B]. The cumulative survival rates of [A] for the 1st-5th year were 65.8%, 52.6%, 39.5%, 32.9% and 27.2%, respectively, and those of [B] were 86.1%, 78.1%, 65.1%, 50.6% and 50.6%.

Carcinoma, Hepatocellular↗
PubMed1985

Preoperative imaging of liver metastases. Comparison of angiography, CT scan, and ultrasonography.

Thirty-one patients with mostly colorectal cancer metastases to the liver had preoperative selective/superselective angiograms (24 cases), computed tomography (CT) [26 cases, mostly enhanced by contrast administered by a peripheral vein (9), the common hepatic artery (9), or the portal vein (5)], and ultrasonography (26 cases). Intraoperative ultrasonography and palpation and examination of the resected specimens revealed 113 tumors. CT detected almost half of the masses smaller than 1 cm, and ultrasonography and angiography about one-third of lesions 1-2 cm in size. Ultrasonography was less powerful for examination of the posterior segment of the liver. CT and ultrasonography placed the tumors into subsegments more accurately than did angiography. Almost 40% of the preoperative plans had to be changed: in two-thirds by extended resections and in one-third by a change from curative to palliative intent. Most changes were due to extrahepatic tumor growth, often within areas screened before surgery. The use of all three imaging modalities for liver metastases is recommended for preoperative planning.

Angiography↗
PubMed1985

Intrahepatic venous collaterals forming via the inferior right hepatic vein in 3 patients with obstruction of the inferior vena cava.

When the inferior vena cava is obstructed, collateral veins enlarge, connecting with the inferior (accessory) right hepatic vein (IRHV) and thence through various hepatic veins to the right atrium. Three such cases are described. In one patient, most contrast material flowed into the IRHV and from there to the left hepatic vein. The second patient had several large collaterals arising from the IRHV and flowing into the right and middle hepatic veins, while the third patient demonstrated anastomoses between the IRHV and the middle hepatic vein. All of these hepatic venous shunts eventually drained into the right atrium. There were no clinical manifestations such as ascites, edema, or dilatation of the abdominal veins. Cavography alone or combined with computed tomography proved to be diagnostic in the assessment of these intrahepatic collaterals.

Collateral Circulation↗
PubMed1985

Bile duct necrosis: complication of transcatheter hepatic arterial embolization.

Bile duct necrosis because of transcatheter hepatic arterial embolization (THAE) in two patients with hepatocellular carcinoma is reported. Preoperative THAE was performed on 29 patients, and bile duct necrosis was experienced by two of the 29 (7%). In these two patients, gelatin (Gelfoam) powder was used as the embolus. Among the 24 whose embolus was clear, four were embolized with gelatin powder. Therefore, incidence of bile duct necrosis after THAE with gelatin powder was 50%. Because of the hazards of severe complications such as bile duct necrosis, we conclude that gelatin powder should not be used except for the THAE of no more than one segment of the liver.

Bile Ducts↗
PubMed1985

Ultrasonically guided subsegmentectomy.

A new operative procedure for systematic subsegmentectomy guided by ultrasound has been described. This operation consists of operative sonography, ultrasonically guided puncture and injection of dye and hemihepatic blood occlusion. Systematic subsegmentectomy was performed upon 57 patients without operative mortality. The cumulative one year survival rate of 35 patients with hepatocellular carcinoma who underwent operation at our hospital was 80.3 per cent. The two and three year survival rates were 63.3 and 52.6 per cent, respectively.

Carcinoma, Hepatocellular↗
PubMed1985

Hepatectomy for metastatic liver tumor.

Hepatectomy for liver metastasis from the colo-rectum and other organs was performed in 77 cases at the National Cancer Center Hospital. The operative procedures included every variety of hepatectomy from extended resection as trisegmentectomy to small resection as partial resection. The operative mortality rate was 3.9% (3/77). The overall cumulative 5-year survival rate was 26.7 +/- 13.9% (survival rate +/- Greenwood's 5% standard error). The long-term survival of the patients with unilobular metastasis (H1) was better than that of bilobular (H2) and disseminated (H3 metastasis). When H1 was divided into solitary unilobular metastasis (H1 solitary) and multiple unilobular metastasis (H1 multiple), the prognosis for the former was better than for the latter after hepatectomy. The long-term survival of patients with H1 multiple was the same as that of patients with H2 and H3; that means that one of the factors affecting prognosis after hepatectomy is whether the tumor is solitary or multiple.

Adolescent↗
PubMed1985

[Clinical studies on changes in serum transaminase, lactate dehydrogenase, total bilirubin and alkaline phosphatase levels after hepatectomy with and without the hemihepatic vascular occlusion technique].

Changes of serum glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), lactate dehydrogenase (LDH), total-bilirubin (T-Bil) and alkaline-phosphatase (AL-P) before operation and for one week of the postoperative period were studied in 45 patients (32 cirrhotic, 13 non-cirrhotic patients) who underwent hepatectomy with the hemihepatic vascular occlusion technique, and compared with 108 patients (42 cirrhotic, 66 non-cirrhotic patients) without it. The blood loss during hepatectomy with hemihepatic vascular occlusion markedly decreased 1500 ml on the average, compared with non-occluded patients. Serum GPT, GOT and LDH level elevated in several postoperative days, however, there was no difference between both groups. Serum total bilirubin level of patients without hemihepatic vascular occlusion elevated more than those with it. This difference was statistically significant. This tendency was more evident in the patients with cirrhosis. Serum AL-P level of patients without hemihepatic vascular occlusion decreased statistically less than those with it. This tendency was more prominent in patients with cirrhosis. With these results, there was no evidence of augmenting the postoperative liver damage by hemihepatic vascular occlusion, even in the patient with cirrhosis. Moreover, the elevation of postoperative serum total bilirubin level was suppressed by hemihepatic vascular occlusion because of the minimum blood loss and minimum blood transfusion.

Alkaline Phosphatase↗
PubMed1984

Segmental assessment on ordinary scintigrams and SPECT images of the liver.

By examining the area of defect elucidated on the scintigrams and SPECT (single photon emission computed tomography) images, the extension of the tumor into segments was assessed in cases where the SOL (space-occupying lesion) was determined by other methods. In this study, we followed the Couinaud 's segmentation. As a result, it was found that the segment with a SOL could be diagnosed fairly well on radionuclide images. Some incorrect assumptions were also found about the segments on ordinary scintigrams in previously published articles. These incorrect assumptions have been accepted for a long time. Although we do not deny that TCT (transmission X-ray computed tomography), echography, angiography, etc. are necessary for a precise judgment on liver segment and also that there are some cases in which the segmental assessment of these radionuclide images is impossible, we do believe that this kind of effort will improve the diagnostic capability of the radionuclide images.

Adult↗
PubMed1984

Primary Budd-Chiari syndrome: ultrasonic demonstration.

Three cases of primary Budd-Chiari syndrome were found by ultrasonic examination. These were confirmed by hepatic venography and inferior vena cavography. The ultrasound findings in these patients included communicating vessels between hepatic veins, enlarged inferior right hepatic vein, reversed blood flow in the hepatic vein, and obstruction of the inferior vena cava. With these findings, ultrasound can be used to diagnose primary Budd-Chiari syndrome without hepatic venography or inferior cavography.

Aged↗
PubMed1984

[Ultrasonic diagnosis of liver tumors--with special reference to its limitations in predicting histology].

Since 1980, ultrasound has become the main diagnostic modality in detecting small hepatocellular carcinomas. We laparotomized 72 patients with 93 hepatocellular carcinomas less than 5 cm in diameter and resected 86 tumors in 68 patients. Sensitivities for these small hepatocellular carcinomas were: ultrasound 90.1%, angiography 86.8%, and CT 91.3%. Ultrasound was the most excellent diagnostic modality in diagnosing the location of the tumor, because of its capability of demonstrating the portal and the hepatic venous branches simultaneously. The characteristics of small hepatocellular carcinomas were a mosaic pattern of internal echos, posterior echo enhancement, thin halo and lateral shadows. These findings were recognized in 68%, 61%, 37% and 18% of cases respectively. However, most of the tumors less than 2 cm appeared as simple low-echo areas. In tumors measuring from 2.1 to 5 cm, these findings were demonstrated in 77%, 74%, 48% and 23% of cases respectively. Liver tumors with a mosaic pattern and posterior echo enhancement were seen only in case of hepatoma. Predictability of hepatocellular carcinoma with these two findings was 60% in patients with hepatocellular carcinomas 2.1 to 5 cm in diameter. Predicting the histology of liver tumors less than 2 cm in diameter was difficult with any diagnostic modalities. However, since small hemangiomas less than 2 cm in diameter were delineated as characteristic echogenic areas, there were patients in whom only ultrasound could predict the tumor histology, even if other diagnostic methods could not. In order to diagnose the histology of small liver tumors, ultrasonically guided aspiration cytology has been generally accepted as a reliable procedure. However aspiration cytology made correct diagnoses in about half the tumors which could not be predicted with any other diagnostic modalities. Among hepatomas less than 2 cm in diameter, those due to low grade malignancy hepatocellular carcinomas are very common (33%). Needle biopsy of the tumor is therefore indispensable.

Carcinoma, Hepatocellular↗
PubMed1983

Hepatocellular carcinoma. A clinical and pathologic analysis of 57 hepatectomy cases.

The following is a clinicopathologic analysis of 57 hepatectomy cases of hepatocellular carcinoma (HCC). The rates of complication from precirrhosis and cirrhosis were 33.3% each. Cirrhosis seemed to have preceded HCC in 13 cases (39.4%) and both diseases appeared to have developed simultaneously in 18 cases (54.5%). Growth patterns of HCC were related to histologic features of livers bearing HCC: HCCs occurring in normal livers were significantly larger in average tumor size than those occurring in cirrhotic livers (9.2 as compared to 4.7 cm) and tended to exhibit a microtrabecular growth pattern (83% of the cases), while HCCs occurring in cirrhotic livers were most commonly macrotrabecular (67%). The factors most significantly influencing survival were the smallness of removed liver and tumor, histologic grades, the presence of bile production, and the absence of satellite tumors and giant cells. The positivity rates of serum hepatitis B virus (HBV) surface antigen averaged 47.2% and the relation of HCC to the role of HBV in the pathogenesis of HCC was discussed.

Adult↗
PubMed1983

The inferior right hepatic vein: ultrasonic demonstration.

The inferior right hepatic vein (IRHV) was demonstrated sonographically in 27 out of 269 patients (10%). It was shown to be thicker than the right hepatic vein in 8 (3%). In 2 patients, two accessory right hepatic veins were demonstrated, with one being the IRHV and the other the middle right hepatic vein. Delineation of the IRHV is significant in hepatectomy, detection of tumor thrombus in hepatocellular carcinoma, Budd-Chiari syndrome, and dilatation of the intrahepatic bile ducts.

Bile Ducts, Intrahepatic↗