Sang Kil Ha-Kawa

A quantitative model of technetium-99m-DTPA-galactosyl-HSA for the assessment of hepatic blood flow and hepatic binding receptor

Technetium-99m-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin (99mTc-GSA) was studied in normal volunteers and in patients with impaired liver function. The extrapolation approach originated the absolute dose of 99mTc-GSA in blood and the hepatic blood volume. The heart and liver regression curves were simultaneously fractionated into the three compartments (extrahepatic blood, hepatic blood and hepatocytes). Four differential equations were integrated with the six parameters as variables, and the smallest residual sum of squares was obtained by the damping Gauss-Newton method. The result of hepatic blood flow was 1603 +/- 144 (ml/min) in normal controls, which was compatible with previously reported values. Maximal removal rate (mg/min) showed statistically significant differences between the normal volunteers and patients with chronic hepatitis or liver cirrhosis. Our kinetic model of 99mTc-GSA can be used in the evaluation of liver function.

Use of technetium 99m diethylenetriaminepentaacetic acid-galactosyl-human serum albumin liver scintigraphy in the evaluation of preoperative and postoperative hepatic functional reserve for hepatectomy

BACKGROUND Technetium 99m diethylenetriaminepentaacetic acid-galactosyl-human serum albumin (99mTc-GSA) is a new liver scintigraphy agent that binds to the asialoglycoprotein receptors. We evaluated the clinical use of 99mTc-GSA for the perioperative assessment of hepatectomy. METHODS Thirty-six patients with hepatocellular carcinoma were admitted for elective hepatectomy. 99mTc-GSA scintigraphy was obtained after the intravenous injection of 99mTc-GSA, and a modified receptor index (MRI) was calculated. 99mTc-GSA scintigraphy, conventional liver function, the plasma disappearance rate, and the 15-minute retention rate of indocyanine green (ICGR15) were carried out before operation and every 1 to 3 months after operation. The relationships between several systemic hemodynamic parameters, histologic activity index (HAI), plasma disappearance rate, and ICGR15 or MRI values were estimated. RESULTS A significant correlation was obtained between the MRI and ICGR15 (r = 0.6231, p < 0.001). Plasma disappearance rates correlated well with systolic volume and left cardiac work, whereas MRI values did not correlate with these systemic hemodynamics. Preoperative discrepancies between the values of MRI and ICGR15 were seen in eight cases. In these cases the MRI values correlated well with HAI scores (p < 0.05) but there was no significant correlation between ICGR15 values and the HAI scores. CONCLUSIONS These results suggested the use of 99mTc-GSA scintigraphy as a easy and reliable method for determining liver functional reserve.

Functional hepatic volume measured by technetium-99m-galactosyl-human serum albumin liver scintigraphy: comparison between hepatocyte volume and liver volume by computed tomography.

OBJECTIVES:We investigated the usefulness of measuring the functional hepatic volume by single-photon emission CT with 99m-technetium galactosyl-human serum albumin scintigraphy (GSA-LV). We then compared this value to the total hepatocyte volume and the hepatic volume determined from CT (CT-LV) in the patients with hepatobiliary tumors.METHODS:Forty-seven patients were divided into two groups, the SM group (subsegmentectomy and monosegmentectomy) and the DT group (disegmentectomy and trisegmentectomy). These groups were further divided into subgroups with or without chronic hepatitis or cirrhosis. The GSA-LV, CT-LV, and the total hepatocyte volume were then calculated. The GSA-LV and CT-LV measurements were performed preoperatively, at 2 and 4 wk, and at 3 and 6 months after surgery.RESULTS:The preoperative GSA-LV values were significantly correlated with the hepatocyte volume and the 15-min retention rate of indocyanine green (ICGR15). Similarly, the hepatocyte volume correlated well with the CT-LV and ICGR15. However, the CT-LV was correlated only with the ICGR15. Recovery of the GSA-LV in the DT group was delayed, and about 90% of the volumetric and functional regeneration was observed within 6 months after the hepatectomy. In contrast, the CT-LV of DT group patients with normal liver remnants returned to approximately 90% of their initial volume within 1 month after the hepatectomy, whereas patients with injured livers regenerated gradually and regained approximately 80% of their preoperative value by 6 months after the hepatectomy.CONCLUSIONS:We conclude that the measurement of functional hepatic volume using the GSA-LV is useful in fully evaluating hepatic function based on hepatocyte volume.

Magnetic Resonance Determination of Tumor Thickness as Predictive Factor of Cervical Metastasis in Oral Tongue Carcinoma

Objectives To establish an accurate and reproducible means of measuring tumor thickness as a preoperative prognostic factor for cervical metastasis in oral tongue carcinoma.

Compartmental analysis of asialoglycoprotein receptor scintigraphy for quantitative measurement of liver function: A multicentre study

A multicentre study on multicompartmental analysis of hepatic scintigraphy using technetium-99m labelled galactosyl serum albumin (GSA), which binds to the asialoglycoprotein receptor, was carried out at seven institutions in Japan. Seventy-four patients with liver disease received 3 mg (185 MBq) of99mTc-GSA by intravenous injection. Sequential scanning was performed 30 min after injection to obtain anterior images of the heart and liver, followed by single-photon emission tomography (SPET). The indices included in this analysis were hepatic blood flow (Q) and maximal receptor binding rate (Rmax), which showed a good correlation with semiquantitative ratio indices for99mTc-GSA, namely the retention rate in blood (HH15) and the hepatic uptake rate (LHL15).Q andRmax also showed a significant correlation with other measures of hepatic function. When patients were grouped according to the severity of chronic liver damage (hepatocellular functional damage),Q was reduced in the moderate and severe groups, whileRmax was reduced in proportion to the functional stage. Both parameters showed no inter-institution difference using analysis of co-variance with the functional stage as a co-variant. With regard to the hepatic uptake rate, anterior planar images and SPET images gave similar results forQ andRmax. Acquisition times of 15 or 30 min provided the same results. The multicopartmental model analysis permitted comparable results to be obtained at institutions using different gamma cameras, and is therefore considered a universally applicable method. These results indicate thatQ andRmax are useful general indices for evaluating the function reserve capacity of the liver.

Usefulness of Tc-99m-GSA scintigraphy for liver surgery

Postoperative mortality remains high after hepatectomy compared with other types of surgery in patients who have cirrhosis or chronic hepatitis. Although there are several useful perioperative indicators of liver dysfunction, no standard markers are available to predict postoperative liver failure in patients with hepatocellular carcinoma (HCC) undergoing hepatectomy. The best preoperative method for evaluating the hepatic functional reserve of patients with HCC remains unclear, but technetium-99m diethylenetriamine pentaacetic acid galactosyl human serum albumin (99mTc-GSA) scintigraphy is a candidate. 99mTc-GSA is a liver scintigraphy agent that binds to the asialoglycoprotein receptor, and can be used to assess the functional hepatocyte mass and thus determine the hepatic functional reserve in various physiological and pathological states. The maximum removal rate of 99m Tc-GSA (GSA-Rmax) calculated by using a radiopharmacokinetic model is correlated with the severity of liver disease. There is also a significant difference of GSA-Rmax between patients with chronic hepatitis and persons with normal liver function. Regeneration of the remnant liver and recurrence of hepatitis C virus infection in the donor organ after living donor liver transplantation have also been investigated by 99mTc-GSA scintigraphy. This review discusses the usefulness of 99mTc-GSA scintigraphy for liver surgery.

Dietary restriction: effects of short-term fasting on protein uptake and cell death/proliferation in the rat liver

Dietary restriction (DR) is known to prolong life in laboratory animals. Intermittent (alternate-day) fasting or short-term repeated fasting has also been reported to increase the life span of animals. In the present study, we investigated the changes or induction of abnormalities of protein metabolism in rats during fasting, and measured asialoglycoprotein uptake and cell death/proliferation in the liver of rats receiving fasting and refeeding. In the results, liver weight decreased significantly after 48 h of fasting and increased during the refeeding period, returning to the pre-fasting level by 12 h of refeeding. Cell death, determined by single stranded DNA (ssDNA) staining method, increased during the fasting period, and returned to the pre-fasting level during the refeeding period. Cell proliferation, determined using antibodies (Ab) against proliferating cell nuclear antigen, decreased during the fasting period, and increased during the refeeding period. Changes in cell death and cell proliferation were inversely related. However, there was no significant difference in asialoglycoprotein uptake by the whole liver between the ad libitum (AL)-fed rats and 48 h fasted rats. Thus, neither the changes in liver weight nor cell death/proliferation affected asialoglycoprotein uptake on a living body. These results suggest that episodes of 48 h fasting do not induce protein metabolism abnormalities in the liver.

Successful Transcatheter Embolotherapy with a New Platinum Microcoil: The Berenstein Liquid Coil

AbstractPurpose: To determine the usefulness of a new platinum microcoil, the Berenstein Liquid Coil for vascular embolization. Methods: Nine patients underwent transcatheter arterial embolization with liquid coils. The occluded vessels included the splenic artery in four patients, gastroduodenal artery in two, arteriovenous malformation or fistula in two, and middle hepatic artery in one. All coils were delivered with a saline flush through a Tracker-18 catheter. Results: All arteries except one were successfully occluded in a one-stage procedure using liquid coils. No friction was observed between the liquid coils and the microcatheter regardless of the tortuosity of the artery. Platelet counts in all patients had increased after splenic embolization. In two patients with liver tumors, perfusion to the inappropriate area during intraarterial chemotherapy was prevented by selective embolization. Life-threatening bleeding was successfully treated by gastroduodenal artery occlusion. No complications were encountered. Conclusion: The Berenstein Liquid Coil provides easy, safe, and rapid vascular occlusion.

Hydralazine at thermoradiotherapy: tumor size and blood flow effects.

PURPOSE This study was aimed to assess the dependence on tumor size and blood flow of the efficacy of a vasoactive drug hydralazine with thermoradiotherapy. METHODS AND MATERIALS Experiments were performed on mice bearing SCC-VII tumors with volumes of about 85 and 340 mm3 (7-8 or 11-12 days after transplantation, respectively). Local hyperthermia (water bath, 43 degrees C, 0.5 h) was started 3 h after irradiation of tumors. Hydralazine (2.5 mg/kg, IP) was given 0.5 h before heating. Tumor blood flow was evaluated by laser Doppler flowmetry before, during and up to 2 days after the treatments. RESULTS It was shown that hydralazine and hyperthermia, even in combination with each other, had very weak anti-tumor effect, especially for 85 mm tumors. The agents also insignificantly enhanced the efficacy of radiotherapy excluding the case of polyradiomodification for 340 mm3 tumors when a dose modifying factor of about 2.0 was achieved. Thermometry showed only a small improvement by HDZ in heating patterns of tumors of both sizes. Meanwhile, the therapeutic efficacy of hydralazine and heat was correlated with the changes in tumor blood flow, first of all with the delayed effects. The radiomodifiers induced only minor and transient suppression of perfusion in the smaller tumors, and more markedly and for longer time decreased blood flow in the larger tumors. In the latter case, the inhibiting effect of the drug plus hyperthermia remained for at least 48 h after the treatment. CONCLUSION (a) The combined use of hydralazine and heat seems to be advisable only at radiotherapy of rather large advanced tumors; (b) the efficacy of such radiomodification is correlated with prolonged inhibition of tumor blood flow by these agents; and (c) hydralazine and hyperthermia are likely to kill selectively both acutely and chronically hypoxic radioresistant cancer cells.

Effects of late evening snack including branched-chain amino acid on the function of hepatic parenchymal cells in patients with liver cirrhosis

Aim:  A late evening snack (LES) improves protein‐energy malnutrition due to overnight starvation and the catabolic state in patients with liver cirrhosis. Our aim was to examine whether LES including a branched‐chain amino acid (BCAA) could maintain hepatic reserve and the function of hepatic parenchymal cells in patients with liver cirrhosis, including those in the early stage of disease.