Biomedical subjects

M Makuuchi

Publications and source records attributed to M Makuuchi.

At least 523 records · Page 29Linked to original sources

PubMedDate not supplied

Appraisal of two-staged pancreatoduodenectomy: its technical aspects and outcome.

BACKGROUND/AIMS: Leakage from the pancreaticoenteric anastomosis after pancreatoduodenectomy is closely associated with intraabdominal hemorrhage, thus contributing to mortality. Recently, two-staged pancreatoduodenectomy including exteriorization of the pancreatic juice and second-look pancreaticojejunostomy was performed in high-risk patients. METHODOLOGY: The authors reviewed 24 patients who underwent two-staged pancreatoduodenectomy from November 1994 to April 1999. RESULTS: Oral intake could be instituted on the 6th (mean) postoperative day. In 23 of the 24 patients, the pancreatic juice leakage stopped within a mean of 10 days without any complications. In the remaining 1, the leakage lasted over 4 weeks and intraabdominal bleeding from the gastroduodenal artery occurred. The median interval between pancreatoduodenectomy and the second operation was 124 days (range: 93-323 days). In 15 patients, a stent tube was placed at the site of pancreaticojejunostomy: 1 patient developed acute pancreatitis due to dislocation of the stent tube, in 3, pancreatic juice leakage necessitated exteriorization of the juice, and the remaining 11 recovered uneventfully. In the other 9 patients, the pancreatic juice was exteriorized: 1 patient had leakage and the other 8 recovered uneventfully. Overall, there was no mortality. CONCLUSIONS: Our two-staged pancreatoduodenectomy is considered to make pancreatoduodenectomy performable safely without any mortality. This procedure is recommended for selected patients, including those who require concomitant major hepatectomy or resection of other organs or who have liver cirrhosis, and may be indicated for patients who have a soft and fragile pancreas or pancreatic trauma.

Evaluation Studies as Topic↗

PubMedDate not supplied

Thoracoabdominal approaches versus inverted T incision for posterior segmentectomy in hepatocellular carcinoma.

BACKGROUND/AIMS: The purpose of the present study was to clarify the indications for a thoracoabdominal right oblique approach and an inverted L incision in posterior segmentectomy of the liver for hepatocellular carcinoma. METHODOLOGY: Forty-six patients with hepatocellular carcinoma who underwent posterior segmentectomy with thoracotomy were divided into 2 groups according to the incision: thoracoabdominal right oblique incision (group A, n = 17) and inverted L incision (group B, n = 29). The perioperative factors of the patients in the 2 groups were compared retrospectively. RESULTS: No significant differences were found in the preoperative factors between the groups. However, a longer operation time (P = 0.01) and more blood loss (P = 0.02) were noted in group B. Although there was no significant difference between the groups in the overall morbidity rate (P = 0.36), a higher rate of pleural effusion was recognized in group A (P = 0.01). CONCLUSIONS: Thoracoabdominal right oblique incision may be suitable for use as an approach for posterior segmentectomy when manipulation of the left lobe is not required.

Adult↗

PubMedDate not supplied

Hepatocellular carcinoma followed by Waldenström's macroglobulinemia: a case report.

A case of hepatocellular carcinoma associated with Waldenström's macroglobulinemia is reported. During treatment and follow-up of hepatocellular carcinoma, a 54-year-old man was found to have a progressive monoclonal increase in serum IgM level and subsequently was diagnosed as having Waldenström's macroglobulinemia. Chemotherapy was carried out to prevent hyperviscosity syndrome due to Waldenström's macroglobulinemia without any surgical management for hepatocellular carcinoma. The association of these diseases is quite rare; only 6 cases have been reported in the literature, and this is the first case in which hepatocellular carcinoma preceded Waldenström's macroglobulinemia.

Blood Viscosity↗

PubMedDate not supplied

Technical dilemma in living-donor or split-liver transplant.

In partial liver transplantation for adults criteria for the extent of reconstruction of middle hepatic vein tributaries have not been clarified. After hepatic venous and portal anastomoses in living-donor liver transplantation using left liver graft without middle hepatic vein, color Doppler ultrasonography was applied to check venous and portal blood flow. Color Doppler ultrasonography demonstrated absent hepatic venous flow and reversed portal venous flow in the congested area of the left paramedian sector which had been drained by the divided branch of the middle hepatic vein. The area was darkly discolored before arterial reperfusion and under clamping of the artery. Reconstruction of the venous branch was added after arterial anastomosis. Color Doppler ultrasonography revealed restored normal venous outflow and portal inflow after venous reconstruction. Postoperative course of the recipient was uneventful with rapid recovery of liver function. We propose that middle hepatic vein tributaries should be reconstructed if color Doppler ultrasonography demonstrates absent venous flow and reversed portal flow, and if the liver volume excluding the discolored area under occlusion of the hepatic artery is estimated to be insufficient for postoperative metabolic demand.

Anastomosis, Surgical↗

PubMedDate not supplied

Alterations of retinoblastoma protein and p16INK4 protein expression in extrahepatic bile duct carcinomas.

BACKGROUND/AIMS: Human cancer development results from dysfunction of G1-phase regulators of the cell cycle. Retinoblastoma protein and p16INK4 are the most essential links between cell cycle control and cancer. We examined the expression of p16INK4 and pRb and their possible prognostic relevance in 34 extrahepatic bile duct carcinomas. METHODOLOGY: Expression of pRb and p16INK4 was determined using immunohistochemical techniques. Associations between expression of pRb and p16INK4 and the clinicopathological features were analyzed by using the chi 2 test and survival analysis was performed by Log-rank test. RESULTS: Two (6%) extrahepatic bile duct carcinomas were pRb negative, 26 (76%) showed pRb overexpression, and 6 (18%) demonstrated moderate expression. Twenty-two (65%) tumors were p16INK4 negative and 12 (35%) were p16INK4-positive. Cases with pRb-negative or pRb overexpression were significantly correlated with tumor progression (P = 0.004) and TNM stage (P = 0.009). Alterations in pRb and p16INK4 expression did not correlate with patient outcome. CONCLUSIONS: Alterations of pRb and p16INK4 expression are frequently involved in extrahepatic bile duct carcinomas, and that aberrant pRb expression significantly associates with tumor progression.

Adenocarcinoma↗

PubMedDate not supplied

Mass-forming inflammatory periductal fibrosis mimicking hilar bile duct carcinoma.

A case of a rare benign biliary lesion at the hepatic hilum mimicking hilar bile duct carcinoma is reported. A 73-year-old man was found to have gastric cancer by gastrointestinal fiberscopy. Dilated right intrahepatic bile ducts and a 2-cm mass in the right hepatic duct were demonstrated by further imaging investigations. He was finally diagnosed as having hilar bile duct and gastric carcinomas, and underwent right portal vein embolization followed by a single-stage extended right hepatectomy and total gastrectomy. Pathologically, however, the lesion in the right hepatic duct showed inflammatory changes with periductal fibrosis, without any signs of malignancy. A literature search revealed 11 such cases including the present one.

Aged↗

PubMedDate not supplied

Polymyositis as a paraneoplastic manifestation of hepatocellular carcinoma.

A case of hepatocellular carcinoma associated with polymyositis is reported. A 70-year-old man noticed muscular weakness mainly in the proximal limb muscles. The clinical course, a raised level of serum creatine kinase and electromyographic findings suggested polymyositis, and the pathological findings on muscle biopsy were compatible with this diagnosis. Computed tomography of the upper abdomen revealed a mass lesion in segment VII and VIII of the liver, which was diagnosed pathologically as hepatocellular carcinoma. The patient underwent systematic resection of segment VII and the dorsal part of segment VIII of the liver. After surgery, the weakness improved and the serum creatine kinase level normalized without medical treatment for the polymyositis. The relief of neurological symptoms and signs after complete resection of the tumor strongly suggests paraneoplastic polymyositis, which has been described only rarely in association with hepatocellular carcinoma.

Aged↗

PubMedDate not supplied

Peritoneal seeding of hepatocellular carcinoma after ethanol injection therapy.

The tumor seeding due to percutaneous ethanol injection therapy has been considered to be a very rare complication. Four cases of peritoneal seeding of hepatocellular carcinoma following percutaneous ethanol injection therapy are presented here. All patients had been initially treated for hepatocellular carcinomas with percutaneous ethanol injection therapy. Between 5 and 20 months after the percutaneous ethanol injection therapy, peritoneal seeding tumors were detected and resected surgically. Three patients recurred in the liver and one patient recurred in the abdominal cavity. Two died of cancer and 2 are still alive. The incidence of seeding following percutaneous ethanol injection therapy should not be so rare as considered referring to that due to fine needle biopsy, therefore careful attentions should be paid during the follow-up of those patients after percutaneous ethanol injection therapy.

Adult↗

PubMedDate not supplied

Liver transplantation using a right lateral sector graft from a living donor to her granddaughter.

One of the major concerns regarding living-related liver transplantation is graft-size disparity. The left liver graft is too small while the right is too large in some recipients. To overcome this problem, the right lateral sector (Segments VI and VII) was transplanted from a living donor (55 kg) to her granddaughter (17 kg). The common hepatic trunk had to be anastomosed end-to-end to the graft hepatic vein without being compressed by the graft overriding the vena cava and without unfavorable tension of the anastomosis. The anterior wall of the hepatic vein of the donor was resected as much as possible. The superficial left, left, middle and right hepatic veins of the recipient were made confluent by incision of the intervening venous walls, and the nicks were sutured to form a wide and long common venous trunk. The recipient received a graft corresponding to 75% of her standard liver volume. She was complicated with gastric dilation and acute rejection, but recovered with no signs of anastomotic stricture. Right lateral sector graft obtained by this innovative procedure may be useful for overcoming borderline graft-recipient size and shape differences.

Age Factors↗

PubMedDate not supplied

Drainage for acute pancreatitis.

In severe acute pancreatitis, the drainage of activated pancreatic enzymes, infectious substances and necrotic tissue from the abdominal cavity is critical, especially after the operation. We use Faycon drainage tubes together with multi-use feeding tubes. Just after the operation, normal saline is added through the feeding tube and the Faycon drainage tube is suctioned continuously. Irrigation is necessary for more than two weeks.

Acute Disease↗

PubMedDate not supplied

Lactate levels in cirrhotic patients undergoing liver resection.

BACKGROUND/AIMS: The role of lactate in liver ischemia-reperfusion injury in cirrhosis has not been clarified. METHODOLOGY: One hundred patients with hepatocellular carcinoma who underwent partial liver resection under Pringle's maneuver were included in this study. Blood lactate was measured before the operation, three times during the surgery and on the first postoperative day to calculate its rate of accumulation or elimination. Aminotransferase levels were also recorded perioperatively. We calculated the rate of lactate accumulation during the pre-ischemic and ischemic phases and the elimination rate during the post-ischemic phase, and examined the correlation between these results and the clinical findings. RESULTS: The rate of lactate accumulation during the pre-ischemic and ischemic phases was correlated with the preoperative indocyanine green retention rate (P = 0.04 and P = 0.004, respectively). The indocyanine green retention rate tended to be correlated with the rate of lactate elimination during the post-ischemic phase (P = 0.06). CONCLUSIONS: The blood lactate profile might be a reliable indicator of liver function during the perioperative period in cirrhotic patients who undergo liver resection with Pringle's maneuver.

Adult↗

PubMedDate not supplied

Inflammatory pseudotumors of the liver: prevalence and clinical impact in surgical patients.

BACKGROUND/AIMS: Progress in diagnostic imaging has increased the number of focal liver lesions detected and reports of an occasional finding of inflammatory pseudotumors of the liver are becoming numerous. To estimate their prevalence and clinical impact in surgical series we evaluate retrospectively our experience. METHODOLOGY: Four hundred and three patients carriers of a total of 717 focal liver lesions underwent liver resection consecutively in our Department from October 1995 to August 1999. All these patients underwent surgery. RESULTS: After surgical resection, 3 patients each proved to be carrying an IPT nodule accounting for 0.7% of all patients and 0.4% of all focal liver lesions. One inflammatory pseudotumor was only disclosed intraoperatively in a patient with an hepatocellular carcinoma. The other 2 accounted for 20% of the patients whose preoperative diagnoses were wrong. The operative procedures for the inflammatory pseudotumor nodules were: wedge resection, because the inflammatory pseudotumor was considered a new malignancy, a limited resection and a left extended hepatectomy with bilioenteric anastomosis, distal gastrectomy and lymphoadenectomy in one patient each. Inflammatory pseudotumors accounted for 33% of wrong indication for surgery. CONCLUSIONS: Our experience shows that, despite the low prevalence of hepatic inflammatory pseudotumors, their impact in the appropriate management of patients with focal liver lesions is not irrelevant.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Ventral dissection of replaced right hepatic artery during pancreatoduodenectomy.

A novel technique for dissecting a replaced right hepatic artery during pancreatoduodenectomy in patients with middle or lower bile duct carcinoma is presented. After skeletonizing the left, proper, common hepatic arteries and the portal vein, the replaced right hepatic artery is dissected from the ventro-medial side of the hepatoduodenal ligament by severing the thin connective tissue behind the portal vein. Thus the hepatic arteries and the portal vein are completely isolated without the Kocher maneuver, leaving the cancer and the bile duct untouched en bloc with the surrounding lymph nodes and the pancreas head. The periaortic lymph nodes can also be resected en bloc with the main lesion.

Bile Duct Neoplasms↗

PubMedDate not supplied

Comparison of continuous versus intermittent hepatic pedicle clamping in an experimental model.

BACKGROUND/AIMS: The tolerance of the liver to ischemia obtained with intermittent clamping of the hepatic pedicle or continuous Pringle maneuver was tested. METHODOLOGY: Ninety rats were divided into three groups undergoing total duration of clamping ischemia of 60, 90, and 120 min. Each group of rats were subdivided to receive continuous Pringle maneuver, 30-min or 15-min intermittent clamping. The clamp release time between the periods of liver ischemia was 5 min. Survival at 7 days and postoperative changes of liver function (transaminase enzymes, bilirubin, and adenosine-5'-triphosphate levels (hepatocellular damage index) were recorded. RESULTS: Intermittent clamping of the hepatic pedicle was better tolerated than the continuous clamping method. With continuous clamping the rat survival rates inversely correlated with the duration of ischemia. Survival rates at 15-min and 30-min intermittent ischemia groups were significantly higher than in the continuous clamping group. CONCLUSIONS: This data suggest that when the Pringle maneuver is adopted, it should be applied intermittently rather than continuously.

Animals↗

PubMedDate not supplied

Restoration of portal vein flow by splenorenal shunt ligation and splenectomy after living-related liver transplantation.

We describe here a case of living-related liver transplantation with a spontaneous splenorenal shunt. On the third postoperative day, Doppler ultrasound follow-up revealed impairment of intrahepatic portal vein flow and reoperation was performed. Intraoperatively, simple compression of the collateral veins forming the splenorenal shunt resulted in an immediate change in the portal flow pattern, which suggested the absence of a portal thrombus. Splenectomy and ligature of the more dilated collateral veins were carried out and satisfactory portal flow was restored. Although the role of splenectomy was controversial, splenectomy provided an increased portal vein flow in the present case. The uneventful postoperative course validated our decision.

Adult↗

PubMedDate not supplied

[Segmentectomy under echographic control on cirrhotic liver].

Hepatectomy for liver cell carcinoma in cirrhosis patients requires peroperative echographic control. Basel on their experience at the National Cancer Center Hospital in Tokyo (more than 500 hepatectomies of cirrhosis livers), the authors describe the advantages of peroperative echography and surgical techniques of various segmentectomy procedures.

Carcinoma↗

PubMedDate not supplied

[Hepatectomy for hepatocarcinoma on a cirrhotic liver: decision plans and principles of perioperative resuscitation. Experience with 204 cases].

Among more than 450 hepatectomies performed in the National Cancer Center Hospital of Tokyo from the beginning of 1977 to the end of 1986, 204 were performed for excision of an hepatocarcinoma on cirrhotic liver. The post-operative mortality (determined until the exit of the patient out of the hospital) was 7.8%. It was rather high at the beginning (20% of the first 30 cases) and progressively decreased with experience, to be only 2.8% of the last 70 cases. According to this experience the authors recommend a decisional diagram which appreciate the quantity of functional liver parenchyma which must be resected (depending on the tumor's characteristics) and the quantity of functional liver parenchyma which can be resected without major operative risk (depending on the gravity of the cirrhosis). They expose their attitude with oesophageal varix, the operative techniques and the peri-operative cares they have trained to decrease dramatically the post-operative complications.

Adult↗

PubMedDate not supplied

Function-preserving segmentectomy of the cirrhotic liver.

BACKGROUND/AIMS: A cirrhotic case of hepatocellular carcinoma (HCC) complicating portal vein tumor thrombi which underwent posterior segmentectomy with anterior portal venoplasty is reported. MATERIALS AND METHODS: The HCC originated in the right posterior segment and grew intraluminally up to the right portal vein, and the laboratory data indicated a presence of severe cirrhosis. The operative procedure undertaken consisted of internal shunting of the portal blood stream by mesentero-umbilical bypass, resection of the posterior segment and the anterior portal venous root, and reconstruction of the anterior portal branch by patch grafting. RESULTS: This operation produced no distinct complications, and it was defined pathologically as being curative. CONCLUSION: The case here introduces rationale of this modified hepatic segmentectomy in view of functional preservation of the residual cirrhotic liver.

Carcinoma, Hepatocellular↗