Junichi Mizutani

Promotion of hepatic metastases by liver resection in the rat

In the early period following radical hepatectomy for hepatoma, recurrences in the remaining liver are frequently found. In regenerating liver, implantation and growth of tumour cells released into the portal system during surgical treatment might be promoted. We examined the relationship between liver regeneration and the formation of metastases following hepatic resection. Intraportal injections of rat ascites containing hepatoma AH130 cells at a concentration of 1 x 10(5) cells 0.2 ml-1 were made at various periods following two thirds liver resection in rats. Tumour cell injections immediately at 24 h after surgery resulted in an increased number of hepatic metastases compared with control animals. Tumour cell injections 2 weeks after hepatectomy, however, had no significant difference in effect compared with control rats. In contrast, tumour cells injected immediately after removal of half of the caudate lobe resulted in the same number of metastases as control animals. These results demonstrate that the number of artificially induced hepatic metastases was increased during an initial period of active liver regeneration and was proportional to the volume of hepatectomy. The effect of 5-fluorouracil (5FU) or mitomycin C (MMC) as inhibitors of hepatic regeneration on liver metastasis after hepatectomy was studied. The administration of 5FU (20 mg kg-1) or MMC (0.2 mg kg-1) immediately, 24 and 48 h after hepatectomy resulted in a marked reduction in metastatic lesions. The administration of 5FU caused delays in weight gain and decreases in the wet weight of remaining liver, while MMC had no effect on either. Accordingly, results of 5FU administration may be due to inhibitory effects on liver regeneration whilst that of MMC administration may be due to cytocidal antitumour effect. The effect of OK-432 as an immunoactivator on the implantation and growth of tumour cells in regenerating liver was also studied. Pretreatment with OK-432, 0.5 mg intraperitoneally on 7 consecutive days, had no effect on hepatic metastases. The pathophysiology of liver regeneration may enhance hematogenous hepatic metastasis and release of tumour cells during surgical manipulation may represent an important cause of recurrence following hepatic resection.

Endoscopic polypectomy under laparotomy throughout the alimentary tract for a patient with blue rubber bleb nevus syndrome

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A new surgical approach for control of pain in chronic pancreatitis: Complete denervation of the pancreas

With the aim of pain control in chronic pancreatitis without the morbidity of insulin-dependent diabetes, a new procedure was devised to completely resect the postganglionic pancreatic nerves and to totally free the pancreas from the posterior abdominal wall. This procedure was performed on two patients with follow-up periods of 24 and 10 months. Pain was resolved in both patients, and their blood glucose levels were substantially unchanged. This new approach offers a means of relieving pain with preservation of endocrine function in selected patients with chronic pancreatitis, especially in patients who have a small pancreatic duct.

Role of Preoperative Endoscopic Retrograde Cholangiography in Laparoscopic Cholecystectomy

Abstract: An endoscopic retrograde cholangiography (ERC) was performed in 303 patients before laparoscopic cholecystectory. The ERC was successful in 275 patients (90.8%). Common bile duct stones were diagnosed in 9 of 275 patients (3.3%). These had not been suspected on the basis of the clinical and laboratory data or ultrasonography results in 8 of them. An endoscopic papilotomy (EPT) was successful in all 9 patients with choledocholithiasis before laparoscopic cholecystectomy. Anatomical variations, such as origin of the cystic duct from the right or left hepatic duct and an accessory bile duct, were detected in 6 patients (2.2%). Preoperative ERC proved useful in determining the biliary anatomy or detecting unsuspected stones. (Dig Endosc 1994; 6 : 24–27)

Endoscopic Treatment of Hepatolithiasis in a Patient Undergoing Pancreatoduodenectomy

Abstract: Our subject was a 70‐year‐old woman who had undergone a pancreatoduodenectomy for cancer of the head of the pancreas 5 years prior to this study. She had prominent signs of jaundice and fever, which had started several days before admission, and which responded to intravenous antibiotic therapy. A peroral biliary fiberscope (XQ‐20, Olympus) was introduced into the afferent loop to the anastomosis of the bile tract, and an endoscopic cholangiograpy revealed hepatolithiasis. Endoscopic balloon dilatation was performed and the stones were removed using the balloon. Endoscopic therapy for hepatolithiasis was successfully performed after a pancreatoduodenectomy.