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Biomedical subjects

E Adachi

Publications and source records attributed to E Adachi.

At least 73 records · Page 4Linked to original sources
PubMed1995

A comparison of the surgical results in patients with hepatitis B versus hepatitis C-related hepatocellular carcinoma.

To assess the differences in the surgical results between patients with hepatitis B- and hepatitis C-related hepatocellular carcinoma (HCC), the operative outcomes of 30 patients with hepatitis B surface antigen (HBsAg)-positive (the B-HCC group) and 96 patients with hepatitis C antibody (HCVAb)-positive (the C-HCC group), who had undergone hepatic resection from 1989 to 1993, were compared. The mean age of the patients in the C-HCC group was higher than that in the B-HCC group (61.7 years vs. 57.0 years, P < .05). The C-HCC group demonstrated both a greater decrease in liver function and a larger enhancement of inflammatory changes in the liver under a pathological examination (the current rate of active hepatitis: 69% vs. 27%, P < .001). There was also a higher incidence of total postoperative complications in the C-HCC group (60% vs. 37%, P < .05); however, regarding each individual complication, the rate was similar between the two groups. Two of the six patients with postoperative hepatic failure in the C-HCC group died. The mortality rate in the C-HCC group was 2%, but no operative death was encountered in the B-HCC group. The crude survival and the disease-free survival rates at 5 years were similar, 61.8% and 46.2% in the B-HCC group and 52.8% and 23.2% in the C-HCC group, respectively. The patterns of recurrence were also similar in both groups. The pathological features of HCC were similar between the two groups. In conclusion, the surgical results between the two groups were almost identical.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

MR imaging of hepatocellular carcinoma. Correlation of metal content and signal intensity.

In order to clarify the factors contributing to the signal intensities (SIs) of HCC on T1-weighted images, the amount of water, lipid, copper (Cu), iron (Fe), and manganese (Mn) was determined in HCC and surrounding hepatic parenchyma of 13 patients. The relationships among these findings, the histopathologic findings, and the SIs of T1-weighted images were evaluated. Among the 13 HCC, 3 had a high SI, 5 were isointense, and 5 had a low SI on T1-weighted images compared to the surrounding hepatic parenchyma. The paramagnetic ions which contributed to the SI patterns were assumed to be Cu in HCC (38.0 +/- 62.4 micrograms/g ww), and Fe in the liver (61.1 +/- 42.4 micrograms/g ww) and HCC (40.0 +/- 34.3 micrograms/g ww). In 8 HCC with high- or isointensity, 2 were grades I, 5 were grade II, and one was grade III according to the Edmondson-Steiner's histopathologic classification. It is concluded that the SI patterns alone can not be a sign of low grade malignancy because of the existence of Fe in livers and HCC.

Aged↗
PubMed1995

Significance of intraoperative measurement of liver consistency prior to hepatic resection.

The functional reserve of the liver should be estimated prior to hepatectomy. While the experienced liver surgeon often relies on the findings of manual palpation intra-operatively, this approach remains a subjective one. In 22 of our patients scheduled for hepatectomy, we measured intra-operatively hepatic consistency as well as the parameters of liver function. Hepatic consistency is augmented during progression from non-fibrosis to cirrhosis. We found a statistically significant correlation between liver consistency and the indocyanine green retention rate at 15 minutes (r = 0.682; p = 0.0009) and portal vein pressure (r = 0.733; p = 0.0008). Prothrombin time, the hepaplastin test, total bilirubin and glutamic pyruvic transaminase showed no significant correlation with hepatic consistency. The safety limits of the hepatic blood circulation for the performance of hepatectomy can be estimated using parameters of consistency in this organ.

Carcinoma, Hepatocellular↗
PubMed1995

[Pharmacological study of 5'-DFUR oral administration and the clinical responses against gastrointestinal carcinoma].

In 4 out of 5 patients given 400 mg orally 5'-DFUR before surgery, intratumor 5-FU concentration showed over 150 ng/g. The concentration of either 5-FU or 5'-DFUR in the portal and peripheral blood of these patients exceeded the limits of assay. 5-FU concentration in peripheral blood was less than 0.05 micrograms/ml. White blood cell and platelet counts in the patients given 1,600 mg/day (no administration for 2 days/week) of 5'-DFUR for one month were essentially the same with those at the time of start of the treatment. Two of three patients showed minor response following the treatment with 5'-DFUR. Thus, administration of 1,600 mg/day of 5'-DFUR may be considered as an effective treatment of fluopyrimidine against advanced cancer. For the prediction of gastrointestinal side effect, assay of the 5-FU concentration in the portal blood seemed to be useful.

Administration, Oral↗
PubMed1994

Cloning and expression of myelin-associated oligodendrocytic basic protein. A novel basic protein constituting the central nervous system myelin.

We have screened genes predominantly expressed in the rat spinal cord, and we report here cloning of the most abundant unknown gene. It is a novel member of the central nervous system (CNS) myelin-constituting proteins, myelin-associated oligodendrocytic basic protein (MOBP). MOBP is abundantly expressed specifically in oligodendrocytes at the mRNA level only next to myelin basic protein (MBP) and proteolipid protein. Two isoforms have been confirmed. One of them has proline-rich tandem repeats and has 84% homology with human counterpart in terms of predicted amino acid sequences. The cDNA-derived primary structure predicts a small, soluble, basic protein. The immunoelectron microscopy has shown that MOBP is expressed throughout compact myelin. All these characteristics are similar to MBP. One definite difference between MBP and MOBP is that MOBP is expressed exclusively in the CNS myelin. These findings suggest that MOBP shares some important functions with MBP in the CNS myelin such as myelin compaction.

Amino Acid Sequence↗
PubMed1994

Self-assembly of collagen I from a proband homozygous for a mutation that substituted serine for glycine at position 661 in the alpha 2(I) chain. Possible relationship between the effects of mutations on critical concentration and the severity of the phenotype.

Procollagen I was isolated from cultured skin fibroblasts from a proband who was homozygous for a mutation in the COL1A2 gene that substituted a serine codon for a glycine codon at position 661 of the alpha 2(I) chain. The procollagen I was cleaved to pCcollagen I by procollagen N-proteinase and the pCcollagen I was used as a substrate for assay of self-assembly of collagen I into fibrils. The mutated pCcollagen I was cleaved to collagen I by procollagen C-proteinase at the same rate as control pCcollagen I. However, self-assembly of the mutated collagen I had a lag period that was 15-fold greater than the lag period observed with normal collagen I under the same conditions. Also, self-assembly of the mutated collagen I had a propagation rate of about one-fourth of the propagation rate of normal collagen I. In addition, the critical concentration for fibril assembly was slightly increased. Rotary shadowing electron microscopy of the mutated procollagen I did not reveal any increased flexibility of the triple helix as was seen previously with two mutated procollagens I in which there were substitutions of cysteine for glycine residues in the alpha 1(I) chain (Vogel, B. E., Doelz, R., Kadler, K. E., Hojima, Y., Engel, J., and Prockop, D. J. (1988) J. Biol. Chem. 263, 19249-19255; Lightfoot, S. J., Holmes, D. F., Brass, A., Grant, M. E., Byers, P. H., and Kadler, K. E. (1992) J. Biol. Chem. 267, 25521-25528). However, morphometric analysis by dark-field light microscopy and electron microscopy showed that the fibrils formed from the mutated collagen I appeared thicker in diameter than the fibrils formed from the normal collagen I. Comparison of the results with similar data on four mutated procollagens previously studied raised the possibility that mutations which markedly increase the critical concentration of fibril assembly produce more severe phenotypes than mutations which change other parameters of fibril assembly.

Amino Acid Sequence↗
PubMed1994

Liver resection for hepatocellular carcinoma in the elderly.

OBJECTIVE: To estimate the effectiveness of hepatic resection on hepatocellular carcinoma (HCC) in the elderly. DESIGN: Comparison with younger patients. SETTING: A municipal hospital and a large university hospital in Japan. PATIENTS: The study included 39 patients (age > or = 70 years [the elderly group]) and 229 patients (age < 70 years [the younger group]) who underwent hepatic resection from April 1985 to March 1993. The preoperative clinical features (Child's classification, association of cirrhosis and liver functions) were comparable between two groups. The positive rate for hepatitis C virus antibody was higher in the elderly group (88% vs 59%; P = .016). MAIN OUTCOME MEASURES: Morbidity and survival following operation and the pathological features of HCC. RESULTS: The incidence of postoperative hepatic failure was higher in the elderly group (10% vs 2%; P = .018). However, the incidence of operative death in the elderly group (5% vs 1%) as well as the incidence of other postoperative complications and rates of long-term survival (75.9% vs 51.6% at 5 years) and disease-free survival (30.4% vs 31.0% at 5 years) were similar to those in the younger group. The pathological features of HCC were identical between the two groups. CONCLUSION: The outcome of surgical treatment of HCC in the elderly group was satisfactory when compared with that in the younger group.

Age Factors↗
PubMed1994

Influence of viral hepatitis status on operative morbidity and mortality in patients with primary hepatocellular carcinoma.

The influence of associated viral hepatitis status on 119 patients with primary hepatocellular carcinoma (HCC) undergoing hepatic resection was investigated. Operative morbidity and mortality were examined in three patient groups: 31 patients (group B) positive for hepatitis B surface antigen (HBsAg), 14 (group Be) positive for both HBsAg and hepatitis B e antigen, and 74 (group C) positive for hepatitis C virus antibody (HCVAb). Preoperative liver function in groups Be and C was similar and more impaired than that of patients in group B; combined active hepatitis was seen most frequently in group C (68 per cent). The tumour size in group B was significantly greater than that in groups Be and C. Postoperative complications occurred more frequently in group C (39 per cent) and early postoperative deaths, other than those from cancer, were seen in nine patients positive for HCVAb, of whom three developed postoperative liver failure. Patients with HCC and hepatitis B without seroconversion as well as hepatitis C frequently have active hepatitis, which may impair liver function and play an important role in operative morbidity and mortality.

Carcinoma, Hepatocellular↗
PubMed1994

Laparoscopy preferable to imaging procedures in detecting metastases of a pancreas carcinoma to the liver. Report of two cases.

In two patients a pancreatic mass, 6 and 4 cm in diameter, respectively, was detected using imaging techniques. Computed tomography, ultrasound, and angiography revealed no evidence of a metastatic lesion in the liver. In the first patient, exploration was done prior to a possible radical operation. Multiple hepatic metastases forming thin, flat lesions on the surface of the liver were present and palliative surgery only was done. In the other patient, laparoscopy was done before surgical exploration and multiple hepatic metastases on the surface of the liver were clearly evident. Laparoscopy can help to avoid unnecessary explorations in patients with large pancreas cancer.

Angiography↗
PubMed1994

Anchoring of epithelia to underlying connective tissue: evidence of frayed ends of collagen fibrils directly merging with meshwork of lamina densa.

We examined the epithelial-subepithelial junction of mouse pancreas, human placenta and monkey oral mucosa. In mouse pancreas, in quick-freeze, deep-etch, rotary-replicated micrographs, collagen fibrils ran close to the lamina densa and frayed out into two or three subfibrils merging with lamina densa meshwork. In placental villi, some collagen fibrils ran toward trophoblasts and probably merging with lamina densa. In oral mucosa, some collagen fibrils curved to epithelial cells, passed through the anchoring fibril network and apparently merged with the basal surface of lamina densa. Together with the morphology of reconstituted collagen fibrils from type V collagen and hybrid fibrils from type V and type I collagen and the results presented here, we propose that a direct connection of collagen fibrils with lamina densa could be a ubiquitous anchoring system to stabilize epithelial tissues.

Animals↗
PubMed1994

Clinical correlation between necrosis of hepatocellular carcinoma nodule and early recurrence after hepatic resection.

Here we report on the case of a 51-year-old man who presented with a high-grade fever six weeks prior to hepatic resection. The resected specimen of the liver showed a well encapsulated and completely necrotic mass and some intrahepatic metastatic disease. Widespread multinodular recurrence in the liver remnant and metastatic foci in the bones were detected approximately one year after surgery. This case suggests that transcatheter arterial embolization--which aims to bring about necrosis of the tumor--followed by hepatic resection might increase the risk of early recurrence of hepatocellular carcinoma, due to the fact that tumor necrosis can facilitate the release of cancer cells from the primary tumor.

Bone Neoplasms↗
PubMed1994

Influence of hepatectomy on cell infiltration in the resected liver parenchyma compared with the biopsy specimen--a preliminary study.

We undertook a preliminary investigation to determine whether or not preoperative hepatitis activity can be evaluated by the finding of cell infiltration into the parenchyma of the resected specimen. In 28 patients who underwent hepatic resection, liver biopsies were obtained just after the laparotomy in order to make a histological comparison with the resected liver specimen. Histological changes were observed in 11 out of 28 patients. However, these were limited to minimal changes of neutrophil infiltration in the portal and subserosal area with no derangement of chronic cell infiltration. In addition, the preoperative liver function and operative findings did not differ between patients with and those without histological changes. The activity of hepatitis was therefore seen not to be histologically influenced by the surgical procedure. Thus, an accurate evaluation of chronic inflammatory cell infiltration activity in the resected liver specimen is a reliable indicator in chronic liver disease patients.

Adult↗
PubMed1994

Indications for major hepatectomy in cirrhotic liver.

In an investigation of the indications for major hepatic resection of the cirrhotic liver, the records of 152 consecutive patients who had undergone a right hepatic resection between April 1985 and January 1991 were reviewed. A comparison of right hepatic lobectomy and right partial hepatectomy of the liver with no cirrhotic changes, revealed that postoperative values of serum glutamic pyruvic transaminase were significantly higher after right partial hepatectomy than after right lobectomy, despite the fact that there were no significant differences with respect to preoperative laboratory data, and there was a greater blood loss and total weight of the resected liver in patients receiving a right lobectomy as compared with those undergoing partial hepatectomy. These results suggest that in order to enable a more favorable recovery from hepatic resection, it is essential to avoid both mechanical damage and ischemic injury to the residual liver during hepatic surgery. A total of 77 patients underwent a partial hepatectomy of a cirrhotic liver, and among these patients, 16 patients had values of the indocyanine green test of less than 20%, as well as a portal pressure of less than 200 mm saline. Compared with these 16 cirrhotic patients and those patients who underwent right lobectomy, there were no significant differences with regard to the pre-operative laboratory data and portal pressure. These results therefore suggest that major hepatic lobectomy could be performed on selected patients with cirrhotic livers.

Adult↗
PubMed1994

Estimation of degree of liver cirrhosis using a fibrosis score; a multivariate analysis of clinical parameters and resected specimens.

We designed this study to estimate the degree of liver cirrhosis using clinical parameters and surgically resected specimens. One hundred and twenty-nine cases who underwent hepatic resection in the Department of Surgery II, Kyushu University Hospital during the period between April 1985 and July 1991 for whom data for all 29 variables evaluated were available, were admitted to this study. On the basis of the histological findings of fibrosis of the liver, the non-neoplastic part of the resected specimens were classified into 3 groups; Z0, no cirrhosis (n = 63), Z1, mild cirrhosis (n = 38), and Z2, severe cirrhosis (n = 28). A univariate analysis revealed 14 significant variables. After multiple logistic regression analysis of these, five independent variables (low platelet count, female, low value of hepaplastin test, a high Pugh's score and a high value of ICG) were identified. We obtained a fibrosis score using the coefficient of each above-mentioned variable. This score increased the discriminative power. The fibrosis score is therefore considered useful for estimating the severity of liver cirrhosis.

Adult↗
PubMed1994

Possible multicentric occurrence of hepatocellular carcinoma: a clinicopathological study.

To assess the features of multicentric occurrence in hepatocellular carcinoma, we analyzed 10 of 72 patients (14%) who had undergone hepatic resection for hepatocellular carcinoma from May 1989 to October 1992 both clinically and pathologically. The multicentric occurrence of hepatocellular carcinoma was defined among the simultaneously detected small tumors as (a) at least one tumor consisting of extremely well-differentiated (grade I) hepatocellular carcinoma growing in a replacing pattern or (b) one of a group of hepatocellular carcinomas growing in an area of adenomatous hyperplasia. Of the 10 patients, the tumors in 9 were diagnosed as synchronous multicentric hepatocellular carcinomas, whereas the tumor in 1 was considered metachronous. All patients had cirrhosis; one of them had hepatitis B virus infection and nine patients had HCV infection. The inflammatory findings in the parenchyma were determined on the basis of serum enzyme values (AST, 89 +/- 27 IU/L; ALT, 96 +/- 43 IU/L). One or two tumors in 9 of 10 patients had thin trabecular or trabecular patterns showing replacing growth. In addition, one of the two tumors in two of nine patients was observed growing in areas of adenomatous hyperplasia. Recurrences were found in 4 of 10 patients. The 3-yr disease-free survival rate was 23%. Multiple recurrences were recognized in the two patients, and in the patients who underwent repeat surgery, grade I tumors were also found. Even though these tumors were small and well-differentiated, the recurrence rate was high. Therefore to detect the recurrence of metachronous multicentric hepatocellular carcinoma at an earlier stage, careful follow-up after surgery should be carried out.

Carcinoma, Hepatocellular↗
PubMed1994

Xanthogranulomatous cholecystitis masquerading as gallbladder carcinoma.

We herein present a case of xanthogranulomatous cholecystitis which involved both the liver and transverse colon, clinically mimicking gallbladder carcinoma. Such cases may sometimes be judged inoperable due to extensive extra-gallbladder invasion, and thus it is necessary for physicians to take this lesion into consideration when making a diagnosis. An intraoperative biopsy is necessary, therefore, even when the features seem to clearly indicate inoperable carcinoma.

Aged↗
PubMed1993

Effects of preoperative transcatheter hepatic arterial chemoembolization for hepatocellular carcinoma. The relationship between postoperative course and tumor necrosis.

BACKGROUND: The effects of preoperative transcatheter arterial chemoembolization (TAE) for hepatocellular carcinoma (HCC) remain a matter of controversy. METHODS: Seventy-two patients with HCC were entered in the study; the patients did not have the risk factors for disease recurrence of tumor larger than 5 cm in diameter, the presence of venous invasion, or intrahepatic metastasis. Only patients with 3 years of follow-up after curative resection were selected. Forty-six underwent TAE (Group I) and 26 did not undergo TAE (Group II). Group I was divided into three subgroups according to the degree of tumor necrosis: IA, complete necrosis; IB, partial necrosis; and IC, no necrosis. Group II was divided into two subgroups: IIB, partial necrosis; and IIC, no necrosis. RESULTS: Preoperative TAE did not improve the average disease-free survival rates of the group as a whole. For patients undergoing TAE, the survival rate of Group IB was significantly worse than that of Groups IA or IC. The survival rate of Group IB was worse than that of Group II, but the difference was not significant. In Group II, the survival of Group IIB was worse than that of Group IIC. Histologically, residual tumor cells lacking mutual contact were detected in some patients in Group IB. CONCLUSION: These results indicate that partial tumor necrosis caused by preoperative TAE or spontaneous tumor necrosis per se might facilitate postoperative disease recurrence. This may occur because in patients with partial necrosis, the remaining tumor cells are less firmly attached and more likely to be dislodged into the bloodstream during hepatic resection.

Adult↗