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Y Shimahara

Publications and source records attributed to Y Shimahara.

At least 37 records · Page 2Linked to original sources
PubMed1998

Nine-year survivor after resection of cholangiocellular carcinoma with tumor thrombi in the main portal trunk.

We report a patient with cholangiocellular carcinoma with tumor thrombi in the main portal trunk who has survived for 9.5 years after hepatic resection. A 57-year-old woman underwent an extended left lobectomy, and resection of the caudate lobe plus the main portal trunk for a liver tumor that had a portal tumor thrombus in the main portal trunk. The portal vein was reconstructed with an autologous vein graft obtained from the external iliac vein. Histological examination of the resected specimen revealed moderately differentiated tubular adenocarcinoma compatible with cholangiocellular carcinoma. Factors contributing to the patient's long-term survival are discussed. Aggressive surgical resection can be effective even for such an advanced case of cholangiocellular carcinoma.

Bile Duct Neoplasms↗
PubMed1998

[Surgical treatment for hepatocellular carcinoma: liver resection using transplantation techniques].

Ex situ partial liver resection was performed in 2 patients with hepatocellular carcinoma (HCC) with Child A-liver cirrhosis that was untreatable by conventional liver resection techniques. In both cases, an extended left lobectomy was first performed, and then the autologous lateral segment was transplanted after removing segment 4 (or + a part of segment 5, 8) together with the tumor by the bench procedure. Although there might have been no difference in preoperative liver function in these cases, the postoperative course was quite different. The first case was successful with an uneventful postoperative course, but, the second case went into postoperative liver failure and the patient died of multiple organ failure on the 20th postoperative day. The cause of liver failure in the second case might be attributable to: 1) prolongation of cold preservation time for the bench procedure (196 min); or 2) over reduction of the native remnant liver (right lobe) due to resection of the huge tumor. In conclusion, the technique using ex situ partial liver resection and transplantation of the remnant section of the liver might be a useful method to extend surgical treatment for some cases of HCC untreatable by conventional liver resection. However, the indications should be carefully considered in each case, since graft damage can occur rapidly during the bench procedure due to combined liver cirrhosis.

Aged↗
PubMed1997

Expression of basic fibroblast growth factor-like immunoreactivity in the nuclei of regenerating hepatocytes.

This study, utilizing rats subjected to two-thirds partial hepatectomy or sham operation, was designed (1) to investigate the content of basic fibroblast growth factor (bFGF) in the subcellular fractions of regenerating and sham-operated rat livers by immunoblot experiments and enzyme-linked immunosorbent assay (ELISA), (2) to show that bFGF immunoreactivity and proliferating cell nuclear antigen (PCNA) immunoreactivity are markers for hepatocellular mitosis before and after partial hepatectomy, and (3) to observe the location and fine structure of the bFGF immunoreaction within the regenerating liver with special attention to bFGF immunoreactivity in the nuclei of regenerating hepatocytes. Immunoblot experiments and ELISA showed a transient increase in high-molecular-weight forms of bFGF in the nuclear subcellular fraction of regenerating liver 48 h after partial hepatectomy. By light microscopy, bFGF and PCNA immunoreactivities were detected in the nuclei of regenerating hepatocytes. Electron microscopy demonstrated bFGF-like immunoreactivity mainly in the nuclear euchromatin and rarely in the heterochromatin or nucleoli of regenerating hepatocytes. The transient increase in high-molecular-weight forms of bFGF in the nuclear euchromatin of regenerating hepatocytes, together with the concomitant expression of PCNA in the regenerating liver, suggests an important role of the high-molecular-weight forms of bFGF in hepatocyte proliferation and/or mitosis, although authentic bFGF with a molecular form of 18 kDa is not considered to be involved in hepatic regeneration.

Animals↗
PubMed1997

[Surgical therapy for hepatocellular carcinoma with liver cirrhosis].

Approximately 80% of hepatocellular carcinoma (HCC) patients in Japan have associated liver cirrhosis, which increases the difficulty of surgical treatment. Liver dysfunction associated with liver cirrhosis is one of the most important predictive prognostic factors for HCC patients. Percutaneous ethanol injection therapy (PEIT) is useful for patients with small HCC or with poor hepatic functional reserve. Transcatheter arterial chemoembolization (TACE) is also useful both for patients with unresectable HCC and patients with multiple intrahepatic recurrence. Liver resection, however, lead to better outcome than other treatments when liver function is maintained after surgery. To determine operative procedures, it is important to evaluate the exact function of remnant liver, based on the preoperative liver function test and the evaluation of tumor character. For advanced HCC patients with vascular invasion, non-surgical treatments such as PEIT or TACE are not indicated, and surgical intervention can be an effective modality to improve their survival. Improvements of surgical technique and perioperative management have decreased fatal complications at a major liver resection and allowed us to carry out liver resection on patients with advanced HCC.

Carcinoma, Hepatocellular↗
PubMed1996

Anterior approach to dorsal short hepatic and right hepatic veins in a right hepatic lobectomy.

A simple procedure of right hepatic lobectomy for bulky liver tumors is proposed. The procedure is named "Anterior approach", which is characterized by transection of hepatic parenchyma without mobilization and rotation of the right hepatic lobe. The transection directly reaches the ventral surface of the retrohepatic inferior vena cava first at the portion of caudate process. The hepatic parenchymal transection proceeds from ventral to dorsal and from caudal to cranial. Several dorsal short hepatic veins are severed on the ventral surface of the IVC and the right hepatic vein is finally severed from inside. This method enables the minimization of operative stress and is especially useful for cases with a huge tumor in the right hepatic lobe which invades the diaphragm or thoraco-abdominal wall.

Aged↗
PubMed1996

Influence of hepatic mitochondrial redox state on complement biosynthesis and activation during and after cardiopulmonary bypass operations.

We have proposed the hazardous phenomena associated with cardiopulmonary bypass (CPB) are due to metabolic derangement by hepatic mitochondrial dysfunction during and after CPB. On the contrary, complement activation and consumption during CPB is reported to be related to the morbidity associated with cardiac surgery. To determine the significance of the hepatic mitochondrial function on the morbidity of cardiac surgery, we measured the serum levels of complements (C3 and C4), activated complements (C3a and C4a), and the arterial ketone body ratio (AKBR), which reflects the hepatic mitochondrial redox state, in 30 patients undergoing CPB. The AKBR, which was at a normal level preoperatively, dropped to a critical level after the initiation of CPB and remained at a low level during the CPB, returning to the preoperative level on the second postoperative morning in a time dependent fashion. The patients group were assigned to two groups according to their AKBR on the first postoperative morning. Group I consisted of patients whose AKBR had recovered to above 0.7 on the first postoperative morning (n = 16). Group II consisted of the rest of the patients (n = 14). The serum complement concentration had considerably decreased by the end of bypass, but recovered in a time-dependent fashion after CPB. The group I patients (C3: 71% of its preoperative value, C4: 85% of its preoperative value) recovered their complements more quickly than the group II patients (C3: 56% of its preoperative value, C4: 54% of its preoperative value). However, the serum C3a and C4a concentrations increased by the end of bypass (C3a: 806% of its preoperative value, C4a: 341% of its preoperative value). The activated complements were significantly higher in the group II patients (C3a: 124% of its preoperative value, C4a: 236% of its preoperative value) than in the group I patients (C3a: 75% of its preoperative value, C4a: 113% of its preoperative value) on the first postoperative morning. It is suggested that hepatic mitochondrial function is related to recovering the complements and to reducing the activated complements after CPB.

Adolescent↗
PubMed1995

Extrinsic sympathetic reinnervation after intestinal transplantation in rats.

Although extrinsic denervation is inevitable after intestinal transplantation and leads to poor intestinal function, little is known about the occurrence of extrinsic reinnervation. In this study, extrinsic sympathetic reinnervation was investigated morphologically following syngeneic intestinal transplantation performed on male Lewis strain rats. At 1, 3, 6, 9, 15, and 27 weeks after transplantation, the graft mesenteric arteries and their branches in the intestinal wall were histochemically examined by a glyoxylic acid method demonstrating perivascular sympathetic nerve fibers. At 3 weeks after transplantation, extrinsic sympathetic reinnervation was recognized in the graft mesenteric arteries, where it traversed the arterial anastomosis and extended along the course of the mesenteric arteries from proximal to distal. The degree of reinnervation in the mesenteric arteries was similar to the results obtained in the simple denervation model. The transplanted intestinal tract itself was sympathetically denervated for at least 9 weeks after transplantation, and reinnervation was not recognized until 15 weeks after transplantation. Reinnervation extended into the intestinal wall in every preparation, and the enteric nerves began to be reinnervated at 27 weeks after transplantation, but the density was still at a low level and complete extrinsic reinnervation of the graft would seem to require a much longer time to reestablish itself.

Animals↗
PubMed1995

Safety of the donor in living-related liver transplantation--an analysis of 100 parental donors.

The safety and lack of undue operative stress on the donor are documented from an analysis of 100 parental donors, whose children (3 months to 17 years old), received LRLTx at our institution between June 1992 and May 1994. Survival rate of recipients was 86%. No primary nonfunctioning liver was observed. The donors were 56 mothers and 44 fathers. Their ages ranged from 19 to 51 years and their weight ranged from 44 to 80 kg. They received partial liver resections to harvest the grafts. With regard to the liver graft, the left lobe was used in 24 cases (group L) and the left lateral segment was used in 75 cases (group S). The right lobe was used in one case. In the two groups, blood losses were 242 +/- 5 (S) and 312 +/- 14 ml (L); operation times were 6.22 +/- 0.11 (S) and 7.15 +/- 0.21 hr (L), respectively; in both groups, the postoperative hospital stay was 11 days (S, L). No significant differences between the two groups were observed in peripheral RBC and WBC count or serum AST. An increase in total bilirubin was not observed. In the exceptional case using the right lobe, blood loss of 2300 ml necessitated a blood transfusion of 1000 ml, and the total bilirubin increased up to 4.0 mg/dl on the third postoperative day, which prolonged the postoperative hospital stay to 17 days. These results conclusively suggest that safety is guaranteed when the left lobe or the left lateral segment is used as the liver graft for LRLTx.

Adolescent↗
PubMed1995

The effect of a bolus injection of TNF-alpha and IL-1 beta on hepatic energy metabolism in rats.

The effects of intravenous bolus injection of tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta) on hepatic mitochondrial energy metabolism were investigated in rats. The rats were injected with 15 micrograms/kg body wt of human recombinant TNF-alpha and IL-1 beta. The hepatic energy charge decreased to 0.794 +/- 0.005 and 0.789 +/- 0.006 in comparison with the sham control value of 0.838 +/- 0.007 and 0.835 +/- 0.011 at 12 and 24 hr after the treatment. The mitochondrial redox state (NAD+/NADH) increased from 17.4 +/- 1.9, 16.6 +/- 1.4, and 19.2 +/- 2.1 to 33.5 +/- 3.5, 27.8 +/- 2.8, and 30.9 +/- 2.6 concomitant with an increase in arterial blood ketone body ratio (acetoacetate/beta-hydroxybutyrate) from 0.49 +/- 0.04, 0.34 +/- 0.04, and 0.44 +/- 0.09 to 1.00 +/- 0.16, 0.69 +/- 0.13, and 0.86 +/- 0.15 at 3, 12, and 24 hr after the treatment. Total ketone body concentration in liver tissue and arterial blood was significantly lower at 24 hr after the treatment. State 3 respiration rate of isolated mitochondria increased by 29.2, 30.3, and 19.2% concomitant with an increase in oxidative phosphorylation rate by 26, 33.7, and 24.3% at 3, 12, and 24 hr after the treatment. These results showed that the administration of TNF-alpha and IL-1 beta in rats induced a hypermetabolic state in hepatic mitochondrial energy metabolism, which is a pattern similar to sepsis and presumably a compensatory reaction to the increased energy consumption.

Animals↗
PubMed1995

Insulin and glucagon levels in living related liver transplantation: their interaction with the recovery of graft liver function.

Insulin and glucagon have opposite effects on various hepatic functions, including energy metabolism, which is essential for hepatic viability. To evaluate the effects of insulin and glucagon on the recovery of graft liver function, changes in these levels were investigated in relation to arterial ketone body ration (AKBR) during a 30-h period after graft liver reperfusion in 29 recipients of living related liver transplants. Insulin levels did not change significantly throughout this study, while glucagon levels decreased immediately after reperfusion, indicating a rapid degradation of glucagon by the graft liver. The insulin/glucagon (I/G) ratio increased after reperfusion concomitantly with AKBR. In addition, the I/G ratio was significantly correlated with AKBR after reperfusion. It is concluded that the increase in the I/G ratio was closely related to the recovery of graft liver function as reflected by the AKBR in living related liver transplantation.

Blood Glucose↗
PubMed1995

Effect of growth hormone on hepatic energy metabolism in normal rabbit liver.

Growth hormone (GH), which is well known as an anabolic agent in systemic protein metabolism but has catabolic effects on the carbohydrate metabolism in the liver, was administered to normal rabbit to investigate its effects on the hepatic energy metabolism. The changes in arterial ketone body ratio (AKBR: acetoacetate/3-hydroxybutyrate), which reflects the hepatic mitochondrial redox state ([NAD+]/[NADH]), after GH injection was studied as an indicator of the hepatic energy metabolism. GH was administered to normal rabbit at the doses of 50 micrograms/kg (GH-50 group), 100 micrograms/kg (GH-100 group) and 200 micrograms/kg (GH-200 group) by intravenous bolus injection. In the GH-50, GH-100 and GH-200 groups, AKBR decreased significantly from 1.40 +/- 0.09 to 0.94 +/- 0.05, from 1.19 +/- 0.11 to 0.83 +/- 0.14, and from 1.19 +/- 0.08 to 0.71 +/- 0.15 at 90 min, respectively. The energy charge of the liver decreased significantly 90 min after 200 micrograms/kg GH injection from 0.872 +/- 0.003 to 0.836 +/- 0.012 (p < 0.05). These results suggest that GH is associated with the deterioration of the hepatic energy metabolism, and that the administration of GH should be carefully weighed up in cases of damaged liver.

Animals↗