Biomedical subjects
Publications and source records attributed to M Makuuchi.
Hepatic artery thrombosis remains a significant cause of graft loss in liver transplantation. We describe a case with thrombosis of the middle hepatic artery that revascularized spontaneously. Close follow-up with duplex ultrasound enabled us to treat the patient promptly and successfully with anticoagulants and antibiotics.
Portal vein thrombosis remains a significant cause of graft loss in liver transplantation. A case with thrombosis at the anastomotic site is described. Close follow-up with ultrasound enabled us to treat the patient promptly and successfully with anticoagulants.
We describe a case of living donor liver transplantation where an intrahepatic portal vein embolism was detected by intraoperative ultrasonography after the completion of portal and arterial anastomoses. The recipient portal vein trunk was clamped and the ligature of the graft's right portal branch was released, thus maintaining the sole arterial supply. Backward flushing of the portal system was achieved, which removed the clot through the reopened right portal branch without the need for thrombectomy by Fogarty balloon catheter.
We describe a case of living donor liver transplantation with hepatofugal portal flow caused by acute cellular rejection. The reversed portal flow was corrected by splenectomy and ligation of the residual collateral veins. Hepatofugal flow causes ischemic damage to the graft, which does not normalize spontaneously. In this particular case, meticulous Doppler ultrasound examination and prompt response to reversed portal flow salvaged the graft.
Three cases of liver granuloma mistakenly diagnosed as metastases from breast cancer are described. No common cause for granuloma formation in the liver was evident among the patients. Although surgical intervention to obtain a definitive diagnosis may occasionally be necessary, care needs to be exercised in the preoperative diagnosis of liver tumors. The growth rate of the lesions may be an important factor to consider.
A case of hepatic angiomyolipoma and its imaging features are presented. Computed tomography of the liver showed a low-density mass without obvious fat. T1-weighted magnetic resonance images revealed a low-signal-intensity mass containing some tiny high-signal-intensity foci. One of the high-signal-intensity foci was found by histology to represent the fat component of the tumor.
We report a case of ischemic cholangitis that occurred after transcatheter hepatic arterial chemoembolization (TAE). Ten months prior to TAE the patient had undergone central bisegmentectomy for hepatocellular carcinoma with resection of the extrahepatic bile duct. Eleven days after TAE, he developed suppurative cholangitis and multiple organ failure. Prior surgical ligation of the peribiliary arteries around the extrahepatic bile duct followed by TAE was considered to have played a crucial role in the development of ischemic cholangitis. This case demonstrates the importance of blood flow from the peribiliary arteries for the survival of the biliary epithelium.
Ultrasonically guided percutaneous transhepatic cholangiography (UG-PTC), bile drainage (UG-PTBD) and gallbladder drainage procedure (UG-PTGBD), developed by us, were performed in 47, 183 and 36 patients, respectively. In 47 patients UG-PTC was successfully performed 51 times without complications. By UG-PTBD 220 intubations were carried out successfully and four attempts failed (1.8%). The main complication was that the catheter slipped out from the bile duct. It was experienced 27 times (12.3%) in 23 patients (12.4%) from two to 47 days after intubation. UG-PTGBD was successfully performed 36 times. Bleeding from the catheter was experienced in four patients. However, other complications such as cholascos were not experienced. Due to the development of ultrasonic diagnosis and the UG-PTBD procedure, the indications for percutaneous transhepatic cholangiography (PTC) are now limited. For differentiation of jaundice, ultrasonic examination takes over from PTC. For preparation of PTBD, thin needle cholangiography is no longer necessary because UG-PTBD is a single-step procedure without the need for cholangiography. Therefore, the indication for PTC is limited to patients with partial dilatation of intrahepatic bile ducts without jaundice, for example when only the left hepatic duct is dilated due to hepatolithiasis.
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A rapidly growing hepatic hemangioma was observed in a 40-year-old woman during the follow-up period of 1.5 years. Contrast enhanced CT and angiography performed 3.5 years prior to and at the time of operation were compatible with hemangioma, but the diameter of the mass changed from 4.6 to 7.2 cm during this period. The pathogenetic reason for this rapid growth was unclear at the time of resection.
We report a patient with a rare cystic hepatic tumor that was demonstrated as a high density mass by unenhanced CT and as a cystic mass with high echoic spots by ultrasonography. At surgery, the tumor was a unilocular cyst containing viscid tan fluid. Histopathologically, it was lined by ciliated epithelium and diagnosed as ciliated hepatic foregut cyst. We discuss the correlation between radiological imaging and content of the cyst.
In three patients with colon cancer and liver metastases who had received intra-arterial chemo-infusion of fluorouracil (5FU) and mitomycin C and/or cis-diamminedichloroplatinum (CDDP), intrahepatic portal vein thrombosis (PVT) was incidentally demonstrated by computerized tomography (CT) 6, 1 and 7 months respectively after the cessation of administration of anti-cancer agents. One patient developed complete PVT in the whole liver as shown by follow-up CT 6 months after a diagnosis of pre-existing sclerosing cholangitis, and died from rupture of oesophageal varices. In the remaining two patients, PVT was found incidentally by follow-up CT in the right portal vein (Case 2) and the right anterior portal vein (Case 3) respectively; it spontaneously recanalized in Case 2 and was still present in Case 3 2 months later. PVT seems to be one of the complications of hepatic arterial chemo-infusion and its possibility must be borne in mind in such patients, even though the exact interval between the arterial chemo-infusion and occurrence of PVT could not be determined.
The results of hepatectomy, percutaneous ethanol injection therapy and transcatheter arterial embolization for small hepatocellular carcinoma (HCC) of 3 cm or less in diameter from the published literature were compared with the authors' experiences with surgical treatment. The survival rates for those treated by hepatectomy and ethanol injection were almost the same, being more than 90% at 1 year and 70% at 3 years. The overall results achieved by embolization were inferior to those achieved by the other two therapeutic modalities, although the 1 year survival rate was not worse. The cancer-free survival rates after hepatectomy and ethanol injection were also similar. Most of the patients with small HCC had associated liver cirrhosis or chronic active hepatitis, but the degree of liver dysfunction and the level of hepatic reserve varied. Anatomically, the number, size, and location of the cancer also varies. Choice of treatment for small HCC should be made based upon the degree of liver function and the anatomic status of the cancer. For example, a patient with multiple (more than four) cancer nodules is a good candidate for embolization. Ethanol injection is indicated for a small HCC, deeply seated in a severely diseased liver. Hepatectomy is the first choice for a small HCC situated near the surface of a liver with relatively good liver function.
The aim of the present study was to investigate whether the rate of thymidylate synthetase inhibition (TSIR) and the rate of proliferating cell nuclear antigen expression (PCNA-R) in gastric cancer tissues, which can be obtained within a short period after surgery, were predictive and quantitative prognostic factors for locally advanced gastric cancer patients with preoperative down-staging chemotherapy. Curatively resected 30 locally advanced gastric cancer patients with preoperative chemotherapies were studied. Three-year survival analysis showed that the higher TSIR and the lower PCNA-R significantly predicted better prognosis (p < 0.01 and p < 0.05, respectively). Multiple regression test showed that the TSIR was a significantly predictive variable for 1-year survival (p < 0.05). The TSIR and PCNA-R could be predictive and quantitative prognostic factors in advanced gastric cancer patients who received preoperative downstaging chemotherapy.
OBJECTIVE: To demonstrate the efficacy of Zamboni's solution and storage medium for immunocytochemistry of Ki-67, p53 tumor suppressor gene product and CD3 on long-preserved, air-dried cytologic specimens. STUDY DESIGN: Air-dried imprint cytologic specimens obtained from 13 lymphatic tissues and 13 colorectal cancers were fixed with Zamboni's solution and stored for various periods in storage medium including 50% glycerol at -10 to -20 degree C. Mouse monoclonal antibody PC, PAb 1801 and anti-Leu-4 were used for immunostaining. RESULTS: Immunocytochemical identification of Ki-67, p53 and CD3 was possible on specimens stored for 36, 32 and 16 weeks, respectively. CONCLUSION: Our method, using Zamboni's solution and storage medium, is feasible for immunocytochemistry on long-preserved, air-dried cytologic specimens using the three antibodies were employed.
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