Nobuki Kameoka

Rotational digital angiography for the evaluation of iliac artery disease

Ten cases with iliac artery disease were evaluated using rotational angiography with revolution of the arm of the X-ray tube support unit. The tip of the catheter was advanced to the infrarenal aorta, and contrast medium was injected at a rate of 6–10 ml/second. Digital angiographic images from multiple projection angles were acquired at 15 frames/second with a rotation speed at about 10°/second and a range of greater than 90°. This method made it possible to detect ulcerations of the artery, which could not be visualized using conventional single-plane angiography. The three-dimensional structure of a dissection could also be visualized. In seven cases of occlusive iliac artery disease, comparison with rotational angiography revealed that anteroposterior views of single-plane angiography underestimated the extent of the disease in four cases and overestimated the extent of the disease in one case. In two cases, no additional clinical information was obtained. In conclusion, rotational angiography provides accurate three-dimensional information concerning the lumen of the iliac arteries.

Changes in liver blood flow after hepatectomy in conscious dogs

Hepatic circulation after hepatectomy was investigated in conscious dogs under fasting and feeding conditions. After a 40% hepatectomy, both the hepatic arterial and portal blood flow were measured simultaneously using ultrasonic transit time flowmeters. During fasting, the total hepatic blood flow (i.e., the sum of arterial and portal blood flow) changed in a biphasic pattern after hepatectomy. The first peak (517.9±42.7 ml/min; 130.1% of preoperative flow) was seen on the 1st postoperative day (POD) and the second peak (444.8±25.6 ml/min; 112.7% of preoperative flow) occurred on the 7th POD. The portal flow demonstrated the same biphasic changes as the total hepatic flow, although the hepatic arterial flow showed only the first peak. A heart rate analysis suggested that the first peak was probably due to hyperdynamic circulatory conditions, as has been previously reported. In addition, the existence of the second peak was established by the present study. The postprandial hepatic blood flow decreased during the first 2 weeks postoperatively, but exceeded the presurgical levels on PODs 21 and 28.

A cholangiocellular carcinoma radically resected by central hepatic bisegmentectomy with en bloc resection of the caudate lobe and extrahepatic bile duct

A case of cholangiocellular carcinoma, involving the hepatic hilus, radically resected by central hepatic bisegmentectomy with en bloc resection of the caudate lobe and extrahepatic bile duct is presented. Preoperative surgical planning was carried out on the basis of an evaluation of the findings of ultrasonography, computed tomography, angiography, percutaneous transhepatic portography, and tube cholangiography. The operation lasted for 16 h and 15 min, with 5700 g blood loss. Postoperative recovery was very good and the patient has now been well for 26 months after surgery. Although the surgical technique of central hepatic bisegmentectomy with en bloc resection of the caudate lobe and extrahepatic bile duct is very difficult, this procedure should be indicated for selected cases of cholangiocellular carcinoma involving the hepatic hilus.