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Biomedical subjects

S Kubo

Publications and source records attributed to S Kubo.

At least 739 records · Page 41Linked to original sources
PubMedDate not supplied

Post-operative blood tests and multicentric recurrence of hepatocellular carcinoma.

Second hepatic resections (SHR) were performed in 2 patients with recurrent hepatocellular carcinoma (HCC) with hepatitis C virus (HCV) more than 10 years after initial curative resections. Appearance on imaging studies of the late recurrences thought to be multicentric primary tumors, was preceded by fluctuating laboratory abnormalities such as increased alanine aminotransferase activity (ALT), increased serum alpha-fetoprotein (AFP), and decreased platelet counts by as long as 2 years. Therefore, serial changes of blood tests after resection of HCC with HCV might be useful predictors of late multicentric recurrence.

Aged↗
PubMedDate not supplied

Human erythrocyte polyamine levels after portal vein embolization.

BACKGROUND/AIMS: Polyamine levels in erythrocytes are related to liver regeneration and could be used as an index of liver regeneration after partial hepatectomy. We investigated liver regeneration after portal vein embolization according to the changes of erythrocyte polyamine levels. METHODOLOGY: Levels of polyamines (putrescine, spermidine, and spermine) in erythrocytes were assayed by high-pressure liquid chromatography for 13 patients with hepatocellular carcinoma after portal vein embolization and 16 patients (8 from group reported earlier) after right bisegmentectomy of the liver for hepatocellular carcinoma. In the first group, embolization preceded surgery by 3 weeks. RESULTS: The mean total polyamine level in erythrocytes and the levels of spermidine and spermine were significantly higher at day 7 after embolization, decreasing later. Spermidine and spermine increased by day 7 after partial hepatectomy, decreasing later. Their mean increase was smaller and more gradual when embolization was done before resection than without embolization. CONCLUSIONS: Embolization causes regeneration of the non-embolized portion of the liver, and embolization before liver resection allows regenerative activities of the liver remaining after resection to be lower than without the embolization.

Adult↗
PubMedDate not supplied

Patterns of and risk factors for recurrence after liver resection for well-differentiated hepatocellular carcinoma: a special reference to multicentric carcinogenesis after operation.

BACKGROUND/AIMS: We studied the patterns of, and risk factors for, recurrence after resection of well-differentiated hepatocellular carcinoma to make a strategy for such carcinoma. METHODOLOGY: The subjects were 36 patients who underwent liver resection for well-differentiated hepatocellular carcinoma. Multicentric carcinogenesis after the operation (multicentric recurrence) was diagnosed when a recurrent tumor included a component of well-differentiated hepatocellular carcinoma. Tumor-free survival rates of patients with various risk factors were calculated and differences between groups were evaluated. For multivariate analysis, Cox's proportional hazard model was used. RESULTS: All recurrent tumors after operation were of multicentric origin. Univariate analysis showed a history of blood transfusion, high alpha-fetoprotein concentration (> 20 ng/ml), and low platelet count (< 10(5)/mm3) to be significant factors. By multivariate analysis, a history of blood transfusion and a low platelet count were independent risk factors. Nonanatomic resection was not a risk factor. CONCLUSIONS: In patients with well-differentiated hepatocellular carcinoma, especially with risk factor(s) for multicentric recurrence, not only anatomic but also nonanatomic resection (partial resection) are indicated for a primary tumor, because almost all recurrent tumors are of multicentric origin. After resection of well-differentiated hepatocellular carcinoma, careful monitoring for multicentric recurrence is important in patients with risk factors.

Adult↗
PubMedDate not supplied

Doppler sonography in hepatolithiasis: a case report.

In the treatment of hepatolithiasis, it is important to not only remove all stones and eliminate bile stasis in the biliary tract, but also to remove atrophic hepatic tissue, as such tissue may cause recurrent cholangitis as well as latent cholangiocarcinoma. A 75-year-old woman was diagnosed as having hepatolithiasis with stenosis at the branching of the bile ducts in segment II and segment III by sonography, computed tomography, endoscopic retrograde cholangiography, and magnetic resonance cholangiography. Portograms did not reveal portal branches in segment III but did demonstrate the portal branches in segment II. During the operation, Doppler sonography was done. Doppler sonography did not reveal the portal blood flow in segment III, but did demonstrate a "to-and-fro" pattern in the portal branches in segment II, indicating atrophic hepatic tissue with disrupted portal blood flow. Lateral segmentectomy (resection of segments II and III and lithotomy with choledo-chotomy were done. The patient is in good health 2 years 6 months after the operation. Doppler sonography is useful in the detection of disrupted portal blood flow and the diagnosis of hepatic atrophy. This is clearly advantageous in the decision-making about whether to perform a liver resection with hepatolithiasis.

Aged↗
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Ornithine decarboxylase activity in the non-cancerous hepatic tissue of patients with hepatocellular carcinoma.

BACKGROUND/AIMS: Hepatocellular carcinoma may develop in patients with chronic hepatitis and cirrhosis. Active hepatitis is an important etiologic factor in the development of hepatocellular carcinoma. We measured ornithine decarboxylase activity, an important enzyme during cell proliferation, in non-cancerous hepatic tissue in patients with hepatocellular carcinoma. METHODOLOGY: Thirty-four patients who underwent liver resection for hepatocellular carcinoma were the subjects of this study. Hepatitis B surface antigen was detected in 7 patients (HBV group) and hepatitis C virus antibody was detected in 27 patients (HCV group). Tissue ornithine decarboxylase activity was measured. Histologic severity in active hepatitis (activity score) and degree of fibrosis (staging score) were determined. RESULTS: Ornithine decarboxylase activity was significantly higher in the HCV group than in the HBV and control groups. In all patients, ornithine decarboxylase activity correlated directly with the histologic activity score and the histologic staging score. In the HCV group, ornithine decarboxylase activity correlated with the histologic activity score. CONCLUSIONS: Ornithine decarboxylase activity in non-cancerous hepatic tissue correlated with the severity of active hepatitis and degree of fibrosis. In patients with hepatitis C virus, active hepatitis with increased ornithine decarboxylase activity is an important factor in the development of hepatocellular carcinoma.

Adult↗
PubMedDate not supplied

Percutaneous ethanol injection for hepatocellular carcinoma originating in the caudate lobe.

BACKGROUND/AIMS: Hepatocellular carcinoma originating in the caudate lobe is rare and the treatments for caudate hepatocellular carcinoma were thought difficult, because of its unique location at hepatic resection, or because of complex arterial supply at transcatheter arterial embolization. Percutaneous ethanol injection is an effective treatment for small hepatocellular carcinoma. The aim of this study was to assess the efficacy of percutaneous ethanol injection for hepatocellular carcinoma originating in the caudate lobe. METHODOLOGY: During the past 4 years, 7 patients with 7 hepatocellular carcinomas originating in the caudate lobe underwent percutaneous ethanol injection as a curative treatment. The outcomes of percutaneous ethanol injection and the survival of the 7 patients were evaluated. RESULTS: Percutaneous ethanol injection was successfully carried out with no severe complications in all patients. During follow-up periods local recurrence was noticed in a patient, that was treated with percutaneous ethanol injection again. Four patients had recurrence in other parts of the liver, who were treated with percutaneous ethanol injection alone or percutaneous ethanol injection and transcatheter arterial embolization. Six patients were alive for 12-55 months after percutaneous ethanol injection and 1 patient died of hepatic failure 15 months after the procedure. CONCLUSIONS: Percutaneous ethanol injection was a safe and effective treatment, and it would be an alternative therapy for hepatocellular carcinoma originating in the caudate lobe.

Aged↗
PubMedDate not supplied

Surgery for mixed hepatocellular and cholangiocellular carcinoma.

BACKGROUND/AIMS: Mixed tumors composed of hepatocellular carcinoma and cholangiocellular carcinoma are rare. In this report, the clinicopathologic characteristics and treatment outcome of four patients with mixed hepatocellular and cholangiocellular carcinomas are described. METHODOLOGY: Of 539 patients with primary liver cancer who underwent hepatic resection in our department over a 17-year period, 4 were diagnosed with mixed hepatocellular and cholangiocellular carcinoma. The clinicopathological features and treatment outcomes of these 4 patients were investigated. RESULTS: All 4 patients were positive for hepatitis C virus antibody and had hypervascular tumors. Tumor resection was performed for all patients. Three underwent lymph node dissection. At the time of this study, 1 patient was alive without recurrence 12 months after surgery. The other patients died within 28 months of surgery. CONCLUSIONS: Mixed tumors should be considered in patients with a liver mass and increased serum carcinoembryonic antigen and carbohydrate antigen 19-9 concentrations, a low alpha-fetoprotein concentration, and hypervascularity. The cholangiocellular carcinoma component appears to determine the prognosis.

Bile Duct Neoplasms↗
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Resected cases of hepatocellular carcinoma detected after interferon therapy for chronic hepatitis C.

BACKGROUND/AIMS: Interferon therapy decreases the incidence of hepatocellular carcinoma in patients infected with hepatitis C virus. However, hepatocellular carcinoma was detected after interferon therapy in some patients. METHODOLOGY: Of the 167 patients who underwent liver resection for hepatitis C virus-related hepatocellular carcinoma between 1993 and September 1998, the carcinoma was detected after interferon therapy in 11 patients. The clinicopathologic findings in these 11 patients were studied. RESULTS: The response to interferon was complete (n = 4), partial (n = 4), or no response (n = 3). Hepatocellular carcinoma was detected 2 months to 3 years 9 months, after interferon therapy. The interval period from the end of interferon therapy to the detection of the carcinoma were significantly correlated with the longest diameter of the main tumor (P = 0.0043), indicating that most carcinomas have already developed before the end of interferon therapy. In one non-responder, multicentric carcinogenesis occurred after liver resection for primary hepatocellular carcinoma. Another patient with advanced hepatocellular carcinoma died of the recurrence. CONCLUSIONS: Surveillance for hepatocellular carcinoma must be performed even in patients successfully treated with interferon because occult carcinoma may have developed before or during the therapy.

Alanine Transaminase↗
PubMedDate not supplied

Resection of a non-functioning islet cell carcinoma occupying the entire pancreas.

A 46-year-old woman with jaundice was found to have enlargement of the entire pancreas on computed tomography. Endoscopy revealed a tumor at the papilla of Vater, although examination of biopsy specimens did not demonstrate a malignancy. The jaundice resolved spontaneously, but reappeared at 7 months. Also noted was increased swelling of the papilla. The serum pancreatic endocrine and exocrine hormone concentrations were within the reference ranges. At surgery, a hard mass was found occupying the entire pancreas. Examination of incisional biopsy specimens from the pancreatic mass and papilla of Vater revealed an islet cell tumor. A total pancreatectomy was performed. The tumor extended from the pancreatic tail to the papilla of Vater. Histopathologic and immunopathologic examination revealed a non-functional islet cell carcinoma. There was no evidence of recurrence at 3 years. A good outcome can be achieved with resection of non-functioning islet cell carcinomas, even if they are advanced.

Ampulla of Vater↗
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Nitric oxide synthase inhibitor increases hepatic injury with formation of oxidative DNA damage and microcirculatory disturbance in endotoxemic rats.

BACKGROUND/AIMS: Nitric oxide plays important roles in the pathogenesis of endotoxin shock and multiple organ failure. Nitric oxide synthase inhibitors are used in patients to improve hemodynamics in endotoxin shock. However, the role of nitric oxide is controversial in hepatic injury with oxidative DNA damage in endotoxemia. This report investigated the role of nitric oxide on hepatic blood flow and liver injury in endotoxemic rats. METHODOLOGY: Under light ether anesthesia, male Wistar rats were given lipopolysaccharide (10 mg/kg) intravenously. Several hours (0-24 hr) later, the animals were used for experiments. In some experiments, NG-[1-iminoethyl]-L-ornithine, a potent inhibitor of nitric oxide synthase, was administered 5 mg/kg intraperitoneally every 3 hour after lipopolysaccharide injection. Hemodynamic changes, biochemical and histological analysis were determined. RESULTS: Lipopolysaccharide increased the activity of inducible nitric oxide synthase in the liver, lungs and spleen. Significant amounts of nitric oxide-hemoglobin complexes and nitrite plus nitrate appearing in the blood peaked at 8 hr after treatment. NG-[1-iminoethyl]-L-ornithine completely inhibited the generation of nitric oxide metabolites, but hardly affected formation of urinary 8-hydroxydeoxyguanosine and the systemic blood pressure in normal rats. NG-[1-iminoethyl]-L-ornithine increased 8-hydroxydeoxyguanosine formation and decreased the blood flow more in the superior mesenteric artery and hepatic microvascular blood flow in endotoxemic rats. Inhibition of nitric oxide synthase markedly caused deterioration of the lipopolysaccharide-induced liver injury indicated by hepatic enzymes and histological findings. CONCLUSIONS: These results suggested that suppresion of endogenous nitric oxide might aggravate hepatic injury, partly caused by decrease in hepatic blood flow accompanied with oxidative stress in endotoxemia.

Animals↗
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A surgically treated case of hepatocellular carcinoma with extensive lymph node metastases.

A 62-year-old man with chronic hepatitis C was found to have a hepatic tumor by ultrasonography. Computed tomography of the liver disclosed a tumor 4 cm in diameter occupying the posterior segment and associated with a portal tumor thrombus and enlargement of hilar and paraaortic lymph nodes. At laparotomy multiple nodal metastases were seen involving hilar, hepatoduodenal, common hepatic arterial, and paraaortic nodes. We performed right hepatic lobectomy and systematic lymph node dissection. Histologic examination of both the main tumor and nodal metastases showed poorly-differentiated hepatocellular carcinoma. Severe postoperative ascites persisted for 1 month. Fifteen months after surgery the patient died of multiple intrahepatic and systemic nodal recurrences. Our experience confirms that surgical treatment of hepatocellular carcinoma with nodal metastases is likely to benefit only a few carefully selected patients, since the prognosis is commonly poor and hepatectomy with lymph node dissection carries the risk of severe complications.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

The effect of flexural load cycling on the microleakage of cervical resin composites.

Although several in vitro studies have attempted to investigate the microleakage of Class V resin composites under loading, the effect of load cycling on marginal seal is still unclear. This may be due to the fact that axial loads were applied to the specimens. This study investigated the effect of flexural loads on marginal sealing of cervical resin composites. One hundred and fifty cervical wedge-shaped cavities were restored with Clearfil Photo Bond, Clearfil Liner Bond 2, Scotchbond Multi-Purpose with 10% maleic acid, Scotchbond Multi-Purpose with 35% phosphoric acid or Mac-Bond 2 according to the manufacturers' instructions. After the restorations were finished, 10 specimens from each group were immersed in 0.5% basic fuchsin solution to examine microleakage. Prior to dye solution immersion, 20 specimens were subjected to flexural load cycling (1 mm labio-lingual or linguo-labial displacement at the incisal edge, 10,000 cycles, 1 cycle/second). The data were analyzed using the Kruskal-Wallis test and the Mann-Whitney U-test (p<0.05). When the flexural loads were not applied, both the incisal and apical margins showed good marginal sealing, regardless of the adhesive system used. Labio-lingual loading significantly deteriorated the marginal integrity at the incisal enamel margins, except for those restored with Clearfil Photo Bond. However, only Clearfil Photo Bond demonstrated a significant increase in microleakage along the apical dentin margins. Linguo-labial loading had no significant effect on the marginal seal.

Alkanes↗
PubMedDate not supplied

[Fatalities in alcoholic intoxication in the aged].

In 1989, the blood-alcohol-concentration of 1545 elderly persons with an age of at least 60 years, who died suddenly or not of natural causes, was determined at the Institute for Legal Medicine in Hamburg. 238 autopsies were performed. In a total of 143, in 55 subjects of the autopsy series, a blood-alcohol-concentration over 0.05% was found. With growing age the number of positive blood-alcohol-analyses decreased. Twenty-two of the autopsied persons (40%) did not die of natural causes; among them were 11 accidents. Alcohol played a significant role in the fatal course of 8 cases; 15 subjects included in the autopsy series (27.3%) had been alcoholics. Preexisting cardiovascular and respiratory disease was diagnosed in most cases of natural death. The causal connection of alcohol, disease, and cause of death in the elderly is discussed.

Accidents↗