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Biomedical subjects

T Kusano

Publications and source records attributed to T Kusano.

193 records · Page 11Linked to original sources
PubMedDate not supplied

Extracorporeal bypass using a centrifugal pump during resection of malignant liver tumors.

BACKGROUND/AIMS: Total hepatic vascular exclusion (THVE) during extracorporeal bypass is used for hepatic resection in patients with malignant liver tumors. The aim of this study was to determine the efficacy of hepatectomy during total hepatic vascular exclusion using a centrifugal pump (Bio-pump). METHODOLOGY: Fourteen patients with malignant liver tumors who underwent hepatectomy during total hepatic vascular exclusion using the Bio-pump were studied retrospectively. RESULTS: In 3 of 14 patients, insufficient hepatic vascular exclusion was achieved. Six patients underwent tumor resection during total hepatic vascular exclusion, without extracorporeal bypass. In the remaining 5 patients, flow exclusion averaging 1500 ml was achieved with the Bio-pump, and hepatectomy was performed during the procedure. In these 5 patients, the mean operative time and blood loss were 11 hours 38 minutes and 6850 +/- 2451 ml. The Bio-pump bypass time, the excluded blood flow and the mean blood pressure were 82 minutes, 1650 ml and 108/53 mmHg, respectively. The arterial ketone body ratio (AKBR) decreased from a pre-operative value of 1.85-0.32 during total hepatic vascular exclusion. CONCLUSIONS: Total hepatic vascular exclusion was useful for hepatectomy in patients with tumor invasion into the hepatic vein and inferior vena cava, or tumor thrombus in the inferior vena cava and right atrium. However, this technique did not decrease blood loss or improve outcome in patients undergoing hepatectomy.

Aged↗
PubMedDate not supplied

Results of retrograde transhepatic biliary drainage after a common bile duct exploration for choledocholithiasis.

BACKGROUND/AIMS: The purpose of this study is to assess the benefits of retrograde transhepatic biliary drainage (RTBD) and a primary closure after a common bile duct (CBD) exploration for patients with choledocholithiasis. METHODOLOGY: We analyzed 143 patients with choledocholithiasis who had been managed by RTBD after undergoing a CBD exploration retrospectively over a 12-year period. The main outcome criteria were frequency of occurrence of post-operative complications which needed a relaparotomy and the clinical long-term results. In addition, the radiographic diameter changes of the CBD at the site of the primary closure and liver function tests after RTBD were also evaluated. RESULTS: The frequency of bile peritonitis in the patients undergoing the RTBD procedure was only 0.7% (1 out of 143 cases). Cholangiography via the RTBD tube revealed no severe stenosis at the site of primary closure. Liver function returned to normal on day 3 after RTBD (p<0.05). Recurrence of common bile duct stones developed in 2 patients in this series during the follow-up (1-12 years). CONCLUSIONS: RTBD and a primary closure of the CBD after CBD exploration appears to be a clinically safe and effective method for such patients with choledocholithiasis who had undergone a complete stone removal intra-operatively.

Adult↗
PubMedDate not supplied

Efficacy of hepatic arterial infusion of prostaglandin E1 in the treatment of postoperative acute liver failure--report of a case.

Prostaglandin E1 (PGE1) has received attention for its protective effects against various types of liver damage. However, it is known that approximately 70% of PGE1 is inactivated during a single passage through the lung. Therefore, direct infusion of PGE1 into the liver bloodstream is preferable to intravenous infusion. A 66-year-old man with hepatocellular carcinoma with liver cirrhosis developed postoperative acute liver failure following posterior segmentectomy under hepatic total vascular exclusion exceeding 1 hour. Because his liver function did not recover in spite of plasma exchange starting on postoperative day 8 and intravenous infusion of PGE1, hepatic arterial continuous infusion of PGE1 at a rate of 0.01 microgram/kg/min was carried out for 7 days from postoperative day 17. Immediately after the start of the arterial infusion, the bile flow significantly increased compared to before the arterial infusion, and the serum total bilirubin level decreased thereafter and finally recovered from the hepatic failure. In addition to its highly efficient drug delivery, the hepatic arterial infusion of PGE1 seems to be more advantageous in oxygen delivery to the liver compared with intravenous infusion. In conclusion, the hepatic arterial infusion of PGE1 may be useful in the treatment of acute liver failure.

Aged↗
PubMedDate not supplied

Whether or not prophylactic excision of the extrahepatic bile duct is appropriate for patients with pancreaticobiliary maljunction without bile duct dilatation.

BACKGROUND/AIMS: The standard treatment for patients with a pancreaticobiliary maljunction (PBM) without bile duct dilatation remains controversial. METHODOLOGY: We followed up 29 patients with such PBM who mainly underwent a cholecystectomy alone. The ages of the patients ranged from 3 to 76 years (average age 47.3 years) and the ratio of males to females was 8 vs. 21. When the diameter of the common bile duct was less than 10mm, such bile ducts were diagnosed to have no dilatation. The main clinical indications for surgery were cholecystolithiasis in 15 patients, choledocholithiasis in 3, cholecystocholedocholithiasis in 2, gallbladder polyp in 2, adenomyomatosis in 2, cholecystitis in 2, and protein plug in 1. RESULTS: The amylase levels of gallbladder bile in 20 patients ranged from 115 to 460,200 IU/mL (a mean of 191,698 IU/mL). One patient died of gastric cancer 182 months after surgery and two patients died of other diseases 153, 171 months after surgeries, respectively. The remaining 26 patients have all been doing well for 36 months to 326 months after surgery (a median follow-up period, 160.5 months). The 10- and 15-year survival rates were 100% and 89.7%. CONCLUSIONS: In conclusion, a prophylactic resection of the extrahepatic bile duct and biliary diversion could be unnecessary for patients with PBM without bile duct dilatation.

Adolescent↗
PubMedDate not supplied

Changes in tumor necrosis factor-a and interleukin-1 beta production following liver surgery on cirrhotic patients.

BACKGROUND/AIMS: The purpose of this study is to investigate the possible participation of inflammatory cytokine release from macrophages/monocytes following liver surgery on cirrhotic patients in the pathogenesis of postoperative organ failures. MATERIALS AND METHODS: Postoperative changes in tumor necrosis factor-a and interleukin-1 beta production in peripheral blood monocytes stimulated by lipopolysaccharide were examined in cirrhotic patients with hepatocellular carcinoma undergoing hepatic resections. RESULTS: Monocytes separated from the blood in cirrhotic patients prior to operation showed a greater ability to produce tumor necrosis factor-a and interleukin-1 beta than those in healthy volunteers. Monocytes in postoperative cirrhotic patients showed a greater ability to produce tumor necrosis factor-a and interleukin-1 beta in the presence of lipopolysaccharide than healthy controls and preoperative cirrhotic patients. In the case of postoperative hepatic failure, tumor necrosis factor-a and interleukin-1 beta production in monocytes showed a remarkable rise along with progression toward hepatic failure. CONCLUSION: These results indicate that tumor necrosis factor-a and interleukin-1 beta play an important role in the pathogenesis of postoperative liver failures. When there are any stimuli to produce cytokines in monocytes, such as ischemia, significant tissue injury and/or endotoxin, organ failures could develop and progress subsequently.

Aged↗
PubMedDate not supplied

The use of intraoperative ultrasonography for detecting tumor extension in bile duct carcinoma.

UNLABELLED: The purpose of this study was to investigate the clinical feasibility of using intraoperative ultrasonography (IOUS) to detect tumor extension in bile duct carcinoma, especially longitudinal invasion along the bile ducts into either the hepatic parenchyma or adjacent hilar vessels. MATERIALS AND METHODS: The medical records of 14 patients with bile duct carcinoma who underwent surgical treatment at the First Department of Surgery, University of the Ryukyus, were retrospectively analyzed. All patients were examined by IOUS during the operation. The resected specimens were processed in order to compare the ultrasound images with the histological findings. RESULTS: The echo level of the primary lesion was not consistent. Specific echo patterns, such as a thickening of the echogenic layer (TEL) adjacent to the main tumor showing cancerous invasion, were observed in ten patients, 71.4% (nodular invasive 7, invasive 3) which were later confirmed by microscopic examinations and ultrasonic findings. The detection rate of TEL was 87.5% in nodular invasive type and 100% in invasive type, respectively. The TEL histologically coincided with a layer of fibrotic hypertrophy around the infiltrating tumor cells. The intramural invasion beyond the edge of TEL was detected in only 2 out of 11 patients. The accurate detection rate of the involvement of the portal vein and the hepatic artery by IOUS was 83.3% and 60%, respectively. Based on the above findings, IOUS is thus considered to be essential for evaluating tumor extension along the bile ducts, and also greatly helps in selection of the most appropriate operative procedure, especially in hilar cholangiocarcinoma.

Adult↗
PubMedDate not supplied

Villous adenoma of the gallbladder: a case report.

A 76-year-old female with villous adenoma of the gallbladder is herein reported. She presented complaining of upper abdominal pain for some months prior to admission. No tumor mass could be detected by transabdominal ultrasonography, but CT scan demonstrated a sessile tumor measuring some 2 cm in diameter. A simple cholecystectomy was thus performed. The resected gallbladder was filled with mucinous material, and showed a sessile tumor with finger-like processes in the fundus. Both the macro- and microscopical findings of the lesion were almost identical to a typical villous adenoma of the colon. Little information is available on villous adenoma of the gallbladder, because such cases are extremely rare. In this paper, is described e a rare villous adenoma lesion while paying special attention to the morphological findings.

Adenoma, Villous↗
PubMedDate not supplied

Vascular reconstruction for intraoperative major vascular injuries.

BACKGROUND: The purpose of this study was to find an effective and precise surgical procedure to cope with the major vascular injuries that might be encountered during hepato-biliary and pancreatic surgery. MATERIALS AND METHODS: Among the 220 cases of hepato-biliary and pancreatic surgery from 1991 to 1995 in our department, 8 patients who sustained 13 different instances of vascular injury were reviewed retrospectively. RESULTS: Five injuries occurred in the portal vein (PV), 4 in the hepatic artery (HA), and 2 in the inferior vena cava (IVC). The repair procedures consisted of 2 direct closures, 2 resections of the injured sites followed by the end to end anastomosis, 2 autologous venous grafts and 1 artificial vascular graft implantation, and 2 diversions of the arterial bloodflow of the middle colic artery and the gastroepiploic artery to the injured HA. The reconstructed vessels showed postoperative obstructions in 2 cases, in which artificial vascular graft implantation and direct closure were used for the reconstruction. CONCLUSIONS: Based on the above findings, the use of an artificial graft and a direct closure all contributed to the early postoperative obstruction of the reconstructed vessels. However, a diversion of the arterial bloodflow to the injured hepatic arteries was found to maintain a good postoperative patency in these cases.

Adult↗
PubMedDate not supplied

Esophageal cancer in patients with head and neck cancers.

Nine male patients with separate primary cancers of the esophagus and head and neck (pharynx, larynx) presented with a mean age of 56 years (41-69). They included 7 pharyngeal cancer patients and 2 laryngeal ones. Esophageal cancer was discovered synchronously in 6 patients and metachronously in 3 (1, 4, and 11 years later, respectively). The head and neck cancer was stage-I in one patient, stage-II in 4 and stage-IV in 4. The esophageal cancer was cervical in 2, thoracic in 6 and abdominal in 1. It was early cancer (stage-0) in 6 patients and advanced (stage-IV) in 3. The esophageal cancer was more advanced in the metachronous group, while it was early in the synchronous group. Since the head and neck cancer was advanced, all patients underwent a total laryngectomy for their head and neck cancers. As for esophageal surgery, a transhiatal esophagectomy was, in principle, performed for early cancers while a total thoracic esophagectomy was done for advanced cancers. For the reconstruction of the esophagus, a gastric tube was used. Four patients are still alive with a mean survival time of 25 months, whereas five died of cancer recurrence of either type a mean of 19 months after surgery. As compared with the survival rates of the patients with esophageal cancer alone, the 5-year survival rate was 18.2% for patients with double cancers in this series and 27.9% for those with esophageal cancer alone.

Adult↗
PubMedDate not supplied

Two-step portal bypass to reconstruct an invaded superior mesenteric vein in pancreatic cancer.

Advanced cancer of the pancreatic head, especially in its caudal portion, has a limited surgical resectability due to its frequent invasion to the superior mesenteric vein (SMV). A patient with advanced carcinoma of the pancreatic head with vascular invasion to the major bifurcation of the SMV, underwent a pancreatico-duodenectomy under a two-step passive bypass of the portal flow. The marginal colic veins were dilated and formed a long collateral route to the inferior mesenteric vein and the splenic vein due to stenosis of the SMV. The venous flow in this vein was then easily interrupted with the surgical manipulation of the transverse colon. The first passive bypass was thus inserted into the accessory right colic vein to preserve the venous return from both the small intestine and the colon, and also to enable surgical dissection of the invaded SMV itself. After a thorough dissection of the invaded SMV, a second bypass was inserted into the main trunk of the SMV through the dissected vascular stump. Subsequently the passive bypass was maintained until the portal reconstruction with an interposition of the left common iliac vein could be performed. The patient recovered well from the surgery without any complications throughout the postoperative course. In summary, the two-step portal bypass describes, is thus considered a stable and safe procedure for the reconstruction of the superior mesenteric vein, during pancreatoduodenectomy for advanced carcinoma of the pancreatic head.

Angiography↗
PubMedDate not supplied

A proposed optimal health care system based on a comparative study conducted between Canada and Japan.

OBJECTIVES: Every country wants a good health care system for all citizens with minimum expenditure. By comparing health care systems in Canada and Japan, both of which have a universal health care system for all citizens in its own country, an attempt was made to visualize or search for an optimal health care system. METHOD: Data and information obtained were tabulated and compared from the standpoint of the effectiveness of the health insurance system and the feasibility of its application so as to propose an optimal health care system. RESULTS AND CONCLUSIONS: Some of the suggestions and proposals made for an optimal health care system for all citizens include implementation and/or establishment of minimal user fees, centralized rational decision-making processes, private delivery system of health care, centralized computer-aided patient record system, insurance monitoring system, patient education, and physician guidelines.

Canada↗
PubMedDate not supplied

Surgical treatment for proximal bile duct carcinoma.

BACKGROUND: The surgical management of proximal bile duct carcinoma is controversial. There is no consensus among surgeons as to the indications for radical resection. This article described personal experience with the different surgical procedures for patients with proximal bile duct carcinoma. METHODS: The medical records of fifty-two consecutive patients undergoing surgical resection over a 20-year period were retrospectively analysed in terms of pathology, perioperative mortality, clinical course, and overall survival. RESULTS: The 1-, 3- and 5-year survivals for the entire group were 63.3%, 24.5%, and 21.0%, respectively. The results for local resection of the extrahepatic bile duct in 35 cases were unsatisfactory. Radical resection that included the right extended hepatic lobe, caudate lobe, and extrahepatic bile duct was performed in 9 patients and demonstrated an excellent 5 year survival rate of 44.4%. However, hospital mortality was 22.2%. There was no significant difference among the operative procedures for patients with advanced disease. CONCLUSION: Radical resection remains the procedure of choice in proximal bile duct carcinoma. However, results with surgical therapy alone remain unsatisfactory. Multimodality treatment that also includes radiotherapy and/or chemotherapy is recommended.

Aged↗