Biomedical subjects

M Ryu

Publications and source records attributed to M Ryu.

80 records · Page 5Linked to original sources

PubMedDate not supplied

Prognosis of hepatocellular carcinoma smaller than 5 cm in relation to treatment: study of 100 patients.

A total of 100 patients with small hepatocellular carcinoma, less than or equal to 5 cm in diameter, seen during the last 8 years were analyzed retrospectively for survival time in relation to treatment and Child's grading. When analyzed with respect to major treatment modalities without considering stage, the median survival was 35.0 months for 34 patients treated by surgery, 28.8 months for 20 patients treated by transcatheter arterial embolization, 10.6 months for 25 patients treated by intraarterial chemotherapy and 9.7 months for 17 patients who received no specific treatment. When patients were divided into three stages without considering treatment, the median survival was 37.1 months for 37 Child's A patients, 16.2 months for 36 Child's B patients and 1.6 months for 27 Child's C patients. These results suggest that the prognosis depended on treatment given and the Child's grade. The effects of major therapeutic modalities on survival were analyzed with regard to Child's grading. Among Child's A patients, the actuarial survival rate for surgery was better than that for transcatheter arterial embolization and for arterial chemotherapy. Among Child's B patients, the survival rate for transcatheter arterial embolization was better than for other treatments. Among Child's C patients, there was no significant difference in survival rate regardless of treatment and its modality. These results suggest that surgery may be indicated as a first choice in Child's A patients, transcatheter arterial embolization in Child's B patients, and there is no effective treatment in Child's C patients. The major cause of death was hepatic failure irrespective of treatment.

Aged↗

PubMedDate not supplied

Detection of bile duct cancer by autofluorescence cholangioscopy: a pilot study.

BACKGROUND/AIMS: There is increasing interest in the detection of malignancy by autofluorescence endoscopy. This is the first report on autofluorescence endoscopy in bile duct cancer. METHODOLOGY: Nine patients with bile duct cancer underwent percutaneous transhepatic autofluorescence cholangioscopy using light-induced fluorescence endoscopy in the gastrointestinal tract (LIFE-GI) system. RESULTS: The cancerous lesion had quite a different color in comparison with normal mucosa, which was seen as light blue, by the autofluorescence endoscopy. In all patients, cancerous legions were observed as dark red. Additionally, in 7 of the 9 cases a white fluorescence was also seen in the cancerous lesion. CONCLUSIONS: In previous reports on the gastrointestinal tract and bronchial tree, cancerous lesions appeared dark red when examined by autofluorescence endoscopy. In our study, it is suggested that a white fluorescence is also an important finding for making diagnosis of bile duct cancer by the autofluorescence endoscopy.

Bile Duct Neoplasms↗

PubMedDate not supplied

Pathophysiology after pylorus-preserving pancreatoduodenectomy: a comparative study of pancreatogastrostomy and pancreatojejunostomy.

BACKGROUND/AIMS: Pylorus-preserving pancreatoduodenectomy using the pancreatogastrostomy technique may result in pancreatic exocrine insufficiency and obstruction of the pancreatic duct. A prospective randomized comparison of pancreatogastrostomy and pancreatojejunostomy was therefore performed to assess pathophysiologic changes after pylorus-preserving pancreatoduodenectomy. METHODOLOGY: The study population consisted of 23 patients (pancreatogastrostomy: 10, pancreatojejunostomy: 13) who were observed for 2 years. RESULTS: Neither physical condition (dietary intake, body weight, performance status, and frequency of bowel movements) nor nutritional parameters (serum levels of total protein, albumin, total cholesterol, and cholinesterase) differed significantly between the two groups; these parameters recovered to pre-operative levels within 1 year in both groups. Changes in pancreatic function diagnosis (PFD) test results were similar between the two groups. The glucose tolerance test results revealed deterioration of glucose tolerance in 2 patients (20%) in the pancreatogastrostomy group and 3 patients (23%) in the pancreatojejunostomy group. In 2 of 3 patients in each group with non-dilated pancreatic ducts before surgery, the pancreatic ducts dilated after surgery. Diabetes developed after surgery in one such patient in each group. No significant differences were observed between the two groups with respect to changes in glucose tolerance test results and the diameter of the pancreatic duct. CONCLUSIONS: This prospective randomized study demonstrates no difference in pathophysiologic changes between patients undergoing pancreatogastrostomy or pancreatojejunostomy after pylorus-preserving pancreatoduodenectomy, at least in the first 2 years.

Adult↗

PubMedDate not supplied

Drainage area of the head of the pancreas by computed tomography under endoscopic retrograde pancreatography (ERP-CT).

BACKGROUND/AIMS: This study evaluated the drainage area of the capitular branches of the pancreas head by computed tomography under endoscopic retrograde pancreatography (ERP-CT). METHODOLOGY: ERP-CT was performed in 43 patients. The drainage area of the capitular branches of Wirsung's and Santorini's ducts were evaluated by dividing the pancreatic head into two areas, the anterior area and the posterior area. RESULTS: The pancreatic duct pattern was classified in 4 types; normal type, ansa type, loop type, and embryonic type. In normal type duct pattern, all inferior capitular branches of Wirsung's duct drained the posterior area and all inferior capitular branches of Santorini's duct drained the anterior area. In ansa type duct pattern, all inferior branches from Wirsung's duct drained the posterior area and inferior branches from Santorini's duct drained the anterior area and the posterior area. In loop type duct pattern, all inferior branches from Santorini's duct drained the posterior area and inferior branches from Wirsung's duct drained the anterior area and the posterior area. Middle capitular branches were detected only in normal B, normal C, and loop type. CONCLUSIONS: ERP-CT is a useful procedure that provided three-dimensional morphology of the capitular branch of the pancreas head.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMedDate not supplied

Spontaneous total necrosis of hepatocellular carcinoma: report of a case.

We report on a 50-year-old man with a liver mass that, when surgically resected, was found to be a hepatocellular carcinoma that had undergone spontaneous complete necrosis without previous treatment. Histologically, no viable tumor cells were observed. The postoperative course was uneventful, and the patient is alive without evidence of recurrence about 5 years after surgery. Spontaneous total necrosis of hepatocellular carcinoma without previous treatment is rare. In particular, spontaneous total necrosis of a hepatocellular carcinoma that has been proven by histologic examination of a surgically resected liver specimen is extremely rare; only three cases of spontaneous complete necrosis of hepatocellular carcinoma have been reported previously. In this report, we present our unusual case and discuss possible causes of spontaneous total necrosis or regression of hepatocellular carcinoma.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Intraoperative and conformal external-beam radiation therapy in patients with locally advanced pancreatic carcinoma; results from a feasibility phase II study.

BACKGROUND/AIMS: Chemoradiation therapy is widely indicated to patients with locally advanced pancreatic carcinoma, though the capability of radiotherapy alone is not assessed enough. The purpose of this study is to clarify the efficacy and safety of a more intensive radiotherapy for those patients. METHODOLOGY: Fifteen patients were enrolled in a feasible phase II study of treatment with intraoperative radiation therapy (25 Gy), followed by conformal external-beam radiation therapy (40 Gy in 20 fractions, 5 times/week). The antitumor effect was evaluated on the early phase of dynamic computed tomography image. RESULTS: The full irradiation dose was feasible in 12 of 15 patients. The overall response rate was 40% (1 complete and 5 partial responses). Grade 3 toxicity was observed in 2 patients (13%) with nausea/vomiting or anorexia. One patient developed gastric ulcer and died of gastrointestinal bleeding 12 months after intraoperative radiation therapy. The median survival time was 11.1 months, and the 2-year survival rates were 13%. Survival for more than 2 years was observed in 2 of the 6 responders. CONCLUSIONS: The above radiotherapy is considered to be active for the locally advanced pancreatic cancer with acceptable toxicity, when the gastrointestinal tract is excluded from the radiation field. This should be further assessed in late phase II studies involving a large number of patients.

Adenocarcinoma↗

PubMedDate not supplied

Surgical treatment of hepatocellular carcinoma with direct removal of the tumor thrombus in the main portal vein.

BACKGROUND/AIMS: Hepatocellular carcinoma with tumor thrombus in the main portal vein is generally associated with a poor prognosis. If the liver function tolerated the hepatic resection, we aggressively selected surgical treatment. METHODOLOGY: We performed surgical treatment in 18 of 72 patients with hepatocellular carcinoma with tumor thrombus in the main portal vein. We analyzed the prognostic factors and survival rate of the surgical treatment group. RESULTS: The overall cumulative survival rates following the operation at 1 and 2 years were 48% and 34%, respectively. No patients died within 30 days of the operation. An univariate survival analysis revealed that intrahepatic metastases (P = 0.013), tumor differentiation (P = 0.011) and operative curability (P = 0.0058) had significant effects on survival. For the 6 patients with a complete resection, the cumulative survival rates at 1 and 2 years were 75% and 75%, respectively. In the 3 of 5 patients who died within 90 postoperative days, incomplete removal of the tumor thrombus in the portal vein or hepatic vein caused early recurrence and death. CONCLUSIONS: If the liver function tolerates the hepatic resection, hepatectomy of the main tumor combined with removal of tumor thrombus in the main portal vein is an effective treatment. This is especially true in patients where a long life is made possible by a complete resection of the main tumor, intrahepatic metastases and tumor thrombus. An important feature of this operation is to attempt complete removal of the tumor thrombus so as to prevent early recurrence and death.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Segmental resection of the duodenum including the papilla of Vater for focal cancer in adenoma.

BACKGROUND/AIM: Adenoma of the papilla of Vater is a premalignant lesion frequently associated with focal cancer. This adenoma has been treated by a variety of methods, and a consensus for its standard treatment has not been reached. A method of resection which is safe and reliable is desired. METHOD: The distal part of duodenum and pancreas were separated. The pancreatic and bile ducts were exposed outside the pancreas and duodenum, respectively, and transected. Segmental resection of the distal part of the duodenum including the papilla of Vater was performed. The jejunum was elevated and anastomosed with the duodenum, bile duct, and pancreatic duct. RESULTS: The resection was safely performed on two patients with focal cancer in adenoma. Delayed gastric emptying which continued for 2 to 3 weeks, occurred in both patients. Postoperatively, the patients resumed a normal life and weigh the same as before surgery. CONCLUSION: Segmental resection of the duodenum including the papilla of Vater is a safe and effective treatment method for adenoma of the papilla of Vater, a premalignant neoplasm that is frequently associated with cancer.

Adenoma, Villous↗