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A Toyosaka

Publications and source records attributed to A Toyosaka.

At least 19 recordsLinked to original sources
PubMed1992

Do the tumor cells of hepatocellular carcinomas dislodge into the portal venous stream during hepatic resection?

BACKGROUND: The current study was undertaken to investigate whether or not tumor cells are dislodged into the portal venous stream during hepatic resection for hepatocellular carcinomas. METHODS: A catheter was placed using echo guidance into the portal branch through the mesenteric vein in 31 patients. Cytologic examinations were done on multiple blood samples at various operative stages. RESULTS: Tumor cells were recovered in 7 of 31 patients in whom the tumor sizes were more than 5 cm and portal invasions were found microscopically and/or macroscopically. By contrast, the remaining 24 tumors were less than 5 cm in size and showed negative portal invasions. Recovery of the tumor cells was found, not during the earlier operative stage of mobilization or rotation of the hepatic lobe, but during the later stages of hilar dissection or hepatic parenchymal dissection. CONCLUSIONS: The portal pedicles should be divided before hepatic dissection in segmentectomy and lobectomy to lessen the chance of dissemination of intravasated tumor cells.

Adult↗
PubMed1992

Establishment of an enzyme immunoassay using monoclonal antibody (HG1-219) and its application for the diagnosis of hepatocellular carcinoma.

A monoclonal antibody (MoAb HG1-219) against a human gastric cancer cell line (HuG-1) and its shedding antigen (HG1-219 Ag) was generated and a solid-phase sandwich enzyme immunoassay (EIA-219) was developed. The mean serum HG1-219 Ag concentration in normal individuals was 30.5 +/- 14.5 U/ml measured by EIA-219. When the mean +3 SD of the antigen concentration in normal individuals was used as a cut-off level, 4.3% (2/47) of patients with chronic hepatitis, 9.1% (4/44) of cirrhotic patients and 37.5% (18/48) of patients with hepatocellular carcinoma (HCC) had HG1-219 Ag above the cut-off value. The positive rates of a-fetoprotein (AFP) (> 400 ng/ml) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) for HCC were 26.7% (12/45) and 33.3% (12/36), respectively. There was no significant correlation between HG1-219 Ag and AFP or PIVKA-II in patients with HCC. The combination assay of EIA-219, AFP and PIVKA-II for HCC gave the positive rate of 75% (27/36). The effect of periodic acid on the HG1-219 Ag and the inhibition of EIA-219 by CA 19-9 suggest that the epitope of HG1-219 Ag is a suger chain similar to CA 19-9.

Animals↗
PubMed1991

Flow cytometric DNA analysis of hepatocellular carcinoma.

The prognostic value of nuclear DNA content was studied retrospectively using flow cytometry in 203 cases of resected hepatocellular carcinoma. The occurrence of DNA aneuploidy, which was detected in 50% of patients, correlated significantly with tumor size and the presence of vascular invasion or intrahepatic metastasis. Overall, patients with DNA aneuploid tumors had a significantly worse prognosis than those with DNA diploid tumors (P less than 0.001) and, also in subdivided groups by tumor size (P less than 0.01). Among DNA aneuploid patients, the survival times were significantly shorter for patients with a low DNA index (less than 1.5) than for those with a high DNA index (greater than or equal to 1.5) (P less than 0.05). In a Cox multivariate analysis, nuclear DNA content provided significant prognostic value (P = 0.008), as did vascular invasion (P = 0.001) and intrahepatic metastasis (P = 0.005). These results indicated that nuclear DNA content has an important prognostic value in hepatocellular carcinoma.

Carcinoma, Hepatocellular↗
PubMed1990

Prognostic factors after hepatectomy for hepatocellular carcinomas. A univariate and multivariate analysis.

The current study determines the prognostic factors after hepatectomy for hepatocellular carcinomas. The 295 patients who underwent hepatectomy from 1973 through 1987 were included for a univariate and a Cox multivariate analysis. The favoring conditions were determined as follows. The essential requirements are (1) the absence of tumor thrombi; (2) no intrahepatic metastasis, but even when present, it should be close to the main tumor and removed with a massive resection; and (3) retention rate of indocyanine green dye (ICG) at 15 minutes should be within 14 +/- 4.2% (M +/- SD) to allow that resection. The desired requirement is that the tumor size should preferably be less than 5 cm; a wider free margin from tumors (greater than or equal to 1 cm) is recommended, but not determining factor. The eligible patients, having no thrombi, no intrahepatic metastasis, a tumor size of 5 cm or less, negative surgical margin (greater than or equal to 1 cm), had achieved a 5-year survival of 78%. In conclusion, resection therapy is the first option for patients with those requirements.

Adult↗
PubMed1990

[Study on function of aganglionic colon musculature of Hirschsprung's disease murine model].

This study examined the function in vitro of aganglionic colon musculature in mice with hereditary aganglionosis--a strain of animals used as a model of Hirschsprung's disease. Double sucrose gap recordings from the muscle strips of both normal and aganglionic colon showed bursts of spike potentials with muscle contraction. Intracellular recordings of the membrane potentials of the circular muscle cells of normal, aganglionic and oligo-ganglionic colon had no statistical difference. Microelectrode recordings from the circular muscle cells of normal siblings, in the presence of nifedipine, irregular ongoing fluctuations in membrane potential, which were abolished by tetrodotoxin and reduced by d-tubocurarine or apamin. The fluctuations were less effected by atropine. These observations suggest that there is ongoing inhibitory neural activity to the circular smooth muscle of normal colon. These ongoing fluctuations were not recorded from the cells of aganglionic and oligo-ganglionic colon of affected animals. Although transmural stimulation of the intrinsic nerves produced cholinergic excitatory and inhibitory junction potentials in normal colon, no junction potentials were evoked by transmural stimulation in aganglionic colon. It was concluded that the ongoing tonic inhibitory activity may contribute to the compliance of the normal mouse colon and lack of the compliance may affect functional intestinal obstruction of the aganglionic colon in Hirschsprung's disease.

Animals↗
PubMed1989

[Criteria of curability in the resection therapy for hepatocellular carcinoma].

The present study was aimed at determining a criteria for curability of hepatic resection in the treatment of hepatocellular carcinomas. The 239 patients hepatectomized from 1973 through 1987 were included for analysis. The patients with the tumor thrombi(V) or intrahepatic metastasis(IM) scattered over the unilateral lobe(IM2) showed very poor prognosis in spite of macroscopically complete resections. Consequently, these conditions were categorized into non-curative group(NC). The 5-year survival rate of the tumors less than 2 cm was 42%, which was much better than that of 5 cm or more group but no better than that of 2 to 5 cm group. When the prognosis was compared by an extent of resection among the patients with the tumors of less than 5 cm in size and V(-), the patients with lobectomy showed a 5-year survival rate of 84%, much better than 45% of those with segmentectomy or less range. The surgical margin (SM) negative patients showed a better prognosis than the SM positive patients with a slight difference. The tumor backgrounds of the 39 patients who survived three years with disease free condition were as follows: V(-) in all, no intrahepatic metastasis(IM0) in 79%, no IM2, massive resection for all IM1 in whom IM was confined to the area close to the main tumors, a tumor size of 5 cm or less in 82%, SM(-) in 62%. From the findings described above, we defined a complete resection for V(-) and IM0-1 as a curative condition, of which absolute curative resections(AC) corresponded to the patients with the tumors of 5 cm or less and SM(-), and relative curative ones(RC) to the remainders.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Hepatocellular↗
PubMed1989

[Diurnal changes in colonic motility in conscious dogs].

Daily profile of colonic motor activity was observed in 10 conscious dogs by means of extraluminal force transducers. Each dog was implanted with a set of seven strain, gauges, one on the terminal ileum and the remaining six on the colon equidistantly. The colonic motor activity was basically composed of migrating and non-migrating motor complexes at all six recording sites. Each motor complex was characterized by a tonic contraction superimposed by rhythmic bursts of phasic contractions. During fasted period these motor complexes recurred at a mean interval of 36 min, and a mean duration was 7 to 12 min. Those motor complexes which migrated over at least three recording sites were defined as "migrating", 72% of those observed at the most proximal sites (n = 2680) were migrating, and the remaining 28% were non-migrating. Of those migrating motor complexes 90.4% migrated caudad (iso-peristalsis), while only 9.4% migrated orad (antiperistalsis). During postprandial period the colonic motor complexes at all recording sites uniformly increased their frequency with shorter intervals. Different from the small intestine, the contractile patterns were essentially the same as those of fasted period. The postprandial acceleration of the colonic motor complexes seems to be compatible with gastrocolic response.

Animals↗
PubMed1989

[Nuclear DNA analysis of hepatocellular carcinoma].

Retrospective DNA ploidy studies of paraffin-embedded blocks were performed by flow cytometry on 212 surgically resected hepatocellular carcinoma. One hundred and sixty-four of 212 specimens yielded evaluable DNA histograms. Eighty-three cases showed a DNA diploid pattern and 81 a DNA non-diploid pattern. The incidence of non-diploid pattern increased with the tumor size. (2cm; 15.4%, 2-5; 42.3%, 5-10; 70.8% greater than 10; 73.3%). The DNA pattern correlated with the backgrounds, the degree of vascular invasion, intrahepatic metastasis and serum AFP levels. Survival of patients with non-diploid pattern was significantly less than those with diploid patients in any different stage. Of thirty who survived three years with disease free condition, 20 patients showed diploid patterns. Though remaining 10 patients were non-diploid patterns, 9 were high DNA index more than 1.5. It is concluded that flow cytometric DNA ploidy study had prognostic value for patients with surgically resected hepatocellular carcinoma.

Carcinoma, Hepatocellular↗
PubMed1989

[Late complications after successful Kasai's operation for biliary atresia].

The late complications in 25 patients more than 3 years after successful Kasai's operation for biliary atresia were presented. Nine (36%) of these 25 patients had episodes of variceal hemorrhage with portal hypertension, and biliary reobstruction in 3 (12%), bleeding from duodenal ulcer in 2, bleeding from gastric erosion in one, and diffuse pulmonary arterio-venous shunt in one were observed. Recently esophageal varices have been well controlled by endoscopic sclerotherapy, and the surgical treatment may be indicated in older children complicated with severe hypersplenism and marked splenomegaly, which are resistant for sclerotherapy. As a surgical procedure, splenectomy with periesophago-gastric devascularization (Hassab's operation) seems to be very useful for portal hypertension by biliary cirrhosis. The reoperation, hepaticoenterostomy, was performed in 3 patients with biliary reobstruction. All three patients are alive and well, and two of them are at 19 years (university student) and 24 years (married life) of age. Hepatic Rehepaticoenterostomy is well indicated rather than liver transplantation, if biliary reobstruction is incurable with conservative therapy. Many of the patients with complications were able to carry on an almost normal life, if suitable treatments for complications were taken.

Adolescent↗
PubMed1986

Plasma exchange therapy for endotoxin shock in puppies.

The efficacy of plasma exchange (PE) therapy for endotoxin (ET) shock has not been evaluated. The following experimental study was designed to evaluate the feasibility of PE in infants and children and determine the efficacy as a therapeutic modality for ET shock. A compact circuit for PE designed for this experiment consists of two pumps and a membrane plasma separator for a venovenous extracorporeal circulation with the limited prime volume of 100 mL. The capacity of this device for PE was tested. When a membrane separator of 0.3 m2 in surface area was used, a plasma flux of 5 to 13 mL/min was satisfactorily obtained with the blood flow rate of 25 to 40 mL/min, which was taken through centrally placed catheters of 18 gauge or larger. Transmembrane pressure was maintained in a safe range (0 to 50 mm Hg) in the first 90 minutes, during which time a PE of 100 mL/kg was completed with a sieving coefficient greater than 0.8. In 14 puppies (1.8 to 3.5 kg), a shock state was produced by infusion of ET (Escherichia coli, 055:B5). Eight puppies were resuscitated simply with lactated Ringer's solution and bicarbonate. Six puppies were treated with PE using 100 mL/kg of fresh-frozen plasma prepared from adult dogs. A significant decrease in the mean blood pressure, platelet and leukocyte counts, total protein, and CH50 was documented in all animals after ET administration. Seven of eight control animals died within 24 hours of post-ET infusion. All of the six PE-treated animals survived for 48 hours or longer.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

Pathological evaluation of hepatic dearterialization in encapsulated hepatocellular carcinoma.

Specimens of encapsulated hepatocellular carcinoma from 48 patients who had received no previous treatment and from six patients previously treated by hepatic arterial interruption by embolization or ligation were obtained by resection and examined for incidence and extent of necrosis of the tumor. Among the 48 specimens from the non-pre-treated patients, 25 tumors were smaller than 5 cm and showed no notable necrosis; of the 23 remaining tumors--which were larger than 5 cm--12 (52%) showed spontaneous central necrosis. The necrosis rate of the tumor ranged from 10% to 40%. In contrast, in six specimens from pretreated cases, more than 60% of the tumors were found to be necrotic. Two tumors smaller than 5 cm were completely necrotized by embolization. The findings indicated the significance of hepatic dearterialization for the management of encapsulated hepatocellular carcinoma. Daughter nodules, however, were found to have escaped necrosis.

Adult↗
PubMed1985

Qualitative and quantitative analysis of muscarinic acetylcholine receptors in the piebald lethal mouse model of Hirschsprung's disease.

Cholinergic innervation in the aganglionic bowel of the piebald lethal mouse model of Hirschsprung's disease was investigated by analysis of muscarinic acetylcholine receptors before and after administration of hexamethonium. After hexamethonium administration in the normal rectum, the maximum specific binding (Bmax) of [3H]quinuclidinyl benzilate increased from 196.6 to 346.2 fmol/mg protein without affecting the dissociation constant. This increase of muscarinic acetylcholine receptors was associated with a decrease in the 50% effective dose (ED50) of contractile response to oxotremorine from 3.8 X 10(-7) M to 6.5 X 10(-8) M. In the aganglionic rectum, hexamethonium administration did not change the Bmax (166.4 fmol/mg protein) or dissociation constant value. The ED50 of contractile response to acetylcholine and oxotremorine (4.3 X 10(-8) M, 6.5 X 10(-8) M) was lower than that in the normal rectum (1.9 X 10(-7) M, 2.0 X 10(-7) M), but it was not changed by hexamethonium. It is concluded that cholinergic innervation is congenitally absent in the aganglionic rectum in piebald lethal mice.

Acetylcholine↗
PubMed1985

Consistency of human liver.

Liver consistency was measured biomechanically on the left lobe during laparotomy (n = 52) and on the resected specimen (n = 24) using a specially devised technique. Its relationship with histological findings and hepatic functions was also investigated. Instrumentation included a venipuncture needle with a closed tip and a round latex microballoon attached at a side hole. The needle was connected to a pressure transducer and infusion pump with a polyethylene tube. After the needle was introduced into the liver tissue, liver consistency was measured as delta P/delta V (cm H2O/ml) from the slope of pressure rise on a Pressure (P)-Volume (V) curve obtained at constant saline infusion. Liver consistency increased proportionally with the degree of hepatic fibrosis: 589 +/- 191 (cm H2O/ml) for nonfibrosis (n = 25), 869 +/- 139 for periportal fibrosis (n = 14), 1030 +/- 116 for incomplete cirrhosis (n = 15), and 1250 +/- 206 for fully developed cirrhosis (n = 22). Correspondingly, liver consistency correlated closely with morphometrically estimated hepatic fiber content (r = 0.82, P less than 0.01). With the exception of albumin, liver function tests including prothrombin time, gamma-globulin fraction, zinc turbidity, and indocyanine green retention rate showed significant correlations with liver consistency (0.41 less than magnitude of r less than 0.68, P less than 0.001). However, correlation was much less than that between liver consistency and hepatic fiber content. The present study demonstrates that liver consistency measured by this technique can be a predictive index of hepatic fiber gradings.

Adult↗
PubMed1985

[Treatment of patients with hepatoma and esophageal varices].

Fifty-nine patients with hepatoma associated with advanced esophageal varices who received a variety of therapeutic modalities in the past 10 years at our department were reviewed. Our therapeutic modalities are hepatic resection, hepatic artery ligation (HAL) and trans-arterial embolization (TAE) for those with hepatoma and non-shunting treatment (NST; esophageal transection or Hassab's procedure) and endoscopic sclerotherapy (ST) for those with esophageal varices. A patient selection was made by our own criterial developed by a multiple regression analysis for the hepatoma and KICG value for esophageal varices. Out of 59.16 underwent hepatic resection and NST. Eight survived more than 2 years. The longest survivor has been living for 4 yr and 4 months. Two-year survival rate is 69.8%. Another 16 underwent HAL and NST. Two-year survival was 14.6%. Another 7 underwent ST following hepatic resection or HAL. Five of the 7 received an emergency ST. Hemostasis was achieved in all of them. Two-year survival was 21.8%. The remaining 20 underwent ST and TAE; 13 received an emergency ST with 85% of hemostasis rate. None of them survived more than 2 years. From these data, it is suggested that a proper selection of patients for a proper therapeutic modality improves the prognosis even in those with hepatoma associated with advanced esophageal varices.

Carcinoma, Hepatocellular↗
PubMed1985

[Pathophysiology of defecatory disturbance in the patient with Hirschsprung's disease and chronically constipated patients with simple megarectum].

The disturbance of defecation in the patient with Hirschsprung's disease and the pathophysiology of constipation in the constipated patient with simple megarectum were investigated. In Hirschsprung's disease, an existence of aganglionosis and the sphincter achalasia are two main factors which cause clinical symptoms such as chronic constipation and megacolon. As a surgical treatment, we have routinely performed our modified Duhamel's operation. Postoperative followup study indicated that the most cases in our series have gained a satisfactory defecatory function 1 to 3 years after operation. In chronically constipated patient with simple megarectum, on the other hand, it was found manometrically that the most of them had significantly high anal canal pressure and incomplete anal relaxation after rectal stimulation. These findings indicate that those patients have hypertonic and achalasic sphincter. Therefore, the authors propose "high anal pressure syndrome (HAPS)" for such constipated patient with simple megarectum. As to the surgical treatment, 6 patients with simple megarectum had a complete posterior internal sphincterotomy and the postoperative results were excellent or good in our series.

Adolescent↗