Biomedical subjects

Tadashi Tsukamoto

Publications and source records attributed to Tadashi Tsukamoto.

At least 19 recordsLinked to original sources

PubMed2005

Metastatic colon cancer from intrahepatic cholangiocarcinoma.

A 62-year-old man had been followed because of an elevated serum level of carcinoembryonic antigen without the detection of any cancer lesions. However, there was a sudden increase in the serum level of carcinoembryonic antigen, and abdominal imagings showed a hepatic tumor with peripheral intrahepatic bile duct dilatation, and a submucosal tumor at the sigmoid colon with intact mucosa. Histopathological findings showed that the hepatic tumor had perineural invasion, suggesting an intrahepatic cholangiocarcinoma, and that the colon tumor infiltrated the submucosa, while its mucosa was intact. Both tumors showed similar pathological features and were positive for cytokeratin 20 and 7. These findings suggested intrahepatic cholangiocarcinoma with metastatic sigmoid colon cancer.

Bile Duct Neoplasms↗

PubMed2005

Type IV collagen 7s domain as a predictor of poor efficacy of portal vein embolization before major hepatectomy.

PURPOSE: We investigated the correlation between serum concentrations of type IV collagen 7s domain (7s collagen) and changes in the volume of the nonembolized liver lobe after subsequent portal vein embolization (PVE). METHODS: The relationship between the pre-embolization results of laboratory tests and the increase in the left lobe volume was evaluated in 32 patients who underwent preoperative PVE via the right portal vein. RESULTS: By 2 weeks after PVE, the mean volume of the left lobe had increased significantly (P < 0.001). The percent increase in the left lobe volume correlated negatively with the pre-embolization serum concentration of 7s collagen (r = -0.472, P = 0.0063). In three of four patients with high serum concentrations (>8 ng/ml), the percent increase was less than 100% and right lobectomy was not performed. The serum 7s collagen concentration correlated with the histologic activity score (r = 0.469, P = 0.0061) and the histologic fibrosis score (r = 0.425, P = 0.0145). CONCLUSION: The serum concentration of 7s collagen may predict the efficacy of PVE. Performing PVE before right lobectomy may not be indicated in patients with high serum concentrations of 7s collagen because the increases in left lobe volume may be insufficient.

Adult↗

PubMed2005

[Clinical study of ambulatory patient cancer chemotherapy for advanced colorectal cancer].

To evaluate ambulatory patient cancer chemotherapy, the clinical response, toxicities and survival time were analysed among 19 patients with non-curative or recurrent colorectal cancer who were treated by Uracil/Tegafur (UFT) plus oral Leucovorin (UZEL) for the past 2 years. The patients were administered UFT (300 mg/m2/day) and UZEL (75 mg/body/day) for 28 days with a one-week interval every 35 days as one course.A partial response (PR) was observed in 6 patients (31.6%) and stable disease (SD) in 8. The median survival time was 16 months. Although nausea/vomiting, diarrhea and leucopenia were noted, no severe side effects were observed. These results suggested that UFT plus Leucovorin therapy might be a useful cancer chemotherapy for ambulatory patients with advanced colorectal cancer.

Administration, Oral↗

PubMed2004

Correlation between preoperative serum concentration of type IV collagen 7s domain and hepatic failure following resection of hepatocellular carcinoma.

OBJECTIVE: To determine the predictive value of the preoperative serum concentration of type IV collagen 7s domain (7s collagen) for postoperative hepatic failure in patients undergoing liver resection for hepatocellular carcinoma. SUMMARY BACKGROUND DATA: Clear and reliable criteria for predicting hepatic failure after liver resection are needed. The serum 7s collagen concentration correlates with the histologic degree of active hepatitis and hepatic fibrosis and may predict the regenerative potential of the liver. METHODS: Potential risk factors for postoperative hepatic failure, including the serum 7s collagen concentration, were evaluated in 251 patients who underwent liver resection for hepatocellular carcinoma. Prognostic significance was determined by univariate and multivariate analyses. RESULTS: Hepatic failure developed postoperatively in 25 patients, 4 of whom died. The serum 7s collagen concentration correlated with the histologic degree of hepatitis activity and hepatic fibrosis. The serum 7s collagen concentration was a risk factor for postoperative hepatic failure by univariate analysis and was the only risk factor on multivariate analysis. No patient with a serum 7s collagen concentration <12 ng/mL died of postoperative hepatic failure, and all 4 patients who died had a serum 7s collagen concentration >or=12 ng/mL. CONCLUSIONS: The preoperative serum 7s collagen concentration correlated independently with hepatic failure following liver resection for hepatocellular carcinoma. Patients whose serum 7s collagen is >or=12 ng/mL are poor candidates for hepatic resection.

Biomarkers↗

PubMed2004

Risk factors for intractable pleural effusion after liver resection.

BACKGROUND: Although intractable pleural effusion is a well-known complication after liver resection, risk factors for this condition have not been established. METHODS: Records of 254 patients who underwent liver resection for hepatocellular carcinoma between January 1994 and December 2002 were reviewed. Postoperative pleural effusion that required thoracentesis or continuous drainage with or without pleurodesis was defined as intractable. Variables evaluated as risk factors included demographic factors, presence of cirrhosis, routine preoperative laboratory data, serum concentration of type IV collagen 7S domain (7S collagen), Child-Pugh class, preoperative interventions, including transcatheter arterial embolization (TAE), operative procedure, intraoperative blood loss, histology of noncancerous hepatic parenchyma, and major postoperative complications. RESULTS: Postoperative intractable pleural effusion developed in 15 (5.9%) patients. Serum concentration of 7S collagen, preoperative transcatheter arterial embolization (TAE), and liver resection that included segments 7 and/or 8 were independent risk factors on multivariate analysis. In patients with high concentration of 7S collagen (> or = 8.0 ng/mL), the incidence of the complication was significantly lower in patients who had not undergone TAE than in those who had undergone TAE. CONCLUSION: An increase in serum 7S collagen concentration (> or = 8.0 ng/mL) and preoperative TAE are independent and preoperative risk factors for the development of intractable pleural effusion after liver resection for HCC. Preoperative TAE should be avoided when possible in patients whose serum 7S collagen concentration is > or = 8.0 ng/mL.

Aged↗

PubMed2003

Laparoscopic excision of a retroperitoneal cystic lymphangioma: report of a case.

A 36-year-old woman without any relevant medical history was admitted to our hospital with an abdominal tumor that had caused recurrent right hypochondral and back pain for 3 months. Retroperitoneal cystic lymphangioma was diagnosed by abdominal ultrasonography and computed tomography. We suc-cessfully excised the tumor laparoscopically. Retroperitoneal cystic lymphangiomas are rare lesions that usually present in infancy, rather than in adulthood. Most patients experience chronic symptoms, necessitating therapeutic intervention. Excision is the treatment of choice, and can be performed laparoscopically in selected patients.

Adult↗

PubMed2003

Refractory empyema caused by an intraoperative rib fracture sustained during esophagectomy: report of a case.

A 57-year-old woman underwent esophagectomy with three-field lymphadenectomy for lower esophageal cancer, followed by gastric roll reconstruction through the posterior mediastinum. A laparotomy and right thoracotomy with partial resection of the right fifth rib were performed. A purulent discharge requiring drainage developed postoperatively and continued for 3 months despite anastomotic integrity and the absence of a bronchopleural fistula. An empyema developed 3 months after drain removal, and a thoracostomy tube was reinserted. A displaced fragment of the right fifth rib was identified within the abscess cavity. Drainage and irrigation were not curative, and removal of the bone fragment was performed 18 months after the initial procedure. The patient has been symptom-free during 1 year of follow-up. We believe that the rib fragment functioned as a foreign body, which complicated treatment of the patient's postoperative infection.

Empyema↗

PubMed2003

Serum concentration of type IV collagen 7S domain as a marker for increased risk of recurrence after liver resection for hepatocellular carcinoma.

BACKGROUND/AIMS: Serum concentration of type IV collagen 7S domain (7S collagen) is a marker of hepatic fibrosis. We investigated the usefulness of measuring the serum 7S collagen concentration as a risk factor for recurrence after liver resection for hepatocellular carcinoma (HCC). METHODS: The serum 7S collagen concentration was measured before liver resection for HCC in 219 patients. Group 1 included 102 patients with a high serum concentration of 7S collagen (>or=8.0 ng/ml), and group 2 consisted of 117 patients with a low serum concentration of 7S collagen (<8.0 ng/ml). Clinicopathologic findings and outcome after surgery were compared between groups. RESULTS: The results of liver function tests were better in group 2 than in group 1. The percentage of patients with cirrhosis or who underwent minor resection was higher in group 1 than in group 2. The percentage of patients with moderately or poorly differentiated HCC or portal invasion was higher in group 2 than in group 1. Univariate and multivariate analyses identified that a high serum concentration of 7S collagen (>or=8.0 ng/ml) was an independent risk factor for recurrence. CONCLUSION: Measuring the serum 7S collagen concentration is useful to estimate the risk of recurrence after resection of HCC.

Adult↗

PubMed2003

Limy bile: a case of obstructive jaundice and review of 26 cases.

BACKGROUND: A number of reports on limy bile have been published but obstructive jaundice due to limy bile is quite rare. We report a case of obstructive jaundice due to limy bile and review 26 cases of limy bile diagnosed in our institution. CASE OUTLINE: A 39-year-old woman was admitted to our hospital with epigastric pain and jaundice. Abdominal ultrasonography and computed tomography revealed limy bile in the common bile duct and a gallbladder stone with biliary obstruction. Percutaneous transhepatic biliary drainage was performed. The limy bile drained out through the catheter over a few weeks. Cholecystectomy and choledochotomy with choledocholithotomy were subsequently performed. DISCUSSION: The strategy for managing patients with limy bile is individualized based on symptoms, the clinical conditions, and the location of the limy bile, and any associated biliary stones or lesions causing cystic duct obstruction.

Aged↗

PubMed2002

Ultrastructure of nuclear aggregates formed by expressing an expanded polyglutamine.

Intranuclear inclusions have been observed in the brains of patients affected with Huntington's disease (HD). Neuro 2A cells that transiently expressed HD exon 1 bearing 74 glutamine repeats linked to the green fluorescent protein (GFP) and the nuclear localization sequence (NLS) contained aggregates in nuclei. The aggregates were purified by fractionation with centrifugation followed by fluorescence-activated cell sorting (FACS). Heat treatment of the aggregate in an SDS sample buffer caused the dense aggregate cores to disappear and generated a basket-like structure composed of fibrils. Biochemical analysis of the aggregates revealed that the HD exon 1-GFP fusion protein was the major component. The heterogeneous nuclear ribonucleoproteins F and H, histones and ubiquitin were found to be associated with the aggregates. Our observations suggest that the N-terminal fragment of huntingtin may organize the skeletal structure of the aggregates and may disturb normal cellular functions by trapping other proteins within the aggregates.

Amino Acids↗

PubMed2002

Asymptomatic thrombosis as a late complication of a retrohepatic vena caval graft performed for primary leiomyosarcoma of the inferior vena cava: report of a case.

A 63-year-old woman successfully underwent a graft replacement of the retrohepatic inferior vena cava with a ringed polytetrafluoroethylene graft for primary leiomyosarcoma of the inferior vena cava (IVC). Although anticoagulant had been administered, a thrombus was found in the IVC just cranial of the downstream anastomosis 67 months after the operation. The patient remained free of symptoms, and she had no evidence of any tumor recurrence. She underwent a complete resection with a prosthetic reconstruction for leiomyosarcoma of the IVC and has since been able to enjoy a reasonably long-term survival. The occurrence of thrombosis must be kept in mind in the long-term follow-up of such cases.

Blood Vessel Prosthesis Implantation↗

PubMed2002

[A clinical study of pachymeningitis].

We report five patients with cranial and spinal pachymeningitis not associated infections or tumors. The underlying causes of pachymeningitis in four patients were Sjögren syndrome, Wegener's granulomatosis, microscopic polyangitis, and dermatomyositis, respectively. In one patient, the cause was unknown. Cerebrospinal fluid analysis showed an increase in cells in only one patient and elevated protein levels in three patients. Blood test revealed an inflammatory disease except in one patient. The anti-nuclear antibody was present in four of five patients examined, and P-ANCA was present in two out of four patients. The prognosis was good except in one patient of Wegener's granulomatosis. We reviewed 48 previously reported cases of pachymeningitis were not associated infections or tumors. The lesions of pachymeningitis were more localized in the cranial dura than the spinal dura, and many cases had immunological abnormalities.

Adult↗

PubMedDate not supplied

Percutaneous management of bile duct injuries after cholecystectomy.

Intraoperative biliary tract injuries are relatively uncommon, but are a cause of significant morbidity and mortality. We have repaired open biliary tract injuries found postoperatively in three patients without reoperation by percutaneous intervention. In two cases, biliary stents were placed percutaneously across the injured portion of the bile duct. For this procedure, a unique coaxial guidewire technique was used. The bile leaks resolved soon after insertion of the biliary stents. In one patient, an expandable metallic biliary endoprosthesis was inserted, and the temporary stent was removed. This patient had no signs or symptoms of cholangitis or biliary obstruction at the 6-year follow-up. The other patient died of heart failure soon after reconstruction. In the last patient, a biliary drain was inserted through the injured duct via the biliocutaneous fistula. In this case, biliary drainage alone resulted in resolution of the bile leak, because the injury was partial without a stricture. This patient was well at the 3-year follow-up. Percutaneous management of bile duct injuries is an alternative in selected patients.

Aged↗

PubMedDate not supplied

Surgically treated cases of mixed hepatocellular carcinoma and cholangiocarcinoma.

The mixed type of combined hepatocellular carcinoma and cholangiocarcinoma is particularly rare. Hepatic resection was performed for two patients with mixed hepatocellular carcinoma and cholangiocarcinoma. In case 1, a 55-year-old Japanese man was found to have a hepatic tumor on ultrasonography. Since ultrasonically-guided needle biopsy revealed that the tumor was poorly differentiated hepatocellular carcinoma, the patient underwent a limited hepatic resection. Histologic and immunohistochemical examination revealed that the tumor had elements of both hepatocellular carcinoma and cholangiocarcinoma. Six months after surgery, the patient died of systemic recurrences. In case 2, a 58-year-old man was found by ultrasonography to have a hepatic tumor occupying the entire right hepatic lobe. Computed tomography revealed that the tumor had a portal tumor thrombus. The diagnosis of hepatocellular carcinoma was made because of a markedly elevated serum alpha-fetoprotein concentration, and a right hepatic lobectomy was performed. Histologic and immunohistochemical examination confirmed that the lesion was mixed hepatocellular and cholangiocellular carcinoma. The patient died of multiple recurrent tumors in the remnant liver 3 months after surgery. Surgical control of mixed hepatocellular carcinoma and cholangiocarcinoma is difficult.

Bile Duct Neoplasms↗

PubMedDate not supplied

Primary liver cancer with dual expression of hepatocyte and bile duct epithelial markers.

A 65-year-old Japanese man with chronic hepatitis C was found to have a hepatic tumor by ultrasonography. Both dynamic computed tomography and hepatic angiography showed a hypervascular tumor with a central defect. Since a diagnosis of hepatocellular carcinoma was made, transcatheter arterial embolization was performed. However, the tumor metastasized to systemic lymph nodes and the patient died 3 months after treatment. An autopsy was performed. Histologic examination of the hepatic tumor revealed that the peripheral part was completely necrotic and the central area was composed of strands of pleomorphic cells with focal gland formation surrounded by fibrosis. No production of mucin or bile was evident. The microscopic findings of metastatic lymph nodes were similar to those of the central portion of the hepatic tumor. Immunohistochemical strains of the hepatic tumor and lymph node metastases showed diffuse positivity for cytokeratins 7 and 19, while hepatocyte paraffin 1 was focally reactive. These findings suggest that the hepatic tumor was a combined hepatocellular carcinoma and cholangiocarcinoma. Since the tumor expressed dual phenotypic markers of both hepatocytes and bile duct cells, the tumor might have an intermediate phenotype between hepatocytes and bile duct cells.

Aged↗

PubMedDate not supplied

Percutaneous transhepatic metallic stent placement for malignant portal vein stenosis.

BACKGROUND/AIMS: We investigated the safety and efficacy of percutaneous transhepatic angioplasty with self-expanding metallic stent implantation to treat malignant portal vein stenosis. METHODOLOGY: Since 1995, we have performed metallic stent implantation in 7 cases of malignant portal vein stenosis (cholangioma, 3 cases; and cancer of the hepatic hilum, pancreatic cancer, metastatic liver tumor, and hepatocellular carcinoma, 1 case each) and in 1 case of obstruction by local recurrence of a hilar tumor. In the 7 cases of portal vein stenosis, a Wallstent was implanted percutaneously transhepatically. In the case of portal vein obstruction, a Gianturco-Rosch Z stent was implanted via the ileocolic vein during laparotomy. RESULTS: There were no complications related to stent placement, and the portal vein pressure decreased after stent implantation in all cases. The patency of the stent was documented by ultrasonography in all 7 cases of portal vein stenosis and was confirmed at autopsy in two cases. No patient treated for portal vein stenosis developed symptoms of portal hypertension. CONCLUSIONS: Percutaneous transhepatic angioplasty with stent insertion is a safe and useful treatment for malignant portal vein stenosis and preserves quality of life by preventing symptoms of portal hypertension.

Aged↗

PubMedDate not supplied

Effects of marker for hepatic fibrosis and viral status on recurrence after resection of hepatitis B virus-related hepatocellular carcinoma.

BACKGROUND/AIMS: We investigated the relationship between the serum concentration of type IV collagen 7s domain (7s collagen) and viral status and the effects of these factors on recurrence after resection of hepatitis B virus-related hepatocellular carcinoma. METHODOLOGY: Serum concentration of 7s collagen was measured in 39 patients who underwent liver resection for hepatitis B virus-related hepatocellular carcinoma. The clinicopathologic findings and tumor-free survival rate were compared between patients with a low serum concentration of 7s collagen (< 7.0 ng/mL, group 1) and those with a high serum concentration of 7s collagen (> or = 7.0 ng/mL, group 2). RESULTS: Aspartate aminotransferase activity and the proportion of patients with a high viral load and cirrhosis were significantly higher in group 2 than in group 1. The tumor-free survival rate was significantly lower in group 2 than in group 1 (P = 0.0050). The survival rate was significantly lower in patients with a high viral load than in patients with a low viral load (P = 0.0006). CONCLUSIONS: A high serum concentration of 7s collagen was closely related with a high viral load of hepatitis B virus. A high serum concentration of 7s collagen and a high viral load of hepatitis B virus are risk factors for recurrence after resection of hepatitis B virus-related hepatocellular carcinoma.

Adult↗

PubMedDate not supplied

Laparoscopic splenectomy for variceal bleeding with non-cirrhotic portal vein thrombosis: a case report.

A 57-year-old man was referred to our hospital for treatment of refractory gastric bleeding from gastric varices secondary to portal vein thrombosis. The patient's liver function tests and coagulation profile were normal. The venous phase of the superior mesenteric arteriogram, on the other hand, showed superior mesenteric vein-portal vein occlusion with surrounding hepatopetal variceal collaterals. The venous phase of the splenic arteriogram additionally showed splenic vein occlusion and collateral vessels from the gastric and retroperitoneal regions flowing into a portal cavernous transformation. Gastroscopy confirmed that the patient had gastric varices in the cardia. We performed laparoscopic splenectomy to treat refractory gastric bleeding from varices and symptomatic hypersplenism. The postoperative course was uneventful; the patient's gastric varices were less prominent on follow-up gastroscopy and the hematologic profile returned to normal. Extrahepatic portal vein thrombosis is the leading cause of variceal hemorrhage in patients with healthy livers. There is a consensus in the literature that splenectomy alone is of minimal value in preventing variceal bleeding in portal vein thrombosis. Splenectomy is, however, indicated in cases in which the patient has hepatopetal collaterals from the mesenteric vein system and whose hemorrhagic gastric varices are related to splenic vein thrombosis as in our case.

Esophageal and Gastric Varices↗