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K Yanaga

Publications and source records attributed to K Yanaga.

At least 19 recordsLinked to original sources
PubMed1998

A thoracoabdominal hepatectomy and a transdiaphragmatic hepatectomy for patients with cirrhosis and hepatocellular carcinoma.

OBJECTIVE: To evaluate the results of a thoracoabdominal hepatectomy and a transdiaphragmatic hepatectomy for hepatocellular carcinoma in patients with impaired liver function. DESIGN: Retrospective study. SETTING: A university hospital in Japan. PATIENTS: Twenty-seven patients who from 1991 to 1996 underwent a thoracoabdominal hepatectomy for hepatocellular carcinoma located mainly in the superior portion of the liver and 20 patients who underwent a transdiaphragmatic hepatectomy for hepatocellular carcinoma located near the diaphragm. MAIN OUTCOME MEASURES: Morbidity, survival, and disease-free survival after each operation. Comparisons were then made with 183 patients who had undergone an ordinary transabdominal hepatectomy during the same period. RESULTS: In the thoracoabdominal hepatectomy group, 17 patients underwent a partial resection, 4 patients underwent a subsegmentectomy, and another 6 patients underwent either a segmentectomy or a procedure that was greater in size than a segmentectomy, whereas all of the patients in the transdiaphragmatic group underwent a partial resection. The morbidities in the thoracoabdominal group included pleural effusion in 6 patients (22%); intra-abdominal infection in 5 patients (19%); and hepatic failure in 3 patients (11%), of whom 1 died (mortality rate, 4%). In the transdiaphragmatic group, only 2 patients (10%) had non-life-threatening complications. The cumulative survival rates and the disease-free survival rates of the patients at 3 years were 51% and 24% in the thoracoabdominal hepatectomy group and 62% and 30% in the transdiaphragmatic hepatectomy group; no significant differences were observed when these findings were compared with those of patients who had undergone a transabdominal hepatectomy. CONCLUSION: The outcomes of the patients undergoing thoracoabdominal hepatectomy and those undergoing a transdiaphragmatic hepatectomy were generally satisfactory in spite of the fact that these procedures were performed on patients with cirrhosis and impaired liver function.

Aged↗
PubMed1998

Prognosis of hepatocellular carcinoma with diabetes mellitus after hepatic resection.

We evaluated the effect of diabetes mellitus on the prognosis of hepatocellular carcinoma after an elective hepatic resection. Of the 342 patients who underwent a hepatic resection between April 1985 and March 1995, 87 (25.4%) were diabetic. Postoperative morbidity was more common among diabetics than among nondiabetics (36.0% vs. 22.5%, P = .0239). The postoperative survival rate and the cancer-free survival rate were also better in patients without diabetes than in those with diabetes (P = .0333, P = .0149). The results of a multivariate analysis show diabetes mellitus to be an independent and prognostic indicator after a hepatic resection with hepatocellular carcinoma. According to the above findings, diabetes mellitus is thus considered to be a risk factor for prognosis after hepatic resection in patients with hepatocellular carcinoma.

Adult↗
PubMed1998

Risk factors linked to postoperative morbidity in patients with hepatocellular carcinoma.

BACKGROUND: The aim of this study was to clarify the risk factors for morbidity as well as to establish an optimum surgical strategy for hepatocellular carcinoma (HCC). METHODS: The risk factors linked to postoperative complications were analysed in 388 patients over a 10-year period, according to the kind of operative procedure. RESULTS: Stepwise regression analysis revealed that the most important factors related to postoperative morbidity were: age, creatinine level and the histological grade of fibrosis for the bisegmentectomy; the presence of diabetes mellitus, blood urea nitrogen level, the indocyanine green dye retention rate at 15 min and blood loss for the segmentectomy; the presence of diabetes mellitus and blood loss for subsegmentectomy; the presence of diabetes mellitus, the aspartate aminotransferase level, and the total operating time for resection less than subsegmentectomy. CONCLUSION: The most important risk factors were not always related to liver function tests, but instead to other coexisting conditions such as diabetes mellitus and operation stress including operating time and blood loss. Therefore, any future treatment strategy of hepatic resection for HCC should make every effort both to evaluate coexisting conditions carefully and to reduce operative stress as far as possible.

Age Factors↗
PubMed1998

Prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma.

OBJECTIVE: The aims of this study were to identify prognostic factors in patients who developed recurrent hepatocellular carcinoma (HCC) after repeat hepatectomy and to elucidate the role of multicentric occurrence in the second tumor after a first hepatectomy. SUMMARY BACKGROUND DATA: A repeat hepatectomy for recurrent HCC has been established as the most effective treatment modality, whenever it is possible. However, the prognostic factors for recurrent HCC after repeat hepatectomy have yet to be clarified. METHODS: Forty-one patients who underwent a curative repeat hepatectomy were retrospectively studied. Patient survival and disease-free survival after recurrence were univariately and multivariately analyzed using 38 clinicopathologic variables. The histologic grade of HCC at repeat hepatectomy was also compared with that at first hepatectomy. RESULTS: Patient survival after repeat hepatectomy did not differ substantially from that in 312 patients undergoing primary hepatectomy. However, the disease-free survival after repeat hepatectomy was significantly lower than that in patients with only a primary hepatectomy (p < 0.05). Multivariate analysis revealed only portal vein invasion in the first hepatectomy to be an independent and significantly poor prognostic factor. Regarding multicentric occurrence at repeat hepatectomy, only 6 of 40 patients (15%) whose specimens could be evaluated histologically were determined to be Edmondson and Steiner's Grade 1. CONCLUSIONS: The only prognostic factor identified in patients with recurrent HCC after repeat hepatectomy was portal vein invasion in the first hepatectomy. Most second tumors after the first hepatectomy are considered to be caused by metastatic recurrence, not by multicentric occurrence.

Algorithms↗
PubMed1998

Effect of thromboxane synthetase inhibitor on non-heart-beating donors in rat orthotopic liver transplantation.

BACKGROUND: The use of non-heart-beating donors could relieve donor organ shortage provided that the outcome of the recipients is not jeopardized. METHODS: In this study we evaluated the effect of thromboxane synthetase inhibitor (OKY-046) on non-heart-beating donors in orthotopic liver transplantation in rodents. OKY-046 (OKY group, n = 8) or vehicle (control group, n = 8) was given to the donor animals for 60 minutes before the induction of 30 minutes of warm ischemia to the liver before transplantation and survival, and several parameters were compared between the two groups. RESULTS: All recipients in the control group died within 2 days, whereas 67% of those of the OKY group had a 2-day survival and 44% had a 2-week survival (p < 0.01). Bile output from the allograft for 2 hours after reperfusion was significantly larger in the OKY group at all time points (p < 0.05). Furthermore, serum transaminase levels 10 minutes after reperfusion were significantly lower in the OKY group (p < 0.05), although those 120 minutes after reperfusion were comparable between the two groups. The thromboxane B2 level in liver tissue 10 and 120 minutes after reperfusion was significantly lower in the OKY group compared with the control group (p < 0.02 and p < 0.05, respectively). CONCLUSIONS: These results indicate that OKY-046 given to the donor before the induction of warm ischemia could ameliorate ischemia/reperfusion injury of the hepatic allograft by reducing thromboxane A2 production after reperfusion.

Alanine Transaminase↗
PubMed1997

Indications for palliative reduction surgery in advanced hepatocellular carcinoma. The use of a remnant tumor index.

OBJECTIVES: To clarify the indications for and the significance of palliative reduction surgery in the multidisciplinary treatment of advanced hepatocellular carcinoma (HCC) and to propose the use of a remnant tumor index (RTI) as a simplified criterion for palliative reduction surgery in cases of advanced HCC. DESIGN: A comparison of survival based on the RTI. SETTING: A large university hospital in Japan. PATIENTS: Twenty-five patients with advanced HCC who underwent palliative reduction surgery were divided into 3 groups as follows: group 1 (n = 9), the remnant tumor after operation existed only in the liver and the RTI was less than 5.0; group 2 (n = 11), the remnant tumor after operation existed only in the liver and the RTI was greater than 5.0; and group 3 (n = 5), extrahepatic metastatic tumor existed after operation. MAIN OUTCOME MEASURES: Pathological findings and survival rate after surgery. RESULTS: There was no significant difference in the degree of macroscopic intrahepatic metastases among the 3 groups; however, both the portal vein invasion and the histological grade tended to be more severe in groups 2 and 3. The respective 1-year and 3-year survival rates for group 1 were 67% and 33%, and those for group 2 were 21% and 0%. There were no survivors in group 3 at 1 year after surgery. Significant differences were found in the survival rates between groups 1 and 2 (P < .05), and between groups 1 and 3 (P < .05). CONCLUSION: Palliative reduction surgery for advanced HCC is only considered effective for patients with both an RTI of less than 5.0 and no extrahepatic metastasis.

Aged↗
PubMed1997

Reduction of rewarming injury of the hepatic graft by a heat insulator.

BACKGROUND: The deleterious effect of rewarming in orthotopic liver transplantation is recognized. This study examined the significance of rewarming the hepatic allograft, and the possibility of using a heat insulator to reduce rewarming injury. METHODS: After total hepatectomy in rats with in situ perfusion by chilled (4 degrees C) lactated Ringer's solution, the livers were divided into four groups of ten each: group 1, 4-h preservation in chilled Ringer's solution and 15 min of rewarming; group 2, 6-h preservation in chilled Ringer's solution; group 3, 6-h preservation in chilled Ringer's solution and 15 min of rewarming; group 4, 6-h preservation in chilled Ringer's solution and 15 min of rewarming with a heat insulator. Glutamic-pyruvic transaminase (GPT) and N-acetyl-beta-glucosaminidase (NAG) concentrations in the final graft effluent, and the amount of adenosine 5'-triphosphate (ATP) in liver tissue after preservation, were measured. RESULTS: GPT and NAG concentrations in the final graft effluent of group 3 were higher than those of group 2 (P < 0.01), whereas values in group 4 were lower than those of group 3 (P < 0.05). The final ATP concentration in group 3 was significantly lower than that in group 2 (P < 0.01), whereas the value in group 4 was significantly higher than that of group 3 (P < 0.01). CONCLUSION: Rewarming diminishes the viability of a liver graft with degradation of ATP, and a heat insulator reduces rewarming injury.

Acetylglucosaminidase↗
PubMed1997

Significance of liver size in hepatic surgery.

The purpose of this study was to evaluate the significance of liver volumetry as a parameter for hepatic functional reserve in cirrhotic patients with hepatocellular carcinoma. Liver volume was calculated from preoperative computed tomograms of 44 cirrhotic patients who underwent elective hepatic resections for hepatocellular carcinoma. The liver volume per body weight of non-alcoholic cirrhotics was significantly smaller than that of alcoholic cirrhotics (20.9 vs. 26.7 cc/kg; p = 0.03). The values for alcoholic cirrhotics was comparable with normal values. The liver volume per body weight of the cirrhotic patients demonstrated correlation with the preoperative serum albumin (p < 0.01) and indocyanine green clearance (p = 0.02). We conclude that the determination of hepatic atrophy by volumetry can serve as a parameter for the assessment of hepatic reserve but not as a predictor of postoperative complications in elective liver surgery for cirrhotic patients.

Atrophy↗
PubMed1997

Significance of donor nutritional status for rewarming injury of the hepatic graft in rats.

We studied the significance of donor nutritional status for hepatic rewarming injury and the usefulness of the glucagon loading test for the assessment of donor nutritional status in rats. In experiment 1, the animals were either free fed or fasted for 6, 24 or 48 h. The livers were preserved in chilled lactated Ringer's solution for 4 h and were divided into eight groups according to the fasting and rewarming periods. The ammonia level in the graft effluent was increased in grafts preserved for 24 h or longer, which was augmented when rewarming time was increased from 15 to 30 min (p < 0.05). In experiment 2, the animals were divided into four groups (n = 3 each) according to the fasting period. The hepatic tissue glycogen content was measured after fasting, and the serum glucose was measured after the administration of 50 micrograms/kg of glucagon i.v. The hepatic tissue glycogen content correlated with the increase rate of serum glucose (p = 0.0001). We conclude that glycogen may protect the hepatic graft from rewarming injury by improving energy status, particularly in prolonged rewarming. The glucagon loading test seems to be useful for assessing the glycogen content of the hepatic graft.

Alanine Transaminase↗
PubMed1997

Analysis of prognostic risk factors in hepatic resection for metastatic colorectal carcinoma with special reference to the surgical margin.

BACKGROUND: Liver resection for metastatic colorectal cancer has been established. Nevertheless, it is still controversial whether the surgical margin from the tumour edge to the cut surface of the liver is a significant prognostic factor in hepatic resection for colorectal metastatic liver cancer. METHODS: To clarify the prognostic risk factors in hepatic resection for colorectal metastasis, univariate and multivariate analyses were performed. Between April 1985 and April 1995, 31 patients underwent curative hepatic resection for metastatic colorectal cancer. The clinical and pathological factors were examined retrospectively. RESULTS: Overall 1-, 3- and 5-year survival rates of the patients were 92, 42 and 39 per cent respectively. Pathological study of 16 resected specimens with a solitary liver tumour revealed hepatic vein invasion by cancer cells in two of 16 cases, portal vein invasion in three, microsatellite lesions in two and biliary tract invasion in six cases. In resected specimens with a solitary tumour measuring less than 4 cm in diameter, one of these factors was observed in only two of nine cases, whereas in specimens with a solitary tumour measuring more than 4 cm in diameter, these factors were observed in six of seven patients (P < 0.05). The distance from the tumour edge to the intrahepatic invasion was less than 10 mm. With univariate analysis, tumour size of 4 cm or more in diameter, an interval of 6 months or less between colorectal and hepatic resection, four or more gross tumours, bilobar involvement and a resection margin from the tumour of less than 10 mm were found to be significant factors indicating a poor prognosis. Cox's proportional hazards model identified a tumour of 4 cm or more in diameter and a resection margin from the tumour of less than 10 mm as poor prognostic factors (P < 0.05). CONCLUSION: In treating metastatic colorectal cancer to the liver, the surgical margin should be more than 10 mm because occult intrahepatic invasion was always found to be located within 10 mm from the edge of the tumour.

Adult↗
PubMed1997

Detection of hepatitis C virus RNA in bile.

OBJECTIVES: The infectivity of bile in patients with hepatitis C virus (HCV) infection remains to be clarified. The purpose of this study was to document the detection of HCV-RNA in bile of patients with HCV infection. METHODS: Bile and serum samples were tested for HCV RNA by a two-step polymerase chain reaction technique in 12 patients with HCV infection. RESULTS: HCV-RNA was detected in the serum of all 12 patients, whereas 6 of 12 bile samples (50%) tested positive. Comparison of laboratory data between patients with and without HCV-RNA in bile demonstrated statistically higher serum total bilirubin among those with positive bile HCV RNA than those without, but other clinical and biochemical variables as well as hepatitis activity scores were comparable between the two groups. CONCLUSIONS: Bile of HCV antibody-positive patients could be infectious.

Aged↗
PubMed1996

Results of 280 liver resections for hepatocellular carcinoma.

OBJECTIVE: To evaluate the recent results of liver resection in patients with hepatocellular carcinoma. DESIGN: Retrospective study. SETTING: A university hospital in Japan. PATIENTS: Two hundred eighty patients who underwent liver resection with complete extirpation of hepatocellular carcinoma from 1985 to 1993. MAIN OUTCOME MEASURES: Morbidity and survival after operation and the pathologic features of hepatocellular carcinoma according to the TNM classification of the International Union Against Cancer. RESULTS: More than 40% of the patients with stages I and II disease underwent a partial resection of the liver, whereas 50% of those with stages III and IVA were operated on with more than a bisegmentectomy. Fifty percent of all patients had no postoperative complications. The morbidities included intra-abdominal abscess (7%), bile leakage (5%), and hepatic failure (4%, of whom half died; mortality rate, 2%). Histopathologically, 32% of the stage I tumors were well differentiated (grade 1), while, in stage III, 56% had portal invasion and 61% had daughter lesions in the liver. The cumulative survival rates of patients with stages I, II, and III disease and all patients at 5 years were 69%, 52%, 32%, and 50%, respectively, while the disease-free survival rates at 5 years were 38%, 34%, 17%, and 29%, respectively. CONCLUSION: The recent results of liver resection for hepatocellular carcinoma are generally satisfactory; however, the recurrence rate is still high.

Aged↗
PubMed1996

Simplified inflow control using stapling devices for major hepatic resection.

We describe the efficacy of a new technique for hepatic inflow division using stapling devices in major hepatic resections. We studied 28 consecutive patients who underwent major hepatic resection at a tertiary referral center by en masse inflow control of Glisson's pedicle in 1993 and 1994, of whom 10 underwent inflow control with stapling devices. Although stapling devices were used for larger tumors (mean +/- SD, 12.2 +/- 8.6 vs 5.7 +/- 5.0 cm; P = .02), the operation time (261 +/- 57 vs 301 +/- 143 minutes), operative blood loss (2071 +/- 1318 vs 4792 +/- 6586 mL), postoperative intra-abdominal bleeding (0% [0/10] vs 17% [3/18]), and hospital stay (16.0 +/- 2.6 vs 20.6 +/- 7.4 days) were favorable for resections with staplers vs resections without staplers; the overall incidences of postoperative complications (40% [4/10] vs 39% [7/18]) and hospital death (10% [1/10] vs 6% [1/18]) were comparable in the two groups. We conclude that stapling devices allow simple, quick, and safe en masse inflow control in major hepatic resections.

Aged↗
PubMed1996

Cardiac complications after hepatic resection.

During a period of 94 months between 1985 and 1993, 474 hepatic resections were performed in 451 patients, of whom 23 (5 per cent) had cardiac problems: ischaemic heart disease in 16 (previous myocardial infarction in five and angina pectoris in 11), arrhythmic disorders in three, valvular disease in three (previous mitral valve replacement in two) and hypertrophic cardiomyopathy in one. The cardiac patients had a higher incidence of cardiac complications (24 versus 0 per cent, P < 0.0001) including two myocardial infarctions, and of non-cardiac complications consisting of postoperative liver failure (16 versus 4 per cent, P < 0.01) and bile leak (16 versus 5 per cent, P = 0.02), as well as hospital death (16 versus 3 per cent, P < 0.001). However, long-term survival was similar in the two groups. Patients with preoperative cardiac conditions appear to be at increased risk for early postoperative morbidity and mortality after hepatic resection.

Adolescent↗
PubMed1996

Thromboxane A2 in preservation-reperfusion injury: the effect of thromboxane A2 synthetase inhibitor.

It has been suggested that thromboxane A2 (TXA) plays important roles in preservation/reperfusion organ injury. In this report, we investigated the prostanoid release from the liver and the effect of a selective TXA synthetase inhibitor (E)-3-[p-(1H-imidazol-yl-methyl)-phenyl]-2-propenoic acid, OKY046) during cold preservation and after reperfusion. Rat livers were preserved in lactated Ringer's solution at 4 degrees C for 2, 4, and 6 hr and perfused with oxygenated Krebs-Henseleit buffer using recirculating perfusion system, and prostanoids were measured during cold preservation and after reperfusion. OKY046 and a novel TXA receptor antagonist [(9,11), (11,12)-Dideoxa-9a, 11a-dimethyl-methano-11,12-methano-13,14-dihydro-13-aza-14-oxo-15-cyclo pentyl-16,17,18,19,20-pentanor-15-epi-TXA, ONO3708] were added into the preservation solution and perfusate. Along with the preservation time, both the production and release of TXA was observed to increase; however, almost all the produced TXA was stored in the liver tissue. Afterwards, the stored TXA was released into perfusate in 15 min after reperfusion. OKY046 significantly decreased both the production and release of TXA. In addition, OKY046 improved the histological damage and trypan blue uptake of liver cells. Our results demonstrate that TXA, stored in the liver during preservation, might therefore be a potential trigger of reperfusion injury, and as a result, OKY046 reduces reperfusion injury by decreasing the production of TXA during preservation.

6-Ketoprostaglandin F1 alpha↗
PubMed1996

Tuberculosis following liver transplantation: report of a case and review of the literature.

We report on a 44-year-old man who developed tuberculosis 4 months after liver transplantation. The diagnosis was confirmed using a polymerase chain reaction (PCR) technique in bronchial alveolar lavage (BAL) fluid, and the patient was successfully treated by reducing his immunosuppression and administering antituberculous drugs. The patient became afebrile 20 days after starting antituberculous therapy and remains well at home. A review of the literature revealed that tuberculosis after liver transplantation is a rare complication with a reported mortality rate of as high as 40%. The mortality is highest for patients who become symptomatic within 3 months after transplantation (83% vs 0%, P < 0.01; Fisher's exact test) and for those with an interval between the initial symptom and diagnosis of more than 2 weeks (71% vs 0%, P < 0.05). Early diagnosis is, therefore, essential for successful resolution of tuberculosis after liver transplantation.

Adult↗