Tetsuro Konno

PRIMARY YOLK SAC TUMOR OF THE LIVER

An autopsy case of yolk sac tumor of the liver in a 29‐year‐old female was reported. The tumor was found originally in the right anterior segment of the liver on the first operation. The autopsy disclosed that the liver was almost entirely replaced by multiple, round tumor nodules. The tumor masses continuously extended to the peritoneum and to the subcutaneous tissue. There were no tumors in other organs including the ovaries, gut, stomach, lung, uterus, and kidneys, indicating that the tumor originated in the liver. Microscopically, the tumor showed typical characteristics of the yolk sac tumor. An immunohistochemical study showed that AFP was distributed fine granularly in the cytoplasm of tumor cells. Electron microscopic observation disclosed large amounts of electron‐dense material being closely related to basement membrane.

Clinical evaluation of palliative therapy for unresectable primary liver cancer

Ninety‐nine patients with unresectable primary liver cancer were treated with ligation of the hepatic artery (LHA), intra‐arterial infusion chemotherapy (IAIC) or transcatheter arterial embolization (TAE) between 1960 and 1983. A statistical study was made of therapeutic effects and prognosis. The results are as follows: (1) The mean survival time of 14 patients treated with LHA was about 5 months. (2) The survival time of the LHA + IAIC with mitomycin C group was not prolonged as compared with that of the LHA group, but LHA + IAIC with Adriamycin (doxorubicin) group showed a significant prolongation of survival time over the LHA group. (3) In the LHA + IAIC with Adriamycin group, the mean survival time was 12.8 months and the 1‐year survival rate was 37.5%. (4) Factors including age, presence of liver cirrhosis, number of involved segments, and degree of anaplasia graded on Edmondsons criteria did not influence survival time. Cancer 58:329–331, 1986.

Maintenance of rat liver viability enhanced by cold flushing with oxygenated perfluorochemicals.

The possible benefit of oxygenation during initial cold flushing was investigated as a means of improving the quality of liver preservation in rats. In five groups of animals (total 61 experiments), the livers were flushed with different perfusates. Non-oxygenated groups included controls, Collins’ solution alone and Collins’ solution containing perfluorotributylamine (FC-43). In the oxygenated groups, Collins’ solution alone and Collins’ solution containing FC-43 were oxygenated by bubbling. The hepatic ATP level and histopathological changes were used to assess the quality of liver preservation. Oxygenation during the initial cooling process proved to be effective in maintaining energy metabolism and preventing the characteristic microscopic changes of ischemic damage. Oxygenated Collins’ solution containing FC-43 showed a much longer lasting effect compared with oxygenated Collins’ solution alone, without FC-43. Under light microscopy, the integrity of the liver appeared to be well preserved up to eight hours with the former solution. It is concluded that enhanced oxygenation with FC-43 in the initial cold flushing period can improve the quality of liver preservation.

Clinical analysis of hepatic surgery for primary liver cancer with glucose intolerance.

は じめ に 原発 性肝癌 は肝 硬変 を 合併す る ことが多 く,耐 糖能 異 常 を有す る症例 を しば しば経 験 し,そ の術 前 ・術後 管 理 が問題 とな る.今 回,耐 糖 能異 常 を有す る原 発性 肝 癌 の術前 ・後術 の血 糖値 変動 お よび術 後合 併症 との 関係 につ いて検討 した. I.方 法お よび対 象 原 発性 肝 癌 手 術 例 を,1970年 日本 糖 尿 病 学 会 勧 告 値1)(表1)に 従 い,50g・O-GTTに お いて,空 腹 時血 糖140mg/dl以 上,ま た は1時 間値160mg/dl,2時 間値 130mg/dl以 上 とと もに満 たす ものを糖 尿 病 域 と し, 空 腹時血 糖100mg/dl以 下,1時 間値140mg/dlお よび 2時 間値100mg/dl以 下 の全 て を満 たす もの を正 常 域 とし,糖 尿病 域 に も正 常域 に も属 さな い ものを境 界域 とし3群 に分 けた. また 各症例 の50g・OGTT時 の ΔIRI/ΔBS2)30分 値, お よび ΣIRI/ΣBS3)180分 値 を求 め て(表1),イ ンス リン応 答能 お よび分泌 量 を検 索 し,術 後 血糖 推移 お よ び術後 合併症 との関係 につ い て検 討 した. 対象症 例 は1975年 か ら1984年 まで の10年 間 に当 科 で 経 験 した原 発 性肝 癌 手術 症 例148例 の うち検索 可 能 で あ った111例 であ る(表2). 検 索症 例111例 中,非 硬変例 は52例 で硬 変合 併例 は59 例 で あ った.耐 糖 能異 常例 で糖 尿病 域 を示す もの は45 例,40.5%で あ り,境 界域 は44例,39.6%に み られ, 表1 耐糖能異常 の判定基準および検検索項 目 1)50gブ ドウ糖 負荷試験(50g・O-GTT)

Clinical application and its appraisal of the laser surgery to advanced carcinoma of the digestive organs

In the advanced carcinoma of the digestive organs, the local recurrence is a major problem in surgery. We have applied a laser irradiation to the area after lymph node dissection in the surgery for the carcinoma of the GI tract and to the raw surface of the liver after hepatic resection. Experimental study demonstrated that the laser surgery have an advantage to prevent the local recurrence. Of 133 patient undergoing the laser surgery, ten patients underwent the laser irradiation and none of these developed the local recurrence so far after 4 years in the longest-term follow up. 47 patients underwent hepatic resection using a laser knife and proved to be a good prognosis. Postoperative prognosis although enough estimation can not be made is preliminarily favolable as a whole.