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Biomedical subjects

T Todoroki

Publications and source records attributed to T Todoroki.

At least 127 records · Page 7Linked to original sources
PubMed1980

Intraoperative radiotherapy for advanced carcinoma of the biliary system.

Since November 1973, intraoperative radiotherapy has been performed on five patients with unresectable, advanced carcinoma of the bile duct at the hepatic hilus and six patients with unresectable carcinoma of the gallbladder. A treatment cone with a diameter ranging from 4--10 cm was directly applied at the lesion. A single dose of 2500--3000 rad with 11 to 20 meV electrons was delivered. In all patients, recanalization of the obstructed bile duct was observed by the postoperative cholangiography. The local efficacy was confirmed histopathologically in eight autopsied materials and a specimen resected 105 days after radiotherapy. Mean survival time of patients with unresectable tumors was 10.9 +/- 5.6 (SD) months after this radiotherapy. Intraoperative radiotherapy increased the effectiveness and length of palliation for the unresectable lesion.

Adenocarcinoma↗
PubMed1980

Gross appearance of carcinoma of the main hepatic duct and its prognosis.

Twenty-three patients with carcinoma of the hepatic hilus, including the upper one-third of the extrahepatic bile duct, were treated by surgical resections. Gross appearances of this lesion are classified into polypoid, nodular, schirrhous constricting and diffusely infiltrating types. Each type has a different resectability and prognosis from the macroscopic point of view. The cell type in all patients was adenocarcinoma. Operation was curative in 100 per cent of four patients with the polypoid type. The chance for survival was definitively better for patients with this type than with the other three. Preoperative percutaneous transhepatic cholangiography as well as endoscopic retrograde cholangiography and celiac angiography can provide an excellent index to the resectability of the tumor and prognosis. Our experience suggests that gross appearance of the tumor may be valid as a prognostic factor in the treatment of the lesion.

Adenocarcinoma↗
PubMed1979

A new device for barium-enema examination following colostomy.

The authors developed a colostomy appliance for use during barium-enema examinations. It is 8 cm in diameter and 4 cm in height, and is made of acrylic resins. With the use of this device, 21 patients were fluoroscopically examined through the stoma; good contrast views of the lower intestinal tract were obtained in all cases without leakage of barium or air.

Barium Sulfate↗
PubMed1978

Successfully resected carcinoma of the bifurcation of the main hepatic ducts--report of two cases.

Two cases of carcinoma of the bifurcation of the main hepatic ducts are presented. The tumors were successfully removed by resection of the bifurcation in one case, and by left hepatic lobectomy in the other. Some other 38 cases of the same condition collected from the world literature are briefly reviewed and discussed with particular reference to their surgical interventions.

Adenocarcinoma, Papillary↗
PubMed1978

Repair of potentially lethal damage after single injection or continuous infusion of bleomycin.

The repair of potentially lethal damage after administration of bleomycin by a single injection or by continuous infusion was studied in vivo. Experimental tumors were the fifth generation isotransplants of a squamous cell carcinoma which arose spontaneously in a C3Hf/He female mouse. Bleomycin was administered intraperitoneally by a single injection or by 24-hr continuous infusion. Cell survival was assayed by TD50 method. Dose-survival curve after a single injection exhibited a biphasic or upward concave curve. Surviving fraction increased rapidly if tumors were left in situ after treatment and reached a plateau at 5 hr, indicating that tumor cells were able to repair the potentially lethal damage induced by bleomycin. Dose-survival curve after continuous infusion was also biphasic, but had a small shoulder. The repair of potentially lethal damage was slight, if any, when tumors remained in situ for 6 hr after the end of 24-hr continuous infusion. This indicates that potentially lethal damage was being repaired during drug infusion.

Animals↗
PubMed1977

Treatment of carcinoma of the biliary system.

A series of 23 patients with carcinoma at the hilus of the bile duct were studied. Fourteen of the 23 patients underwent surgical resection. Nine of the 14 patients had a curative resection. Six patients are alive after a follow-up period of five to 25 months. The remaining five patients had noncurative resection, and four of them died from metastatic carcinomas during the next 14 months. One patient who had a left hepatic lobectomy is still alive eight months after operation. The other three patients with advanced carcinoma at the hilus of the bile duct were treated by intraoperative radiotherapy. A single dose of 3,000 rads was emitted directly to the tumors. The remaining six patients were treated by drainage procedures only. Four patients with advanced carcinoma of the gallbladder had received radiotherapy. Six of the eight patients who were treated by radiotherapy are alive, although the follow-up period extends to 11 months only.

Adult↗
PubMedDate not supplied

Resection combined with intraoperative radiation therapy (IORT) for stage IV (TNM) gallbladder carcinoma.

From October 1976 to May, 1990, a total of 86 patients with stage IV (TNM) gallbladder cancer were treated at Tsukuba University Hospital. Twenty-seven of the 86 patients underwent tumor resection; 43 patients received palliative surgery. The remaining 16 were too advanced to have surgery. Of 27 patients who had tumor resection, 9 had resection alone, 17 had intraoperative radiation therapy (IORT) +/- postoperative external radiotherapy (ERT), and 1 had postoperative ERT. The procedures used were: extended right hepatic lobectomy plus hepaticobiliary resection (HBR) (n = 2), hepatic segmentectomy (SIVb, SV) plus HBR (n = 9), hepatic segmentectomy (SIV, V, VI) with HBR (n = 1), hepatic segmentectomy (SIV, V) plus HBR with pancreaticoduodenectomy (PD) (n = 3), PD plus HBR (n = 1), cholecystectomy with wedge resection of the gallbladder fossa plus HBR (n = 3), and cholecystectomy plus HBR (n = 3), and cholecystectomy (n = 4). Regional lymph node dissections were performed in every patient and 17 of 27 patients underwent additional resections of adjacent organs such as the stomach, duodenum, colon, and abdominal wall. A single dose of 20-30 Gy was delivered intraoperatively for 17 patients. A mean total dose of 36.4 Gy (1.8/fraction) was added to IORT for 10 patients. The three-year cumulative survival rate was 10.1% for resection plus IORT but 0% for resection alone. The longest survivor is alive and well at 3 years and 3 patients are alive 16, 13, and 4 months after tumor resection followed by IORT plus ERT.

Adenocarcinoma↗
PubMedDate not supplied

Alcohol dehydrogenase: a new sensitive marker of hepatic centrilobular damage.

To determine whether serum alcohol dehydrogenase (ADH) activity reflects hepatic damage of centrilobular region (zone 3), the rats were given either bromobenzene (BB) or allyl alcohol (AA) IP to produce the pericen tral or periportal necrosis respectively. After AA or BB serum alanine aminotransferase (ALT) activity showed no significant difference between the two groups. By contrast, serum ADH and glutamate dehydrogenase (GLDH) activities were elevated preferentially in the BB treated rats. However, AA administration to rats also resulted in a significant increase in GLDH activity, whereas ADH activity was only slightly elevated when compared to controls. Moreover, acute ethanol administration to rats resulted in a significant elevation of the serum ADH activity, whereas serum GLDH and ALT activities remained normal. These data suggest that serum ADH activity appears to be a sensitive and specific marker of hepatic centrilobular damage.

1-Propanol↗
PubMedDate not supplied

Amplification of the c-erbB-2 gene detected by FISH in gastric cancers.

The amplification and overexpression of the c-erbB-2 gene are considered to be implicated in the process of carcinogenesis of a variety of human tumors. The amplification and overexpression of c-erbB-2 were investigated in 48 surgically resected human gastric cancers by means of fluorescence in situ hybridization and immunohistochemistry. DNA ploidy was determined by flow cytometry. The c-erbB-2 amplification was demonstrated as a cluster of signals, suggesting homogeneously staining region (HSR), in three tumors (6.3%) accompanied by the overexpression of its protein. Such overexpression was detected in another tumor without amplification of the c-erbB-2 gene. All tumors with amplification and overexpression of c-erbB-2 were differentiated adenocarcinoma histologically, but only 10.3 and 13.8% of differentiated carcinomas showed amplification and over-expression of the c-erbB-2 gene, respectively. There was no relationship between the amplification and overexpression of c-erbB-2 and the depth of tumor invasion and lymph node involvement. Three of four cases with overexpression of c-erbB-2 were classified into DNA aneuploid tumor.

Adenocarcinoma↗
PubMedDate not supplied

Activation of intracellular neutrophil elastase in the transplantation of ischemic liver.

Ischemia-reperfusion injury is an important cause of primary nonfunction of transplanted organs, and neutrophil elastase has been implicated in the pathophysiology of ischemia-reperfusion injury. We assessed the kinetics of intracellular neutrophil elastase (INE) activity in canine liver transplantation. Mongrel dogs underwent orthotopic whole-liver transplantation. The animals in group I (n = 6) received fresh liver grafts, and all of the dogs survived longer than 24 h. The animals in group II (n = 5) received liver grafts injured by 30 min of warm ischemia. Only 1 animal survived longer than 24 h after reperfusion. A significant increase in the serum ALT and LDH levels was observed in group II after reperfusion of the graft. Isolated peripheral neutrophils were homogenized, and the neutrophil elastase activity in the supernatant was determined by using a spectrophotometric assay. The INE activity was expressed as the neutrophil elastase value per 1 x 10(10) peripheral neutrophils. In group I, the INE activity 10 min and 2 h after reperfusion was 7.6 +/- 2.6 and 6.1 +/- 2.4 U, respectively. In group II, this activity was 25.9 +/- 7.4 and 44.3 +/- 23.7 U, respectively. There was a significant correlation between serum LDH levels and INE activity 10 min after reperfusion (gamma = 0.70, p < 0.02). In conclusion, the INE activity increased more sharply after the reperfusion of ischemically injured liver grafts. The INE activity correlates with serum LDH levels immediately after reperfusion, suggesting that the increase in the INE activity depends on the severity of ischemic damage.

Alanine Transaminase↗
PubMedDate not supplied

Benefits of combining radiotherapy with aggressive resection for stage IV gallbladder cancer.

BACKGROUND/AIMS: The efficacy of combining resection and radiation in the management of advanced gallbladder cancer has not yet been defined. In this study, effects of combining radiation therapy on survival, local control and the pattern of recurrences were analyzed as a retrospective review. METHODOLOGY: From October 1976 to May 1996, 85 patients with stage IV (pTNM) gallbladder cancer underwent various aggressive resection modalities in our institute, including 34 liver resections, 30 hepatopancreaticoduodenectomies. Intra-operative, external or intracavitary radiation therapy was supplemented to resection in 47 patients. RESULTS: The 30-day operative mortality rate was 5.9% and the overall 5-year survival rate of stage IV disease patients was 6.3%; 3 patients are living well more than 6 years after surgery. Adjuvant radiotherapy yielded a significantly (p=0.0023) higher 5-year survival rate (8.9%) than resection alone (2.9%). The local control rate was significantly (p=0.0467) higher in the adjuvant radiation group than in the resection alone group (59.1% vs. 36.1%). However, there was no statistical difference in the frequency of distant metastasis between the two groups. Significant improvement (p=0.0028) of long-term survival was exhibited when radiation was used appropriately on patients with microscopic residues only. Those with macroscopic or without microscopic residues failed to improve. The 5-year survival rate and median survival time of patients receiving adjuvant radiation therapy for microscopic residues were 17.2% and 463 days, respectively. CONCLUSIONS: Adjuvant radiation therapy following aggressive resection, in certain circumstances, improves prognosis with acceptable operative mortality for stage IV gallbladder cancer.

Adenocarcinoma↗
PubMedDate not supplied

Outcomes of aggressive treatment of stage IV gallbladder cancer and predictors of survival.

BACKGROUND/AIMS: Stage IV gallbladder carcinoma patients are rarely considered treatable by resection. They resign themselves to palliation because there is no long-term survival data available on the risks of morbidity and mortality following aggressive treatment. The aim of this study was to evaluate predictors of survival following aggressive resection surgery for stage IV gallbladder carcinoma. METHODOLOGY: In this retrospective study, we examined 93 patients with stage IV gallbladder carcinoma who had undergone resections. Of the 93 patients, 69 had undergone liver resection to various extents together with hepaticocholedochus resection (HCR); 2 had undergone pancreaticoduodenectomy (PD) both with and without HCR; 31 had undergone hepatopancreaticoduodenectomy (HPD); 7 had undergone cholecystectomy together with HCR; 12 had undergone cholecystectomy; and 3 had undergone extended cholecystectomy. Fifty of the 93 patients had also undergone adjuvant radiotherapy. Using univariate and multivariate analyses, 13 clinicopathologic risk factors were analyzed to predict survival. RESULTS: Operative morbidity and mortality rates were 17.2% and 5.4%, respectively. Overall, the 5-year survival rate and median survival time were 9.8% and 243 days, respectively. The 5-year survival rate was significantly higher in stage IVA (n = 17) than in stage IVB (n = 76), at 42.8% and 4.9%, respectively. Multivariate analysis revealed that sex, histopathologic type, lymph node involvement (N), subgroup of stage IV, post-resection residual tumors, and adjuvant radiotherapy were significant predictors of survival. CONCLUSIONS: Long-term survival, with acceptable mortality and morbidity, can be expected in female patients who have stage IVA gallbladder cancer consisting of well-differentiated adenocarcinoma and who undergo either complete microscopic resection or grossly complete resection followed by adjuvant radiotherapy.

Adenocarcinoma↗
PubMedDate not supplied

Hepatic functional reserve in patients with biliary malignancies: an assessment by technetium 99m galactosyl human serum albumin hepatic scintigraphy.

PROBLEM: Technetium 99m galactosyl human serum albumin (99mTc-GSA) is a hepatic scintigraphy agent that binds to the asialoglycoprotein receptors. We evaluated the clinical use of the scintigraphy for the pre-operative assessment of biliary malignancies. PATIENTS AND METHODS: Scintigraphy was performed before operation in 56 patients with biliary malignancies. A hepatic uptake ratio of 99mTc-GSA (LHL15; the count ratio of the liver to the sum of the heart and liver 15 min after injection of 99mTc-GSA) was calculated. RESULTS: LHL15 was significantly associated with bilirubin half-life in patients treated before operation with percutaneous transhepatic biliary drainage (P = 0.007). After operation, 4 of 18 patients with LHL15 < 0.925 died within 30 days. The postoperative mortality was significantly greater in patients with LHL15 < 0.925 than in patients with LHL15 > or = 0.925 (P = 0.033). CONCLUSION: 99mTc-GSA scintigraphy is useful in evaluating the hepatic functional reserve in patients with biliary malignancies.

Adult↗