Biomedical subjects

Taichi Shuto

Publications and source records attributed to Taichi Shuto.

At least 37 records · Page 2Linked to original sources

PubMed2004

Clinicopathologic analysis of risk factors for distant metastasis of hepatocellular carcinoma.

Background: Numbers of patients with extrahepatic metastasis of hepatocellular carcinoma (HCC) are increasing. As characteristics of HCC patients who develop distant metastasis remain uncertain, we analyzed potential risk factors. Methods: Among patients followed up after hepatic resection for HCC, we identified 31 patients with extrahepatic metastasis (extrahepatic metastasis group, EM). In 46 other patients we found intrahepatic metastasis synchronously with the primary HCC. In these patients no extrahepatic metastasis occurred during 5 years of follow-up (intrahepatic metastasis group, IM). During the 5-year follow-up period, 14 patients have remained alive with no metastasis (no metastasis group, NM). We compared age, gender, hepatitis virus infection status, grade of liver dysfunction, serum alpha-fetoprotein (AFP) concentration, tumor size, tumor differentiation, presence of portal or hepatic venous infiltration, and surgical strategy among these three groups. Results: No significant difference in clinicopathologic factors was noted among the three groups except for immunohistochemical staining for CD44. A significantly higher proportion of tumors was immunoreactive for CD44v3 in the EM group than in the other groups ( [Formula: see text] ). By multivariate analysis, CD44v3 expression (risk ratio, 9.28; [Formula: see text] ) was a significant independent risk factor for extrahepatic metastasis. Conclusion: CD44v3 expression in HCC may be a useful predictor of likelihood of distant metastasis.

Journal Article↗

PubMed2004

Correlation between low platelet count and multicentricity of hepatocellular carcinoma in patients with chronic hepatitis C.

We investigated correlations between laboratory test results and multicentric development of hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) in 202 patients who underwent liver resection. Two types of HCC were considered to meet multicentricity criteria: in one, at least one tumor was well-differentiated, with at least one other being less differentiated; in the other, all tumors included well-differentiated HCC with or without less differentiated components. Forty-five patients had multicentric HCC. Platelet counts were lower in patients with multicentric HCC than in others. Serum concentrations of type IV collagen 7s domain and alpha-fetoprotein, histologic hepatitis activity score, and histologic hepatic fibrosis score were higher in patients with multicentric HCC. By multiple logistic regression analysis, low platelet count was an independent risk factor for multicentric HCC. The proportion of patients with multicentric HCC was significantly higher among patients with low platelet counts (below 10(5)/mm(3)) than in patients with a higher count. Thus, HCC patients with a platelet count below 10(5)/mm(3) may require particularly careful examination for multicentricity.

Journal Article↗

PubMed2004

Surgical strategy for hepatocellular carcinoma originating in the caudate lobe.

BACKGROUND: The prognosis of hepatocellular carcinoma originating in or mainly involving the caudate lobe (caudate HCC) is generally poor. We reviewed the clinicopathologic findings of patients who underwent liver resection of caudate HCC and correlated the outcome with the surgical strategy. METHODS: Records of 402 patients who underwent liver resection for HCC were reviewed. The patients were divided into 2 groups. One group consisted of 15 patients who underwent liver resection for caudate HCC. The other group included 387 patients with HCC in a site other than the caudate lobe. RESULTS: Anatomic resection of Couinaud segment I or IX (a partial caudate lobectomy), conforming to portal anatomy, was performed in 13 patients with caudate HCC, and segmentectomies of segments I and IX (a total caudate lobectomy) were performed in 2 patients with caudate HCC. The incidence of postoperative complications was similar in the caudate HCC group and HCC in other sites group, with no operative deaths in the caudate HCC group. Tumor-free survival and cumulative survival were similar in the 2 groups. However, among patients with caudate HCC, tumor-free and cumulative survival were lower in patients with than without microscopic portal venous involvement (P<.01). CONCLUSIONS: Partial caudate lobectomy (anatomic resection of segment I or IX) along the portal system is an appropriate procedure for caudate HCC, especially in patients with impaired liver function or a small HCC. Patients with caudate HCC who have microscopic portal venous involvement may require adjuvant therapy as early recurrence is likely.

Adult↗

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

Hepatitis C virus infection as a likely etiology of intrahepatic cholangiocarcinoma.

Although hepatitis C virus (HCV)-related cirrhosis has been suggested as a risk factor for intrahepatic cholangiocarcinoma (ICC), few sizeable studies have tested this hypothesis. We investigated ICC risk factors, with special reference to HCV infection. We conducted a hospital-based case-control study including 50 ICC patients and 205 other surgical patients without primary liver cancer. HCV seropositivity was detected in 36% of ICC patients and 3% of controls. By univariate analysis, the odds ratio (OR) for association of anti-HCV antibodies with development was 16.87 (95% confidence interval (CI), 5.69 to 50.00). History of blood transfusion or diabetes mellitus, elevated serum total bilirubin, elevated aspartate aminotransferase and alanine aminotransferase, decreased serum albumin and decreased platelet count were identified as other possible ICC risk factors. By multivariate analysis, anti-HCV antibodies (adjusted OR, 6.02; 95% CI, 1.51 to 24.1), elevated alanine aminotransferase, decreased serum albumin, and decreased platelet count were found to be independent risk factors for ICC development. As liver status worsened, the adjusted OR for ICC tended to increase. HCV infection is a likely etiology of ICC in Japan.

Aged↗

PubMed2004

[Hepatic failure after liver resection in patients with cirrhosis].

Despite improvements in the preoperative assessment of liver function and advances in surgical techniques, liver resection for hepatocellular carcinoma still holds a risk for postoperative hepatic failure, especially in patients with cirrhosis. Physiologic characteristics in patients with cirrhosis include hyperdynamic state of the systemic circulation, decrease in hepatic blood flow, portal hypertension, metabolic disorders, dysfunction of the reticuloendothelial system, and thrombocytopenia. Surgical stress including massive bleeding, disturbance of hepatic circulation, and infection are risk factors for postoperative hepatic failure. The risk of hepatic failure also correlates with the severity of active hepatitis and the degree of hepatic fibrosis. To prevent postoperative hepatic failure, dopamine, prostaglandin, and hydrocortisone have been used. Although various treatments including plasma exchange have been tried in hepatic failure, the results have often been unsatisfactory. Careful preoperative evaluation of the hepatic functional reserve and the severity of active hepatitis, and adequate selection of surgical method are important to prevent postoperative hepatic failure.

Alprostadil↗

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↗

PubMed2004

Nonoprerative management of obstructive jaundice caused by a benign hepatic cyst.

A 64-year-old man with a 9.0 cm benign hepatic cyst near the hepatic hilum presented with obstructive jaundice caused by the compression of the hepatic ducts. The cyst was aspirated percutaneously, and minocycline hydrochloride was instilled as a sclerosant through a catheter inserted into the cyst. The cyst gradually became smaller, relieving the obstructive jaundice. There were no complications or side-effects. The instillation of minocycline hydrochloride is a useful alternative to ethanol instillation for treating benign hepatic cysts, even when the cyst is causing obstructive jaundice.

Administration, Cutaneous↗

PubMed2003

Eosinophilic enteritis presenting as acute intestinal obstruction: a case report and review of the literature.

A 37-year-old man was admitted to our hospital complaining of severe abdominal pain and vomiting. His abdomen was distended, and there was diffuse tenderness and guarding in all four quadrants. Laboratory examinations revealed leukocytosis without eosinophilia. Abdominal radiograph revealed air-fluid levels in the small intestine. Computed tomography confirmed a dilatation of the small intestine and the presence of ascites. An emergency laparotomy was performed for a diagnosis of peritonitis due to intestinal obstruction. A large amount of yellow transudate was present in the abdominal cavity. An area of induration in the ileum was identified about 40 cm from the ileocecal valve. The ileum proximal to the induration was dilated, and the site of obstruction seemed to be the indurated segment. A partial iliectomy was performed. Histologically, dense infiltration of eosinophils was found transmurally, and eosinophilic enteritis was diagnosed. One year later, the patient was free of gastrointestinal symptoms. The relevant literature on eosinophilic gastroenteritis is discussed.

Acute Disease↗

PubMed2003

Appropriate surgical management of small hepatocellular carcinomas in patients infected with hepatitis C virus.

We investigated the incidence of recurrence after resection of small hepatocellular carcinomas (HCC) in patients infected with hepatitis C virus (HCV) to determine the appropriate surgical management of these patients. Sixty-one patients with anti-HCV antibody who underwent curative liver resection for small HCC ( or= 8 ng/ml. Serum concentration of 7S collagen correlated with the severity of active hepatitis and the degree of fibrosis in the noncancerous hepatic tissue, both of which are related to risk potential of hepatocarcinogenesis. Serum concentration of total bilirubin, aspartate aminotransferase activity, indocyanine green retention rate at 15 minutes, the proportion of patients who were Child-Pugh class B, and the proportion of patients with severe active hepatitis or cirrhosis (determined by histologic examination) were significantly higher in group 2 than in group 1. Platelet count was significantly lower in group 2. Tumor-free survival rates were not different between the groups. In group 1, nonanatomic resection was a risk factor for recurrence by univariate and multivariate analyses (odds ratio = 3.45, p = 0.040). In group 2, nonanatomic resection was not a risk factor for recurrence. In patients with small HCV-related HCC, anatomic resection is recommended when the serum concentration of 7S collagen is low (< 8 ng/ml) because the potential of hepatocarcinogenesis may be low even after the operation.

Aged↗

PubMed2003

Treatment with STI571, a tyrosine kinase inhibitor, for gastrointestinal stromal tumor with peritoneal dissemination and multiple liver metastases.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are usually refractory to standard chemotherapeutic agents. We successfully treated a patient with a tyrosine kinase inhibitor (STI571) for GIST with peritoneal dissemination and liver metastases. METHODS: In a 32-year-old man presenting with abdominal pain from diffuse peritonitis, a GIST and associated perforated small intestine were resected. Multiple liver metastases were present. After therapies with microwave coagulation, ethanol injection, and local and systemic antineoplastic drugs (fluorouracil, cisplatin, tegafur-uracil, and tegafur) failed, investigational treatment with a tyrosine kinase inhibitor was initiated (STI571, 300 mg, p.o. daily). RESULTS: Anorexia and abdominal fullness resolved within a few days. At 24 days after initiation, positron emission tomography showed a remarkable decrease in the abdominal uptake of [18F] fluorodeoxyglucose. Adverse effects of STI571, including mild alopecia and anemia, were minimal. CONCLUSIONS: The tyrosine kinase inhibitor STI571 may be effective against GISTs.

Adult↗

PubMed2003

Surgical management of cystic hepatic neoplasms.

BACKGROUND: The clinicopathologic features of cystic neoplasms of the liver, such as cystadenoma and cystadenocarcinoma, are poorly defined because these lesions are extremely rare. METHODS: Clinicopathologic findings in six patients who underwent surgery for a cystic hepatic neoplasm were reviewed retrospectively to determine the best surgical strategy to treat this condition. RESULTS: Five patients had a multilocular cyst or elevated lesions detected on preoperative imaging studies. The remaining patient had elevated serum concentrations of carcinoembryonic antigen and carbohydrate antigen 19-9, even though preoperative imaging studies of the hepatic cystic lesion revealed no imaging features of cystadenocarcinoma. Cytology failed to detect malignant cells in the cyst contents of any patient. One patient underwent palliative resection because pleural dissemination was present, and five patients underwent curative resection. Three patients had cystadenoma diagnosed in the surgical specimen. One patient with cystadenocarcinoma has survived for more than 8 years after a curative resection that was limited to the cyst wall, and another patient died of recurrence 13 months after surgery. CONCLUSIONS: When a cystic neoplasm is suspected of being cystadenocarcinoma, hepatic resection should be considered, because reliable criteria for distinguishing cystadenoma from cystadenocarcinoma clinically do not exist.

Adult↗

PubMed2003

Secondary hemocholecyst after radiofrequency ablation therapy for hepatocellular carcinoma.

A 65-year-old Japanese man underwent radiofrequency ablation (RFA) therapy of a hepatocellular carcinoma. Hemobilia from the intrahepatic bile ducts adjacent to the tumor developed on the fifth day after the RFA therapy. Ultrasonograms and computed tomograms showed swelling of the gallbladder, which was filled with a clot, suggesting the diagnosis of hemocholecyst. The hemobilia resolved with conservative therapy, but a cholecystectomy was performed to manage postprandial abdominal pain. The resected gallbladder was filled with a clot, but injury or ulceration of the gallbladder was absent, suggesting that the hemocholecyst developed secondary to the hemobilia. Secondary hemocholecyst is a rare complication of RFA therapy. The number of cases of secondary hemocholecyst is likely to increase as hepatocentestic therapy becomes more common. Cholecystectomy is indicated for hemocholecyst because spontaneous liquefication and drainage of a clot in the gallbladder usually does not occur.

Aged↗

PubMed2003

Multicentric occurrence of hepatocellular carcinoma in patients with a somatic mutation of mitochondorial DNA and hepatitis C virus.

The relationship between the multicentric occurrence of hepatocellular carcinoma (HCC) and the frequency of mutation of mitochondrial DNA (mtDNA) in the noncancerous hepatic tissue in patients infected with hepatitis C virus was investigated. Of the 48 patients, multicentric occurrence of HCC was found in ten of 33 patients with three or more mutations in the mtDNA, whereas no patients had multicentric HCCs in 15 patients with two or fewer mutations in the mtDNA (P=0.0201). A high rate of mtDNA mutation in noncancerous hepatic tissue may be related to multicentric hepatocarcinogenesis and the hypercarcinogenic state in such patients.

Journal Article↗

PubMed2003

Usefulness of viral concentration measurement by transcription-mediated amplification and hybridization protection as a prognostic factor for recurrence after resection of hepatitis B virus-related hepatocellular carcinoma.

We examined the usefulness of a transcription-mediated amplification and hybridization protection assay (TMA-HPA) for the evaluation of the degree of active hepatitis and estimation of recurrence after resection of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). We compared results obtained with TMA-HPA with results obtained with a branched DNA assay. Fifty-two patients with HBV-related HCC were divided into two groups; group 1 consisted of 28 patients with a high serum concentration of HBV (>/=3.7 LGE/ml) and group 2 consisted of 14 patients with a low serum concentration of HBV (<3.7 LGE/ml). Serum activities of aspartate and alanine aminotransferases were higher in group 1 than in 2 (P=0.0002, P=0.0020, respectively). The proportion of patients with mildly or moderately active hepatitis, evaluated by histologic examination, was higher in group 1 than in 2 (P=0.0025). The tumor-free survival rate was significantly lower in group 1 than in 2 (P=0.0014). In multivariate analysis, a high viral concentration (risk ratio, 6.37; 95% CI, 1.46-27.78), young age, and multiple tumors were independent risk factors for recurrence. The serum HBV concentration obtained with TMA-HPA seemed to correlate with the degree of active hepatitis more closely than that obtained with the branched DNA assay. The serum concentration of HBV, measured with TMA-HPA, is closely related to the degree of active hepatitis, and the measurement of the serum concentration of HBV is useful for estimating recurrence after resection of HBV-related HCC.

Journal Article↗

PubMed2003

Cytokeratin 19 expression in hepatocellular carcinoma predicts early postoperative recurrence.

Clinicopathologic features and postoperative outcomes were investigated for patients who underwent curative surgery for biliary marker (CK7 and CK19)-positive hepatocellular carcinoma (HCC). Of 157 HCCs, 93 were CK7(-)CK19(-), 49 were CK7(+)-CK19(-), 1 was CK7(-)CK19(+), and 14 were CK7(+)- CK19(+). Semiquantitative analysis of expression levels demonstrated a significant correlation between CK7 and CK19 expression. Of various clinicopathologic parameters, tumor differentiation exhibited a significant correlation with CK7 and CK19 expression. All 15 patients with CK19-positive HCC also had anti-HBc. Log-rank test revealed that CK7 expression, CK19 expression, high aspartate aminotransferase (AST) activity, low albumin concentration, portal invasion, intrahepatic metastasis, and severe fibrosis (cirrhosis) reduced the tumor-free survival rate. Multivariate analysis demonstrated that CK19 expression, intrahepatic metastasis, and severe fibrosis were independent predictors of postoperative recurrence, while CK7 expression was not. Twelve of 15 patients with CK19-positive HCC had tumor recurrence within 2 years after surgery, a significantly higher incidence of early recurrence than for CK19-negative HCC. The incidence of extrahepatic disease, especially lymph node metastasis, was significantly higher for patients with CK19-positive HCC. These findings indicate that CK19 expression is a predictor of early postoperative recurrence due to increased invasiveness.

Adult↗

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

Intrahepatic cystadenocarcinoma with pleural dissemination: a case report.

A 40-year-old Japanese woman, who previously had undergone choledocho-jejunostomy in childhood for a congenital choledocal cyst, presented with right-sided chest pain. Computed tomography and ultrasonography demonstrated a right pleural effusion and a 10-cm unilocular hepatic cystic lesion with no solid component. These findings suggested a non-neoplastic cyst or cystadenoma. However, intracystic fluid aspirated had high concentrations of carbohydrate antigen 19-9 and carcinoembryonic antigen. Cytology of the pleural effusion demonstrated malignant cells. During exploratory laparo- and thoracotomy, a hepatic cystadenocarcinoma with invasion of the diaphragm and pleural dissemination was discovered. This case demonstrates that malignancy should be ruled out when a patient with an intrahepatic unilocular cystic lesion presents with atypical symptoms and findings, such as chest pain, pleural effusion, and high serum concentration of tumor markers. We believe that intrahepatic cystic lesions should be approached aggressively, including the use of exploratory laparotomy/laparoscopy to be certain that cancer is not present.

Adult↗