Most informative projection for portography: quantitative analysis of 47 percutaneous transhepatic portograms.

The goal of this study was to determine which projection for percutaneous transhepatic portography best depicts the anatomy of the proximal portal vein. Portograms ( n = 47) obtained in the anteroposterior, right anterior oblique, and right anterior caudal oblique projections were analyzed retrospectively. Lengths of the right portal trunk, the transverse portion of the left portal vein, and the right anterior and posterior portal branches, as well as angles between the right portal trunk and the transverse portion of the left portal vein and between the right anterior and posterior portal branches were measured in the various projections.

A novel platinum compound inhibits telomerase activity in vitro and reduces telomere length in a human hepatoma cell line.

Telomerase activity is detectable in most human tumors but not in most normal somatic cells or tissues. Telomerase inhibition has, therefore, been proposed as a novel and potentially selective strategy for antitumor therapy. In the present study, we found that platinum compounds, including cisplatin [cis-diamminedichloro-platinum (II)], strongly inhibited the activity of partially purified rat telomerase.

Factors influencing postoperative hospital mortality and long-term survival after radical resection for stage IV gallbladder carcinoma.

Factors influencing postoperative hospital mortality and long-term survival after radical resection of stage IV gallbladder carcinoma remain unclear. The objective of this study was to identify characteristics of patients who are good candidates in terms of surgical risk and long-term survival for radical resection of stage IV gallbladder carcinoma. A retrospective study was made of attempted surgical cure in 72 patients with stage IV gallbladder carcinoma.

[Biliary bacterial infection in liver surgery].

Hepatectomy for biliary tract carcinoma with obstructive jaundice is associated with a higher incidence of postoperative septic complications as compared with hepatectomy for hepatocellular carcinoma or metastatic liver cancer. Since most bacteria isolated from septic sites are identical to those found in the preoperative percutaneous transhepatic biliary drainage (PTBD) bile, bacterial colonization in bile appears to be responsible for posthepatectomy septic complications in patients with biliary tract carcinoma. Although it remains unclear how bile becomes contaminated after bile duct obstruction or why preoperative PTBD increases the incidence of biliary infection, bacterial translocation via the portal vein, resulting from loss of integrity of the intestinal mucosa and change in intestinal microflora, may in part account for the mechanisms.

Extended surgery in bilio-pancreatic cancer: the Japanese experience.

Aggressive surgery has been used in bilio-pancreatic cancers in many institutions in Japan. Approaches in pancreatic cancer include extended lymph node and soft tissue dissection in patients with ductal carcinoma of the pancreatic head. In biliary tract disease, approaches have included hepatectomies with or without vascular resection, reconstruction designed according to the extent of disease in individual patients, and combined liver and pancreas resection (hepatopancreatoduodenectomy) in locally advanced disease.

Immunohistochemically demonstrated lymph node micrometastasis and prognosis in patients with otherwise node-negative hilar cholangiocarcinoma.

Objective: To investigate whether immunohistochemically demonstrated lymph node micrometastasis has prognostic significance in patients with histologically node-negative (pN0) hilar cholangiocarcinoma.

Summary Background Data: The clinical significance of immunohistochemically detected lymph node micrometastasis recently has been evaluated in various tumors. However, no reports have addressed this issue with regard to hilar cholangiocarcinoma.

Cystic duct carcinoma: a proposal for a new "working definition".

Background: Farrar's criteria for cystic duct carcinoma (histopathological diagnosis of a carcinoma strictly limited to the cystic duct) have practical limitations. We propose new "working definition": a gallbladder tumor, the center of which is located in the cystic duct.

Patients And Methods: Between 1980 and 2000 we diagnosed cystic duct carcinoma in 31 patients, 28 of whom (90%) had increased serum bilirubin concentrations.

Germline mutations of the APC gene in two Japanese adenomatous polyposis patients.

Germline mutations of the adenomatous polyposis coli (APC) gene have been reported in patients with familial adenomatous polyposis (FAP) and are believed to be an early event in colorectal carcinoma. We report the results of screening for germline mutations of the APC gene in 4 cases of 2 kindreds using non-radioactive PCR-SSCP (polymerase chain reaction-single strand conformation polymorphism) analysis. The mutation in kindred 1 was a 4 bp deletion at codon 849 in exon 15, resulting in a frameshift leading to truncation of the APC gene product.

Effect of chitosan film containing basic fibroblast growth factor on wound healing in genetically diabetic mice.

Basic fibroblast growth factor (bFGF) has been shown to stimulate wound healing. However, consistent delivery of bFGF has been problematic. We studied the stability of bFGF incorporated into a chitosan film as a delivery vehicle for providing sustained release of bFGF.

Profiling of gene expression associated with hepatolithiasis by complementary DNA expression array.

By use of cDNA expression array method, we compared the expression profiles of genes in hepatolithiasis tissues with those of paired normal tissues. Expression of 1176 cancer related genes that include 33 tumor suppressor genes, 100 proto-oncogenes and 37 DNA damage repair genes were examined in this study. We found that expression of tumor suppressor genes and proto-oncogenes was systemically activated in hepatholithiasis tissues, suggesting that expression of genes controlling cell growth becomes unstable in liver lobe of hepatolithiasis.

Mode of tumor spread and surgical strategy in gallbladder carcinoma.

Background And Aims: The mode and degree of tumor spread in gallbladder carcinoma is poorly documented. The present study classifies the patterns of dissemination of this tumor with a focus on surgical strategy.

Patients And Methods: Surgical specimens from 112 patients who underwent curative resection were reviewed.

P53 labeling index in cholangioscopic biopsies is useful for determining spread of bile duct carcinomas.

Background: Preoperative biopsy specimens obtained by means of percutaneous transhepatic cholangioscopy are useful for planning curative resection of bile duct carcinoma in an effort to improve survival. However, tissue diagnosis is sometimes difficult. This study evaluated the usefulness of p53 immunostaining of cholangioscopic specimens for determination of tumor spread.

Infrarenal aortic dilatation less than 4 cm is not unusual in patients with aortoiliac occlusive disease.

Background: The relationship between atherosclerosis and abdominal aortic aneurysm is now controversial. To better define the contribution of atherosclerosis to the development of aneurysm of the infrarenal aorta, we determined the incidence of aortic dilatation in patients undergoing arterial reconstruction for an atherosclerotic aortoiliac occlusive disease (AIOD). The role of aortic wall calcification and intraluminal thrombus was also determined.

Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma.

Background: To the authors' knowledge, the significance of postoperative adjuvant chemotherapy in pancreaticobiliary carcinoma has not yet been clarified. A randomized controlled study evaluated the effect of postoperative adjuvant therapy with mitomycin C (MMC) and 5-fluorouracil (5-FU) (MF arm) versus surgery alone (control arm) on survival and disease-free survival (DFS) for each specific disease comprising resected pancreaticobiliary carcinoma (pancreatic, gallbladder, bile duct, or ampulla of Vater carcinoma) separately.

Methods: Between April 1986 and June 1992, a total of 508 patients with resected pancreatic (n = 173), bile duct (n = 139), gallbladder (n = 140), or ampulla of Vater (n = 56) carcinomas were allocated randomly to either the MF group or the control group.

Clinicoanatomical study on the infraportal bile ducts of segment 3.

In some patients, bile ducts of segments 2 and 3 (B2 and B3) run caudally to the umbilical portion of the left portal vein (UP)--an infraportal course. We aimed to evaluate the frequency and clinical implications of this variation. Between January 1992 and October 2000, 108 patients underwent resection for hilar cholangiocarcinoma.

Pathological appraisal of lines of resection for bile duct carcinoma.

Background: The aim of this study was to determine the most appropriate line of resection for extrahepatic bile duct carcinoma.

Methods: A retrospective review was carried out of 253 resected specimens of extrahepatic bile duct carcinoma. Carcinomas were classified histologically as invasive or non-invasive in addition to assessment of the resection margin.

[Surgical treatment for advanced gallbladder cancer: indications and limitations].

We have aggressively performed extensive surgery including major liver resection for advanced gallbladder cancer since 1979. The 5-year survival rates for stage IVa and IVb patients after curative resection were 19% and 6%, respectively. Seven patients in the stage IVa group (n = 69) and one in stage IVb (n = 16) have survived for more than 5 years.

Perineural invasion has a negative impact on survival of patients with gallbladder carcinoma.

Background: The clinical significance of perineural invasion of gallbladder carcinoma remains unclear. The aim of this study was to elucidate the incidence and mode of perineural invasion of gallbladder carcinoma and clarify its prognostic significance.

Methods: A clinicopathological study was conducted on 68 patients who underwent attempted curative resection for gallbladder carcinoma.

Expression of angiogenesis and angiogenic factors in human aortic vascular disease.

Background: This paper presents an investigation into the expression of endothelial cells and vascular endothelial growth factor (VEGF) in the aortic wall in vascular diseases such as atherosclerotic abdominal aortic aneurysm (AAAA), inflammatory abdominal aortic aneurysm (IAAA), and aortic occlusive disease (AOD) to determine whether the differences in both neovascularization and angiogenic factor expression are related to the pathogenesis of aortic vascular disease.

Materials And Methods: Surgical specimens of aorta (10 IAAA, 13 AAAA, 6 AOD) were studied pathologically and immunohistochemically. Representative sections of aorta were stained with hematoxylin-eosin, elastica von Gieson, CD34, and VEGF antibody.

Hepaticojejunostomy using a Roux-en-Y jejunal limb via the retrocolic-retrogastric route.

Background: Hepaticojejunostomy following hepatobiliary resection has been performed using a Roux-en-Y jejunal limb via the antecolic or the retrocolic-anteduodenal route. However, in morbidly obese patients difficulty arises from the thickened, foreshortened mesentery of the jejunum and from limited mobility due to intra-abdominal fat deposition.

Methods: We developed new placement of Roux-en-Y jejunal limb in which the limb is placed via the retrocolic-retrogastric route.

Bacteremia after hepatectomy: an analysis of a single-center, 10-year experience with 407 patients.

Background And Aims: Septic complications after hepatectomy remain a difficult problem. Intra-abdominal sources of postoperative infections are well described in the literature. However, no studies have examined the cause and outcome of bacteremia after hepatectomy.

Mechanical stress-dependent secretion of interleukin 6 by endothelial cells after portal vein embolization: clinical and experimental studies.

Background/aims: Interleukin-6 (IL-6) is an essential early signal in liver regeneration, however, little is known about what triggers IL-6 release. Changes in portal hemodynamics after portal vein embolization (PVE) may contribute to IL-6 release, leading to regeneration of non-embolized lobe.

Methods: In 22 patients who underwent right PVE, the diameters of the left portal branches, liver volumes, and serum concentrations of IL-6, tumor necrosis factor-alpha (TNF-alpha), and hepatocyte growth factor (HGF) were measured.

SHPS-1: a budding molecule against cancer dissemination.

The expression of SHPS-1 is down-regulated by several oncogene products such as v-Src in fibroblasts. In addition, the down-regulation of SHPS-1 is also found inhuman breast cancer tissues compared with the matched normal tissues. On the other hand, forced expression of SHPS-1 suppresses anchorage-independent cell growth of v-Src-transformed cells in vitro as well as peritoneal dissemination of the cells in nude mice.