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Biomedical subjects

N J Lygidakis

Publications and source records attributed to N J Lygidakis.

At least 19 recordsLinked to original sources
PubMed1995

Hepatectomy under extracorporeal circulation.

BACKGROUND: Resection of hepatic tumors located near the confluence of the hepatic vein or invading the inferior vena cava has become technically feasible and relatively safe by using venovenous bypass. However, some technical problems remain to be solved. METHODS: We performed three cases of hepatic resection under extracorporeal circulation combined with hypothermic perfusion. RESULTS: An unexpected hemorrhage was observed in all three cases for different causes. The patient of case 2 died of liver failure developed from fatty liver. Bile duct stenosis was observed in cases 1 and 3. CONCLUSIONS: Although hepatectomy under total vascular exclusion by use of Biopump is now considered a safe procedure, attention should be paid when this procedure is performed because some technical problems still remain.

Blood Loss, Surgical↗
PubMed1995

Combined transarterial targeting locoregional immunotherapy-chemotherapy for patients with unresectable hepatocellular carcinoma: a new alternative for an old problem.

The prognosis for patients with advanced (stage III and IV) hepatocellular carcinoma (HCC) remains poor. Liver resection and liver transplantation have limited effects on overall survival. Our study was carried out to assess a novel therapeutic approach, which includes transarterial locoregional chemotherapy and in vivo locoregional dual immunostimulation, in patients with unresectable HCC. A group of 20 patients with stage III and IV hepatocellular carcinoma had 10 courses (once per day) of transarterial targeted locoregional immunotherapy with interferon-gamma (IFN-gamma) and interleukin-2 (IL-2), emulsified in a Lipiodol-Urografin mixture. The target organs were the spleen and the liver tumor itself. One course of intrahepatic locoregional targeting transarterial chemotherapy was given 10 days after completion of immunotherapy (mitomycin C, carboplatin, Farmorubicin, Leucovorin, 5-fluorouracil, and IFN-gamma). This was followed after 2 months by another course of transarterial targeted locoregional immunotherapy-chemotherapy. All patients survived the operation and had a mean survival time of 18 months (4-22 months). There was a decrease in the tumor size of 14 of the 20 patients. Serum alpha-fetoprotein (AFP) levels declined in 14 patients, reaching normal levels in 12 patients. These preliminary results indicate that combined locoregional immunotherapy-chemotherapy is a promising therapeutic approach in patients suffering from advanced nonresectable HCC and merits further evaluation.

Aged↗
PubMed1995

Extracorporeal circulation and hypothermic perfusion for caval tumor thrombus complicating hepatocellular carcinoma: a case report.

A tumor thrombus complicating hepatocellular carcinoma developed in a 61-year-old male patient. Embolization of the right branch of portal vein was performed 2 weeks before operation. Curative resection of the tumor was performed on by extended hepatectomy plus in situ hypothermic perfusion of the liver and extracorporeal circulation. Postoperative course was uneventful until bile leakage occurred on the 11th postoperative day. A bile duct stenosis was diagnosed by cholangiogram, and hepaticojejunostomy was carried out. The patient recovered well without further complications. The pitfalls and technical problems encountered in this case are herein discussed.

Carcinoma, Hepatocellular↗
PubMed1995

Resection versus resection combined with adjuvant pre- and post-operative chemotherapy--immunotherapy for metastatic colorectal liver cancer. A new look at an old problem.

Forty patients with metastatic liver disease from colorectal carcinoma are presented in this study. Patients were randomly assigned to two groups: Group A (20 patients) who had liver resection and Group B (20 patients) who had liver resection combined with post-operative locoregional immuno- therapy + chemotherapy. Thus, during the first year following surgery, they have four courses of targeted locoregional transarterial chemotherapy-immunotherapy, two courses during the second year and one course during the third year. Two patients died, one in each group, during the first 30 postoperative days. Survival in Group A (19 surviving patients) ranged from 4 to 25 months, mean 11 months. Eight (8) patients had intrahepatic recurrence of the disease and 11 are still alive and free of disease. Of those with intrahepatic recurrence, three (3) patients died 15, 15 and 17 months following surgery of causes related to the disease. In Group B (19 surviving patients), survival ranged from 3 to 30 months, mean 20 months. At present, all 19 patients are alive and free of disease (p < 0.001). None has had intrahepatic recurrence (p < 0.001). On the basis of present results, liver resection supplemented with postoperative targeted transarterial locoregional immunotherapy-chemotherapy is associated with optimal results. It is highly recommended as the procedure of choice in dealing with patients operated upon for metastatic liver disease due to colorectal carcinoma.

Adenocarcinoma↗
PubMed1995

Changes in IL-6 and IL-8 after hepatectomy in patients with liver cirrhosis.

Changes in tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), and interleukin-8 (IL-8) were investigated before and after hepatectomy in patients with or without liver cirrhosis (5 cases without liver cirrhosis and 14 cases with liver cirrhosis). Both the IL-6 and IL-8 values of the cirrhotic patients were significantly higher on the first postoperative day (POD) as compared with the non-cirrhotic patients. Overall, no significant correlation was found between peak values of IL-6 or IL-8 and blood loss or operating time. In the case of the cirrhotic patients, correlation of both IL-6 and IL-8 with operating time was significant at p < 0.05, gamma = 0.534 and 0.586, respectively. No correlation was found between blood loss and the peak value of IL-6, but significant correlation (gamma = 0.647, p < 0.05) was found between them in cirrhotic patients. There was no consistent increase in TNF-alpha and IL-1 beta following hepatectomy. These findings indicate that procedures undertaken to reduce the excessive production of these cytokines may be useful for preventing complications after hepatectomy in cirrhotic patients.

Carcinoma, Hepatocellular↗
PubMed1994

Hepatectomy with extracorporeal circulation for liver metastasis from colon carcinoma located at the confluence of the major hepatic vein: a case report.

Liver metastasis located at the confluence of the major hepatic veins developed after an operation for sigmoid colon carcinoma in a 63-year-old patient. Curative resection of the tumor was performed by in situ hypothermic perfusion of the liver and extracorporeal circulation. Intra-abdominal bleeding occurred on the first postoperative day, and ligation of the right inferior phrenic artery was performed via an emergency laparotomy. Only mild elevation of ALT and recovery of the arterial ketone body ratio to the "safety zone" was noted on the second postoperative day. Hepatic function gradually deteriorated after the 4th postoperative day with no distinct cause. Diffuse fatty liver was suspected as a cause of liver failure. The patient died on the 31st postoperative day. The problems encountered in this case are discussed in this paper.

Adenocarcinoma↗
PubMed1994

Prognostic significance of tumor DNA content in carcinoma of the hepatic duct confluence.

BACKGROUND: In an attempt to identify prognostic factors in carcinoma of the hepatic duct confluence, the value of tumor DNA content was studied in 58 patients with this type of malignancy. METHODS: Of 58 patients (ages 26 to 74 years) surgically treated for carcinoma of the hepatic duct confluence, tumor DNA content was assessed in relationship to clinical-pathologic characteristics and patient survival. Thirty-three patients underwent additive radiotherapy. Nuclear DNA content was analyzed by flow cytometry. RESULTS: Resection was radical in only three patients with negative surgical resection margins and dissection (cleavage) margins. Twenty-eight patients (48%) had diploid tumors, and 30 patients (52%) had aneuploid tumors. No significant correlation was found between tumor DNA ploidy, degree of tumor differentiation, lymph node status, and hepatic infiltration. Aneuploid tumors were significantly associated with neural invasion. The median overall survival was 18 months. The survival period of patients with diploid tumors was significantly (p < 0.0003) longer than the survival period of those with aneuploid tumors (median survival, 26 months and 11 months, respectively). Additive radiotherapy improved survival significantly only in patients with aneuploid tumors. When tested by univariate survival analysis, DNA ploidy, additive radiotherapy, and the state of the surgical resection margins were significant prognostic factors. With multivariate survival analysis, only DNA ploidy, age, hepatic infiltration, and lymph node status were significantly related to prognosis. CONCLUSIONS: This survival analysis shows that DNA ploidy is a powerful prognostic determinant of carcinoma of the hepatic duct confluence.

Adult↗
PubMed1993

Interleukin-6 mediates host defense responses induced by abdominal surgery.

BACKGROUND: Cytokines have been implicated as pivotal mediators of the host defense reaction. In patients undergoing surgery we investigated the relationship between such mediators and postoperative host defense responses. METHODS: Tumor necrosis factor (TNF) was determined with an immunoradiometric assay, interleukin (IL)-6 by a B9-cell bioassay, and endotoxin by a chromogenic limulus lysate assay. C-reactive protein, alpha 1-antitrypsin, and alpha 2-macroglobulin were quantified by nephelometric assay. RESULTS: In 19 consecutive patients undergoing pancreaticoduodenectomy, a large increase in portal, and a significantly lower increase in peripheral, IL-6 levels was observed. No significant increase in TNF levels was noted. Fever developed in 16 patients within 24 hours (84%). The highest peripheral IL-6 levels correlated logarithmically (R = 0.59; p = 0.0039) with the peak body temperatures. C-reactive protein levels correlated with IL-6 levels (R = 0.49; p = 0.020). Increased IL-6 levels were observed in all nine patients undergoing either hemihepatectomy, breast reduction, or extensive breast reconstruction; however, only patients undergoing hemihepatectomy had endotoxemia. CONCLUSIONS: We conclude that abdominal surgery causes acute release of IL-6, but not TNF, in the portal circulation. IL-6 seems to be a major endogenous mediator of fever and the acute-phase response. The presence of endotoxin might be synergistic but is not obligatory for the host defense response after surgical trauma.

Acute-Phase Proteins↗
PubMed1993

Technical considerations and results of a "new" method of reconstruction of alimentary continuity after duodenopancreatectomy.

A total of (152) patients who consecutively underwent extended pancreaticoduodenectomy between 1983 and August 1992 had reconstruction of alimentary continuity, using two independent jejunal loops. One for the fashioning of a pancreatic and biliary anastomosis and the other for creating the gastric anastomosis. From the results of this study it has been shown that the present technique is contributing to low mortality, early morbidity and a satisfactory quality of post-operative life in long-term survivors. Four patients died during the first 30 days after surgery, and only 25% of those with confirmed pancreaticojejunal anastomotic leakages required early reoperation. Moreover, no patient developed marginal ulceration, or reflux gastritis, or dumping, while the incidence of steatorrhea and diabetes mellitus remained low. Additionally, the present technique makes locoregional radical surgery possible and we thus believe that it merits consideration with respect to the choice of method of reconstruction of alimentary continuity after extended pancreaticoduodenectomy. The present technique has been proved to be safe, simple and effective in fulfilling current demands on resectional pancreatic surgery, particularly in the case of pancreatic malignancies, and can therefore be recommended.

Adult↗
PubMed1993

Induced in vivo targeted transarterial and transvenous immunostimulation in patients with unresectable pancreatic carcinoma.

On the basis of the preliminary results of this study, in vivo dual immunostimulation in patients with advanced pancreatic cancer appears to be a promising therapeutic alternative. A surgical technique is presented in which the spleen of the patient is used as the target organ for in vivo lymphokine activated killer cell generation. Additionally, applying locoregional transvenous administration of gamma-INF and IL2 in the area of the tumor, tumor infiltrating lymphocytes (TIL) area activated, thus completing the system of dual in vivo immunostimulation.

Aged↗
PubMed1992

Resection of a large liver cell adenoma originating in the caudate lobe.

A rare case is reported of a large liver cell adenoma originating in the caudate lobe of the liver in a 38-year-old women with no history of liver cirrhosis or use of oral contraceptives: Caudate lobectomy of the liver is described. Passing tapes around the inferior vena cava was useful for controlling the bleeding from a torn short hepatic vein. This resection of a large hepatocellular adenoma originating in the caudate lobe is to our knowledge only the second case to be reported in the English literature.

Adult↗
PubMed1992

Clinical application of peroperative ultrasonography in liver surgery.

This communication outlines the findings at peroperative ultrasonography in patients who had resectional liver surgery because of primary hepatocellular carcinoma. Peroperative ultrasonography revealed the accurate location of the tumor, its relation with locoregional vascular structures, presence of tumor metastases and tumor thrombus. Additionally, ultrasonography provided useful guidance for tumor resection by making possible tumor staining via echo-guided puncture of the feeding vessel of the tumor.

Carcinoma, Hepatocellular↗
PubMed1992

Surgical treatment for hepatocellular carcinoma (HCC) 3 cm or less than 3 cm in diameter.

The efficacy of surgical treatment of small hepatocellular carcinoma (3 cm less in diameter) was studied in 30 patients with solitary tumors. The survival of the patients surviving at least three months after resection was 95% at 1 year, 69% at 2 years, 50% at 3 and 4 years. With regard to the range of resection in cases of partial resection the survival rate was 94% after 1 year, 64% after 2 years, and 47% after 3 and 4 years, while in the case of more than subsegmental resection the 4-year survival rate was 100% and a significant difference was noted. Recurrence was noted after 47% of the partial resections and 25% of the subsegmental or larger resections, and 6 of the 8 recurrent site especially in lesions of less than 2 cm were within the same segmental region. Thus, in the surgical treatment of solitary cancers smaller than 3 cm in size, resection of the segmental resection seems to be preferred whenever the functional reserves of the liver permits.

Carcinoma, Hepatocellular↗
PubMed1992

A new look in the management of unresectable primary hepatocellular carcinoma.

From January 1992 to October 1992, nine patients with unresectable primary hepatocellular carcinoma were treated either by liver resection combined with transarterial on-target chemotherapy (n = 4) or by transarterial on-target chemotherapy alone (n = 5). All nine patients were seen with diffuse spread of their disease and were considered as refractory to surgical treatment. The patients who had liver resection combined with alcohol transtumoral injection of the residual tumor in the liver remnant and transarterial lipiodol on-target chemotherapy, responded well and were seen postoperatively with a significant decrease in size of their residual tumor, which was found histologically to have advanced necrotic changes. Similarly, the remaining patients, who had only alcohol injection and frequent administration of on-target chemotherapy, were seen with necrosis of their tumor and with decrease in its size. The fetoprotein serum levels were decreased in all patients. None of the patients showed systemic effects from the use of chemotherapy, nor did they demonstrate any hepatotoxic side effects.

Aged↗
PubMed1992

A retrospective comparative study of reconstructive methods following pancreaticoduodenectomy--pancreaticojejunostomy vs. pancreaticogastrostomy.

Reconstructive methods following pancreaticoduodenectomy in our department are discussed and evaluated in this study. Between January 1980 and November 1990 fifty-two consecutive patients underwent pancreaticoduodenectomy because of pancreas head disease. Thirty-one patients underwent pancreaticojejunostomy and twenty-one had pancreaticogastrostomy as reconstructive procedures. Mortality rate was 6% in pancreaticojejunstomy versus zero in pancreaticogastrostomy. Six patients had leakage from the pancreaticojejunostomy, but only one patient had necrosis of the gastric stump and leakage from the pancreaticogastrostomy. This case had previous distal gastrectomy done for gastric ulcer. The residual stomach might not have been large enough, and the blood supply of the gastric stump might not have been adequate for pancreaticogastrostomy. Except for this case, none was observed with leakage from the pancreatic anastomosis in the pancreaticogastrostomy group. No statistical significance in operating time or blood loss was observed between the two methods. The pancreaticogastrostomy cases without complications had significantly less loss of body weight than those with pancreaticojejunostomy at the date of discharge (p < 0.05). It is concluded that pancreaticogastrostomy is the safer reconstructive method following pancreaticoduodenectomy, although it may not be indicated in patients with prior gastrectomy.

Adult↗
PubMed1992

Damage and repair of hepatocyte nuclear DNA after hepatic inflow occlusion.

Recent reports emphasize that ischemic tissue damage is caused mainly by superoxide produced at the reperfusion rather than by ischemia itself. In this paper, the damage and repair of hepatocyte nuclear DNA of is investigated using rats with portasystemic shunt. Hepatic inflow was occluded for 30, 60 and two times 30 (with a 10-minute interval) minutes. Extent of DNA damage and repair were measured by nick-translation and 3H-thymidine incorporation, respectively. Superoxide, GOT and endotoxin were also measured. The results are as follows. 1. Sixty minutes of ischemia produced more serious DNA damage of the hepatocyte nucleus and a significant delay in repair as compared with 30 minutes of ischemia. 2. Intermittent ischemia for two times 30 minutes produced milder damage to DNA, and earlier recovery than a single ischemia of 60 minutes. 3. Serum and tissue peroxide increased after reperfusion in 60 minutes and intermittent ischemia, but not after 30 minutes of ischemia. Endotoxin level increased only in 60-minute ischemia. Histological change, neutrophilic cell infiltration, was most prominent in 60-minute ischemia. On the basis of these data, insofar as the duration of ischemia is not so long that cell damage becomes irreversible, damage by superoxide after reperfusion will be negligible. Therefore, intermittent short-term inflow occlusion is preferable in hepatic surgery.

Animals↗