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T Tsunoda

Publications and source records attributed to T Tsunoda.

At least 181 records · Page 10Linked to original sources
PubMed1992

[Recurrent hepatocellular carcinoma after hepatic resection].

A total of 125 patients with hepatocellular carcinoma (HCC) treated by hepatic resection in our department from 1970 to 1989 were reviewed to determine recurrent factors, recurrent modes of HCC and to assess the treatment for recurrent HCC. Seventy-five of 125 patients had recurrent tumors after the first hepatic resection. The 1-, 2-, and 3-year cumulative recurrent rates after hepatic resection were 25%, 52% and 67% respectively. The size of the tumor, intrahepatic metastasis, portal vein involvement, clinical stage and DNA ploidy pattern were judged as useful predictive factors for recurrence of HCC after hepatic resection. In the patients with intrahepatic metastases, the bilateral lobes of the remnant liver were the most frequent recurrent sites. The treatment for recurrent HCC was divided into 3 groups such as re-resection, transcatheter arterial embolization (TAE) and palliative treatment. The survival curves of patients receiving re-resection and TAE were significant better than those of patients receiving palliative treatment. Patients treated by re-resection for recurrent HCC had the longest survival. The 1-, 3- and 5-year cumulative survival rates after re-resection were 84%, 60% and 48% respectively. It is concluded that the early detection of recurrent HCC is important and re-resection or TAE is effective treatment for recurrent HCC.

Adult↗
PubMed1992

[Evaluation of hepatectomy in small hepatocellular carcinoma--comparison with transcatheter arterial embolization therapy].

Therapeutic effect on 81 hepatectomized patients with hepatocellular carcinoma (HCC) less than 5cm in diameter was compared to that achieved by transcatheter arterial embolization therapy (TAE) in 61. The 5-year cumulative survival rate after hepatectomy was 38%, which was better than that of TAE (8%). Outcome after hepatectomy was better than that after TAE, according to tumor size in less than 2cm in diameter and single nodule. The 3-, and 5-year survival rates for curative hepatectomy were significantly better than those for TAE. But there was no significant difference in survival curves between relative noncurative hepatectomy and TAE. In terms of hepatic reserve with reference to Child's classification, the survival curve for TAE was better than that for relative noncurative hepatectomy in patients with Child-A, but there was no significantly difference between these two methods. Survivors more than 3 years after hepatectomy and TAE were 24 (48.0%) and 11 (23.4%) patients, respectively. Nineteen of 24 patients with hepatectomy had recurrent HCCs, of which reresection was done in 6, TAE in 11 and other treatments in 2. The advantage of hepatectomy in comparison with TAE is a possibility of long-term survival, if curative hepatectomy is performed.

Adolescent↗
PubMed1992

[Evaluation of immunoreactivity to erbB-2 protein as a marker of prognosis in bile duct carcinoma].

Recent studies of erbB-2 expression have shown that the erbB-2 oncoprotein correlated with poor prognosis of patients with breast cancer. Surgical treatment of the bile duct carcinoma is currently unsatisfactory. To evaluate erbB-2 oncoprotein as a marker of prognosis, we analyzed 68 bile duct carcinomas immunohistologically, using monoclonal antibody against erbB-2 oncoprotein, as well as clinicopathological data and outcome. High incidence of expression of erbB-2 oncoprotein was shown in bile duct carcinoma. Positive rates of erbB-2 oncoprotein correlated with stage of bile duct carcinoma. Survival of patients with erbB-2 expression cancer was shorter than those without erbB-2 expression cancer and erbB-2 expression has a prognostic value in bile duct carcinoma.

Bile Duct Neoplasms↗
PubMed1992

Immunohistochemical study of pancreatic cystadenocarcinoma.

Seven cases of pancreatic cystadenocarcinoma were studied clinicopathologically and immunohistochemically. Four patients died of the disease or recurrence with metastasis to the liver and peritoneum within 2 yr after surgery. The remaining three patients are well after surgery. To distinguish the cystoadenocarcinoma with excellent prognosis from that with poor prognosis, we performed immunohistochemical staining with monoclonal antibodies directed against tumor markers. Five specimens were strongly and diffusely reactive with tumor marker antibodies, whereas two were reactive with the apical portion of lining epithelial cells. With the findings of the immunohistochemical examination, the diagnosis of two patients could be revised from cystadenocarcinoma to premalignancy. Thus, immunohistochemical examination with tumor markers could correlate with the clinical outcome of the patients and is useful in distinguishing two distinct populations of mucinous cystic tumor.

Aged↗
PubMed1991

Augmentation of cytotoxic activity by combination with interleukin 2 and interferon gamma.

The synergy of cytotoxic activity by interleukin 2 (IL-2) and interferon gamma (IFN-gamma) was evaluated in human peripheral blood mononuclear cells (PBMC) and spleen cells. PBMC incubated with IL-2 (10 IU/ml) and IFN-gamma (200 IU/ml) for 4 days showed the stronger cytotoxic activity against K562, MOLT-4 and Daudi cells. Combination with IL-2 and IFN-gamma induced stronger activity than IL-2 or IFN-gamma alone. In order to investigate the sequential roles of IL-2 and IFN-gamma in the killer cell function, the cells were stimulated with IFN-gamma after washing of IL-2 or stimulated by IFN-gamma at various timing and duration without washing of IL-2. IL-2 was essential to induce the synergistic effect of IL-2 and IFN-gamma to cytotoxic activity. The similar augmentation of cytotoxic activity was observed by the addition of IFN-gamma at any incubation periods with IL-2, compared with stimulation with IL-2 or IFN-gamma alone. The phenotypes of the killer cells by stimulation with IL-2, IFN-gamma alone or IL-2 plus IFN-gamma were mainly CD2+, CD16+, indicating the activated natural killer cells.

Cytotoxicity, Immunologic↗
PubMed1991

[Nasobiliary drainage for spontaneous bile peritonitis due to cholangiocarcinoma].

We report a case of cholangiocarcinoma presented with bile peritonitis, in which endoscopic nasobiliary drainage (ENBD) as well as pleural and abdominal drainages improved the general condition leading to a radical operation. The case was a 79-year-old woman with the chief complaints of fever and right hypochondralgia due to pleural effusion and infected ascites contaminated with bile including E. coli. However gall-stones were not recognized in any biliary trees. US-guided drainage was performed into the pleural and abdominal cavities because of poor condition. After continuous drainages, peritonitis was improved, but hematoemesis and tarry stool appeared. Emergent endoscopy revealed a multiple gastric ulcer, and the bleeding was stopped by an injection of ethanol. ERCP findings revealed a cholangiocarcinoma in superior and middle portion of the bile duct obstructed nearly completely. After improvement in general condition by ENBD, cholecystectomy, resection of extrahepatic bile duct and subtotal gastrectomy were performed followed the reconstruction with Roux-en-Y method. Postoperative course was uneventful and the patient was discharged at the postoperative 35th day. Thus, the appropriate and opportune multiple biliary drainages can save a patient with cholangiocarcinoma in poor condition and lead to tolerate the operation even if he or she is suffering from severe bile peritonitis.

Adenoma, Bile Duct↗
PubMed1991

Tuberculous liver abscess with bronchobiliary and gastrobiliary fistulae--a case report.

A rare case of a primary tuberculous liver abscess with bronchobiliary and gastrobiliary fistula formation is presented herein, emphasizing the difficulty in establishing its diagnosis. The clinical course was complicated and a wide range of antibiotics administered repeatedly, based on the initial diagnosis of a liver abscess, until the final diagnosis of a tuberculous liver abscess was established by histopathological reinvestigation of the resected liver specimen. Thereafter, antituberculous chemotherapy proved extremely effective for the alleviation of symptoms, reduction of the abscess and closure of the fistulae.

Adult↗
PubMed1991

Common bile duct exploration--primary closure of the duct with retrograde transhepatic biliary drainage.

A new method of retrograde transhepatic biliary drainage (RTBD) using an RTBD tube with primary closure of the common duct was investigated with special reference to the usefulness and feasibility of this procedure. At operation, an atraumatic vinyl chloride tube was inserted from a choledochotomy incision and in most cases advanced via the left hepatic duct to the liver surface, which was then penetrated. After the choledochotomy incision had been primarily sutured, the RTBD tube was fixed to the abdominal wall. This drainage method was applied to 71 patients as an alternative to the conventional T-tube drainage and its effect on bile drainage was prominent. The insertion of an RTBD tube did not influence liver function tests and an RTBD tube cholangiography revealed no severe deformity at the primary closure site of the bile duct. The most common complication was movement of the optimal site for stenting of the bile duct, however, no serious complications were encountered. On average, the RTBD tube was removed on the 16th postoperative day, the mean postoperative stay in hospital being 22 days. These findings suggest the need for a prospective randomized clinical trial to prove the usefulness and feasibility of primary bile duct closure using our drainage method.

Bile↗
PubMed1991

Lithium carbonate in the preoperative preparation of Graves' disease.

Lithium carbonate was given in the preoperative preparation of 12 patients with Graves' disease, the reasons for its use being side effects of thionamide in 9 patients, insufficient control by thionamide in 1 and psychic symptoms in 2. Lithium carbonate was often used in combination with other drugs, namely; thionamide in 4 patients, beta-adrenergic blockades in 5, reserpine in 5 and glucocorticoid in 1. This preoperative control significantly decreased the mean serum T2 and T4 levels from 656 +/- 55 ng/dl to 180 +/- 16 ng/dl and from 25.9 +/- 2.1 micrograms/dl to 9.7 +/- 1.5 micrograms/dl, respectively. The only adverse effect of lithium carbonate was pollakisuria observed in one patient. All patients underwent subtotal thyroidectomy uneventfully. It is concluded that the administration of lithium carbonate alone or in combination with other drugs is an effective method of preoperatively controlling hyperthyroidism when conventional antithyroid drugs show adverse effects.

Adolescent↗
PubMed1991

Segmental primary sclerosing cholangitis mimicking bile duct cancer--report of a case and review of the Japanese literature.

A rare case of the segmental type of primary sclerosing cholangitis (PSC) is reported herein. A 27 year old Japanese man with obstructive jaundice was referred to our hospital with a provisional diagnosis of bile duct cancer at the hepatic hilum. A PTCD tube had been inserted from the right anterior segmental duct and direct cholangiograms showed complete obstruction of the bile duct at the confluence of the right and left hepatic ducts. Resection of the extrahepatic bile duct and partial hepatectomy were thus performed, however, the postoperative histological examination revealed no malignant features. Instead, the lesion was shown to be compatible with PSC microscopically. A diagnosis of PSC was finally established on the basis of clinical features, cholangiographic appearance and the pathological report.

Adult↗
PubMed1991

Hashimoto's thyroiditis presenting with severe pressure symptoms--a case report.

A extremely rare case of Hashimoto's thyroiditis presenting with pressure symptoms is described herein. A 50 year old Japanese woman was referred to our department with swelling of the anterior neck, facial edema and recent heavy snoring. Oto-rhinolaryngological examinations revealed no movement of the bilateral vocal cords, severe laryngeal edema and diffuse edema of the tongue and pharynx. These findings had apparently been induced by compression of the bilateral recurrent nerves and internal jugular veins by an enlarged thyroid gland. The results of thyroid function and autoimmune tests were compatible with a diagnosis of Hashimoto's disease and thus, total thyroidectomy with a tracheostomy was performed uneventfully. The resected specimen weighed 168 grams and was confirmed histologically to be Hashimoto's disease. Following her operation, all the above symptoms disappeared and 4 months later, the patient is well and asymptomatic.

Cranial Nerve Diseases↗
PubMed1991

Hyperparathyroidism following the atomic bombing in Nagasaki.

Forty-three patients with hyperparathyroidism (HPT), including 20 atomic bomb survivors (46.5 per cent) were treated surgically in our institute during the last 19 years. The mean age of the patients at the time of atomic bomb exposure (AB*E) was 17.6 +/- 1.5 years. The mean latent interval between atomic bomb exposure and detection of HPT was 39.1 +/- 1.1 years. We compared the 20 AB*E patients with 23 patients who had a history of neither atomic bomb exposure nor therapeutic irradiation to the neck region (non-AB*E patients). It was determined that females were more prominently affected by HPT than males among AB*E patients. The parathyroid lesions in AB*E patients consisted of adenoma in 16 patients and hyperplasia in 4. A similar proportion of pathological lesions was also observed in non-AB*E patients. Thyroid lesions accompanied by HPT, however, were more often revealed in AB*E patients than in non-AB*E patients. The two most common lesions in AB*E patients were papillary carcinoma in 3 patients (15 per cent) and adenoma in 3 (15 per cent). These findings suggest that atomic bomb survivors may be at a greater risk of developing HPT with a high incidence of accompanying thyroid disease.

Female↗
PubMed1991

Caroli's disease associated with hepatolithiasis: a case report and review of the Japanese literature.

A 27-year-old woman was admitted to Nagasaki University Hospital complaining of abdominal pain and fever. Percutaneous transhepatic cholangiography showed multiple cystic dilatations of the intrahepatic bile ducts without stone formation. The illness was diagnosed as a pure type of Caroli's disease. No surgical intervention was made. Subsequently, the patient suffered repeated attacks of cholangitis, and six years later, computed tomography demonstrated cystic lesions of both lobes of the liver and stones within the cystic lesions of the right lobe. We collected 62 cases of Caroli's disease reported in the Japanese literature, including our own case. Among them, cholangitis was found in 43.5%, hepatolithiasis in 30.6%, esophageal varices in 17.7% and cholangiocarcinoma in 8.1%. It is difficult to successfully treat Caroli's disease involving both lobes of the liver. Long-term repeated cholangitis could lead to fibrosis of the liver, hepatolithiasis, portal hypertension and cholangiocarcinoma. Considering the above-mentioned aspects of the disease, careful follow-up studies are required in each case.

Adult↗
PubMed1991

Endoscopic microwave coagulation therapy for villous adenoma of the duodenum--a case report.

The effects of endoscopic microwave coagulation therapy on duodenal adenoma in a 58-year-old man are reported. The patient had a 35-mm sessile tubulo-villous adenoma in the duodenal bulb. Endoscopic polypectomy followed by microwave coagulation therapy for duodenal adenoma was performed to avoid a major surgical procedure which would disturb the physiological functions of the gastrointestinal tract. After partial polypectomy which included the core of the adenoma, the entire remaining adenoma was destroyed after three microwave therapy sessions. During a follow-up period of 14 months, neither endoscopic nor histologic evidence of recurrence has been noted. Endoscopic microwave coagulation therapy is considered to be useful in the treatment of large sessile duodenal villous adenoma, provided that repeated endoscopic follow-up surveillance is also performed.

Adenoma↗
PubMed1991

UICC and Japanese stage classifications for carcinoma of the pancreas.

The stage classification (SC) for carcinoma of the pancreas recommended by UICC (UICC-SC) was compared with that of Japan Pancreas Society (JPN-SC) using 229 patients encountered consecutively at the Second Department of Surgery, Nagasaki University School of Medicine over the past 20 yr. By UICC-SC, 51% of the patients belonged to stage IV and 38% to Stage III. By JPN-SC, 82% of the patients belonged to stage IV. Curative resection rates in JPN stage II and III were significantly higher than those in UICC-SC by the chi-squared test. In 60 patients undergoing resectional surgery, postoperative cumulative survival (PCS) curves and rates by each staging criterion (tumor size [T], lymph node metastasis [N], distant metastasis [M], serosal invasion [S], retroperitoneal invasion [Rp], and invasion to the portal venous systems [V]) were calculated by the Kaplan-Meier method. Among these prognostic factors, significant differences in the PCS curves were demonstrated only between Rp(-) and Rp(+), and between V(-) and V(+) according to the generalized Wilcoxon's text. In UICC-SC, the underestimation of these factors leads to a tendency to classify the patients in a less advanced stage than in JPN-SC. JPN-SC is more complex than UICC-SC. Continuing efforts are necessary to establish a more practical, simple, and universal staging system for the disease.

Adolescent↗
PubMed1991

Chemosensitivity testing with highly purified fresh human tumour cells with the MTT colorimetric assay.

A major problem associated with the succinate dehydrogenase inhibition (SDI) test using tetrazolium dye (MTT) as a cancer chemosensitivity testing is the contamination of non-malignant cells in the tumour tissues. Highly purified fresh human tumour cells from 44 solid tumours and 24 malignant ascites were used for the MTT assay. The purity of tumour cells was greater than 90% after separation on Ficoll-Hypaque and Percoll discontinuous gradients. The OD570 obtained from tumour cells alone was higher than that from non-malignant cells. The chemosensitivity of tumour cells was distinct from that of non-malignant cells. Moreover, the chemosensitivity of highly purified tumour cells was also distinct from that of non-purified cells just separated from tumour tissues. 31 of the 68 patients had evaluable lesions, and received cancer chemotherapy according to the results of MTT assay using highly purified tumour cells. A clinical response was obtained in 10 of the 31 patients (response rate = 32.3%, 5 complete responses, 5 partial responses).

Adolescent↗