Nobuyoshi Tanaka

Extrahepatic Blood Supply to Hepatocellular Carcinoma: Angiographic Demonstration and Transcatheter Arterial Chemoembolization

PurposeTo evaluate the incidence of each extrahepatic collateral pathway to hepatocellular carcinoma (HCC) and to assess technical success rates and complications of transcatheter arterial chemoembolization (TACE) through each collateral.MethodsWe retrospective evaluated extrahepatic collateral pathways to HCC on angiography in 386 procedures on 181 consecutive patients. One hundred and seventy patients had previously undergone TACE. TACE through extrahepatic collaterals using iodized oil and gelatin sponge particles was performed when a catheter was advanced into the tumor-feeding branch to avoid nontarget embolization.ResultsA single collateral was revealed in 275 TACE procedures, two were revealed in 74, and three or more were revealed in 34. Incidences of collateral source to HCC were 83% from the right inferior phrenic artery (IPA), 24% from the cystic artery, 13% from the omental artery, 12% from the right renal capsular artery (RCA) and left IPA, 8% from the right internal mammary artery (IMA) and right intercostal artery (ICA), and 7% from the right inferior adrenal artery (IAA). Technical success rates of TACE were 53% in the right ICA, 70% in the cystic artery, 74% in the omental artery, 93% in the left IPA, 96% in the right IPA, and 100% in the right RCA, right IMA, and right IAA. Complications included skin necrosis after TACE through the right IMA (n = 1), cholecystitis after TACE through the cystic artery (n = 1), and ulcer formation after TACE through the right gastric artery (n = 1), in addition to pleural effusion and basal atelectasis after TACE through the IPA and IMA.ConclusionOur study suggests that TACE through extrahepatic collaterals is possible with high success rates, and is also relatively safe.

Growth of Hepatocellular Carcinoma into the Right Atrium: Report of Five Cases

Five patients had hepatocellular carcinoma growing into the right atrium. Clinically, all patients had edema in the legs, venous dilatation in the abdominal wall, ascites, and dyspnea. Paroxysmal aggravation of dyspnea and its alleviation by a left decubitus position were noted in three patients. Three patients developed shock after a change in posture. A gallop rhythm in the cardiac murmur was detected in two. Pathologically, all livers had hepatocellular carcinoma and macronodular cirrhosis. At autopsy, a tumor thrombus was found that completely occluded the right hepatic vein and extended into the inferior vena cava and right atrium, partially occluding the inferior vena cava. Antemortem diagnosis of right atrial tumor thrombi in patients with primary hepatocellular carcinoma is difficult, but the condition should be suspected when dyspnea, abnormal cardiac sounds, and shock develop.

K-ras mutations in duodenal aspirate without secretin stimulation for screening of pancreatic and biliary tract carcinoma.

K‐ras mutations at codon 12 (KRM) have been detected in over 80% of tissues and pure pancreatic juice (PPJ) samples from patients with pancreatic carcinoma (PCa) and are promising genetic tumor markers. Aspirating PPJ not only requires technical skill, but is also exhausting for patients. The authors attempted to evaluate whether the detection of KRM in the duodenal aspirate (DA) obtained immediately after endoscopic retrograde cholangiopancreatography (ERCP), an easier sample‐collecting method than collecting PPJ, could be useful for the diagnosis of PCa and biliary tract carcinoma (BTCa).

Transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma fed by the cystic artery.

PURPOSE To evaluate the safety, technical success rate, and effectiveness of transcatheter arterial chemoembolization (TACE) for unresectable hepatocellular carcinoma (HCC) fed by the cystic artery. MATERIALS AND METHODS Treatment of 27 tumors in 25 patients fed by the cystic artery was attempted with TACE. Twenty-two patients had previously undergone one to eight TACE sessions (mean, four sessions), and the duration after initiation of treatment of HCC was 4-69 months (mean, 24). In three patients, parasitization of the cystic artery was revealed at initial angiography. TACE was performed only when the microcatheter could be inserted into the tumor feeding branch and the stain of the gallbladder wall disappeared. The therapeutic effects and complications were retrospectively analyzed. RESULTS Seventeen tumors were completely fed by the cystic artery and 10 were fed by both the hepatic artery and cystic artery. Attenuation or occlusion of the hepatic artery was observed in 56%. The tumor feeding branch arising from the cystic artery could be successfully embolized in 18 tumors (67%) of 16 patients without severe complications. Adequate iodized oil accumulation was achieved in 14 tumors (52%) of 12 patients. Percutaneous therapy (n = 7), radiation (n = 4), and TACE after cholecystectomy (n = 1) were added for tumors with incomplete or unsuccessful TACE. Local progression was observed in three (21%) of 14 tumors treated by TACE alone during a mean follow-up period of 18 months. CONCLUSION TACE via the cystic artery was safe and technically possible in 67% of patients. If adequate iodized oil accumulation is obtained, which was only achieved in 52% of patients, sufficient therapeutic effect may be expected.

Subsegmental Transcatheter Arterial Embolization for Hepatocellular Carcinoma in the Caudate Lobe

PURPOSE To clarify the effectiveness of transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) in the caudate lobe of the liver. MATERIALS AND METHODS Thirteen patients with HCC in the caudate lobe underwent TAE. TAE was performed by injection of the mixture of anticancer drugs (mitomycin C and doxorubicin or epirubicin) and iodized oil, followed by gelatin sponge particles. Arterial anatomy of the caudate branch, local recurrence rate, and survival rate were evaluated. RESULTS From 31 TAEs for the caudate lobe, 22 subsegmental TAEs were successfully performed (71%). Local recurrence in the caudate lobe was seen in 10 patients (77%). Subsegmental TAE for the caudate lobe was repeated one to five times. Cumulative local recurrence rates were 33% and 75% within 3 and 6 months, respectively. Survival rates after first TAE for HCC in the caudate lobe were 89% and 74% for 1 and 3 years, respectively. CONCLUSION Local recurrence rate after subsegmental TAE for HCC in the caudate lobe was high. However, repeated subsegmental TAE possibly improves the prognosis of HCC in the caudate lobe.

Histopathological findings after ultraselective transcatheter arterial chemoembolization for hepatocellular carcinoma

Aim:  To evaluate the histopathologic findings in the surgical specimen of hepatocelluar carcinoma after transcatheter arterial chemoembolization (TACE) at the most distal portion of the sub‐subsegmental artery of the liver (ultraselective TACE).

Association of serum glycated albumin to haemoglobin A1C ratio with hepatic function tests in patients with chronic liver disease

Background In patients with chronic liver disease (CLD), glycated haemoglobin (HbA1C) levels have been shown to be apparently lower than real values, whereas serum glycated albumin (GA) levels are apparently higher. The present study was aimed to examine whether both glycaemic indices are influenced by hepatic function. Methods Subjects consisted of 82 patients with CLD. Various indicators for hepatic function as well as HbA1C and GA were also measured. Estimated HbA1C values were calculated from the mean plasma glucose levels. Two hundred and two type 2 diabetic patients without CLD were studied as controls. Results Although GA was strongly correlated with HbA1C in patients with CLD as well as diabetic patients, GA levels in patients with CLD were relatively higher than those in diabetic patients. In patients with estimated HbA1C ≤5.8%, GA levels significantly increased but HbA1C levels decreased as a function of decreasing hepaplastin test (HPT). The ratio of GA/HbA1C (G/H ratio) increased as a function of decreasing HPT. In patients with estimated HbA1C >5.8%, in contrast, GA levels were independent of HPT levels. In the patients with CLD, GA and HbA1C were associated with mean plasma glucose levels and some indicators for hepatic function. The multivariate analysis revealed a significant association of G/H ratio with HPT, cholinesterase and direct bilirubin. The G/H ratio was not associated with the mean plasma glucose but with HPT and cholinesterase levels. Conclusions The G/H ratio correlates with hepatic function but not with plasma glucose levels. Therefore, CLD should be suspected for diabetic patients with an elevated G/H ratio.

Obesity may attenuate the HbA1c-lowering effect of sitagliptin in Japanese type 2 diabetic patients

Aims/Introduction:  The aim of the present study was to assess the independent predictors of the HbA1c‐lowering effect of sitagliptin in Japanese type 2 diabetic patients.

Use of a catheter with a large side hole for selective catheterization of the inferior phrenic artery.

The authors report the use of a catheter with a large side hole in the catheterization of the right inferior phrenic artery (IPA) arising from the proximal portion of the celiac trunk. A 5-F catheter with a side hole on either the top or the right side of the superior portion near the tip was used in five patients with hepatocellular carcinoma fed by the right IPA, which could not be selected by a conventional coaxial technique. In all patients, a 3-F microcatheter was successfully advanced into the right IPA through the side hole of this catheter introduced into the celiac artery or the common hepatic artery.

Bowel preparation for the total colonoscopy by 2,000 ml of balanced lavage solution (Golytely) and sennoside

SummaryOne of disadvantages of the Golytely preparation is that examinees have to drink as much as 4,000 ml of Golytely. To overcome this disadvantage, we designed a modified preparation regimen in which examinees have to drink only 2,000 ml of Golytely by taking sennoside orally. Bowel preparation was carried out in 297 examinees by this modified method. Examinees ate their usual diet and took 36 mg of sennoside orally on the night before the examination. On the day of the examination, the examinees drank a total of 2,000 ml of Golytely. No severe complications were noted and 97% of the examinees were able to drink the dose of 2,000 ml. Subjects who had also experienced bowel preparation by the modified method of Brown were asked to compare the two regimens, and only 1% preferred Brown’s method while 73% preferred bowel preparation by our Golytely method. The result of bowel preparation by this method was excellent or good in 90 to 97% of the subjects at all sites in the colon and rectum. We conclude that bowel preparation for total colonoscopy using 2,000 ml of Golytely and sennoside is superior because it is highly acceptable to the examinees and provides excellent gut irrigation.