Kazuhiko Nomura

Detection of hepatic metastases from colorectal carcinoma: comparison of histopathologic features of anatomically resected liver with results of preoperative imaging.

Goals The specificity and sensitivity of intravenous-enhanced multidetector row computed tomography (MDCT), superparamagnetic iron oxide-enhanced magnetic resonance imaging (SPIO-MRI), multidetector row computed tomography with arterioportography combined with multidetector row computed tomography with hepatic arteriography (CTAP/CTHA), and intraoperative ultrasonography (IOUS) for detecting hepatic metastases from colorectal carcinoma were evaluated based on histopathologic examination of resected livers. Study MDCT, SPIO-MRI, CTAP/CTHA, and IOUS were performed routinely to determine surgical indications and methods in patients with hepatic metastases from colorectal carcinoma. The resected liver specimens were then cut serially into sections 3 to 5 mm thick for routine histologic examination. Results Fifty metastatic lesions were detected by histopathologic study of a large amount of anatomically resected liver from 8 patients with colorectal liver metastasis. The tumors ranged in size from 3 to 53 mm (mean 13.8 mm) and 26 lesions (52%) were less than 10 mm in diameter. Histopathologic examination of the resected liver specimens showed that CTAP/CTHA was the most sensitive imaging modality, followed in order by IOUS, SPIO-MRI, and MDCT. Among all the tumors detected by CTAP/CTHA, SPIO-MRI overlooked 5, but all of the tumors detected by SPIO-MRI were also detected by CTAP/CTHA. The number of metastatic liver tumors detected differed significantly among MDCT, SPIO-MRI, and histopathologic examination. One false-positive lesion was detected by IOUS. Conclusions CTAP/CTHA is a useful preoperative imaging modality for detecting small hepatic metastases from colorectal carcinoma.

Relationship between Doubling Time of Liver Metastases from Colorectal Carcinoma and Residual Primary Cancer

Background: The doubling times of liver metastases were calculated in order to clarify their usefulness in predicting the presence of residual cancer in the abdominal cavity in patients who had undergone curative resection of primary colorectal cancer. Patients and Methods: Tumor doubling times were calculated retrospectively in 22 patients by serial measurement of the size of their liver metastases. Results: Patients with a tumor doubling time of less than 92.4 days had a significantly poorer prognosis than those with a doubling time more than or equal to 92.4 days (p < 0.05). Local recurrence or peritoneal dissemination was significantly more likely to occur when the tumor doubling time was less than 92.4 days than when it was more than or equal to 92.4 days (p < 0.01). Conclusion: The doubling time of hepatic metastases in patients with colorectal carcinoma may be a useful prognostic indicator, with patients who have a shorter tumor doubling time carrying a greater risk of residual primary cancer in the abdominal cavity.

Inhibition of urokinase-type plasminogen activator delays expression of c-jun, activated transforming growth factor β1, and matrix metalloproteinase 2 during post-hepatectomy liver regeneration in mice

BACKGROUND/AIMS Although urokinase-type plasminogen activator (u-PA) is suggested to initiate various factors in liver regeneration after hepatectomy, no corroborative evidence has been reported. In the present study, we investigated the effect of u-PA on liver regeneration after hepatectomy. METHODS Mice were placed into either a control group or a u-PA-inhibited group that received an in vivo u-PA inhibitor, p-aminobenzamidine. After we had removed two-thirds of the liver, we examined the expressions of c-jun mRNA and activated transforming growth factor beta 1 (TGF-beta 1), matrix metalloproteinase-2 (MMP-2) activity, and the level of hepatocyte and non-parenchymal cell proliferation in the two groups. RESULTS In the u-PA-inhibited group, the delays in c-jun mRNA expression, hepatocyte proliferation, activated TGF-1 expression, and expression of MMP-2 activity, were 2h, 1, 2, and 1 day, respectively, and the sinusoid architecture was not restored by 10 days after hepatectomy. CONCLUSIONS u-PA inhibition delays the expression of c-jun mRNA, hepatocyte proliferation, and restoration of the sinusoid architecture, suggesting that u-PA plays important roles in liver regeneration after hepatectomy through control of a transcription factor, c-jun expression.

Sonographic detection of visceral adhesion in percutaneous drainage of afferent-loop small-intestine obstruction.

To facilitate the percutaneous drainage of an afferent‐loop small‐intestine obstruction, we used sonography to detect visceral adhesions and select a safe puncture route. The portion of the small intestine that was fixed to the anterior abdominal wall was sonographically identified by using a high‐frequency transducer to locate the area of restricted visceral sliding. The needle was then inserted into the intestine. In 3 cases, we have found that this technique improves the confidence of the physicians who perform the percutaneous drainage and may help to minimize the risks associated with the percutaneous drainage.

Plasma Concentration of Endothelin-1 Does Not Reflect Renal Vasoconstriction as Estimated by Duplex Ultrasonography in Cirrhosis

Endothelin, a potent vasoconstrictor, is thoughtto play a role in liver cirrhosis-related functionalkidney failure. Our aim was to investigate thecorrelation between renal vasoconstriction, as detected by a Doppler ultrasound technique, and plasmaconcentrations of endothelin in cirrhotic patients.Fifty cirrhotic patients underwent Doppler examinationsto detect renal vasoconstriction. The plasmaconcentration of endothelin was measured in 10 patients whoexhibited vasoconstriction of the renal microvesselsdiagnosed by Doppler waveform analysis and was comparedto that of patients in whom there was no sign of such vasoconstriction. No difference wasobserved in the plasma concentration of endothelinbetween patients in whom renal vasoconstriction wasdiagnosed and those in whom it was not. Our resultssuggested that the circulating endothelin does notreflect renal vasoconstriction, at least in the earlyphase of the functional renal failure associated withcirrhosis of the liver.

Impairment of changes in the diameter of the pancreatic portion of the superior mesenteric vein: an ultrasonographic sign of chronic pancreatitis or fibrosis.

Objective. A new ultrasonographic technique for detecting parenchymal stiffness of the pancreas is proposed. This technique measures changes in the diameter of the origin of the superior mesenteric vein (SMV) induced by deep inspiration. The origin of the SMV has extensive attachments to the pancreatic parenchyma; therefore, both physiologic enlargement and shrinkage of the venous lumen cannot occur without changes in the shape of the surrounding parenchyma. Therefore, increased parenchymal stiffness due to chronic pancreatitis (CP) may result in impaired changes in the venous diameter. To confirm this hypothesis, patients with CP and those with a normal pancreas were examined in this study. Methods. Twelve patients in each group were examined. Images of the origin of the SMV were obtained with a commercial ultrasound system. The smallest diameter of the SMV was measured during normal breathing. The patients were then asked to take a deep breath to increase the portal blood pressure followed immediately by the same measurements as performed during normal breathing, and the ratio of the change was calculated. Results. In the normal group, the diameter of the SMV changed by 79.5% ± 43.8% (mean ± SD), whereas a change of 1.4% ± 7.3% was observed in the CP group. The difference between the two groups was statistically significant (P < .0001). Conclusions. The physiologic change in the diameter of the origin of the SMV enhanced by deep inspiration may reflect the stiffness of the pancreatic parenchyma. Therefore, detection of an impaired diameter change may be useful for screening of CP.

A Case of Hepatic Resection for Colorectal Hepatic Metastasis after Radio Frequency Ablation

大腸癌肝転移に対し他院で行われたラジオ波焼灼(radio frequency ablation;以下, RFA)後に, 当科で肝切除術を施行した1例について報告する. 症例は50歳の男性で, 多発性肝転移の一部の腫瘍に対しRFAが行われ, 残りの未治療の腫瘍に対する加療目的で当科に紹介となった. RFA後の腹部CTでは, 焼灼部は腫瘍より広範囲に造影欠損が認められ, 焼灼により治療しえたと判断されたが, 肝切除術により得られた標本の病理組織学的検査では焼灼部に腫瘍の遺残を認めた. 大腸癌肝転移に対する治療は肝切除が第1選択であり, RFAの有効性はいまだ議論の多いところである. RFA後の局所再発や, 穿刺に伴う播種により根治性を損なうとの報告もあり, 大腸癌肝転移の治療としてRFAの適応は慎重に検討すべきである.

Hepatopancreatoduodenectomy for Diffuse Bile Duct Carcinoma Arising in Choledochal Cyst

We report a 66-year-old man with diffuse bile duct carcinoma arising in a choledochal cyst, who underwent right portal venous branch embolization to minimize the hepatic deficit that would result from