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Background: Hepatocellular carcinoma (HCC) commonly develops in patients with chronic hepatitis. This situation is one of the reasons why intrahepatic recurrence frequently occurs even after curative resection. There are two different components of such recurrences, which occurs within 12 months (the early recurrence group) and at more than 12 months after resection (the late recurrence group). The present study was conducted to clarify the factors contributing to these different types of HCC recurrence. Methods: Ninety seven patients who underwent curative resection for HCCs were followed for initial recurrence, and predictive factors of recurrence were examined. Results: Early and late intrahepatic recurrences developed in 30 and 42 patients, respectively. In the former group, univariate analyses showed the serum AFP level (>100ng/ml, P=0.045), higher inflammatory activity (Grading) (p=0.048) and status of fibrosis (Staging) (p=0.027) in non-cancerous liver tissues to be significant risk factors, while the serum AFP level (>100ng/ml) was the only independent risk factor based on a multivariate analysis (RR: 2.78). In the latter group, only the presence of hyperplastic foci (HPF) was found to be a significant risk factor (p=0.005). Higher Grading tended to be linked to shorter disease-free survival time, although not significant. In the non-cancerous liver tissues with HPF, the level of Grading, Staging, and PCNA labeling index was significantly higher (p=0.033, 0.003, 0.040, respectively).Conclusion: Not only the tumor factors but also the underlying hepatic status including HPF, Grading, and Staging were significant risk factors for intrahepatic recurrence after curative resection for HCC., Acta medica Nagasakiensia, 53(4), pp.97-104 ; 2009

Although the prognosis of differentiated thyroid cancer is generally favorable, some patients develop progressive disease resulting in a life-threatening condition and occasionally fatal outcome. CD44v6 is known to be a marker linked to distant metastasis in several types of human malignancy. In the present study, we analyzed the expression of CD44v6 in primary tumors and recurrent disease in the regional lymph node and evaluated its correlation with clinical variables and prognostic factors in patients with differentiated thyroid cancer. CD44v6 expression in the primary tumor was immunohistochemically detected in 58 of 79 patients (73%). Among parameters investigated, none except patient age showed a correlation with CD44v6 expression; the rate of positivity for CD44v6 was significantly higher (p=0.023) in patients aged 50 years or less than in those aged over 50 years. During the follow-up period, 14 patients were found to have recurrent cancer in regional lymph nodes, and among these, distant metastases were later detected in bones and/or lungs in 6 patients. Although an overall correlation between the expression of CD44v6 in the regional recurrent site and in distant metastasis was not statistically significant, there was a tendency that patients with positive CD44v6 in the regional lymph nodes subsequently developed distant matastases. CD44v6 appears to play an important role in tumor progression in patients with differentiated thyroid cancer, particularly in terms of recurrent disease in regional lymph nodes., Acta medica Nagasakiensia. 2007, 52(2), p.53-57

The Roux limb is the most commonly used procedure for hepato-biliary surgery in pediatric cases. Notwithstanding, the postoperative status of the limb has not been well described. In this report, our group attempted to observe the Roux limb ultrasonically after performing a Roux-en-Y jejunostomy. Hepatic porto-jejunostomy and hepatico-jejunostomy were performed in 2 patients with biliary atresia and 4 patients with congenital bile duct dilatation, respectively. The Roux limb was observed by real-time ultrasonography from postoperative day (POD) 1 to POD 12. The wall thickness and luminal diameter of the Roux limb were measured, and the movement of the limb was observed. In the 2 hepatic porto-jejunostomy patients, the wall thickness was increased on POD 1 but thereafter improved from PODs 3 to 6. The lumen of the Roux limb was difficult to describe in one of the patients because of an inadequate amount of bile flow. Cooperative peristalsis appeared on PODs 4 to 6 following the commencement of irregular movement from PODs 2 to 3. In the 4 hepatico-jejunostomy patients, the wall thickness was increased by POD 1 but improved from PODs 2 to 6. Cooperative peristalsis appeared on PODs 4 to 5 following the commencement of irregular movement. In conclusion, ultrasound examination is useful for observing the postoperative morphological aspects of the Roux limb., Acta medica Nagasakiensia. 2006, 51(2), p.45-49

A six-year-old girl with biliary atresia underwent a living donor liver transplantation because of deteriorating intrapulmonary shunting related to portal hypertension. Following transplantation, the patient's oxygenation improved after the tenth postoperative day and returned to normal within thirty days. The important points of early post-transplantation management for intrapulmonary shunting are as follows: 1) coping with large volume of sputum and thus, if necessary, a prompt tracheotomy should be performed; 2) when dealing with persistent hypoxemia, it is essential to maintain the preoperative oxygenation levels and avoid any outflow disturbance of the graft liver; and 3) the prevention of the fatal vascular thrombosis. Phlebotomy to correct the presence of underlying polycythemia is also required., Acta medica Nagasakiensia. 2004, 49(1-2), p.51-54

We investigated the clinical significance of telomerase activity and telomere length in hepatocellular carcinomas (HCCs) and chronic liver diseases. Telomerase activity was assessed quantitatively using 'Stretch PCR' assay and telomere length by Southern blotting in 24 HCCs, 2 focal nodular hyperplasia, 8 liver cirrhosis, 10 chronic hepatitis and 8 histologically normal livers. The latter were obtained from normal sections of resected specimens of cholangiocellular carcinoma, metastatic liver tumor or hemangioma. The relative titers of telomerase activity (RTA) were significantly higher in HCCs (average, 54 units) than in chronic liver diseases (average, 0.6 units) (P, Acta medica Nagasakiensia. 2003, 48(1-2), p.55-60

The effects of early feeding for postoperative ileus remain unclear. We evaluated whether the early feeding is safe and feasible in Japanese patients after open bowel resection, and whether early feeding can enhance the resolution of postoperative ileus. An early feeding protocol was applied to 23 patients (Group 1). As a control, we reviewed the charts of 25 consecutive patients who were operated on just before the protocol and whose diet was started by traditional methods (Group 2). Daily examination and interviews of patients were performed. The majority of the patients in Group 1 (87.0%) tolerated the early feeding. There were no major complications or mortality that was related to early postoperative feeding. There was a significant difference between Group 1 and Group 2 in the distributions of the time to passage of flatus (median?2 vs. 3 days, p=0.002), the time of the first bowel movement (median?3 vs. 5 days, p=0.001), and the length of postoperative hospital stay (median?15 vs. 22 days, p, Acta medica Nagasakiensia. 2005, 50(4), p.143-145

One hundred twenty one patients with primary hepatolithiasis (PHL) was encountered for the last 7 years. In order to elucidate how to follow and treat PHL, PHL was classified into five types (I-V) on the basis of morphological findings obtained by CT. It depends mainly on the presence of atrophy of hepatic parenchyma (AHP) and dilatation of intrahepatic bile ducts (DIBD). Methods of treatment were selected for each patient according to the classification. Type I patients comprised of 43.8% in observation group. These patient were asymptomatic and just followed since neither APH nor DIBD were observed. The remaining patients in the observation group, operation was refused or contraindicated. Most of them were asymptomatic. Surgical treatments were done on 47 patients (hepatic resection in 32 patients, surgical lithotomy in 10 and others in 5). In Type III, IV and V, hepatic resection was often performed to remove all of stones and bile stasis since improvement in hepatic function could not be expected in view of AHP. All patients were followed-up 79 months or less. In the surgically terated patients, recurrence was not observed. In observation group, no new symptome developed during the follow-up period. It was suggested, therefore, that the present classification of PHL was helpful in determining therapeutic strategy for PHL., Acta medica Nagasakiensia. 1993, 38(2-4), p.288-292

A 58-year-old man who had undergone a gastrectomy for early cancer was admitted with a diagnosis of esophageal cancer. A subtotal esophagectomy with a reconstruction using the right hemicolon was performed. However, the reconstructed colon became necrotic and, as a result, the necrotic section of the colon was removed and the temporary esophagectomy and colostomy were made. A repeat reconstruction using free jejunal graft with micro vascular anastomoses was thus performed and the results were satisfactory., Acta medica Nagasakiensia. 2000, 45(3-4), p.49-51