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Biomedical subjects

T Matsumata

Publications and source records attributed to T Matsumata.

At least 145 records · Page 8Linked to original sources
PubMed1989

Patterns of intrahepatic recurrence after curative resection of hepatocellular carcinoma.

Using selective angiograms of the liver, we analyzed the patterns of intrahepatic recurrence of hepatocellular carcinomas following curative surgery. In 33 patients with intrahepatic recurrences, seven patients (21%) had a recurrence near the resected hepatic stump. The remaining 26 had either a nodular recurrence in segments away from the resected margin or a widespread multinodular recurrence in the liver remnant. There was a recurrence within the first postoperative year in five of 16 patients with a nodular recurrence and in eight of 10 patients with a widespread multinodular recurrence. In these patients, particularly those with a widespread multinodular recurrence, tumor thrombi in the portal vein present before the operation and/or disseminated during operation from such an advanced main tumor seemed to be the most important and significant factor related to the early recurrence in the remnant liver. This evidence suggests that in cases of surgery for hepatocellular carcinoma it is important to establish a technique to prevent dissemination of cancer cells due to operative manipulation and also adequate adjuvant therapy rather than attempting to obtain an ample resection margin.

Adult↗
PubMed1989

A 5-year experience of lipiodolization: selective regional chemotherapy for 200 patients with hepatocellular carcinoma.

Between 1982 and 1987, selective regional cancer chemotherapy using Lipiodol plus an anticancer drug (lipiodolization) was prescribed for 200 patients with hepatocellular carcinoma. One hundred forty-nine patients were given lipiodolization alone, and the remaining 51 underwent hepatic resection following lipiodolization. The grades of deposits of the oily contrast medium in the neoplastic tissue seen on the plain X-ray correlated well with the antitumor effect. In the resected specimens of 17 patients treated with lipiodolization prior to surgery, concentrations of adriamycin in the malignant liver tissues were 13.2 +/- 18.2 micrograms per gm, whereas the adjacent liver parenchyma contained 1.4 +/- 2.0 micrograms per gm of adriamycin; the difference was statistically significant (p less than 0.05). In the 149 patients treated with lipiodolization, 1-, 2-, 3- and 4-year survival rates were 56.1, 28.9, 17.3 and 7.4%, respectively. Thus, lipiodolization was considerably more effective, compared to the results achieved by hepatic artery ligation and cannulation into the hepatic artery for patients in Stages I and II. In this sequential nonrandomized study, the survival rates for patients undergoing hepatic resection were superior to those for patients in Stage I and treated with lipiodolization. The significant difference appeared to depend on incomplete killing of tumor cells, which are most often present in the fibrous capsule, by lipiodolization. We conclude from these data that lipiodolization is an effective treatment for hepatocellular carcinoma when the tumor is not curatively resectable. When the clinical status is good, then surgery is warranted.

Antineoplastic Agents↗
PubMed1989

Lack of muscularis mucosa and the occurrence of Boerhaave's syndrome.

Six patients with spontaneous rupture of the esophagus (Boerhaave's syndrome) were surgically treated in the Department of Surgery II, Kyushu University. Two patients underwent esophageal resection. Histopathologic examinations revealed the absence of muscularis mucosa around the sites of esophageal rupture in these two patients. In the patient treated most recently, serial histologic investigation demonstrated that the lack of muscularis mucosa existed not only around but also along the longitudinal extension of the site of rupture. This finding suggests that lack of muscularis mucosa in the esophageal wall may be one cause of spontaneous rupture of the esophagus.

Adult↗
PubMed1989

Levels of vitamin A and cellular retinol binding protein in human hepatocellular carcinoma and adjacent normal tissue.

The levels of vitamin A (retinol) and vitamin E were measured in the blood, in tissues of human hepatocellular carcinoma (HCC), and in adjacent liver parenchyma. The median values of vitamin A were 11.5 micrograms/g (ranging 0-82.5 micrograms/g) in HCC and 52.1 micrograms/g (ranging 0.4-895.2 micrograms/g) in normal liver tissues; the difference was statistically significant (p less than 0.05). By contrast, there was no significant difference in vitamin E levels between the two tissues. Although the levels of vitamin A were significantly lower in HCC in 10 patients, no significant difference was noted in the cellular retinol binding protein levels in the normal and malignant tissues. These results suggest that the decreased levels of vitamin A in HCC are not due to altered cellular retinol binding protein levels in tumors and the different vitamin A blood supply system. We conclude that either the decreased uptake of vitamin A, but not vitamin E, by HCC cells or the lack of vitamin A-storing cells in tumors might be responsible for the low levels of vitamin A in HCC.

Adult↗
PubMed1989

Surgical margin and recurrence after resection of hepatocellular carcinoma in patients with cirrhosis. Further evaluation of limited hepatic resection.

This report attempts to elucidate the manner in which the surgical margin is linked to a recurrence after curative hepatectomy for hepatocellular carcinoma (HCC) in patients with cirrhosis. Forty patients were divided into two groups: those in whom the margin from the cut surface to HCC in the fresh resected specimen was less than 10 mm wide, and patients in whom the surgical margin was equal to or exceeded 10 mm. These margins were expressed as tumor wedge positive [TW(+)], and tumor wedge negative [TW(-)], respectively. There were 24 and 16 patients in the TW(+) and TW(-) groups, respectively. There was no statistically significant difference in clinicopathologic variables, except for age and values of serum albumin between the two groups. There was a recurrence in ten of 24 patients (42%) of the TW(+) group and in eight of 16 patients (50%) of the TW(-) group. Mean disease-free periods were 21.4 months in the TW(+) group and 23.6 months in TW(-) group. These 40 patients were also divided with regard to the time of recurrence, the early recurrence within 24 months, and the late recurrence after 24 months. There was no statistically significant difference in the rate of recurrence and mean disease-free period between the TW(+) and TW(-) groups in the early and late recurrence groups. In both the TW(+) and TW(-) groups, there were no recurrences in 13 of 16 patients (81.3%) with a tumor less than 4 cm in diameter, yet there were recurrences in seven of eight patients (87.5%) with a tumor exceeding 4 cm in diameter, regardless of the time to recurrence. These results suggest that in patients with a tumor less than 4 cm, the extent of TW is not linked to an early recurrence. However, when the tumor size exceeds 4 cm, 10 mm of TW is inadequate to achieve curability. When a wide resection is not feasible, then adjuvant chemotherapy should be aggressive.

Adult↗
PubMed1989

Lack of intrahepatic recurrence of hepatocellular carcinoma by temporary portal venous embolization with starch microspheres.

Immediate recurrence in the hepatic remnant is sometimes evidenced after curative resection for treatment of hepatocellular carcinoma. One possible cause of this early recurrence is the multiple dissemination of tumor cells via the portal vein in the remnant liver as a result of surgical manipulations. In an attempt to prevent such recurrences, we performed ultrasonically guided, intraoperative portal embolization with starch microspheres in eight patients with hepatocellular carcinomas. These starch microspheres lodge only temporarily in the microvasculature, and there are no adverse effects, such as a rise in portal pressure or postoperative liver dysfunction. To date, there is no recurrence in any patient.

Adult↗
PubMed1989

[Eight cases of non-resectable hepatocellular carcinoma surviving for more than 3 years after Lipiodol administration].

From December 1982 to February 1986, selective regional cancer chemotherapy using Lipiodol plus anticancer drug (Lipiodolization) was prescribed for 87 patients with non-resectable hepatocellular carcinoma (HCC). Eight out of 87 cases survived for more than 3 years. The mean age of the 8 long survivors was 52.6. In the liver function, 2 cases were in Child A, 5 cases in Child B, and 1 case in Child C. The largest diameter of HCCs was 5.3 cm, and the number of the tumors was one in 6 cases, two in one case, and three in one case. No vascular invasion was detected on hepatic angiography. These findings suggested that long survivors in lipiodolization are not in far advanced HCCs. For these 8 cases, lipiodolization was repeatedly prescribed from two to 6 times. The largest amount of adriamycin was 192 mg/case. The longest survivor has lived for 5 years and 6 months after first lipiodolization. After lipiodolization, one tumor vanished, and three tumors decreased in size. Although seven tumors increased in size after lipiodolization, the tumor doubling time of seven tumors were 64, 265, 313, 317, 350, and 1943 days (average 539 +/- 639 days). It is possible that lipiodolization remarkably inhibited tumor growth. Nevertheless, in 5 out of 7 cases, the daughter lesions increased in size and number, although the main tumors grew slowly. Lipiodolization was less effective for newly arising daughter lesions than main lesions.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Clinical management of recurrent hepatocellular carcinoma after primary resection.

Curative resections were performed on 121 patients with primary hepatocellular carcinoma from 1975 to 1986 at Kyushu University Hospital, Japan. Up to August 1987 there was a recurrence in 41, detected between 4 and 86 (mean 20) months after surgery. Intrahepatic recurrences were the most common (82 per cent). There was no statistically significant correlation between size of the primary tumour and interval from surgery to detection of recurrence (r = -0.09). Serial measurement of serum alpha-fetoprotein (AFP) was useful for the detection of recurrences. However, the levels of AFP seem to be a non-specific, unreliable test for such patients since this tumour marker showed different ranges before the primary surgery and at the time of recurrence in 5 of the 41 patients (12 per cent). Postoperative chemotherapy with oral 5-fluorouracil had no apparent preventative effect on the recurrence. A second curative resection was effective in four patients, and three survived for over 2 years; the longest survival time is 9 years after the second procedure.

Adult↗
PubMed1988

Hepatic resection for hepatocellular carcinoma in elderly patients.

Of 154 elective hepatectomies performed during the 13 year period from 1973 to 1985 for hepatocellular carcinoma, 27 (17.5 percent) were performed on patients 65 years of age or older. Among these elderly patients, 40.7 percent died in the hospital compared with 21.3 percent of the younger patients (p less than 0.05). Sepsis accounted for 72.7 percent of the hospital deaths among the elderly patients, in contrast to 25.9 percent among the younger patients. The overall incidence of hospital death due to sepsis was significantly higher in the elderly patients (p less than 0.001). Hepatic lobectomy or segmentectomy in the elderly patients with cirrhosis was followed by hospital death in 88.9 percent compared with 25 percent of the elderly patients without cirrhosis (p less than 0.01). A higher incidence of hospital death occurred among the elderly in Okuda's stage I (p less than 0.05), Child's class A (p less than 0.02), and in those with concomitant systemic disorders (p less than 0.05). We conclude that in patients 65 years of age or older with hepatocellular carcinoma, concomitant systemic disorders play a role in determining the outcome of hepatectomy. Elderly patients with cirrhosis are high-risk candidates for major hepatectomy for whom limited hepatic resection should be considered.

Age Factors↗
PubMed1988

Lack of preventive effect of branched-chain amino acid solution on postoperative hepatic encephalopathy in patients with cirrhosis: a randomized, prospective trial.

The purpose of this randomized, prospective study was to determine whether the infusion of branched-chain amino acid (BCAA)-enriched solution had a preventive effect for treating postoperative hepatic encephalopathy in patients with cirrhosis. Among the 56 patients with cirrhosis, 29 were given BCAA-enriched solution, and 27 were given the conventional amino acid solution for 14 days postoperatively. These groups were indistinguishable with regard to clinical and laboratory criteria at entry, except by sex. The molar ratio of BCAA to aromatic amino acids in the BCAA group was increased postoperatively, whereas the ratio in the control group was decreased, the difference being statistically significant. Among the 29 who received BCAA, three (10.3%) had hepatic encephalopathy; two died and one recovered. Of the 27 control patients, hepatic encephalopathy occurred in three (11.1%); one died and two recovered. There was no significant difference in rate of occurrence of hepatic encephalopathy between the groups. Thus the infusion of BCAA-enriched solution apparently had no preventive effect with regard to hepatic encephalopathy for patients with cirrhosis who underwent surgical treatment.

Amino Acids↗
PubMed1987

[1-Hexylcarbamoyl-5-fluorouracil (HCFU) effective in hepatocellular carcinoma metastatic to the lungs--a case report].

A 74-year-old female undergoing hepatic resection for hepatocellular carcinoma developed intrahepatic recurrence together with lung metastases 6 months later. At detection of recurrence, she was treated by lipiodolization using 20 mg adriamycin by Seldinger's technic. She was then placed on oral 1-hexylcarbamoyl-5-fluorouracil (HCFU) daily. Three months later, it was found that the numbers and size of metastatic nodules in the lungs had markedly decreased on plain chest X-ray. Hepatic angiogram also showed a decrease in the size and numbers of intrahepatic nodules. Serum concentration of alpha-fetoprotein dropped from 8,200 ng/ml at detection of recurrence to 19.1 ng/ml 9 months after initiation of HCFU therapy. She has been on oral HCFU without any adverse effect and she was well at the time of writing, 19 months and 13 months after surgery and detection of recurrence, respectively.

Administration, Oral↗
PubMed1987

Combined Penrose and silicone drains provide excellent drainage.

We designed an effective combination drainage, using available silicone and Penrose drains, the latter placed within the former. Occlusion at the tip by fibrin materials never occurs in clinical application. If complications, such as leakage and abscess have occurred, this drain is extremely effective to ensure drainage and suction or irrigation, or both, as the Penrose drain can be replaced with sump tube drain. This simple hybrid for double lumen drain has proved to be both efficient and safe.

Clinical Trials as Topic↗
PubMed1987

Early gastric cancer and a concomitant pregnancy.

Gastric cancer associated with pregnancy is most often associated with a poor prognosis because the cancer stage is usually advanced at the time of diagnosis. The symptoms are frequently masked by factors related to the normal pregnancy and diagnostic approaches are restricted by physical and psychological clinical events. The authors treated a 30-year-old woman at 35 weeks of gestation. She had episodes of hematemesis and a prompt diagnosis of early gastric cancer was made following observations using a gastroduodenal fiberscope. A living normal child was delivered following oxytocin-induced labor and, 18 days later, curative resection for the gastric cancer was done. The patient has been doing well for over 16 months at this writing, with no evidence of recurrence. Based on the author's experience and a review of the literature, they conclude that early gastric cancer detected during pregnancy has a satisfactory prognosis and that use of the gastrofiberscope facilitates an early diagnosis in a pregnant subject with untoward symptoms of the GI tract.

Adenocarcinoma↗
PubMed1987

Postoperative mechanical ventilation preventing the occurrence of pleural effusion after hepatectomy.

To determine factors leading to pleural effusion after hepatectomy, the frequency of pleural effusion was investigated in 68 patients who underwent hepatic resection, with or without dissection of the right coronary ligament. In 36 of 44 patients (81.8%) who underwent hepatic resection with complete dissection of the right coronary ligament, and in two of 24 (8.3%) who underwent the procedure without dissection of this ligament, pleural effusion developed in the right hemithorax (p less than 0.001). Difference in pressure between the abdominal and thoracic cavities was considered to lead to ascites in the chest via the diaphragmatic triangular area (where there is no parietal peritoneum). While investigating the preventive effect of mechanical ventilation following hepatic resection on the occurrence of pleural effusion in 12 patients, we concluded that effusion could be prevented with use of mechanical ventilation--an approach that retained the intrathoracic pressure in a positive state.

Adult↗
PubMed1986

Acute liver failure in rats inhibited by intrasplenic administration of OK-432.

Intrasplenic administration of OK-432, an immunostimulant derived from Streptococcus, prevented hepatic failure induced in rats by D-galactosamine. When OK-432 was given 1.0 K.E. (Group I) or 0.1 K.E. (Group II) into the subcutaneously transpositioned spleen three times prior to dosing with D-galactosamine, survival rates were 100 and 87%, respectively. On the contrary, with a splenic injection of saline (Group III), the survival rate was 47 and 32% in rats given OK-432 1.0 K.E. intraperitoneally (Group IV). The poisoned rats given no pretreatment (Group V) survived at a rate of 26%. These results show that intrasplenic administration of OK-432 leads to a significant enhancement of survival. Metabolic data and histological findings were compatible with survival rates, in each group. Activation of the reticuloendothelial function by the intrasplenic administration of this immunostimulant seems to have prevented acute liver failure.

Acute Disease↗
PubMed1985

The value of ultrasound in the diagnosis and treatment of small hepatocellular carcinoma.

Thirty-two patients with a solitary hepatocellular carcinoma of less than 4 cm diameter were treated during the 13 years from 1971 to 1983, two-thirds of them since 1981. Serum alpha-fetoprotein levels proved to be an excellent diagnostic tool for these early stage carcinomas which are generally asymptomatic. Ultrasonography forms an invaluable test for the detection of occult liver cancer and has enhanced the ability to detect small sized lesions. The accuracy of this method increased from 25 per cent for the period 1971-1980 to 89 per cent for the period 1981-1983. The cumulative survival rates for the 32 patients treated by hepatic resection at 1, 2 and 5 years were 85, 70 and 22.2 per cent (excluded from these figures are four operative deaths giving a 12.5 per cent operative mortality).

Adult↗
PubMed1984

Limited hepatic resection effective for selected cirrhotic patients with primary liver cancer.

We evaluated in retrospect the applicability of limited hepatic resection in cases of primary liver cancer in cirrhotic patients. According to the severity of impaired liver function, 37 patients underwent limited resection, and for 13, standard major hepatic resection was done. The mortality rate in case of limited resection was 10.8%, and the rate in case of massive excision was 15.4%. One, two- and five-year survival rates of limited operation were 79.9, 60.3, and 32.6%, respectively. After standard resection, the rates were 78.7, 67.5, and 22.5%, respectively. There were no significant differences in the mortality and survival rates between the two groups. These results indicate that, for the patient with a small liver cancer, and poor liver function, the limited procedure leads to a comparatively longer survival. This limited resection can be selectively used to treat cancer associated with cirrhosis and encapsulated tumors. For the preoperative evaluation, hepatic arteriograms aid in patient selection.

Adult↗