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Biomedical subjects

H Yukaya

Publications and source records attributed to H Yukaya.

At least 37 records · Page 2Linked to original sources
PubMed1989

Androgen receptor in hepatocellular carcinoma as a prognostic factor after hepatic resection.

Androgen receptors (AR) in the cytosol of hepatocellular carcinoma (HCC) were assayed in 45 unselected patients in whom radical hepatic resection was performed. Thirty-one patients had detectable amounts of ARs in tumors, ranging from 2.3 to 82.6 fmol/mg protein with the dissociation constants (Kd) of 4.1 - 30.9 x 10(-10) M. The receptor was not found in the remaining 14 cases. AR negative HCCs were significantly more common among women and nonalcoholic patients. Otherwise, there were no significant difference in the clinicopathologic background between patients with AR positive HCCs and those with AR negative tumors. Three patients died of liver failure in the former group, whereas two died in the latter; one patient died of liver failure and the other died of pneumonia (results were not statistically significant). Excluding those five operative deaths, the recurrence rates were 67.9% in the group of patients with AR positive HCCs and 33.3% in the group of patients with AR negative tumors (0.1 less than p less than 0.05). The 5-year survival rate was significantly better (p less than 0.05) in patients with AR negative HCCs (62.2%) than in those with the positive tumors (17.3%). In light of the current results and previous experimental works by others, it is likely that testosterones enhance the growth and invasiveness of human HCC, which is mediated by AR in the tumor.

Carcinoma, Hepatocellular↗
PubMed1989

Adverse effects of preoperative hepatic artery chemoembolization for resectable hepatocellular carcinoma: a retrospective comparison of 138 liver resections.

During the past 8 years we have treated 268 patients with primary hepatocellular carcinoma (HCC); total extirpation of the tumor was carried out in 138. Thirty-one of the patients with resectable HCCs had already been treated with transcatheter arterial embolization (TAE) of the liver before they were referred to us. The clinical values of preoperative TAE were retrospectively evaluated for those 31 patients and for the remaining 107 patients without TAE. There were no substantial differences between the two study groups in the clinical and histopathologic backgrounds. No differences were observed in the extent of liver resection, estimated blood loss during surgery, and operation time. During surgery, however, troublesome intra-abdominal complications relevant to TAE were encountered in 15 patients, and detection of tumors was impossible, even with intraoperative ultrasonography, in five patients in the group with TAE. Such findings were not present in any of the patients without TAE. Postoperative morbidity and mortality rates were similar in the two groups. There was no significant difference in the rate of recurrence of tumor in the liver, but the recurrence time was significantly shorter in the group with TAE. TAE did not improve the long-term survival rates in patients either with or without cirrhosis. Results of our study seem to indicate that preoperative TAE is meaningless in the treatment of resectable HCCs and therefore should be avoided, particularly in patients with advanced cirrhosis of the liver.

Carcinoma, Hepatocellular↗
PubMed1989

Recurrent form of hepatocellular carcinoma after partial hepatic resection.

An analysis of 27 recurrent cases after partial hepatic resection for hepatocellular carcinoma, closely followed-up with various diagnostic imagings, is reported. The patients comprised 22 males and 5 females. Their ages ranged from 34 to 76 years, with an average of 57.8 years. Twenty-five had underlying cirrhosis and 2 presented chronic hepatitis histologically. The 27 patients were classified into the following three types. Type I comprised 18 patients with local recurrence. Local recurrence means that the tumor recurred in an adjacent segment to that initially affected or in the same segment. Thirteen of these patients had a recurrence within a year-after the initial operation. Type II comprised 6 cases of multiple intrahepatic metastases, and Type III 3 cases which were thought to represent a metachronous occurrence. Five of the 6 cases of Type II had multiple intrahepatic metastases within 3 months after the initial operation. The results of the present series indicate that when patients with hepatocellular carcinoma are operated on, manipulation should be as careful as possible in order not to disperse the cancer cells, and close follow-up with imagings more than once every three months, especially in the first year after the initial operation should be ensured wherever possible.

Adult↗
PubMed1989

Better survival in women than in men after radical resection of hepatocellular carcinoma.

During the period between January 1980 and December 1987, 229 male and 39 female adult patients with primary hepatocellular carcinoma (HCC) were hospitalized in our unit. Radical hepatic resection was carried out in 90 (39.3%) males and 17 (43.6%) females in whom no specific cancer treatment had been attempted preoperatively. The 1-, 3-, and 5-year survival rates in the male and female patients were 78% and 70%, 45% and 52%, and 19% and 52%, respectively. The difference was significant after 47 months. No substantial differences were found between the two groups with respect to age, preoperative clinical condition and laboratory data, method of liver resection, postoperative morbidity and mortality, postoperative adjuvant chemotherapy, and histopathology of HCC and the liver. Only the incidence of alcohol abuse was significantly different, being higher in male than in female patients. However, the survival analysis demonstrated that alcohol abuse had had no influence on recurrence rate and long-term survival in either male or female patients. As a control, survival was analyzed for the patients with similar clinicopathological background but without HCC who had undergone distal splenorenal shunt for esophageal varices. There was no significant difference between the male and female patients. The current clinical results seems to support our hypothesis based upon sex hormone receptor studies that HCC may be androgen-dependent.

Carcinoma, Hepatocellular↗
PubMed1988

Elevation of alpha-fetoprotein level without evidence of recurrence after hepatectomy for hepatocellular carcinoma.

Seven Japanese patients showed a gradual rise in serum alpha-fetoprotein (AFP) levels for periods of 4 to 14 weeks after partial hepatectomy for hepatocellular carcinoma. These levels then gradually decreased, but not always to a normal level, and various procedures after surgery failed to detect tumor recurrence. All the cases were complicated with liver cirrhosis. It is suggested that the postoperative elevation in the AFP level may have been caused by hepatic regeneration as a result of the intervention chemotherapy and/or surgery, but it does not exclude the possibility of a tumor recurrence.

Aged↗
PubMed1988

Concurrent treatment of hepatocellular carcinoma and esophageal varices by hepatic resection and distal splenorenal shunt.

Ten patients with both hepatocellular carcinoma (HCC) and esophageal or esophagogastric varices were concurrently treated by partial hepatic resection and distal splenorenal shunt. All the patients were men aged from 45 to 71 years. Four patients had had recent episodes of variceal bleeding. Six patients were considered to be at high risk for bleeding, as their varices were large and had "red color signs" endoscopically. Liver cirrhosis was associated with all cases. The grade of hepatic dysfunction was Child A in seven and Child B in three patients. As the HCCs were relatively small, partial wedge hepatectomy was carried out in all patients. Five patients underwent the original Warren shunt, but the remaining five had modified shunts with expanded polytetrafluoroethylene (Gore-Tex) interposition. There was no operative mortality within one month. Nine patients with patent shunts had no variceal bleeding despite the fact that three of them had tumor recurrence in the liver. Hepatic encephalopathy occurred transiently in only one instance. Six patients were alive at the time this report was written, eight to 49 months after operation. Five were free of cancer and one had tumor recurrence. This result may indicate that relatively small HCCs and esophageal varices can be simultaneously treated by limited hepatic resection and distal splenorenal shunt in patients with Child A or B liver disease.

Aged↗
PubMed1988

Hepatocellular pseudotumour (regenerating nodule) in the cirrhotic liver mimicking hepatocellular carcinoma.

During a recent 6-year period we have encountered 10 patients with 'hepatocellular pseudotumour in the cirrhotic liver' (regenerating hyperplastic nodule). The patients were all male, aged 40-82 years. Seven were chronic alcohol consumers. None was positive for HBs-Ag but seven had either anti-HBs or anti-HBc. Serum AFP level ranged from 4 to 28 ng/ml in six patients who did not have hepatocellular carcinoma at the time of the diagnosis of the pseudotumour. The lesions were depicted by ultrasonography in seven, by computed tomography in two, and by angiography in one case. Liver scan was negative in all five cases investigated. The pre-operative diagnosis was definitely or highly suspicious of hepatocellular carcinoma in three, of pseudotumour in the cirrhotic liver in three, and of recurrent carcinoma in one. In another three patients, pseudotumour was coincidentally discovered in resected specimens with hepatocellular carcinoma. The histopathological and follow-up studies demonstrated synchronous or metachronous development of carcinoma in seven patients. Whether or not these lesions in the cirrhotic liver are premalignant remains to be elucidated.

Carcinoma, Hepatocellular↗
PubMed1988

Ultrasonographic features of hepatocellular pseudotumour in the cirrhotic liver.

Eight cases of hepatocellular pseudotumours (HPT) were encountered in 6 years during which time 140 hepatectomies were performed for hepatocellular carcinoma (HCC). All were found during screening of cirrhotic patients. The ultrasonographic pattern of HPT was similar to that of HCC and their correct diagnosis was impossible by ultrasonography alone. A space-occupying lesion in the cirrhotic liver which is detected by ultrasonography but not by computed tomography and angiography may be a hepatocellular pseudotumour. This diagnosis is particularly likely if the serum alpha-fetoprotein level is normal.

Adult↗
PubMed1988

Morbidity and mortality after major hepatic resection in cirrhotic patients with hepatocellular carcinoma.

Major hepatic resection was carried out on 23 adult patients with hepatocellular carcinoma (HCC) and underlying cirrhosis of the liver (macronodular in six cases, micronodular in 11 and mixed type cirrhosis in six). Pre-operative liver functional state was Child's class A in 19, class B in three, and class C in one. The operations performed were extended right lobectomy in four patients, right lobectomy in 10, left found in 10 patients, five of whom had duplicated complications and finally died of liver failure 15-65 days after operation. In three of those five patients, other complications (hemorrhagic shock in two and portal thrombosis in one) had preceded liver failure. Eighteen patients tolerated the resection and were discharged from hospital. However, among 13 noncirrhotic patients with HCC who had undergone major hepatic resection during the same period of time, only two had postoperative complications and all patients were discharged from hospital. The 1-, 2- and 3-year survival rates in the 23 cirrhotics were 60.9%, 37.5% and 24.9% respectively, whereas the 1-5-year survival rates were all 61.5% in the 13 noncirrhotics. Thus, major hepatic resection may be indicated in selected patients with HCC and associated cirrhosis, but meticulous managements during and after operation are mandatory to prevent fatal postoperative liver failure.

Adolescent↗
PubMed1988

Emergency distal splenorenal shunt for medically uncontrollable variceal haemorrhage.

Emergency distal splenorenal shunt was prospectively carried out on 14 patients presenting with active bleeding from esophagogastric varices which was not controllable by medical treatment. Patients were composed of nine males and five females. Age ranged from 34 to 76 years with an average of 56.2. Underlying liver disease were cirrhosis of the liver in seven, cirrhosis and hepatocellular carcinoma (HCC) in five, primary biliary cirrhosis in one, and chronic hepatitis in one instance. Preoperatively, the Child's classification was A in one, B in five, and C in eight patient. Two patients underwent the original Warren shunt but the remaining 12 were treated by modified distal splenorenal shunts using Gore-Tex interposition. Three patients with Child's class C disease died within one month (operative mortality 21.4%). An oldest woman transiently had hepatic encephalopathy but recurrent variceal bleeding was not observed in any of the patients. Distal splenorenal shunt is a safe and reliable means in the treatment of medically intractable variceal hemorrhage.

Adult↗
PubMed1988

Prophylactic distal splenorenal shunt for child's class A and B patients at high risk of bleeding.

During recent 17 years, prophylactic distal splenorenal shunt was carried out on 29 patients. Patients were composed of 18 males and 11 females. Age ranged from 34 to 66 years with an average of 52.4. All patients had risky esophagogastric varices; varices larger than 5 mm in diameter and or varices with red color signs such as cherry red spots endoscopically. Underlying liver disease were cirrhosis of the liver in 27, chronic hepatitis in one, and idiopathic portal hypertension in one. Twenty-three patients were in Child's class A and six were in class B. Thirteen patients underwent the original Warren shunt but the remaining 16 had modified distal splenorenal shunts with expanded polytetrafluoroethylene interposition. Portal-azygos disconnection was routinely performed. One patients (3.4%) died of hepatic failure on the 6th postoperative day. Four patients (14.3%) developed hepatic encephalopathy of mild to moderate degree but no patients have suffered from variceal bleeding until now. The 5-, 10-, and 15-year survival rates were all 85.5 per cent. It is concluded that distal splenorenal shunt is a safe and reliable method to prevent variceal bleeding in a selected group of patients.

Adult↗
PubMed1987

Evaluation of hepatic resection for hepatocellular carcinoma in the elderly.

The results of 139 hepatic resections in 154 patients with hepatocellular carcinoma (HCC) operated upon in the last 6 years are reported. These 139 Japanese patients were classified into three groups according to age. Group I included 58 patients under 55 years of age, group II 44 aged from 56 to 65 years and group III 37 aged over 66 years. Fewer cases in group III had histological evidence of cirrhosis than in the other two groups. There was a statistically significant marked decline in the preoperative cardiac and pulmonary function in group III patients. However, there was no statistical difference in postoperative complications, mortality and survival rate among the three groups. The results after hepatic resection seemed to depend on pre-operative liver function and histology, and on control of the haemorrhage at operation. The results indicate that liver surgery for elderly patients with hepatocellular carcinoma is justifiable given careful patient selection.

Aged↗
PubMed1987

Appraisal of hepatic resection in the treatment of minute hepatocellular carcinoma associated with liver cirrhosis.

During the last 6 years, 205 patients with primary hepatocellular carcinoma (HCC) were admitted to our surgical departments. Thirty-eight had HCC smaller than 3 cm in diameter. There were 34 men and 4 women with an average age of 56.5 years. All patients had underlying hepatic disease: liver cirrhosis in 35 patients and chronic active hepatitis with fibrosis in the remaining 3. Pre-operative complications included: oesophageal varices in ten, cholelithiasis in five, peptic ulcer in two, gastric cancer in one, and severe hypersplenism in one instance. A radical resection was performed in 32 cases and palliative resection in 6. Simultaneous operations were carried out for the above mentioned associated conditions: distal splenorenal shunt in six, Hassab's devascularization procedure in one, splenectomy in one, cholecystectomy in four, cholecystolithotomy in one, and partial gastrectomy in one. Four patients had postoperative complications: liver failure, rebleeding, right haemothorax, and upper gastrointestinal bleeding from acute mucosal lesion of the stomach. One patient with liver failure died in coma within 1 month. The operative and in-hospital mortality rates were 2.6 and 7.9 per cent, respectively. Survival rates during the first 4 years in 32 patients with radical hepatic resection were 89.9, 67.2, 58.8, and 58.8 per cent, respectively. We suggest that hepatic resection should be the first choice of treatment for minute HCC even in the presence of liver cirrhosis.

Adult↗
PubMed1987

Human liver regeneration after major hepatic resection. A study of normal liver and livers with chronic hepatitis and cirrhosis.

The regenerative process was evaluated in terms of liver size, function, and histology in 28 adults who had major hepatic resection: hepatocellular carcinoma (HCC) in 21, secondary liver cancer from colorectum in four, carcinoma of the gallbladder in one, Klatskin tumor in one, and Caroli's disease in one. There were 22 men and six women. Ages ranged from 17 to 74 years with a mean age of 56.7. All patients with HCC had underlying liver disease: liver cirrhosis in 14 and chronic hepatitis in seven. Extended right lobectomy was done on 10 patients, right lobectomy on 16 patients, and left lobectomy on two patients. The residual liver size was serially estimated with computed tomography (CT) in 15 patients: six with normal liver, five with chronic hepatitis, and four with cirrhosis. A complete restoration of the residual liver size was found within 3 months in 3 and 6 months, respectively, in two patients with normal livers. The liver was enlarged in all patients with the parenchymal diseases but obviously more slowly compared with normal liver. Liver functions were restored normally within 2-3 weeks in patients with normal livers, but hyperbilirubinemia persisted longer in those with chronic hepatitis and cirrhosis. A continuous rise of bilirubin was an ominous sign of liver failure and subsequent death, which occurred in five patients with cirrhosis. Serum alpha-fetoprotein did not rise in accordance with the regeneration. Histologically, evidence of active regeneration with increased mitotic activity was found at 10 and 35 days in those patients with normal livers. Mitosis was not seen in a specimen taken at 7 days. Enlarged cuboidal hepatocytes and cells with basophilic cytoplasm or two nuclei were observed more or less in all specimens. The livers with cirrhosis or hepatitis also showed histologic evidence of regeneration during the first 2 months but substantially less compared with normal liver, which was well supported by the volumetric study of the liver remnants with CT.

Adolescent↗
PubMed1987

Clinical comparison between original and modified distal splenorenal shunts.

This article reports on a retrospective clinical comparison between the original Warren shunt and one that we modified with Gore-Tex (expanded polytetrafluoroethylene) interposition. The former operation was performed on 35 patients between June 1969 and November 1983 and the latter on 29 patients between October 1983 and January 1986. There were no significant differences in the patients' backgrounds between the two study groups. Blood loss during surgery was significantly greater and operation time was longer in the original shunt group than in the modified shunt group. The incidence of postoperative morbidity and mortality was also significantly higher in the former group than in the latter (major complication rate: 20.0% versus 3.4%; operative death within 1 month: 5.7% versus 0%; in-hospital death: 11.4% versus 3.4%). The modified shunts had a 100% patency rate, and no variceal bleeding was evident, whereas shunt occlusion was observed in two patients and portal thrombosis in one patient of the original shunt group. The incidence of hepatic encephalopathy was 14.3% in the original shunt group and 6.9% in the modified shunt group, and the follow-up time was shorter in the latter group. A significantly greater rate of survival was achieved with the modified Warren shunts. Thus the current study seems to indicate that our modifications could be alternatives to the original distal splenorenal shunt in terms of postoperative morbidity, mortality, and survival.

Adult↗
PubMed1986

Active uptake of testosterone by androgen receptors of hepatocellular carcinoma in humans.

Hepatocellular carcinoma (HCC) is more prevalent in males than it is in females, which has often been explained by the fact that alcoholism and chronic hepatitis B virus infection are more prevalent among males. The current studies, using biochemical and autoradiographic methods, verified that HCC contains higher concentrations of androgen receptors than the surrounding liver parenchyma and that extrinsically given testosterone are actively taken up by such tumors. These results may suggest that HCC is an androgen-dependent tumor and that, therefore, this tumor is more prevalent in males than it is in females.

Autoradiography↗
PubMed1986

Serum ferritin level after resection of hepatocellular carcinoma. Correlation with alpha-fetoprotein level.

Total serum ferritin concentrations were serially estimated in 24 patients with primary hepatocellular carcinoma (HCC) for 4 to 8 weeks after resection of the tumor. The patients were divided into four groups according to the tumor size and the result of ferritin was compared with that of serum alpha-fetoprotein (AFP) levels. All patients had underlying parenchymal diseases of the liver (liver cirrhosis in 19 and chronic hepatitis in 5 cases). The serum ferritin levels did not reflect the therapeutic result of hepatic resection in most of the patients of all groups. Serum AFP levels, which were measured simultaneously with ferritin levels, were much superior to the ferritin estimation. The current study may indicate that ferritin cannot be used as a tumor marker in the follow-up of Japanese patients with HCC and associated liver disease. Acidic isoferritin, which is known to be produced in and secreted from HCC, should be measured for this purpose.

Adolescent↗