Biomedical subjects

K Tokui

Publications and source records attributed to K Tokui.

22 records · Page 2Linked to original sources

PubMedDate not supplied

A case of complex hepatolithiasis successfully treated with a systematic approach.

A systematic approach is required to treat complex hepatolithiasis. A 45 year-old female patient with hepatolithiasis had bilateral intrahepatic stones, biliary strictures at the right hepatic duct and segment IV duct, cholangitic abscess, and shrinkage of the right hepatic lobe. Six sessions of lithotomy were carried out under the guidance of percutaneous transhepatic choledochoscopy using a dye-laser lithotriptor through the segment III duct. Although stones were eradicated from the common bile duct and segment III duct, stones remained in other segments where cholangioscopic access was not feasible. Biliary bilirubin concentration increased and the liver abscess was resolved. Thereafter, the patient underwent right hepatectomy and choledochojejunostomy. After surgery, percutaneous transhepatic cholangio-drainage and balloon dilatation of the segment IV duct was performed. The patient underwent 11 more sessions of cholangioscopic lithotomy through 2 transhepatic routes and the bilioenteric bypass. Thereafter, the patient became almost stone-free. After discharge, biliary tracts were irrigated with saline through a subcutaneously placed reservoir. The patient is alive and well and had been without stone recurrence for 3 years. This report shows the efficacy of the vigorous combination therapy, including repeated cholangioscopic lithotomy through multiple routes using laser lithotripsy, surgery, and long-term biliary irrigation.

Bile Duct Diseases↗

PubMedDate not supplied

A long-term survivor undergoing extensive microwave coagulation for unresectable hepatocellular carcinoma.

Surgery for advanced hepatocellular carcinomas (HCCs) has not been standardized. We report on a long-term tumor-free survivor who underwent extensive microwave coagulation therapy (MCT) for multiple bilobar HCCs. A 61 year-old woman was diagnosed to have bilobar HCCs, including a large tumor, 9 cm in diameter, and 4 small satellite nodules, associated with chronic hepatitis B. The patient had received repeated chemoembolizations using iodized oil, but the increased alpha-fetoprotein level did not fall to normal. The main tumor was unresectable because the tumor involved the caval vein and hepatic veins. The patient underwent extensive MCT with a total of 134 electrode insertions. The paracaval portion of the main tumor was meticulously coagulated under sonographic guidance to avoid vascular injury. The post-operative course was uneventful. Post-operative computed tomography (CT) showed complete necrosis of all tumors. The patient is alive without tumor recurrence for 4 years after MCT. This case proves that extensive MCT can provide a chance of cure in selected patients with multiple bilobar HCCs and centrally located HCCs near the caval vein.

Alanine Transaminase↗

PubMedDate not supplied

Intravenous nutrition with high-dose fat emulsion and amino acids without glucose provision after hepatic resection.

BACKGROUND/AIMS: Controversy remains regarding the optimal nutrition after hepatic resection. We studied the feasibility and efficacy of an intravenous nutrition with high-dose fat emulsion and amino acids without glucose provision by comparing a glucose-based intravenous nutrition. METHODOLOGY: Twenty-eight patients received either glucose-intravenous nutrition (glucose-IVN group: glucose, 4.2 g; amino acids, 0.8 g/Kg/day) or high-dose fat emulsion and amino acids without glucose provision (HFHA-IVN group: lipids, 2.2 g; amino acids, 1.6 g/Kg/day) for 7 days after hepatic resection (14 patients in each group). Postoperative changes in biochemical tests and plasma levels and arterial-venous concentration differences of amino acids and total ketone bodies across the leg were compared between the two. RESULTS: The 2 groups were comparable regarding perioperative patients' characteristics. None of the patients from either group developed any complications. Postoperative glucose levels showed normal in the HFHA-IVN group, but elevated in the glucose-IVN group. Seven of the glucose-IVN group patients required exogenous insulin administration. Lipid levels were decreased in the glucose-IVN group, but remained normal in the HFHA-IVN group. The HFHA-IVN group showed higher amino acid levels, higher amino acid release, and hyperketonemia and vigorous uptake of ketones by skeletal muscle. CONCLUSIONS: These results indicate that dextrose provision is not essential and the HFHA-IVN provides an alternative to glucose-based intravenous nutrition in patients developing glucose intolerance after hepatic resection.

Aged↗

PubMedDate not supplied

Hepatobiliary cystadenocarcinoma connected to the hepatic duct: a case report and review of the literature.

We present a rare case of hepatobiliary cystadenocarcinoma with biliary communication. A 74-year-old woman had a liver cyst that had enlarged from 5 cm to 8 cm in diameter over the last 2 years. A mural nodule, 1 cm in diameter, was first demonstrated by computed tomography in a multilocular cyst in segment IV. The nodule showed hypervascularity at angiography and computed tomography during arteriography. Percutaneous transhepatic cystography demonstrated a communication between the cyst and the biliary tract. The cyst was filled with mucinous and gelatinous fluid and was revealed to contain cancer cells. The patient underwent total tumor extirpation with the surrounding hepatic parenchyma. We confirmed and closed the biliary fistula connected to the right hepatic duct. Histologically, the cyst wall was composed of cystadenoma and the mural nodule showed in situ papillary adenocarcinoma. The patient is doing well 9 months after surgery. Complete tumor extirpation and closing of the biliary fistula is the treatment of choice.

Adenocarcinoma, Papillary↗