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Biomedical subjects

H Yukaya

Publications and source records attributed to H Yukaya.

At least 55 records · Page 3Linked to original sources
PubMed1986

Estrogen receptors in hepatocellular carcinoma.

Estrogen receptors (ER) were assayed on hepatocellular carcinoma (HCC) and surrounding liver tissue in 30 adult patients. All specimens were obtained at the time of surgery. Cirrhosis of the liver was associated with 28 patients and chronic hepatitis in 2 patients. ERs were detected in 12 of 30 HCCs. The value ranged from 1.4 to 9.2 fmol/mg cytosol protein with the dissociation constant (Kd) value less than 1 nanomol. On the other hand, 13 of 28 cirrhotic livers had measurable amounts of the receptors that ranged from 1.5 to 4.1 fmol/mg cytosol protein. Two livers with chronic hepatitis did not have detectable amounts of ERs. The receptors were not detected in both the tumor and liver in ten patients. The ER titers in HCC did not have any correlation with serum levels of alpha-fetoprotein or carcinoembryonic antigen, hepatitis B virus profiles, and histologic types of the tumor. In the light of the current results, it would be of great interest whether hormone therapy can be used or not as a treatment of naturally occurring HCC in humans.

Aged↗
PubMed1986

Second hepatic resection for recurrent hepatocellular carcinoma.

During the last 5 years, radical hepatic resection was performed in 91 patients with hepatocellular carcinoma (HCC). Thirty-one of them had tumour recurrence in the remaining liver during the follow-up period. Second hepatic resection was carried out on nine of them 4-38 months after the first hepatectomy. The ages of these patients ranged from 39 to 65 years with an average of 53.7. There were six men and three women. Eight patients had underlying cirrhosis of the liver and one chronic active hepatitis. Six patients are alive, four being free of HCC and two with disease, for 15-45 months after the first operation. Two patients died of systemic cancer dissemination. The remaining patient had tumour recurrence in the liver again and died of hepatic failure after the third laparotomy. The survival rate of these nine patients was significantly better than that of twenty-two patients who were treated by other palliative methods. The present result shows that a second hepatic resection is a possible and meaningful method of treatment for the patients with recurrent HCCs in the liver remnant.

Adult↗
PubMed1986

Clinical experience with 118 hepatic resections for hepatocellular carcinoma.

During the recent 5 2/3 years, hepatic resection was performed on 118 patients with hepatocellular carcinoma. Ages ranged from 17 to 78 years with an average of 57 years. There were 101 males and 17 females. Underlying cirrhosis of the liver was found in 101 cases, and chronic hepatitis was found in 16 cases. Before surgery 62 patients had 71 associated conditions such as esophageal varices, diabetes mellitus, cholelithiasis, or peptic ulcer. Operations for the varices and cholelithiasis were performed simultaneously with hepatic resection in 15 and six patients, respectively. The operative mortality rate within 1 month was 7.6%, and the overall in-hospital death rate was 14.4%. In 94 patients with curative resection, the 2-year survival rate was 81.2% in patients without cirrhosis and 55.4% in patients with cirrhosis. The 4-year survival rate was 81.2% in the former and 34.8% in the latter group. The prognosis was significantly better in patients without cirrhosis than in those with cirrhosis. On the contrary, 21 of 24 patients with palliative resection died within 2 years despite extensive chemotherapy. The present results may indicate that the resectability rate of hepatocellular carcinoma is currently increasing, even in the presence of cirrhosis of the liver due to early detection of the tumor by current advances in diagnostic methods and also that major hepatic resection is possible in selected patients with cirrhosis.

Adolescent↗
PubMed1986

[Intra-arterial administration of epirubicin in the treatment of non-resectable hepatocellular carcinoma. Epirubicin Study Group for Hepatocellular Carcinoma].

A group study was conducted to investigate the effect of intra-hepatic arterial administration of epirubicin in the treatment of non-resectable hepatocellular carcinoma(HCC). Sixty-four patients were entered into the study. There were 51 males and 13 females, with an age range from 32 to 79 years, the average being 59.1 years. Fifty-four patients had associated cirrhosis of the liver. Epirubicin at a dose of 60-90 mg/m2 was infused as a bolus into the hepatic artery 1 to 4 times (average 1.8) at an interval of 3 weeks to 3 months. Tumor size was properly evaluated in 53 patients. There were 1 CR, 7 PR, 7 MR, 27 NC, and 11 PD. Thus, the response rate (CR + PR) was 15.1%. Seventeen patients are still alive 305 to 720 days (mean 505 days) after the initial treatment. The most common side effects of this drug were bone marrow suppression, gastrointestinal complaints, and alopecia. Cardiac toxicity was negligible at the doses used in this study. A retrospective comparison of the present results with those for patients treated by intra-arterial administration of doxorubicin demonstrated that epirubicin is more effective than doxorubicin in terms of survival rate. The current study indicates that epirubicin may be a promising alternative in the treatment of HCC. The appropriate dosage of the drug and the interval for infusion are to be elucidated. Also, the combination of epirubicin with other cytostatic drugs is open for study.

Adult↗
PubMed1986

[Studies on long-term survival and prognostic factors after surgical treatment of breast cancer].

Two hundred twenty-nine patients with primary breast cancer seen from 1970 through 1983 were investigated in terms of the survival rate and factors relevant to the prognosis. The operative methods were as follows: so-called radical in 191, modified radical in 24, super radical in eight, and other limited operations in six. Fifty-four patients had Stage I, 128 had Stage II, 45 had Stage III, and four had Stage IV diseases. The curabilities of these operations were absolute curative in 190, relative curative in 26, and non-curative in 13 cases. The overall cumulative survival rate was 80.9% and 78.2% at five and 10 years, respectively.

Adult↗
PubMed1985

Bilateral gastric venous decompression by a modified Warren shunt.

A new modification of the Warren shunt by which the coronary and short gastric venous systems can be simultaneously decompressed was carried out on two patients with oesophagogastric varices due to liver cirrhosis. One was an elective and the other an emergency operation. The left gastric vein entering the splenic vein was also drained through a Gore-Tex graft between the splenic and left renal veins. The proximal end of the splenic vein was ligated at its junction to the superior mesenteric vein. Porta-azygos disconnection was achieved by ligating the right gastric and gastro-epiploic veins. The shunt was patent and its effect on the varices was immediate with good decompression in both patients. The patients have had no recurrent variceal haemorrhage or postshunt encephalopathy. This modification may be indicated for selected patients with portal hypertension for both elective and emergency operations.

Aged↗
PubMed1985

Hepatic resection in the treatment of hepatocellular carcinoma: report of 60 cases.

During the last 3 years and 9 months, hepatic resections were carried out on 60 patients with hepatocellular carcinoma (HCC). The resections were radical in 44 and palliative in 16 cases. Simultaneous operations were performed for oesophageal varices in 11 (9 prophylactic and 2 therapeutic) and for cholelithiasis in 9 patients. Fifty-nine patients had underlying hepatic disease; 52 had cirrhosis and 7 chronic hepatitis. Operative mortality rate within 1 month was 10 per cent and overall hospital mortality rate was 16.7 per cent. Excluding operative and hospital deaths, 76.8 per cent of patients who had radical excision and 18.8 per cent with palliative resections are alive. The result indicates that HCCs are frequently resectable even in the presence of liver cirrhosis provided that they are discovered at a relatively early stage.

Adolescent↗
PubMed1985

Segmental and subsegmental resections of the cirrhotic liver under hepatic inflow and outflow occlusion.

Segmental and subsegmental resections of the cirrhotic liver were carried out on 44 patients with hepatocellular carcinoma (HCC) and three cases with regenerating liver nodules. Seventeen patients underwent hepatectomies without hepatic vascular arrest (Group 1). In Group 2 (19 occasions), the Pringle manoeuvre was used for 8-46 min during parenchymal dissection. Hepatic resections were performed during simultaneous occlusion of hepatic inflow and outflow for 20-47 min in 11 patients (Group 3). The estimated blood loss during surgery was 2924 ml in Group 1, 1239 in Group 2, and 765 in Group 3 (Group 1 versus Group 2; P less than 0.02, Group 1 versus Group 3; P less than 0.02). Haemorrhagic shock occurred in three patients of Group 1, one of Group 2, and none of Group 3. Life-threatening postoperative complications occurred in four patients in Group 1, two in Group 2, and none in Group 3. Hospital death rate was 23.5 per cent in Group 1, 10.5 per cent in Group 2, and nil in Group 3. The present results may indicate that in performing nonanatomical resection of cirrhotic livers temporary occlusion of both hepatic inflow and outflow can be achieved for at least 30 min and is useful in reducing postoperative morbidity and mortality.

Adult↗
PubMed1985

Effect of cimetidine on portal pressure and systemic hemodynamics in patients with and without liver cirrhosis.

Portal pressure and systemic hemodynamics were evaluated for 30 minutes after intravenous injection of 400 mg of cimetidine in patients with and without liver cirrhosis when they were operated upon for varying surgical diseases. A transient fall of arterial pressure was seen in both groups of patients, but the change was statistically significant only in those with cirrhosis. Cimetidine did not substantially alter pulse rate, CVP, and portal pressure in both groups. The present results seem to indicate that rapid administration of cimetidine does not induce a fall of portal venous pressure in both cirrhotic and non-cirrhotic patients.

Adult↗
PubMed1985

Serum levels of estrogens and testosterone in cirrhotic men with and without hepatocellular carcinoma.

Serum levels of estrogens and testosterone were measured in 25 male patients with hepatocellular carcinoma and associated cirrhosis of the liver and in another 25 male patients with cirrhosis only. The two groups were statistically comparable in terms of age distribution, duration of liver disease, incidence of alcohol abuse, incidence of hepatitis B surface antigenemia, and grade of hepatic dysfunction. Estrone was significantly elevated in both groups of patients. Estradiol concentrations were above normal in 10 patients with hepatocellular carcinoma and in 11 with cirrhosis only. All patients had normal concentrations of estriol. There were no statistical differences between the two groups in either individual or total estrogen levels (estrone 0.05 less than p less than 0.1). Eight of the patients with hepatocellular carcinoma and 5 of the cirrhotics had lower testosterone levels than normal, but this difference was not significant. However, the estrone to testosterone ratios were significantly higher in the hepatocellular carcinoma group than in the cirrhosis group (p less than 0.05). The present study seems to indicate that hyperestrogenemia commonly seen in male patients with liver cirrhosis may play some role in hepatic carcinogenesis of cirrhotic livers. Further studies are needed to determine if the estrone to testosterone ratio is implicated in hepatocarcinogenesis in cirrhotic men.

Adult↗
PubMed1985

Androgen receptors in hepatocellular carcinoma and surrounding parenchyma.

The androgen receptor content of normal human liver, hepatocellular carcinoma, and surrounding liver tissue was determined in patients with chronic liver disease. Androgen receptor was detected in all six normal livers obtained from 4 men and 2 women. The androgen receptor content in these 6 individuals ranged from 5.0 to 10.2 fmol/mg protein (Kd 10.6-31.8 X 10(-10) M). The livers from 2 patients with chronic active hepatitis and from 10 cirrhotic patients with hepatocellular carcinoma had detectable amounts of androgen receptor ranging from 2.0 to 14.8 fmol/mg protein (Kd 4.0-30.9 X 10(-10) M). Androgen receptor was found in the cytosol of 14 of 19 men with hepatocellular carcinoma. The titer ranged from 3.7 to 45.4 fmol/mg protein (Kd 3.2-21.4 X 10(-10) M). Hepatocellular carcinoma had a significantly higher concentration of androgen receptor than did the surrounding cirrhotic liver tissue. In 2 men and 1 woman, androgen receptor was detected in the cirrhotic liver but not in the tumor. In the remaining 3 men, both tumor and cirrhotic liver were negative for androgen receptor.

Adult↗
PubMed1985

Comparative study of selective shunts v.s. nonshunt procedures in the treatment of esophageal varices.

Results of selective shunts and nonshunt procedures in elective treatment of esophagogastric varices were retrospectively evaluated. There were 40 patients undergoing selective shunts; 31 distal splenorenal shunts and 9 left gastric vena caval shunts. Thirty-three patients underwent nonshunt procedures; 9 esophageal transections, 11 transections or resections of the cardia, and 13 Hassab procedures. Operative mortality rate (0.05 less than P less than 0.1) and incidence of recurrent variceal bleeding (0.1 less than P less than 0.2) tended to be higher in the nonshunt group than in the selective shunt group. Postoperative hepatic encephalopathy was seen in three patients of the selective and in one instance of the nonshunt groups. The late survival and rehabilitation status of the patients were similar in both groups. The present results, although not prospectively randomized, seem to indicate that selective shunts are preferred to nonshunt procedures in the elective treatment of esophagogastric varices.

Adolescent↗
PubMed1985

Intraoperative direct portography to achieve selective distal splenorenal shunt.

Repeated direct portography was performed during distal splenorenal shunt in 13 consecutive patients with esophageal varices due to cirrhosis of the liver. The roentgenogram taken at the completion of all operative procedures demonstrated incomplete disconnection between the mesentericoportal and gastrosplenic compartments in four patients. After further disconnection of the veins, the third portogram showed a successful isolation of both systems. The flow state through and the size of the shunt were appropriate in all instances on the roentgenograms. The shunt was patent in all patients, which was confirmed before discharge from the hospital. Hepatic encephalopathy was encountered one year after operation in one patient with the poorest hepatic functions. Esophageal varices disappeared or nearly disappeared at the time of discharge in ten patients. The remaining varices at discharge in another three patients completely disappeared within six months after operation. None of the patients experienced variceal bleeding during the follow-up period of three to 25 months. The results may indicate that repeated intraoperative direct portography is useful in achieving a selective distal splenorenal shunt.

Adult↗
PubMed1985

Modified distal splenorenal shunt with expanded polytetrafluoroethylene interposition.

Two types of modified distal splenorenal shunt with expanded polytetrafluoroethylene (Gore-Tex; WL Gore & Associates Inc., Elkton, Md.) interposition were performed in 18 consecutive patients with esophageal or esophagogastric varices. There were 12 men and six women ranging in age from 32 to 76 years. The causes of portal hypertension were cirrhosis of the liver in 15 patients, chronic hepatitis in two, and idiopathic portal hypertension in one. In five patients the left gastric vein branched off from the splenic vein; bilateral gastric venous decompression was achieved by preserving the splenic vein. Porta-azygos disconnection was routinely performed by confirming repeated intraoperative direct splenoportography. The operations were elective in seven and were emergencies in five patients. Six patients underwent a prophylactic shunt; all patients had "red color signs" endoscopically, and three of them had concomitant hepatocellular carcinoma. Postoperative morbidity was minimal and there was no mortality. Shunt patency was confirmed angiographically in all patients 14 to 56 days after surgery. The varices disappeared or significantly improved in all patients. No patients had variceal bleeding postoperatively. Hepatic encephalopathy was transiently seen in one (the oldest) patient.

Adult↗
PubMed1984

Hepatocellular pseudotumor in the cirrhotic liver. Report of three cases.

Three cases of regenerating hyperplastic nodule in the cirrhotic liver are reported in detail. The patients were all men, ranging in age from 41 to 57 years. They were all heavy drinkers and had chronic liver disease for 6 to 10 years. All patients had slightly elevated alpha-fetoprotein levels and were positive for HBs and HBc antibodies. Radiologic findings were not uniform except for ultrasonography, which demonstrated the lesion in all cases. Preoperative diagnosis was hepatocellular carcinoma (HCC) or highly suspicious of HCC in all of them. At laparotomy, all lesions were embedded in the liver parenchyma and invisible from the hepatic surface. With the aid of intraoperative sonography, partial hepatic resections were performed. Pseudocapsule was seen in two cases. Definitive differential diagnosis of regenerating nodules from HCC in the cirrhotic liver was extremely difficult. The authors propose the name "hepatocellular pseudotumor in the cirrhotic liver" to describe such lesions.

Adult↗
PubMed1984

The natural history of hepatocellular carcinoma. A study of 100 untreated cases.

The natural course of hepatocellular carcinoma (HCC) was evaluated in 100 untreated patients who were seen during recent 13 years. There were 80 males and 20 females. The macroscopic type of tumor was massive in 58, nodular in 35, and diffuse in 7 cases. Liver cirrhosis was associated with in 80% of patients. The mean survival time of overall patients was 4 months from the onset of initial symptoms to death and 2 months from admission to death. Occult and cirrhotic types of HCC showed a longer survival than frank and febrile types that had a mean survival time of all patients. The prognosis of icteric and metastatic types was poorest. Sex, tumor type, or associated cirrhosis did not substantially affect the natural course of HCC. The tumor stage and clinical stage were grossly correlated to the prognosis. In terms of symptoms, severe jaundice and ascites were the most dismal prognostic signs.

Adult↗
PubMed1984

Tolerance of the cirrhotic liver to normothermic ischemia. A clinical study of 15 patients.

Temporary occlusion of hepatic inflow, namely, the Pringle maneuver, was adopted for 15 patients with liver cirrhosis who underwent partial hepatectomy. The warm ischemia time ranged from 2 to 32 minutes with an average of 19 minutes. The procedure did not cause any harmful effects on systemic hemodynamic and postoperative liver function. The results in our patients were compared with those of 15 comparable control patients who had been operated on over the same period of time without inflow obstruction. The Pringle maneuver significantly diminished the estimated blood loss during surgery, intraoperative and postoperative complications, and suppressed the operative mortality rate from 20 percent to 0.

Adult↗