J Furui

Numazu City Hospital, Sizuoka, Shizuoka, Japan

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Publications (45)93.28 Total impact

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    ABSTRACT: Surgery remains the treatment of choice for patients with Graves' disease. The purpose of the present study was to assess the usefulness and efficacy of video-assisted subtotal or near-total thyroidectomy in patients with Graves' disease. Between March 2000 and December 2004, 63 patients with Graves' disease underwent video-assisted subtotal, near-total or total thyroidectomy. Fifty-three patients (84 per cent) were considered for surgery after failure of antithyroid drug and radioiodine therapy, whereas the other ten patients were initially selected for surgical treatment based on their own preference. Treatment outcome was evaluated, including surgical complications, thyroid function, quality of life and patient satisfaction with the surgical result. All patients were operated on using a video-assisted technique, with some modifications depending on time and experience. There were no conversions to open surgery. Three patients (5 per cent) had temporary recurrent laryngeal nerve palsy that recovered spontaneously. Most patients were satisfied with the surgical results, particularly regarding the placement of the surgical scars. Video-assisted subtotal or near-total thyroidectomy is a safe and effective procedure for treatment of Graves' disease.
    British Journal of Surgery 01/2006; 93(1):61-6. DOI:10.1002/bjs.5173 · 5.21 Impact Factor
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    ABSTRACT: This study assessed the value of the time-signal intensity curve (TIC) obtained from dynamic magnetic resonance imaging (MRI) in the evaluation of remnant pancreatic fibrosis after pancreaticojejunostomy in patients undergoing pancreaticoduodenectomy. Two modes of pancreaticojejunostomy-duct-to-mucosa anastomosis (DMA; 24 patients) and pancreatojejunoserosal anastomosis (PJSA; 22 patients)-were used in 46 consecutive patients undergoing pancreaticoduodenectomy. All patients underwent dynamic contrast-enhanced MRI of the pancreas before pancreaticoduodenectomy. Retrospective review of the pancreatic magnetic resonance images and histological examination of the pancreas were performed, and the patterns of TICs from dynamic MRI were compared with the degree of pancreatic fibrosis. Dynamic MRI of the residual pancreas was carried out for 1-3 years after pancreaticoduodenectomy in 26 patients (14 DMA, 12 PJSA) who had a histologically verified normal pancreas with no fibrosis at the time of pancreaticoduodenectomy. Evaluation of preoperative dynamic magnetic resonance images showed that a pancreatic TIC with a rapid rise to a peak followed by a rapid decline (type I) was characteristic of a normal pancreas without fibrosis. Pancreatic TICs with a slow rise to a peak followed by a slow decline or a plateau (types II and III) indicated a fibrotic pancreas. Postoperative pancreatic MRI demonstrated that six of 12 patients with a PJSA had a type II TIC, whereas 12 of 14 patients with a DMA had a type I curve (P = 0.046). The TIC obtained from dynamic MRI is a reliable indicator of fibrosis in the remnant pancreas after pancreaticoduodenectomy. Use of a DMA was associated with a lower risk of pancreatic fibrosis 1-3 years after surgery than a PJSA.
    British Journal of Surgery 05/2004; 91(5):595-600. DOI:10.1002/bjs.4461 · 5.21 Impact Factor
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    ABSTRACT: Fulminant hepatic failure (FHF) is a life-threatening condition marked by many excessively increased unmetabolized toxins and growth factors. Recently developed bioartificial liver (BAL) systems containing hepatocytes can be used to treat patients with FHF However, the behavior of these hepatocytes on exposure to FHF serum in vitro remains unclear. In the present study, we used FHF rat models and the sera from these rats (i.e., FHF serum) contained elevated inflammatory cytokines (TNF-alpha, IL-1beta, and IL-6), HGF, and TGF-beta1. In addition, 1x10(8) hepatocytes were harvested from the livers of inbred rats and incubated with microcarrier beads. Four hours later, the hepatocyte-coated beads were inoculated into a hollow-fiber module (=BAL system). FHF serum or normal control serum circulated for 6 hours through the BAL system. Expressions of mRNA for albumin, GST A1, CYP 1A2, OTC and c-fos were investigated by RT-PCR, and PCNA staining was performed before and after perfusion. The expressions of albumin, GST A1, and CYP 1A2 mRNAs were markedly decreased, whereas those of OTC and c-fos were modestly decreased. PCNA positive cells were low and showed no difference between FHF and normal serum-exposed hepatocytes. In conclusion, the exposure of hepatocytes to hypercytokinemia, including inflammatory cytokines and positive and negative growth factors, caused a loss in liver specific functions. This environment also failed to facilitate hepatocyte regeneration.
    The International journal of artificial organs 05/2004; 27(4):303-10. · 1.45 Impact Factor
  • Endoscopy 03/2004; 36(2):193. DOI:10.1055/s-2004-814194 · 5.20 Impact Factor
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    ABSTRACT: The outcome after surgery for intrahepatic cholangiocarcinoma (ICC) is dismal and data on long-term survival are not available. This study evaluated prognostic indicators and characteristic features of long-term survivors after hepatic resection for ICC. Thirty-one patients who had undergone hepatic resection for ICC were studied. Univariate and multivariate survival analyses of clinicopathological data included an intraductal papillary carcinoma component (IDPCC) in the tumour, which was defined as the histological demonstration of cancer cells growing in a papillary fashion into the lumen of the large bile duct. The overall cumulative survival rate after hepatic resection for ICC was 51.2 per cent at 1 year and 24.5 per cent at 5 years, with a mean(s.d.) survival time of 11(4) months. The presence of IDPCC (P = 0.003), curative resection (P = 0.009) and the absence of perineural invasion (P = 0.040) were identified as favourable independent prognostic factors in multivariate analysis. Eight patients with IDPCC had a 5-year survival rate of 87.5 per cent and a mean(s.d.) survival time of 69(13) months. All seven patients who survived for more than 5 years after surgery had IDPCC, regardless of the gross appearance of the tumour. An IDPCC in the tumour resulted in long-term survival after hepatic resection for ICC.
    British Journal of Surgery 01/2004; 91(1):99-104. DOI:10.1002/bjs.4366 · 5.21 Impact Factor
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    ABSTRACT: In living donor liver transplantation (LDLT), Roux-en-Y hepaticojejunostomy has been a standard technique for biliary reconstruction because the majority had been pediatric patients with biliary atresia. Adult-to-adult LDLT using the right lobe graft has recently been developed and we introduced duct-to-duct biliary reconstruction (hepaticohepaticostomy) in such cases. The aim of this study is to evaluate the feasibility of this procedure in adult-to-adult LDLT. From August 2000 to October 2001, five patients underwent adult-to-adult LDLT using the right hepatic lobe and were followed for more than 6 months at our institution. All patients underwent duct-to-duct biliary reconstruction (single hepaticohepaticostomy in one, multiple in four). For the grafts with multiple bile ducts, various techniques were used for reconstruction. In all patients, oral intake could be started early after the operation, and biliary leakage was not encountered. One patient developed two episodes of acute cholangitis who later developed biliary anastomosis stricture which required percutaneous dilatation at 11 months postop. However, otherwise, there were no infectious complications postoperatively. We conclude duct-to-duct biliary reconstruction is feasible and effective in adult-to-adult LDLT.
    Clinical Transplantation 11/2002; 16(5):345-9. · 1.49 Impact Factor
  • Nippon rinsho. Japanese journal of clinical medicine 11/2001; 59 Suppl 6:511-5.
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    ABSTRACT: This study was performed to investigate whether colorectal cancers produce proliferative factors for venous endothelial cells, and whether the proliferative activity is related to basic FGF and VEGF and also to the clinicopathological findings. Surgically resected specimens of 17 colorectal cancer patients were fragmented and cultured, and the supernatant was collected. A human umbilical endothelial cell line (EA-hy 926 cells) was incubated with the supernatant. The proliferative activity was examined and the levels of basic FGF and VEGF were measured. The activities were found to be significantly related to VEGF, the depth of tumor invasion and the tumor stage.
    Oncology Reports 09/2001; 8(5):1057-61. DOI:10.3892/or.8.5.1057 · 2.19 Impact Factor
  • S Minami, J Furui, T Kanematsu
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    ABSTRACT: Carcinoembryonic antigen (CEA) has been reported to promote the metastatic potential in some experimental tumors. Adhesion molecules are known to play an important role in the process of metastasis. Cytokines, including interleukin 1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha), which are produced by Kupffer cells, induce endothelial cells to express adhesion molecules. As a result, the present study was designed to investigate whether the interaction between CEA and Kupffer cells accelerated the metastatic potential of tumors in the liver. Kupffer cells isolated from the liver of male BALB/c mice were cultured with CEA, either with or without the addition of a cytokine inhibitor. The levels of IL-1beta and TNF-alpha were examined in a culture medium. An adhesion assay of colon cancer cell lines to human umbilical vein endothelial cells was also performed. When CEA was added to the Kupffer cell culture medium, cytokines were produced. Elevated levels of cytokines appeared to lead to increased rates of adhesion of cancer cells to endothelial cells. However, these phenomena were blocked by the addition of cytokine inhibitors. CEA stimulated Kupffer cells to produce cytokines. An elevated number of cytokines have been proven to promote the expression of adhesion molecules in endothelial cells. These processes are therefore considered to contribute to the metastasis of malignant cells to the liver. These results suggest that cytokine inhibitors may therefore play an important role in the inhibition of hepatic metastasis.
    Cancer Research 04/2001; 61(6):2732-5. · 9.28 Impact Factor
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    ABSTRACT: We encountered a case of polycystic liver disease for which unroofing and fenestration procedures were performed. The patient was a 55-year-old Japanese female with epigastralgia and abdominal fullness. On computed tomography, millions of low-density areas were seen, particularly in S6, 7, where huge cysts 15 cm in diameter were observed. Magnetic resonance imaging showed a T1 low T2 high-intensity lesion, which was compatible with simple cysts. Unroofing for the cysts in S6, 7 and fenestration of other cysts were performed. Histological examination revealed cuboidal and flat monolayer epithelia with no dysplasia in the wall of the cysts. The postoperative course was uneventful, and the patient's abdominal symptoms remarkably improved. The percentage of the liver volume which was increased in relation to standard liver volume was reduced from 241% (3386 mL: liver parenchyma 750 mL, cysts 2636 mL) to 180% (2525 mL, 1566 mL, 959 mL, respectively) after surgery. The potent mitogen, hepatocyte growth factor, was rapidly increased after the operation and stayed high during the observation period. In this patient, since no liver resection was performed, liver regenerative stimulus was considered to be the loss of space. This phenomenon represents a model of liver regeneration in response to loss of occupied space in an absence of shear stress.
    Hepato-gastroenterology 01/2001; 48(42):1733-5. · 0.91 Impact Factor
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    ABSTRACT: During the last few years, video-assisted neck surgery (VANS) became one option for thyroid and parathyroid surgery. Reports on VANS were limited to partial resection of the thyroid gland. In this study, we described total thyroidectomy in a patient with Graves' disease. The patient had a thyrotoxic periodic paralysis and methimazole-induced hepatic toxicity as well as hepatitis B virus. Two incisions of 3.5 and 3 cm were placed in the right and left subclavicular regions, respectively. A third incision of 0.5 cm was made just to the right of the midline for the camera. Devascularization of the thyroid gland was performed by using ultrasonically activated shear. Tubal drains were inserted on both sides. The patient suffered from temporary postoperative hoarseness with the voice but had a normal calcium level. The drains were removed on the first postoperative day. The use of VANS may provide a new method for total thyroidectomy with a better cosmetic outcome.
    International surgery 01/2001; 86(3):195-7. · 0.25 Impact Factor
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    ABSTRACT: Establishment of a bioartificial liver support system using genetically modified hepatocytes is a potential approach to improve the treatment of severe liver failure. We describe the development of an efficient ex vivo method of gene transfer into a large number of porcine hepatocytes using hemagglutinating virus of Japan (HVJ)-liposome. The transfection efficiency of HVJ-liposome into isolated porcine hepatocytes attached to microcarrier beads was evaluated by beta-galactosidase (beta-gal) staining, fluorescence activated cell sorting analysis for beta-gal and luciferase assay, respectively. To examine the function and cellular damage of transduced hepatocytes, we used enzyme-linked immunosorbent assay for porcine albumin synthesis, lidocaine clearance test (P-450 activity), aspartate aminotransferase, and lactic dehydrogenase release assays. The optimal conditions for gene transfer into the beads-attached hepatocytes using HVJ-liposome included 4 microg of deoxyribonucleic acid with 200 microg of lipid/2 x 105 cells and exposure duration of 90 min. Under these conditions, beta-gal and luciferase genes were transduced to 2.5 x 108 isolated porcine hepatocytes following attachment to the beads. Positive beta-gal staining was observed in more than 30% of the beads-attached hepatocytes. The gene transfer activity of HVJ-liposome method determined by luciferase activities was about 100-fold of that of the lipofection method. Transfected porcine hepatocytes remained functional without any significant cell damage. Our results demonstrated that HVJ-liposome mediated gene transfer into microcarrier-attached porcine hepatocytes is an efficient and nontoxic method suitable for a bioartificial liver support sytem.
    Artificial Organs 01/2001; 24(12):932-8. · 1.87 Impact Factor
  • Transplantation Proceedings 12/2000; 32(7):2195. DOI:10.1016/S0041-1345(00)01631-6 · 0.95 Impact Factor
  • Transplantation Proceedings 12/2000; 32(7):2348. DOI:10.1016/S0041-1345(00)01694-8 · 0.95 Impact Factor
  • Transplantation Proceedings 12/2000; 32(7):1662. DOI:10.1016/S0041-1345(00)01430-5 · 0.95 Impact Factor
  • Transplantation Proceedings 12/2000; 32(7):2343-4. DOI:10.1016/S0041-1345(00)01692-4 · 0.95 Impact Factor
  • Transplantation Proceedings 12/2000; 32(7):2320-1. DOI:10.1016/S0041-1345(00)01681-X · 0.95 Impact Factor
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    ABSTRACT: Recently, bioartificial liver (BAL) treatment was reported to provide beneficial effects for patients with fulminant hepatic failure (FHF). Some success in experimental or clinical trials has been reported; however, the evaluation of BAL efficacy remains unclear, especially in comparison with other treatments for FHF. The purpose of this study was to compare the efficacy between BAL and plasma exchange (PE) in experimentally induced FHF in pigs. Pigs undergoing hepatic devascularization (HD) were placed into the following groups: no treatment (control; n = 6), BAL treatment (BAL; n = 5), and plasma exchange (PE; n = 5). Each treatment was initiated 6 h after HD and lasted for 4 h. BAL treatment significantly improved liver functions in FHF pigs. The decrease in cerebral perfusion pressure was also significantly suppressed in the pigs with BAL, and their survival time was prolonged compared with the results in pigs with PE. The effects of BAL outperform those of PE in the treatment of experimental FHF model.
    Artificial Organs 05/2000; 24(4):265-70. · 1.87 Impact Factor
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    ABSTRACT: Transcatheter hepatic arterial embolization and lipiodolization have been reported to be effective palliative treatments for patients with unresectable hepatocellular carcinoma. We experienced 2 patients with advanced hepatocellular carcinoma which were initially considered to be unresectable due to the extreme extension of the primary lesions. Therefore, transcatheter hepatic arterial embolization with lipiodolization were selected as the treatments of choice. Thereafter, these tumors markedly decreased in size and, as a result, curative resections could subsequently be performed. The pathological examination of the resected specimens revealed necrosis and hyaline degeneration in the main tumors. Viable tumor cells, however, still remained adjacent to the main tumors. Such evidence indicated the limited efficacy of transcatheter hepatic arterial embolization with lipiodolization and the necessity of performing surgical treatment in combination with transcatheter hepatic arterial embolization with lipiodolization. Based on these findings, transcatheter hepatic arterial embolization with lipiodolization both appear to be a good mode of therapy for advanced hepatocellular carcinoma, and in selected patients, subsequent surgery can also be considered.
    Hepato-gastroenterology 01/2000; 47(36):1706-10. · 0.91 Impact Factor
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    ABSTRACT: The validity of mass screening using fecal occult blood testing remains controversial. In addition, no controlled clinical study has yet been performed to show the usefulness of sigmoidoscopy. The purpose of the present study was to compare the surgical results achieved in asymptomatic patients with colorectal cancer detected by screening with those in symptomatic individuals. A total of 285 patients underwent a surgical resection of colorectal cancer between 1991 and 1997 at our institution. Among them, 233 patients had complaints related to cancer at the time of diagnosis. In contrast, 52 were asymptomatic. In those 52 patients, colorectal cancer had been suspected based on routine screening including fecal occult blood testing, colonoscopy and/or elevated serum levels of carcinoembryonic antigen. Early stage of colorectal cancer was more frequently seen in asymptomatic patients than in symptomatic patients P < 0.01. The survival rates for asymptomatic patients was also superior to those of symptomatic patients P < 0.05. Screening using fecal occult blood testing, colonoscopy and tumor markers is thus considered to be beneficial for the early detection of colorectal carcinoma, which also tends to demonstrate good surgical results.
    Hepato-gastroenterology 01/2000; 47(34):1011-4. · 0.91 Impact Factor