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  • 1
    Electronic Resource
    Electronic Resource
    Pelvic perfusion hyperthermia for advanced pelvic malignancies (1985)
    Springer
    Surgery today 15 (1985), S. 49-54 
    Details
    ISSN: 1436-2813
    Keywords: pelvic perfusion hyperthermia ; isolation-perfusion chemotherapy ; perfusion hyperthermia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Pelvic perfusion hyperthermia (PPH) for malignant gynecologic diseases in the pelvis was performed for four hours with favorable results. Serial monitoring of chemotherapeutic drug concentrations in the blood, tissues and circuit showed that the drugs were satisfactorily incorporated into the tumor bearing area and that the systemic leak was minimal with no demonstrable systemic side effects. The temperature of the tumor was kept between 41.8°C and 42.7°C for over three hours. The esophageal temperature was maintained below 40°C throught the procedure. In one patient, there was an eighty percent reduction in tumor size and in the other, a complete regression of the tumor. We conclude that the PPH is a procedure that warrants further attention as an adjunct to cancer therapy for malignant pelvic tumors.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02469857
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  • 2
    Electronic Resource
    Electronic Resource
    Determinants of long-term survival following hepatectomy for hepatocellular carcinoma, with special reference to patients surviving more than 10 years (1994)
    Springer
    Journal of hepato-biliary-pancreatic surgery 1 (1994), S. 107-112 
    Details
    ISSN: 1436-0691
    Keywords: hepatocellular carcinoma ; hepatectomy ; long-term survival
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To elucidate the determinants of survival and the clinicopathologic features of long-term survivors of resections for HCC, we reviewed 539 patients who had had hepatectomy alone or hepatectomy together with hepatic arterial ligation or ethanol injection for the treatment of hepatocellular carcinoma (HCC) at our department between 1973 and December 1992. Of these patients, 30% (79/264) survived for more than 5 years and 11% (10/87) for more than 10 years. All the long-term survivors had received curative resections. The 5- and 10-year survivors accounted for 58% (79/136) and 29% (10/35) of those with curative resections, respectively. Crucial determinants for long-term survival were the absence of portal invasion and satellite nodules, a diploid pattern of DNA content, and a curative resection. A curative resection for diploid HCCs led to much better survival rates (73%) at 5 years than such a resection for aneuploid HCCs (35%), and than for non-curative resections for aneuploid HCCs (0%). The history and tumor background of the ten patients who survived for more than 10 years were characterized by good reserve liver function, warranting a wider resection, predominance of female sex, single nodular growth, and the absence of poorly differentiated cells, in addition to the favorable conditions described above. Three of the ten patients developed a new lesion; these were successfully treated by re-resection or repeated arterial embolization, since they were confined to the remnant liver and showed single nodular growth without extranodular spread. This analysis indicates that hepatectomy is the option of first choice for HCC patients with the potential for cure and good reserve liver function.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01222231
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  • 3
    Electronic Resource
    Electronic Resource
    Multivariate analysis of liver regenerative capacity after hepatectomy in humans (1997)
    Springer
    Journal of hepato-biliary-pancreatic surgery 4 (1997), S. 78-82 
    Details
    ISSN: 1436-0691
    Keywords: liver regeneration ; hepatectomy ; liver fibrosis ; multiple regression equation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Many factors affect liver regeneration after partial hepatectomy; however, those factors that are essential for regulation of liver regeneration in humans are not known. Using multiple regression analysis we conducted a study to determine essential factors involved in the speed of liver regeneration after hepatectomy. The subjects were 59 patients who underwent hepatic resection between January 1980 and December 1991. A regression equation for predicting regeneration speed (Y; cm3/day) during the 1st postoperative month was obtained by stepwise forward multiple regression analysis, using 11 explanatory parameters (Xi). The regeneration speed and the resection ratio (%; indicating the magnitude of resection) were calculated based on a computed tomography (CT) scan volumetric study. The degree of liver fibrosis, expressed as the fibrotic index (%), was morphometrically determined in Azan-Mallory stained sections. Of the 11 explanatory parameters, the resection ratio and the fibrotic index had a significant simple correlation with Y. The following regression equation was obtained: Y (cm3/day)=−1.1+3.7 × resection ratio −5.4 × alkaline phosphatase −3.7 × fibrotic index +1.2× total bilirubin −2.6 × glutamic pyruvic transaminase (multiple correlation coefficient, 0.82). We found that the extent of resection and the degree of fibrosis, as well as alkaline phosphatase, total bilirubin, and glutamic pyruvic transaminase, contributed to the speed of regeneration after partial hepatectomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01211346
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  • 4
    Electronic Resource
    Electronic Resource
    Idiopathic benign biliary stricture (1998)
    Springer
    Journal of hepato-biliary-pancreatic surgery 5 (1998), S. 463-466 
    Details
    ISSN: 1436-0691
    Keywords: Key words: benign biliary stricture ; localized primary sclerosing cholangitis ; extrahepatic bile duct
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: A rare case of idiopathic benign biliary stricture is reported. A 50-year-old man with liver dysfunction underwent ultrasonography, which revealed dilation of the intrahepatic bile ducts, and endoscopic retrograde cholangiopancreatography, which revealed a short, ring-like stenosis at the junction of the left and right hepatic ducts. Although a benign stricture was suspected, radiologic tests alone were insufficient to make a firm diagnosis. Therefore, a cholecystectomy and resection of the extrahepatic biliary tract were performed. Microscopic examination of the resected specimen demonstrated no evidence of malignancy. The final diagnosis was mild, localized, chronic cholangitis. The patient had not had previous biliary tract surgery, choledocholithiasis, nor did he have a congenital abnormality of the biliary tract, bile duct carcinoma, or pancreatic disease. Since there was no evidence of primary sclerosing cholangitis, the stricture was considered to be idiopathic.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005340050074
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  • 5
    Electronic Resource
    Electronic Resource
    Cellular DNA content and histopathological analysis in hepatocellular carcinoma with multiple nodules (1997)
    Springer
    Surgery today 27 (1997), S. 483-490 
    Details
    ISSN: 1436-2813
    Keywords: hepatocellular carcinoma ; DNA ploidy ; multiple nodules
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Multiple tumors within the liver are a characteristic feature of hepatocellular carcinoma (HCC). This study investigated alterations in the histologic type and DNA content of multiple nodules of HCC. Both a pathologic examination and flow cytometric DNA analysis were performed on 49 resected specimens of multinodular HCC. The results showed that 35 cases had multiple metastatic satellite nodules around the main tumor (group 1), while 14 had two solitary nodules in different segments without satellite nodules (group 2). In group 1, 28 out of 35 (80.0%) showed a single DNA index while 7 (20.0%) revealed two different DNA contents in the main tumor. The histological type, cytological grade, and DNA index were equivalent between the main and satellite tumors in 100%, 88.6%, and 97.1% of the cases, respectively. In group 2, all tumors showed a single histological type, cytological grade, and DNA index in each nodule. The histological type was identical in 85.7% of the pairs of nodules, but the cytological grade and DNA index were different in 42.9% and 85.7%, respectively. The patients in group 2 showed a significantly higher 5-year survival rate than that in group I (64.8%vs 27.2%,P〈0.05). This study thus indicates that the cytological grade and DNA content are useful in distinguishing multicentric occurrence from intrahepatic metastasis in HCC.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02385799
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  • 6
    Electronic Resource
    Electronic Resource
    Does Topical Cooling Alleviate Ischemia/Reperfusion Injury During Inflow Occlusion in Hepatectomy? Results of an Experimental and Clinical Study (2000)
    Springer
    Surgery today 30 (2000), S. 795-804 
    Details
    ISSN: 1436-2813
    Keywords: Key Words Hepatectomy ; Ischemia/reperfusion injury ; Vascular occlusion ; X-Ray microanalysis ; Subcellular element
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study was undertaken to evaluate whether topical cooling can alleviate ischemia/reperfusion injury, after continuous inflow occlusion during hepatectomy. Using a canine model of 70% partial liver ischemia (60 min), alteration in the subcellular (cytoplasm, mitochondria, nucleus) elements calcium, sodium, potassium, and chloride, and liver functions following reperfusion were compared between control livers and livers subjected to topical cooling down to 23°± 4.9°C by seeding ice slush over the ischemic lobe. The elements were determined by X-ray microanalysis using liver biopsy specimens. A similar clinical study was undertaken examining ten patients with hepatocellular carcinoma and chronic liver disease who underwent right-sided segmentectomy under continuous right inflow occlusion, five of whom were given topical cooling and five of whom were not. In the experimental study, postreperfusion worsening of liver function tests was significantly suppressed in the cooling group, which was associated with the suppression of subcellular Ca, Na, and Cl increases and K decreases after reperfusion. In the clinical study, the occlusion time was significantly longer in the hypothermic patients than in the normothermic patients, but no significant differences in postoperative liver function or postischemic increases in Ca, Na, or Cl and decreases in K were observed. These experimental and clinical findings suggest that topical cooling alleviates ischemic insult and enhances safe prolonged inflow occlusion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005950070061
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  • 7
    Electronic Resource
    Electronic Resource
    Viral serostatus and coexisting inflammatory activity affect metachronous carcinogenesis after hepatectomy for hepatocellular carcinoma. A further report (2000)
    Springer
    Journal of gastroenterology 35 (2000), S. 206-213 
    Details
    ISSN: 1435-5922
    Keywords: Key words: hepatocellular carcinoma, hepatectomy, intrahepatic recurrence, metachronous carcinogenesis, viral serostatus, viral hepatitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: Little data are available regarding the effects of hepatitis virus serostatus and the severity of coexisting chronic inflammation on intrahepatic recurrence after hepatectomy for hepatocellular carcinoma (HCC). We investigated the extent to which these factors modified the prognosis of hepatectomized patients. A total of 274 patients treated in the period January 1981 to December 1996 were divided into three groups: anti-hepatitis C-positive (HCV; n = 144), hepatitis B surface antigen-positive and HCV antibody (Ab)-negative (HBsAg; n = 106), and HBsAg-negative and HCV Ab-negative (NBNC; n = 20). Positivity for HBV-related antibody in the HCV group was 76%. Histologic grading of inflammatory activity from coexisting hepatitis was determined according to Knodel's histological activity index (HAI) scoring system. Post-hepatectomy crude survival rates and disease-free survival (DFS) rates were compared, according to tumor characteristics, between the three groups. In the patients overall and also in the patients with a single nodular HCC, the HCV group had significantly higher HAI scores and preoperative serum aspartate aminotransaminase (AST) levels than the other two groups. When the patients were limited to those with a single nodular HCC, the crude survival was similar in the three groups with comparable tumor characteristics; however, the DFS was different (NBNC 〉 HBsAg 〉 HCV). When the patients were further limited to those with a single nodular HCC without microscopic extracapsular spread, in whom removal of the tumor was expected to be microscopically complete, the difference in the DFS became more marked. Irrespective of the viral serostatus, better crude and disease-free survivals were observed in the patients with lower AST levels (≧50 IU/l) than in those with higher AST levels (〉50 IU/l). In contrast, there were no differences in survivals and HAI scores according to the presence or absence of HBV-related antibody in the HCV group. From our univariate analysis, we can conclude that the severity of virally induced inflammation, which was well correlated with viral serostatus, may be a factor that affects intrahepatic recurrence, which is more likely to originate from metachronous carcinogenesis. Prior co-infection of HBV in HCV patients may not be an adverse risk factor for intrahepatic recurrence.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005350050332
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  • 8
    Electronic Resource
    Electronic Resource
    Evolution of and obstacles in surgical treatment for hepatocellular carcinoma over the last 25 years: differences over four treatment eras (2000)
    Springer
    Journal of gastroenterology 35 (2000), S. 613-621 
    Details
    ISSN: 1435-5922
    Keywords: Key words: hepatocellular carcinoma ; hepatectomy ; disease-free survival ; prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: This study was designed to clarify what differences the last 25 years have made in surgical results for patients with hepatocellular carcinoma (HCC). We examined results for 716 hepatectomized patients in four treatment eras: first era (1973–1980; n = 58), second era (1981–1985; n = 155), third era (1986–1990; n = 243), and fourth era (1991–1997; n = 260). Patient background, tumor characteristics, type of hepatectomy, treatment for intrahepatic recurrences, and surgical results in the four eras were compared by univariate analysis to clarify the factors that have contributed to or impeded progress in the surgical treatment of HCC. Although there were no significant chronological differences in liver pathology and surgical resectability, operative mortality was reduced to 2% in the fourth era, from 29% in the first era. With an increasing proportion of early-stage HCCs (TNM, stages I and II), the cumulative survival rate at 5 years improved in the course of the eras in our overall population of patients (12%, 31%, 38%, and 51%, respectively, for the first, second, third, and fourth eras) and in a subset of the population divided according to tumor stage. Also, we found a chronological improvement in the survival rate at 3 years after intrahepatic recurrence (10%, 28%, 36%, and 44%, respectively in the first second, third, and fourth eras). This improvement was associated with the establishment of an early detection program for intrahepatic recurrences. However, the recurrence rate was similar in any subset of the population through the four eras. Although this univariate study could not determine independent factors that contributed to the chronological progress in results for HCC surgery in the four eras, it is conceivable that the establishment of indication criteria for hepatectomy, an early detection program for primary and recurrent lesions, and the introduction of multimodal treatment for recurrence were contributory factors in this im-provement. A strategy for alleviating the frequent recurrences originating from posthepatectomy metachronous carcinogenesis remains to be established.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005350070061
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  • 9
    Electronic Resource
    Electronic Resource
    Microwave Coagulonecrotic Therapy for Hepatocellular Carcinoma (1996)
    Springer
    World journal of surgery 20 (1996), S. 1076-1081 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The present study reports on the usefulness of microwave coagulonecrotic therapy (MCT) as a treatment option for hepatocellular carcinoma (HCC) with poor hepatic reserve. From June 1992 to March 1995, MCT using a microwave electrode was employed on 8 patients using laparoscopic control and 19 with the open method, and wedge resection (Hx) was applied to the 23 patients. All patients had HCC with poor hepatic reserve. Radiation output was 100 watts with a mean radiation duration of about 30 minutes. The severity of liver dysfunction and the regional characteristics of the tumor (tumor size, multiplicity, portal invasion, tumor depth) were comparable between the MCT and Hx groups. The operative time was significantly shorter for the MCT group than the Hx group. The mean blood loss was 1570 ml in the Hx group but negligible in the MCT group. There was no operative mortality in the MCT group in contrast to 4.3% (1 of 23) in the Hx group. Complications were observed in 11.1% (3 of 27) and 34.8% (8 of 23), respectively, for the MCT and Hx groups. The postoperative total bilirubin had lower values and the start of diet was earlier in the MCT group than the Hx group. The 3-year crude and disease-free survival rates were 86% and 44%, respectively, for patients who underwent MCT, which were comparable to 75% and 14% for those with Hx. MCT can achieve long-term results equivalent to those obtained by wedge resections, but it is less invasive and technically easier. Therefore it can be an alternative option in place of limited resection for HCC with poor hepatic reserve.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002689900163
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  • 10
    Electronic Resource
    Electronic Resource
    Results of surgical treatments of primary hepatocellular carcinoma: Some aspects to improve long-term survival (1984)
    Springer
    World journal of surgery 8 (1984), S. 360-365 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé De 1973 à 1982 les auteurs ont opéré 226 malades qui présentaient un cancer hépatocellulaire, 103 par hépatectomie et 93 par ligature de l'artère hépatique. La majorité des patients présentaient une cirrhose ou des lésions hépatiques, un tiers étaient porteurs de varices oesophagiennes. Comme dans les autres séries japonaises ou asiatiques, les résultats à long terme chez les 90 malades qui avaient subi une hépatectomie furent décevants par comparaison avec les séries occidentales concernant les sujets indemnes de cirrhose. Cependant la survie actuarielle à 3 ans fut de 90% chez les opérés qui présentaient un cancer d'un diamètre inférieur à 3 cm (n=18). Le taux de survie à 5 ans fut de 70,8% chez 25 malades qui avaient subi une résection à but curatif, et le taux de survie à 3 ans fut de 100% chez 16 opérés qui avaient subi une résection pour une tumeur d'un diamètre inférieur à 5 cm. Quatrevingt-quatre malades ont survécu à la ligature de l'artère hépatique; chez 50 d'entre eux la zone ischémique provoquée par la ligature intéressait la totalité de la région hépatique occupée par les lésions néoplasiques. Le taux de survie de ces 50 malades fut toujours supérieur à celui de ceux qui n'avaient pu être l'objet d'une résection hépatique. De cette étude, on peut retenir les conclusions suivantes: le diagnostic précoce et la résection à but curatif du cancer hépatocellulaire chez les cirrhotiques représentent des conditions favorables à l'obtention de résultats à long terme satisfaisants; les résultats de la ligature de l'artère hépatique sont supérieurs à ceux de la résection incomplète (résection à but non curatif).
    Abstract: Resumen Hemos tratado 226 pacientes con carcinoma hepatocelular primario entre 1973 y 1982, incluyendo 103 con hepatectomía y 93 con ligadura de la arteria hepática. La mayoría apareció asociada con cirrosis o enfermedades hepáticas relacionadas y un tercio con varices esofágicas. Al igual que en otras series japonesas y asiáticas, nuestros resultados globales a largo término para los 90 pacientes que sobrevivieron la hepatectomía fueron pobres en comparación con las series occidentales que incluyen pacientes no cirróticos. Sin embargo, la tasa de supervivencia actuarial a 3 años fue del 90% en pacientes con carcinomas menores de 3 cm de diámetro (n= 18). La tasa de supervivencia en 5 años fue de 70,8% en los 25 pacientes cuyos carcinomas fueron sometidos a resección curativa, y del 100% en 3 años en los 16 pacientes en quienes se resecó un tumor de menos de 5 cm de diámetro. Ochenta y cuatro pacientes sobrevivieron la ligadura de la arteria hepática; en 50 de éstos se consideró que el área de isquemia incluía las lesiones neoplásicas contenidas en el hígado. La tasa de supervivencia de estos 50 pacientes fue superior a la de los pacientes que fueron sometidos a resección hepática no curativa. Nuestra conclusión es que la detección precoz y la resección curativa son la mejor manera de superar los resultados a largo plazo en pacientes cirróticos con carcinoma hepatocelular y que la ligadura de la arteria hepática es superior a la resección incompleta (no curativa).
    Notes: Abstract From 1973 through 1982 we have treated 226 patients with primary hepatocellular carcinoma, including 103 by hepatectomy and 93 by hepatic artery ligation. Most were associated with cirrhosis or related liver diseases and one-third with esophageal varices. As in other Japanese and Asian series, our long-term overall results for the 90 patients who survived hepatectomy were poor in comparison with Western series dealing with non-cirrhotic patients. However, the actuarial survival rate at 3 years was 90% in patients with carcinomas smaller than 3 cm in diameter (n = 18). The 5-year survival rate was 70.8% in the 25 patients whose carcinoma had a curative resection, and 100% at 3 years in the 16 patients in whom a tumor smaller than 5 cm had been resected. Eighty-four patients survived hepatic artery ligation; in 50 of them the area of ischemia was thought to include all the neoplastic lesions within the liver. The survival rate of these 50 patients was superior to that of the patients who had undergone noncurative hepatic resection. We conclude that early detection and curative resection is the best way to improve the long-term results in cirrhotic patients with hepatocellular carcinoma and that hepatic artery ligation is better than incomplete (noncurative) resection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01655077
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