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T Matsumata

Publications and source records attributed to T Matsumata.

At least 109 records · Page 6Linked to original sources
PubMed1993

Hepatocellular carcinoma: prospective assessments of the T-factor with CT, US, and MR imaging.

The capabilities of computed tomography (CT), ultrasonography (US), and magnetic resonance (MR) imaging were studied in order to determine the role of each of these noninvasive examinations for estimating the T-factor of hepatocellular carcinomas (HCCs). Fifty-one patients with surgically proven HCCs received CT (50 patients), US (46 patients), and MR (44 patients). The images of CT, US, and MR were prospectively evaluated for main tumor size, intrahepatic metastases, and vascular invasion, which compose the T-factor of HCC, and compared to pathological results. The sizes of the main tumor were estimated correctly by all examinations. For estimating intrahepatic metastases, US (74%) and MR (73%) were superior to CT (65%). For estimating portal invasion, CT (79%) was superior to US (70%) and MR (66%), because CT could demonstrate the segmental staining caused by portal invasion. The estimates of hepatic venous invasion were difficult during any of the examinations. We conclude that presurgical evaluations of the T-factor require the use of US and CT or MR and CT.

Aged↗
PubMed1993

Open and closed suction drainage after hepatic resection.

A retrospective study was conducted to compare open conduit drains with closed suction drains, with regard to the occurrence of intraperitoneal septic complications after hepatectomy (IPSCH). The subjects comprised 50 consecutive Japanese patients who underwent hepatic resection followed by the insertion of a closed suction drain and the control group comprised 50 patients in whom a simple conduit drain had been placed following liver surgery. There were no significant differences between the two groups in sex, age, underlying liver disease, or the type of hepatectomy performed; nor was there a significant difference in the incidence of IPSCH, the simple conduit drain group versus the closed suction drain group being (10% versus 8%, respectively). However, bile leakage was highly related to IPSCH, the incidence being 60% and 100% in the simple conduit drain and closed suction drain groups, respectively. Thus, to prevent IPSCH, the treatment of bile leakage is a much more important factor than the type of drain used.

Aged↗
PubMed1993

The significance of methicillin-resistant Staphylococcus aureus infection in general surgery: a multivariate analysis of risk factors and preventive approaches.

To investigate the characteristics, risk factors, and prevention of methicillin-resistant Staphylococcus aureus (MRSA), a total of 3,627 patients were studied. Among these, 1,336 patients with various infections were used in a risk factor analysis of MRSA to determine the relationship between the use of antibiotics and the incidence of MRSA. Only 3.0% of infections were attributed to MRSA, the esophagus and colorectal region being highly involved, as anastomotic or pelvic abscesses, while the lung had a lower incidence. Almost half the patients with MRSA infections (47.6%) had concomitant infection. A univariate analysis revealed the following significant factors: The coexistence of gastrointestinal or metastatic malignancy, sepsis, tracheostomy, and the prior use of antibiotics such as the beta-lactam compounds or aminoglycosides. A multivariate analysis showed that gastrointestinal malignancy, sepsis, and the prior use of aminoglycosides, tetracycline, macrolides, and carbapenems were independently significant factors. To promote the education of doctors and nurses, regular in-service meetings on MRSA were held in the ward. Moreover, preventive approaches such as patient isolation, strategically placed hand washing equipment, and the use of disposable gloves and contaminated waste bags, have been initiated, and the incidence of MRSA has decreased significantly since then. Thus, to control MRSA, the following steps should be taken: (1) constant and careful surveillance, (2) regular risk factor analyses, (3) the optimal administration of antibiotics, and (4) the education of all hospital staff.

Cross Infection↗
PubMed1993

Alternate hemihepatic vascular control technique for hepatic resection.

This report describes a simple and improved inflow control technique for resection of a hepatic tumor that lies across the right and left hepatic lobes. With alternate hemihepatic inflow control by en masse occlusion of Glisson's sheath of each hemipedicle at the bifurcation, hepatic resection across the two hepatic lobes is completed. Compared with Pringle's maneuver, this technique eliminates splanchnic congestion and reduces warm ischemia of the remnant liver, while maintaining a comparable hemostatic effect.

Humans↗
PubMed1993

Pedunculated hepatocellular carcinoma and surgical treatment.

To determine the optimal surgical therapy for patients with pedunculated hepatocellular carcinoma (HC), we evaluated findings in ten patients with pedunculated HC among 350 patients with HC who underwent hepatectomy from 1975 to 1991 at Kyushu University Hospital. These patients were classified into three groups: Group I (n = 4) Pedunculated HC with no intrahepatic HC, Group II (n = 2) Pedunculated HC with a single intrahepatic HC, and Group III (n = 4) Pedunculated HC with multiple intrahepatic HC. Patients in group I and II were treated by partial hepatic resections or subsegmentectomies. In two patients there was an intrahepatic recurrence in the same lobe, after radical resection. All patients in group III who underwent palliative resection died within 8 months after surgery. Retrospectively, we favour the view that patients in Groups I or II may have had a better prognosis if lobectomy rather than partial hepatectomies had been done.

Adult↗
PubMed1993

The mutation of codon 249 in the p53 gene is not specific in Japanese hepatocellular carcinoma.

Hepatocellular carcinoma samples obtained from 59 patients at surgical resection were examined for mutations of the third base at codon 249 of the p53 gene, using the polymerase chain reaction and oligonucleotide hybridization techniques. This point mutation, which is frequently observed in HCC cases from Southern Africa and Quidong in China, was not recognized in either 60 hepatocellular carcinomas or 53 noncancerous liver tissue samples from Japan. Thirty-four of 45 patients (75.6%) were positive for the hepatitis C virus, which was a higher rate than that for hepatitis B virus infection (9 of 55; 16.4%). The exposure to aflatoxin B1 was not considered to be remarkable. These results suggest that the point mutation of the third base at codon 249 is not common in Japanese patients, and it is suggested that numerous other factors affect the mutation of the p53 gene and the development of hepatocellular carcinoma.

Adult↗
PubMed1993

A safe and simple technique for exchanging central venous catheters.

A safe and simple technique for exchanging central venous catheters is herein described. Our technique is based on a modification of Seldinger's method, in which a new outer sheath is introduced over the previous catheter as a guidewire in order to simplify the exchange of central venous catheters. This technique can be successfully performed by new residents and can be applied to the exchange of clotted catheters.

Catheterization, Central Venous↗
PubMed1993

Hepatocellular carcinoma: correlation of CT, angiographic, and histopathologic findings.

PURPOSE: To elucidate the causes of various enhancement patterns of hepatocellular carcinomas (HCCs). MATERIALS AND METHODS: Computed tomographic (CT) scans of 68 surgically resected HCCs (62 patients) were obtained 45 seconds and 6 minutes after administration of contrast material. These scans were compared with angiographic and histopathologic findings. RESULTS: On the early images, 24 HCCs (35%) were hypoattenuating, 33 were totally or partially hyperattenuating (48%), and 11 were isoattenuating (16%) compared to adjacent liver. On the delayed images, 55 HCCs (81%) were hypoattenuating and 13 (19%) were isoattenuating. Twenty-nine of the 48 very hypervascular or hypervascular tumors (60%) were hyperattenuating or partially hyperattenuating at early CT. Sixteen of the 20 slightly hypervascular or hypovascular tumors (80%) were isoattenuating or hypoattenuating. CONCLUSION: Although there was relatively good agreement between tumor vascularity and enhancement pattern (60% correlation for hypervascular tumors, 80% correlation for hypovascular tumors), hyperattenuation of the large HCCs (> or = 5 cm) at CT appeared to be a function of dilated sinusoids within the tumor (peliotic changes) as well as vascularity. In patients with advanced cirrhosis, hypovascular HCCs could be hyperattenuating at CT.

Angiography↗
PubMed1993

Multistep, multicentric, and simultaneous development of hepatocellular carcinoma.

We resected a multiple hepatocellular carcinoma (HCC) which contained portal tracts, showed evidence of an early multistep condition, and a multicentric development of HCC which progressed simultaneously. A preoperative working examination revealed a tumor in S5 of the liver, which was 2.5 cm in diameter. In addition, a "nodule-in-nodule" appearance was seen on the ultrasonographic imaging. At intraoperative ultrasonography, an additional two HCCs were detected. At histologic examination of the resected specimen, the main nodule showed a nodule-in-nodule appearance. In the outer nodule, there was a well-differentiated HCC, while the portal tracts remained. The less-differentiated HCC grew in the inner nodule and was replacing the well-differentiated HCC in the outer nodule. These findings suggests morphological transition in the early stages of the multistep development of HCC. Two additional tumors (1.1 cm and 1.0 cm in diameter) detected at intraoperative ultrasonography proved to be HCCs (grade I) with marked fatty change, and with portal tracts remaining within both the HCCs. Furthermore, both of the HCCs retained their preexisting liver structure. These histologic findings coincided with the characteristics of the early stage HCC, whereas the coexistence of early stage HCCs suggests the multicentric development of HCC. Distortion, compression, and invasion of the portal tracts may appear as the tumor grows, thereby evoking an increasing risk of metastasis via the portal tracts. Therefore, the early diagnosis and treatment of HCC before the portal tracts disappear, when 1.5 cm in size or less, may be very important for surgeons and diagnosticians, as an effective curative resection may be feasible.

Carcinoma, Hepatocellular↗
PubMed1993

Possibility of hepatic resection in patients on maintenance hemodialysis.

A review of seven hepatic resections in six patients undergoing maintenance hemodialysis is presented. These cases consisted of hepatocellular carcinoma in four, and cholangiocellular carcinoma, myelolipoma and focal nodular hyperplasia in one each. The last preoperative hemodialysis was undertaken within 24 h prior to the operation with heparin. Intraoperatively, infused solutions containing no potassium, along with strict attention to preventing overhydration, allowed us to manage the patients without hemodialysis on the day of the operation. No specific intra-operative complications related to hemodialysis were noted. Postoperative hemodialysis was performed on the first or second day after operation, using nafamstat mesilate, a synthetic protease-inhibiting agent. The morbidity rate in the hemodialyzed patients was 85.7% (6/7), which was significantly higher than that in the non-hemodialyzed patients who underwent hepatic resections in our hospital. Fluid collection in the pleural and/or peritoneal cavities was frequent and difficult to control, but transient. Our experience suggests that hepatic resection is an acceptable procedure for hemodialyzed patients, when used in conjunction with careful perioperative management.

Adenoma, Bile Duct↗
PubMed1993

Graft replacement of pararenal inferior vena cava for leiomyosarcoma with the use of venous bypass.

Total replacement of the inferior vena cava across the renal vein confluence was successfully performed under venovenous bypass in a patient with primary leiomyosarcoma of the inferior vena cava. Concomitant resection of metastases by right nephrectomy, partial hepatectomy, and cholecystectomy allowed recurrence-free survival for the past 20 months. To the best of our knowledge, this is the first report of successful replacement of the inferior vena cava for a primary tumor.

Female↗
PubMed1993

Liver resection and intractable postoperative ascites.

Among 211 patients who, between 1985 and 1990, underwent liver resection in Kyushu University Hospital, uncontrollable ascites occurred in 53 (25%). A univariate analysis revealed that postoperative death with liver failure occurred more frequently in patients with intractable ascites (p < 0.05). Alanine amino transferase levels were significantly higher in patients with intractable ascites (p < 0.05), but serum bilirubin, alkaline phosphatase and serum albumin levels did not differ significantly. Portal pressure (p < 0.05), the operation time (p < 0.01) and blood loss (p < 0.01) were significantly higher in patients with intractable postoperative ascites. A multiple analysis showed a correlation between the operation time, portal hypertension and postoperative intractable ascites. Postoperative histology revealed that a larger number of patients with cirrhosis had intractable ascites (p < 0.05). We conclude that cirrhosis, portal pressure and operating time are the most important factors related to intractable ascites in the case of hepatectomy. Areas of the liver to be resected should be limited in cirrhotic patients with portal hypertension.

Adult↗
PubMed1993

[Two cases of huge hepatic hemangioma].

We have experienced two cases of huge hepatic hemangioma. Case 1 was a 51-year-old man complaining of abdominal fullness and was shown low density area in the right hepatic lobe by abdominal computed tomography. He was treated with segmentectomy of the right hepatic lobe. The resected specimen was histologically diagnosed as cavernous hemangioma. Case 2 was a 61-year-old man who showed no symptom and was shown 10 x 6.5 cm hemangioma by abdominal ultrasonography. He have been untreated. For 10 years, 29 cases of huge hepatic hemangioma, including our two cases have been reported in Japan. The female to male ratio is 5:1. The incidence of huge hepatic hemangioma was frequent in the fifth and sixth decades of life. The majority of patients complained of palpable abdominal mass and abdominal pain. The dominant site of huge hepatic hemangioma was the anatomical right hepatic lobe.

Hemangioma, Cavernous↗
PubMed1993

Extracorporeal hepatic resection for previously unresectable neoplasms.

BACKGROUND: Some hepatic tumors are judged inoperable solely for anatomic reasons, such as the proximity of the tumor with the major vasculature. This is because of high mortality and morbidity rates, as well as a compromised surgical margin. METHODS: We successfully performed extracorporeal hepatic resections in two patients who were judged to have inoperable tumors by conventional means. RESULTS: Both patients had an uneventful postoperative course, and although one patient had intrahepatic recurrence 6 months after operation, the other patient shows no recurrence 10 months later. CONCLUSIONS: Advances in techniques for liver transplantation and organ preservation now allow resection of anatomically unresectable hepatic tumors that were deemed inoperable in the past.

Extracorporeal Circulation↗
PubMed1992

Limitations of current preoperative liver imaging techniques for intrahepatic metastatic nodules of hepatocellular carcinoma.

To determine the limitations of the latest techniques in preoperative liver imaging for hepatocellular carcinoma, 20 patients with histologically proven intrahepatic metastatic tumors were studied. In 32 masses, we were able to assess the relationship between these intrahepatic metastatic tumors and the findings of preoperative imaging individually. Six intrahepatic metastatic tumors not exceeding 5 mm in diameter were missed in all the imaging examinations. The detection rate was 60% in 13 intrahepatic metastatic tumors of 5 to 10 mm, 77% in 10 intrahepatic metastatic tumors of 10 to 20 mm and 100% in 3 intrahepatic metastatic tumors exceeding 20 mm. In total, computed tomographic imaging during arterial portography demonstrated the highest rate of detection (40%) of all the studies performed. Magnetic resonance imaging, which was recently introduced, was rather disappointing (31%) in this series. In two patients, intrahepatic metastatic tumors were only histologically confirmed. Our study suggests a low rate of detection of intrahepatic metastatic tumors with current preoperative imaging modalities. For improvement of prognosis after hepatectomy for hepatocellular carcinoma adjuvant therapy and extended hepatectomy seem necessary if the functional capacity of the remaining liver permits.

Aged↗