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Biomedical subjects

M Ebara

Publications and source records attributed to M Ebara.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Percutaneous ethanol injection (PEI) for small hepatocellular carcinoma--study on its therapeutic effect and prognosis based on long-term observation].

Percutaneous ethanol injection (PEI) was performed on 183 tumors in 147 patients with small hepatocellular carcinoma (HCC), of no larger than 3 cm in size and less than three in number, during 9 years and 4 months between August 1983 and December 1992. The 1-, 3- and 5-year survival rates of all 147 patients calculated by the Kaplan-Meier method were 96.3%, 62.5% and 40.7% respectively. Multivariate analysis (Cox's proportional hazard model) demonstrated that the most significant factor contributing to the prognosis of the patients was the severity of liver dysfunction (clinical stage) before treatment. Recurrence was seen in different areas of the liver from the original lesion in 26.9% in one year and 61.5% in three years. Multivariate analysis demonstrated that the most significant factor contributing to the recurrence was the number of tumors before treatment. Regrowth of the original tumor occurred in two patients (1.4%). There was no serious complication due to PEI. To evaluate the therapeutic effect of PEI, contrast-enhanced CT with intravenous bolus injection was considered to be indispensable. We conclude that PEI can be indicated in most patients with small HCC and is also effective.

Adult↗
PubMed1994

[Ultrasonography in the diagnosis of liver cirrhosis].

Ultrasound is now widely used in the diagnosis of liver diseases. Applications of ultrasound in the diagnosis of liver cirrhosis are reviewed in this paper. Characteristic findings of liver cirrhosis in ultrasound are nodular liver surface, round edge, and hypoechoic nodules in liver parenchyma which represent regenerative nodules of cirrhotic liver. Detection of hypoechoic nodule more than 10 mm is important in the early diagnosis of hepatocellular carcinoma. Detection of splenomegaly, ascites, and portosystemic collaterals is possible by ultrasound. Evaluation of portosystemic collaterals is beneficial in the management of esophagogastric varices and portosystemic encephalopathy. Ultrasound is useful in the non-invasive diagnosis and long-term management of cirrhotic patients.

Ascites↗
PubMed1993

[Percutaneous ethanol injection (PEI) for small hepatocellular carcinoma].

Percutaneous ethanol injection (PEI) was applied to 162 lesions in 133 patients with hepatocellular carcinomas (HCC) 3 cm or less in diameter (small HCC) between Aug. 1983 and Apr. 1992. Histological findings in resected specimen for which PEI had previously been performed before surgery showed that PEI could completely necrotize an HCC of 32 mm in diameter. The antitumoral effect by PEI could correctly be evaluated by enhanced CT. The 1-, 3-, 5- and 7-year survival rates after PEI calculated by the Kaplan-Meier method were 95.9%, 60.5%, 36.9% and 21.7%, respectively. The survival rate of post-PEI patients with I or II grade in clinical stage was better than that of those with III. Recurrence occurred in hepatic areas different from the original lesion in 27.8% in one year and 63.6% in three years after PEI, rates quite similar to those of recurrence after surgical resection for HCCs of 3 cm or less in diameter. For such recurrence, PEI alone was then repeated in half of the 76 patients. Complications caused by PEI were not serious and did not necessitate intensive care. Because of its anti-tumor therapeutic effect and minimal damage to the liver, PEI might be considered a viable alternative to surgery for most patients with small HCC.

Carcinoma, Hepatocellular↗
PubMed1993

[Usefulness of percutaneous biopsy under sonographic control and histological examination in the early diagnosis of hepatocellular carcinoma].

We evaluated the usefulness of percutaneous biopsy under sonographic control and histological examination in the early diagnosis of hepatocellular carcinoma (HCC) in comparison with CT and angiography. 121 patients in whom hepatic nodules 3cm or smaller in size were found by ultrasound as suspected HCC underwent percutaneous biopsy, CT and angiography. 118 patients were finally diagnosed as HCC. Correct diagnosis of HCC was obtained by each modality in relation to tumor size as follows: 87.3% by histological examination, 55.1% by CT, 52.5% by angiography. However, the diagnostic capability of these modalities for HCC 1.5cm or smaller in size was as follows: 88.5% by histological examination, 34.6% by CT, and 23.1% by angiography. Cytology using a biopsy specimen was performed in 26 patients and it showed a positivity of 61.5%. In conclusion, for a definitive diagnosis of small HCC 1.5cm or less in size, the current imaging modalities have some limitations. On the other hand, percutaneous biopsy and histological examination are the most reliable and indispensable for making a definite diagnosis of small HCC.

Adult↗
PubMed1992

Diagnosis of portal vein tumor thrombus by pulsed Doppler ultrasonography.

The blood flow of portal vein thrombus was studied by pulsed Doppler ultrasonography in 21 patients with tumor thrombus and 14 with blood clot thrombus. Pulsatile waves were observed in 19 of the 21 with tumor thrombus, with backward continuous waves in 3, and forward/backward continuous waves in 2. In contrast, forward continuous waves were observed in 2 of the 14 with blood clot thrombus. By color imaging, the blood flow could be observed in 9 of 14 with tumor thrombus, but in 1 of 7 with blood clot thrombus. Pulsatile and backward continuous waves were characteristic of tumor thrombus.

Adult↗
PubMed1992

[Study of sonographic findings of small hepatocellular carcinoma based on its pathologic findings].

Sonograms of 282 cases of hepatocellular carcinoma (HCC) less than 5 cm in size were examined. Among these, 73 cases of resected or biopsied HCCs were compared in terms of their pathologic findings and sonograms. Low echoic pattern was the more common among smaller HCCs, and low echoic periphery pattern tended to prevail with increasing size. The pathologic factors of fatty change and clear cell formation are responsible for elevating the echo level. Among HCCs less than 2 cm, the low echoic group is more differentiated than the iso-echoic group by Edmondson's classification. "Lateral acoustic shadow", "nodule in nodule", and "septum" are characteristic findings in HCC by sonography, and they correspond to the pathologic findings. However, "posterior echo enhancement" was not seen to be specific for HCC, as it was also observed with similarly frequency in hemangiomas.

Adult↗
PubMed1992

[Diagnostic significance of angiography for small hepatocellular carcinoma--comparison with other examinations].

The diagnostic value of angiography for small hepatocellular carcinoma was evaluated in comparison with histology, contrast-enhanced computed tomography, and ultrasonography. A total of 120 patients with small hepatocellular carcinoma (less than 3 cm in size) were examined. The definitive detection rate for primary tumors less than 2 cm in size was 44.9% by angiography, while it was 68.6% for primary tumors between 2 cm and 3 cm in size. When the primary tumor was less than 2 cm in size and without tumor vessels on angiography, it tended to be of Edmondson's grade 1 and to show fatty change. When the primary tumor was less than 2 cm in size and without tumor stain while non-cancerous parenchyma showed irregular stain, it tended to be of Edmondson's grade 1 and normotrabecular type. Angiography was found to be of particular value in detecting satellite tumors with a nodular parenchymal echo pattern in non-cancerous areas, because ultrasonography often fails to differentiate these satellite tumors from non-affected parenchyma.

Adult↗
PubMed1992

[Ultrasonographic findings of abdominal tuberculous lymphadenitis].

Five patients with abdominal tuberculous lymphadenitis were studied by ultrasound. The final diagnosis of tuberculosis was based on open biopsy in 2 patients, neck lymph node biopsy in 1, needle biopsy under ultrasound control in 2. Low-echoic and iso-echoic abdominal lymph nodes were seen in all patients and a mixed echoic lymph node was found in one of them. Enlarged, round or oval, lymph nodes were conglomeratically observed along the common hepatic artery, in the hepatoduodenal ligament and along the abdominal aorta. The size of the lymph node was found to be 20-70 mm. In one case, compression of the portal trunk and the common bile duct due to a large lymph node was observed, and arterioportography showed hepatopetal collateral veins. In the other case, multiple mass lesions in the liver and the spleen were observed. In the 4 patients who were observed by ultrasound at 2 months after anti-tuberculosis therapy, enlarged lymph nodes decreased and 3 of them changed from low-echo to iso-echo in the echo pattern. Of the 4 patients who were followed for more than 4 months, lymph nodes disappeared in 2 at 4 months and in one at 12 months. The remaining patient showed residual nodes which decreased in half at 8 months. Ultrasound is now used commonly in the examination of the abdomen, and there are cases of abdominal lymph nodes swelling due to varied diseases. In this study, there were no characteristic ultrasonographic findings in abdominal tuberculous lymphadenitis. So, it is difficult to diagnose the cause of abdominal lymph node swelling by only ultrasound.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1991

MR imaging of small hepatocellular carcinoma: effect of intratumoral copper content on signal intensity.

Small (less than 5 cm) hepatocellular carcinomas (HCCs) in 45 of 112 patients (40.2%) had a high-signal-intensity pattern (relative to that of liver) on T1-weighted magnetic resonance (MR) images. To identify the cause of this pattern, specimens of histologically defined HCC with high- (n = 21), iso- (n = 6), and low- (n = 22) intensity patterns were histologically evaluated for paramagnetic ionic forms of metals. The incidence of steatosis, clear cell formation, and copper accumulation was statistically (P less than .01) higher in tumors with the high-intensity pattern than in those with other patterns. Of 17 HCCs that stained positive for copper, 16 (94%) had a high-intensity pattern; the pattern of one tumor (6%) was isointense. All 21 tumors with the high-intensity pattern had at least one of the findings of steatosis, clear cell formation, or copper accumulation. These features were evident in only four of 28 tumors (14%) with an iso- or low-intensity pattern. Thus, copper accumulation might be a cause of the high-intensity pattern on T1-weighted images of small HCCs.

Adult↗
PubMed1991

Histological and morphometrical indicators for a biopsy diagnosis of well-differentiated hepatocellular carcinoma.

Among 597 patients with nodular hepatic lesions who underwent ultrasonically guided needle biopsy, 305 were histologically confirmed as having hepatocellular carcinoma, and 37 patients had borderline lesions. Histological reexamination was correlated with morphometrical analysis on selected cases of well-differentiated, microtrabecular hepatocellular carcinomas (n = 29), borderline lesion (n = 10), typical (mid-sized and macrotrabecular) hepatocellular carcinomas (n = 15) and cirrhotic liver tissue obtained from extranodular hepatic parenchyma of hepatocellular carcinoma patients (n = 47). Morphometrical analyses revealed that the mean cell size and nucleocytoplasmic ratio were most useful for distinguishing well-differentiated, microtrabecular hepatocellular carcinoma from cirrhosis. These two parameters were well correlated with nuclear density. The grade of nuclear density, therefore, seemed to be a convenient semiquantitative indicator for diagnosing well-differentiated hepatocellular carcinoma. A comparison between intranodular and extranodular hepatic tissues was particularly important for its assessment. It is concluded from the results that hepatic nodules presenting a nuclear density larger than two times that of controls could be classified into the overt hepatocellular carcinoma group. From the statistical aspect, the possibility of microtrabecular hepatocellular carcinoma should be considered when a nodule has a nuclear density exceeding 1.3 times that of the extranodular tissue.

Biopsy↗
PubMed1991

[Infusion of LAK cells and anticancer drugs with a total implantable port to a patient with metastatic liver and spleen tumors].

A case of hepatic and splenic metastases of lung cancer infused with LAK cells and anticancer drugs from hepatic artery with total implantable port (Port-A-Cath: Pharmacia, Incorp.) was reported. A 56-year-old male was admitted to our hospital because of general fatigue, jaundice, pleural effusion and elevation of transaminase caused by hepatic and splenic metastases of lung carcinoid. Abdominal ultrasonography revealed 6 hepatic metastatic foci 10-35 mm in diameter and splenic metastases. The patient received 5 courses of MMC infusion, CPA (2 courses) and epirubicin, CDDP (3 courses), and 5 courses of LAK cells (total 1.4 x 10(10)) with IL-2 and OK-432. Eight months after initiation of treatment, jaundice and pleural effusion disappeared, transaminase returned to the normal level and the condition of the patient improved. Although the response of hepatic metastases to the treatment was NC, the size of a splenic metastasis decreased from 35 x 55 mm to 24 x 35 mm (PR).

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Histological features and clinical course of large regenerative nodules: evaluation of their precancerous potentiality.

Seventeen patients with cirrhosis and histologically defined, ultrasonically detected, large regenerative nodules of the liver were followed without treatment for more than 1 yr (range = 13 to 51 mo). During the follow-up period, none of the nodules were demonstrated sonographically to have enlarged. Computed tomography and/or hepatic angiography were also performed in 14 patients, but there was no evidence of malignant transformation in these lesions. None of the 17 patients showed acute elevation of serum alpha-fetoprotein levels. Furthermore, four nodules became undetectable by these imaging procedures. Follow-up biopsy performed in seven patients revealed no significant histological changes from the first biopsy sample. However, HCCs developed apart from these large regenerative nodules in four patients. These HCCs suddenly appeared and did not seem to have been derived from preexisting large regenerative nodules. From these observations, it was not possible to regard a large regenerative nodule having no cytological atypia as a high-potential premalignant lesion. Their precancerous potentiality needs to be compared with that of ordinary pseudolobules.

Angiography↗
PubMed1990

[A combination treatment of transcatheter arterial embolization (TAE) and irradiation for hepatocellular carcinoma (HCC)--evaluation for therapeutic efficacy in comparison with TAE or irradiation alone].

Therapeutic effects of a combination therapy (TAE and irradiation) and a radiation therapy alone were evaluated comparatively in 54 patients with HCCs. Twenty eight patients of them underwent external X-irradiation with a linear accelerator after TAE and the remaining twenty six did irradiation alone. The incidence of partial response was 82.1% in the combination therapy and 69.2% in the radiation therapy. The cumulative rates of survival in the combination therapy were 70.8% (1-year), 37.1% (3-year), and 27.9% (5-year), which were higher than those in the radiation therapy. The cumulative rates of recurrence in the former were lower than those in the latter. The prognoses after the both treatments were poor in the patients with advanced liver cirrhosis (Child C). In the patients with HCCs smaller than 5 cm in diameter or accompanied by portal vein thrombi, the combination therapy was superior to TAE alone in the cumulative rates of survival. It is considered from the above results that the combination therapy is useful in the patients with HCCs when properly selected.

Carcinoma, Hepatocellular↗
PubMed1990

[Relationship between ultrasound-findings of low-echoic nodule of hepatic parenchyma in liver cirrhosis and development of hepatocellular carcinoma].

We investigated development of hepatocellular carcinoma (HCC) in 90 patients with liver cirrhosis by follow up study for a period from 6 months to three and half years, making special reference to ultrasound-findings of the parenchyma of the liver. Liver cirrhosis was classified into four types and two, non-nodular and nodular, groups according to low-echoic nodules distributed in the parenchyma. The development of HCC was higher at the rate of incidence in patients of the nodular group than those of the non-nodular. It was more closely related with the male in patients of the non-nodular group, and both the old age and the advanced hepatic injury in those of the nodular group. A rise of the level of serum AFP during a period of the follow up was not observed in relation to the development of HCC and seemed to be ineffective for detection of carcinoma small sized. The echo-types of the parenchyma in liver cirrhosis were most significantly correlated with the development of HCC in comparison with the other etiologic factors.

Adult↗
PubMed1989

Biopsy diagnosis of well-differentiated hepatocellular carcinoma based on new morphologic criteria.

Nodular hepatic lesions detected in 123 patients with chronic liver diseases were subjected to ultrasonically guided needle biopsy. Of these, 94 cases were diagnosed as hepatocellular carcinoma of a moderately or poorly differentiated type with classical histologic features of hepatocellular carcinoma. In 14 cases in whom hepatocytes had minimal atypical changes and were mostly of normotrabecular arrangement (one to two cells thick), a diagnosis of well-differentiated hepatocellular carcinoma was made on the basis of the following three histologic criteria: nuclear crowding, increased cytoplasmic basophilia and microacinar formation. The nodules which showed two or more of these findings were diagnosed as well-differentiated HCC. The diagnoses of these 14 cases were subsequently confirmed by clinical course, histology in the resected specimen and/or autopsy findings. The nodules that presented similar but equivocal changes were arbitrarily categorized as borderline lesions (five cases). The nodules showing the findings almost identical with those of pseudolobules were regarded as benign, large regenerative nodules (nine cases). The remaining one case had a hemangioma. Thus, these three histologic criteria proved to be useful in the biopsy diagnosis of nodular hepatic lesions, with certain limitations. Additionally, the majority of large regenerative nodules, borderline lesions and well-differentiated HCCs were found to be smaller than 2 cm.

Biopsy, Needle↗
PubMed1989

Strategy for early diagnosis of hepatocellular carcinoma (HCC).

Two hundred and eighty-two patients with HCC including 89 with tumors 2 cm or smaller in size and 193 of 2-5 cm were studied on clinical and pathological findings and correlated with the value of various diagnostic imaging modalities. There were apparent differences in histological findings of HCC between 2 cm or smaller in size and larger ones; the former had much less invasion of malignant cells to the extracapsule and portal vein neighbouring the HCC than the latter. In 83 patients with HCCs 2 cm or less in diameter AFP level was normal (less than 20 ng/ml) in 39.8%, 20-200 ng/ml in 44.6% and more than 200 ng/ml in only 15.6%. Detectability of HCC measuring 2 cm or less by various imaging modalities was as follows: 97.8% by US, 54% by X-ray computed tomography (CT), 61.6% by magnetic resonance imaging (MR) and 75.4% by angiography. There was considerable limitation of imaging modalities in making a definitive diagnosis of the smaller HCCs, particularly in the differentiation from regenerative nodules of liver cirrhosis. Tissue biopsy under ultrasound control provided a correct diagnosis in 36 out of 41 patients (87.8%) with HCCs 2 cm or less in size, a better ratio than for aspiration biopsy.

Adult↗