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Biomedical subjects

T Matsumata

Publications and source records attributed to T Matsumata.

At least 91 records · Page 5Linked to original sources
PubMed1994

Major hepatic resection in patients with a prosthetic heart valve receiving anticoagulation treatment.

We experienced two patients with a prosthetic heart valve, who underwent hepatic resection for hepatoma while on anticoagulation therapy. Patients with a prosthetic heart valve have the following characteristics; an increased risk of thromboembolism due to diminished anticoagulation in the perioperative period, a greater risk of endocarditis due to the artificial material in the heart, and impaired cardiopulmonary function including possible arrhythmia and heart failure. Furthermore, when such patients also have liver cirrhosis with a hepatoma, there is an increased risk of perioperative bleeding while on anticoagulation due to coagulopathy and also a risk of infection due to decreased cellular immunity. Patients with a prosthetic heart valve therefore require special care and attention whenever they have to undergo hepatic resection. With respect to anticoagulation, a minimal level is required to prevent bleeding and thromboembolism. Warfarin being administered preoperatively may be switched to heparin while closely monitoring the activated clotting time (biomaterial valve: 130-150 sec, non-biomaterial valve: 150-180 sec); the heparin should then be changed back to warfarin immediately after starting oral intake following operation. For the prevention of infection, a broad spectrum antibiotic should be used prophylactically both intra-operatively and postoperatively. The cardiopulmonary function must also be carefully monitored. For the assessment of postoperative liver function, lecithin: cholesterol acyltransferase, serum bilirubin and albumin are useful because there is no relevance of coagulation parameters such as prothrombin time under anticoagulation.

Carcinoma, Hepatocellular↗
PubMed1994

Clinical correlation between necrosis of hepatocellular carcinoma nodule and early recurrence after hepatic resection.

Here we report on the case of a 51-year-old man who presented with a high-grade fever six weeks prior to hepatic resection. The resected specimen of the liver showed a well encapsulated and completely necrotic mass and some intrahepatic metastatic disease. Widespread multinodular recurrence in the liver remnant and metastatic foci in the bones were detected approximately one year after surgery. This case suggests that transcatheter arterial embolization--which aims to bring about necrosis of the tumor--followed by hepatic resection might increase the risk of early recurrence of hepatocellular carcinoma, due to the fact that tumor necrosis can facilitate the release of cancer cells from the primary tumor.

Bone Neoplasms↗
PubMed1994

Influence of hepatectomy on cell infiltration in the resected liver parenchyma compared with the biopsy specimen--a preliminary study.

We undertook a preliminary investigation to determine whether or not preoperative hepatitis activity can be evaluated by the finding of cell infiltration into the parenchyma of the resected specimen. In 28 patients who underwent hepatic resection, liver biopsies were obtained just after the laparotomy in order to make a histological comparison with the resected liver specimen. Histological changes were observed in 11 out of 28 patients. However, these were limited to minimal changes of neutrophil infiltration in the portal and subserosal area with no derangement of chronic cell infiltration. In addition, the preoperative liver function and operative findings did not differ between patients with and those without histological changes. The activity of hepatitis was therefore seen not to be histologically influenced by the surgical procedure. Thus, an accurate evaluation of chronic inflammatory cell infiltration activity in the resected liver specimen is a reliable indicator in chronic liver disease patients.

Adult↗
PubMed1994

Indications for major hepatectomy in cirrhotic liver.

In an investigation of the indications for major hepatic resection of the cirrhotic liver, the records of 152 consecutive patients who had undergone a right hepatic resection between April 1985 and January 1991 were reviewed. A comparison of right hepatic lobectomy and right partial hepatectomy of the liver with no cirrhotic changes, revealed that postoperative values of serum glutamic pyruvic transaminase were significantly higher after right partial hepatectomy than after right lobectomy, despite the fact that there were no significant differences with respect to preoperative laboratory data, and there was a greater blood loss and total weight of the resected liver in patients receiving a right lobectomy as compared with those undergoing partial hepatectomy. These results suggest that in order to enable a more favorable recovery from hepatic resection, it is essential to avoid both mechanical damage and ischemic injury to the residual liver during hepatic surgery. A total of 77 patients underwent a partial hepatectomy of a cirrhotic liver, and among these patients, 16 patients had values of the indocyanine green test of less than 20%, as well as a portal pressure of less than 200 mm saline. Compared with these 16 cirrhotic patients and those patients who underwent right lobectomy, there were no significant differences with regard to the pre-operative laboratory data and portal pressure. These results therefore suggest that major hepatic lobectomy could be performed on selected patients with cirrhotic livers.

Adult↗
PubMed1994

Estimation of degree of liver cirrhosis using a fibrosis score; a multivariate analysis of clinical parameters and resected specimens.

We designed this study to estimate the degree of liver cirrhosis using clinical parameters and surgically resected specimens. One hundred and twenty-nine cases who underwent hepatic resection in the Department of Surgery II, Kyushu University Hospital during the period between April 1985 and July 1991 for whom data for all 29 variables evaluated were available, were admitted to this study. On the basis of the histological findings of fibrosis of the liver, the non-neoplastic part of the resected specimens were classified into 3 groups; Z0, no cirrhosis (n = 63), Z1, mild cirrhosis (n = 38), and Z2, severe cirrhosis (n = 28). A univariate analysis revealed 14 significant variables. After multiple logistic regression analysis of these, five independent variables (low platelet count, female, low value of hepaplastin test, a high Pugh's score and a high value of ICG) were identified. We obtained a fibrosis score using the coefficient of each above-mentioned variable. This score increased the discriminative power. The fibrosis score is therefore considered useful for estimating the severity of liver cirrhosis.

Adult↗
PubMed1994

Characteristics of hepatocellular carcinoma originating in the caudate lobe.

Nine patients with hepatocellular carcinoma originating in the caudate lobe who underwent hepatic resection were studied. The caudate lobe was divided into three parts, according to the criteria of Kumon, including the Spiegel lobe, the paracaval portion and the caudate process. The tumors were located in the Spiegel lobe in four, the paracaval portion in four and the caudate process in one. Surgical procedures consisted of right hepatic lobectomy in one, central bisegmentectomy in one and caudate lobectomy in seven. The mean surgical time was 379 +/- 129 min; the mean estimated blood loss was 2,994 +/- 2,303 ml. The above-mentioned surgical risks were more clearly recognized in the paracaval portion than in the Spiegel lobe. In addition, most patients experienced significant post-operative complications. Six of eight patients with 6 mo or longer follow-up had recurrences, and two of six patients died. The characteristics of hepatocellular carcinoma in the caudate lobe were as follows: (a) a higher surgical risk, and more definite risk in the paracaval portion; and (b) a higher rate of early recurrence. A left lobectomy for the Spiegel lobe, a right or left trisegmentectomy for the paracaval portion and a right lobectomy for the caudate process would be ideal from the point of view of the portal supply of the caudate lobe. However, in cirrhotic patients either a caudate lobectomy or partial resection might be preferable because longer survival can be expected.

Aged↗
PubMed1994

Xanthogranulomatous cholecystitis masquerading as gallbladder carcinoma.

We herein present a case of xanthogranulomatous cholecystitis which involved both the liver and transverse colon, clinically mimicking gallbladder carcinoma. Such cases may sometimes be judged inoperable due to extensive extra-gallbladder invasion, and thus it is necessary for physicians to take this lesion into consideration when making a diagnosis. An intraoperative biopsy is necessary, therefore, even when the features seem to clearly indicate inoperable carcinoma.

Aged↗
PubMed1994

Changes in regulating blood coagulation in hepatic resection with special references to soluble thrombomodulin and protein C.

The protein C anticoagulant pathway in hepatic resection was studied. The patients were divided into two groups--group 1 consisted of patients with a normal liver and group 2 consisted of patients with either hepatitic or a cirrhotic liver. Plasma protein C activity and soluble thrombomodulin were then sequentially measured during hepatectomy and in the early postoperative period. The protein C activity in group 1 decreased during hepatectomy and reached a low immediately after operation, and thereafter, recovered to near preoperative levels. However, the preoperative value in group 2 was lower than that in group 1 and the postoperative values were significantly lower than those in group 1 (p < 0.05). The level of soluble thrombomodulin in group 1 decreased during hepatectomy but later returned to preoperative levels. However, in group 2, the preoperative value was higher than that in group 1 and the postoperative values were greater than that of the preoperative values, while the values were significantly higher than those in group 1 (p < 0.05). During hepatectomy, hypercoagulability may contribute to the low levels of protein C and soluble thrombomodulin. The postoperative significant increase of soluble thrombomodulin may, thus, indicate the occurrence of endothelial injury in the remnant liver. The sequential measurements of both parameters can, therefore, be useful in detecting coagulopathy and endothelial injury in hepatic resection.

Aged↗
PubMed1994

Effect of nafamostat mesilate on coagulation and fibrinolysis in hepatic resection.

The effect of nafamostat mesilate on coagulation and fibrinolysis was investigated in a study of 22 patients with hepatocellular carcinoma who underwent a hepatic resection. The patients were divided into two groups: group 1, control (n = 11) and group 2, those with the intraoperative and postoperative use of nafamostat mesilate (0.2 to 0.4 milligram per kilogram per hour, n = 11). Nafamostat mesilate tended to suppress the coagulation expressed by thrombin-antithrombin III complex and fibrinopeptide A both during and immediately after operation. Moreover, nafamostat mesilate significantly suppressed the fibrinolysis expressed by euglobulin lysis activity both during and after operation. With regard to the initial stage of the fibrinolytic system, such as tissue-type plasminogen activator and plasminogen activator inhibitor-1, there was no difference between the groups. Therefore, the suppression of the euglobulin lysis activity may be caused by the inhibition of plasmin activity. There was no difference between the groups regarding operative blood loss. However, the rate of blood transfusion in group 2 was lower than that in group 1, and no fresh frozen plasma was required for the patients who lost over 2,000 milliliters of blood. Nafamostat mesilate can suppress euglobulin lysis activity both intraoperatively and postoperatively, and thus decrease the amount of blood transfusion needed. Therefore, at present, nafamostat mesilate seems to be one of the most useful agents for stabilizing the coagulant and fibrinolytic systems in hepatic resection.

Aged↗
PubMed1994

Repeat hepatectomy for recurrent hepatocellular carcinoma.

BACKGROUND: The significance of repeat hepatectomy for recurrent hepatocellular carcinoma remains controversial. Therefore the aim of this study was to reevaluate both the survival and the surgical risks of repeat hepatectomy. METHODS: The significance of repeat hepatectomy including the survival and the surgical risks for recurrent hepatocellular carcinoma were investigated with 21 patients who underwent a curative repeat hepatectomy during the period between May 1975 and July 1993. For a comparison of survival, 253 patients who underwent a curative primary hepatectomy during the period between April 1985 and July 1993 were used. Moreover, the preoperative liver function tests were also compared between the first and second hepatectomies. RESULTS: Regarding the preoperative liver function tests, the indocyanine green dye excretion rate at 15 minutes in the second hepatectomy (18.7% +/- 8.7%) was significantly higher than that in the first hepatectomy (14.7% +/- 5.9%). With regard to the surgical risks, there was no difference in the clinical parameters for blood loss, operation time, and the incidence of postoperative complications between the first and second hepatectomies. The postoperative hospital stay for the second hepatectomies was relatively shorter than that for the first hepatectomies. In addition, the patient's survival and disease-free survival after a curative repeat hepatectomy were almost identical to that after a curative primary hepatectomy. CONCLUSIONS: A curative repeat hepatectomy is thus considered to be the most effective therapeutic modality for recurrent hepatocellular carcinoma.

Adult↗
PubMed1994

Isolated hepatic caudate lobectomy.

BACKGROUND: Isolated caudate lobectomy is a challenging surgical procedure for which safe and reliable techniques have yet to be developed. METHODS: Isolated caudate lobectomy was performed by initial inflow control of the caudate lobe, full mobilization of the liver from the inferior vena cava by dividing all short hepatic veins, and parenchymal division dorsal to the major hepatic veins with a clockwise rotation of the liver while the liver was selectively devascularized by Pringle's maneuver and occlusion of the confluence of the major hepatic veins flush with the inferior vena cava. RESULTS: Two patients with cirrhosis underwent this procedure successfully without intraoperative hemodynamic instability or postoperative liver dysfunction. CONCLUSIONS: This technique allows safe and truly selective excision of the caudate lobe without the need for occlusion of the inferior vena cava or venovenous bypass.

Carcinoma, Hepatocellular↗
PubMed1993

Effects of preoperative transcatheter hepatic arterial chemoembolization for hepatocellular carcinoma. The relationship between postoperative course and tumor necrosis.

BACKGROUND: The effects of preoperative transcatheter arterial chemoembolization (TAE) for hepatocellular carcinoma (HCC) remain a matter of controversy. METHODS: Seventy-two patients with HCC were entered in the study; the patients did not have the risk factors for disease recurrence of tumor larger than 5 cm in diameter, the presence of venous invasion, or intrahepatic metastasis. Only patients with 3 years of follow-up after curative resection were selected. Forty-six underwent TAE (Group I) and 26 did not undergo TAE (Group II). Group I was divided into three subgroups according to the degree of tumor necrosis: IA, complete necrosis; IB, partial necrosis; and IC, no necrosis. Group II was divided into two subgroups: IIB, partial necrosis; and IIC, no necrosis. RESULTS: Preoperative TAE did not improve the average disease-free survival rates of the group as a whole. For patients undergoing TAE, the survival rate of Group IB was significantly worse than that of Groups IA or IC. The survival rate of Group IB was worse than that of Group II, but the difference was not significant. In Group II, the survival of Group IIB was worse than that of Group IIC. Histologically, residual tumor cells lacking mutual contact were detected in some patients in Group IB. CONCLUSION: These results indicate that partial tumor necrosis caused by preoperative TAE or spontaneous tumor necrosis per se might facilitate postoperative disease recurrence. This may occur because in patients with partial necrosis, the remaining tumor cells are less firmly attached and more likely to be dislodged into the bloodstream during hepatic resection.

Adult↗
PubMed1993

The association between transfusion and cancer-free survival after curative resection for hepatocellular carcinoma.

BACKGROUND: In cases of surgery for hepatocellular carcinoma (HCC), postoperative intrahepatic recurrence is the main obstacle to long-term survival of patients. The association between perioperative transfusion and recurrence-free survival was studied in 126 patients with HCC who underwent hepatic resection between 1985 and 1990 and in whom complete follow-up information was available until 1992. METHODS: Patients who received neither whole blood nor packed erythrocytes during hospitalization formed the no transfusion group (n = 72), and the remaining patients who were given either whole blood or packed erythrocytes during hospitalization constituted the transfusion group (n = 54). RESULTS: The 1-year, 3-year, and 5-year recurrence-free survival rates of the nontransfused versus transfused groups were 80.6% versus 74.1%, 50.9% versus 33.4%, and 37.1% versus 26.2%, respectively (P = 0.1590). After adjustment for other covariates, the serum albumin level and histological intrahepatic metastasis (im) remained as significant variables for recurrence-free survival. Although there was no association between the erythrocyte transfusion and the recurrence-free survival of the patients with serum albumin levels either more than 3.5 g/dl or less than or equal to 3.5 g/dl, the 1-year, 3-year, and 5-year recurrence-free survival rates of the nontransfused versus transfused groups of the patients with im-negative HCC were 92.2% versus 80.0%, 62.6% versus 36.3%, and 47.4% versus 27.1%, respectively (P = 0.0254). CONCLUSIONS: The association between erythrocyte transfusion and the recurrence-free survival was recognized only in patients with im-negative HCC.

Adult↗
PubMed1993

Tumor progression in hepatocellular carcinoma may be mediated by p53 mutation.

Human hepatocellular carcinoma (HCC) often contains intratumoral subpopulations of heterogeneous cellular differentiations within each tumor. To analyze the genetic alterations of p53 in the heterogeneous subpopulations, we examined 68 intratumoral nodular lesions within 34 HCCs composed of two distinct subpopulations. The cellular differentiations were determined histologically by Edmondson's grading system. Nine (26.5%) of 34 HCCs examined were found to have genetic alterations in exons 5 to 8 of the p53 gene, resulting in amino acid substitutions. Three of these nine HCCs with p53 mutations showed genetic heterogeneity of the p53 gene within each tumor; one HCC had a single missense mutation at codon 210 (asparginine to 210-serine) in an intratumoral lesion of Edmondson Grade II and double missense mutations at codons 210 and 217 (asparginine to 210-serine and valine to 217-alanine) in another intratumoral lesion of Edmondson Grade III. The remaining two HCCs had p53 mutations only in lesions of a higher grade. In total, the p53 mutations were detected in none of eight Edmondson Grade I lesions, in five of 29 Grade III lesions (17.2%), in eight of 26 Grade III lesions (30.8%), and in three of five Grade IV lesions (60.0%). Thus, our data revealed that the p53 mutations were closely related to the progression of HCC and that, in certain cases, malignant cells which acquired the p53 mutations might develop into dedifferentiated subpopulations within individual HCC.

Amino Acid Sequence↗
PubMed1993

A comparative study of hepatic resection and transcatheter arterial embolization for the treatment of primary hepatocellular carcinoma.

BACKGROUND: Because transcatheter arterial embolization (TAE) has been shown to be effective in patients with unresectable hepatocellular carcinoma (HCC), the question arises whether TAE has an equivalent or superior effect on resectable HCC compared with surgery. To clarify this point, the authors compared the therapeutic results achieved by surgery and TAE in patients with early-stage HCC and well-preserved liver function, who were independently treated by two different policies in two separate departments of the same university hospital during the same period. METHODS: From 1983 to 1987, 67 patients with HCC underwent hepatic resection at the Department of Surgery of Kyushu University Hospital. During the same period, TAE was the treatment of first choice for HCC, and surgical resection was not chosen in the Department of Internal Medicine of the hospital. TAE was done in 68 patients, who were evaluated blindly in terms of liver function reserve and roentgenographic resectability of the tumor. Among the 68 patients, 20 were thought to have anatomically and functionally resectable disease. The therapeutic results obtained in the two groups were compared. RESULTS: The 1-year, 3-year, and 5-year cumulative survival rates for 67 patients undergoing surgery, including one operative death and four hospital deaths, were 89.1%, 74.6%, and 54.6%, respectively. However, the rates were 90.0%, 50.0%, and 17.5%, respectively, for the 20 patients treated with TAE; these differences were statistically significant (P < 0.05). CONCLUSIONS: Surgery can offer more favorable results in patients with early-stage HCC compared with TAE.

Carcinoma, Hepatocellular↗
PubMed1993

Effect of diabetes mellitus on hepatic resection.

We evaluated the effect of diabetes mellitus on mortality and morbidity after elective hepatic resections. Of 209 patients who underwent hepatic resections between April 1985 and July 1990, 49 (23.4%) were diabetic. Postoperative morbidity was more common among diabetics than among nondiabetics (75.5% vs 51.3%), mainly due to hepatic decompensation (55.1% vs 36.3%) and intraperitoneal sepsis (18.4% vs 6.3%). However, their incidence of hospital death (2% vs 2.5%), mean +/- SD postoperative hospital stay (36.1 +/- 20.2 days vs 29.4 +/- 28.2 days), and long-term survival were comparable with those of nondiabetics. Diabetics with and without complications were similar in preoperative or postoperative insulin requirement, duration of diabetes, and preoperative fasting glucose. Nevertheless, all eight patients with 24-hour urinary glucose excretion above 1 g developed complications. We conclude that diabetics are at a high risk of morbidity, but not of mortality after elective hepatic resection.

Adolescent↗
PubMed1993

Ethanol injection therapy in RBT-1 carcinoma of the rat liver evokes enhancement of metastasis.

To search for possible untoward effects of ethanol injection into a malignant tumor, a series of experiments was carried out using the model of RBT-1 carcinoma. Ten days after the inoculation of RBT-1 carcinoma into the rat liver, the animals were separated into three groups: Group A, ethanol injection during relaparotomy; group B, physiological saline injection during relaparotomy; and group C, relaparotomy alone without ethanol injection. Twenty minutes after these procedures, the tumor was surgically removed and histologically examined. The incidence of vascular permeation of liver tumor cells into the hepatic vein was significantly higher in groups A and B (P < 0.05). On the 10th day after relaparotomy, the number of metastatic nodules in the lungs was significantly increased in groups A and B, compared to the findings in group C (P < 0.05). Regarding the survival time of rats after relaparotomy, there was no statistically significant difference among the three groups. These results are taken to mean that ethanol injection into a tumor may enhance metastasis.

Animals↗