Biomedical subjects

S Togo

Publications and source records attributed to S Togo.

65 records · Page 4Linked to original sources

PubMedDate not supplied

Use of transcatheter arterial infusion of anticancer agents with lipiodol to prevent recurrence of hepatocellular carcinoma after hepatic resection.

BACKGROUND/AIMS: Hepatectomy has been accepted as a reliable cure for primary hepatocellular carcinoma (HCC). However, the residual liver recurrence rate after hepatectomy remains high. To improve the prognosis after hepatectomy for HCC, repeated post-operative transcatheter arterial infusions of anticancer drugs and lipiodol (TAI) was given. This study evaluates the efficacy of this treatment for preventing residual liver recurrence after hepatectomy. METHODOLOGY: TAI after hepatectomy was performed in 24 (TAI group) of 65 cases showing tumor invasion such as infiltration to the capsule, intraportal spread, and intrahepatic metastasis. In TAI, a mixture of Mitomycin C (MMC) and Adriamycin (ADM) is administered with lipiodol via the hepatic artery. The recurrence and survival rates of the TAI (n = 24) and non-TAI (n = 41) groups were compared to evaluate the efficacy of TAI after hepatectomy. RESULTS: The TAI group had a lower cumulative residual liver recurrence rate than the non-TAI group (p < 0.01). Division of residual liver recurrence cases into two groups according to the duration of recurrence showed that the rate of recurrence within 1 year after hepatectomy was lower in the TAI group (10.0%) (1/10) than in the non-TAI group (48.4%) (15/31) (p = 0.07). Also, the cumulative survival rate in the TAI group was significantly higher (p < 0.05). The morbidity rate was 16.6%. Bilomas occurred without infection in 2 cases, and liver abscess in one. CONCLUSIONS: TAI may be an effective surgical adjuvant against residual liver recurrence, and we suggest that its effectiveness results from suppression of intrahepatic micrometastases rather than multicentric carcinogenesis.

Aged↗

PubMedDate not supplied

Subdivision of liver anterior segment into two units according to hepatic venous drainage.

BACKGROUND/AIMS: In anatomic liver resection, consideration of the distribution of the hepatic vein is important for maximizing remnant liver function. We have examined the anterior segment of the liver tomographically and subdivided it according to the hepatic venous distribution. METHODOLOGY: Thirty patients in whom liver tumors were diagnosed and who were examined by three-dimensional computed tomography were reviewed. Portal and hepatic venous distributions in the anterior segment were analyzed using the tomograms obtained, and the anterior segment was divided into the ventral and dorsal units. RESULTS: S8d was present in only 23 cases, out of which in 14 cases, drainage veins were present. When P8d was supplied by P8, S8d together with S8a were classified into the ventral unit (8 cases). When P8d was supplied by P8c, S8d and S8b and S8c were in the dorsal unit (4 cases). S5a was in the ventral unit in 26 cases and the dorsal unit in 4 cases. S5b was in the ventral unit in 11 cases and in the dorsal unit in 19 cases. The ventral unit was drained by the middle, and the dorsal by the right, hepatic vein. CONCLUSIONS: Three-dimensional computed tomography made it possible to classify the anterior segment into ventral and dorsal units according to the distribution of the hepatic vein. This new classification makes possible new operative procedures in which resection is limited to one of the units with or without one or more segments, and which result in better remnant liver function.

Aged↗

PubMedDate not supplied

Early enteral nutrition after hepatectomy to prevent postoperative infection.

BACKGROUND/AIMS: Enteral nutrition helps to prevent septic complications in patients with critical illness, but there are few reports on its use after hepatectomy. To evaluate its benefits, we studied the indications for it. METHODOLOGY: In a retrospective study we reviewed 67 hepatectomized patients, 19 with enteral nutrition after hepatectomy (EN group) and 48 without (TPN group). In the TPN group, the risk factors of postoperative infections were analyzed with discriminant analysis. Then we prospectively selected high-risk patients before surgery and started enteral nutrition soon after surgery. The incidences of postoperative infections were examined in the EN and TPN groups of high-risk patients. RESULTS: In high-risk patients selected using a new discriminant formula, the infection rate was decreased from 73.1% in the TPN group to 53.3% in the EN group (NS). However, in cases in which enteral nutrition was initiated within 4 days after surgery, the infection rate dropped to 30%, a significant decrease (P < 0.03). In this prospective study, the infection rate of high-risk patients was markedly decreased and the overall infection rate was decreased significantly, to 21.4% from 47.4% in the retrospective study (P < 0.02). CONCLUSIONS: We conclude that early enteral nutrition after hepatectomy is helpful for preventing septic complications, especially in patients at high risk of infection as evaluated with our new formula.

Enteral Nutrition↗

PubMedDate not supplied

Changes in clinicopathological findings after portal vein embolization.

BACKGROUND/AIMS: Portal vein embolization is becoming more common as a method of preventing hepatic failure after an extended hepatectomy but its mechanism is not well understood. This clinicopathological study focused on its mechanism. METHODOLOGY: Thirty patients who underwent extended hepatectomy after portal vein embolization were evaluated. Liver volume was measured before and after portal vein embolization, and histological studies were performed to examine morphological changes, morphometric parameters and apoptosis of hepatocytes. RESULTS: The mean volume of the non-embolized lobe grew significantly from 392 to 462 mL after portal vein embolization (P < 0.0001). The hypertrophy ratio of the non-embolized lobe (100 x volume change during portal vein embolization/volume before portal vein embolization, %) was correlated closely with the volume of the non-embolized lobe before portal vein embolization (r = -0.65, P < 0.0001). Histological study showed the embolized lobe hepatocytes to be atrophic, partly necrotic and apoptotic. In the non-embolized lobe, the mean hepatocyte volume was 8686 micron 3 (control: 6544 micron 3) and the mean hepatocyte count was 109 x 10(6)/mL (control: 122 x 10(6)/mL). CONCLUSIONS: The enlargement of the non-embolized lobe was caused by hypertrophy rather than hyperplasia suggesting hyperfunction. The resection of the atrophic embolized lobe, leaving the hypertrophic non-embolized lobe was thought to be less surgically stressful than hepatectomy without portal vein embolization.

Aged↗

PubMedDate not supplied

Indications for posthepatectomy hepatic vein reconstruction from functional and morphological studies: clamping test and hepatic vein branch distribution determined by three-dimensional computed tomography.

BACKGROUND/AIMS: Indications for hepatic vein reconstruction for preserving remnant liver function after hepatectomy were assessed using the clamping test and the findings of preoperative 3D-CT (3-dimensional computed tomography). METHODOLOGY: Fifteen patients who underwent hepatectomy for malignant tumors in segment VII or VIII, or both, were examined with preoperative 3D-CT and an intraoperative clamping test. RESULTS: On the basis of changes in right hepatic venous pressure during clamping, we classified all patients into 3 types: the persistent elevation type (P-type, 8 patients), the no elevation type (N-type, 3 patients) and the transitory elevation type (T-type, 4 patients). Hepatic venous hemoglobin oxygen saturation (ShvO2) decreased significantly in the P type but hardly changed in the T and N types during the clamping test. Both the inferior right hepatic vein (IRV6) and the tributary of the middle hepatic vein draining segment V (MV5) were detected by preoperative 3D-CT in the T and N types. CONCLUSIONS: Assessments of hepatic vein branch distribution using preoperative 3D-CT served to predict the results of the hepatic vein clamping test. The results of preoperative 3D-CT were useful as indications for hepatic vein reconstruction.

Adult↗

PubMedDate not supplied

Is hepatic resection for multiple liver metastases from colorectal carcinoma acceptable treatment?

BACKGROUND/AIMS: To determine an appropriate surgical treatment for patients with multiple liver metastases, we evaluated the efficacy of treatment in patients with 5 or more liver tumors in both lobes after metastasis from colorectal carcinoma which we refer to as H3 liver metastasis. METHODOLOGY: Seventy-two cases of H3 liver metastasis were classified as follows into four types according to tumor distribution in the liver: type A (n = 16), multiple metastases present in one lobe, and, in the other, confined to one segment; type B (n = 12), multiple metastases present bilaterally, but with tumors larger than 2 cm in diameter confined to one lobe or to three segments; type C (n = 10), multiple and diffuse metastases present in both lobes and all tumors 2 cm or less in diameter; and type D (n = 34) metastatic tumors larger than 2 cm in diameter occurring in every segment of the both lobes. Hepatectomy was performed within a possible range as a rule for all cases, and intrahepatic arterial infusion was performed in unresectable cases. In cases that responded to intrahepatic arterial infusion, hepatectomy was considered and performed when technically possible and potentially curative. RESULTS: The proportion of cases treated with hepatectomy were: type A, 56.3%; type B, 8.3%; type C, 10.0%; and type D, 2.9%. The regional intrahepatic arterial infusion ratios and response rates to it were 18.8% and 0.0% in type A, 91.7% and 33.3% in type B, 80.0% and 71.4% in type C, and 64.7% and 0.0% in type D, respectively. One type B patient whose tumor showed complete resolution after intrahepatic arterial infusion and one type C patient with a partial response underwent hepatectomy. The cumulative survival rate at two years was significantly lower in type D (3.2%), than in the other types (type A, 33.3%; type B, 36.4%; and type C, 11.7%). CONCLUSIONS: These results suggested that hepatectomy should be performed in cases of type A, and that intrahepatic arterial infusion may be effective as neoadjuvant chemotherapy for type B or C. However, there is no effective treatment for type D at present.

Aged↗

PubMedDate not supplied

Monocyte CD14 changes and endotoxemia after major hepatectomy.

BACKGROUND/AIMS: This study was designed to ascertain whether decreases in membrane CD14 (mCD14), the endotoxin receptor on the surface of the monocyte cell membrane, reflect the presence of endotoxemia, and whether endogenous endotoxemia is present after hepatectomy. METHODOLOGY: First, in cases with a definitive clinical diagnosis of endotoxemia, we determined the serum endotoxin level by the ES (Endospesy) method, from the percentage of cells positive for membrane CD14, from the CD14 fluorescence intensity (MFI-CD14), and from the quantification of soluble CD14 (sCD14); and calculated the diagnostic accuracy obtained with each. Next, in 13 cases of extended hepatectomy (in excess of lobectomy) the mCD14-positive rates were determined around the time of the operation, and compared with the clinical courses of infection foci, if any, and other findings. RESULTS: The diagnostic accuracy of endotoxemia obtained by ES, mCD14, MFI-CD14 and sCD14 were 77.3%, 95.5%, 86.7% and 66.7%, respectively, so that the highest was given by the positive mCD14 cell rate. Although no infectious complication was detected in any of the 9 patients in whom the mCD14-positive rates changed within the normal range, of the 4 patients in whom the mCD14-positive rates fell, 2 had cholangitis due to gram-negative bacilli, one who was infected by central vein catheterization, was thought to have exogenous endotoxemia; and the fourth, in whom no clear focus of infection was detected, ran a temperature of 38 degrees C (over 100 degrees F) of unknown origin for 16 days. In this last patient, gram-negative bacilli were detected in both the saliva and the gastric juice, and so endogenous endotoxemia was suspected. CONCLUSIONS: These results show that decrease in the mCD14-positive rate is more accurately diagnostic of endotoxemia than the endotoxin value obtained by the ES method, and was considered to be a definitive diagnosis of endotoxemia. In addition, from the reduction of the mCD14-positive rate after extended hepatectomy, it was considered that endogenous endotoxemia occurred in one case out of 13 (8%).

Endotoxemia↗

PubMedDate not supplied

Clinical significance of serum CEA protein and CEA mRNA after resection of colorectal liver metastases.

BACKGROUND: It is difficult to predict the recurrence of colorectal liver metastasis after curative hepatectomy. We investigated the relationship between subsequent metastasis and both CEA protein and CEA mRNA (TaqMan PCR) diachronic levels. PATIENTS AND METHODS: The subjects were 30 patients with colorectal liver metastases. Serum CEA protein and CEA mRNA assays were performed every month after hepatectomy. RESULTS: Metastasis recurred in 21 of the 30 patients. The CEA mRNA assay showed 26 cases with high (H) levels and 4 with low (L). Among the 15 patients whose protein levels were not elevated (NE group), 6 had recurrence; all 6 belonged to the mRNA H group. None of the 4 patients in the mRNA L group had recurrence. In the protein-elevated (E) group (DFI > 6 months) (n = 7), mRNA was elevated in 5 cases (71.4%) 6 months before recurrence, whereas protein was elevated in 1 case. The sensitivity, specificity and accuracy of CEA protein/mRNA for identifying recurrence were 71.4/100, 100/44.4, and 80/83.3%, respectively. CONCLUSION: CEA mRNA is more sensitive than CEA protein in detecting recurrence. CEA mRNA may be useful for identifying high-risk groups or detecting recurrence at an early stage, when the CEA protein level is still low.

Aged↗

PubMedDate not supplied

"Seed" to "soil" is a return trip in metastasis.

A critical aspect in understanding and treating cancer progression and metastasis is the relationship of the host originating organ and metastatic "soil" organs that support the growth and progression of the cancer "seed". We have recently demonstrated that there is a great difference in seemingly similar visceral organs, the colon and the stomach to support the growth progression of transplanted human colon tumors in nude mice. To further understand the relationship of seed and soil in cancer, we transplanted the metastatic human colon tumor CO-3 on the liver of nude mice, which is a usual metastatic soil organ for this tumor if transplanted to the nude-mouse colon. The intrahepatically-transplanted CO-3 tumor grew extensively on the nude-mouse liver without intra-hepatic metastasis. However, cecal growth, peritoneal dissemination, and invasiveness were noted after extensive growth on the liver with no spread to other organs. This phenomenon suggested that the intra-hepatically transplanted tumor could "reversibly metastasize" to the orthotopic site and secondarily spread into the abdominal cavity. The observation reported here suggests that "seed" to "soil" is reversible in metastasis in that the tumor can spread in either direction between two "matched" organ "soil".

Adenocarcinoma↗

PubMedDate not supplied

Cancer seed and soil can be highly selective: human-patient colon tumor lung metastasis grows in nude mouse lung but not colon or subcutis.

The question remains as to whether metastatic cells (cancer seed) that eventually colonize a particular organ (cancer soil) have specific properties that distinguish them from the other cells of the primary tumor. However until recently there have not been model systems in which this question could be fully answered. To further understand the relationship between seed and soil we have developed an orthotopic-transplantation nude-mouse model that allows human tumors to essentially replicate their behavior they had in the patient. The patient-like behavior of the transplanted human tumor in the nude mouse depends on the use of intact tumor tissue for orthotopic transplantation. Here we report that a colorectal tumor lung metastasis surgically resected from a patient could grow in nude mouse lung, but not in either the colon or the subcutis after transplantation of intact tissue. The results were striking in that the human colorectal tumor lung metastasis grew in the lung of the animals and not in the colon or in the subcutis of the animals. The results described here suggest that the lung metastasis of the patient colon tumor is distinct in its soil requirement from the majority of the cells of the original colon tumor. In contract, in the intact-tissue orthotopic transplant model, primary human colon tumors grow when transplanted to the colon of the nude mouse. Thus the colorectal cancer "seed" which metastasized to the lung in the patients seems very selective for the "soil" of the lung of both the patient and the nude mouse.

Animals↗

PubMedDate not supplied

Management of malignant tumor with intracaval extension by selective clamping of IVC.

BACKGROUND/AIMS: Malignant tumors with retrohepatic intracaval extensions are difficult to treat. We report five cases of intracaval tumor emboli (3 hepatocellular carcinoma, 2 renal cell carcinoma). MATERIAL AND METHODS: The tumor embolus is removed by the following methods according to site: in the right atrium, by open heart surgery after clamping of the inferior vena cava between the superior vena cava and the intrahepatic inferior vena cava and of the portal vein, in combination with a cardiopulmonary bypass using a pump oxygenator; above the confluence of the hepatic vein with the inferior vena cava, by inferior vena cava clamping between its suprahepatic and intrahepatic portions, shunting from the inferior vena cava and the portal vein to the axillary vein; below the inferior vena cava-hepatic vein confluence, by inferior vena cava clamping below the confluence and in the infrahepatic portion; and around the confluence, by side clamping of the inferior vena cava, maintaining both hepatic and systemic circulations. RESULTS: Pulmonary emboli were diagnosed in one patient. However, the patient's condition improved with anti-coagulant therapy. No major complication was observed in any other patient. All patients were discharged after a mean postoperative period of 32.8 days. One patient with HCC died of lung metastasis at 5 months and the other two, of recurrence in the residual portion of the liver at 4 and 16 months, and the two with RCC are still alive without recurrence of the carcinoma 9 and 14 months later. CONCLUSIONS: Preoperative recognition by ultrasonography, computed tomographic scanning, cavography and especially trans-esophageal endoscopic ultrasonography is important. Vascular exclusion may also be performed by various techniques depending on the site of the tumor embolus.

Adult↗