Biomedical subjects

T Matsumata

Publications and source records attributed to T Matsumata.

At least 127 records · Page 7Linked to original sources

PubMed1992

Hepatic resection for a hepatocellular carcinoma larger than 10 cm.

Twenty-one patients with hepatocellular carcinoma (HCC) larger than 10 cm diameter were treated during the 18 year period from 1971 to 1988. The mean tumor size was 13 cm (range 10-18 cm). Nineteen patients (90.5%) had subjective symptoms. Eight patients (38.1%) had alpha-fetoprotein (AFP) levels over 10,000 ng/ml, and in 18 patients (85.7%) the levels were over 20 ng/ml. Nevertheless, only three (14.3%) were detected by AFP. Scintigraphy before 1981 and ultrasonography after 1982 appears to be most helpful for detection of HCC. Nineteen lesions (90.5%) were localized in the right hepatic lobe. Large HCC showed a low incidence of histologically verified concomitant cirrhosis (33%; 7 of 21) and a relatively well preserved hepatocellular function (indocyanine green test; 13.9 +/- 6.6%). Curative resection could be done for all 21 patients. There were three (14.3%) operative deaths. The 1-, 3-, and 5-year survival rates were 72.2, 32.9, and 8.2%, respectively. One patient who underwent a left hepatic lobectomy has survived for over 5 years, with recurrence. There were 14 recurrences (66.7%) in 21 patients: 11 were hepatic and three were in the lungs. In patients with large HCC, surgical resection should be done, provided the clinical status and hepatocellular reserves are adequate.

Carcinoma, Hepatocellular↗

PubMed1992

Simplified hilar division in controlled right hepatectomy.

Right hepatectomy with preliminary vascular control at the hepatic hilus could be performed not by the method of dividing the structures in the hepatoduodenal ligament separately but instead by simultaneously employing both the hemihepatic vascular control method and the ultrasonic dissector. When applying the tape around the first portal pedicle, the anterior and posterior portal pedicles are easily exposed by using the ultrasonic dissector and, thereafter, ligated and cut; by utilizing this simplified hilar division, hemostasis of the right hepatic lobe can be achieved.

Hepatectomy↗

PubMed1992

The difference in chemosensitivity to antineoplastic agents of human hepatocellular carcinoma cells under normo-oxygenated or hypoxic conditions.

In order to select more effective drugs under hypoxia for the treatment of hepatocellular carcinoma, the cytotoxicity of antineoplastic agents for two hepatoma cell lines, PLC/PRF/5 and HuH-7, was examined under both oxygenated and hypoxic conditions. Mitomycin C was observed potentially to have enhanced cytotoxicity under hypoxic conditions for both hepatoma cell lines. Carboquone showed enhanced cytotoxicity under hypoxia for PLC/PRF/5 alone. On the other hand, there was no cytotoxic enhancement of adriamycin or cisplatin in either cell line. Thus, the sensitivity of tumour cells to the cytotoxic agents altered according to the conditions to which the tumour was exposed. The selection of the antineoplastic drugs for chemotherapy therefore should depend not only on the sensitivity of individual tumours to various drugs, but the alteration of the cytotoxicity of the drugs under certain conditions should also be carefully taken into account.

Antineoplastic Agents↗

PubMed1991

Management of haemangioma of the liver: comparison of results between surgery and observation.

Cavernous haemangioma of the liver was diagnosed in 33 patients using hepatic angiography between 1978 and 1988. Thirteen of these patients underwent surgery. There were no deaths after operation; morbidity included upper gastrointestinal bleeding in two patients and liver dysfunction in one. The follow-up study showed no evidence of recurrence in any of the 13 patients up to 143 months after operation. In the operated patients, a small haemangioma was left in the liver of two for anatomical reasons, but the size of these tumours showed no change over 3 years. The remaining 20 patients had no specific treatment for haemangioma and were followed up for between 18 months and 8 years. Of these 20 patients, 19 had tumours of less than 5 cm in size. As there was no enlargement or rupture of haemangiomas of less than 5 cm, it was felt that these could be observed. Cases having a potential for exposure to trauma, rapid tumour growth, or displaying severe symptoms should be considered for surgical treatment; this can be justified due to low morbidity and no mortality.

Female↗

PubMed1991

Factors linked to early recurrence of small hepatocellular carcinoma after hepatectomy: univariate and multivariate analyses.

The purpose of this study was to clarify the factors linked to recurrence of small hepatocellular carcinomas, up to 3 cm in diameter, after hepatectomy. Fifty patients with small hepatocellular carcinomas who underwent hepatectomy between 1976 and 1988 were observed for possible recurrence for at least 2 yr. These patients were divided into two groups: 20 patients who had recurrence within 2 yr and 30 patients who had no recurrence within 2 yr. The recurrence pattern was analyzed by hepatic angiography. Statistical analysis by the chi 2 test and stepwise logistic regression showed that the risk factors linked to recurrence were (a) tumor diameter greater than 2.2 cm, (b) intracapsular infiltration of tumor cells, (c) tumor location deep in the liver, (d) macroscopical and microscopical tumor invasion into the portal vein and (e) tumor invasion into the portal vein or intrahepatic metastasis. When patients diagnosed with small hepatocellular carcinomas have any of these risk factors, postoperative adjuvant therapy and follow-up should be particularly carefully considered, since these patients are at high risk for early recurrence.

Carcinoma, Hepatocellular↗

PubMed1991

Successful surgical treatment of hepatocellular carcinoma invading into biliary tree.

A 41-year-old woman was admitted to hospital with obstructive jaundice. Computed tomography showed a large mass in the right hepatic lobe and marked dilatation of the biliary tree in the left lateral segment of the liver. Angiography showed evidence of neovascularity. Percutaneous transhepatic cholangiography revealed complete obstruction of the common bile duct just below the bifurcation. The serum level of alpha-fetoprotein on admission was 1,080,000 ng/ml. These findings suggested to us a primary hepatocellular carcinoma invading the intrahepatic bile duct. Extended right lobectomy and hepaticojejunostomy for bile drainage was carried out. The patient is doing well 3 years after surgery. Hepatocellular carcinoma (HCC) invading to the portal vein is not so rare, but invasion into the bile duct is much less common. In 1947, Mallory described a single case of HCC invading the gallbladder and obstructing extrahepatic bile ducts. In 1975, Lin termed this HCC "Icteric type hepatoma". The incidence of such HCC in Japan was reported to be 1.9-9%. Obstructive jaundice is a clinical manifestation of the terminal stage in HCC. We describe here our treatment of a woman with HCC invading the common bile duct. Right extended lobectomy and reconstruction of hepaticojejunostomy were effective.

Adult↗

PubMed1991

Human hepatocellular carcinoma sensitivity to antitumor drugs assayed using the succinate dehydrogenase inhibition test.

Chemosensitivity of hepatocellular carcinoma tissues from 72 patients to 6 antitumor agents was assayed using the succinate dehydrogenase inhibition test. Sensitivity was positive in 47.2% of tissues exposed to adriamycin, 53.5% to mitomycin C, 10.3% to 5-fluorouracil, 51.5% to cisplatin and aclacinomycin A. respectively, and 52.9% to carboquone. Eight percent of the tissues were sensitive to all 6 drugs, while the resistance rate to all drugs was 36.5%. The remaining 55.5% were sensitive to only some of the drugs. When a comparison of the sensitivity to the 6 drugs was made between two different areas of tumors in 16 patients, positive or negative sensitivity was in a range of 76.9-92.9%. The hypovascular masses seen on the angiography and the histologically well differentiated tumors were resistant to adriamycin, a drug most commonly prescribed to treat patients with liver cancer. For some of these tumors, mitomycin C or carboquone may be effective. Our observation shows that the succinate dehydrogenase inhibition test is useful for determining which drugs will be effective for a particular tumor.

Aged↗

PubMed1991

Modified technique of Pringle's maneuver in resection of the liver.

Crushing of the hepatic parenchyma with hepatic clamps to minimize blood loss during resection of the liver leads to mechanical damage of hepatocytes. Pringle's maneuver may precipitate liver failure by hepatic warm ischemia as well. Therefore, we controlled bleeding from the surface of the resection by using light compression on the hepatic parenchyma with a band while applying a hepatic arterial clamp at the hepatic hilus. This vascular control method can be done because the portal pressure is about one-tenth of the hepatic artery pressure and provides an efficient and harmless transection of the liver.

Animals↗

PubMed1991

Possible transmission of serum hepatitis in liver surgery with the ultrasonic dissector.

When the ultrasonic dissector is used during liver surgery, the possibility exists of the transmission of virus to the attending hospital personnel because of unavoidable splashing of the irrigating solution. It becomes apparent from this study that the titer of hepatitis B surface antigen in the aspirated irrigating solution is almost the same level as that in the serum. We therefore strongly recommend that eye shields should be used in hepatic surgery when the ultrasonic dissector is in use.

Adult↗

PubMed1990

Clinicopathologic features of hepatocellular carcinoma in young patients.

To investigate clinicopathologic characteristics of hepatocellular carcinoma (HCC) in young adults, excised tumors from 21 patients younger than 45 years (young group) were compared with findings in tumors from 204 patients older than 45 (old group). In the young group HCC showed (1) a high incidence of positive hepatitis B virus surface antigen (HBsAg) (young 71.4% versus old 20.1%); (2) relatively well-preserved hepatocellular function (indocyanine green test; young 10.7 +/- 8.8% versus old 20.6 +/- 10.8%); (3) low incidence of histologically verified concomitant cirrhosis (young 52.4% versus old 78.4%); and (4) a more advanced stage of the disease in TNM classification (Stage III; young 52.4% versus old 18.1%). With respect to survival rates achieved by surgery, there was no statistically significant difference between the two groups. Thus, hepatitis B virus may relate to the occurrence of HCC in the young patients. Despite the advanced stage in the young group, survival rate after surgery was comparable with that achieved in the old group. These observations mean that a close periodic surveillance of young adults with a positive HBsAg is required to detect HCC at an early stage. Treatment of patients with HBsAg using interferon or vidarabine and hepatitis B vaccine should be made to convert HBsAg to negative in these individuals.

Adult↗

PubMed1990

Decreased morbidity and mortality rates in surgical patients with hepatocellular carcinoma.

From September 1981 to December 1988, 163 patients underwent hepatic resection for hepatocellular carcinoma. The patients were divided into two groups: those operated on from September 1981 to March 1985 (n = 58) and those operated on from April 1985 to December 1988 (n = 105). There was an increase in the number of relatively small hepatocellular carcinomas in 1987-88. Differences in the incidence of accompanying liver cirrhosis (72 versus 62 per cent) were not statistically significant; however, values of the indocyanine green test (21.5 versus 17.0 per cent, P less than 0.01) aided in strict patient selection. In more recent years, initial hepatic hilar dissection for control of vascular structures was undertaken and an ultrasonic dissector was used in about three-quarters of these patients. Consequently, the mean estimated blood loss (2500 versus 1300 ml, P less than 0.001) and mean intraoperative blood replacement (2200 versus 560 ml, P less than 0.001) were significantly less than in the earlier period. Among the 58 patients treated in the early period, hospital morbidity and mortality rates were 52 and 29 per cent respectively. In contrast, the rates were 23.8 and 1.9 per cent respectively among the 105 patients operated on during the recent period (P less than 0.01). The decline in hospital mortality is attributed to the careful selection of patients, use of modern tools, and a diminished blood loss.

Adult↗

PubMed1990

Surgical manipulation of VX2 carcinoma in the rabbit liver evokes enhancement of metastasis.

To search for possible untoward effects of surgical manipulation of a malignant tumor, a series of experiments was carried out using VX2 carcinoma of rabbits. Fourteen days after inoculation of VX2 carcinoma into the liver, the rabbits were separated into two groups: Group I, manual manipulation during relaparotomy; and Group II, relaparotomy alone without manual manipulation of the tumor. After these procedures, the tumor was surgically removed and histologic examinations were made. The incidence of vascular permeation of liver tumor cells into the hepatic vein was significantly higher in Group I (P less than 0.01). On the 14th day after resection of the tumor, the number of metastatic nodules in the lungs was significantly increased in Group I (P less than 0.01). Survival time of rabbits after resection of tumor was significantly shorter in Group I (P less than 0.01). These results are taken to mean that manual manipulation of a tumor may well enhance metastasis.

Animals↗

PubMed1990

Bioenergy status of human liver during and after warm ischemia.

Changes in the human liver's cellular bio-energy status during warm ischaemia and the subsequent blood reflow period were investigated by means of adenosine triphosphate (ATP) assay. In 8 patients, the average level of ATP in the liver tissue decreased significantly (p less than 0.05) from 28.7 +/- 8.6 mumol/g protein to 19.1 +/- 8.7 mumol/g protein within 10 minutes of warm ischemia. The pattern of decline in ATP levels did not correlate with clinical parameters, including presence of cirrhosis, liver function, type of ischemic method employed and postoperative complications. After reperfusion, ATP levels increased rapidly from 15.1 +/- 8.9 mumol/g protein to 19.6 +/- 8.2 mumol/g protein within 10 minutes, although the difference was not statistically significant. These patients' postoperative course was uneventful, and the results of serum chemistry tests were normal. The present study demonstrates a direct correlation between the levels of tissue ATP and the status of the liver's blood supply.

Adenosine Triphosphate↗

PubMed1990

Lipiodol drug targeting in the treatment of primary hepatocellular carcinoma.

When Lipiodol Ultra-Fluid (lipiodol) is administered through arteries feeding the tumor, lipiodol remains selectively in the neoplastic tissue for an extended period of time. This characteristic of the oily contrast medium has been utilized for regional targeting of chemotherapy in patients with hepatocellular carcinoma, which has been termed "lipiodolization". The current status of lipiodolization is reviewed herein.

Antineoplastic Agents↗

PubMed1990

Advances in the treatment of hepatocellular carcinoma and concomitant esophageal varices.

Twenty-four patients with hepatocellular carcinoma (HCC) concomitant with esophageal and/or cardial varices concurrently underwent hepatic resection for HCC and various treatments for varices. All patients had cirrhosis of the liver, and had either blue or white varices with "red color signs" endoscopically. These patients were assigned to two groups. Group A patients simultaneously underwent partial hepatectomy and selective shunt or direct interruption procedures (n = 13). Group B patients underwent hepatic resection and devascularization of the upper half of the stomach and/or preoperative or postoperative endoscopic injection sclerotherapy (n = 11). Seven patients in Group A had a tumor recurrence 4 to 58 months postoperatively, while in Group B, one of 11 patients had a tumor recurrence in the remnant liver. There was one patient in Group A with postoperative rebleeding from esophageal varices, and there was neither variceal bleeding nor variceal recurrence after treatment in Group B. Liver failure was the immediate cause of death in five, including three in-hospital deaths in Group A. Survival rates during the first 5 years in Group A were 75%, 67%, 31%, 21% and 10%, while the four-year survival rate in group B was 100%. In the light of this evidence, the treatment given to Group B is to be preferred.

Adult↗

PubMed1990

New approaches to hepatocellular carcinoma and concomitant esophageal varices prolong survival.

A retrospective study was done on 226 patients with hepatocellular carcinoma and coexisting esophageal varices treated at our institute between 1974 and 1988. The patients were divided into two groups: Group A containing patients treated between 1974 and 1982 (n = 92), and Group B comprising those treated between 1983 and 1988 (n = 134). Surgical treatments were applied to 64 patients (69.6%) and 37 patients (27.6%) in groups A and B, respectively (p less than 0.001). Ninety out of 134 patients (67.2%) in group B were prescribed regional chemotherapy. Forty-nine patients (53.3%) in group A, and 96 (71.6%) in group B had esophageal varices that were about to rupture as indicated endoscopically. Nineteen patients (38.8%) in group A, and 10 (10.4%) in group B were treated surgically (p less than 0.005). The varices in 76 out of 96 patients (79.2%) in group B were treated by endoscopic sclerotherapy. Survival rates during the first 5 years in groups A and B were 28% and 65%, 16% and 43%, 5% and 27%, 4% and 18%, and 4% and 6%, respectively. It would appear that appropriate conservative treatment of the poor surgical candidates will, in general, lead to good clinical results.

Adult↗

PubMed1990

Lipiodolization prolongs survival rates in postoperative patients with a recurrent hepatocellular carcinoma.

Curative resections were performed in 200 patients with primary hepatocellular carcinoma (HCC) during the period from 1971 to 1988, at Kyushu University Hospital. Patients seen before 1982 numbered 73 (group I), and the remaining 127 underwent hepatic resection after 1983 (group II). Thirty-nine (53.4%) of the 73 patients in group I had a recurrence during the follow-up period, as did 61 (48.0%) in group II. HCC resections done after 1983 (group II) were associated with (1) a low incidence of operative deaths (I 15.1% vs. II 2.4%) and hospital deaths (I 30.1% vs. II 5.5%), (2) relatively well-preserved hepatocellular function (indocyanine green test, I 24.5 +/- 12.6% vs. II 17.4 +/- 9.2%), (3) a low incidence of histologically verified concomitant cirrhosis (I 87.7% vs. II 68.5%) (4), and smaller HCC nodules (I 6.4 +/- 4.4 cm vs. II 4.1 +/- 3.1 cm). The survival rates of patients seen after 1983 were significantly better than those of patients resected prior to 1982. With respect of the recurrence-free rates achieved by curative hepatic resection, there was no statistically significant difference to be seen between the two groups. In the case of patients submitted of lipiodolization treatment for a recurrent HCC, the survival rates were better than in patients on systemic chemotherapy. Since lipiodolization prolongs survival time after a recurrence of HCC, this form of treatment should be given due consideration.

Adult↗

PubMed1989

Myelolipoma of the liver. A case report.

We treated a 56 year-old woman with myelolipoma originating from the liver. Hepatic imagings, including ultrasound and computed tomography (CT), demonstrated characteristic features of a fat-enriched tumor. Since this tumor was symptomatic, hepatic resection was done, with good results. The histology revealed tissues mainly composed of fat and bone marrow elements. The diagnosis was hepatic myelolipoma.

Female↗