Biomedical subjects

N Koyanagi

Publications and source records attributed to N Koyanagi.

81 records · Page 5Linked to original sources

PubMedDate not supplied

Surgical results of spontaneously ruptured hepatocellular carcinoma.

Seventeen patients with ruptured hepatocellular carcinoma (HCC) underwent a hepatic resection from 1985 to 1992 at either Kyushu University Hospital or Iizuka Hospital in Japan. They all underwent elective surgical procedures except for one patient who experienced a repeated rupture during hospitalization. A comparative study between the patients with ruptured HCC and non-ruptured large HCC measuring more than 6 cm in size (n = 29) revealed that the 3-year disease-free survival rate of the ruptured HCC group was 14.5% which was worse than that of the non-ruptured group at 39.9%. There was no difference in the rates of peritoneal dissemination, distant metastasis or intrahepatic recurrence between the two groups. Regarding the intrahepatic recurrence pattern, widespread multinodular recurrence frequently occured in the ruptured patients, which was thought to be caused by the high incidence of venous invasion in the primary tumor. The intratumor pressure of the ruptured HCC appeared to be elevated and is considered to be one of the main reasons for the high incidence of venous invasion.

Adult↗

PubMedDate not supplied

Small hepatic nodules surrounding hepatocellular carcinoma.

BACKGROUND/AIMS: We investigated whether or not small hepatic nodules surrounding the main hepatocellular carcinoma were malignant, while also analyzing the role of intraoperative ultrasonography in detecting these small nodules. MATERIALS AND METHODS: Thirty-three small hepatic nodules near the main tumor in 17 patients were retrospectively studied. They were first detected either during or after the operation using intraoperative ultrasonography and/or after examining a cross-section of the resected specimen. RESULTS: Twenty-six of the 33 small nodules were shown to be malignant when studied histologically (79%). The reliability of intraoperative ultrasonography was higher than 80 per cent for detecting nodules measuring more than 5 mm in diameter. However, it was only 25 per cent reliable with smaller nodules measuring less than or equal to 5 mm. CONCLUSIONS: These results suggest that most small hepatic nodules with hepatocellular carcinoma should be considered to be malignant. In addition, smaller nodules measuring less than 5 mm in size can hardly be detected by intraoperative ultrasonography.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Clinical and angiographic assessments and treatment of patients with recurrent varices after transabdominal transection of the esophagus.

BACKGROUND/AIMS: Risk factors regarding the recurrence of esophageal varices and were researched preoperative clinical and angiographic findings in patients with variceal recurrence and/or rebleeding after transabdominal esophageal transection were analyzed. MATERIALS AND METHODS: Clinical and angiographic assessments of recurrence of varices after transabdominal esophageal transection were made on 55 patients with portal hypertension. In all these patients, postoperative endoscopy was performed at 3-6 monthly intervals. RESULTS: Varices recurred in 13 patients and 4 patients re-bled during the 5-106 month follow up. There was a significant increase in the rate of recurrence in patients with a history of hematemesis, and in those with a higher grade of development of cephalad collateral vessels in the lesser splanchnic area, as seen on the preoperative portography. Eight of the 13 patients were then effectively treated by endoscopic injection sclerotherapy. CONCLUSIONS: Despite transabdominal transection of the esophagus, varices may well recur if the patient has had a history of hematemesis and a higher grade of development of cephalad collateral vessels. In such cases endoscopic injection sclerotherapy should be done.

Adult↗

PubMedDate not supplied

Does a long pre-operative hospital stay before hepatectomy improve liver dysfunction in HCC patients with chronic liver disease?

BACKGROUND/AIMS: We retrospectively evaluated whether or not hepatic dysfunction improved in patients with chronic liver disease who had been waiting to undergo a hepatectomy after admission. MATERIALS AND METHODS: Fifty-two hepatocellular carcinoma patients had been admitted for more than 2 weeks prior to undergoing a hepatectomy. They had a liver function test twice, at admission and just before surgery, during the hospitalization period. Twenty-six of them were histologically diagnosed as having chronic hepatitis while the remainder had liver cirrhosis. In the liver function test, the serum levels of albumin, total bilirubin, glutamic pyrubic transaminase (alanine transaminase), total cholesterol and the Child grade were examined. RESULTS: First, including the pre-operative treatment cases for small tumors under angiography, the total bilirubin and transaminase levels improved in the chronic hepatitis patients with a statistically significant difference, but no difference was observed in the Child grade. In the examined cirrhotic patients, no significant difference was shown in the tests. Second, after excluding the pre-operative treatment cases, we performed the same investigation as that for chronic liver disease cases and only the transaminase level significantly improved. CONCLUSIONS: A long pre-operative hospital stay might only by justified in patients with a high level of transaminase corresponding to chronic active hepatitis.

Adult↗

PubMedDate not supplied

A new technique for repairing a blunt injured duodenum.

Repairing a blunt injured duodenum remains a problem for surgeons because of the difficulty in early diagnosis, associated organ injuries, and frequent anastomotic site leakage. We have devised a simpler and safer procedure for transecting the ligament of Treitz and performing a debridement of the duodenum The duodenum is freed and exposed by transecting the ligament of Treitz. The injured site is then resected with appropriate debridement. The remnant stumps of the duodenum and the jejunum are anastomosed. The advantages of our method are less invasion, a more physiologic state, and no retention of food in the repaired duodenum. This technique reduces tension in the repaired wound and also reduces mortality and morbidity.

Digestive System Surgical Procedures↗

PubMedDate not supplied

Tumor stage in the proximal colon under conditions of a proximal shift of colorectal cancer with age.

BACKGROUND/AIMS: Although the incidence of proximal colon cancer is known to increase with age, the prognosis of proximal colon cancer remains unclear. METHODOLOGY: One thousand two hundred and five patients with colorectal cancer were analyzed with regard to tumor location, age and Duke's stage. RESULTS: When Duke's stage was compared with tumor location, an advanced Duke's stage was found more frequently in the proximal colon than in the distal colorectum (p<0.01). In Duke's A colorectal cancer, the incidence of tumors limited to within the submucosal layer decreased from 73.1% in patients under 65 years of age to 60.9% in patients over 65 years of age. CONCLUSIONS: Since advanced stage cancer was more frequently found in the proximal colon than in the distal colorectum, careful examination for the early detection of proximal colon cancer, particularly in the elderly, is called for.

Adult↗

PubMedDate not supplied

Possibility of different cancer development between the proximal and distal colon: comparison of the distribution between adenomatous polyps and cancer.

BACKGROUND/AIM: The aim of this study was to compare the distribution of adenomatous polyps with that of cancer in the colon by using adenomatous polyps removed by colonoscopy. METHODOLOGY: 1223 adenomatous polyps removed by an endoscopic polypectomy were compared with 226 colon cancers with regard to their distribution, size and age. RESULTS: With patients over 65 years of age, the incidence of adenomatous polyps was lower in the proximal colon than in the distal colon, however, the incidence of cancer was higher in the proximal colon than in the distal colon (p<0.05). The distribution of adenomatous polyps according to size was also significantly different between the proximal and distal colon (p<0.05). CONCLUSION: These results thus suggest that some difference may exist in cancer development between the proximal and distal colon.

Adenocarcinoma↗

PubMedDate not supplied

Natural history of hepatectomy regarding liver function: a study of both normal livers and livers with chronic hepatitis and cirrhosis.

BACKGROUND/AIMS: The cirrhotic liver has been shown to regenerate after hepatectomy based on the findings of various imaging techniques. However, little has been reported so far regarding the restorative process using the liver function test in a long series after hepatectomy of both normal and injured livers. METHODOLOGY: A retrospective review was performed of 48 patients who underwent hepatic resection due to either primary or secondary liver cancers. They were histologically divided into three groups of 6 normal, 23 chronic hepatitis and 19 cirrhotic liver patients. In addition, the hepatitis group was divided into two groups according to the resected volume, which were 16 of a small resected volume and 7 of a large volume. For these patients, both a complete blood count and normal liver function test were performed before operation, and 7 and 14 days, 1, 3, and 6 months, and 1, 2, and 3 years, postoperatively. RESULTS: In the normal patient group, almost all test results recovered to their preoperative levels by 14 days to 1 month postoperatively. In the cirrhotic group, however, the red blood cell count and hematocrit levels did not recover to preoperative levels until 3 months postoperatively, while the GPT levels, the total bilirubin and albumin all recovered by one month postoperatively. However, the total cholesterol level needed 6 months to recover. In the large resection hepatitis group, the GPT level needed 7 days to recover, while the albumin and total cholesterol level needed three months to do so. In addition, the platelet level decreased significantly at 3 months postoperatively and thereafter it seemed to remain at a lower level. CONCLUSIONS: We demonstrated that a hepatic resection in patients with chronic liver disease requires a longer period of time to recover to preoperative levels based on the type of underlying liver parenchymal disease and the extent of resection.

Aged↗

PubMedDate not supplied

Appraisal of a manual blunt dissection for an intraoperative diagnosis of extrahepatic cancer invasion.

BACKGROUND/AIMS: Liver cancer extension to the adjacent organs does not necessarily indicate tumor invasion. It is very hard to diagnose extrahepatic cancer invasion to the adjacent organs using preoperative imaging. This study was undertaken, therefore, to determine the real cancer invasion using a manual dissection. METHODOLOGY: Of the 51 consecutive patients with liver cancer, 6 cases with extrahepatically growing tumors were suspected to have cancer invasion both preoperatively and intraoperatively. Thus, we diagnosed whether or not any real extrahepatic cancer invasion was present by either removing the tumour by hand or by performing a blunt gauze dissection. RESULTS: Three hepatocellular carcinomas and one metastatic cancer were stripped off from the adjacent organ using a manual blunt dissection. However, the other two tumors could not be removed in the same manner and therefore a combined resection of the invaded portion had to be performed along with the hepatectomy. A postoperative detailed pathological examination revealed no cancer cells on the surface of the adjacent organ in the former 4 tumors. Cancer invasion was recognized, however, on the outside of the liver in the latter 2 combined resected tumors. CONCLUSIONS: An accurate intraoperative diagnosis of extrahepatic cancer invasion can be made using manual blunt dissection.

Aged↗