Biomedical subjects

T Matsumata

Publications and source records attributed to T Matsumata.

At least 55 records · Page 3Linked to original sources

PubMed1995

Small hepatocellular carcinoma of single nodular type: a specific reference to its surrounding cancerous area undetected radiologically and macroscopically.

A total of 128 surgically resected small hepatocellular carcinomas, measuring less than or equal to 3 cm in diameter, were studied by both macroscopic and histologic examinations. In 95 single nodular-type tumors of the 128 lesions, eight tumors were associated with the cancerous areas of well differentiated hepatocellular carcinoma around the nodule. These surrounding cancerous areas went undetected by both the preoperative radiological examinations and the gross findings of resected specimens. Based on the immunohistochemical findings, the labeling index, both of the proliferating cell nuclear antigen (PCNA) and of the Ki-67 in the surrounding cancerous areas, were lower than that of the main nodules but higher than in the nontumorous liver parenchyma in seven of eight cases. These results suggest that the main nodule was generated from the surrounding cancerous area, supporting the hypothesis of a stepwise progression of HCC. Even if the tumor seems to be a small and single nodular type, it is recommended that its surrounding areas should be closely examined and the surgical cutting margin should be made more than 1.0 cm away from the main nodule at hepatic resection.

Carcinoma, Hepatocellular↗

PubMed1995

Occurrence of intraperitoneal septic complications after hepatic resections between 1985 and 1990.

In this study, the risk factors related to intraperitoneal septic complications occurring after hepatectomy (IPSCH) as well as the effect of various perioperative variables on the outcome of IPSCH between 1985 and 1990 were analyzed. Twenty-one of 211 patients (10.0%) developed IPSCH. The findings in the patients with IPSCH were compared with those in 190 patients without IPSCH. The significant variables associated with the development of IPSCH included a high incidence of accompanying chronic renal failure (14.3% vs 2.1%), a larger blood loss during surgery (2,130 vs 1,340 ml) as well as a greater amount of intraoperative blood replacement (1,130 vs 570 ml), and a greater weight of the resected liver (367 vs 233 g). IPSCH occurred in 10 of 12 patients who had postoperative bile leakage. Eighteen patients (85.7%) with IPSCH were discharged from the hospital after non-operative management; however, the hospital death rate (14.3% vs 1.1%) was significantly higher in patients with IPSCH. This review suggests that the incidence of IPSCH has not decreased recently. Thus, to prevent IPSCH, at least following bile leakage, it is necessary to perform a careful division of the liver parenchyma followed by a bile leakage test, and when this complication occurs unexpectedly in patients who have a good functional reserve of the remnant liver, IPSCH can be effectively drained percutaneously under ultrasound guidance.

Abdominal Abscess↗

PubMed1995

Risk factors for intrahepatic recurrence in human small hepatocellular carcinoma.

BACKGROUND/AIMS: Postoperative intrahepatic recurrence of human hepatocellular carcinoma is high. Recently, the relationship between proliferating cell activity in the cirrhotic liver and occurrence or recurrence of hepatocellular carcinoma has been reported. METHODS: One hundred two resected cases of small hepatocellular carcinoma of < 3 cm in diameter without venous invasion or intrahepatic metastasis were examined to ascertain the factors affecting postoperative intrahepatic recurrence. RESULTS: Cumulative intrahepatic recurrence rates at 1, 3, and 5 years after surgery were 12.0%, 57.2%, and 67.6%, respectively. The log-rank test indicated that serum albumin levels of < 3.7 g/dL, alanine aminotransferase levels of more than 54 IU/L, active inflammation in the nontumorous portion, and high proliferating cell nuclear antigen labeling index in the nontumorous portion (> 23.2%) were significant risk factors for recurrence. Tumor factors, including tumor size, histological grade, or alpha-fetoprotein level, were not significant risk factors. Cox's proportional hazard model identified that serum albumin level and alanine aminotransferase level were independently associated with intrahepatic recurrence after hepatectomy. CONCLUSIONS: This study suggests that the principal cause linked to either a recurrence or a second new growth of hepatocellular carcinoma in the remnant liver after hepatectomy was the state of the underlying liver parenchyma as well as other tumor factors per se.

Adult↗

PubMed1995

Des-gamma-carboxy prothrombin and proliferative activity of hepatocellular carcinoma.

BACKGROUND: Des-gamma-carboxy prothrombin (DCP) is a useful marker for the prognosis of hepatocellular carcinoma (HCC). In this report we investigated the relationship between the positivity of DCP and proliferative activity of HCC and discuss the cause of poor prognosis of DCP-positive HCC. METHODS: Immunohistochemical and clinicopathologic study was done in 114 patients with resected HCC measuring less than 6 cm in diameter by using monoclonal antibody for proliferating cell nuclear antigen (PCNA). RESULTS: PCNA labeling index (PCNA-LI) was significantly higher in the patients with DCP-positive HCC than in those with DCP-negative HCC; also a positive correlation was noted between the PCNA-LI and the DCP level. We divided patients into two groups according to the PCNA-LI. In the high PCNA-LI group the patients with DCP-positive HCC exhibited a higher PCNA-LI than did the patients with DCP-negative HCC. As for pathologic prognostic factors, the DCP-positive high PCNA-LI group showed the highest incidence of tumor thrombus of the portal vein and intrahepatic metastasis while also exhibiting the lowest recurrence-freedom rate. From multivariate analysis we find that DCP, as well as PCNA-LI, is one of the risk factors for recurrence of HCC after hepatectomy. CONCLUSIONS: Our results thus suggest that DCP-positive HCC showed high PCNA-LI, and this might be the main cause for early intrahepatic spread and poor prognosis of DCP-positive HCC.

Adult↗

PubMed1995

Preliminary report of tumor metastasis during liver regeneration after hepatic resection in rats.

In an attempt to ascertain possible facilitation of tumor metastasis during liver regeneration after hepatectomy, a series of experiments in rats was carried out using the RBT-1 carcinoma. WKA rats were separated into three groups: Group A received a sham operation; Group B underwent one-third hepatectomy; and Group C underwent two-thirds hepatectomy. Three groups had viable tumor cells injected into the tail vein after treatment. Survival period and lung metastases were analysed 14 days after initial injection of tumor. When comparisons were made between all groups, survival was shown to be significantly shorter in Group C than Group A (P < 0.05). The number of metastatic nodules in the lungs was significantly increased in Group B (P < 0.05) and C (P < 0.01), compared to Group A and in Group C, compared with Group B (P < 0.05). These results suggest that facilitation of tumor metastasis during liver regeneration may be proportional to the extent of liver resection.

Animals↗

PubMed1995

Levels of amino acids in human hepatocellular carcinoma and adjacent liver tissue.

Total parenteral nutrition can be used to overcome amino acid imbalance in cancer patients. Because there is little documentation of treatment for amino acid imbalance in patients with hepatocellular carcinoma (HCC), we designed a study 1) to compare tissue levels of amino acids between HCC and the adjacent liver and 2) to determine which serum amino acids correlate to tumor volume. A significant elevation of methionine and a significant decrease of glycine and cystine were observed in HCC compared with adjacent liver tissue, and a significant correlation was found between tumor volume and serum methionine levels (r = -0.636, p < 0.01). Thus the tumor tissue competes successfully with host tissue for nitrogen substrates, particularly methionine, and an accelerated protein synthesis in HCC consumes large amounts of these amino acids. The possibility of methionine-depleted treatment could be considered for patients with HCC.

Aged↗

PubMed1995

Portal vein thrombosis due to antithrombin III deficiency. A case report.

The authors report a case of intrahepatic portal vein thrombosis in a sixty-four-year-old Japanese man with antithrombin III deficiency who successfully underwent cholecystectomy and common bile duct exploration. To their knowledge, this is the first report of portal vein thrombosis due to primary antithrombin III deficiency.

Antithrombin III Deficiency↗

PubMed1995

[Intra-bile duct growth of hepatocellular carcinoma: value of biliary dilatation on CT].

In order to evaluate the usefulness of CT in demonstrating biliary invasion by hepatocellular carcinoma, 191 surgically proved cases were studied. Among 191 CT scans performed before surgery, six (3%) showed biliary dilatation. Pathological biliary invasion was found in eight cases (4%). Of these eight cases, four cases (50%) showed biliary dilatation on CT. In six cases with biliary dilatation on CT, pathological biliary invasion was revealed in four cases (67%). In two cases, the large (> or = 6cm) encapsulated tumors located in the hepatic hilum dilated the intrahepatic bile duct without intraductal tumor growth. We concluded that biliary dilatation on CT cannot be a sign of biliary invasion by hepatocellular carcinoma.

Adult↗

PubMed1995

The clinical significance of p53 gene mutation in hepatocellular carcinomas from Japan.

To clarify the clinical significance of the mutation of p53 gene in hepatocellular carcinoma (HCC), 90 resected specimens from Japanese patients were assayed using a polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis. p53 mutations were detected in 25 cases (27.8%) at exons 4, 5, 6, 7, and 8, and the most frequent region of the mutation was at exons 5 and 7. No statistically significant correlation was observed between the p53 mutations and the clinical features except for the preoperative alpha-fetoprotein (AFP) level (P < .05). According to the pathological features, prognostic factors, such as size of the tumor, vascular invasion, fibrous capsule infiltration, and intrahepatic metastasis, showed no relationship to the existence of the mutation. However, p53 mutations were significantly associated with the degree of differentiation of HCC; that is, the mutation was found in 19 cases of 53 poorly differentiated HCCs (35.9%) and 2 of 3 cases of anaplastic HCCs (66.7%). The presence of p53 mutations was associated with a shortened cancer-free survival (P < .001, by log rank test) and a shortened survival (P < .05). A multivariate analysis by the Cox regression analysis showed that the p53 mutations were an unfavorable prognostic factor related to recurrence (P < .005), which is especially significant within the first postoperative year. These results suggest that the mutations of p53 gene of HCC might be an independent prognostic predictor to help in the selection of candidates who should undergo more intensive postoperative treatment.

Adult↗

PubMed1995

Thrombomodulin inhibits intrahepatic spread in human hepatocellular carcinoma.

Thrombomodulin (TM) converts thrombin from procoagulant into anticoagulant protein to activate protein C. Thrombin also plays an important role in the metastatic process of cancer cells. We performed an immunohistochemical and clinicopathological study of TM in 141 cases with resected hepatocellular carcinoma (HCC) measuring less than 6 cm in diameter. Twenty-five specimens (17.73%) stained positive for TM. TM was found in the cytoplasm and surface of cancer cells. The clinicopathological findings according to the positive of TM are examined in HCC. The preoperative plasma TM level of the patients with tissue that stained positive for TM was significantly higher than that of the patients with negative results; for the postoperative TM level, there were no differences between them. In addition, the frequencies of intrahepatic metastasis, tumor thrombus in the portal vein, and capsular infiltration were significantly lower in patients whose tissue stained positive for TM than in patients whose tissue stained negative for TM. The recurrence freedom rate was significantly higher in patients whose tissue stained positive for TM than patients whose tissue stained negative for TM. Thus, TM-producing HCC shows a slow intrahepatic spread. Therefore, these findings suggest that TM may inhibit the adhesion of tumor cells to the portal vein because of anticoagulant activity and thus prevent the spread of intrahepatic metastasis.

Adult↗

PubMed1995

The pathogenesis of decreased aspartate aminotransferase and alanine aminotransferase activity in the plasma of hemodialysis patients: the role of vitamin B6 deficiency.

The mechanisms responsible for the low plasma (p) AST and ALT activity in HD patients remain elusive. This prospective study was undertaken to clarify the relationship of AST, ALT and pyridoxal-5'-phosphate (PLP) levels (active form of vitamin B6) in these patients. A group of 52 HD patients were given oral pyridoxine HCl (30 mg daily), for 5 weeks. Prior to supplementation (Day 0), 17 (33%) patients had deficient pPLP levels (Group 1), the remainder (35 patients) had normal pPLP values (Group 2). A positive correlation was noted between pPLP and pAST (r = 0.57, p < 0.01) or pALT (r = 0.68, p < 0.01). The mean pAST (9.2 +/- 0.3 vs 13.4 +/- 0.7 U/l) and pALT (8.6 +/- 0.6 vs 11.4 +/- 0.9 U/l) were markedly lower in Group 1 than those in Group 2, respectively. These low AST and ALT levels increased to those seen in Group 2 where no change from basal values was seen despite vitamin B6 supplementation (Day 35). The administration of vitamin B6 resulted in a significant increase in pPLP in both groups (Day 35) but pPLP dropped to subnormal levels in 5 patients in Group 1 and 7 in Group 2 three months after supplementation was stopped (Day 125). The mean AST and ALT of these 12 pPLP deficient patients became lower than those of the remaining 40 patients with normal pPLP values (p < 0.05). In conclusion, low pAST and pALT levels in HD patients are in part due to a deficiency of pPLP which serves as a coenzyme for these transaminases.

Adult↗

PubMed1995

MR imaging of hepatocellular carcinoma. Correlation of metal content and signal intensity.

In order to clarify the factors contributing to the signal intensities (SIs) of HCC on T1-weighted images, the amount of water, lipid, copper (Cu), iron (Fe), and manganese (Mn) was determined in HCC and surrounding hepatic parenchyma of 13 patients. The relationships among these findings, the histopathologic findings, and the SIs of T1-weighted images were evaluated. Among the 13 HCC, 3 had a high SI, 5 were isointense, and 5 had a low SI on T1-weighted images compared to the surrounding hepatic parenchyma. The paramagnetic ions which contributed to the SI patterns were assumed to be Cu in HCC (38.0 +/- 62.4 micrograms/g ww), and Fe in the liver (61.1 +/- 42.4 micrograms/g ww) and HCC (40.0 +/- 34.3 micrograms/g ww). In 8 HCC with high- or isointensity, 2 were grades I, 5 were grade II, and one was grade III according to the Edmondson-Steiner's histopathologic classification. It is concluded that the SI patterns alone can not be a sign of low grade malignancy because of the existence of Fe in livers and HCC.

Aged↗

PubMed1995

Significance of intraoperative measurement of liver consistency prior to hepatic resection.

The functional reserve of the liver should be estimated prior to hepatectomy. While the experienced liver surgeon often relies on the findings of manual palpation intra-operatively, this approach remains a subjective one. In 22 of our patients scheduled for hepatectomy, we measured intra-operatively hepatic consistency as well as the parameters of liver function. Hepatic consistency is augmented during progression from non-fibrosis to cirrhosis. We found a statistically significant correlation between liver consistency and the indocyanine green retention rate at 15 minutes (r = 0.682; p = 0.0009) and portal vein pressure (r = 0.733; p = 0.0008). Prothrombin time, the hepaplastin test, total bilirubin and glutamic pyruvic transaminase showed no significant correlation with hepatic consistency. The safety limits of the hepatic blood circulation for the performance of hepatectomy can be estimated using parameters of consistency in this organ.

Carcinoma, Hepatocellular↗

PubMed1995

Recurrence near the resection line of hepatocellular carcinoma in the anterosuperior subsegment of the liver--the effect of the argon beam coagulator.

The present paper examines the relationship between the patterns of intrahepatic recurrence after resections of hepatocellular carcinoma and surgical margins in cases located in the anterosuperior subsegment of the liver. In 95 curative resections of the liver for hepatocellular carcinomas less than 5 cm in size, 29 tumors were located in the anterosuperior subsegment of the liver. The recurrence rates of tumors in the anterosuperior subsegment and other regions were 16/29 (55.2%) and 39/66 (59.1%), respectively. Recurrences near the resection line were significantly more common in the anterosuperior subsegment (6/29) than in other regions (2/66) of the liver (P < 0.05). The surgical margin from the tumor edge to the resection line was significantly shorter in tumors of the anterosuperior subsegment (4.6 +/- 9.7 mm) than in those of other regions (9.7 +/- 10.6 mm) (P < 0.01). The effect of an argon beam tissue coagulator was also examined in rat livers. Exposure to an argon beam tissue coagulator for 10, 30 and 60 seconds at a power setting of 100 watts was capable of burning out tissue to a depth of 6.0, 10.5 and 13.3 mm from the resection line of the rat liver, respectively. An exposure of 10 seconds is thought to be sufficient to destroy any microscopic residues of malignant cells near the resection line. Thus, an argon tissue coagulator could potentially be of value for the prophylaxis of recurrence near the resected surface.

Animals↗

PubMed1994

Protein induced by vitamin K absence or antagonist II as a prognostic marker in hepatocellular carcinoma. Comparison with alpha-fetoprotein.

BACKGROUND: Protein induced by vitamin K absence or antagonist II (PIVKA-II) was widely used as a diagnostic marker for hepatocellular carcinoma (HCC), however, its prognostic value is unclear. The authors evaluated PIVKA-II clinicopathologically as a prognostic marker for HCC. METHODS: The relationship between pathologic prognostic factors and plasma PIVKA-II and alpha-fetoprotein (AFP) was investigated in 72 patients with resectable HCC measuring less than 6 cm in greatest dimension. RESULTS: PIVKA-II shows significantly lower sensitivity, but higher specificity than AFP, and the use of these two complementary markers appears to be useful in the diagnosis of HCC. The frequencies of intrahepatic metastasis, portal vein tumor thrombus, hepatic vein tumor thrombus, and capsular infiltration were significantly higher in patients with positive PIVKA-II than in those with negative-PIVKA-II, and the recurrence-free rate was significantly lower in patients with positive rather than with negative PIVKA-II. However, there were no significant differences between the patients who were AFP positive and those who were AFP negative in pathologic prognostic factors and the recurrence-free rate. From univariate and multivariate analyses, the authors find that PIVKA-II is one of the risk factors for recurrence of HCC after hepatectomy. CONCLUSIONS: PIVKA-II may be a useful marker for the prediction of intrahepatic spread and for the prognosis of HCC. In addition, PIVKA-II-positive patients, thus, need aggressive postoperative adjuvant therapy for undetectable residual tumors and careful postoperative monitoring to enable the early recognition of recurrence.

Adult↗

PubMed1994

Modulation of coagulation and fibrinolysis in hepatic resection: a randomized prospective control study using antithrombin III concentrates.

A randomized prospective control trial for determining the efficacy of antithrombin III concentrates in hepatic resection was performed using 24 patients with hepatocellular carcinoma. Thirteen patients were given antithrombin III concentrates (1,500 IU) immediately before operation, during hepatectomy and immediately after operation. Coagulant and fibrinolytic profiles were determined by molecular markers such as thrombin-antithrombin III complex and plasmin-alpha 2plasmin inhibitor complex. During hepatic resection, both hypercoagulability and mainly primary hyperfibrinolysis occurred. Regarding the effectiveness of antithrombin III concentrates, in the antithrombin III treatment group, only a significant lower incidence of positive soluble fibrin monomer complex at postoperative days 1 and 5 was found among all the parameters studied. Therefore, no definite evidence of clinical usefulness of the perioperative administration of antithrombin III concentrates in hepatic resection was proved.

Aged↗

PubMed1994

Multiple hepatic hemangiomas with significant arterioportal venous shunting.

A patient with multiple hepatic hemangiomas and significant arterioportal shunting who was successfully treated by a left-hepatic lobectomy is presented herein. In hemangiomas with significant arterioportal venous shunting, it is essential to differentiate between hepatocellular carcinoma and hypervascular metastatic tumors because few typical findings of hemangioma can be recognized. Moreover, an increased hepatic arterial flow can increase the risk of spontaneous rupture as well as portal hypertension due to the increased inflow to the portal vein. Therefore, a definitive diagnosis should be made by liver biopsy when imaging alone is not sufficient to rule out malignancy. Furthermore, hepatic resection for hemangiomas with significant arterioportal venous shunting may be indicated due to the higher risk of rupture and the possibility of progressive portal hypertension.

Angiography↗

PubMed1994

Liver resection for hepatocellular carcinoma in the elderly.

OBJECTIVE: To estimate the effectiveness of hepatic resection on hepatocellular carcinoma (HCC) in the elderly. DESIGN: Comparison with younger patients. SETTING: A municipal hospital and a large university hospital in Japan. PATIENTS: The study included 39 patients (age > or = 70 years [the elderly group]) and 229 patients (age < 70 years [the younger group]) who underwent hepatic resection from April 1985 to March 1993. The preoperative clinical features (Child's classification, association of cirrhosis and liver functions) were comparable between two groups. The positive rate for hepatitis C virus antibody was higher in the elderly group (88% vs 59%; P = .016). MAIN OUTCOME MEASURES: Morbidity and survival following operation and the pathological features of HCC. RESULTS: The incidence of postoperative hepatic failure was higher in the elderly group (10% vs 2%; P = .018). However, the incidence of operative death in the elderly group (5% vs 1%) as well as the incidence of other postoperative complications and rates of long-term survival (75.9% vs 51.6% at 5 years) and disease-free survival (30.4% vs 31.0% at 5 years) were similar to those in the younger group. The pathological features of HCC were identical between the two groups. CONCLUSION: The outcome of surgical treatment of HCC in the elderly group was satisfactory when compared with that in the younger group.

Age Factors↗