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Biomedical subjects

J Furuse

Publications and source records attributed to J Furuse.

At least 19 recordsLinked to original sources
PubMed2001

Visualization of blood flow in hepatic vessels and hepatocellular carcinoma using B-flow sonography.

PURPOSE: A B-flow sonographic technique was recently developed to provide direct visualization of blood flow with gray-scale sonography. Compared with color Doppler sonography, B-flow imaging has wideband resolution and a high frame rate. The purpose of this study was to evaluate the usefulness of B-flow sonography for visualizing blood flow in hepatic vessels and tumor vascularity in patients with liver cirrhosis or hepatocellular carcinoma (HCC). METHODS: Twenty-five patients with liver cirrhosis, including 15 with HCC, were studied by B-flow and color Doppler sonography. Blood-flow detection rates in portal veins and hepatic arteries and tumor vascularity in HCC were analyzed, and the 2 methods were compared. RESULTS: Using B-flow, blood flow was visualized in the portal vein in 23 (92%) of 25 patients and was visualized in the hepatic artery separately from the portal vein in 9 (36%) of 25 patients. The blood-flow signals were visualized only within vessels, never "bleeding" outside the vessel's lumen. Blood flow in the portal vein was observed with color Doppler sonography in all 25 patients, but the hepatic artery was never clearly separated from the portal vein. Vascularity within the HCC tumor was detected in 9 (60%) of 15 nodules with B-flow imaging, and fine arteries flowing into the tumor were observed in 6 nodules. Color Doppler sonography detected blood flow in 13 (87%) of the 15 HCC nodules. CONCLUSIONS: Blood flow in hepatic vessels and tumor vessels of HCC were visualized with B-flow sonography. B-flow sonography is a potentially useful technique for the evaluation of liver vascularity and intratumoral vessels.

Aged↗
PubMed2001

Combination radiotherapy for hepatocellular carcinoma with intraductal tumor thrombus: a case report.

We report the successful treatment of hepatocellular carcinoma (HCC) associated with an intraductal tumor thrombus in a 67-year-old male. Abdominal ultrasonography (US) and computed tomography (CT) revealed intrahepatic biliary dilatation in the left hepatic lobe and an intraductal tumor thrombus. The main tumor lesion was not clearly visualized on abdominal US, dynamic CT, and hepatic angiography. We biopsied the intraductal tumor thrombus under US guidance. Histologically the biopsy specimen was a poorly differentiated HCC We thus diagnosed HCC with intraductal tumor thrombus. The total serum bilirubin level gradually rose to 3.1 mg/dl. This tumor was inoperable because of severe hepatic dysfunction. We chose to treat the patient with radiotherapy aimed only at the intraductal tumor thrombus because the main tumor was unclear. A percutaneous transhepatic biliary drainage (PTBD) tube was inserted into the common bile duct beyond the tumor thrombus and the tube was dilated. Once total serum bilirubin had reached the normal range, a combination of external beam radiation therapy (EBRT) plus an intraluminal brachytherapy, 192Ir boost was administered. The intraductal tumor thrombus was found to have vanished and the PTBD tube was removed. After this treatment, transcatheter hepatic arterial embolization was performed at the point of tumor appearance. This patient had a relatively long survival, approximately 30 months, with no clinical evidence of recurrent disease and biliary drainage was not necessary.

Aged↗
PubMed2001

Duodenal tuberculosis with a choledocho-duodenal fistula.

A 22-year-old man visited our hospital (National Cancer Center Hospital East) complaining of fatigue and anorexia. A laboratory investigation demonstrated a biochemical 'picture' of obstructive jaundice. An abdominal CT showed a low density mass in the retropancreatic area with multiple enlarged periportal lymph nodes. Upper gastrointestinal endoscopy revealed active ulceration on the dorsal wall of the descending part of the duodenum, and histopathology of the biopsy specimen revealed an ulcer with reactive inflammatory cell infiltration; no tumor cells were detected. The possibility of neoplasm had been ruled out by the use of CT and angiography. The jaundice recovered spontaneously and the abdominal mass gradually decreased in size. Endoscopic retrograde pancreatography showed no evidence of pancreatic disease; however, endoscopic retrograde cholangiography showed a choledocho-duodenal fistula. This patient showed hypersensitivity against the tuberculin skin test and Mycobacterium tuberculosis was successfully detected in gastric juice by using a polymerase chain reaction method and culture. Biopsy samples obtained from the duodenal ulcer at the second upper gastrointestinal endoscopy showed chronic inflammation with an epithelioid granuloma, suggesting tuberculosis. We thus diagnosed this case as a duodenal tuberculosis with a choledocho-duodenal fistula. To the best of our knowledge, there has been no report available of duodenal tuberculosis being the cause of a choledocho-duodenal fistula.

Adult↗
PubMed2001

Phase I trial of gemcitabine in patients with advanced pancreatic cancer.

BACKGROUND: Gemcitabine is the most promising new agent currently being tested in pancreatic cancer. The present study was conducted to confirm the tolerability of a weekly schedule of gemcitabine at a dose of 1000 mg/m2 in Japanese patients with advanced pancreatic cancer. METHODS: The primary end-point was to evaluate the frequency of dose-limiting toxicity. Gemcitabine 1000 mg/m2 was administered over 30 min weekly in two schedules: gemcitabine x3 every 4 weeks (Schedule 1) and gemcitabine x7 followed by a week of rest and then gemcitabine x3 every 4 weeks thereafter (Schedule 2). At least three patients entered each schedule and three additional patients were treated in the presence of dose-limiting toxicity. RESULTS: Eleven chemo-naive patients with a good Karnofsky performance status of > or =80 points and distant metastasis were entered into this trial. In Schedule 1, no dose-limiting toxicity was observed in the three patients. In Schedule 2, the evaluation of dose-limiting toxicity was complete in six of the eight enrolled patients and two patients showed dose-limiting toxicity in this Schedule; one patient experienced both grade 4 leukocytopenia and grade 4 neutropenia, and both grade 4 neutropenia and grade 3 GOT/GPT increased in another patient. Two patients (18%) showed a partial response and a clinical benefit response was also achieved in two (29%) of the seven evaluable patients. CONCLUSION: Gemcitabine 1000 mg/m2 weekly x7 followed by a week of rest and weekly x3 every 4 weeks thereafter may be tolerated in Japanese patients with advanced pancreatic cancer.

Adult↗
PubMed2000

Assessment of arterial tumor vascularity in small hepatocellular carcinoma. Comparison between color doppler ultrasonography and radiographic imagings with contrast medium: dynamic CT, angiography, and CT hepatic arteriography.

Hepatocellular carcinoma (HCC) is characterized by tumor vascularization from the hepatic artery. The objective of our work was to compare color Doppler ultrasonography (CDU), including power Doppler ultrasonography (PDU) with radiographic imagings with contrast medium in regard to the detection of the arterial tumor vascularity of small hepatocellular carcinomas (HCC). We examined 42 small HCC lesions 2 cm or less in diameter in 37 patients for arterial tumor vascularity by conventional CDU, PDU, dynamic computed tomography (dCT), digital subtraction angiography (DSA), and CT hepatic arteriography (CTA). Color images were detected in 25 (59.5%) and 28 (66.7%) of the 42 lesions with conventional CDU and PDU, respectively, and tumor vascularity was detected in 26 (61.9%) by dCT, 23 (54.8%) by DSA, and 29 (69.0%) by CTA. Tumor vascularity could be detected in 51.9% by PDU and CTA, more than by conventional CDU, dCT, and DSA (44.4, 44.4, and 33.3%, respectively) in well-differentiated HCC, whereas the detection rates by these techniques were almost equal (86.7% by CDU, 93.3% by PDU, dCT, and DSA, 100% by CTA, respectively) in moderately and poorly differentiated HCC. PDU is superior to CDU, dCT and DSA and equal to CTA for the detection of tumor vascularity in small HCC, particularly in well-differentiated HCC.

Aged↗
PubMed1999

Clinical significance of magnetic resonance cholangiopancreatography for the diagnosis of cystic tumor of the pancreas compared with endoscopic retrograde cholangiopancreatography and computed tomography.

BACKGROUND: Cystic tumor of the pancreas has been investigated by a variety of imaging techniques. Magnetic resonance cholangiopancreatography (MRCP) is being widely used as a non-invasive diagnostic modality for investigation of the biliary tree and pancreatic duct system. The purpose of this study was to compare MRCP images with those of endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT) in order to clarify the diagnostic efficacy of MRCP for cystic tumor of the pancreas. METHODS: We retrospectively studied 15 patients with cystic tumor of the pancreas that had been surgically resected and histopathologically confirmed. There were five cases of intraductal papillary adenocarcinoma, five of intraductal papillary adenoma, two of serous cyst adenoma, two of retention cyst associated with invasive ductal adenocarcinoma and one of solid cystic tumor. RESULTS: In all cases MRCP correctly identified the main pancreatic duct (MPD) and showed the entire cystic tumor and the communication between the tumor and the MPD. On the other hand, the detection rate by ERCP of the cystic tumor and the communication between the cystic tumor and the MPD was only 60%. Although the detection rates by CT for the septum and solid components inside the cystic tumor were 100 and 90.0%, respectively, those of MRCP for each were 58.3 and 20.0%. CONCLUSION: MRCP is capable of providing diagnostic information superior to ERCP for the diagnosis of cystic tumor of the pancreas. Although MRCP may provide complementary information about the whole lesion of interest, the characteristic internal features of cystic tumor of the pancrease should be carefully diagnosed in combination with CT.

Adenocarcinoma↗
PubMed1999

Computed tomography under endoscopic retrograde pancreatography (ERP-CT) to investigate the drainage area of the pancreatic head.

The aim of this study was to evaluate the drainage area of the pancreatic head with computed tomography under endoscopic retrograde pancreatography (ERP-CT). ERP-CT was performed in 26 patients without lesions of the pancreatic head. By comparing ERP-CT images with ERP images, we evaluated the drainage area of the inferior branch of the pancreatic head. In 77% of these cases, the drainage function of Santorini's duct system (including the accessory papilla) was impaired. In 13 cases with the normal duct pattern, all inferior branches from Santorini's duct drained the anterior inferior area and all inferior branches from Wirsung's duct drained the posterior inferior area. In six cases with an ansa-type duct pattern, all inferior branches from Wirsung's duct drained the posterior inferior area, and inferior branches from Santorini's duct were divided into branches draining the anterior inferior area and branches draining the posterior inferior area. ERP-CT is a useful method for evaluating the three-dimensional anatomic variations of the pancreatic duct.

Aged↗
PubMed1997

Comparison of clinical features and survival in patients with hepatitis B and C virus-related hepatocellular carcinoma.

We analyzed the clinical characteristics and survival of 185 patients with hepatitis B virus-related hepatocellular carcinoma (HBV group) and 1033 with hepatitis C virus-related hepatocellular carcinoma (HCV group) by multi center study. The patients in the HBV group (mean age 52.1 yr) were about 10 years younger than those in the HCV group (mean age 62.9 yr). Liver function, as measured by indocyanine green retention at 15 min, was better in the HBV group (17.5%) than in the HCV group (25.4%). A higher proportion of the HBV group (55%) than the HCV group (44%) had clinical stage I, T-factor differed significantly between the groups: 53% of the HBV group were T3-4 compared with 41% of the HCV group. Furthermore, a higher proportion of the HBV group were graded 2-3 for tumor thrombus in the portal vein (20.3%) and had poorly differentiated hepatocellular carcinoma (7%) compared with the HCV group (7.1% and 5% respectively). Univariate analysis identified poor prognostic factors for hepatocellular carcinoma as HBV, age < or = 50 yr, clinical stage II-III, a high AFP level, higher number of tumors, larger tumor size, tumor thrombus in the portal vein 2-3 and in the hepatic vein 2-3. On multivariate analysis, poor prognostic factors were a high AFP level, higher number of tumors, tumor thrombus in the portal vein 2-3 and in the hepatic vein 2-3, but not HBV, age, clinical stage or tumor size. These results suggest that HBV itself is not a stronger prognostic factor than HCV.

Aged↗
PubMed1997

Therapeutic results of resection, transcatheter arterial embolization and percutaneous transhepatic ethanol injection in 3225 patients with hepatocellular carcinoma: a retrospective multicenter study.

The outcome in 3225 patients with hepatocellular carcinoma (HCC) was studied in groups with equivalent prognosis treated with resection, transcatheter arterial embolization (TAE), and percutaneous transhepatic ethanol injection (PEI). Significant factors for better clinical background included a tumor diameter of < or = 30 mm, tumor number < or = 3 and (clinical) Stage I. In patients with Stage I disease having tumors of < or = 30 mm and < or = 3 in number, survival afer resection and PEI did not differ, while survival after TAE was significantly worse. In those patients with Stage II disease, survival after PEI was significantly better than after resection or TAE. In patients with Stage I or II disease having tumors > or = 31 in size and < or = 3 number, survival after resection was significantly better than after TAE. In patients with Stage I disease having tumors of > or = 31 mm and > or = 4 in number, survival after resection was significantly better than after TAE. Our conclusions are as follows. Firstly, resection or PEI is recommended for patients with Stage I disease having < or = 3 tumors all < or = 30 mm in size. Secondly, PEI is recommended for patients with Stage II disease having < or = 3 tumors all < or = 30 mm in size. Thirdly, for patients with Stage I disease having tumors 31 mm or larger in size, whatever the number of tumors, resection should be selected rather than TAE.

Adolescent↗
PubMed1997

Spontaneous regression of hepatocellular carcinoma: a case report.

We report a hepatocellular carcinoma that appeared to undergo spontaneous regression twice. On June 5, 1995, two hepatocellular carcinomas were detected by ultrasonography in a 72-year-old woman. On July 1, 1995, the tumor in the lateral segment had increased in size from 2.0 cm to 3.2 cm in 27 days, and the level of alpha-fetoprotein (AFP) had increased from 743 to 1300 ng/ml. On September 22, 1995, one tumor appeared as a typical hypervascular lesion on contrast-enhanced computed tomography. It was 3.9 cm in size and located in the posterior segment. The other was a 3.9-cm cystic mass located in the lateral segment. The tumor in the posterior segment was treated with an emulsion of epirubicin and lipiodol administered via the posterior branch of the right hepatic artery and percutaneous ethanol injection. The tumor in the lateral segment was kept under observation because it was avascular, had regressed to 2.0 cm in size, and the patient's AFP level had decreased to 237 ng/ml by December 5, 1995. By February 21, 1996, the AFP level had increased again to 105,340 ng/ml, and by March 22, 1996, the latter tumor had increased in size to 3.8 cm. However, it later regressed again to 1.6 cm, and the AFP level decreased spontaneously to 7 ng/ml. From the changes in the contrast-enhanced computed tomographic images, and the level of AFP, we cannot rule out the possibility that the spontaneous regression might have been caused by the tumor's rapid growth.

Aged↗
PubMed1997

Hepatocellular carcinoma with portal vein tumor thrombus: embolization of arterioportal shunts.

PURPOSE: To evaluate transcatheter arterial embolization in patients with hepatocellular carcinoma, portal vein tumor thrombus, and arterioportal shunts. MATERIALS AND METHODS: Ten patients with hepatocellular carcinoma, portal vein tumor thrombus, and severe arterioportal shunting were identified; in these patients, portal blood flow before embolization was hepatofugal. Embolization of arterioportal shunts was performed with steel coils that were introduced through a catheter during arteriography. After embolization, changes in portal hemodynamics and clinical signs and performance status of patients were evaluated; survival rates of patients with and patients without severe arterioportal shunting were compared. RESULTS: In all patients after embolization, angiography showed resolution of arterioportal shunting, and portography showed hepatopetal blood flow in the portal vein trunk. After embolization, performance status of five patients with initial scores of 2 or 3 improved. Ascites resolved in four patients and improved in four patients. One patient died of hepatic failure caused by rupture of esophageal varices 7 days after embolization. Median survival was 4.3 months, and the 6-month and 1-year survival rates were 45% and 12%, respectively. There were no significant differences between survival rates in patients with and patients without severe arterioportal shunting. CONCLUSION: Transcatheter arterial embolization of arterioportal shunts is a useful treatment for improving quality of life in patients with hepatocellular carcinoma.

Adult↗
PubMed1996

Evaluation of blood flow signal in small hepatic nodules by color Doppler ultrasonography.

Small hepatic nodular lesions are frequently detected by ultrasonography in patients with liver cirrhosis during follow-up. However, hepatocellular carcinomas (HCCs) and non-HCC nodules are difficult to differentiate by ultrasonography because they have a similar appearance. We used color Doppler ultrasonography (CDU) to examine 29 HCCs and 26 non-HCC nodules less than 2 cm in diameter to determine whether CDU can be used to differentiate small hepatic nodules. There were no significant differences between the examined HCCs and non-HCC nodules with regard to ultrasonographic appearance, i.e., hypoechoicity or hyperechoicity. Blood flow signals were detected in a significantly higher percentage of HCCs (13 of 29, 44.8%) than in non-HCC nodules (2 of 26, 7.7%; P<0.005), although the sensitivity was low. Therefore, we classified nodules as hypoechoic or hyperechoic by B-mode ultrasonography and examined their blood flow signals. Among nodules that were hypoechoic, signals were detected in a significantly higher percentage of HCCs (12 of 18, 66.7%) than in non-HCC nodules (2 of 13, 15.4%; P<0.005). In contrast, among hyperechoic nodules, signals were detected in only 1 of 11 (9.1%) HCCs and in 0 of 13 non-HCC nodules. Our results suggest that examination of blood flow by CDU is useful for differentiating small hepatic nodules, especially hypoechoic nodules.

Blood Flow Velocity↗
PubMed1996

Percutaneous transhepatic biliary drainage for the treatment of obstructive jaundice caused by metastases from nonbiliary and nonpancreatic cancers.

The usefulness of percutaneous transhepatic biliary drainage (PTBD) in the treatment of obstructive jaundice caused by metastases from nonbiliary and nonpancreatic cancers was evaluated. Eighteen patients underwent PTBD during a 3-year period. The primary cancers were located in the stomach (nine cases), colon (four), lung (three), uterus (one), and breast (one). The causes of obstructive jaundice and bile duct strictures were investigated using both abdominal computed tomography and abdominal ultrasonography. The causes of obstructive jaundice, the usefulness of PTBD in terms of the relief of symptoms and laboratory data, survival after PTBD, and the relationship between patient characteristics and survival were evaluated. Obstructive jaundice was most often attributable to metastases to the lymph nodes (17 of 18 cases). One case was attributed to metastasis to the liver. PTBD decreased the jaundice and relieved the symptoms caused by biliary tract obstruction. Median survival after PTBD was 59 days. Patients whose performance status was 2 or less survived longer than those with a performance status of 3 or more (P=0.018). Furthermore, patients aged less than 60 years tended to survive longer than those aged 60 or over (P=0.057). Our results suggest that PTBD is useful for relief of symptoms caused by obstructive jaundice in patients with nonbiliary and nonpancreatic cancers.

Adult↗
PubMed1995

Segmental resection of the duodenum for treating leiomyosarcoma associated with von Recklinghausen's disease: a case report.

We report a case of leiomyosarcoma originating from the second portion of the duodenum and associated with von Recklinghausen's disease. A 62-year-old man was admitted to our hospital complaining of abdominal pain and melena. A 5 cm tumor in the descending part of the duodenum was detected by hypotonic duodenography, CT, ultrasonography and endoscopy. Angiography revealed the tumor to be supplied by the mesenteric artery of the transverse colon. A segmental resection of the distal part of the duodenum was performed, preserving the head of the pancreas. Histologically, the tumor was a leiomyosarcoma, and the surgical margin was free of tumor cells. This surgery is safer than pancreatoduodenectomy, and is appropriate for treating non-epithelial tumors in the distal part of the duodenum in the absence of invasion of the head of the pancreas and regional lymph node metastasis. When carrying out the procedure, it is essential to ligate the branch of the pancreaticoduodenal vessels as close as possible to the duodenal side in order to preserve the blood supply to the pancreatic head.

Duodenal Neoplasms↗
PubMed1993

Hemodynamics of the left gastric vein in portal hypertension.

BACKGROUND: Esophageal varices reflect the hemodynamics of the left gastric vein, which can now be studied by Doppler ultrasonography. The purpose of this study was to elucidate the hemodynamic features of the left gastric vein in portal hypertension. METHODS: Flow direction and velocity in the left gastric vein were examined by the pulsed Doppler flowmeter in 53 healthy adults and 216 patients with liver cirrhosis. RESULTS: Flow direction was hepatopetal in all healthy controls, whereas it was hepatofugal in 72% of the patients with esophageal varices. In the early stage of mild esophageal varices, flow direction was still hepatopetal. However, in portal pressure > 250 mm H2O, hepatofugal flow was highly frequent (56 of 59 patients, 95%). Hepatofugal flow velocity in patients with varices was 8.5 +/- 2.5 cm/s in mild varices, 11.6 +/- 2.4 cm/s in intermediate varices, and 13.8 +/- 3.4 cm/s in marked varices. Variceal bleeding was frequent in patients with a flow velocity > 15 cm/s (7 of 14 patients, 50%). Flow velocity in the left gastric vein increased after ingestion of glucose in 43 of 56 patients with esophageal varices. CONCLUSIONS: In portal hypertension, as the size of varices enlarged, hepatofugal blood flow in the left gastric vein increased in parallel. High flow velocity in the left gastric vein was strongly associated with variceal bleeding. Increase of blood flow after ingestion of glucose suggests postprandial increase in variceal flow.

Administration, Oral↗