Biomedical subjects

Y Nimura

Publications and source records attributed to Y Nimura.

516 records · Page 29Linked to original sources

PubMedDate not supplied

A case of intrahepatic stones with an anomalous intrahepatic portal venous system.

A 64-year-old woman who had undergone surgery for gallstones twice was admitted with epigastric pain and fever. Ultrasonography revealed gallstones in the dilated left lateral intrahepatic bile ducts. Abdominal computed tomography disclosed atrophy of the left lateral segment and the right lobe of the liver, and hypertrophy of the left medial segment and the caudate lobe. Percutaneous transhepatic cholangiography demonstrated that the stones were localized in the left lateral intrahepatic bile ducts, and that the choledochoduodenostomy previously established was patent. Percutaneous transhepatic portography revealed that the left portal vein was absent and the left medial segment was supplied by the right portal vein. Left lateral hepatic segmentectomy and release of the choledochoduodenostomy were performed. Postoperative recovery was good, and the patient is now well without any complaint. This report discusses the surgical treatment for intrahepatic stones under very complicated conditions and the relationship between intrahepatic stones and anomalous portal venous system.

Bile Duct Diseases↗

PubMedDate not supplied

Case of bile duct carcinoma of the hepatic hilus with segmental obstructive cholangitis.

Cholangitis is a risk factor for posthepatectomy liver failure and therefore should be treated aggressively by urgent biliary drainage before definitive liver surgery for bile duct carcinoma. We present a case of bile duct carcinoma of the hepatic hilus with segmental cholangitis. The patient was a 38-year-old man. Percutaneous transhepatic biliary drainage (PTBD) was performed in the left anterior, right anterior, and right posterior segmental ducts to alleviate jaundice and to evaluate the biliary system. One month after PTBD, the patient developed high fever with leukocytosis, suggesting the onset of segmental cholangitis. An urgent repeat PTBD was carried out at the caudate and left medial segmental bile ducts. The bile juice was purulent, and the tube cholangiogram revealed miliary abscesses. After PTBD, cholangitis was subsided, and extended left hepatic lobectomy with caudate lobectomy was performed. The postoperative recovery was uneventful and the patient has been well for 13 months. We conclude that the onset of fever in patients with hilar bile duct cancer, PTBD catheters, and undrained biliary segments suggests the presence of segmental cholangitis.

Adult↗

PubMedDate not supplied

Multiple angiomyolipomas of the liver (case report).

Angiomyolipoma of the liver is an extremely rare type of tumor and reported cases are few and far between. This case study reports on a 37-year-old woman who suffered from multiple angiomyolipomas of the liver. Ultrasonography (US) and computed tomography (CT) initially revealed the existence of two tumors located in the right lobe of the liver and measuring 20 x 15 mm and 8 x 7 mm in size. The patient underwent partial resections of the liver. Histopathologic examination of both the resected specimens revealed angiomyolipoma. This is the first reported case of multiple angiomyolipomas of the liver. Furthermore, the lesions of our case study were small in size and rich in fat component. Under such conditions, preoperative examination resulting in an angiomyolipoma diagnosis is difficult even with the aid of imaging modality and needle biopsy techniques.

Adult↗

PubMedDate not supplied

Resection of metastatic liver cancer in a patient with an anomalous intrahepatic portal system: a case report.

Resection of metastatic liver cancer in a patient with an anomalous intrahepatic portal system is presented. A 67-year-old man was referred to our hospital with a liver tumor. Percutaneous transhepatic portography demonstrated that the right anterior branch of the portal vein rose from the left portal vein with agenesis of the umbilical portion. Cholangiography disclosed obstruction of the right posterior segmental bile duct by the tumor. Barium enema demonstrated a Borrmann type II cancer in the sigmoid colon. Right hepatic lobectomy and high anterior resection of the colon were performed, and postoperative histologic examination confirmed that the liver tumor was metastatic adenocarcinoma of the colon. The ligamentum teres arose from the right anterior portal vein and separated the left medial segment from the right anterior portal segment of the liver. These anomalies led to the performance of right lobectomy instead of trisegmentectomy and the patient died 10 months later of hepatic recurrence. This case emphasizes the importance of delineating the hepatic vascular anatomy before liver resection and illustrates one of the pitfalls related to portal venous anomalies.

Adenocarcinoma↗

PubMedDate not supplied

Duodenal obstruction due to annular pancreas associated with pancreatic head carcinoma.

A patient with obstructive jaundice due to carcinoma of the pancreas head showed painless vomiting from the supra-papillary duodenal obstruction. Computed tomography demonstrated a space-occupying lesion in the head of the pancreas, which was not so large as to make an obstruction of the proximal portion of the duodenum. Pylorus preserving pancreatoduodenectomy was performed and the surgical specimen showed that the duodenal obstruction was caused by a swollen annular pancreas associated with obstructive pancreatitis by the carcinoma of the pancreas head. Duodenal obstruction is a rare symptom of annular pancreas in adults. It is thought to be necessary to remind of the coexistence of the annular pancreas, when patients with pancreatic or periampullary malignancies are complicated with unexpected obstruction of the second portion of the duodenum in proportion to the size.

Adenocarcinoma↗

PubMedDate not supplied

Biliary cystadenocarcinoma resected by segment 3 and 4 hepatectomy.

We describe a case of biliary cystadenocarcinoma of the liver in a 72 year-old woman presented to our hospital with abdominal fullness. Laboratory data showed an elevation of alkaline phosphatase and a decreased excretion of Indocyanine green (ICG). CT revealed a cystic tumor with papillary projections, measuring 13A approximately 15cm, in the left medial segment of the liver (S4). Percutaneous transhepatic cholangioscopy (PTCS) disclosed the tumor in the dorsal subsegmental duct of S4 and the cholangioscopic biopsy from the tumor revealed papillary adenocarcinoma. PTCS showed the left lateral posterior segmental bile duct (B2) joined the common tract of the left medial (B4) and left lateral anterior (B3) segmental bile duct, and the tumor involved B4 and B3 but not the common tract of B4 and B3. A radical surgery, which included segment 4 and 3 resection with preservation of the left hepatic duct and the segment 2 was performed. The histopathological examination revealed that the tumor did not involve the liver parenchyma and had no lymph node metastasis. Postoperative course was unremarkable and the patient at present time, 4 years after the operation, is doing well. This case report discusses the importance of preoperative evaluation by PTCS for a rational surgical procedure.

Aged↗

PubMedDate not supplied

Partial hepatectomy for metastatic seeding complicating pancreatoduodenectomy.

We present a case report of metastatic seeding at the percutaneous transhepatic biliary drainage tract in a 68 year-old man who previously underwent pancreatoduodenectomy with bile duct resection for distal bile ductal carcinoma. Three years and 5 months after the initial operation, dilation of the left lateral segmental bile ducts was detected by abdominal ultrasonography. Percutaneous transhepatic cholangiography disclosed a stricture at the confluence of the ventral and dorsal branches of the left lateral anterior segmental duct. This region corresponded to the punctured point of the previous percutaneous transhepatic biliary drainage. Implantation of the bile duct carcinoma at the percutaneous transhepatic biliary drainage sinus tract was diagnosed, and the recurrent tumor was successfully resected by an extended left hepatic lobectomy with a total caudate lobectomy. Currently, 8 years and 3 months after the second surgery, the patient is in good health without any signs of tumor recurrence. This case report discusses the entity of metastatic seeding, a rare but serious complication of percutaneous transhepatic biliary drainage. An aggressive surgical approach is important for recurrent biliary tract malignancies.

Adenocarcinoma↗

PubMedDate not supplied

Multiple hepatic cysts along the intrahepatic bile duct--case report.

A case of multiple hepatic cysts of the periductal gland located along the left intrahepatic bile duct is described. Ultrasonography and computed tomography disclosed many cystic lesions along the left portal vein in the left lateral segment of the liver. Percutaneous transhepatic cholangiography showed many compressed lesions. The resected specimen revealed multiple cysts of 2-7mm in diameter along the intrahepatic bile duct. Microscopically, cysts within the large Glisson's capsule were intermixed with lobuli of the periductal glands, thus suggesting periductal gland origin. Histopathological features of these cysts were similar to those of "multiple hilar cysts" reported by Nakanuma, but lack of portal hypertension and underlying chronic liver disease is the significant characteristics in this case which is different from "multiple hilar cysts".

Aged↗

PubMedDate not supplied

Segmental liver resections for hilar cholangiocarcinoma.

BACKGROUNDS/AIMS: Liver resection for hilar cholangiocarcinoma is now popular, and combined en bloc resection of the caudate lobe has become general practice, especially in Japan and some European countries. However, surgical procedure is not yet standardized, and many problems concerning surgical treatment of this disease still remain unsolved. METHODOLOGY: From April 1977 to December 1996, 173 patients with hilar cholangiocarcinoma were treated at The First Department of Surgery, Nagoya University Hospital. Of the 173 patients, 138 patients underwent surgical resection, including 124 liver resections and 14 bile duct resections. RESULTS: Several kinds of hepatic segmentectomy with en bloc resection of the caudate lobe were performed in the 124 patients: 109 underwent hepatic lobectomy or more extensive resection including central bisegmentectomy; 15 received resection of one or less segment of the liver. Aggressive resections, including combined portal vein and liver resection (n = 41) and hepatopan-creatoduodenectomy (n = 16), were applied to advanced hilar cholangiocarcinoma. The hospital death rate in hepatectomized patients was 9.7% (12/124). The 3- and 5-year rates for the 97 patients with curative hepatectomy were 42.7%, and 25.8%, respectively. CONCLUSIONS: Aggressive liver resection improves survival of patients with hilar cholangiocarcinoma. Resection procedures should be designed based on a precise diagnosis of the extent of carcinoma.

Bile Duct Neoplasms↗

PubMedDate not supplied

Advanced endocrine cell carcinoma of the gallbladder: a patient with 12-year survival.

Gallbladder carcinoid is a rare disease. In previous reports, classical carcinoid, an entity with a good prognosis, has not been distinguished from endocrine cell carcinoma, a tumor associated with marked cell atypia and mitosis, and a poor prognosis. The patient was a 66 year old woman who presented to our hospital with a chief complaint of jaundice. Pre-operatively, she was diagnosed as having advanced gallbladder carcinoma invading the liver and the hepatic hilus. The patient underwent right hepatic trisegmentectomy with en bloc resection of the caudate lobe and extrahepatic bile ducts, extended lymph node clearance and left hepaticojejunostomy. Histopathological examination showed positive Grimelius staining, marked mitosis, and intense atypism, hence, the tumor was diagnosed as an endocrine cell carcinoma. Twelve years after surgery, the patient is healthy, without any sign of recurrence. We present this novel case of long-term survival and review the literature.

Aged↗

PubMedDate not supplied

Malignant fibrous histiocytoma of the gallbladder.

We report two extremely rare cases of primary malignant fibrous histiocytoma (MFH) of the gallbladder. The first case occurred in a 70 year old woman who presented with a large tumor of the gallbladder and multiple liver metastases. The second case involved a 74 year old man with a small submucosal tumor of the gallbladder and a single large liver metastasis. Histologically, these tumors consisted of spindle cells in a storiform pattern intermingled with bizarre giant cells. Both of these patients died of liver failure 3 months post-operatively.

Aged↗

PubMedDate not supplied

Prospective randomized trial of 5-fluorouracil, doxorubicin, and mitomycin C for non-resectable pancreatic and biliary carcinoma: multicenter randomized trial.

BACKGROUND/AIMS: The efficacy of combination chemotherapy, which consists of fluorouracil, doxorubicin and mitomycin, was compared with that of palliative surgery-only in patients (control) having non-resectable pancreatic and biliary carcinomas in a multicenter randomized trial. METHODOLOGY: The patients were assigned to combination chemotherapy consisting of concomitant 5-fluorouracil 200 mg/m2, doxorubicin 15 mg/m2, and mitomycin 5 mg/m2 by intravenous administration. This combination chemotherapy was given concurrently as the initial dose within 1 week after palliative operation, and this regimen was repeated for at least 2 whole courses at 4-week intervals before the next course of therapy. Forty-two cases of this combination chemotherapy group and 41 of the control group were completely eligible for analysis. RESULTS: Regarding the overall 50% inhibition of tumor progression and that of gallbladder carcinoma, there were significantly better outcomes in the modified FAM therapy group. In this group, tumor reduction was achieved in 1 complete response (CR) and 2 partial response (PR) patients. With respect to the overall and differentiated survival times according to the tumor sites and the clinical efficacy, there was no difference between the groups. The most frequent adverse reactions were gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea; also noted was alopecia. CONCLUSIONS: Since this combination chemotherapy inhibited the tumor progression for significantly longer duration and, to a lesser extent, reduced the tumor size in non-resectable gallbladder carcinomas compared to a non-administrated chemotherapy group, this study will function as the basis for pursuing a more effective chemotherapy.

Adult↗