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AbstractPurpose  Interferon therapy suppresses the development of hepatocellular carcinoma (HCC) and tumor recurrence after a resection of HCC in patients with chronic hepatitis C. However, the value of a liver resection and which method is best for the treatment of HCC detected after successful interferon therapy remains to be clarified. The risk factors for tumor recurrence after a liver resection for HCC detected after successful interferon therapy were investigated to determine the appropriate operative method for such HCC.Methods  Risk factors including the clinicopathologic findings and the operative methods for tumor recurrence were evaluated by univariate and multivariate analyses in 24 patients who underwent liver resection for HCC detected after successful interferon therapy (sustained viral response or biochemical response).Results  According to a univariate analysis, large tumor (>2 cm,P= 0.0326), multiple tumors (P= 0.0372), nonanatomic resection (P= 0.0103), and positive surgical margin (<5 mm of a free surgical margin,P= 0.0245) were possible risk factors for short tumor-free survival time after surgery. A multivariate analysis showed that large tumor (P= 0.0407), nonanatomic resection (P= 0.0215), and positive surgical margin (P= 0.0253) were independent risk factors for a short tumor-free survival time after surgery.Conclusion  An anatomic resection with an appropriate surgical margin (≥5 mm of a free surgical margin) is recommended for patients with HCC detected after successful interferon therapy. [ABSTRACT FROM AUTHOR]

Sporadic cases of hepatocellular carcinoma (HCC) originating from nonalcoholic steatohepatitis (NASH) have recently been reported. Thus, we investigated the prevalence of NASH in patients with HCC. A review of the clinical records of 481 patients who underwent liver resection for HCC in our department between January 1991 and December 2003 revealed only two (0.4%) patients with HCC associated with NASH. Both of these patients had noninsulin-dependent diabetes mellitus, and neither had a history of alcohol consumption or blood transfusion. All serologic markers for hepatitis B and C viruses were negative. Histological examination of the noncancerous hepatic tissue revealed NASH with moderate hepatic fibrosis in one patient and cirrhosis in the other. Thus, clinical follow-up and screening for HCC should be done for patients with hepatic fibrosis caused by NASH, even though this form of hepatitis is an uncommon cause of HCC. [ABSTRACT FROM AUTHOR]

Abstract Pancreatoduodenectomy can be difficult in patients with obstruction of the celiac axis because of the development of collateral arteries around the head of the pancreas. Bleeding from a pseudoaneurysm is a rare and serious complication of pancreatoduodenectomy. We report a case of a pseudoaneurysm of an enlarged dorsal pancreatic artery, which formed as a result of obstruciton of the celiac axis after pancreatoduodenectomy. We assumed that a weakness in the wall of this dorsal pancreatic artery caused by the dissection led to the formation of the aneurysm. Although transcatheter arterial embolization (TAE) could not treat the aneurysm or stop bleeding from the aneurysm completely, it achieved transient hemostasis, whereby the patients condition improved, making laparotomy safe. This case demonstrates that the dissection of arteries that have developed around the head of the pancreas must be considered in patients with obstruction of the celiac axis. [ABSTRACT FROM AUTHOR]

Purpose We investigated the correlation between serum concentrations of type IV collagen 7s domain (7s collagen) and changes in the volume of the nonembolized liver lobe after subsequent portal vein embolization (PVE). Methods The relationship between the pre-embolization results of laboratory tests and the increase in the left lobe volume was evaluated in 32 patients who underwent preoperative PVE via the right portal vein. Results By 2 weeks after PVE, the mean volume of the left lobe had increased significantly ( P < 0.001). The percent increase in the left lobe volume correlated negatively with the pre-embolization serum concentration of 7s collagen ( r = −0.472, P = 0.0063). In three of four patients with high serum concentrations (>8 ng/ml), the percent increase was less than 100% and right lobectomy was not performed. The serum 7s collagen concentration correlated with the histologic activity score ( r = 0.469, P = 0.0061) and the histologic fibrosis score ( r = 0.425, P = 0.0145). Conclusion The serum concentration of 7s collagen may predict the efficacy of PVE. Performing PVE before right lobectomy may not be indicated in patients with high serum concentrations of 7s collagen because the increases in left lobe volume may be insufficient. [ABSTRACT FROM AUTHOR]

Purpose We investigated the clinical and virologic findings in hepatitis B surface antigen (HBsAg)-negative and anti-hepatitis C virus antibody (anti-HCV)-negative patients with hepatocellular carcinoma (HCC) to investigate the role of previous or occult hepatitis B virus (HBV) infections in the development of HCC. Methods We examined sera and HCC samples from 40 HBsAg-negative and anti-HCV-negative patients. Sera were tested for some viral markers, and genomic DNA was extracted from the HCC samples. HBx RNA was also extracted from the HCC and amplified by a polymerase chain reaction with reverse transcription (RT-PCR). Results Hepatocellular carcinomas from five patients with anti-HBc (group 1, 25 patients) and nine patients without anti-HBc (group 2, 15 patients) were examined for HBx RNA. HBx RNA was detected in four of the five HCC samples from group 1 and in four of the nine HCC samples from group 2. Conclusion These findings suggested that previous or occult hepatitis B virus infection is common in HBsAg-negative and anti-HCV-negative patients with HCC. [ABSTRACT FROM AUTHOR]

SUMMARY: OBJECTIVE To determine the predictive value of the preoperative serum concentration of type IV collagen 7s domain (7s collagen) for postoperative hepatic failure in patients undergoing liver resection for hepatocellular carcinoma.SUMMARY BACKGROUND DATA Clear and reliable criteria for predicting hepatic failure after liver resection are needed. The serum 7s collagen concentration correlates with the histologic degree of active hepatitis and hepatic fibrosis and may predict the regenerative potential of the liver.METHODS Potential risk factors for postoperative hepatic failure, including the serum 7s collagen concentration, were evaluated in 251 patients who underwent liver resection for hepatocellular carcinoma. Prognostic significance was determined by univariate and multivariate analyses.RESULTS Hepatic failure developed postoperatively in 25 patients, 4 of whom died. The serum 7s collagen concentration correlated with the histologic degree of hepatitis activity and hepatic fibrosis. The serum 7s collagen concentration was a risk factor for postoperative hepatic failure by univariate analysis and was the only risk factor on multivariate analysis. No patient with a serum 7s collagen concentration <12 ng/mL died of postoperative hepatic failure, and all 4 patients who died had a serum 7s collagen concentration ≥12 ng/mL.CONCLUSIONS The preoperative serum 7s collagen concentration correlated independently with hepatic failure following liver resection for hepatocellular carcinoma. Patients whose serum 7s collagen is ≥12 ng/mL are poor candidates for hepatic resection. [ABSTRACT FROM AUTHOR]

The article reports on 47-year-old Japanese man with Von Hippel-Lindau (VHL) disease who was admitted to the hospital for further examination of anemia, although he had no evidence of gastrointestinal bleeding such as hematemesis. He had undergone surgery for cerebellar hemangioblastoma at the age of 28 years and thereafter had undergone neurosurgery four times. At the age of 32, a huge serous cystadenoma of the pancreas and bilateral renal cysts were detected by CT scan. VHL disease is an autosomal dominant hereditary disorder characterized by a predisposition to develop a variety of neoplasms in multiple target organs.

Background. Gastrointestinal stromal tumors (GISTs) are usually refractory to standard chemotherapeutic agents. We successfully treated a patient with a tyrosine kinase inhibitor (STI571) for GIST with peritoneal dissemination and liver metastases. Methods. In a 32-yearold man presenting with abdominal pain from diffuse peritonitis, a GIST and associated perforated small intestine were resected. Multiple liver metastases were present. After therapies with microwave coagulation, ethanol injection, and local and systemic antineoplastic drugs (fluorouracil, cisplatin, tegafur­uracil, and tegafur) failed, investigational treatment with a tyrosine kinase inhibitor was initiated (STI571, 300mg, p.o. daily). Results. Anorexia and abdominal fullness resolved within a few days. At 24 days after initiation, positron emission tomography showed a remarkable decrease in the abdominal uptake of [18F] fluorodeoxyglucose. Adverse effects of STI571, including mild alopecia and anemia, were minimal. Conclusions. The tyrosine kinase inhibitor STI571 may be effective against GISTs. [ABSTRACT FROM AUTHOR]