Epidermoid cyst in an intrapancreatic accessory spleen: CT and pathologic findings.
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Choristoma↗
Biomedical subjects
T Kosuge
Publications and source records attributed to T Kosuge.
[Long-term results after hepatectomy for hepatocellular carcinoma according to cancer stage].
The survival rates after hepatectomy for hepatocellular carcinoma (HCC) according to cancer stage were reported. The 5-year survival rates of Stage 1, 2, 3 and 4 were 69.6%, 54.2%, 35.9% and 30.2%, respectively. A significant difference was observed between any neighboring two stages. But more than 5 years till 20 years, the survival curves cross at some times. That means after 5 years the influence of the anatomic condition of the initial cancer has been weak. Probably another factor which controls multi-centric carcinogenesis of HCC may work. When the survival rate was calculated dividing the stage group into two sub-groups according to liver function, with good function or poor function, the survival of the poor liver function group of any stage group was worse than that of the good liver function group of the nearest worse stage group. The survival after hepatectomy of HCC depends not only upon anatomic condition of the cancer but also upon the liver function.
Carcinoma, Hepatocellular↗
[Systematic resection for hepatocellular carcinoma].
We have performed systematic subsegmentectomy in patients with hepatocellular carcinoma complicated mainly by cirrhosis. Such small anatomical resections have become possible due to the introduction of intraoperative ultrasonography and of vascular occlusion techniques. As a result of our clinical experience involving 163 cases, it has been clarified that subsegmentectomy is a safe procedure (operative mortality rate, 0.6%) and results in a favorable long-term outcome (5-year survival rate, 51%). In the resected specimens, microscopic cancer spread was recognized frequently (portal venous invasion, 41%; intrahepatic metastasis, 31%). Subsegmentectomy is therefore the first procedure of choice in patients who have small hepatocellular carcinoma and chronic hepatitis or cirrhosis.
Aged↗
Molecular cloning and sequence analysis of the lysR gene from the extremely thermophilic eubacterium, Thermus thermophilus HB27.
We have isolated a lysine-auxotrophic and kanamycin-resistant mutant from an extreme thermophile, Thermus thermophilus HB27. This mutant showed the lysA- or lysR- genotype since it could not grow on the minimal plate which contained diaminopimelic acid. Sequence analysis of the clones which could rescue the Lys- mutant indicated the lysR gene. The lysR gene overlapped with the rimK gene for the modification enzyme of ribosomal protein S6. In the Lys- mutant, the lysR gene was disrupted and the C-terminus region of the RimK protein was different from that of the wild-type, which contributed to the Lys- and kanamycin-resistant phenotype. The deduced amino acid sequence of the lysR gene showed 20.9% identity with the LysR protein of Escherichia coli. The percentage of use of cytosine or guanine in the third letter of the codons in the lysR gene was only 67.4%. We also determined that the argC gene encoding N-acetyl-gamma-glutamyl phosphate reductase and the argB gene encoding acetylglutamate kinase were located immediately upstream of the lysR gene.
Anti-Bacterial Agents↗
Use of a bovine jugular vein graft with natural valve for right ventricular outflow tract reconstruction: a one-year animal study.
OBJECTIVE: We evaluated a bovine jugular vein graft with a natural trileaflet valve for right ventricular outflow tract reconstruction in a canine study for an entire year. METHODS: Heparinized bovine jugular vein grafts with a natural valve cross-linked with a hydrophilic polyepoxy compound of 18 to 20 mm in internal diameter were implanted in the right ventricular-pulmonary arterial position in eight dogs, and the main natural pulmonary artery was ligated. Anticoagulants were not used after implantation. Five grafts were retrieved on day 182 after implantation and the other three grafts on days 196, 375, and 385, respectively, and were inspected by macroscopic and microscopic observation. Cardiac catheterization, followed by angiography and echocardiography, was done just before graft retrieval. RESULTS: No graft kinking or regurgitation of the valve was observed. Echocardiography showed natural valve motion without thickening of the leaflets. Blood pressure in the conduits ranged from 18/9 to 31/4 mm Hg, in the right ventricle from 18/4 to 40/0 mm Hg, and the gradient varied from 0 to 14 mm Hg. The explanted conduits maintained their original shape, softness, and pliability with good coaptation of valves, without calcification or degenerative changes, except for one leaflet with slight deformation. In microscopic observation, endothelial cells lined the luminal surface of the conduit except for the areas adjacent to the valve. CONCLUSION: The graft worked perfectly as a right ventricular-pulmonary arterial valved conduit without anticoagulant therapy for a long time.
Animals↗
Intraductal papillary tumors and mucinous cystic tumors of the pancreas: clinicopathologic study of 38 cases.
Clinicopathological features of 28 patients with intraductal papillary tumor (IDPT) and 10 patients with mucinous cystic tumor (MCT) of the pancreas were studied. Both IDPT and MCT showed papillary projections of the epithelium with abundant mucus secretion in the ectatic ducts or cystic spaces. The patients with IDPT comprised 19 men and 9 women with a mean age of 64.9 years. Three fourths of the IDPTs were located in the pancreatic head, and the mean tumor size was 3.5 cm. Local recurrence was observed in one patient, but none died of IDPT. In contrast, all patients with MCT were women, with a mean age of 49.4 years. None of the MCTs arose in the head, and the mean tumor size was 7.1 cm. One patient died of MCT, but all of the others survived without recurrence. Eight IDPTs and three MCTs showed invasion into the surrounding pancreatic tissue. Muconodular infiltration was mainly observed in five IDPTs and one MCTs and tubular infiltration in three IDPTs and two MCTs. A characteristic histological finding associated with the muconodular infiltration in IDPT was subepithelial "mucin droplets" that appeared to represent a change in polarity of mucus secretion. The formation of such subepithelial "mucin droplets" may be the initial step of muconodular infiltration in IDPT. Muconodular infiltration in IDPT appears different morphologically and biologically from the mucinous carcinoma subtype of conventional invasive ductal carcinoma.
Adenocarcinoma, Papillary↗
Intrahepatic cholangiocarcinoma presenting intrabile duct extension: clinicopathologic study of five resected cases.
Intrahepatic cholangiocarcinoma, which is ordinarily a very invasive tumor and often takes a rapid and fatal course, sometimes shows macroscopic intrabile duct extension. The purpose of this study is to illustrate the clinicopathologic features of this variant of intrahepatic cholangiocarcinoma, which has occasionally been reported. Five cases of the tumor with gross extension to the bile duct lumen were studied to determine their clinical and pathologic features. The tumor showed intrabile duct growth and superficial mucosal spread in two patients. In two other patients, an apparent mass lesion accompanied the intraluminal component. In the remaining patient, a polypoid tumor infiltrated the portal tract of the left lateral segment, where it had arisen. Microscopic examination did not reveal any vascular involvement or intrahepatic or lymph node metastasis. All of the patients are alive without recurrence, except for Patient 1 who died 7 years and 7 months after surgery from a rapidly growing tumor in the liver remnant. Intrabile duct growth of intrahepatic cholangiocarcinoma may reflect indolent biological behavior and thus warrants an aggressive surgical approach, which appears to give a good prognosis.
Adenocarcinoma↗
Retroperitoneal schwannoma mimicking hepatic tumor in the caudate lobe.
We report a 41-year-old woman with a retroperitoneal schwannoma mimicking hepatic tumor in the caudate lobe. Dynamic computed tomography in the early phase showed an enhanced tumor (2.7 cm in diameter) in the Spiegel lobe of the liver, which compressed the inferior vena cava (IVC). We also performed left hepatic angiographic computed tomography, and found that the tumor was less enhanced. The patient underwent laparotomy under a preoperative diagnosis of primary hepatic caudate tumor with faint neovascularity. At surgery, the tumor was found to be located between the left caudate lobe and the IVC, and was resected as being of a retroperitoneal origin. This case illustrates that tumor location must be determined with great care when the mass seems to exist at the dorsal edge of the liver, and especially when the tumor is hypovascular.
Adult↗
Pheochromocytoma growing exophytically from the right adrenal gland and invaginating into the liver.
A 5-cm pheochromocytoma located in segment 7 of the liver was found incidentally in a 45-year-old man with mild diabetes mellitus and hypertension, and resected. The tumor was demonstrated by computed tomography and magnetic resonance imaging to have completely invaginated itself into the liver and to be receiving blood from a dilated right hepatic artery alone. Surgery revealed the hepatic mass to be tightly adherent to the right adrenal gland. The histopathologic diagnosis was pheochromocytoma growing exophytically from the right adrenal gland. There was no association with multiple endocrine neoplasia type 1 and type 2. A postoperative 131I metaiodobenzylguanidine scan revealed no accumulation, and the patient is currently doing well without recurrence or hypertension one year after the operation. A pheochromocytoma deeply invaginating into the liver should be considered in the differential diagnosis of primary hypervascular hepatic tumors.
Adrenal Gland Neoplasms↗
Analysis of biliary drainage in the caudate lobe of the liver: comparison of three-dimensional CT cholangiography and rotating cine cholangiography.
PURPOSE: To evaluate the bile duct anatomy of the caudate lobe without disease involvement with use of three-dimensional (3D) cholangiography and to compare the usefulness of this technique with that of rotating cine cholangiography. MATERIALS AND METHODS: In 12 patients with obstructive jaundice but without lesions at the hepatic hilum who underwent percutaneous transhepatic biliary drainage, serial examination was performed with cine cholangiography and helical computed tomography (CT). From helical CT scans, 3D cholangiograms were reconstructed. Cine and 3D cholangiograms were evaluated and compared simultaneously. RESULTS: In the 12 patients, 40 branches of the caudate lobe were detected with 3D cholangiography (mean, 3.3 branches per patient), while 31 were detected with cine cholangiography (mean, 2.6 branches per patient). The difference in detection rate was significant (P < .01). Nine (23%) of 40 branches were detected with 3D cholangiography alone, and all 31 branches detected with cine cholangiography were also detected with 3D cholangiography. CONCLUSION: 3D cholangiography was superior to cine cholangiography in assessment of bile duct anatomy of the caudate lobe of the liver because 3D cholangiography eliminated the overlap of different branches of the bile duct.
Aged↗
An aggressive therapeutic approach to carcinoma of the body and tail of the pancreas.
BACKGROUND: Prognosis of patients with adenocarcinoma of the pancreatic body and tail is extremely poor. Anatomically, this part of the pancreas is thin, and cancerous invasion to the retropancreatic structures occurs easily. The majority of patients have residual tumor in the retroperitoneal tissues after conventional distal pancreatectomy. METHODS: Between 1962 and 1979, 10 patients with carcinoma of the pancreatic body underwent simple distal pancreatectomy. Between 1980 and 1990, 22 patients including 7 with distant metastasis underwent a more aggressive approach intended to achieve longer survival: distal pancreatectomy with extended dissection of the lymph nodes and adjacent structures, especially into the retropancreatic space. After 1984, intraoperative ŕadiation (IORT) by electron beam and chemotherapy by hepatic infusion plus systemic injection of mitomycin C (MMC) were added for 7 patients without distant metastasis. RESULTS: The 10 patients who underwent pancreatectomy between 1962 and 1979 all died within 20 months after their operations. Conversely, the patients treated with an aggressive approach between 1980 and 1990 survived longer; the 5-year survival rate for 15 patients without distant metastasis was 29%, though the 7 patients with distant metastasis died within 10 months of their operations. There were 4 long term survivors (> or = 5 years); 3 of whom received IORT and chemotherapy with MMC. Invasion to the retropancreatic soft tissues was present in 95% of the resected specimens from the 22 patients. However, invasion to the surgical margin at the posterior surface of the resected specimen was present in only 36% after extended resection of the retropancreatic structures. CONCLUSIONS: Survival improved for this disease after distal pancreatectomy with extended dissection, especially of the retropancreatic structures, adjuvant IORT, and chemotherapy had been performed.
Adenocarcinoma↗
Local recurrence of hepatocellular carcinoma after percutaneous ethanol injection.
BACKGROUND: Percutaneous ethanol injection (PEI) therapy is now widely used for small hepatocellular carcinomas (HCC). However, only limited information is available regarding local tumor recurrence after PEI treatment. METHODS: We investigated the relationship of pretreatment clinicopathologic variables (tumor size, tumor cell differentiation and tumor staining) to local recurrence in 170 PEI-treated HCC nodules (measuring 5-39 mm in greatest dimension) in 84 patients. RESULTS: Local recurrence was observed in 17 of 170 PEI-treated nodules. Among these, 13 local recurrences were observed as the first event of progression after PEI. Local recurrence rates at 1, 2, and 4 years were 6.6%, 14.2%, and 14.2%, respectively, and all recurrences were observed within 2 years after PEI. Of the 3 variables investigated, large tumor size (31 mm or larger in greatest dimension) was significantly associated with a higher local recurrence rate. CONCLUSIONS: This study demonstrated that tumor size influences the local efficacy of PEI for small HCC. Therefore, we recommend that a reasonable indication for PEI therapy is HCC lesions measuring less than 30 mm in greatest dimension.
Antineoplastic Agents↗
Re-reconstruction of a single remnant hepatic vein.
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Adult↗
CT diagnosis of intraductal papillary neoplasm of the pancreas in comparison with histopathologic findings.
CONCLUSION: The existence of excrescent nodules in the cystic component of intraductal papillary neoplasms (IPN) on computed tomography (CT) is useful for differentiating between malignant and benign lesions. BACKGROUND: We sought to evaluate the ability of CT to differentiate malignant from benign lesions in IPN of the pancreas. METHODS: CT findings in 20 cases of IPN (11 benign and 9 malignant lesions) were compared with histopathological findings from subsequent surgery. RESULTS: The size of the cystic portion on CT did not correlate with the malignant potential of the lesion. Seven (78%) of 9 malignant lesions had excrescent nodules on CT, whereas 1 (9%) of 11 benign lesions did.
Adenoma↗
Serous cystadenoma of the pancreas communicating with a pancreatic duct.
CONCLUSION: To differentiate serous cystadenoma from other cystic lesions communicating with the pancreatic duct, careful radiological examination is necessary. BACKGROUND: Communication between the cystic cavity and the pancreatic duct in an ordinary serous cystadenoma is uncommon, although it is not uncommon in other cystic lesions, such as pseudocyst, mucinous cystadenoma/adenocarcinoma, and intraductal papillary tumor. METHODS. A serous cystadenoma of the pancreas communicating with main pancreatic duct in a 76-yr-old male is reported. RESULTS: The communication was preoperatively demonstrated by endoscopic retrograde cholangiopancreatography and confirmed by histopathological examination of the resected specimen.
Aged↗
Study on neurotoxic shellfish poisoning involving the oyster, Crassostrea gigas, in New Zealand.
Lipid-soluble polyether marine toxins were isolated from 80% methanol extract of oysters, Crassostrea gigas, harvested in 1993 at Tiki Road, Coromandel Peninsula, New Zealand, by chromatography on columns of LH-20 and ODS (C18), followed by reversed-phase high-performance liquid chromatography. They were identified as known brevetoxins, PbTx-2 and 3. PbTx-3 was also isolated from oysters collected at Rangaunu Harbour in February 1994 and June 1995, followed by the above procedures.
Animals↗
A World Wide Web-based user interface for a data management system for use in multi-institutional clinical trials--development and experimental operation of an automated patient registration and random allocation system.
We have employed the Hypertext Transfer Protocol (HTTP) and Hypertext Markup Language (HTML) to develop an automated patient registration and random allocation system for use in a multi-institutional clinical trial. We made it available on-line to World Wide Web clients in each hospital through a user friendly graphical user interface. During experimental operation, the physicians found it satisfactory from the viewpoint of both ease of operation and response time. For the development of a graphical user interface in network-based information system for use in multi-institutional clinical trials, HTTP/HTML has several advantages over an ordinary client-server model. Therefore, we concluded that we would adopt HTP/HTML for the construction of user interfaces for physicians in each spital and for data managers in our coordinating center.
Chemotherapy, Adjuvant↗
Successful radical surgery for an undifferentiated gallbladder carcinoma with lymph node metastases to the mesocolon.
We report successful radical systematic surgery for an undifferentiated gallbladder carcinoma with metastasis to the mesocolonic lymph nodes. The patient, a 70-year-old woman, was admitted with abdominal fullness and appetite loss. Imaging modalities revealed a 10-cm tumor originating from the gallbladder and infiltrating both the liver and transverse colon. As multiple mesocolonic lymph node metastasis was confirmed on laparotomy, right hemicolectomy with systematic lymph node dissection (D3 resection) was performed, in addition to extended cholecystectomy with partial resection of segments 4, 5 and 6 of the liver and distal gastrectomy. Histologically, the tumor was diagnosed as an undifferentiated carcinoma, and metastases were indentified in the mesocolonic lymph nodes (17/50 nodes) but not in the peri-gallbladder lymph nodes (0/16 nodes). The patient has been recurrence-free for 4 years after the operation. This case illustrates that even if gallbladder cancer infiltrates into adjacent organs with regional lymph node metastasis, it is of value to perform radical surgery with systematic lymph node dissection for the involved organs.
Aged↗