Showing papers by "Hidefumi Higashi published in 1994"

Liver Resection for Hepatocellular Carcinoma in the Elderly

Abstract: Objective: To estimate the effectiveness of hepatic resection on hepatocellular carcinoma (HCC) in the elderly. Design: Comparison with younger patients. Setting: A municipal hospital and a large university hospital in Japan. Patients: The study included 39 patients (age ≥70 years [the elderly group]) and 229 patients (age P =.016). Main Outcome Measures: Morbidity and survival following operation and the pathological features of HCC. Results: The incidence of postoperative hepatic failure was higher in the elderly group (10% vs 2%; P =.018). However, the incidence of operative death in the elderly group (5% vs 1%) as well as the incidence of other postoperative complications and rates of long-term survival (75.9% vs 51.6% at 5 years) and disease-free survival (30.4% vs 31.0% at 5 years) were similar to those in the younger group. The pathological features of HCC were identical between the two groups. Conclusion: The outcome of surgical treatment of HCC in the elderly group was satisfactory when compared with that in the younger group. (Arch Surg. 1994;129:846-850)

Serum hyaluronic acid for the assessment of graft viability in porcine liver transplantation

Abstract: For the assessment of graft viability, serum hyaluronic acid (HA) levels during porcine orthotopic liver transplantation were measured in two groups: group 1 (viable:n = 5) in which allografts were transplanted following a minimal cold (4°C) preservation, and group 2 (nonviable:n = 4) in which allografts were transplanted after cold static storage (4°C) for 24 h in University of Wisconsin solution. The changes in the HA levels reached a significant difference between the two groups at 30 min after reperfusion (P < 0.02). In group 1, all animals survived for over 4 days, while all animals in group 2 died within 24 h. The serum HA also demonstrated a significant correlation with prothrombin time, s-glucuronidase, and aspartate aminotransferase at 120 min after reperfusion. These results suggest that the measurement of serum HA is a potentially effective index for evaluating hepatic allograft viability.

Indications for major hepatectomy in cirrhotic liver.

Abstract: In an investigation of the indications for major hepatic resection of the cirrhotic liver, the records of 152 consecutive patients who had undergone a right hepatic resection between April 1985 and January 1991 were reviewed. A comparison of right hepatic lobectomy and right partial hepatectomy of the liver with no cirrhotic changes, revealed that postoperative values of serum glutamic pyruvic transaminase were significantly higher after right partial hepatectomy than after right lobectomy, despite the fact that there were no significant differences with respect to preoperative laboratory data, and there was a greater blood loss and total weight of the resected liver in patients receiving a right lobectomy as compared with those undergoing partial hepatectomy. These results suggest that in order to enable a more favorable recovery from hepatic resection, it is essential to avoid both mechanical damage and ischemic injury to the residual liver during hepatic surgery. A total of 77 patients underwent a partial hepatectomy of a cirrhotic liver, and among these patients, 16 patients had values of the indocyanine green test of less than 20%, as well as a portal pressure of less than 200 mm saline. Compared with these 16 cirrhotic patients and those patients who underwent right lobectomy, there were no significant differences with regard to the pre-operative laboratory data and portal pressure. These results therefore suggest that major hepatic lobectomy could be performed on selected patients with cirrhotic livers.

Influence of hepatectomy on cell infiltration in the resected liver parenchyma compared with the biopsy specimen : a preliminary study

Abstract: We undertook a preliminary investigation to determine whether or not preoperative hepatitis activity can be evaluated by the finding of cell infiltration into the parenchyma of the resected specimen. In 28 patients who underwent hepatic resection, liver biopsies were obtained just after the laparotomy in order to make a histological comparison with the resected liver specimen. Histological changes were observed in 11 out of 28 patients. However, these were limited to minimal changes of neutrophil infiltration in the portal and subserosal area with no derangement of chronic cell infiltration. In addition, the preoperative liver function and operative findings did not differ between patients with and those without histological changes. The activity of hepatitis was therefore seen not to be histologically influenced by the surgical procedure. Thus, an accurate evaluation of chronic inflammatory cell infiltration activity in the resected liver specimen is a reliable indicator in chronic liver disease patients.