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T Kin

Publications and source records attributed to T Kin.

At least 37 records · Page 2Linked to original sources
PubMed1998

Comparison of hemodynamic changes in two veno-venous bypass techniques modified at the portal cannulation site.

Veno-venous bypass under total vascular exclusion is a useful technique to permit safer resection of hepatic malignancy. We describe here a retrospective study of two modified venous bypass techniques as alternatives to the conventional end-on portal cannulation technique. Portal decompression via inferior mesenteric vein access was performed in eight patients (group A), and portal decompression via a passive shunt between a branch of the mesenteric vein and the right saphenous vein was performed in a second group (group B; n = 8). Both techniques were used in hepatic resection for malignancy under total vascular exclusion. To assess the efficacy of these bypass techniques, we compared the hemodynamic changes in the two groups. There were no differences in the bypass flow between the two groups. Neither group showed any significant changes in hemodynamic parameters (including mean arterial pressure, cardiac index, systemic vascular resistance index, and pulmonary artery pressure) between the pre-bypass and bypass phases. The heart rate in the bypass phase was significantly increased compared to that in the pre-bypass phase in both groups. All hemodynamic parameters in each phase were similar in the two groups. We conclude that both techniques maintained adequate venous return and stabilized the hemodynamic changes during hepatic resection under total vascular exclusion, and that either technique can be selected according to the intraoperative situation.

Aged↗
PubMed1998

Repeat hepatectomy for recurrent colorectal metastases.

Recurrence rates after hepatic resection in patients with colorectal metastases are reported to range from 47% to 80%. Hepatic recurrence is seen in 35% to 50% of patients. Aggressive surgical resection appears to be a worthwhile treatment in patients with recurrent hepatic metastases to promote longer patient survival because surgical resection remains the only curative therapy available. This is a retrospective review of our experience with 15 patients undergoing repeat hepatic resection culled from 67 patients undergoing initial hepatectomy for metastatic colorectal cancer. Of 67 patients who underwent hepatectomy for colorectal hepatic metastases, 33 developed hepatic recurrence at a median interval of 23 months (range 1-176 months) after the first hepatectomy. The second hepatectomy was performed in 15 patients 5 to 29 months after the first hepatectomy, with no mortality. The mean operating time and blood loss at the second hepatectomy were similar to those at the first hepatectomy. The mean hospital stay at the second hepatectomy was significantly shorter than that at the first hepatectomy. The cumulative survival rate for the 15 patients was 42.4% at 3 years and 21.2% at 5 years, respectively, which compared favorably with the survival rate of the 67 patients who underwent initial hepatectomy. Patients who underwent the second hepatectomy had significantly higher survival rates from the first hepatectomy than the 18 patients with unresectable hepatic recurrence. Repeat hepatectomy can be performed safely and provides long-term survival rates similar to those of first hepatectomies. In appropriately selected patients, repeat hepatectomy for colorectal metastases is a worthwhile treatment.

Adult↗
PubMed1998

[Successful management for chemorefractory testicular cancer with brain and lung metastases. A case report].

This is a report of successful management for a far advanced, chemorefractory testicular cancer patient. A 29-year-old male was referred to our hospital for the treatment of progressive lung metastases with elevated hCG level, which had recurred after complete remission following 3 courses of BEP chemotherapy and progressed after transient partial regression following 2 courses of intensified EP chemotherapy. In addition, a 3 cm in diameter, solitary brain metastasis was detected on CT. First, we performed wedge resection of bilateral pulmonary lower lobe for chemorefractory pulmonary metastases. Histological examination revealed viable embryonal carcinoma identical to the primary one. Thereafter, whole brain irradiation in combination with VIP chemotherapy (etoposide 100 mg/m2, cisplatin 20 mg/m2 and ifosfamide 1200 mg/m2 daily for 5 consecutive days) was carried out to treat brain metastasis. By 2 cycles of VIP therapy and irradiation (36 Gy), partial tumor regression and normalization of hCG level were achieved, leading to salvage surgery of the brain metastasis which histologically proved to be necrosis. Following an additional cycle of VIP therapy, the patient has been free of recurrence 24 months after completion of the treatment.

Adult↗
PubMed1998

Examination of prognostic factors after resection of pulmonary metastasis of osteosarcoma by multivariate analysis.

Prognostic factors for the case of pulmonary metastasis of osteosarcoma was examined using the multivariate analysis. 1) The 3-year survival rate after operation of primary focus in 23 cases was 34.8% and the 5-year survival rate was 30.4%. The 3-year survival rate after the first operation of pulmonary metastasis was 30.4% and the 5-year survival rate was 12.2%. No deaths attributed to operation were found. 2) Gender, age, histological type, solitary or multiple pulmonary metastasis, laterality, number of pulmonary metastatic tumors, TDT and DFI were examined, and the laterality, number of pulmonary metastatic tumors and DFI were considered to be useful prognostic factors. DFI among them was most closely associated with postoperative survival days. 3) A significant difference in the number of excised nodules was found between the DFI less than 90 days group and the DFI not less than 90 days group, and the number in the former group was significantly larger. 4) It was suggested that postoperative observation and close examination for pulmonary metastasis at about 3 months intervals after of primary focus are important, and also, positive or negative pulmonary metastasis as the time of examination, particularly, the number metastatic nodules of less than 5 or not less than 5, are reflected in the prognosis. 5) Expected survival time after the first operation pulmonary metastasis appeared possible to estimate as 3.0 x DFI days.

Adolescent↗
PubMed1998

A case of pulmonary metastases of synovial sarcoma surviving for a long period after active surgery.

The patient was a 24-year-old woman. She underwent marginal excision of synovial sarcoma originating in the right femoral soft tissue at the age of 18, followed by local radiation therapy and chemotherapy. At the age of 20, abnormal shadow was indicated in bilateral lungs on plain roentgenography of the chest, and she underwent open-chest surgery for excision of bilateral pulmonary metastatic tumors. She was subjected to bilateral thoracotony repeatedly thereafter for a total of 5 times, and all of the metastatic foci detected in each operation were resected. Consequently, she has been surviving for a long period of about 7 years. The therapeutic outcome of tumor of bone soft tissue is greatly affected by its pulmonary metastasis. Although the therapeutic outcome has recently been improved by large dose chemotherapy and active excision of metastatic foci in the lung, survival time in the case of synovial sarcoma, giant cell sarcoma and Ewing's sarcoma is not very long yet. In the present study, we observed a patient who had lung metastasis of synovial sarcoma of which prognosis is generally considered poor has been surviving for a long time of 7 years owing to active excision of pulmonary metastatic foci. The relation of the present prognostic factors to those in the past were compared.

Adult↗
PubMed1997

Transthoracic transdiaphragmatic approach for hepatectomy of Couinaud's segments VII and VIII.

For hepatectomy of Couinaud's segment VII or VIII, severe compression and mobilization of the liver is required to establish the operative field via the usual transabdominal approach. Compression of the cirrhotic liver impairs hepatic and systemic blood circulation, which may cause liver dysfunction. We adopted a transthoracic transdiaphragmatic approach for hepatectomy of segment VII or VIII in cirrhotic patients to establish a good operative field without compressing the liver. The aim of this study was to evaluate the benefits of this approach. Forty-four patients with hepatocellular carcinoma (HCC) complicating liver cirrhosis who underwent limited hepatectomy of Couinaud's segment VII or VIII were studied. The patients were randomized to two groups preoperatively: group I (n = 22), transabdominal approach; group II (n = 22), transthoracic transdiaphragmatic approach. There were no differences in preoperative liver function tests, hepatic functional reserve, or extent of tumor between the two groups. The operative time in group II was significantly shorter than that in group I (243 +/- 50 versus 313 +/- 80 minutes;p < 0.01). Operative blood loss in group II was also significantly smaller than that in group I (1190 +/- 1098 versus 2679 +/- 2267 g;p < 0.01). Serum lactate dehydrogenase levels on postoperative day 1 in group II were significantly lower than those in group I (587 +/- 154 versus 791 +/- 383 IU/L;p < 0.05). Major postoperative complications were significantly fewer in group II. It was concluded that the transthoracic transdiaphragmatic approach is a useful method for hepatectomy of segments VII and VIII in cirrhotic patients.

Chi-Square Distribution↗
PubMed1996

Influence of associated viral hepatitis status on recurrence of hepatocellular carcinoma after hepatectomy.

The purpose of this study was to investigate the relation between the recurrence of hepatocellular carcinoma (HCC) and the histologic status of underlying chronic liver disease from a viewpoint of multicentric hepatocarcinogenesis. Sixty-eight patients who underwent curative resection of HCC and have been followed for more than 2 years are reported. Based on the microscopic findings of the noncancerous part of the liver, the patients were divided into normal liver (N,n = 2), chronic persistent hepatitis (CPH,n = 6), chronic aggressive hepatitis (CAH,n = 31), and liver cirrhosis (LC,n = 29) according to a classification by the European Association for the Study of the Liver. Background data for the groups showed no significant differences. Recurrence was observed in none of the patients in the N and CPH groups, 26 (83.9%) of the patients in the CAH group, and 12 (41.4%) of the patients in the LC group. The cumulative disease-free survival rate of the CAH group was significantly lower than that of the CPH group (p < 0.05) and LC group (p < 0.01). This study revealed that the histologic status of the underlying chronic liver disease influenced the recurrence rate in patients with HCC. CAH was considered to be a risk factor for recurrence after resection of HCC.

Aged↗
PubMed1996

Significant influence of accompanying chronic hepatitis status on recurrence of hepatocellular carcinoma after hepatectomy. Result of multivariate analysis.

OBJECTIVE: The aim of this study was to evaluate the correlation between the histologic status of accompanying chronic hepatitis and the recurrence rate of hepatocellular carcinoma (HCC) after hepatectomy by multivariate analysis. SUMMARY BACKGROUND DATA: Recent studies have suggested that a considerable number of intrahepatic recurrence of HCC after hepatectomy might be the results of metachronous multicentric hepatocarcinogenesis. The authors hypothesized that the incidence of recurrence due to metachronous multicentric hepatocarcinogenesis would depend on the histologic status of accompanying chronic viral liver disease, which is a main promoter of HCC. METHODS: One hundred ten patients with HCC who underwent curative resection were studied. Histologic status of accompanying chronic hepatitis was classified into the three categories: 1) normal liver or chronic persistent hepatitis (CPH, n = 13), 2) chronic aggressive hepatitis (CAH, n = 50), and 3) liver cirrhosis (LC, n = 47). RESULTS: The Cox multivariate proportional hazard model showed that the accompanying chronic viral hepatitis status (p = 0.0133), extent of hepatectomy (p = 0.0078), and number of tumors (p = 0.0475) were significantly predictive variables for recurrence-free survival. By the log-rank test, recurrence-free survival rate in patients with CPH was significantly higher than those in patients with CAH (p = 0.0005) and LC (p = 0.0075). Patients with CAH had the lowest recurrence-free survival rate (vs. LC, p = 0.028). CONCLUSIONS: The results of this study indicated the significant influence of histologic activity of hepatitis on recurrence of HCC. This might support the concept of significant contribution of multicentric hepatocarcinogenesis to recurrence of HCC after hepatectomy.

Adult↗
PubMed1996

Different immunosuppressive effects of liposomal FK506 in liver and kidney transplantation.

The efficacy of liposomal FK506 was compared between a canine liver transplantation model and a canine kidney transplantation model. The present study revealed that liposomal FK506 increased immunosuppressive efficacy of FK506 in liver transplantation but decreased in kidney transplantation. Because liposomal FK506 increased FK506 levels in the liver and spleen, and decreased FK506 levels in the kidney, it was suggested that enhanced immunosuppressive efficacy in liver transplantation should be attributed to the local immunosuppressive effects in the hepatic allograft rather than effective suppression of splenocyte activity.

Animals↗
PubMed1996

Liver transplantation for hepatocellular carcinoma: consideration from the findings on autopsy.

Extrahepatic spread of hepatocellular carcinoma was investigated in twenty autopsy cases with unresected hepatocellular carcinoma to define the appropriate patient selection criteria for liver transplantation. Diagnosis of extrahepatic spread of cancer by diagnostic imaging was not easy, and unsatisfactory prognosis after liver transplantation in patients with hepatocellular carcinoma might have been attributed to the high incidence of extrahepatic occult foci of cancer. All patients with multiple nodular, massive and diffuse tumor had extrahepatic spread of cancer. Only patients with a single nodular type tumor, no larger than 30 mm in diameter, had no extrahepatic metastasis, and these patients are the preferred candidates for liver transplantation.

Aged↗
PubMed1996

[Prognostic factors of resected pulmonary metastases of osteogenic sarcoma].

From December 1979 to December 1994, 22 patients with osteogenic sarcoma underwent a total of 34 thoracotomies for resection of pulmonary metastases in our department. We did a retrospective study to identify prognostic factors. The tumor doubling time (TDT) calculated for 21 patients before the first (if multiple) resection was not correlated with days of survival after resection of the primary tumor, nor was it correlated with days of survival after the first (if multiple) resection of the pulmonary metastatic tumors. Of the nine patients who underwent at least two thoracotomies, the TDT calculated from X-ray films taken before the second (or later) thoracotomy was significantly shorter than the TDT calculated before the preceding thoracotomy (p < 0.05). The disease-free interval (DFI) after resection of the primary tumor was correlated with the days of survival after that resection (p < 0.001) and also with survival after resection of the pulmonary metastatic tumors (p < 0.01). This DFI of patients who survived at least 2 years from the date of the resection of the primary tumor was significantly longer than in patients who survived less than 2 years from that date (p < 0.05). The most significant prognostic factor was this DFI. The cumulative survival rate was 42.4% at three years and 33.9% at five years, with an operative mortality of 0%.

Adolescent↗
PubMed1995

The enhanced immunosuppressive efficacy of newly developed liposomal FK506 in canine liver transplantation.

Local delivery of immunosuppressants to the graft and lymphatic tissue is a potential appraoch to enhance the immunosuppressive efficacy and to alleviate systemic adverse effects simultaneously. By taking advantage of this method, we developed liposomal FK506. Previous pharmacokinetic study of liposomal FK506 indicated increased FK506 levels in the liver and spleen. Because the liver is the site of the allograft in liver transplantation and the spleen is a major lymphoid tissue, we hypothesized that liposomal FK506 would increase immunosuppressive efficacy in liver transplantation. We evaluated this hypothesis in a canine model. Orthotopic liver transplantation was performed using beagle dogs, and the recipients were divided into the following groups: group I, no immunosuppression (n = 5); group II, 0.05 mg/kg/day of FK506 i.v. in a commercially available i.v. formulation for 14 days (n = 5); and group III, 0.05 mg/kg/day of FK506 i.v. in a liposomal formulation for 14 days (n = 5). All recipients in group I died within 2 weeks. Recipients in group II died within 33 days. In contrast, three recipients in group III survived for more than 200 days (P < 0.05 versus group I or group II). In DNA analysis, splenocyte proliferation activity in group III was significantly suppressed in comparison with group II. These results suggest that liposomal FK506 markedly increase the immunosuppressive efficacy of FK506 in liver transplantation. A local immunosuppressive effect in the grafted liver and significant suppression of splenocyte proliferation might contribute to enhancement of the immunosuppressive efficacy of liposomal FK506.

Animals↗
PubMed1995

Successful management of portal hypertension following artificial arterioportal shunting: report of a case.

A 63-year-old woman diagnosed as having hepatic hilar cancer underwent an extended left lobectomy of the liver with excision of the right hepatic artery which was involved by the tumor. Because the hepatic artery could not be reconstructed by direct anastomosis, an artificial arterioportal (A-P) shunt was constructed between the common hepatic artery and the portal vein. However, 4 weeks after the operation, portal hypertension with severe esophageal varices developed. Under the diagnosis of portal hypertension caused by excessive blood flow from the A-P shunt, coil embolization of the common hepatic artery was performed using an angiographic technique, following which the esophageal varices completely disappeared. This case demonstrates that portal hypertension after A-P shunting can be effectively treated with coil embolization.

Angiography↗