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Biomedical subjects

M Makuuchi

Publications and source records attributed to M Makuuchi.

At least 469 records · Page 26Linked to original sources
PubMed1983

Ultrasonic characteristics of the small hepatocellular carcinoma.

Fifty five small hepatocellular carcinoma less than 5 cm in diameter among 41 patients were examined by linear arrayed electronic scanning system with 3.5 MHz transducer. Characteristics of the sonogram were enhanced posterior echoes of the tumor, mosaic pattern of internal echoes, halo and lateral shadows. These findings are appeared in 69%, 64%, 35% and 22% of tumors respectively. Among 45 tumors from 2.1 cm to 5 cm in diameter, these findings are appeared in 81%, 73%, 40% and 24% respectively. Among 10 tumors less than 2 cm in diameter, these characteristics were rare and these minimal hepatocellular carcinomas were demonstrated as a simple low echo area. Fifty tumors in 39 patients were resected. Lobulation of the hepatocellular carcinoma on the cut surface of the resected specimen and mosaic pattern on the sonogram are closely connected with each other. Thin fibrous capsule of the hepatocellular carcinoma corresponded to halo and lateral shadows. Posterior echo enhancement was due to the softness of the hepatocellular carcinoma. By those four characteristics, hepatocellular carcinoma can be differentiated from hemangioma and metastatic liver tumor.

Carcinoma, Hepatocellular↗
PubMed1983

Intraoperative ultrasonic examination for hepatectomy.

Intraoperative ultrasonic examination (IUE) was performed on 118 patients who were laparotomized for hepatectomy with five types of specially designed real-time linear array transducers. Many lesions which were invisible and nonpalpable from the surface of the liver were present in 58% of patients. All these lesions were detected by IUE. Among 16 tumors in 13 patients, IUE demonstrated 11 tumor thrombi (69%). By angiography, definite and equivocal diagnosis was made only in six tumor thrombi. Systematic subsegmentectomy was performed in 41 cases. The new concept of partial hepatectomy was accomplished by IUE. IUE is an indispensable operative procedure for hepatectomy.

Carcinoma, Hepatocellular↗
PubMed1983

[Development on segmentectomy and subsegmentectomy of the liver due to introduction of ultrasonography].

Due to introduction of preoperative and intraoperative ultrasound into liver surgery, three dimensional structure of the liver is understood much better than before. Intraoperative sonography demonstrated many daughter nodules and tumor thrombi which were not detected preoperatively. Therefore, a part of noncurative resection of the liver can be avoided. In patients with liver cirrhosis and small hepatoma, 60 per cent of hepatomas could not be visible nor palpable from the surface of the liver. In these patients, if hepatic lobectomy is performed, liver dysfunction will develop after surgery. Therefore, small partial resection is indicated and identification of site of the tumor is indispensable. With intraoperative sonography, all invisible and nonpalpable tumors in the liver were demonstrated. Clinicopathological studies of the hepatocellular carcinoma suggest that the tumor cells spread in the liver through the portal venous branches even in the small hepatocellular carcinoma. Daughter nodules will grow in the distal region of the portal venous branch. Therefore, total resection of the subsegment which contains the tumor is indicated. For this purpose, systematic subsegmentectomy is considered. In this operation, portal area containing tumor is identified by ultrasonically guided puncture of the portal venous branch. By identification of the inferior right hepatic vein, the right postero-inferior area can be preserved, even if right hepatic vein is resected. This type of hepatectomy is called inferior right hepatic vein preserving operation. We already performed this operation in three patients.

Carcinoma, Hepatocellular↗
PubMed1983

Ultrasonographic diagnosis and drainage in noncalculous acute cholecystitis following surgery.

Postoperative acute cholecystitis is not so rare complication especially in postgastrectomy patients. Ultrasonic examination is the most suitable means of identifying postoperative acute cholecystitis. 24 patients were diagnosed as postoperative acute chlecystitis mainly by ultrasonic examination. The majority of cases recovered only by conservative treatment. Clinically severe cases are particularly indicated for ultrasonically guided percutaneous transhepatic gallbladder drainage. Moreover, patient with postoperative acute cholecystitis are considered to require follow-up studies after recovery.

Adult↗
PubMed1983

[Significance of major hepatectomy for metastatic liver malignancy].

Major hepatectomies for 24 metastatic liver tumors including 13 of colo-rectum origin were performed. The cumulative survival rate in 23 cases excluding one case of operative death is 67.4%, 44.3% and 29.1% for 1, 3 and 5 year, respectively. The significant difference was observed in survival rate between H1(n = 16) and H2 - 3 (n = 7). In colo-rectum origin group the survival rate of solitary H1 was better than that of multiple H1 significantly. The Japanese Colon Cancer Research Meeting reported the relative survival rate of 33 cases of H1 colo-rectum origin including 2 of hepatectomized cases. The survival rate of the present 11 hepatectomized cases in the same category is significantly better than that in the report of Colon Cancer Research Meeting, which shows utility of hepatectomy for H1 metastatic tumor. Although in H2 - 3 group 5 of 7 cases died within one year after hepatectomy, 2 particular cases survived 22 months and 57 months. The primary lesions of these two were leiomyosarcoma of the jejunum and carcinoid tumor of the lung. The indication for major hepatectomy for metastatic liver malignancy is the tumor of H1, especially solitary and the slow growing or some kind of functioning tumor.

Adult↗
PubMed1980

Sonographic differentiation between the umbilical portion of the left portal vein and intrahepatic bile ducts.

The method of differentiating between the portal vein and the bile ducts by means of their intrahepatic portions was studied. The left branch of the portal vein courses horizontally as the transverse portion, then veers anteriorly at an acute angle to make the umbilical portion. This characteristic form was demonstrated in all normal controls and 95% of the jaundiced patients studied. The left hepatic duct does not curve anteriorly at an acute angle, but branches off to the lateral segment running superior to the umbilical portion. This anatomic relationship and characteristic form of the umbilical portion were useful in differentiating the portal vein and the bile ducts.

Bile Ducts, Intrahepatic↗
PubMed1980

Ultrasonically guided percutaneous transhepatic cholangiography and percutaneous pancreatography.

Ultrasonically guided percutaneous transhepatic cholangiography and percutaneous pancreatography were successfully performed in a patient with periampullary carcinoma. The entire biliary tree, including the dilated pancreatic duct, was visualized on both occasions. The techniques used are described, and the clinical significance of ultrasound as a guide in percutaneous puncture is discussed.

Aged↗
PubMed1980

Ultrasonically guided percutaneous transhepatic bile drainage: a single-step procedure without cholangiography.

Percutaneous transhepatic bile drainage under real-time ultrasonic guidance was performed in 16 patients (21 procedures) without cholangiography. All bile ducts were successfully intubated. Merits of ultrasonically guided percutaneous transhepatic bile drainage are (a) the fact that only a single step is involved, without thin-needle cholangiography; (b) no contrast medium is injected; (c) the left-sided approach permits longer intubation; and (d) irradiation is not employed.

Bile↗
PubMed1978

Echo guided percutaneous transhepatic cholangiography with puncture transducer.

Conventional percutaneous transhepatic cholangiography (PTC) has some disadvantages because it is customarily performed blindly. If the bile duct is made visible, these disadvantages are eliminated. The biliary tree, if dilated, can be clearly delineated by ultrasound technique. By combining the B-mode examination of the biliary tract with the ultrasonic puncture transducer, percutaneous transhepatic cholangiography was performed successfully in 16 examinations on 12 patients. PTC needle could be inserted directly into the lumen of the bile duct without appreciable difficulty. The echo guided PTC was found to be an easier, safer, and more reliable method than the conventional blind technique.

Aged↗
PubMedDate not supplied

Surgery for small liver cancers.

During the last 16 years, we have resected small hepatocellular carcinomas (HCCs) measuring 5 cm or less from 362 patients, 266 of whom also had liver cirrhosis. The operative and hospital mortality rate were 1.7% and 1.9%, respectively. These showed a gradual decrease year by year in parallel with reduction of intraoperative blood loss achieved by the selective vascular occlusion technique and Pringle method. In 1989, 87% of hepatectomy patients were discharged without the need for whole blood transfusion, and 5-year survival was 43.7%. Tumor size, number of tumors, intrahepatic metastasis, vascular invasion, and capsular invasion were significant prognostic factors. Edmondson grade and the operative procedure employed were significantly related to outcome. Our standard policy for selection of operative procedures and perioperative care is described, and the selection of treatment modalities is discussed.

Adult↗
PubMedDate not supplied

Results of hepatic resection for hepatocellular carcinoma.

The results of 122 hepatic resections in 112 patients with hepatocellular carcinoma are described. The type of liver resection performed was selected according to the patient's liver function. Forty-nine patients underwent anatomic resections, including 1 trisegmentectomy, 5 lobectomies, 11 segmentectomies, and 32 subsegmentectomies; the remaining 63 patients had nonanatomic resections. The 1-, 2-, and 3-year survivals after liver resection for all patients, taking into account one operative and one hospital death (0.9% each), were 92.4%, 85.0%, and 78.9%, and disease-free survivals at 1, 2, and 3 years were 68.6%, 46.2%, and 32.6%, respectively. Twenty-one repeat hepatic resections (17.2% of the total of 122 resections) were performed with no hospital mortality. Cumulative survival from the time of repeat hepatectomy in these 21 patients was 84.2% and 56.3% at 1 and 2 years, respectively. Among the factors that may affect survival or disease-free survival, the absence of vascular invasion (p < 0.05) and intrahepatic metastases (p < 0.01) were significantly related to the disease-free survival time. A good outcome was obtained after liver resection in 112 patients with hepatocellular carcinoma through appropriate choice of the type of resection, careful follow-up, and a vigorous surgical approach for recurrence.

Adult↗
PubMedDate not supplied

Central bisegmentectomy of the liver: experience in 16 patients.

Fourteen patients with hepatocellular carcinoma and mild to moderate liver dysfunction and 2 with metachronous liver metastases from rectal cancers underwent central bisegmentectomy of the liver, i.e., en bloc removal of the left medial and right anterior segments. One patient who had undergone preoperative liver artery embolization died in the hospital. Four patients survived without relapse 60-135 months postoperatively. Eleven patients had recurrent tumors, all in the liver remnant, and 2 also had recurrent tumors in the lungs. Six patients who relapsed died 28-93 months postoperatively. Four were alive with disease at 7-89 months, 1 after a second liver resection 54 months after central bisegmentectomy. Six of the 16 patients survived for 5 years or more. The results are favorable for these advanced tumors, often in the presence of liver dysfunction. The indications, technique, and results are discussed.

Aged↗
PubMedDate not supplied

Restrictive versus liberal blood transfusion policy for hepatectomies in cirrhotic patients.

To evaluate the worth of intra- and postoperative blood transfusion in cirrhotic patients undergoing resection for hepatocellular carcinoma, we compared 13 patients receiving transfusions and 14 matched contemporary patients who did not receive blood. Preoperative hematological and biochemical parameters, the type and extent of liver resection, and the mean blood loss (862 and 870 ml) were similar in the 2 groups. The total volume of intra- and postoperative blood transfused ranged from 400 to 1,800 ml (mean, 1,223 ml) in the patients receiving transfusions. During various postoperative time intervals, the mean values of hematocrit, hemoglobin, serum total bilirubin, and lactic dehydrogenase activity were significantly higher in the patients who were transfused compared to those who were not. Mean serum transaminase activities were similar in the 2 groups at the same times. The mean hematocrit values decreased from 36.8% preoperatively to a postoperative minimum of 27.0% in the transfused group, and from 39.9% to 26.1% in the nontransfused group. Our experience and theoretical reasons have led us to withhold blood transfusion until the hematocrit values fall below 30% during hepatectomy and below 20% in the postoperative period (or unless circulatory instability cannot be corrected otherwise). Fresh frozen plasma is preferred for volume substitution and, if blood has to be given, only up to 60-70% of estimated losses should be replaced by fresh blood.

Adult↗
PubMedDate not supplied

Usefulness of intraoperative color doppler ultrasonography in decision making regarding conversion of an accessory hepatic vein after a Fontan-type operation.

An accessory hepatic vein (AHV) after a Fontan-type operation will result in progressive desaturation if left intact. We report a case in which intraoperative color Doppler ultrasonography revealed the absence of AHV flow and reversed portal vein flow when the AHV was clamped, suggesting that simple ligation of the AHV would lead to liver dysfunction in the area affected. Based on the results of the ultrasonography evaluations, diversion of the AHV into the pulmonary circulation was performed without cardiopulmonary bypass, and the clinical outcome has been favorable.

Adolescent↗