Chizu Koreeda

A Prospective Randomized Controlled Trial of Preoperative Whole-Liver Chemolipiodolization for Hepatocellular Carcinoma

BackgroundWe previously reported that preoperative chemolipiodolization of the whole liver is effective for reducing the incidence of postoperative recurrence and prolonging survival in patients with resectable hepatocellular carcinoma (HCC). The present randomized controlled trial was performed to evaluate the influence of preoperative transcatheter arterial chemoembolization (TACE) on survival after the resection of HCC.MethodsOperative results and long-term outcome were prospectively compared among 42 patients who received only selective TACE targeting the tumor (selective group), 39 patients who received TACE targeting the tumor plus chemolipiodolization of the whole liver (whole-liver group), and 43 patients without preoperative TACE or chemolipiodolization (control group).ResultsThere were no serious side effects of TACE or chemolipiodolization and the operative outcomes did not differ among the three groups. Even though preoperative TACE induced complete tumor necrosis, there were no significant differences in the pattern of intrahepatic recurrence or the time until recurrence among the three groups. There were also no significant differences in disease-free survival or overall survival among the three groups, even among patients with larger tumor size.ConclusionThese results indicate that preoperative selective TACE and whole-liver chemolipiodolization plus TACE do not reduce the incidence of postoperative recurrence or prolong survival in patients with resectable HCC.

Effects of late evening snack including branched-chain amino acid on the function of hepatic parenchymal cells in patients with liver cirrhosis

Aim:  A late evening snack (LES) improves protein‐energy malnutrition due to overnight starvation and the catabolic state in patients with liver cirrhosis. Our aim was to examine whether LES including a branched‐chain amino acid (BCAA) could maintain hepatic reserve and the function of hepatic parenchymal cells in patients with liver cirrhosis, including those in the early stage of disease.

Hepatic parenchymal changes after the intraarterial injection of lipiodol in tumor-bearing rabbits.

RATIONALE AND OBJECTIVES.The influence of lipiodol injection on hepatic morphology and function was investigated in 119 rabbits with hepatic VX2 tumors. METHODS.The rabbits were divided into the following three groups, according to the materials injected via the proper hepatic artery: group 1 received doxorubicin (Adriamycin [ADM]); group 2 received lipiodol (LPD); and group 3 received LPD plus ADM. Groups 2 and 3 were each divided into three subgroups, according to the dose of LPD injected (0.3, 0.6, and 1.2 mL). Non-tumorous regions in the tumor-bearing lobe and the tumor-free lobe were examined histologically; low-kilovolt x-ray studies and computed tomography (CT) also were performed in 84 rabbits. Liver function tests were performed in 35 rabbits. RESULTS.Elevation of the serum aminotransferase levels was observed after the administration of LPD. Hepatocellular degeneration was marked in the tumor-free lobe, but was much more severe in the tumor-bearing lobe in groups 2 and 3. The degree of degeneration depended on the dose of LPD. Both low-kilovolt x-ray studies and CT showed the heavy accumulation of LPD in the tumor-bearing lobe. CONCLUSIONS.The current study shows that the histologic and functional adverse effects of oily chemoembolization depend on the dose of LPD administered to the liver.

Evaluation of hepatic function using 99mTc-galactosyl human serum albumin (GSA) scintigraphy: comparison with antipyrine plasma clearance

Abstract 99m Tc-galactosyl human serum albumin (GSA) is a new scintigraphy agent which binds specifically to asialoglycoprotein receptors on hepatocytes, and can be used to evaluate hepatic function. Indocyanine green (ICG) is hepatic blood flow-dependent, while antipyrine plasma clearance is independent of blood flow and thus antipyrine plasma clearance is an excellent parameter with which to assess liver function. In this study, we investigated the relationship between GSA examination and antipyrine plasma clearance to assess the usefulness of GSA in evaluating metabolic function of the liver. Studies were performed on 22 patients with liver diseases. Antipyrine plasma clearance measurement, ICG testing and biochemical analysis of blood were performed at the same time as GSA examination. GSA HH15 and antipyrine plasma clearance showed a good correlation ( r = −0.702, P r = 0.449, P

Late Evening Snack, Branched Chain Amino Acids, and Cirrhosis

Patients with liver cirrhosis (LC) have decreased gluconeogenic capacity, which leads to decreased availability of sugar and increased availability of fat especially during the fasting period from after the evening meal until morning. Furthermore, due to gluconeogenesis requirements for amino acids being met by the breakdown of muscle protein, skeletal muscle is decreased and the nitrogen balance becomes negative. Thus, patients with LC present with protein energy malnutrition (PEM).Branched chain amino acid (BCAA) therapy for LC is effective for ameliorating this condition by correcting PEM and improving both quality of life (QOL) and prognosis. A late evening snack (LES) using Aminoleban EN for LC has beneficial effects on hepatic parenchymal cells in addition to nutritional effects. A LES using BCAA is both safe and useful, as nutritional and dietary therapy, comprising one part of the four-meal-a-day dietary intervention.

Recent diagnosis and therapy for liver cancer

This review described diagnosis and treatment of hepatocellular carcinoma. Hepatocellular carcinoma commonly develops in patients with chronic hepatitis caused by hepatitis C and hepatitis B virus. Ultrasound imaging, computerized tomography and magnetic resonance imaging are useful for disclosing hepatocellular carcinoma. Surgical resection, percutaneous needle therapy, transarterial therapy and systematic chemotherapy are used to treatment of hepatocellular carcinoma.

A case of hepatocellular carcinoma complicated with biliary pleuritis after liver infarction due to per-cutaneous radiofrequency ablation

症例は65歳の男性. 肝S8肝門部の肝細胞癌に対しTAE後に経皮的ラジオ波焼灼治療 (PRFA) を施行したところ肝梗塞を合併. その後敗血症性ショックにより再梗塞を惹起. さらに胆管胸腔瘻が形成され胆汁性胸膜炎を来した. 胆管内圧の減圧を目的に内視鏡的胆管ドレナージを施行し, 瘻孔閉塞に成功したが長期間の入院加療が必要となった. 以前よりラジオ波焼灼による脈管障害は軽微と報告されているが, 時として本症例のように重大な合併症を引き起こす可能性がある. 特に脈管損傷を来しやすい肝門部に位置する肝細胞癌に対し本法を施行するに当たっては, 患者に対する術前の十分な説明と術後の注意深い経過観察が必要である. PRFAにより肝梗塞を合併し, その後胆管胸腔瘻から胆汁性胸膜炎に至った肝細胞癌の1例を経験したので報告した.