Biomedical subjects

M Makuuchi

Publications and source records attributed to M Makuuchi.

At least 541 records · Page 30Linked to original sources

PubMedDate not supplied

Biliary stricture due to mucosal hyperplasia of the common bile duct: a case report.

A 71-year-old man with a tumorous lesion of the common bile duct is presented. Although histological examination of tumor biopsy specimens taken at the time of duodenoscopy or percutaneous transhepatic choledochoscopy showed mucosal hyperplasia, cancer could not be ruled out; therefore, the patient underwent pancreatoduodenectomy. However, histology showed nodular mucosal hyperplasia and an ectopic pancreas adjacent to the papilla of Vater, which was suspected to have contributed to the development of the lesion by stimulating the mucosa of the papilla and the distal common bile duct.

Aged↗

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Duct-ectatic type of mucin producing tumor of the pancreas--new concept of pancreatic neoplasia.

BACKGROUND/AIMS: Although there have been recent reports of mucin-producing tumor of the pancreas, there has been no thorough clinicopathological analysis of a large number of cases. MATERIALS AND METHODS: Two hundred forty four cases of mucin-producing tumor of the pancreas from Japanese, European and American reports, together with 15 cases of our own, were analyzed clinicopathologically. RESULTS: Mucin-producing tumor of the pancreas was found in 177 males and 82 females (M:F = 2.2:1). The mean age was 65.5 years. Jaundice, diabetes mellitus and a past history of pancreatitis were found in 15%-19% of the cases. The tumor was most frequently (62%) found in the head of the pancreas. Pathologically, hyperplasia or adenoma was found in 58 cases, and adenocarcinoma in 160 cases. Five-year-survival rate by the Kaplan-Meier method was 82.6% in all of the cases and postoperative survival curve was much better in cases with this type of carcinoma than in cases with ordinary pancreatic duct cell carcinoma (5-year-survival rate: 82.6% vs 17.3%). Serum tumor markers such as CEA or CA 19-9 were not effective in differentiating between benign and malignant, or in determining the degree of cancerous spread, while cytology of the pancreatic juice and biopsy of the tumor could contribute to the diagnosis. CONCLUSIONS: Mucin-producing tumor has unique clinicopathological characteristics, such as the dilated main pancreatic duct or branches, dilatation of the orifice of the papilla of Vater, or good prognosis. Since a diagnosis for benign or malignant is very difficult in some cases, methods for distinguishing benign from malignant lesions or for determining cancerous spread, such as molecular biological techniques, should be established.

Adenocarcinoma, Mucinous↗

PubMedDate not supplied

Hepatoid adenocarcinoma of the stomach: a case report.

A patient with primary gastric carcinoma showing a high level of serum a-fetoprotein (AFP) (368 ng/ml) is described. Subtotal gastrectomy was performed, and a month after surgery the level of serum AFP fell rapidly to within normal limits. Histologically, two types of cells coexisted in the tumor: medullary-type cells resembling trabecular-type hepatocellular carcinoma, and moderately differentiated adenocarcinoma cells. The cells of the former type were arranged mostly in a trabecular pattern with bile granules, but also showed a scirrhous pattern in a restricted area. Immunohistochemistry demonstrated that both types of tumor cells stained positively for AFP. This tumor, which should be classified as a hepatoid adenocarcinoma of the stomach, is of interest because of its rarity, bile secretion (indicating marked differentiation toward a hepatocyte form), and two cellular arrangements-trabecular and scirrhous.

Adenocarcinoma↗

PubMedDate not supplied

Portal tumor thrombi due to gastric cancer.

A patient with a primary gastric carcinoma complicated with a tumor thrombus in the portal vein is described. Pancreatoduodenectomy with tube pancreatostomy was performed. The location and size of tumor thrombi in the portal vein could be determined accurately by intraoperative ultrasonography and removed with the wall of the portal vein and superior mesenteric vein. There was no evidence of recurrence one year after the operation. Tumor thrombus in the portal vein in gastric cancer is rarely reported and has a poor prognosis. If there is no associated liver metastasis, aggressive surgical approach followed by appropriate chemotherapy may prolong the life of the patient.

Adenocarcinoma↗

PubMedDate not supplied

Subtotal resection of the head of the pancreas preserving duodenum and vessels of pancreatic arcade.

We reported a procedure of duodenum-preserving subtotal pancreatectomy of the pancreas according to the precise anatomy of the pancreatoduodenal region, especially of the pancreaticoduodenal arteries which provide blood to the duodenum. After a complete Kocher's maneuver is performed, the pancreas is cut above the portal vein and removed from the third portion of the duodenum, followed by the removal of the posterior surface of the pancreas head from a connective tissue membrane. The main pancreatic duct is identified at its junction with the terminal portion of the bile duct from the posterior surface of the head of the pancreas and is cut at the junction. The pancreas is cut in the line of the ASPD. The reason we leave the part of the pancreas between the auodenum, ASPD and the common bile duct is that the artery toward the papilla of Vater runs along the right side of the common bile duct and would be difficult to be preserved with the removal of this part of the pancreas. The most important techniques of this procedure is to keep the connective tissue membrane of the posterior surface of the pancreas intact so as to preserve pancreaticoduodenal arteries and veins. Benign lesions as well as lowgrade malignancy of the head of the pancreas may be possible indications for this procedure.

Angiography↗

PubMedDate not supplied

Reconstruction of the inferior vena cava using a hepatic venous patch obtained from resected liver.

A 59-year-old woman with a 3 cm liver metastasis from rectal cancer underwent an extended right hepatic lobectomy with partial resection of the wall of the inferior vena cava. The metastasis was located behind the roots of the right and middle hepatic veins and involved the inferior vena cava. For reconstruction of the inferior vena cava, the intrahepatic middle hepatic vein, 2.5 cm in length, which was distant from the metastatic lesion, was removed from the resected liver. Then divided longitudinally to prepare a venous patch of 2.5 by 2.0 cm in size and applied to the defect. This technique facilitates reconstruction of the inferior vena cava without sacrificing other veins.

Female↗

PubMedDate not supplied

Appleby operation for carcinoma of the body and tail of the pancreas.

Long-term survival of carcinomas in the body and tail of the pancreas after surgery is still rare. One of the major reasons for unresectability is cancerous invasion to major vessels, such as the common hepatic and splenic arteries. Resection of the involved arteries can increase resectability and thus might increase post-operative survival. The aim of this study was to clarify the importance of the Appleby operation for carcinoma of the body and tail of the pancreas. A Case Report was carried out with a 54 year-old man, had suffered back pain and loss of body weight for six months. Imaging procedures such as US, CT or angiography showed a carcinoma in the body of the pancreas, about 3 cm in size, and both the common hepatic and splenic arteries were invaded by the tumor. The Appleby operation was used for this patient, since firstly there was no invasion to the head of the pancreas, secondly neither the proper hepatic artery nor the SMA was involved, thirdly the root of the CA was free of carcinoma, and finally because clear pulsation of the proper hepatic artery could be felt one or two minutes after occlusion of the CHA, which indicated that resection of the CHA would not lead to hepatic ischemia. The postoperative course was uneventful. His appetite recovered well and his body weight increased to the level before the disease. The patient was relieved from back pain and has returned to work 18 months after the operation, although he had a local recurrence eight months after the operation. In addition, eleven cases with carcinoma of the body and tail of the pancreas were used for a literature review. The average survival time after the Appleby operation is 6.6 months, and four patients are still alive. One patient has survived 13 years after the operation. It was concluded that although the prognosis after Appleby procedure is still not satisfactory that this operation can at least offer patients a better quality of life.

Back Pain↗

PubMedDate not supplied

Long-term survival after surgery for advanced intrahepatic cholangiocarcinoma: a case report.

Intrahepatic cholangiocarcinoma has a tendency to disperse intrahepatically and extrahepatically, therefore, resectability is limited and prognosis is generally poor. A 68-year-old female was diagnosed as intrahepatic cholangiocarcinoma in the right lobe based on systematic images including computed tomography, magnetic resonance imaging, ultra-sonography, endoscopic retrograde cholangiography, angiography, chest X-ray, as well as laboratory data. Tumor invasion to the right diaphragm, lung and chest wall was suspected pre-operatively. After pre-operative portal embolization, extended right hepatectomy with partial resection of the involved organs including diaphragm, lung, and chest wall was done en bloc. The patient made an uneventful postoperative recovery and there has not been any evidence of recurrence at present, over four and a half years after surgery. Experience in the present case indicates that radical surgery may be a potential approach to yield a hopeful outcome for patient with intrahepatic cholangiocarcinoma, even if the tumor invades adjacent organs directly.

Aged↗

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Hepatectomy for metastatic renal cell carcinoma.

The experience with hepatectomy for metastatic renal cell carcinoma (RCC) has been very rarely reported, because multiple organ metastases ordinarily coexist when hepatic metastases are found out. Three patients who underwent hepatectomy for metastatic RCC are presented here. Radical nephrectomy was performed for the primary renal lesions in all the patients, and their hepatic metastases were resected simultaneously in one of them with a solitary tumor, and about one month later in two of them with multiple (3 and 6) tumors. These operations produced no distinct complications. The patients with 1 and 3 hepatic metastatic lesions survived without tumor recurrence for 12 and 21 months, respectively, while the patient with 6 hepatic metastatic lesions had tumor-free interval of only 2 months and died 10 months after hepatectomy due to lung metastasis. Hepatectomy may be the only promising treatment for hepatic metastases from RCC, but the indication for surgery should be evaluated according to the number of hepatic metastases.

Carcinoma, Renal Cell↗

PubMedDate not supplied

Extended right trisegmentectomy for hilar bile duct carcinoma.

Extended right trisegmentectomy with total caudate lobectomy, extrahepatic bile duct resection and lymphadenectomy was performed for a 54-year-old man, who was diagnosed as type IV hilar bile duct carcinoma. After division of the right portal vein and all the portal venous branches to the caudate lobe and the left medial segment, the left hepatic artery and its branches to the segment II and III were dissected from the corresponding bile ducts to about 1 cm beyond the left margin of the umbilical portion of the left portal vein, where the lateral segmental bile ducts were divided after transection of the hepatic parenchyma. All bile duct margins were free from cancer microscopically. To our knowledge this is the first report of extended right trisegmentectomy for hilar bile duct carcinoma, in which the bile ducts of the left lateral segment are divided at the left side of the umbilical portion of the left portal vein. This technique facilitates making the intrahepatic bile duct stumps free from cancer. However, its impact on long-term survival remains to be determined.

Bile Duct Neoplasms↗

PubMedDate not supplied

Comparison between thoracoabdominal and abdominal approaches in occurrence of pleural effusion after liver cancer surgery.

BACKGROUND/AIMS: Pleural effusion is a complication occasionally encountered in hepatic surgery. The production of pleural effusion was compared between thoracoabdominal and abdominal approach for hepatic surgery of hepatocellular carcinoma. METHODOLOGY: All the 98 patients undergoing liver resection for hepatocellular carcinoma at the National Cancer Center Hospital from May 1992 to March 1994 were included into the study, of those 70 were by the thoracoabdominal and 28 by the standard abdominal approach. Comparisons were made in regard to the rate of pleural effusion, the rate of postoperative thoracentesis, the number of postoperative thoracentesis procedures per patient, the total volume of pleural effusion obtained by thoracentesis per patient, and the duration of pleural effusion. RESULTS: Forty-three percent of patients treated with the abdominal approach in contrast to 73% of patients treated with the thoracoabdominal approach developed pleural effusion (p < 0.01). Seven percent of the patients treated with the abdominal approach in contrast to 17% of the patients treated by the thoraco-abdominal approach required thoracentesis. The number of thoracentesis required for the abdominal approach was 1, for the thoracoabdominal approach was 3 (p < 0.02). The bile leakage rate was 17% for thoracoabdominal versus 33% for abdominal approach. CONCLUSIONS: Due to frequent pleural effusion, the thoracoabdominal approach should not be used for every liver operation. However, when treatment to the neck of the right hepatic vein is necessary, the thoracoabdominal approach might be recommended because of the easy access to the operating field and the reduced rate of bile leakage.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Segmental liver resections, present and future-caudate lobe resection for liver tumors.

BACKGROUND/AIMS: Resection of the caudate lobe of the liver is difficult to perform because of a deep location and an adjacency to the major vessels. METHODOLOGY: A total of 30 patients with hepatocellular carcinoma (HCC) originating in the caudate lobe underwent hepatic resection. The lobe was classified to Spiegel's portion, the process portion, and the caval portion. The operative procedure undertaken was chosen on the basis of tumor location as well as hepatic function of each patient. RESULTS: In 14 patients who had an HCC located at Spiegel's portion or the process portion, the tumor was removed by local resection of the caudate lobe (n = 10), or by resection combined with lobectomy (n = 2) or subsegmentectomy (n = 2). In 16 patients with an HCC at the caval portion, caudate lobe resections with preparatory lobectomy (n = 6), segmentectomy (n = 1), or subsegmentectomy (n = 4) were performed. In the other 5, isolated total or partial resection of the caudate lobe was carried out because of the presence of severe cirrhosis. All operations were defined as curative, but produced two operative deaths due to liver failure. The cumulative rate of overall survival was 41% at 5 years after surgery. CONCLUSIONS: Caudate lobe resection for HCC can be performed even in cirrhotic patients with a favorable surgical outcome.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Selective and unselective clamping in cirrhotic liver.

BACKGROUND/AIMS: Liver surgery requires a reduction of the operative blood loss especially for patients with cirrhosis. Selective or unselective liver clamping during hepatic resection is performed to minimize the surgical risk for such compromised patients. METHODOLOGY: We carried out elective hepatic resection in 158 patients with the use of total hilar clamping (Pringle's manoeuvre) or selective vascular clamping (Makuuchi's manoeuvre). The clinical outcomes were evaluated according to the clamping method and the condition of background liver. RESULTS: Pringle's manoeuvre was used in 132 patients who underwent all types of hepatectomy, whereas Makuuchi's manoeuvre was applied selectively to 26 patients, most of whom underwent segmentectomy or subsegmentectomy. A modified Makuuchi's manoeuvre was used in eight healthy donors who underwent left-sided hepatectomy for transplantation. The cumulative clamping times and blood losses were 61 +/- 47 min (mean +/- SD) and 831 +/- 716 ml in the Pringle's manoeuvre group, and 95 +/- 47 min and 1.035 +/- 577 ml in the Makuuchi's manoeuvre group. In patients with normal hepatic parenchyma the longest clamping time was 322 min, and in those with cirrhosis it was 202 min. All the patients in this series tolerated vascular clamping well, and their hepatic functional parameters returned, regardless of the presence or absence of cirrhosis, to the baseline levels within a week. As a whole, the operative morbidity and mortality rates were 20.3% and 0%, respectively. CONCLUSIONS: Intermittent total or selective clamping can be an indispensable procedure during hepatic resection for all patients, irrespective of the degree of hepatic dysfunction, to improve safety and resectability.

Blood Loss, Surgical↗

PubMedDate not supplied

A new porto-systemic bypass technique for hepatopancreatoduodenectomy with portal vein resection.

When reconstructing the portal vein (PV) following hepatopancreatoduodenectomy (HPD) with PV resection, a new porto-systemic bypass (PSB) technique can be employed to prevent intestinal vascular congestion. The Whipple procedure is performed in a standard manner, as long a portion of the gastrocolic trunk is preserved for insertion of an antithrombogenic catheter (ATC). After harvesting the left external iliac vein and exposing the right great saphenous vein, the end of the ATC is inserted in the superior mesenteric vein via the gastrocolic trunk in the distal direction and the other end of the ATC is inserted in the greater saphenous vein. PSB is achieved as a result of the venous pressure gradient. By employing this technique, an ATC can be inserted without damaging another mesenteric venous branch and with minimal damage to the endothelium, and the small intestine is not exposed in the operative field until enteric reconstruction is started. This technique is a promising option for PSB during HPD with PV resection.

Catheterization↗

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Preoperative portal embolization.

Excess parenchymal loss associated with hepatectomy is the leading risk factor/for liver failure especially in patients with impaired hepatic function. Selective portal embolization (PE) before hepatectomy is aimed to induce an atrophy of the embolized lobe to be resected, with a compensatory hypertrophy of the/counterlobe to be preserved. We performed PE followed by hepatectomy in 58 patients with hepatocellular carcinoma (HCC, n. = 44) or metastatic liver tumour (MLT, n. = 14). All the patients well tolerated PE, and hepatic functional data returned to the baseline levels within a week. The left lobe volume increased by about 10% after the right PE. Hepatectomy procedures undertaken comprised right or extended right lobectomy (n. = 39), central bisegmentectomy (n. = 3), extended segmentectomy (n. = 12), and limited resection (n. = 4). The 25 of HCC patients underwent right-sided lobectomy despite a presence of hepatic functional impairment, and the 3 of MLT patients under went right lobectomy with additional resection of the left lobe. As a whole, the operative morbidity and mortality rates were 15.5% and 1.7%, respectively (one patient died of liver failure). The 5-year over all survival rates were 46.8% in HCC patients and 38.0% in MLT patients, respectively. Preoperative PE therefore can be an ancillary procedure for patients, despite with hepatic dysfunction or with bilobar tumours, who may need extensive hepatectomy.

Embolization, Therapeutic↗

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Clear demonstration of carcinoma of the ampulla of Vater with ultrasonography.

We present a non-icteric case, in which an ampullary polypoid lesion was clearly demonstrated by ultrasonography, suggesting carcinoma of the ampulla of Vater. The lesion was a 3 cm in diameter, spherical tumor with a polypoid surface, and internal hyperechogenicity. The patient underwent a curative pylorus-preserving pancreaticoduodenectomy.

Adenocarcinoma, Papillary↗

PubMedDate not supplied

Septic cholangitis occurring 11 years after inadvertent ligation of the right hepatic duct during cholecystectomy: a case report.

We report a case of acute cholangitis caused by the inadvertent ligation of the right hepatic duct during a cholecystectomy performed 11 years before. When the condition of the right hepatic duct or accessory bile duct ligation persists for more than several years, resulting in atrophy of the relevant part of the liver, bile duct ligation will rarely cause severe clinical problems. However, acute cholangitis may occur, as in our patient, so long-term follow-up of the patient is warranted.

Acute Disease↗

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Cell cycle regulators and human hepatocarcinogenesis.

G1 phase progression of mammalian cells is mainly controlled by the cyclin-cyclin-dependent kinase (CDK)-CDK inhibitor-retinoblastoma protein (pRb) regulatory pathway. Cell cycle regulators controlling G1 phase progression are frequently involved in the carcinogenesis of many human cancer types. In hepatocellular carcinoma (HCC) the CDK inhibitor p16INK4 is predominantly inactivated by post-transcriptional regulation and p16INK4 inactivation participates in the early-stage of hepatocarcinogenesis and in disease progression. Reduced p21(WAF1/CIP1) expression, which is associated mainly with p53 gene mutation in HCCs, contributes to hepatocarcinogenesis. Reduced p27Kip1 expression is also frequently involved in HCC. The CDK inhibitors p16INK4, p21(WAF1/CIP1) and p27Kip1 are independently affected and a change in the expression of one or more of these inhibitors contributes to carcinogenesis of the majority (nearly 90%) of HCCs. Cyclin D1 amplification and overexpression play a role in the carcinogenesis of a subset (11-13%) of HCCs. Disruption of the regulatory system controlling G1 phase progression is a common event in human hepatocarcinogenesis. Further studies systematically analyzing the major regulators controlling G1 phase progression in a large cohort of HCCs will strengthen our understanding of the molecular mechanism underlying human hepatocarcinogenesis. Correcting alterations that have occurred in the G1 phase regulatory machinery may provide a novel weapon to treat and prevent HCC.

Carcinoma, Hepatocellular↗