Keisuke Hamazaki

Hepatectomy under extracorporeal circulation

BACKGROUND Resection of hepatic tumors located near the confluence of the hepatic vein or invading the inferior vena cava has become technically feasible and relatively safe by using venovenous bypass. However, some technical problems remain to be solved. METHODS We performed three cases of hepatic resection under extracorporeal circulation combined with hypothermic perfusion. RESULTS An unexpected hemorrhage was observed in all three cases for different causes. The patient of case 2 died of liver failure developed from fatty liver. Bile duct stenosis was observed in cases 1 and 3. CONCLUSIONS Although hepatectomy under total vascular exclusion by use of Biopump is now considered a safe procedure, attention should be paid when this procedure is performed because some technical problems still remain.

Heterotopic gastric mucosa in the gallbladder

Abstract: We report on a case of heterotopic gastric mucosa in the body of the gallbladder. A 39-year-old man, who was asymptomatic, visited our hospital because of a polypoid lesion in the gallbladder, discovered during a routine health screening. Ultrasonography (US) revealed a broad-based polypoid lesion 1.7 cm in diameter in the body of the gallbladder, which was free of gallstones. The gallbladder mass was faintly enhanced by helical computed tomography. Laparoscopic cholecystectomy was performed because of the possibility of malignancy. The specimen revealed a 1.7 × 1.3 cm polypoid lesion with deep delle in the body, with no gallstones in the gallbladder. Intraoperative frozen examination yielded a diagnosis of hyperplastic polyp of the gallbladder. Histologically, the polypoid lesion consisted of gastric fundic glands located in the whole wall of the gallbladder. The surrounding mucosa consisted of almost normal epithelium without any metaplastic changes. Postoperative technetium 99m-pertechnetate scintigraphy demonstrated no evidence of gastric heterotopia elsewhere in the body. We also review 18 other reports of heterotopic gastric mucosa in the gallbladder in the Japanese medical literature.

Kupffer cell function in chronic liver injury and after partial hepatectomy.

The reticuloendothelial system (RES) plays an important role in the biological defense system. In the liver, Kupffer cells are the main constituent of the RES, and when their function is impaired postoperative complications may more often occur. By using99mTc-labeled human serum albumin millimicrospheres (99mTc-HSA-MM) combined with assessment of single photon emission computed tomography (SPECT), we have attempted to determine the function of Kupffer cells independently of the hepatic blood flow. First, Kupffer cell function in rats with chronic liver injury caused by CCl4 was studied. The hepatic uptake rate in chronic liver injury was decreased, and a reduced phagocytic activity of the Kupffer cells was noted. The parameter concerning Kupffer cell degradation, the excretion rate (k), was markedly decreased in the early period of chronic liver injury. Changes in Kupffer cell function after 30% and 70% hepatectomy were also studied. After 30% hepatectomy, the excretion rate was decreased on the first postoperative day (POD), and it was increased beyond that found after sham operation on the 3rd POD. In contrast, slower recovery of uptake rate was demonstrated. After 70% hepatectomy, both uptake and excretion rates were markedly reduced, and recovery was prolonged beyond the 5th POD. The hepatic uptake was not parallel with the excretion rate in either experiment. These results suggest that the method that measures the hepatic excretion rate may provide a better assessment of Kupffer cell function than the current uptake measurement with radiolabeled colloid.

Asymptomatic membranous obstruction of the inferior vena cava due to large intrahepatic collaterals

This paper presents a case of asymptomatic membranous obstruction of the inferior vena cava with a rare hemodynamic pattern consisting of large intrahepatic venous connections between the right inframembranous and the middle supramembranous hepatic vein. These remarkably large collaterals obviated significant enlargement of the azygous venous system and the development of a Budd-Chiari syndrome.

Schedule-Dependent Combined Sensitivity Testing of Anti-Cancer Agents in Human Gastric Carcinoma Cell Lines

The efficacy of combination chemotherapy for gastric carcinoma has been unsatisfactory, although the prognosis of advanced and recurrent disease has improved with the introduction of cisplatin (CDDP). This study examines the effect of the anti-cancer therapies CDDP, doxorubicin (ADM) and etoposide (VP-16) on the cell cycle and their cytotoxicity against two gastric carcinoma cell lines: MKN-28 (well differentiated) and MKN-45 (poorly differentiated). The treatments have different cytocidal mechanisms, and they were studied in dual combinations. For all combinations studied, cytotoxicity against MKN-45 was higher than against MKN-28. For ADM plus CDDP, or ADM plus VP-16, cytotoxicity was higher in patients pretreated with ADM than other regimens. The highest anti-tumour activity against both cell lines was obtained with ADM followed by CDDP (we have obtained good clinical results with this regimen). Schedule-dependent combined sensitivity testing of anti-cancer agents will be useful for the clinical application of therapies

Laparoscopic Cholecystectomy with Endoscopic Naso-biliary Drainage (ENBD) Tube Inserted into the Hepatic Duct Joining the Cystic Duct

肝管後区域枝が胆嚢管に合流する走行異常例と右肝管が胆嚢管に合流する走行異常例の2例で, 選択的に総胆管→胆嚢管→肝内胆管と内視鏡的経鼻胆管ドレナージ (endoscopic nasobiliary drainage; 以下, ENBD) チューブを挿入して腹腔鏡下胆嚢摘出術を行った. 温存すべき走行異常胆管へENBDチューブを留置することは術中造影に役立つだけでなく保護したい胆道のスプリントになり, 強い炎症を伴うときの腹腔鏡下胆嚢摘出術に際して有用と考えられた.

Effect of OP-2507, a prostacyclin analogue, on endotoxin-induced hepatic necrosis in rats after partial hepatectomy

Abstract Objective: We assessed the cytoprotective effect and mechanism of action of a prostacyclin analogue, OP-2507, on the massive hepatocytic injuries induced in rats by the administration of lipopolysaccharide (LPS) after 70% hepatectomy. Methods: OP-2507 was injected subcutaneously at 1 of 2 doses (100 μg/kg and 300 μg/kg) 30 minutes before, immediately before, or 10 minutes after LPS administration. Liver function, prothrombin time, and tumor necrosis factor alpha (TNF-α) in the serum as well as hydroxyl radicals in the hepatic tissue were measured serially after LPS administration. Results: Pretreatment with OP-2507 attenuated the increase in plasma TNF-α and hydroxyl radicals in hepatic tissue and the increase in plasma aminotransferase activity; it also improved the survival rate. However, these effects were not observed when OP-2507 was administered immediately before or 10 minutes after LPS administration. Conclusions: These results indicate that OP-2507 prevents hepatic damage induced by LPS administration after 70% hepatectomy when it is given 30 minutes before LPS administration.

The Long-Term Survival of Patients with Ductal Carcinoma of the Pancreatic Head and Body

Seventy-six patients with ductal carcinoma of the pancreatic head and body who underwent resection during the past 20 years were studied. Included were 1 patient in stage I, 5 patients in stage II, 27 patients in stage III, 24 patients in stage IVa, and 19 patients in stage IVb. Curative resection was achieved in 100% of the patients with stage I and II, 81.5% of stage III, 41.7% of stage IVa, and 10.5% of stage IVb. The surgical procedure involved pancreatoduodenectomy or total pancreatectomy with extensive skeletonization. Intraoperative radiotherapy and perioperative chemotherapy were seldom performed. Surgical mortality (deaths within 3 months after surgery) decreased from 19.4% before 1986 to 2.5% after 1987. There were 11 (18.6%) long-term survivors of more than 3 years among 59 patients and 7 (15.2%) survivors of more than 5 years among 46 patients. These long-term survivors were all found in the group that underwent pathologically curative resection, and there were no long-term survivors among patients with pathologically noncurative resection. In the group receiving curative resection, 28.9% (11/38) of patients survived more than 3 years and 24.1% (7/29) of patients survived more than 5 years. The 3-year-survival rates were 60% in stages I and II, 26.9% in stage III, 4.2% in stage IVa, and none in stage IVb; the 5-year-survival rates were 40% in stages I and II, 19.2% in stage III, and none in stage IV. Curative resection should be applied to patients with stages I, II, III, and IVa tumors, and excessive surgery should be avoided for patients with stage IVb.

The effect of OP-2507, a prostacyclin analogue, on endotoxin-induced extensive hepatic necrosis in rats following partial hepatectomy

Prostaglandin 12 and its derivative have been shown to reduce hepatic damage induced by galactosamine (I). However, the mechanism for cytoprotective activity of these prostaglandins is still unclear. So, in this study, we attempted to elucidate the effect of 0P-2507 in a rat model of endotoxininduced extensive hepatic cell necrosis following partial hepatectomy (2). In male Wistar rats weighing 200-250 g, 70~ hepatectomy was performed under ether anestesia. Forty-eight hours later, the rats were divided into four groups (7 in each group). Group A: Received a single intravenous administration of LPS (500 Hg/kg) alone, Group B and C: Received subcutaneous administration of 0P2507, 100 pg/kg and 300 N g/kg respectively, 30 min before LPS injection (same dose), Group D: Received intravenous administration of saline alone. Survival rate and serum TNF-~ (5 in each group) were evaluated. The survival rates at 8 hours in groups A through D were 0%, 57~, 86~ and I00~ respectively; and at 24 hours in groups B, C and D were 43%, 71g and I00~ respectively. Serum TNF-~ at I hour in groups A, B and C was 788• 186 JRU/ml, 36 • JRU/ml and 16.4• 6.0 JRU/ml respectively, and at 3 hours was 4.9 • 4.6 JRU/ml in group A, and O JRU/ml for the other 3 groups. These results suggest that 0P-2507 administration can improve survival rates by suppression of TNF-~ production from macrophages.

Studies on clinical pathophysiology and treatment of hepatolithiasis.

病態を明確にしえた肝内結石症30例について検討した. 結石所在部位はR8例, RL13例, L9例であったが, 胆管狭窄に主眼をおくと, 1) 左右肝内胆管無狭窄型6例, 2) 右肝内胆管狭窄型7例, 3) 左肝内胆管狭窄型15例, 4) 左右肝内胆管狭窄型2例となった. これらについて結石の分布と個数および肝内胆管狭窄の関係から進展形式について考察すると, 肝内胆管に狭窄がある型では結石は狭窄部の末梢に原発して他の部位にも移動してゆくが, 肝内胆管無狭窄型では結石は肝外胆管に原発して積み上げによって肝内に及ぶと推察された. 治療は肝内胆管狭窄を有する症例24例中22例に狭窄胆管を含む肝切除が行われたが予後は良好であった.