[Show abstract][Hide abstract] ABSTRACT: To elucidate the metabolism and the effect of the cyclosporin A (CyA) as a representative immunosuppressive drug used in transplantation in a partially hepatectomized rat model.
CyA was administered to rats that underwent a 70% hepatectomy. These rats were randomly assigned into three groups according to the dose of CyA administration as follows; (group 1) water, (group 2) 5 mg/kg CyA, (group 3) 10 mg/kg CyA. On postoperative days-1, 3, 7 and 14, the rats were killed to analyze the serum concentration of CyA, the liver regeneration ratio, biochemical or histological markers, and mRNA expression using reverse transcriptase-polymerase chain reaction method to determine albumin and cytochrome p450 expression.
The serum concentration of CyA in group 3 was significantly higher than group 2 during liver regeneration. CyA enhanced the liver regeneration in a dose dependent manner. The mRNA expression associated with CyA metabolism was significantly decreased on day 14, while preserving the albumin producing activity.
These data indicate that the p-450 activity required to metabolize the CyA may be reduced during regeneration of the remnant liver after a hepatectomy, which may, therefore, be linked to difficulty in controlling the optimal dose of CyA during early period of LDLT.
World Journal of Gastroenterology 12/2008; 14(41):6355-9. · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A simple procedure of direct end-to-end anastomosis between the middle hepatic vein tributary of the right hepatic graft and the preserved recipient middle hepatic vein is described. During the final step of total hepatectomy in the recipient, the middle hepatic vein was preserved, while crushing the liver tissue for a sufficient length of middle hepatic vein to perform tension-free anastomosis with the middle hepatic vein tributary of the graft. This procedure enabled us to avoid using an interposition graft.
The American Journal of Surgery 10/2006; 192(3):393-5. DOI:10.1016/j.amjsurg.2005.12.004 · 2.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We herein report the case of an idiopathic liver cystic mass which aggressively infiltrated the thoraco-abdominal wall. A 74-year-old woman who had a huge cystic lesion in her right hepatic lobe was transferred to our hospital for further examinations. Imaging studies revealed a simple liver cyst, and the cytological findings of intracystic fluid were negative. She was followed up periodically by computed tomography (CT) scans. Seven years later, she complained of a prominence and dull pain in her right thoraco-abdominal region. CT revealed an enlargement of the cystic lesion and infiltration into the intercostal subcutaneous tissue. We suspected the development of a malignancy inside the liver cyst such as cystadenocarcinoma, and she therefore underwent surgery. A tumor extirpation was performed, including the chest wall, from the 7th to the 10th rib, as well as a right hepatic lobectomy. Pathologically, the lesion consisted of severe inflammatory change with epithelioid cell granuloma and bone destruction without any malignant neoplasm. No specific pathogens were evident based on further histological and molecular examinations. Therefore the lesion was diagnosed to be a destructive granuloma associated with a long-standing hepatic cyst. Since undergoing surgery, the patient has been doing well without any signs of recurrence.
World Journal of Gastroenterology 04/2006; 12(11):1798-801. · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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<0.0001). There was no significant difference in the frequency of postoperative complications between the groups (p=0.44). Early postoperative feeding protocol is safe and feasible for patients who are required colorectal surgery. Early feeding may promote the early resolution of postoperative ileus
[Show abstract][Hide abstract] ABSTRACT: Changes in the serum concentration of hepatocyte growth factor (HGF), a potent mitogen for hepatocytes, were investigated in adult-to-adult living-donor liver transplantation (LDLT) in which liver regeneration is involved. Between August 2000 and November 2002, 15 consecutive adult-to-adult LDLTs were performed using the right lobe graft. The recipients were divided into two groups: acute liver failure (n=6) and chronic liver failure (n=9). In addition, right lobe donors (n=12) were evaluated. Measurement of HGF was performed on preoperative and postoperative days 1, 3, 7, and 14 after LDLT. The pretransplant levels of serum HGF were higher in the acute liver failure group than in the chronic liver failure group (P<0.05). After liver replacement, serum HGF levels normalized rapidly in both groups and remained rather low. Despite vigorous liver regeneration in all groups, serum HGF levels did not change significantly after adult-to-adult LDLT with right lobe graft.
[Show abstract][Hide abstract] ABSTRACT: In order to evaluate the biological significance of thrombomodulin (TM) in the serum and its expression in the liver, changes in TM were investigated in rats with fulminant hepatic failure (FHF) or after extensive hepatectomy. Forty-two rats were divided into four groups as follows: control (sham, n=6), 70% hepatectomy (70% Hx, n=12), 90% hepatectomy (90% Hx, n=12) and fulminant hepatic failure (FHF, n=12). The soluble-TM levels in the 90% Hx and FHF groups were significantly higher than that in the 70% Hx group. In the FHF group, the soluble-TM level 24 h after induction was significantly higher than that at 12 h (P<0.05). Moreover, the level of soluble TM was significantly higher in the FHF group than that in the 90% Hx group, while hyaluronic acid was not increased at statistical significance. The expression of TM in the liver intensified with time in both FHF and 90% Hx groups, which was more pronounced in zone 3 of the liver in FHF group than in the 90% Hx group. In conclusion, elevation of s-TM in the serum and expression of TM in the sinusoidal endothelial cell are useful markers of hepatic failure and its sinusoidal endothelial injury, especially in the state of FHF, since the presence of necrotic liver tissue is the only difference between FHF and 90% Hx in the model of the rats.
Hepatology Research 03/2002; 22(3):206-213. DOI:10.1016/S1386-6346(01)00133-4 · 2.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We studied the effect of preoperative hepatocyte transplantation on the prevention of liver failure in cirrhotic rats after hepatic resection. Two groups of Lewis rats were rendered cirrhotic by i.p. injection of 1% dimethylnitrosamine and were subjected to 33% hepatectomy. Two days before the resection, 36 rats in group I received intrasplenic hepatocyte transplantation, and 25 rats in group II were given intrasplenic injection of normal saline as a control. By the end of the third postoperative day, the rats in group I had better survival and a better biochemical profile than those in group II. The liver growth rate and the labeling index of proliferating cell nuclear antigen (PCNA-LI) showed a steady rise in group I. Compared with group II, group I had a significantly lower transforming growth factor (TGF-beta1) level (p < 0.05). We conclude that preoperative intrasplenic hepatocyte transplantation improves survival and facilitates regeneration in cirrhotic rats after hepatic resection.
[Show abstract][Hide abstract] ABSTRACT: We present herein two cases of a ruptured aneurysm of the visceral artery. The first case involved a 74-year-old man with abdominal pain who was admitted to our hospital with a tentative diagnosis of intra-abdominal bleeding of unknown origin. Computed tomography revealed a hematoma in the greater curvature of the stomach. At surgery, a hematoma along the right gastroepiploic artery was found and totally removed. Histological examination showed a pseudo-aneurysm of unknown etiology. The second case involved a 68-year-old man with progressive anemia who presented with spontaneous intra-abdominal bleeding. A ruptured aneurysm of the accessory middle colic artery was diagnosed by superior mesenteric angiography. The ruptured aneurysm was ligated and totally resected without a colectomy. Histological examination showed a pseudoaneurysm of unknown etiology. The postoperative courses were uneventful, and both patients were doing well at the time of writing.
Surgery Today 02/2001; 31(7):660-4. DOI:10.1007/s005950170103 · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although recombinant human hepatocyte growth factor (rhHGF) is a potent mitogen, the dose used for patients is still not clear and must be low to avoid untoward effects. Firstly, the optimal strategy of the dose and route of rhHGF was investigated. Secondly, low-dose rhHGF, which would induce proliferation of transplanted hepatocytes, was explored using Nagase analbuminemic rats.
1) Concentrations of rhHGF in the portal vein were measured after continuous administration of titrated rhHGF through the jugular vein or portal vein. 2) F344 rat hepatocytes (2 x 10(7) cells) were transplanted in the liver of Nagase analbuminemic rats. On the 7th day, the rats were subjected to a low-dose rhHGF treatment.
When the rats were given rhHGF in a dose of 50 micrograms/kg/day, the mean concentration in the portal vein (0.8 +/- 0.1 ng/mL) was almost similar to the minimum concentration which stimulated hepatocyte proliferation in vitro. When low-dose rhHGF (50 micrograms/kg/day) was administered directly into the portal vein following hepatocyte transplantation in Nagase analbuminemic rats, the serum levels of albumin were significantly higher than in other groups. It was found that the concentration of rhHGF in the portal vein were 3.1 +/- 0.5 ng/mL with continuous intraportal infusion and 0.8 +/- 0.1 ng/mL with continuous systemic infusion.
It was found that the minimal dose of rhHGF needed to stimulate hepatocyte proliferation was 50 micrograms/kg/day. With rhHGF (50 micrograms/kg/day), continuous intraportal infusion afforded a more favorable outcome in case of proliferation of hepatocytes.