Biomedical subjects

M Shimada

Publications and source records attributed to M Shimada.

At least 1,027 records · Page 57Linked to original sources

PubMedDate not supplied

The role of interleukin-6, interleukin-16, tumor necrosis factor-alpha and endotoxin in hepatic resection.

BACKGROUND/AIMS: The role of cytokines was investigated in patients undergoing hepatic resection. MATERIALS AND METHODS: Cytokines such as interleukin-16, interleukin-6 and tumor necrosis factor-alpha were serially measured both before and after hepatic resection. RESULTS: The levels of interleukin-16 and interleukin-6 increased immediately after operation, while that of tumor necrosis factor-alpha was only slightly elevated. The increase in interleukin-6 was more prominent than that in interleukin-16. The level of urinary polyamine was elevated at postoperative day 1, while the level of C-reactive protein reached a peak at postoperative day 3. Moreover, no endotoxin in either the peripheral or portal vein was ever detected in this series. Regarding the comparison between major (more than 2 segments) and minor (less than 1 segment) resections, no significant difference was found in the levels of interleukin-1 beta, interleukin-6 or urinary polyamine. CONCLUSIONS: Therefore, interleukin-6 is considered to be a more sensitive marker of surgical stress than interleukin-1 beta and CRP, while both interleukin-6 and interleukin-16 are suggested to induce hepatic regeneration and the production of acute phase protein in the liver. Furthermore, the absence of any correlation between the volume resected and those cytokine levels suggests that some other as yet unidentified mechanism could be also related to the regulation of hepatic regeneration.

Aged↗

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The role of prostanoid in hepatic damage during hepatectomy.

BACKGROUND/AIMS: The aim of this study in hepatectomy is to investigate whether or not hepatic ischemia elevates the serum prostanoid levels, and whether or not thromboxane A2 (TXA2) synthetase inhibitor (OKY 046) improves hepatic damage. MATERIALS AND METHODS: The prostanoid levels were measured in 22 hepatectomy cases. The beneficial effects of thromboxane A2 synthetase inhibitor were examined in cases who underwent hepatectomy under hemihepatic vascular control. The total prostanoid levels (6-keto PG Fla+ PGE2 + TXB2) were measured in 22 cases before and after hepatectomy. The hepatic ischemic time (HIT) was defined as the time required to perform a hepatic mobilization plus the right hemihepatic vascular control technique. RESULTS: The total prostanoid levels increased after hepatectomy (P < 0.01). The changes in the total prostanoid levels positively correlated with the HIT (P < 0.01). The 17 cases who underwent hepatectomy with the HIT were randomly divided into 2 groups; the OKY group (n = 9), OKY 046 (0.2 mg/kg/hr), the control group (n = 8); no drug was given. The OKY 046 administration reduced the TXB2 levels (P < 0.01), without any changes in the PGE2, or 6-keto PGF1a levels. The serum glutamic oxaloacetic transaminase levels after operation were lower, and the hepaplastin tests were higher in the OKY group than those of the control (P < 0.05). CONCLUSION: These results demonstrated that hepatectomy under ischemia elevated the prostanoid levels. OKY 046 significantly reduced the TXB2 levels and the degree of hepatic damage in hepatectomy under ischemia.

Aspartate Aminotransferases↗

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Renal function after elective hepatic resection.

BACKGROUND/AIMS: Although morbidity and mortality associated with liver surgery has declined, in particular operative death from liver failure, accumulation of fluid in the peritoneal or pleural cavities after hepatic resection is still the most common post-operative complication and it often decreases the patient's quality of life. The purpose of this retrospective review is to discuss the effect of renal dysfunction following hepatic resection on ascites formation in patients who underwent hepatic resection. MATERIALS AND METHODS: The patients who underwent hepatectomy were assigned to two groups; Group A patients (n = 119) had some form of ascites or pleural effusion, either intractable or easily controlled, while Group B patients (n = 178) had neither ascites nor pleural effusion. We compared the clinical and laboratory data, operative risk factors, and the post-operative renal as well as hepatic functions of the two groups. RESULTS: In addition to ordinary risk factors associated with ascites formation such as decreased plasma oncotic pressure due to hypoalbuminemia along with increased hydrostatic pressure in the portal circulation, renal dysfunction after hepatic resection might be the primary cause of fluid accumulation in the peritoneal cavity. CONCLUSION: As one of the mechanisms of ascites formation following hepatic resection, we must consider the presence of renal dysfunction and protect against ascites formation and treat refractory ascites after hepatic resection not only by such traditional methods such as water and salt restriction, the use of diuretics, and the infusion of albumin products, but also by preserving the renal function after hepatectomy.

Ascites↗

PubMedDate not supplied

Nutritional support after hepatic resection: a randomized prospective study.

BACKGROUND: A consensus as to whether hypertonic dextrose should be given to patients with chronic liver diseases such as cirrhosis or chronic hepatitis after major hepatectomy has not been reached, mostly because metabolism in the remnant liver switches from utilization of blood glucose to utilization predominantly of fatty acid as an energy source. We investigated whether nutritional support would have beneficial effects for such patients. PATIENTS AND METHODS: Among 19 patients, 10 were given peripheral dextrose (10 kcal/kg/day) for seven days following hepatectomy and the other 9 were given hypertonic glucose. Twenty and 30 kcal/kg/day was the average non-protein caloric intake, including free oral intake during the first one week following hepatectomy, respectively. RESULTS: The groups were comparable with regard to laboratory data and operative stress. There were no untoward effects related to this support. In patients given nutritional support, retinol binding protein and prealbumin improved (p < 0.05 and p < 0.05, respectively), urinary 3-methylhistidine excretion decreased (p < 0.01) and the nitrogen balance normalized earlier (p < 0.05), as compared to findings with the conventional method. CONCLUSION: The remnant liver can utilize dextrose and nutritional support improves the nutritional status and may even preserve muscle protein mass.

Amino Acids, Branched-Chain↗

PubMedDate not supplied

Surgically resected primary malignant lymphoma of the liver.

Primary malignant lymphoma of the liver is extremely rare, and its preoperative or even premortem diagnosis is still difficult. The authors herein report a case of primary malignant lymphoma of the liver in a 51-year-old Japanese man. The findings at angiography were non-specific, but a hypoechoic mass with a halo was demonstrated by ultrasound sonography, which revealed rapid progression. The tumor volume doubling time was 9.6 days. An extended right hepatic lobectomy with lymph nodes dissection was done on the basis of a preoperative diagnosis of hepatocellular carcinoma, while the diagnosis based on immunohistological studies was T cell malignant lymphoma of the liver. After the adjuvant chemotherapy, the patient continues to be free of disease for three years and nine months. We herein describe the optimum methodology for making a preoperative diagnosis of primary malignant lymphoma of the liver. We also consider that a curative hepatic resection with adjuvant chemotherapy for primary malignant lymphoma of the liver is an adequate treatment for this disease.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

A primary adenosquamous carcinoma of the liver with an elevated level of serum squamous cell carcinoma related antigen.

A case of primary adenosquamous carcinoma of the liver with an elevated level of serum squamous cell carcinoma related antigen is herein reported. Various hypotheses on the pathogenesis of adenosquamous carcinoma of the liver have been set forth previously, however there is still no widely accepted theory because of the absence of any sufficient evidence. The postoperative transition of serum squamous cell carcinoma related antigen and the immunohistochemical findings using anti-involucrin antigen in this case support the hypothesis that the squamous cell carcinoma component arises as a result of the metaplastic transformation of adenocarcinoma cells.

Aged↗

PubMedDate not supplied

The effect of a perioperative steroid pulse on surgical stress in hepatic resection.

Little has been reported on the control of cytokine release, which is induced by surgical stress. The aim of this study was to investigate the effect of a perioperative short-term steroid pulse on surgical stress. Seventeen patients with a non-cholestatic liver, who underwent hepatic resection, were included in this study. The patients were classified into two groups consisting of a control group (n = 11) and a steroid pulse group (n = 6), in whom 30 mg/kg of methylprednisolone was intravenously administered 3 hours before the operation, and thereafter 1 gram of methylprednisolone was also intravenously administered both immediately after operation and on postoperative day 1. Interleukin 6 was serially measured, and the perioperative clinical parameters including C-reactive protein were compared between both the control and the steroid pulse groups. The IL-6 values immediately after operation, as well as at postoperative days 1 and 3 in the steroid pulse group were significantly lower than those in the control group. The value of the C-reactive protein at postoperative day 3 in the steroid pulse group was significantly lower than that in the control group, and the postoperative peak value of bilirubin as well as the incidence of postoperative complications in the control group tended to be higher than those in the steroid pulse group. In addition, the steroid pulse demonstrated no adverse side effects. A perioperative short-term steroid pulse using methylprednisolone is thus suggested to reduce surgical stress by decreasing cytokine release.

Aged↗

PubMedDate not supplied

Prognosis of well differentiated small hepatocellular carcinoma--is well differentiated hepatocellular carcinoma clinically early cancer?

BACKGROUND/AIMS: The purpose of this study is to examine whether or not well differentiated (w-d) hepatocellular carcinoma (HCC) is indeed clinically early cancer. MATERIALS AND METHODS: Seventy six patients with solitary small HCCs up to 3 cm in diameter, who underwent hepatectomy, were observed for at least 2 years for possible recurrence. These patients were divided into two groups: 10 patients with w-d HCCs (Edmondson and Steiner's grade I) and 66 patients with less differentiated (l-d) HCCs (Edmondson and Steiner's grade I-II, II-III, and III). RESULTS: The histological analysis revealed that w-d HCCs had lower incidences of fibrous capsule formation (P<0.01), when compared to l-d HCCs. There were no significant differences in the incidence of intrahepatic metastasis, or portal vein invasion. In a resected specimen of w-d HCC, barium sulfate and gelatin were injected into portal vein and a transparent specimen was made. The transparent specimen showed that the portal vein in the tumor seemed to be intact. Microscopically, cancer cell infiltration into the fibrous frame of the portal tract was present. There were no significant differences in the disease free survival between the two groups. An analysis of tumor volume doubling time in recurrent foci suggested that minute cancerous foci had been present at the time of operation. CONCLUSIONS: W-d HCCs were clinically demonstrated not to be early cancer, because there was no significant difference in disease free survival between the patients with w-d and l-d HCCs.

Carcinoma, Hepatocellular↗

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A case of the incomplete double aortic arch diagnosed in adulthood by MR imaging.

Double aortic arch is a rare vascular anomaly, particularly in adults. Most of patients were infants or children. In this report we describe a case of the incomplete double aortic arch in a 55 years old woman complaining of esophageal symptoms was found by esophagography and examined by MR imaging. This anomaly had double aortic arch with partial atresia of the left arch. The right common carotid artery (RCCA) and the right subclavian artery (RSA) arose from the large right aortic arch (RAA). The left common carotid artery (LCCA) and subclavian artery (LSA) arose from the left aortic arch (LAA). Aortic diverticulum was detected at the interior site of the descending aorta connected with the left subclavian artery (LSA). The mediastinal organs were surrounded by the vascular ring (RAA, LAA, LSA and aortic diverticulum).

Aorta, Thoracic↗

PubMedDate not supplied

Chemosensitivity in primary liver cancers: evaluation of the correlation between chemosensitivity and clinicopathological factors.

BACKGROUND/AIMS: The aim of this study is to investigate the correlation of the chemosensitivity of primary liver cancers and the clinicopathological factors. MATERIALS AND METHODS: The correlation of the chemosensitivity was investigated along with the associated clinicopathological factors, using 229 cases with hepatocellular carcinoma (HCC) and 8 with cholangiocellular carcinoma (CCC), ,who all underwent hepatic resection. Chemosensitivity was determined by a succinate dehydrogenase inhibition assay. RESULTS: The overall rate of chemosensitivity among the HCCs was as follows: 34.8% to adriamycin, 40.5% to mitomycin C, 38.2% to cisplatin, respectively, while the resistant rate to all drugs tested was 50.9%. The chemoresistant rate of the HCCs with hepatitis C tended to be higher (62%) than that of the HCCs with hepatitis B (50%). In the HCCs, there was no definite correlation between the chemosensitivity to each drug and the histological findings, while there seemed to be a positive correlation between the chemoresistant rate and the poor prognostic risk factors, such as vascular invasion and intrahepatic metastasis. In CCCs, the chemoresistant rate to all drugs tested was 77.7%, moreover, both the age and the CA 19-9 level in the chemosensitive group were significantly higher than those in the chemoresistant group. CONCLUSION: HCC with hepatitis C, as well as the higher degree of malignant potentials such as vascular invasion, intrahepatic metastasis and poor differentiation tended to be resistant to all 3 drugs tested. CCC was also highly resistant to all 3 drugs tested. For such resistant tumors, the drug-resistant mechanism urgently needs to be identified as soon as possible.

Adult↗

PubMedDate not supplied

A comparison of parenteral hyperalimentation and early enteral feeding regarding systemic immunity after major hepatic resection--the results of a randomized prospective study.

BACKGROUND/AIMS: To compare the nutritional efficacy, especially regarding the systemic immunity of early enteral (EEN) and total parenteral nutrition (TPN) in major hepatic resection. MATERIAL AND METHODS: A randomized, prospective controlled study was performed in the Second Department of Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan. Twenty-six patients who underwent a major hepatic resection were divided into 2 groups: EEN (n = 13), and TPN (n = 13). There was no significant difference between the two groups in regard to either clinical backgrounds, nutritional parameters. RESULTS: There was no significant difference in the nutritional parameters after hepatectomy, such as the serum levels of retinol binding protein, transierrin, pre-albumin, and 3-methylhistidine between the two groups. Among the immunologic parameters, NK activity and changes in the lymphocyte number, the PHA response and the NK activity, which was expressed as a percentage of the preoperative values, was significantly higher in the EEN group than in the TPN group (p < 0.05). The incidence of infectious complications in the TPN group was 4 of 13 patients (31%), although the same incidence in the EEN group was only 1 of 13 (8%). In one case of TPN, a bacterial strain of gut origin was isolated from the intra-abdominal abscess, which suggested that bacterial translocation occurred. CONCLUSION: No significant difference was observed in the nutritional parameters between the EEN and TPN groups. Early enteral feeding maintained immunocompetence, and thus such feeding possibly reduced the rate of infectious complications after major hepatic resection.

Aged↗

PubMedDate not supplied

Circulating intercellular adhesion molecule-1 in patients with hepatocellular carcinoma before and after hepatic resection.

BACKGROUND/AIMS: We recently demonstrated that an activated inflammation in a non-tumorous portion was a significant risk factor for recurrence in patients with small hepatocellular carcinoma. The purpose of this study is to provide further proof for this mechanism by explaining the relation ship between the post-operative hepatitis state and intrahepatic recurrence. PATIENTS AND METHODS: We used an enzyme-linked immunosorbent assay to detect cICAM-1 in the serum of 18 patients with hepatocellular carcinoma before and after hepatic resection. RESULTS: A complete surgical resection of the tumor masses did not result in a significant reduction of cICAM-1 levels. The levels of aminotransferase after hepatic resection in patients with an increased level of cICAM-1 in the post operative period (n = 7) were much higher than in patients with a decreased level of cICAM-1 (n = 11) (p < 0.05). The 1-, 2- and 3- year disease free survival rates in the former group were 42.9%, 14.3% and 0%, respectively, and those in the later group were 72.7%, 54.5% and 54.5%, respectively (p < 0.05). CONCLUSIONS: The enhancement of inflammation in the remnant liver tissue is related to intrahepatic recurrence after hepatic resection through adhesion molecules, such as cICAM-1.

Aged↗

PubMedDate not supplied

Right hepatic lobectomy in elderly patients with hepatocellular carcinoma.

BACKGROUND/AIMS: The outcome of hepatectomy in elderly patients with hepatocellular carcinoma have been reported, however neither the morphological nor functional hepatic regeneration in elderly patients have been fully investigated. MATERIALS AND METHODS: Fifty-six patients with hepatocellular carcinoma, who underwent a right hepatic lobectomy over an 8-year period, were classified into three groups according to their age; group 1 (n = 7), more than 70 years of age; group 2 (n = 40), patients from 50 to 69 years of age and group 3 (n = 9), under 50 years of age. There were no significant differences regarding backgrounds or intra-operative parameters among the three groups. The perioperative hepatic function, postoperative complications and the regeneration rate of the remnant left lobe at 1 month after operation were compared. RESULTS: No differences were found in the regeneration rate, however, the levels of the hepaplastin test and lecithin:cholesterol acyltransferase at 7 days after hepatectomy in group 1 (31.3%, 8.8 U) were significantly lower than those in groups 2 and 3 (37.4%, 18.4 U; 47.9%, 29.4 U, respectively). The incidence of hospital death due to hepatic failure in group 1 (42.9%) was also significantly higher than that of group 2 (5.0%) or group 3 (0%). CONCLUSION: The decline of postoperative protein synthesis regardless of the voluminal regeneration is a characteristic of the elderly. This phenomenon might thus be an important promoter of postoperative hepatic failure which remains unpredictable using any type of examination. Therefore, at this time, a major hepatectomy is not recommended as a viable treatment alternative in the elderly.

Adult↗

PubMedDate not supplied

Assessment of breast cancer with dynamic gadolinium-enhanced MR imaging combined with magnetization transfer contrast using a newly developed breast surface coil for the supine position.

To assess the value of dynamic gadolinium-enhanced MR imaging combined with magnetization transfer contrast (MTC) of breast cancer by SPGR sequence, 15 patients with breast cancer were imaged in the supine position with the newly developed breast coil in a 1.5 Tesla imager. Dynamic gadolinium-enhanced MR imaging combined with MTC (10 cases) and conventional dynamic gadolinium-enhanced MR imaging (5 cases) were performed after the administration of Gd-DTPA (0.2 ml/kg). Sagittal images were obtained every 22 seconds during the first 264 seconds. Thus, a total of 15 images were obtained in each lesion. The signal intensity ratio (SIR) of lesion to mammary glarid was calculated for each image as follows: (SI lesion/SI mammary gland)/(SI (pre)lesion/SI (pre)mammary gland). Dynamic gadolinium-enhanced MR imaging with MTC always allowed better SIR at 88 seconds than conventional dynamic gadolinium-enhanced MR imaging after bolus injection (p < 0.01). Dynamic gadolinium-enhanced MR imaging with MTC improved detection of the boundary of the lesion and mammary gland.

Adult↗

PubMedDate not supplied

Controlled release of cisplatin incorporated into biodegradable poly-d, l-lactic acid.

Using a melt-pressing technique, we produced a small solid cylinder containing cisplatin (CDDP) embedded in poly-d, l-lactic acid (CDDP-PLA). The in vitro release of CDDP from the polymer was examined in an immersion system. CDDP was released continuously for more than four weeks with no initial burst. Drug distribution for CDDP-PLA was compared with CDDP solution (CDDP-SOL) by subcutaneous administration into the back of rats. In the CDDP-PLA group, a high concentration of CDDP was maintained in the subcutaneous tissues near the implants for 20 days. However, in the CDDP-SOL group, the concentration of CDDP was low by 10 days after drug administration. CDDP-PLA may become a useful tool in locoregional chemotherapy as a solid type of drug delivery system with longlasting release.

Animals↗

PubMedDate not supplied

Urinary excretion of prostaglandins and renal function after hepatic resection.

BACKGROUND/AIMS: The leading postoperative complication associated with hepatic resection is the accumulation of fluid in the abdominal cavity, which usually develops approximately one week after surgery. This study was undertaken to investigate the role of renal prostaglandins in modulating renal sodium and water retention in patients who underwent hepatic resection. METHODS: Urinary excretion of thromboxane B2 and 6-keto-prostaglandin F1 alpha as well as renal function were investigated serially in 7 patients with hepatocellular carcinoma who underwent hepatic resection. We administered 60 mg of OKY 046, a selective thromboxane A2 synthetase inhibitor, for 6 hours by continuous drip infusion from the commencement of surgery. RESULTS: Urinary sodium excretion was reduced from 165 mEq/day pre-operatively to 73 mEq/day on postoperative day 6 (p = 0.0181), however, there was no decline in urinary osmorality. OKY 046 administration inhibited intrarenal thromboxane A2 production, on the other hand, it significantly increased the production of intrarenal prostaglandin I2 (from 147 +/- 19 to 6339 +/- 1861 pg/mg creatinine, p = 0.0017) on the day of surgery. The level of thromboxane A2 was significantly increased to 2440 +/- 1099 pg/mg creatinine (p = 0.006, vs. pre-operative value), whereas the level of prostaglandin 12 was significantly reduced to 687 +/- 163 pg/mg creatinine (p = 0.0181, vs. the value on the day of surgery) on postoperative day 6. CONCLUSIONS: Urinary thromboxane A2 synthesis might contribute to sodium and water retention after hepatic resection. These results suggest that combined use of OKY 046 and diuretics prevent ascites formation after hepatic resection.

6-Ketoprostaglandin F1 alpha↗

PubMedDate not supplied

The characteristics of hepatocellular carcinoma with a high level of serum lactic dehydrogenase: a case report.

Hepatocellular carcinoma (HCC) remains one of the most important malignancies in Japan (1, 2). Lactic dehydrogenase (LDH), which is a glycolyticenzyme, and exists in various types of human tissue and neoplasms, has also been reported to demonstrate a high level (especially LDH 5) in the serum of patients with HCC (3-10). We herein report the findings of a 68-year-old male patient with hepatocellular carcinoma (HCC), whose serum lactic dehydrogenase (LDH) level more closely correlated with the clinical course than the alpha-feto-protein level (AFP). Both the AFP and LDH levels were high before the operation (AFP 1402 ng/ml; LDH 638 IU/L) (LDH1 11%; LDH2 24%; LDH3 34%; LDH4 19%; LDH5 12%). The levels of the serum LDH and AFP one week after the right hepatic lobectomy both decreased to 423 IU/L and 331 ng/ml, respectively. In addition, the LDH isozyme pattern returned to normal. Six weeks after the operation, the serum LDH increased to 3504 IU/L, however, the AFP levels remained low at 43.4 ng/ml, and the CT findings demonstrated multiple recurrent nodules in the whole remnant liver. At eighty-one days after the operation, the patient died due to a rupture of the recurrent HCC. Immunohistochemical observations were performed using the peroxidase labeled streptavidin-biotin technique with slight modifications and using two monoclonal antibodies for AFP and for Ki-67. Most portions of the primary tumor consisted of poorly to undifferentiated HCC. The portion of undifferentiated HCC did not stain for AFP antibody, but the portion of poorly differentiated HCC stained positively for it. It was thus speculated that LDH was mainly produced in the portion of undifferentiated HCC. In addition the undifferentiated HCC were strongly positive for Ki-67, while, in contrast, the poorly HCC was only weakly positive for Ki-67. Based on the above findings, HCC with a high serum level of LDH appears to show both a rapid growth and highly malignant tumors.

Aged↗

PubMedDate not supplied

Hepatic resection for icteric type hepatocellular carcinoma.

Icteric-type hepatocellular carcinoma, which initially presents as jaundice, is known to be rare. Furthermore, the number of such cases that undergo hepatic resection is also very small. The purpose of this study was to clarify the characteristics of icteric type hepatocellular carcinoma and discuss the efficacy of hepatic resection in this condition. Herein, we present five cases of icteric type hepatocellular carcinoma which were among a study of 438 patients who underwent hepatic resection. Most of these cases were in the advanced stages, and a high incidence of early death was recognized. However, two patients are doing well, without further recurrence (8 years and 7 months, and 13 months, respectively). It is important to consider icteric type hepatocellular carcinoma whenever a patient has a potential risk for hepatocellular carcinoma. In addition, it is also important to understand that in diagnosing icteric type HCC, sometimes neither choledocholithiasis nor cholangiocellular carcinoma can be clearly ruled out. Extensive examinations of the biliary tract, including percutaneous transhepatic cholangiography as well as endoscopic retrograde cholangiography are indicated for such patients when they exhibit either temporary cholangitis or jaundice, as well as when there is biliary dilatation within the liver. Furthermore, hepatic resection is also considered to be a viable alternative for such cases.

Adult↗