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Biomedical subjects

S Futagawa

Publications and source records attributed to S Futagawa.

At least 73 records · Page 4Linked to original sources
PubMed1987

Intrahepatic portosystemic venous shunt: occurrence in patients with and without liver cirrhosis.

Portosystemic venous shunt within the hepatic parenchyma is rare, and its cause is disputed. Only 12 cases have been reported in the literature. Four new patients are presented here, all of whom had cerebral manifestations due to elevated blood-ammonia levels. One patient, initially misdiagnosed as having a psychiatric disorder, had multiple small portohepatic venous shunts in the peripheral hepatic parenchyma that were believed to be congenital in origin. The other three patients with clinical evidence of cirrhosis and portal hypertension had large tubular shunts between the posterior branch of the portal vein and the inferior vena cava. Shunts of this type were considered to be the collateral pathways developed in the hepatic parenchyma as a result of portal hypertension. The diagnosis of intrahepatic portosystemic venous shunts was established by angiography in all four patients. Sonography and CT failed to show the multiple small shunts, but did provide diagnostic information concerning the large tubular shunts. Intrahepatic portosystemic venous shunt can be the cause of hepatic encephalopathy. One should be familiar with the typical radiographic manifestations of this condition to prevent misdiagnosis as a psychiatric or neurologic disorder.

Aged↗
PubMed1985

[Treatment of hepatocellular carcinoma with esophageal varices].

This report describes 53 patients with hepatocellular carcinoma (HCC) complicated with esophageal varices. Esophageal varices were due to cirrhosis of the liver in all cases. Hepatic resection and blocking operations such as Sugiura procedure, transabdominal esophageal transection or Hassab's operation were performed for the treatment of HCC and esophageal varices in 6 cases with satisfactory results. Non-operative treatments such as TAE or arterial infusion chemotherapy for HCC and blocking operations for esophageal varices were performed in 17 cases. Late deaths were recognized in 10 cases. Causes of late deaths were carcinoma of the liver in 7 cases and ruptured varices in only 1 case. In 13 cases with severe hepatic failure, only endoscopic sclerotherapy was performed for the treatment of esophageal varices. However 8 cases of 13 had rebleeding from esophageal varices and died after sclerotherapy. We concluded that effective treatments for HCC complicated with esophageal varices were to perform both the hepatic resection and the blocking operation and these treatments prolong the long-term survival of patients with HCC with esophageal varices.

Aged↗
PubMed1984

Results of six hundred thirty-six esophageal transections with paraesophagogastric devascularization in the treatment of esophageal varices.

This report describes 636 patients with portal hypertension in whom esophageal transections with paraesophagogastric devascularization were performed for the management of esophageal varices. The procedure was a prophylactic measure in 185 patients, elective surgery in 349, and an emergency procedure in 102. Portal hypertension was due to cirrhosis of the liver in 464 patients (40 alcoholic and 424 cryptogenic), idiopathic portal hypertension in 99, extrahepatic portal vein occlusion in 38, hepatoma in 22, and other causes in 13. The operative mortality rates were as follows: emergency 13.7%, elective cases 3.2%, prophylactic cases 4.3%, and overall 5.2%. There were no deaths in the 233 patients in Child's clinical class A; 232 class B patients had a 2% mortality rate, and 171 class C patients had a 17% mortality rate. The 10-year actuarial survival rates in patients with cirrhosis of the liver were 55% in emergency cases and 72% in both prophylactic and elective cases. In patients without cirrhosis the survival rates were 90%, 96%, and 95%, respectively. Recurrence of variceal bleeding or varices was less than 5%. We conclude that the Sugiura procedure is safe and effective in controlling esophageal varices and prolongs the long-term survival of patients with portal hypertension.

Adult↗
PubMed1984

Influence of esophageal transection for esophageal varices on serum bile acid level.

The concentration of total bile acids in the serum was measured in thirty-three patients before and after esophageal transection for esophageal varices, in an attempt to determine the influence of this surgery on the naturally developed portasystemic shunt and also the liver function relating to the bile acid metabolism. The levels of fasting total bile acids in the serum were decreased on the first postoperative day, but gradually increased up to the preoperative levels by the twenty-first postoperative day. The maximum value of total bile acids, as determined in ursodeoxycholic acid tolerance tests, was decreased after the esophageal transection (p less than 0.01). The average of the maximum total bile acids in UDCA tolerance tests was 79.5 microM in the preoperative stage, and 61.0 microM in the postoperative stage. This finding suggested that esophageal transection abolished the portasystemic collaterals and contributed to an increase in efficient hepatic blood flow, which led to the improvement of liver function.

Adult↗