Biomedical subjects

Taichi Shuto

Publications and source records attributed to Taichi Shuto.

At least 73 records · Page 4Linked to original sources

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Prognostic factors in patients with carcinoma of the papilla of Vater.

BACKGROUND/AIMS: The prognosis after curative resection for patients with carcinoma of the papilla of Vater is relatively better than that for other peripancreatic cancer. However, prognostic factors after resection of the carcinoma have not been identified. METHODOLOGY: From 1983 to 1999, 16 patients with carcinoma of the papilla of Vater underwent standard pancreatoduodenectomy and dissection of regional lymph nodes. We followed the patients for 63 days to 17 years (median, 27 months) and analyzed clinicopathologic variables in relation to prognosis. RESULTS: The survival rate at 5 years was 50.5%. The morphologic factors predicting poor outcome were macroscopic ulcer formation and microscopic pancreatic, venous, or perineural invasion. Tumors with ulcer formation tended to infiltrate into the duodenum and pancreas, but not into veins or the perineural space. Eight of 16 patients died due to recurrence of the cancer; liver metastasis (n = 6) or peritoneal dissemination (n = 2). CONCLUSIONS: Patients with carcinoma of the papilla of Vater demonstrating ulcer formation or invasion into the pancreas, vein, or perineural space may benefit from adjuvant therapy to reduce the risk of liver metastasis. Careful observation is essential for liver metastasis or peritoneal dissemination after surgery; especially in patients with ulcer formation or venous invasion.

Aged↗

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A long-term survival case underwent repeated hepatic arterial infusion chemotherapy with portal branch ligation and wrapping of the liver using sheets for hepatocellular carcinoma.

Despite progress in therapeutic modalities for hepatocellular carcinoma, chemotherapy is the only remaining option for a considerable number of patients because of severe advanced disease and/or cirrhosis. Repeated hepatic arterial infusion chemotherapy with portal branch ligation and decollateralization using a silicone rubber sheet was performed for hepatocellular carcinoma. Tumor size and serum concentration of alpha-fetoprotein markedly decreased after hepatic arterial infusion chemotherapy. Although the patient had no recurrent tumor, he died of hepatorenal failure 7 years after treatment. Hepatic arterial infusion chemotherapy combined with portal branch occlusion and decollateralization is a new therapeutic method for unresectable hepatocellular carcinoma.

Antineoplastic Agents↗

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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↗

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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↗

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Surgical repair of a liver injury in a patient: accompanied with tricuspid regurgitation.

A 42-year-old man with acute myocarditis developed a right lung abscess and tricuspid regurgitation with valvular vegetations. A chest tube was inserted from the 8th intercostal space on the anterior axillary line to drain acute thoracic empyema caused by rupture of the lung abscess. Six hours after the insertion, the patient went into shock. Since abdominal ultrasonography showed intraabdominal bleeding, an urgent laparotomy was performed. A large amount of blood was present in the peritoneal cavity. Pulsatile bleeding from the hepatic laceration and penetration of diaphragm were observed. Mattress sutures were used to close the hepatic laceration and the rent in the right hemi-diaphragm. Because the patient was hemodynamically stable postoperatively tricuspid valvular replacement was performed 5 days after the laparotomy. Four months after valve replacement, the patient is in good condition without any complaints.

Adult↗

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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↗

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Clinicopathologic features in patients with long-term survival following resection for intrahepatic cholangiocarcinoma.

BACKGROUND/AIMS: As the overall prognosis for patients with intrahepatic cholangiocarcinoma is extremely poor, it is important to identify specific clinicopathologic features associated with long-term survival after hepatic resection for this tumor. METHODOLOGY: Of 54 patients who underwent hepatic resection for intrahepatic cholangiocarcinoma, 9 survived more than 5 years after surgery (survival group), while 28 patients died of recurrence within 3 years of surgery (early recurrence group). Clinicopathologic features were compared retrospectively between groups. RESULTS: Although clinical features in patients with long-term survival were similar to those in patients with early recurrence, lymphatic invasion, lymph node metastasis, intrahepatic metastasis and tumor involving the resection margin were more frequent in patients with early recurrence. CONCLUSIONS: Hepatic resection for intrahepatic cholangiocarcinoma without lymph node metastasis or intrahepatic metastasis offers hope for long-term survival.

Aged↗

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Expression of bile duct-type cytokeratin in noncancerous hepatocytes in patients with hepatitis B virus-related hepatocellular carcinoma.

BACKGROUND/AIMS: Hepatocytes express bile duct-type cytokeratin in various conditions, which indicates the presence of hepatic progenitor cells. We investigated the clinical significance of cytokeratin 7 expression in the noncancerous hepatitis tissue in patients with hepatitis B virus-related hepatocellular carcinoma. METHODOLOGY: Specimens were obtained from 24 patients who underwent liver resection for hepatitis B virus-related hepatocellular carcinoma. The hepatocytes in the noncancerous hepatic tissue were examined immunohistochemically using monoclonal antibodies against cytokeratin 7. RESULTS: Expression of cytokeratin 7 was observed in 9 patients (group 1). Group 2 consisted of the other 15 patients. Serum transaminases were significantly higher in group 1 than in group 2. The percentage of patients with moderate or severe active hepatitis, the percentage of patients with cirrhosis, and the percentage of patients with portal invasion were significantly higher in group 1 than in group 2. The tumor-free survival rate was significantly lower in group 1 than in group 2. CONCLUSIONS: The expression of cytokeratin 7 in noncancerous hepatic tissue is closely related to the severity of and duration of chronic hepatitis B. The expression of cytokeratin 7 in the noncancerous hepatic tissue is a possible risk factor for recurrence after resection of hepatitis B virus-related hepatocellular carcinoma.

Adult↗

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Portal thrombosis due to intrahepatic cholangiocarcinoma following successful treatment for hepatocellular carcinoma.

A 57-year-old man, who had undergone hepatic arterial infusion chemotherapy with right portal occlusion for hepatocellular carcinoma was admitted to our hospital because of severe abdominal pain. Contrast-enhanced computed tomograms revealed that most areas of the liver were not enhanced, a finding suspicious for perfusion disturbance in the liver. Angiography revealed an interrupted right hepatic artery. Arterial portograms revealed complete obstruction of the right portal vein and a small left branch of the portal vein. Despite anticoagulant therapy with urokinase for portal vein thrombosis, the patient died from hepatorenal failure. Autopsy revealed that cholangiocarcinoma occupied almost the entire parenchyma of the right lobe, although the treated hepatocellular carcinoma lesion was completely necrotic. The right hepatic artery was obstructed due to direct invasion of tumor. There were diffuse thrombi in the left portal branches surrounded by tumor infiltrating along Glisson's sheath to the peripheral portion of the left lobe.

Bile Duct Neoplasms↗

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Multifocal hepatocellular carcinoma in patients undergoing living-related liver transplantation.

Many institutions apply the indications for living-related liver transplantation in patients with hepatocellular carcinoma based on the Milan criteria, which state that transplantation is not indicated when more than three foci of disease are present. However, the relationship between the number of foci identified preoperatively and the number detected on pathologic examination of the surgical specimen is unknown. The case of a 66-year-old Japanese woman with cirrhosis secondary to type C viral hepatitis who developed hepatic failure secondary to multifocal hepatocellular carcinoma is presented. Three foci of hepatocellular carcinoma were identified radiologically preoperatively. Following successful living-related liver transplantation, pathologic examination of the surgical specimen revealed that six foci of hepatocellular carcinoma and one dysplastic nodule were present. Although the number of foci of hepatocellular carcinoma is a predictor of recurrence and > 3 is a relative contraindication to transplantation, lesions undetected radiologically (such as dynamic computed tomography) are unlikely to have metastatic or invasive potential because they have yet to evolve a capillary blood supply and still receive their nutrition via hepatic sinusoids on immunohistochemical and radiological findings. Foci of hepatocellular carcinoma undetected preoperatively are unlikely to effect prognosis when total hepatectomy is performed in the context of living-related liver transplantation.

Aged↗

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Hepatocellular carcinoma fed by an aberrant posterior right hepatic artery.

An aberrant hepatic artery arising from the dorsal pancreatic artery is extremely rare, although the arterial blood supply to the liver is variable. A 56-year-old Japanese man was admitted to our hospital with a lesion in the right hepatic lobe. Serum concentrations of alpha-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19-9 were within the reference range. Abdominal arteriography showed a hypervascular lesion measuring 3.0 cm in diameter in the right hepatic lobe. The left hepatic artery, the middle hepatic artery, and the anterior branch of the right hepatic artery were derived from the common hepatic artery, while the posterior branch originated from the dorsal pancreatic artery. Computed tomography performed during arteriography via the common hepatic artery showed an arterial perfusion defect in the posterior segment of the right hepatic lobe and enhancement of the ventral portion of the tumor, while the dorsal portion was not enhanced. However, the dorsal portion of the tumor was enhanced when arteriography was performed via the dorsal pancreatic artery. A limited hepatic resection was performed. Histologically, the tumor was a moderately differentiated hepatocellular carcinoma with a thick trabecular pattern.

Carcinoma, Hepatocellular↗

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Usefulness of biodegradable absorbable rib connecting pins in thoracoabdominal hepatectomy.

BACKGROUND/AIMS: Some patients who undergo thoracoabdominal hepatectomy suffer from pain and discomfort after because rib and/or costal cartilage was cut during the operation. The usefulness of absorbable rib connecting pins in thoracoabdominal hepatectomy was evaluated. METHODOLOGY: Of 18 patients who underwent thoracoabdominal hepatectomy, the stumps of ribs were not fixed in 9 patients (group 1) and the stumps of ribs were fixed with the rib connecting pins in 9 other patients (group 2). We evaluated the usefulness of these pins in thoracoabdominal hepatectomy. RESULTS: In 8 patients in group 1 and 2 patients in group 2, pain continued for 1 month after the operation (p = 0.015). At 2 months after the operation, pain continued in 6 patients in group 1 and no patients in group 2 (p = 0.009). At 6 months after the operation, 2 patients in group 1 still had pain. Rib instability continued in 8 patients in group 1 at 6 months after the operation, although rib instability disappeared by 2 months after the operation in all group 2 patients (p = 0.0004). CONCLUSIONS: Biodegradable absorbable pins for rib fixation are useful for preventing pain and discomfort around the cut stumps of ribs in thoracoabdominal hepatectomy.

Absorbable Implants↗

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Hepatectomy with transcatheter arterial embolization for large hepatoma in the caudate lobe.

The prognosis of hepatocellular carcinoma originating from the caudate lobe (caudate HCC) is generally poor, and surgical treatment for caudate HCC is difficult to perform due to the location. We postulate that a combination of surgical resection and transcatheter arterial embolization improves the prognosis, and that operative procedure is straightforward. We examined three cases of large solitary caudate HCC. Three patients (a 68-year-old woman, 65-year-old man, and 71-year-old man) with caudate HCC and viral chronic hepatitis were treated with preoperative transcatheter arterial embolization and partial resection of the caudate lobe. After transcatheter arterial embolization, the solitary hepatocellular carcinomas decreased in size (9 to 6, 10 to 8, and 7 to 5 cm in diameter, respectively) which simplified surgical resection (1120, 3010, and 2110 cc blood loss; 4.5, 7, and 7 hours of operative time, respectively). All the hepatocellular carcinomas were poorly differentiated, and had infiltrated microscopically into the portal vein. The outcome was satisfactory (18, 16, and 10 months after the operation, two cases were alive, and one dead, respectively). The combination of preoperative transcatheter arterial embolization and partial resection for caudate HCC, especially large solitary caudate HCC, works well as a multimodal therapy.

Aged↗

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Polyamine metabolism and recurrence after resection for hepatocellular carcinoma.

BACKGROUND/AIMS: Ornithine decarboxylase activity, a rate-limiting enzyme in polyamine biosynthesis, is correlated with the degree of malignancy of hepatocellular carcinoma. We investigated the relationship between polyamine metabolism in hepatocellular carcinoma tissues and the recurrence after resection of hepatocellular carcinoma. METHODOLOGY: The subjects were 49 patients who underwent liver resection for hepatocellular carcinoma. The relationship between ornithine decarboxylase activity and polyamine concentration in hepatocellular carcinoma tissues and the pathologic findings or recurrence after the operation was studied. RESULTS: The prevalences of moderately or poorly differentiated hepatocellular carcinoma, portal invasion, and intrahepatic metastasis were higher in patients with a high ornithine decarboxylase activity (> or = 100 pmol putrescine/h/mg protein) than in patients with a low ornithine decarboxylase activity (< 100 pmol putrescine/h/mg protein). The tumor-free survival rate was significantly lower in patients with a high ornithine decarboxylase activity than in patients with a low ornithine decarboxylase activity (p=0.0394). The tumor-free survival rate was significantly lower in patients with a high spermidine concentration (> or = 80 nmol/mg protein) than in patients with a low spermidine concentration (< 80 nmol/mg protein, p = 0.0454). CONCLUSIONS: A high ornithine decarboxylase activity and a high spermidine concentration of hepatocellular carcinoma were risk factors for recurrence after resection of hepatocellular carcinoma.

Carcinoma, Hepatocellular↗

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Self-expanding metallic stent for benign biliary strictures: seven-year follow-up.

We report two cases of benign biliary strictures managed by metallic stent placement because the patients refused surgical repair. One patient is a 67-year-old man who had a stricture of the right hepatic duct and a bile leak following a cholecystectomy. The second patient is a 50-year-old man who had a stricture of the left hepatic duct following a right hepatic lobectomy for hepatolithiasis. For treatment of these bile duct strictures, a Gianturco-Rosch Z stent was placed in the former case and a Wallstent in the latter. Luminal patency of the stent was maintained for 7 years in the former case but in the latter, luminal stenosis of the stent was induced soon after placement. However, in the former, bile stasis in the left hepatic duct system, which emptied into the side of the stent, gradually developed without signs or symptoms of cholangitis or biliary obstruction. Therefore, the use of metallic stents for benign biliary stricture remains controversial. However, if metallic stent placement is the only therapeutic option, it is necessary to maintain bile flow not only through the stent but also in the bile ducts which flow into the side of the stent.

Aged↗

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Surgery for segmental primary sclerosing cholangitis.

Primary sclerosing cholangitis is an uncommon chronic hepatobiliary disorder, and the definitive surgical treatment for symptomatic primary sclerosing cholangitis is liver transplantation. Although some cases with primary sclerosing cholangitis treated with hepaticojejunostomy or partial hepatectomy have been reported, the indications for these procedures and their long-term results have not been well defined or studied. We present three patients with segmental primary sclerosing cholangitis, and discuss the indication of surgical treatment for primary sclerosing cholangitis excluding liver transplantation. Three patients with segmental primary sclerosing cholangitis of the common bile duct and the hepatic ducts were treated by hepaticojejunostomy with partial resection of the common bile duct. We investigated clinical features such as angiography, cholangiography, and surgical treatment outcomes. It was difficult to differentiate primary sclerosing cholangitis from a cholangioma preoperatively, despite the use of cytology, angiography, and cholangiography. Two of the three patients were preoperatively suspected to have cholangioma. Segmental primary sclerosing cholangitis was diagnosed operatively. All patients were treated hepaticojejunostomy and achieved long-term survival. Although liver transplantation is the treatment of choice for primary sclerosing cholangitis, in cases of segmental primary sclerosing cholangitis, local resection of the involved structures may be curative. Resection of a discrete lesion may provide many years of survival with a good quality of life, in some cases obviating the need for liver transplantation.

Aged↗

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Serum markers of liver fibrosis and histologic severity of fibrosis in resected liver.

BACKGROUND/AIMS: Serum concentrations of the 7S fragment of type IV collagen (7S collagen), amino-terminal propeptide of type III procollagen (PIIIP), and hyaluronic acid (HA) have been reported to serve as serologic markers of liver fibrosis in hepatitis and cirrhosis. We investigated whether these fibrosis markers reliably reflect histologic changes in the livers of patients with hepatocellular carcinoma. METHODOLOGY: Subjects included 165 patients undergoing liver resection for hepatocellular carcinoma. Most were seropositive for chronic hepatitis B or C. Histopathologic changes in liver tissue resected with the tumor were scored according to Knodell's histologic activity index. Serum was sampled for assays shortly before surgery. RESULTS: Significant correlations were found between hepatitis activity score and 7S collagen, PIIIP, and HA. Concentrations of 7S collagen differed significantly between activity grades, but differences were not significant for PIIIP or HA. Significant correlations were found between fibrosis staging score and all these three markers. When patients were divided according to activity grade, 7S collagen showed stronger correlation with fibrosis staging score than did PIIIP or HA. CONCLUSIONS: The 7S collagen fragment correlated more strongly than PIIIP or HA with stage and activity grade in patients with hepatocellular carcinoma. However, overlapping of results between histologically defined groups appeared to limit clinical diagnostic usefulness of all markers in individual patients.

Biomarkers↗

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Living-related liver transplantation in a patient with end-stage hepatolithiasis and a biliary-bronchial fistula.

Liver transplantation in patients with end-stage hepatolithiasis is complicated by the high incidence of the suppurative cholangitis and systemic infection. A 43-year-old Korean-Japanese woman with hepatolithiasis, biliary cirrhosis, suppurative cholangitis, and biliary-bronchial fistula underwent living-related liver transplantation (LRLT) using a right lobe graft of her sister. The risk of infection was minimized by preoperative percutaneous transhepatic biliary drainage initiated 2 months before transplantation. The native liver was resected en bloc with the extrahepatic bile ducts and the infected section of the right hemidiaphragm. Opportunistic infection was prevented by limiting antimicrobial therapy to the interval from preoperative day 3 to postoperative day 4. Immunosuppressive agents were given below standard dose. The postoperative course following LRLT was uncomplicated, and hepatic function was good. Careful management of infection and adequate graft size are essential for successful LRLT in patients with end-stage hepatolithiasis.

Adult↗