RESUMEN
The purpose of this study was to evaluate the efficacy and toxicity of weekly vinorelbine (VNB) in patients with metastatic breast cancer previously treated with both adriamycin (ADM) and docetaxel (TXT). VNB was administered weekly at the dose 20 mg/m2 by i.v. infusion over 20 minutes followed by flushing the vein with 100 ml of normal saline. From June 1999 to August 2000, ten patients were enrolled in this study. Patient characteristics were that the cumulative doses (median) of previous ADM and TXT were 300 mg (range, 120-880 mg), 560 mg (range, 120-960 mg) respectively. The median number of metastatic sites was four, with poor performance status (ECOG 1-2: 40%, 3-4: 60%). The median cycles of weekly VNB were seven (range: 2-12). Two of 10 assessable patients obtained partial response, with an overall response rate of 20%. The main toxicity (NCI grade 4) was leukopenia in 10% of 10 patients. Phlebitis (grade 2) was observed in 4 of 10 patients (40%). VNB is an active agent against metastatic breast cancer pretreated with both ADM and TXT, possessing no severe toxicities.
Asunto(s)
Antineoplásicos Fitogénicos/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Taxoides , Vinblastina/uso terapéutico , Adulto , Antineoplásicos Fitogénicos/efectos adversos , Neoplasias Óseas/secundario , Neoplasias de la Mama/patología , Docetaxel , Doxorrubicina/uso terapéutico , Esquema de Medicación , Resistencia a Antineoplásicos , Femenino , Humanos , Leucopenia/inducido químicamente , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/secundario , Persona de Mediana Edad , Paclitaxel/análogos & derivados , Paclitaxel/uso terapéutico , Resultado del Tratamiento , Vinblastina/efectos adversos , Vinblastina/análogos & derivados , VinorelbinaRESUMEN
We report herein the case of a 59-year-old man found to have adenosquamous carcinoma of the remnant stomach which demonstrated rapid progression. The patient was admitted to our hospital to undergo surgery for a papillary tumor of the remnant stomach. Total resection of the remnant stomach with lymph node dissection was performed, and pathological examination confirmed a diagnosis of adenosquamous carcinoma with invasion into the muscularis propria and lymph node metastasis around the perigastric areas. Multiple liver metastases were found 6 months after the operation, for which a right hepatectomy was performed with curative intent; however, he died 2 months later due to lymphangitis carcinomatosa of the lung.
Asunto(s)
Carcinoma Adenoescamoso/patología , Carcinoma Papilar/patología , Neoplasias Gástricas/patología , Carcinoma Adenoescamoso/cirugía , Carcinoma Papilar/cirugía , Humanos , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasia Residual , Neoplasias Gástricas/cirugíaRESUMEN
The purpose of this study was to evaluate the effect of prostaglandin E1 (PGE1) on protecting against hepatic endothelial cell damage and increasing graft viability after cold preservation and reperfusion, using an isolated perfused rat liver (IPRL) model. The grafts were divided into three groups, according to the cold preservation time and PGE1 administration, namely: 4h preservation (group 1, n = 9), 6h preservation (group 2, n = 9), and 6h preservation followed by PGE1 infusion (group 3, n = 9). After cold storage, the grafts were put on the recirculating IPRL system, then reperfused for 120 min at 37 degrees C with oxygenated Krebs-Henseleit buffer containing hyaluronic acid (HA). To examine the function of the sinusoidal endothelial cells and hepatocytes, serial measurements of HA, tumor necrosis factor-alpha (TNFalpha), thromboxane B2 (TXB2), acid phosphatase, and conventional parameters in the perfusate were made. After perfusion, the trypan blue exclusion test was performed to assess the presence of any microscopic sinusoidal lining cell damage. In group 3, the bile output and HA clearance were significantly greater, while glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, TNFalpha, TXB2, and acid phosphatase in the perfusate were significantly lower than in group 2. Histologically, less endothelial cell damage and hepatocyte damage than in group 2 was also confirmed. These results therefore suggest that the improvement of hepatic graft viability by PGE1 administration is mainly due to sinusoidal endothelial cell protection.
Asunto(s)
Alprostadil/administración & dosificación , Trasplante de Hígado , Daño por Reperfusión/prevención & control , Fosfatasa Ácida/análisis , Alanina Transaminasa/análisis , Alprostadil/farmacología , Animales , Aspartato Aminotransferasas/análisis , Criopreservación , Endotelio/citología , Endotelio/efectos de los fármacos , Supervivencia de Injerto/efectos de los fármacos , Ácido Hialurónico/metabolismo , L-Lactato Deshidrogenasa/análisis , Masculino , Ratas , Ratas Endogámicas Lew , Tromboxano B2/análisis , Factor de Necrosis Tumoral alfa/análisisRESUMEN
We investigated whether hypertension contributes to the development of atheloscrelosis in patients with chronic liver disease. There were no significant differences with respect to the ordinary biochemical data of serum concentrations of both protein and lipid metabolites between the hypertension group (n = 21) and the non-hypertension group (n = 31). In the hypertension group, serum creatinine level and serum concentration of lipoprotein (a) were significantly higher than those in non-hypertension group. However, there was no significant difference between the two groups with respect to the atherogenic index (apolipoproteins B versus A1 ratio). Serum glutamic oxaloacetic transaminase activity was positively correlated with serum apolipoprotein E concentration, and inversely correlated with serum lipoprotein (a) concentration, in 52 patients with chronic liver disease. Active hepatitis in patients with chronic liver disease might retard the development of atherosclerosis.
Asunto(s)
Arteriosclerosis/prevención & control , Hepatopatías/complicaciones , Anciano , Apolipoproteína A-I/sangre , Apolipoproteínas B/sangre , Arteriosclerosis/sangre , Arteriosclerosis/etiología , Enfermedad Crónica , Creatinina/sangre , Femenino , Humanos , Hipertensión/sangre , Hipertensión/complicaciones , Lipoproteína(a)/sangre , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
To determine if peritoneal collagen type IV levels could serve as a parameter for predicting metastasis and the subsequent course of disease, the concentration of collagen IV in the peritoneal fluid of 85 patients with adenocarcinoma of the gastrointestinal tract, including 50 with gastric cancer and 35 with colorectal cancer, was measured radioimmunologically. The peritoneal collagen type IV levels were elevated in 13 (26%) of the patients with gastric cancer, in 8 (23%) of those with colorectal cancer, and in none of the control subjects. The mean concentration of collagen type IV in tumors characterized by peritoneal dissemination was significantly higher than that in those without metastasis; however, there were no significant differences in the collagen type IV levels between tumors with and those without liver metastasis, or between those with and those without lymph node metastasis. There was a significant correlation between the peritoneal collagen type IV level and survival time in patients with clinically evident peritoneal dissemination. A positive correlation was also found between collagen type IV and carcinoembryonic antigen levels. In conclusion, the levels of peritoneal collagen type IV provide evidence of peritoneal dissemination, and can aid in the prediction of life expectancy in patients with adenocarcinomas of the gastrointestinal tract.
Asunto(s)
Adenocarcinoma/patología , Biomarcadores de Tumor/análisis , Colágeno/análisis , Neoplasias del Colon/patología , Neoplasias Gástricas/patología , Adenocarcinoma/química , Adenocarcinoma/secundario , Adulto , Anciano , Anciano de 80 o más Años , Líquido Ascítico/química , Neoplasias del Colon/química , Femenino , Humanos , Esperanza de Vida , Neoplasias Hepáticas/química , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Pronóstico , Neoplasias Gástricas/químicaRESUMEN
A 65-year-old woman with hepatocellular carcinoma underwent right hepatic lobectomy. Her alpha-fetoprotein levels significantly dropped from 285,000 ng/ml to 3,100 ng/ml for one month without any preoperative treatment. The tumor thrombus in the portal vein showed complete necrosis, and lymphocytes infiltration around the main tumor were present microscopically. However, there was no necrotic area in the main tumor. This patient is living with no evidence of recurrence for 3 years and 6 months following hepatic resection.
Asunto(s)
Neoplasias Hepáticas/patología , Regresión Neoplásica Espontánea , Anciano , Biomarcadores de Tumor/análisis , Femenino , Hepatectomía , Humanos , Neoplasias Hepáticas/cirugía , Necrosis , Factores de Tiempo , alfa-Fetoproteínas/análisisRESUMEN
BACKGROUND/AIMS: We recently demonstrated that an activated inflammation in a non-tumorous portion was a significant risk factor for recurrence in patients with small hepatocellular carcinoma. The purpose of this study is to provide further proof for this mechanism by explaining the relation ship between the post-operative hepatitis state and intrahepatic recurrence. PATIENTS AND METHODS: We used an enzyme-linked immunosorbent assay to detect cICAM-1 in the serum of 18 patients with hepatocellular carcinoma before and after hepatic resection. RESULTS: A complete surgical resection of the tumor masses did not result in a significant reduction of cICAM-1 levels. The levels of aminotransferase after hepatic resection in patients with an increased level of cICAM-1 in the post operative period (n = 7) were much higher than in patients with a decreased level of cICAM-1 (n = 11) (p < 0.05). The 1-, 2- and 3- year disease free survival rates in the former group were 42.9%, 14.3% and 0%, respectively, and those in the later group were 72.7%, 54.5% and 54.5%, respectively (p < 0.05). CONCLUSIONS: The enhancement of inflammation in the remnant liver tissue is related to intrahepatic recurrence after hepatic resection through adhesion molecules, such as cICAM-1.
Asunto(s)
Carcinoma Hepatocelular/sangre , Hepatectomía , Molécula 1 de Adhesión Intercelular/sangre , Neoplasias Hepáticas/sangre , Anciano , Alanina Transaminasa/sangre , Fosfatasa Alcalina/sangre , Aspartato Aminotransferasas/sangre , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Supervivencia sin Enfermedad , Ensayo de Inmunoadsorción Enzimática , Femenino , Estudios de Seguimiento , Hepatitis/sangre , Hepatitis/patología , Humanos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Masculino , Recurrencia Local de Neoplasia/sangre , Recurrencia Local de Neoplasia/patología , Células Neoplásicas Circulantes/patología , Factores de Riesgo , Tasa de Supervivencia , gammaglobulinas/análisisRESUMEN
BACKGROUND/AIMS: The outcome of hepatectomy in elderly patients with hepatocellular carcinoma have been reported, however neither the morphological nor functional hepatic regeneration in elderly patients have been fully investigated. MATERIALS AND METHODS: Fifty-six patients with hepatocellular carcinoma, who underwent a right hepatic lobectomy over an 8-year period, were classified into three groups according to their age; group 1 (n = 7), more than 70 years of age; group 2 (n = 40), patients from 50 to 69 years of age and group 3 (n = 9), under 50 years of age. There were no significant differences regarding backgrounds or intra-operative parameters among the three groups. The perioperative hepatic function, postoperative complications and the regeneration rate of the remnant left lobe at 1 month after operation were compared. RESULTS: No differences were found in the regeneration rate, however, the levels of the hepaplastin test and lecithin:cholesterol acyltransferase at 7 days after hepatectomy in group 1 (31.3%, 8.8 U) were significantly lower than those in groups 2 and 3 (37.4%, 18.4 U; 47.9%, 29.4 U, respectively). The incidence of hospital death due to hepatic failure in group 1 (42.9%) was also significantly higher than that of group 2 (5.0%) or group 3 (0%). CONCLUSION: The decline of postoperative protein synthesis regardless of the voluminal regeneration is a characteristic of the elderly. This phenomenon might thus be an important promoter of postoperative hepatic failure which remains unpredictable using any type of examination. Therefore, at this time, a major hepatectomy is not recommended as a viable treatment alternative in the elderly.
Asunto(s)
Carcinoma Hepatocelular/cirugía , Hepatectomía/métodos , Neoplasias Hepáticas/cirugía , Adulto , Factores de Edad , Anciano , Envejecimiento/metabolismo , Análisis de Varianza , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/fisiopatología , Causas de Muerte , Femenino , Estudios de Seguimiento , Hepatectomía/efectos adversos , Humanos , Incidencia , Indicadores y Reactivos , Hígado/metabolismo , Hígado/fisiopatología , Fallo Hepático/etiología , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/fisiopatología , Regeneración Hepática , Masculino , Persona de Mediana Edad , Compuestos Orgánicos , Fosfatidilcolinas , Biosíntesis de Proteínas , Esterol O-Aciltransferasa/análisis , Resultado del TratamientoRESUMEN
OBJECTIVES: To clarify the indications for and the significance of palliative reduction surgery in the multidisciplinary treatment of advanced hepatocellular carcinoma (HCC) and to propose the use of a remnant tumor index (RTI) as a simplified criterion for palliative reduction surgery in cases of advanced HCC. DESIGN: A comparison of survival based on the RTI. SETTING: A large university hospital in Japan. PATIENTS: Twenty-five patients with advanced HCC who underwent palliative reduction surgery were divided into 3 groups as follows: group 1 (n = 9), the remnant tumor after operation existed only in the liver and the RTI was less than 5.0; group 2 (n = 11), the remnant tumor after operation existed only in the liver and the RTI was greater than 5.0; and group 3 (n = 5), extrahepatic metastatic tumor existed after operation. MAIN OUTCOME MEASURES: Pathological findings and survival rate after surgery. RESULTS: There was no significant difference in the degree of macroscopic intrahepatic metastases among the 3 groups; however, both the portal vein invasion and the histological grade tended to be more severe in groups 2 and 3. The respective 1-year and 3-year survival rates for group 1 were 67% and 33%, and those for group 2 were 21% and 0%. There were no survivors in group 3 at 1 year after surgery. Significant differences were found in the survival rates between groups 1 and 2 (P < .05), and between groups 1 and 3 (P < .05). CONCLUSION: Palliative reduction surgery for advanced HCC is only considered effective for patients with both an RTI of less than 5.0 and no extrahepatic metastasis.
Asunto(s)
Carcinoma Hepatocelular/cirugía , Neoplasias Hepáticas/cirugía , Cuidados Paliativos , Anciano , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/patología , Femenino , Humanos , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Tasa de SupervivenciaRESUMEN
BACKGROUND: This study was done to determine the potential role of sex steroid hormone receptors in the development of human colorectal cancer. METHOD: Receptors for estrogen (ER) and progesterone(PgR) were investigated in surgical specimens from 22 patients with colorectal cancer, using enzyme immunoassay. These values were examined in relation to cell kinetics parameters determined by DNA flow cytometry. RESULTS: ER and PgR were detected in 27% and 41%, respectively. There were no significant differences in the expression of ER or PgR according to the age, sex of the patients, tumor size, location, histological differentiation and lymph node metastasis. Although ER status appeared to be independent of DNA parameters, there were better correlations of PgR-negative tumors with increased hyperaneuploid levels. There were significantly higher values of heterogeneity index score in PgR-negative tumors compared with PgR-positive tumors. In the multiple regression analysis, PgR levels proved to be a major independent factor for changes in DNA index and heterogeneity index score. CONCLUSION: The PgR status is a critical factor for determining the proliferative activity of colorectal cancer tissue and may play a biological role in regulating the growth of the tumor.
Asunto(s)
Adenocarcinoma/química , Neoplasias del Colon/química , Neoplasias Hormono-Dependientes/química , Receptores de Estrógenos/análisis , Receptores de Progesterona/análisis , Neoplasias del Recto/química , Adenocarcinoma/patología , División Celular , Neoplasias del Colon/patología , ADN de Neoplasias/análisis , Femenino , Citometría de Flujo , Humanos , Técnicas para Inmunoenzimas , Masculino , Persona de Mediana Edad , Neoplasias Hormono-Dependientes/patología , Neoplasias del Recto/patología , Análisis de RegresiónRESUMEN
BACKGROUND/AIMS: Infection after hepatic resection constitutes a major cause of morbidity and mortality. We examined the role of Candida antigen in systemic immunity and the infectious complications after hepatectomy. MATERIAL AND METHODS: In 25 hepatectomized patients, the Candida antigen titers were measured by a latex agglutination test (CAND-TEC). In the patients with Candida antigen (n = 10; 40%) and those without (n = 15; 60%), multiple immunological parameters, including the total lymphocyte count, lymphocyte subpopulations, phytohemagglutinin (PHA) response, and natural killer (NK) activity, and the incidence of infectious complications were compared. RESULTS: In the preoperative and operative parameters, there were no significant differences between the two groups. In the postoperative immune parameters, a significant attenuation in the total lymphocyte number (p < 0.01) and NK activity (p < 0.01) was observed in the patients with Candida antigen, compared with the findings in patients without Candida antigen. A bacterial infection was identified in 5 of 10 patients (50.0%) with Candida antigen, and in 1 of 15 patients (6.7%) without Candida antigen (p < 0.05). In contrast, the Candida culture was negative for all patients. CONCLUSIONS: Both a profound attenuation of systemic immunity and frequent bacterial infections were observed in the hepatectomized patients with Candida antigen.
Asunto(s)
Antígenos Fúngicos/análisis , Infecciones Bacterianas/inmunología , Candida albicans/inmunología , Hepatectomía , Complicaciones Posoperatorias/inmunología , Adulto , Anciano , Anticuerpos Monoclonales , Antígenos CD/análisis , Traslocación Bacteriana , Femenino , Humanos , Inmunidad , Pruebas de Fijación de Látex , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/microbiologíaRESUMEN
To evaluate the benefits of performing laparoscopic cholecystectomy (LC) in patients with cirrhosis, data on 13 patients with liver cirrhosis who underwent cholecystectomy for gallstones between 1989 and 1995 were retrospectively collected from charts filed at Fukuoka City Hospital. These 13 patients were classified into two groups; one, comprised of 7 who underwent LC, and another, comprised of 6 who underwent open cholecystectomy (OC). No statistical differences were observed in the duration of surgery or the intraoperative blood loss between the two groups; however, the C-reactive protein (CRP) level in the serum was significantly higher in the OC group than in the LC group. LC was followed by a significantly earlier resumption of a normal diet (P < 0.05) and a shorter hospital stay (P < 0.05) in comparison to OC. All of the patients who underwent OC had an uneventful clinical course; however, one of the patients who underwent LC suffered from intractable ascites postoperatively. The difference in the cost of hospitalization between the two groups was not statistically significant. These findings suggest that the therapeutic significance of performing LC in patients with cirrhosis should be assessed after carefully evaluating all factors including mortality, morbidity, and cost-effectiveness. Thus, further controlled trials are necessary.
Asunto(s)
Colecistectomía Laparoscópica , Colecistectomía , Colelitiasis/cirugía , Anciano , Colecistectomía Laparoscópica/economía , Colelitiasis/epidemiología , Comorbilidad , Análisis Costo-Beneficio , Femenino , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios RetrospectivosRESUMEN
A case of primary splenic lymphoma in a patient with chronic hepatitis C is reported. A 69-year-old man with chronic hepatitis C was admitted to Fukuoka City Hospital for evaluation of an enlarging splenic tumour. In the spleen, ultrasonographic examination revealed a hypoechoic tumour and computed tomography demonstrated a non-enhancing low density area measuring 7 cm in diameter; coeliac angiography revealed a hypovascular tumour. Gallium scintigraphy showed uptake of the radioisotope in the splenic tumour. A splenectomy was performed and the morphological and immunohistochemical findings of this tumour were compatible with those of non-Hodgin's B cell lymphoma. Recently, cases of malignant B cell lymphoma associated with hepatitis C virus infection have been reported. Lymphotropism of hepatitis C virus may play a pathological role in the development of non-Hodgkin's lymphoma. We emphasize the importance of considering lymphoma in the differential diagnosis of extrahepatic disorders during the course of chronic hepatitis C virus infections.
Asunto(s)
Hepatitis C/complicaciones , Linfoma de Células B/complicaciones , Linfoma no Hodgkin/complicaciones , Neoplasias del Bazo/complicaciones , Anciano , Aberraciones Cromosómicas , Trastornos de los Cromosomas , Enfermedad Crónica , Humanos , Linfoma de Células B/diagnóstico por imagen , Linfoma de Células B/patología , Linfoma no Hodgkin/diagnóstico por imagen , Linfoma no Hodgkin/patología , Masculino , Radiografía , Neoplasias del Bazo/diagnóstico por imagen , Neoplasias del Bazo/patologíaRESUMEN
BACKGROUND/AIMS: The aim of this study in hepatectomy is to investigate whether or not hepatic ischemia elevates the serum prostanoid levels, and whether or not thromboxane A2 (TXA2) synthetase inhibitor (OKY 046) improves hepatic damage. MATERIALS AND METHODS: The prostanoid levels were measured in 22 hepatectomy cases. The beneficial effects of thromboxane A2 synthetase inhibitor were examined in cases who underwent hepatectomy under hemihepatic vascular control. The total prostanoid levels (6-keto PG Fla+ PGE2 + TXB2) were measured in 22 cases before and after hepatectomy. The hepatic ischemic time (HIT) was defined as the time required to perform a hepatic mobilization plus the right hemihepatic vascular control technique. RESULTS: The total prostanoid levels increased after hepatectomy (P < 0.01). The changes in the total prostanoid levels positively correlated with the HIT (P < 0.01). The 17 cases who underwent hepatectomy with the HIT were randomly divided into 2 groups; the OKY group (n = 9), OKY 046 (0.2 mg/kg/hr), the control group (n = 8); no drug was given. The OKY 046 administration reduced the TXB2 levels (P < 0.01), without any changes in the PGE2, or 6-keto PGF1a levels. The serum glutamic oxaloacetic transaminase levels after operation were lower, and the hepaplastin tests were higher in the OKY group than those of the control (P < 0.05). CONCLUSION: These results demonstrated that hepatectomy under ischemia elevated the prostanoid levels. OKY 046 significantly reduced the TXB2 levels and the degree of hepatic damage in hepatectomy under ischemia.
Asunto(s)
Inhibidores Enzimáticos/uso terapéutico , Hepatectomía , Metacrilatos/uso terapéutico , Prostaglandinas/fisiología , Daño por Reperfusión/prevención & control , Aspartato Aminotransferasas/sangre , Femenino , Humanos , Hígado/irrigación sanguínea , Masculino , Persona de Mediana Edad , Prostaglandinas/sangre , Tromboxano-A Sintasa/antagonistas & inhibidoresRESUMEN
It has been suggested that thromboxane A2 (TXA) plays important roles in preservation/reperfusion organ injury. In this report, we investigated the prostanoid release from the liver and the effect of a selective TXA synthetase inhibitor (E)-3-[p-(1H-imidazol-yl-methyl)-phenyl]-2-propenoic acid, OKY046) during cold preservation and after reperfusion. Rat livers were preserved in lactated Ringer's solution at 4 degrees C for 2, 4, and 6 hr and perfused with oxygenated Krebs-Henseleit buffer using recirculating perfusion system, and prostanoids were measured during cold preservation and after reperfusion. OKY046 and a novel TXA receptor antagonist [(9,11), (11,12)-Dideoxa-9a, 11a-dimethyl-methano-11,12-methano-13,14-dihydro-13-aza-14-oxo-15-cyclo pentyl-16,17,18,19,20-pentanor-15-epi-TXA, ONO3708] were added into the preservation solution and perfusate. Along with the preservation time, both the production and release of TXA was observed to increase; however, almost all the produced TXA was stored in the liver tissue. Afterwards, the stored TXA was released into perfusate in 15 min after reperfusion. OKY046 significantly decreased both the production and release of TXA. In addition, OKY046 improved the histological damage and trypan blue uptake of liver cells. Our results demonstrate that TXA, stored in the liver during preservation, might therefore be a potential trigger of reperfusion injury, and as a result, OKY046 reduces reperfusion injury by decreasing the production of TXA during preservation.
Asunto(s)
Inhibidores Enzimáticos/farmacología , Hígado/fisiología , Metacrilatos/farmacología , Preservación de Órganos/métodos , Receptores de Tromboxanos/antagonistas & inhibidores , Daño por Reperfusión/fisiopatología , Tromboxano A2/análogos & derivados , Tromboxano A2/fisiología , Tromboxano-A Sintasa/antagonistas & inhibidores , 6-Cetoprostaglandina F1 alfa/metabolismo , Animales , Ácido Araquidónico/metabolismo , Frío , Endotelio/citología , Endotelio/patología , Tamaño de los Órganos/efectos de los fármacos , Fosfolipasas A/metabolismo , Ratas , Ratas Endogámicas Lew , Tromboxano A2/farmacología , Tromboxano B2/metabolismoRESUMEN
OBJECTIVE: To evaluate the recent results of liver resection in patients with hepatocellular carcinoma. DESIGN: Retrospective study. SETTING: A university hospital in Japan. PATIENTS: Two hundred eighty patients who underwent liver resection with complete extirpation of hepatocellular carcinoma from 1985 to 1993. MAIN OUTCOME MEASURES: Morbidity and survival after operation and the pathologic features of hepatocellular carcinoma according to the TNM classification of the International Union Against Cancer. RESULTS: More than 40% of the patients with stages I and II disease underwent a partial resection of the liver, whereas 50% of those with stages III and IVA were operated on with more than a bisegmentectomy. Fifty percent of all patients had no postoperative complications. The morbidities included intra-abdominal abscess (7%), bile leakage (5%), and hepatic failure (4%, of whom half died; mortality rate, 2%). Histopathologically, 32% of the stage I tumors were well differentiated (grade 1), while, in stage III, 56% had portal invasion and 61% had daughter lesions in the liver. The cumulative survival rates of patients with stages I, II, and III disease and all patients at 5 years were 69%, 52%, 32%, and 50%, respectively, while the disease-free survival rates at 5 years were 38%, 34%, 17%, and 29%, respectively. CONCLUSION: The recent results of liver resection for hepatocellular carcinoma are generally satisfactory; however, the recurrence rate is still high.
Asunto(s)
Carcinoma Hepatocelular/cirugía , Hepatectomía , Neoplasias Hepáticas/cirugía , Anciano , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/patología , Femenino , Humanos , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Despite recent progress in diagnostics for hepatocellular carcinoma, the rate of resectability remains low, mainly because of the advancement of the underlying liver disease. We report a case of a 54-year-old man with a hepatocellular carcinoma and poor liver function that was treated successfully with a laparoscopic hepatic resection. Laparoscopic hepatic resection is considered to be feasible with the aid of an ultrasonic dissector and a microwave coagulator; however, close attention should be paid to the development of air embolism and hepatic vein injury.
Asunto(s)
Carcinoma Hepatocelular/cirugía , Hepatectomía , Laparoscopía , Neoplasias Hepáticas/cirugía , Disección/instrumentación , Electrocoagulación/instrumentación , Embolia Aérea/prevención & control , Estudios de Factibilidad , Hepatectomía/instrumentación , Hepatectomía/métodos , Venas Hepáticas/lesiones , Humanos , Complicaciones Intraoperatorias/prevención & control , Laparoscopios , Laparoscopía/métodos , Masculino , Microondas/uso terapéutico , Persona de Mediana Edad , Terapia por Ultrasonido/instrumentaciónAsunto(s)
Amoníaco/sangre , Supervivencia de Injerto , Trasplante de Hígado , Humanos , Periodo PosoperatorioRESUMEN
UNLABELLED: Serum hyaluronic acid (HA) levels during or after liver transplantation can reflect graft viability in animal models. Decreased HA clearance in nonviable grafts seems to reflect hepatic endothelial cell damage induced by cold preservation/reperfusion. Therefore, we examined the relationship between HA clearance and endothelial cell damage, using an isolated perfused rat liver (IPRL) model. The grafts were separated into four groups, according to cold preservation time: minimal storage ( CONTROL: n = 9), 4-hr preservation (n = 9), 5-hr preservation (n = 8), 6-hr preservation (n = 9). After cold storage, grafts were put on the recirculating IPRL system and then reperfused for 120 min with 37 degrees C oxygenated Krebs-Henseleit buffer, containing HA and sodium taurocholate. To examine the function of sinusoidal endothelial cells and hepatocytes, serial measurements of HA, total bile acids, and conventional parameters in the perfusate were taken. After the perfusion, a trypan blue exclusion test was done to assess the microscopic sinusoidal lining cell (SLC) damage. HA clearance from the perfusate showed a preservation time-dependent decrease which clearly distinguished between 4- and 6-hr preserved grafts. Trypan blue uptake ratio of SLC increased in accordance with preservation time. HA clearance at 120 min after reperfusion showed a highly significant correlation with histologically assessed SLC damage. These results suggest that HA is useful to evaluate the extent of endothelial cell damage after cold storage and reperfusion. The significance of HA as a predictor of graft viability is also confirmed.
Asunto(s)
Criopreservación , Ácido Hialurónico/farmacocinética , Hígado/metabolismo , Hígado/patología , Reperfusión , Animales , Aspartato Aminotransferasas/metabolismo , Bilis/fisiología , Endotelio/metabolismo , Endotelio/patología , Masculino , Ratas , Ratas Endogámicas Lew , Factores de Tiempo , Azul de TripanoRESUMEN
A quick and simple technique for the selective control of hepatic arterial inflow is described for hepatic resections or hepatic hilar lymph node dissection which allows arterial hemostasis without causing splanchnic congestion.