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Takanori Ochiai

Publications and source records attributed to Takanori Ochiai.

15 recordsLinked to original sources
PubMed2006

Outcomes and recurrence of initially resectable hepatocellular carcinoma meeting milan criteria: Rationale for partial hepatectomy as first strategy.

BACKGROUND: Partial hepatectomy and liver transplantation are considered curative treatments for small hepatocellular carcinoma (HCC) meeting the Milan criteria (solitary tumor <5 cm or up to 3 nodules <3 cm). This study was designed to clarify whether partial hepatectomy can be the first option in patients eligible for both treatments. STUDY DESIGN: All patients (n = 152) underwent curative surgical operation for primary HCC during 2000 to 2005 at our hospital. Eighty-seven patients met Milan criteria and the remaining 65 did not. Outcomes were examined according to Milan criteria. RESULTS: After partial hepatectomy, 3-year survival rate was 89.6% for the group that met Milan criteria, compared with 60.8% for the group that did not (p = 0.0044). Among patients with HCC who initially met the criteria, tumor recurrences were observed in 30 patients; 23 patients met criteria and 7 patients exceeded the criteria at first diagnosis of recurrence. Patients with recurrence within the criteria showed a higher 3-year survival rate compared with patients with recurrence exceeding the criteria (100% versus 19.8%; p < 0.0001). Analysis of clinicopathologic variables to predict mode of recurrence revealed tumor size (p < 0.0001) and lower histologic differentiation (p = 0.0326) as positive factors for recurrence exceeding Milan criteria. CONCLUSIONS: Our results suggest that it is an appropriate strategy to treat HCC patients who meet Milan criteria with partial hepatectomy. It should be noted that approximately one-tenth of patients who initially met Milan criteria experienced postoperative recurrence that exceeded the criteria.

Adult↗
PubMed2006

The close participation of ET-1 and NO in human hepatic hemodynamics.

BACKGROUND: Nitric oxide and endothelin-1 (ET-1) are believed to closely participate in the hepatic circulation. However, there are no clinical studies evaluating the participation of these two molecules in the hepatic circulation. PATIENTS AND METHODS: All 27 patients had liver tumors; 6 liver tumors were associated with liver cirrhosis and 12 patients had chronic hepatitis. Portal vein and hepatic arterial blood flow was measured with an electromagnetic flowmeter. Blood was sampled to quantitate endothelin-1 and nitrate/nitrite (NO(x)) from portal veins, peripheral veins and peripheral arteries. RESULTS: Serum ET-1 levels tended to be higher in patients with liver cirrhosis than patients with chronic hepatitis or patients with normal livers. There were no apparent differences in NO(x) concentrations among underlying liver disease states. Portal blood flow and estimated total hepatic blood flow was adversely correlated with ET-1 in portal veins with relatively higher correlation coefficients whereas arterial blood flow was not correlated to ET-1. On the other hand, arterial plasma ET-1 concentrations were not correlated to any type of blood flow. NO(x) concentrations were not correlated with any type of hepatic blood flow. The ratio of NO(x) to ET-1 in portal veins was correlated with portal blood flow and estimated hepatic blood flow. This correlation coefficients were higher than correlation coefficients between ET-1 concentrations in portal veins, and portal and hepatic blood flow. CONCLUSION: ET-1 levels in portal blood are significantly associated with portal blood flow and total hepatic blood flow in humans, and ratio of NO(x) to ET-1 is better indicators than either ET-1 or NO(x) alone. Although this study has limitations because it was carried out in a clinical setting, the data may contribute to the understanding of human hepatic hemodynamics.

Journal Article↗
PubMed2006

[VDT worker's posture and workload in free-address office system].

A free-address system is a new office layout in which a worker can freely sit in their favorite place with a computer and materials. Since this layout has recently been introduced in offices, we conducted a questionnaire survey which aimed to clarify the effects of the free-address system on visual display terminals (VDT) workers' posture and workload. A total of 203 male VDT workers who were system engineers aged 20 to 59 using a notebook computer were evaluated, of whom 150 used the free-address layout, and 53 used the fixed-address layout. The free-address layout was effective in the improvement of individual work space compared with the fixed-address layout. Also, in this layout the worker did not feel dissatisfaction with communication or support between workers. However, workers using the free-address layout assumed an unsuitable work posture, without adjusting the height of their chairs. Furthermore, this layout might have risk factors which increase neck/shoulder and low back stiffness and/or pain. Therefore, the free-address layout may have incipient problems, and it will be necessary to examine further the effects of this layout on VDT worker's health.

Adult↗
PubMed2004

Is drip infusion cholecystocholangiography (DIC) an acceptable modality at cholecystectomy for cholecystolithiasis, considering the frequency of bile duct maljunction and intraoperative bile duct injury?

BACKGROUND/PURPOSE: Knowledge of the configuration of the extrahepatic bile duct is indispensable to avoid bile duct injury during cholecystectomy. Various methods of examining the biliary tract have been developed; however, the most appropriate preoperative diagnostic modality at cholecystectomy for cholecystolithiasis has not yet been reported. Considering the frequency of bile duct maljunction (BDM) and operative bile duct injury, in addition to the cost and invasiveness of the various examination methods, we evaluated the usefulness of drip infusion cholecystocholangiography (DIC) as the optimal method of examination at cholecystectomy for cholecystolithiasis. METHODS: Preoperative diagnostic accuracy of BDM was analyzed in relation to operative bile duct injury using 469 patients with benign biliary diseases who was diagnosed with DIC and endoscopic retrograde cholecystography and underwent cholecystectomy. BDM was classified according to Hisatsugu criteria. RESULTS: Out of 469 consecutive patients who underwent a cholecystectomy for biliary stones between January 1, 1995, and September 30, 1998, at Ohta Nishinouchi General Hospital, 21 (4.48%) had a cystic duct maljunction (CDM) and 12 (2.56%) had an aberrant bile duct (ABD). The most common variants were types C and D for CDM, and types II and III for ABD, according to Hisatsugu's classification. Fourteen patients (42.4%) were diagnosed before the surgery; 13 of them received preoperative endoscopic retrograde cholangiography (ERC), and the remaining patient underwent preoperative drip infusion cholecystocholangiography (DIC). Nineteen patients could not be correctly diagnosed based on their preoperative examinations, but were diagnosed during surgery. Operative bile duct injury occurred in 1 patient (0.2%) whose maljunction could not be diagnosed before the operation. CONCLUSIONS: Taking into account the medical cost and invasiveness, and the frequency of BDM and related bile duct injuries, we conclude that DIC is an acceptable preoperative diagnostic modality to employ at cholecystectomy for cholecystolithiasis. Knowledge of the configuration of the extrahepatic bile duct is indispensable to avoid bile duct injury during cholecystectomy. Various methods of examining the biliary tract have been developed; however, the most appropriate preoperative diagnostic modality at cholecystectomy for cholecystolithiasis has not yet been reported. Considering the frequency of bile duct maljunction (BDM) and operative bile duct injury, in addition to the cost and invasiveness of the various examination methods, we evaluated the usefulness of drip infusion cholecystocholangiography (DIC) as the optimal method of examination at cholecystectomy for cholecystolithiasis.

Bile Ducts, Extrahepatic↗
PubMed2004

Liver metastasis from rectal cancer with prominent intrabile duct growth.

Intrabiliary growth of liver metastases from colorectal cancer has rarely been studied. A surgically resected case of a metastatic liver tumor with prominent intrabiliary growth derived from rectal cancer is reported. The patient was a 62-year-old man who had received a low anterior resection for rectal cancer in March 2000. He was re-admitted due to obstructive jaundice in January 2003, and was diagnosed with hepatic malignancy in segment II of the liver with an intrabiliary tumor extending from the intrahepatic bile duct of segment II to the common hepatic duct. He underwent a left hepatectomy, a partial resection of segment VI, and an extrahepatic bile duct resection with reconstruction of the biliary tract. In the resected specimen, there were whitish tumors of 3 cm and 1.5 cm in diameter in segments II and VI, respectively, and an intrabiliary tumor originating from the main tumor in segment II extended to the common hepatic duct. Both the liver tumors and the intrabiliary tumor consisted of a well- to moderately differentiated adenocarcinoma, which showed the same histological features as the rectal cancer. The immunohistochemical findings strongly supported that these tumors, including the intrabiliary growth, were liver metastasis from the rectal cancer. The intrabiliary invasion and growth of metastatic liver tumors has generally been overlooked, notwithstanding their frequently observed biological behavior. The present case is informative, and further investigation into this type of metastatic liver tumor may be warranted.

Adenocarcinoma↗
PubMed2004

[Survey on visual and musculoskeletal symptoms in VDT workers].

With the spread of visual display terminals (VDT) in offices, the numbers of workers using VDT and the working hours at such equipment have increased rapidly in recent years. Also, preventive measures for fatigue have been proposed and the office-working environment has been improved. To examine the effects of the rapid changes in working conditions and environment on the health of VDT workers, we conducted a questionnaire survey in 2002. A self-reported questionnaire was distributed to 3,927 office workers; 2,374 (60.5%) responded. Subjects whose questionnaires had missing data were excluded from analysis. As a result, 1,406 (male: 1,069, female: 337) workers aged 20 to 59 were subjected to analysis. By a logistic regression model, we examined the association between VDT use and visual and musculoskeletal symptoms. Prevalence of eye strain and/or pain (72.1%) was the highest, followed by neck stiffness and/or pain (59.3%), low back stiffness and/or pain (30.0%) and hand or arm strain and/or pain (13.9%). Women consistently reported more discomfort than men. As a result of the logistic regression model, eye strain and/or pain was associated with dissatisfaction with airflow, but not with factors affecting visual symptoms as reported in previous studies, for example, reflection of light and blurred characters on the screen. It was thought that airflow appeared as a risk factor because the lighting environment had been improved in offices to prevent reflection of light on the screen. Neck stiffness and/or pain was associated with raising the shoulders during VDT work, the unsuitable shape of the computer mouse for a hand, and the inconvenient arrangement of the mouse in relation to the body. Hand or arm strain and/or pain were associated with the arrangement of the mouse and inappropriate height of the desk. Low back stiffness and/or pain were associated with dissatisfaction with the chair and using the keyboard without a wrist rest. Although measures to prevent fatigue had been implemented for VDT workers, risk factors for musculoskeletal symptoms would be the same as in previous studies.

Adult↗
PubMed2004

Development of action checkpoints for comfortable computer work.

We developed a manual including a checklist format for undertaking measures to prevent fatigue in visual display terminals (VDT) workers. With this manual, problems related to VDT work can be recognized by using checklists which allow for self-evaluation by the workers. The manual helps the workers to consider measures for improvement by themselves and will contribute to better occupational health education.

Computer Terminals↗
PubMed2002

[A case report of intra-hepatic arterial infusion of mitomycin C with degradable starch microspheres for liver metastases of sigmoid colon carcinoma].

A 46-year-old man underwent polypectomy of sigmoid colon in January 1996. The adenocarcinoma invaded the submucosal layer, and sigmoidectomy and D2 lymph node dissection were performed one month later. Follow-up CT revealed liver metastases, and partial hepatectomy was performed in January 1998. Afterward, weekly high dose intra-hepatic arterial chemotherapy (5-FU: 1,000 mg/body) was performed 41 times, but CT revealed multiple liver metastases in October 1998. Therefore, intra-hepatic arterial infusion of mitomycin C (MMC) with degradable starch microspheres (DSM) was given in November 1998. As follow-up CT revealed that the liver metastases were growing, partial hepatectomy was performed again in March 1999. No carcinoma was seen in the resected liver. After the second hepatectomy, intra-hepatic arterial infusion of MMC with DSM was performed five times. No evidence of recurrence has been seen. Intra-hepatic arterial infusion of MMC with DSM is recommended for liver metastases of colorectal cancer as a second line treatment.

Adenocarcinoma↗
PubMed2002

[5-FU pharmacokinetic study of 5-FU hepato-arterial infusion with oral UFT].

5-FU hepato-arterial infusion (HAI) is powerful chemotherapy for liver metastases of colorectal cancers. Event though hepatic lesions are controlled by 5-FU HAI, we have found that extra-hepatic lesions are the limiting factor for colorectal cancer patients. General chemotherapy is necessary in addition to 5-FU HAI. The chemotherapy of 5-FU venous infusion plus oral UFT is called "pharmacokinetic modulating chemotherapy (PMC)." This protocol is very effective for colorectal cancers, because UFT reduces the rate of metabolism of infused 5-FU. We studied the plasma 5-FU concentration at the time of weekly high dose 5-FU HAI plus oral UFT. The plasma concentration of 5-FU in 5-FU HAI plus UFT is 1.5-6 times as high as with 5-FU HAI only. 5-FU concentration in the liver tissue is likely to be much higher at the time of 5-FU HAI. 5-FU HAI plus oral UFT can be more effective for not only liver metastases but also for extra-hepatic lesions than 5-FU HAI alone.

Administration, Oral↗
PubMed2002

[Pharmacokinetic study of CPT-11, SN-38 and SN-38 glucuronide in the ascites, plasma and bile after intraperitoneal administration of CPT-11].

We studied the pharmacokinetics of CPT-11 with intraperitoneal administration in a patient with a PTCD tube. The patient had advanced gastric cancer with peritoneal metastasis. CPT-11 was administrated in a dose of 40 mg and the intraperitoneal, plasma and bile levels of CPT-11, SN-38 and SN-38 glucuronide (SN-38 GLU) were measured periodically. The results showed that the periodical concentration pattern of CPT-11, SN-38 and SN-38 GLU in the bile was closely related to that of CPT-11 in the abdominal cavity.

Aged↗
PubMed2002

[Pharmacological study on levofolinate in intraperitoneal leucovorin-5-FU chemotherapy].

We report the pharmacological findings on levofolinate after the intraperitoneal administration of leucovorin-5-FU. Levofolinate 300 mg/saline 500 ml and 5-FU 750 mg/saline 500 ml were administered intraperitoneally over 1.5 h. The plasma and intraperitoneal concentrations of levofolinate at 0, 0.5, 1, 2, 4, 8, 22(20) h after the administration were evaluated at 6 points with HPLC analysis. The intraperitoneal levofolinate concentration went up as high as 100 micrograms/ml and remained above 10 micrograms/ml over 8 hours. This suggested that intraperitoneal administration elevated the portal vein and abdominal lymphatic levofolinate levels. Intraperitoneal levofolinate-5-FU is a promising protocol for gastro-intestinal cancers.

Aged↗
PubMed2002

[Staging laparoscopy for advanced gastric cancer].

Staging laparoscopy was carried out for 12 cases of advanced primary gastric cancer to evaluate the condition of peritoneal seeding. Peritoneal seeding was indicated in five cases. Abdominal lavage sampling was positive in six cases. Among six cases with positive cytology, surgery was adopted in three cases to lessen bleeding or stricture. Chemotherapy were carried out for the other three cases. Radical lymph node resection was carried out in six cases without peritoneal seeding. Laparoscopic observation was easier and more feasible under general anesthesia than local anesthesia. Preoperative staging laparoscopy for advanced gastric carcinoma can evaluate the condition of peritoneal seeding. Based on the results, a suitable treatment plan for each patient can be determined.

Anesthesia, General↗
PubMed2002

[Airway stent for airway obstruction caused by esophageal carcinoma].

The result of airway stent and adjuvant therapy for airway obstruction caused by advanced esophageal carcinoma was evaluated. In Tokyo Metropolitan Ohkubo Hospital, four cases of esophageal carcinoma with airway obstruction were treated by tracheo-bronchial stent. Two were primary cases and the others were recurrent cases. Three of the patients demonstrated progressive dyspnea due to airway obstruction, and the other complained of bloody discharge. An ultraflex non-covered stent was used cases. After insertion of the airway stent. The patients' dyspnea improved immediately. One patient was discharged without adjuvant treatment, and died of the cancer one month later. Adjuvant treatment was adopted in the other three cases. The size of the tumor decreased, but fistula formation was observed in two cases. An airway stent is an effective treatment with immediate results for dyspnea caused by airway obstruction. Adjuvant treatment after stent placement is often associated with fistula formation. It should be considered carefully.

Airway Obstruction↗
PubMedDate not supplied

SOFA score predicts postoperative outcome of patients with colorectal perforation.

BACKGROUND/AIMS: Colorectal perforation remains a life-threatening condition associated with high mortality. Various factors and operative procedures have been discussed in regard to prediction of outcome, and several scoring systems have been proposed to predict the outcome of critically ill patients. The present study was undertaken to identify factors and determine predictive scoring systems for the postoperative outcome of patients with colorectal perforation. METHODOLOGY: Between January 1996 and December 2000, 45 consecutive patients underwent emergency operation for colorectal perforation. Twelve patients (26.7%) died in hospital. The correlation of outcome with various preoperative factors, APACHE II and SOFA scores were assessed retrospectively. RESULTS: Univariate analysis showed that outcome was significantly related to maximum SOFA score (p=0.0069). Multivariate logistic regression analysis demonstrated that the maximum SOFA score was an independent predictor (p=0.016). Serum creatinine level (p=0.013) and platelet count (p=0.036) were associated with patient outcome in the SOFA score. Patients with a SOFA score higher than 7 had a greater risk of hospital death (p=0.0085). CONCLUSIONS: The maximum postoperative SOFA score is a useful predictor of the outcome from surgery for colorectal perforation.

APACHE↗