Biomedical subjects

Taichi Shuto

Publications and source records attributed to Taichi Shuto.

At least 55 records · Page 3Linked to original sources

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

Expression of bile duct-type cytokeratin in hepatocellular carcinoma in patients with hepatitis C virus and prior hepatitis B virus infection.

The clinicopathologic findings in patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) positive for biliary markers, those related to the hepatic progenitor cells, were investigated. Cytokeratin (CK) 19 was reactive for HCCs only in patients with prior hepatitis B virus (HBV) infection. The proportions of patients with prior HBV infection and poorly differentiated HCC were significantly higher among those with CK 19-positive HCC than among those with CK 19-negative HCC. Some HCCs develop from the hepatic progenitor cells in patients with HCV infection and prior HBV infection, which may affect the clinicopathologic findings of HCV-related HCCs.

Aged↗

PubMed2002

Effect of the presence of hepatitis B e antigen on prognosis after liver resection for hepatocellular carcinoma in patients with chronic hepatitis B.

We examineded the clinical effects of serum hepatitis B e antigen (HBeAg) positivity on clinicopathologic findings and prognosis after liver resection for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. A series of 56 patients who underwent curative resection were divided into two groups: 25 HBeAg-positive patients (group 1) and 31 HBeAg-negative patients (group 2). The mean age was significantly lower in group 1 than in group 2 (p = 0.0021), and the proportion of patients with symptoms was significantly higher in group 1 than in group 2 (p = 0.037). There were no significant differences in other clinical findings between the two groups, including laboratory test results, coexisting medical conditions, and operative methods. Although tumor size, degree of differentiation of the main tumor, and the prevalence of vascular invasion did not differ between the groups, the prevalence of intrahepatic metastasis and the proportion of patients with active hepatitis were significantly higher in group 1 than in group 2 (p = 0.009 and p = 0.043, respectively). Tumor-free and cumulative survival rates were significantly lower in group 1 than in group 2 (p = 0.022 and p = 0.0001, respectively). Multivariate analysis of various possible risk factors demonstrated serum HBeAg positivity to be an independent risk factor for recurrence [risk ratio (RR) 2.49; 95% confidence interval (CI) 1.12-5.49; p = 0.032] and an independent unfavorable factor for the survival time (RR 7.58; 95% CI 2.10-27.8; p = 0.0020). We concluded that the prognosis after liver resection for HCC is worse for HBeAg-positive patients than for HBeAg-negative patients.

Adult↗

PubMed2002

Evaluation of the effect of portal vein embolization on liver function by (99m)tc-galactosyl human serum albumin scintigraphy.

BACKGROUND: Preoperative percutaneous transhepatic portal vein embolization (PTPE) increases the safety of liver resection and improves the outcome after surgery for hepatocellular carcinoma. Scintigraphy with (99m)Tc-galactosyl human serum albumin (GSA) causes specific binding to viable hepatocytes and serves as an index of liver function. MATERIALS AND METHODS: (99m)Tc-GSA scintigraphy was performed before and 2 weeks after PTPE of the right portal vein in 16 patients. The total receptor index, reflecting overall liver function, right receptor index (right lobe), and left receptor index (left lobe) were calculated. RESULTS: After PTPE, the proportion of the volume of the nonembolized lobe (left lobe) increased (P = 0.0002). The total receptor index slightly decreased after PTPE (P = 0.090), the right receptor index decreased (P < 0.0001), and the left receptor index increased (P < 0.0001). The average increase rate in the left receptor index was 30% of the pre-PTPE value. In 2 patients with portal hypertension (> or =30 cm H(2)O) after PTPE, the left receptor index did not change. In 4 patients whose left receptor index after PTPE (including the 2 patients with portal hypertension) was <0.35, right lobectomy was not performed. CONCLUSIONS: (99m)Tc-GSA scintigraphy demonstrated that PTPE induces a shift in hepatic function from the embolized part to the nonembolized part of the liver. PTPE of the right portal vein increases the hepatic functional reserve of the left lobe as well as its volume. The changes in (99m)Tc-GSA uptake following PTPE may predict the response to liver resection.

Aged↗

PubMed2002

Histologic bile duct invasion by a mass-forming intrahepatic cholangiocarcinoma.

BACKGROUND/PURPOSE: Although curative surgical resection provides the best chance of long-term survival for patients with intrahepatic cholangiocarcinoma, the presence of bile duct invasion decreases postoperative survival rates in patients with mass-forming intrahepatic cholangiocarcinoma. We carried out this study to determine a surgical strategy for patients with bile duct invasion of these tumors. METHODS: Forty-one patients with mass-forming intrahepatic cholangiocarcinoma were classified as either having bile duct invasion ( n = 26) or not having bile duct invasion ( n = 15). Clinicopathologic findings, including postoperative outcomes, were compared between these two groups. RESULTS: Perineural invasion, lymphatic invasion, and a positive resection margin were more frequent in patients with ductal invasion. Patients with ductal invasion had lower survival rates than those without ductal invasion. CONCLUSIONS: Intraoperative frozen section examination of the bile duct stump to confirm a clear resection margin is required in patients with mass-forming tumors. Resection of the extrahepatic bile duct should be considered when tumor cells are identified at the surgical margin of the resected bile duct.

Aged↗

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

Incidence and management of bile leakage after hepatic resection for malignant hepatic tumors.

BACKGROUND: Bile leakage is one of the frequent and disturbing complications of hepatic resection. STUDY DESIGN: Clinical records of the 363 patients who underwent hepatic resections without biliary reconstruction for hepatic cancers between January 1994 and June 2001 were reviewed. Postoperative bile leakage was defined as continuous drainage with a bilirubin concentration of 20 mg/dL or 1,500 mg/d lasting 2 days. Leakage that continued longer than 2 weeks or that required surgical intervention was defined as uncontrollable. Differences in incidence and frequency of uncontrollable leakage for the different types of hepatic resection, tumors, and underlying liver disease were investigated. Outcomes after treatment for uncontrollable bile leakage were also reviewed. RESULTS: Postoperative bile leakage occurred in 26 of 363 patients (7.2%). Although the incidence in patients with cholangiocellular carcinoma (3/9 [33%]) was higher (p = 0.03) than in patients with hepatocellular carcinoma, rates of occurrence were similar among the different types of hepatic resection and underlying liver disease. Eight of the 26 patients (31%) had uncontrollable leakage. Two patients required reoperation to control leakage; one of these developed hepatic failure and died 2 months after surgery. Four patients underwent endoscopic nasobiliary drainage 21 to 34 days after hepatectomy, and the leakage resolved within 3 to 21 days. Fibrin glue sealing was effective in two patients whose leaking bile ducts were not connected to the common bile duct. CONCLUSIONS: Although meticulous surgical technique can minimize the risk of postoperative bile leakage, some instances of leakage are unavoidable. Nonsurgical treatments, such as nasobiliary drainage or fibrin glue sealing, are preferable to reoperation.

Adolescent↗

PubMed2002

Relationship between response to previous interferon therapy and postoperative recurrence of hepatitis C virus-related hepatocellular carcinoma.

Although interferon (IFN) therapy suppresses the development of hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC), the relationship between response to previous IFN therapy and postoperative outcome has not been clarified in patients who underwent curative resection for HCC. Of 175 patients who underwent curative hepatic resection for HCV-related HCC, 24 patients had HCC detected after IFN therapy. 11 patients who had a biochemical response (a normalized alanine aminotransferase (ALT) activity with or without disappearance of serum HCV RNA) were classified as the response group, while 13 patients were classified as the non-response group because they had no decrease in their ALT activity and had persistence of serum HCV RNA. The non-IFN group included 151 patients who had not received previous IFN therapy. The clinicopathologic findings and surgical outcomes were compared among these three groups. The serum activities of the aspartate aminotransferase and ALT just before surgery were significantly lower in the response group than in the other groups. Although no significant differences were noted in the other clinicopathologic findings or the operation method among these groups, the tumor-free survival rate of the response group was significantly higher than that of the two other groups. By multivariate analysis, the response group had an independently lower risk for postoperative recurrence (risk ratio, 0.07; P=0.0072). Hepatic resection offers hope for low incidence of postoperative recurrence in patients with HCC, especially when previous IFN therapy has controlled their active hepatitis associated with HCV.

Journal Article↗

PubMed2002

Power Doppler ultrasonographic diagnosis of small hepatocellular carcinomas.

BACKGROUND/AIMS: Power Doppler ultrasonography can evaluate the hemodynamics of intrahepatic tumors. The ability of power Doppler ultrasonography to detect small hepatocellular carcinomas and estimate the differentiation of the tumor by the patterns of intranodular waves was assessed. METHODS: We used conventional B-mode ultrasonography, power Doppler ultrasonography, and dynamic computed tomography to examine 71 hepatocellular carcinomas (</=3 cm) before liver resection. RESULTS: The sensitivity of conventional ultrasonography, power Doppler ultrasonography, and computed tomography increased as tumor diameter increased, with little difference between modalities. Nodules up to 5 mm in diameter as well as some nodules in the lateral segment or the subphrenic area of the liver were not detected by power Doppler ultrasonography, although two nodules not detected by computed tomography were apparent from power Doppler ultrasonography. With the latter modality, the proportion of nodules with afferent pulsatile waves was higher in moderately or poorly differentiated hepatocellular carcinomas than in well-differentiated hepatocellular carcinomas. Afferent continuous waves were detectable only in well-differentiated hepatocellular carcinomas. CONCLUSION: Although the sensitivity of power Doppler ultrasonography remains unsatisfactory for minute lesions (</=5 mm) and for laterally or subphrenically situated lesions, this method can usually distinguish moderately or poorly differentiated from well-differentiated hepatocellular carcinomas, which is useful in planning treatment and predicting outcome.

Aged↗

PubMed2002

[A case of unresectable gastric cancer complicated by a serious hepatic disorder and Virchow lymph node metastasis in which FP therapy and TS-1 administration were effective].

The patient was a 65-year-old woman who came to our hospital because she had noticed swelling of a left supraclavicular lymph node. Endoscopy revealed an ulcerous lesion in the L chain region, and poorly differentiated adenocarcinoma of the stomach was diagnosed as a result of a biopsy. Oral therapy was impossible because of pyloric stenosis, and a gastrojejunal bypass operation was performed. Serious hepatic dysfunction occurred postoperatively due to swelling that was suspected of being due to lymph node metastasis in the porta hepatis. For this reason, the TS-1 therapy that had been initially scheduled was abandoned, and low-dose FP therapy was instituted for 4 weeks. Afterward, the swelling resolved and the patient's hepatic disorder and systemic condition improved. Administration of TS-1, 80 mg/day (bid), was started in the outpatient clinic 4 weeks after the completion of FP therapy. Administration had to be discontinued after the first course of TS-1 therapy because of grade 3 thrombocytopenia and neutropenia. However, since marked decreases in tumor markers were observed, TS-1 administration was resumed after recovery. After completion of the second course of TS-1 therapy, a decrease in size of the Virchow lymph node was noted, and PR was diagnosed. TS-1 as initial chemotherapy had to be abandoned for this patient because of a serious hepatic disorder, in which TS-1 administration is contraindicated. However, a favorable response was obtained by concomitant use of FP therapy.

Adenocarcinoma↗

PubMed2002

Distant metastatic recurrence after hepatic resection for hepatocellular carcinoma.

To identify clinicopathologic features of distant metastatic recurrence (DMR) after hepatic resection for hepatocellular carcinoma, we investigated 352 recurrent patients. Of them, 261 with only intrahepatic recurrence were compared with 91 with DMR. Between two groups, there was significantly difference with respect to preoperative liver function, positive tests for protein induced by vitamin K absence or antagonist-II (PIVKA-II), major resection, tumor-free interval, tumor diameter, extrahepatic progression of the tumor, single nodular configuration, and portal vein invasion. Survival rates at 1 and 5 years after intrahepatic recurrence were 73% and 17%, while these were 57% and 18% when recurrences were DMR (p = .0362). DMR was frequent when a resected tumor was large, extrahepatic, ill defined or multinodular or associated with portal vein invasion, good preoperative liver function, or PIVKA-II positivity. Such patients should receive particularly careful follow-up during the first 2 years after hepatic resection focusing on early detection of DMR.

Carcinoma, Hepatocellular↗

PubMed2001

Resectable Pleomorphic Giant Cell Carcinoma of the Pancreas.

We present a 72-yr-old woman who underwent surgical resection of a large pancreatic tumor. On preoperativeimaging, an intratumoral cavity containing necrotic tissue was noted, mimicking the appearance of acystic tumor. There was no invasion of adjacent organs nor distant metastasis, and histopathologic examinationrevealed the tumor to be a giant cell carcinoma. Postoperatively, the patient has been followed for 1.5 yrwithout evidence of recurrence. Giant cell carcinoma generally is associated with a poor prognosis, and patientsusually die within months despite intensive multimodality therapy. Some patients with giant cell carcinomas,however, achieve long-term survival when invasion of adjacent organs and distant metastases are absent. Surgicalresection is the appropriate treatment for tumors with these favorable characteristics.

Journal Article↗

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

Macroscopic types of intrahepatic cholangiocarcinoma: clinicopathologic features and surgical outcomes.

BACKGROUND/AIMS: The prognosis of patients with intrahepatic cholangiocarcinoma is different for the different macroscopic types of this tumor. This study correlated clinicopathologic features and outcome after surgery with macroscopic types of intrahepatic cholangiocarcinoma to determine prognostic predictors. METHODOLOGY: Resected intrahepatic cholangiocarcinomas were classified into the following growth types: mass-forming (n = 10), periductal-infiltrating (n = 11), mass-forming plus periductal-infiltrating (n = 14), and intraductal (n = 2). Intraductal tumors were not considered further. The prognostic significance of clinicopathologic features was determined by univariate and multivariate analyses. RESULTS: Perineural invasion (P = 0.00051), lymphatic invasion (P = 0.0088), and positive resection margin (P = 0.028) were less frequent in patients with mass-forming tumors than with mass-forming plus periductal-infiltrating tumors. Patients with mass-forming plus periductal-infiltrating tumors had shorter survival than those with mass-forming tumors (P = 0.0072). By univariate analysis, an elevated serum carcinoembryonic antigen concentration, lymphatic invasion, lymph node metastasis, intrahepatic metastasis, and positive resection margin predicted shorter survival after surgery. An elevated serum carcinoembryonic antigen concentration, lymphatic invasion, and positive resection margin were independent prognostic factors on multivariate analysis. The macroscopic type did not correlate independently with prognosis. CONCLUSIONS: Extended hepatic resection should be performed in patients with intrahepatic cholangiocarcinoma to obtain a tumor-free margin of resection.

Adult↗

PubMedDate not supplied

Successful surgical control for hepatocellular carcinoma disseminated to the peritoneum: a case report.

Treatment for dissemination of hepatocellular carcinoma to the peritoneum has not yet been established. A case of a 62-year-old man who underwent curative resection for hepatocellular carcinoma 1 month after ultrasonically guided needle biopsy is presented. At 23 months after surgery, computed tomography revealed a mass in the abdominal cavity. At laparotomy 3 months later, a peritoneal tumor deposit directly invading the colon was resected in continuity with a portion of large intestine. The tumor was confirmed histopathologically to represent dissemination of hepatocellular carcinoma. No other lesions were detected 20 months after the second operation. Surgical treatment can locally control peritoneally disseminated hepatocellular carcinoma provided that lesions have limited extent.

Biopsy, Needle↗

PubMedDate not supplied

The separate-lesion type combined hepatocellular carcinoma and cholangiocarcinoma.

The separate-lesion type of combined hepatocellular carcinoma and cholangiocarcinoma is particularly rare. We treated two such patients with hepatic resection after performing dynamic computed tomography. In case 1, a 64-year-old Japanese man with chronic hepatitis C underwent right hepatic lobectomy for two hepatic tumors; both tumors originally were thought to be hepatocellular carcinomas because both were hypervascular. However, histologic examination revealed that one tumor was hepatocellular carcinoma and another tumor was tubular adenocarcinoma. In case 2, a 73-year-old man, a second lesion was detected 8 months after transcatheter arterial embolization for hepatocellular carcinoma associated with chronic hepatitis C. The newer lesion in case 2 showed delayed enhancement by dynamic computed tomography. We diagnosed the lesion as cholangiocarcinoma and performed right hepatic lobectomy and dissection of lymph nodes in the hepatoduodenal ligament. Histologic examination confirmed that the new lesion was tubular adenocarcinoma. Case 1 and 2 respectively represent synchronous and metachronous occurrence of the separate-lesion variety of combined hepatic cancer.

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↗