Akira Kakita

Liver resection using a water jet

SummaryThe water-jet method has been used during hepatic resection. The instrument cuts the hepatic tissue with the high pressure of the fine water flow, while the exposed elastic intrahepatic vessels are spared injury. A comparative study on the water-jet method with the previously employed conventional methods was undertaken. Hepatic resections were performed on 35 patients using the water-jet method. Cirrhosis of the liver was associated with 10 of the 24 patients with hepatocellular carcinoma. An ordinary saline solution was used as the jet, which was projected at a pressure of between 12 kg/cm2 and 20 kg/cm2 through a 0.15/mm-diameter nozzle. A higher jet pressure was needed to cut the fibrotic hepatic parenchyma. In the case of normal liver, the intrahepatic vessels of more than 0.2 mm were well preserved. In most of the cases, the loss of blood when cutting the hepatic parenchyma can be easily reduced with a jet pressure of 15–16 kg/cm2, thus preserving the fine vessels more than 0.2 mm in diameter without injury. When the same pressure was applied in the cutting of a cirrhotic liver, it took much longer time compared to that of a non-cirrhotic normal liver parenchyma. The cut surface was smooth compared to that after using CUSA, although its disadvantages lie in the formation of air bubbles, which obscure the operative field. The controlled projection of a jet of water under optimal pressure may ensure a safe hepatic resection of both normal and cirrhotic livers. Furthermore, because of its uncomplicated form, a wide range of applications can be expected, while the lower cost will also expedite its large-scale use for economic reasons.

PRIMARY YOLK SAC TUMOR OF THE LIVER

An autopsy case of yolk sac tumor of the liver in a 29‐year‐old female was reported. The tumor was found originally in the right anterior segment of the liver on the first operation. The autopsy disclosed that the liver was almost entirely replaced by multiple, round tumor nodules. The tumor masses continuously extended to the peritoneum and to the subcutaneous tissue. There were no tumors in other organs including the ovaries, gut, stomach, lung, uterus, and kidneys, indicating that the tumor originated in the liver. Microscopically, the tumor showed typical characteristics of the yolk sac tumor. An immunohistochemical study showed that AFP was distributed fine granularly in the cytoplasm of tumor cells. Electron microscopic observation disclosed large amounts of electron‐dense material being closely related to basement membrane.

Experimental studies on hemorrhagic tendency in totally hepatectomized dogs

Eight pa t ien ts of clonorchiasis s inensis were treated. Four of them had cholelithiasis. Daily dose of 100 m g / k g of Hetol was orally given every other day for five doses. No harmful side effects were detected in hematological examinations, liver funct ion tests, urine tests and clinical examinat ions in all cases. The effectiveness of Hetol was evaluated wi th the disappearance of eggs in faeces af te r t rea tment . Seven of eight cases were proved to be cured completely. We concluded tha t Hetol is far more effective for the t r ea tmen t of clonorchiasis s inensis than any other agents hi ther to used for th is disease.