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Otake K, Uchida K, Inoue M, Koike Y, Narushima M, Kusunoki M. Use of computed tomography-lymphangiography with direct injection of water-soluble contrast medium to identify the origin of chylous ascites. J Vasc Surg Venous Lymphat Disord 2015; 3:90-3. [PMID: 26993687 DOI: 10.1016/j.jvsv.2014.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/23/2014] [Indexed: 12/23/2022]
Abstract
Contrast lymphangiography is a useful technique to determine the site of lymphatic leakage in the patient with chylous ascites. Conventional lymphangiography with lipid-soluble contrast material carries the disadvantage of complications, such as oil emboli and lymphedema. The authors report a successful case of computed tomography (CT)-lymphangiography with direct injection of water-soluble contrast medium into a lower limb lymphatic vessel to determine the site of lymphatic leakage in a pediatric patient with refractory primary chylous ascites. The patient subsequently underwent laparoscopic ligation of the leaking site and recovered well. This novel technique offers superior potential for preoperative assessment and the planning of laparoscopic repair.
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Uchida K, Araki T, Hashimoto K, Inoue M, Otake K, Koike Y, Okita Y, Fujikawa H, Tanaka K, Mohri Y, Kusunoki M. Segmental distribution in refractory ulcerative colitis: a histological evaluation in pediatric and adult patients who underwent proctocolectomy. Inflamm Bowel Dis 2014; 20:1227-35. [PMID: 24865779 DOI: 10.1097/mib.0000000000000082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Histological segmental distribution of ulcerative colitis (UC) may represent an early finding of newly diagnosed UC, especially in pediatric patients; a sign of Crohn's disease; or a predictor of refractory UC. However, its significance remains unknown. This study was performed to compare the final pathologic findings in resected total colon and rectum specimens between pediatric and adult patients with refractory UC who underwent proctocolectomy and clarify the significance of segmental distribution in pediatric patients with UC. METHODS Ninety patients with medically refractory UC (14 with childhood-onset UC and 76 with adult-onset UC) who underwent a two-staged operation comprising total proctocolectomy and ileal J-pouch anal anastomosis in the first stage were included in this study. We retrospectively reviewed all patients' medical records and performed a histological evaluation of the resected total colon using Geboes' grading system for histological inflammation activity of UC and factors of Tanaka's criteria for refractory UC. RESULTS Histological segmental distribution was more frequently observed in the resected colon at surgery in pediatric (64%) than in adult patients (21%) with refractory UC. The administration of immunomodulators or anti-TNF-α antibody within 30 days before surgery was more frequently performed in adults than in children. Patients with refractory UC with a segmental distribution had a statistically significant relationship with shorter duration before surgery (P = 0.0009), male gender (P = 0.0342), and higher activity of disease inflammation in rectum (P = 0.0399). Multivariate analysis revealed the statistically significant relationship between segmental distribution and disease duration before surgery ≤ 6 years (P = 0.0031). CONCLUSIONS Endoscopists should perform biopsies of both normal and abnormal mucosa throughout the total colon and follow changes in the pathological pattern because segmental distribution is an important predictor of prognosis.
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Koike Y, Uchida K, Matsushita K, Otake K, Nakazawa M, Inoue M, Kusunoki M, Tsukamoto Y. Intraluminal appendiceal fluid is a predictive factor for recurrent appendicitis after initial successful non-operative management of uncomplicated appendicitis in pediatric patients. J Pediatr Surg 2014; 49:1116-21. [PMID: 24952800 DOI: 10.1016/j.jpedsurg.2014.01.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 01/16/2014] [Accepted: 01/17/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The risk factors for recurrent appendicitis in pediatric patients are unclear. This study aimed to identify the predictive factors for recurrent appendicitis in pediatric patients who initially underwent successful non-operative management of uncomplicated appendicitis. METHODS Potential predictive factors for recurrent appendicitis in terms of clinical characteristics, laboratory data, and abdominal ultrasonography and computed tomography findings, were evaluated. RESULTS This study included 125 patients who underwent initial successful non-operative management of appendicitis. The rate of recurrent appendicitis was 19.2%, and the mean time to recurrence was 12.6 months. Univariate analyses found that rebound tenderness, muscle guarding, appendicoliths, appendiceal diameter >9 mm, and intraluminal appendiceal fluid were associated with recurrent appendicitis. Multivariate analysis identified only intraluminal appendiceal fluid as an independent predictor of recurrent appendicitis. CONCLUSIONS Intraluminal appendiceal fluid is a predictive factor for recurrent appendicitis after initial non-operative management. The results of this study provide valuable information that may help to determine the appropriate management during the first episode of appendicitis.
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Koike Y, Uchida K, Inoue M, Ide S, Hashimoto K, Matsushita K, Otake K, Ohkita Y, Araki T, Kobayashi M, Mohri Y, Kusunoki M. Infantile Crohn's disease is one of the risk factors for catheter-related bloodstream infection. Pediatr Int 2014; 56:364-8. [PMID: 24517844 DOI: 10.1111/ped.12304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 08/01/2013] [Accepted: 11/20/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Central venous catheterization is recognized as a lifeline that is important for chemotherapy or nutritional support in pediatric patients with malignant disease and intestinal failure. This study analyzed the risk of infection with Broviac line use among these patients at a single Japanese center. METHODS Two hundred and four Broviac lines were inserted in patients in the pediatric ward from January 2003 to October 2011. We analyzed the risk of catheter-related bloodstream infection (CR-BSI) using clinical characteristics including underlying disease, sepsis history, inserted situation, drug use, and laboratory data at the time of Broviac insertion or before CR-BSI. RESULTS During the study period, data from a total of 15 lines were excluded because of missing blood culture data. In the remaining 189 Broviac lines, 52 lines developed CR-BSI. On univariate analysis, leukemia, infantile Crohn's disease, sepsis history before Broviac insertion, existence of a stoma opening, and immunosuppressant use before CR-BSI were risk factors for CR-BSI. On multivariate logistic regression analysis infantile Crohn's disease, sepsis history before Broviac insertion, and immunosuppressant use before CR-BSI were independently associated with CR-BSI (P = 0.015, P = 0.045, and P = 0.043, respectively). CONCLUSIONS Infantile Crohn's disease carries a high risk for CR-BSI because of its pathological condition, the therapeutic drugs required, and surgical intervention.
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Iwasa T, Ohashi H, Kihira K, Koike Y, Otake K, Inoue M, Sawada H, Toyoda H, Komada Y. 10-year-old girl with life-threatening idiopathic systemic capillary leak syndrome: a case report. BMC Pediatr 2014; 14:137. [PMID: 24885961 PMCID: PMC4229935 DOI: 10.1186/1471-2431-14-137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 05/23/2014] [Indexed: 11/12/2022] Open
Abstract
Background Idiopathic systemic capillary leak syndrome (ISCLS) is a rare disorder, characterized by episodic life-threatening hypotension, hypoalbuminemia, and hemoconcentration. Case presentation A 10-year-old girl presented with abdominal pain, vomiting, diarrhea, fever and developed generalized edema a day after admission. Clinical and laboratory findings were consistent with ISCLS. She received aggressive fluid replacement, methylprednisolone pulse (30 mg/kg/day), high-dose intravenous immunoglobulin (IVIG, 2 g/kg/day) and plasma exchange in acute phase. She received fasciotomy of bilateral lower extremities as she developed complications of compartment syndrome. Since there were two episodes of ISCLS attacks, theophylline and terbutaline were initiated for prevention of attacks and then the remission is currently maintained. Because of high fatality rate in ISCLS, prompt diagnosis and intervention are very important. Conclusion We describe here, a rare case of pediatric ISCLS. ISCLS should be considered as a differential diagnosis, when the patient presents with unexplained or sudden hypovolemic shock. Reports on pediatrics ISCLS are very few, and accumulation of similar case reports is needed.
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Okita Y, Araki T, Tanaka K, Hashimoto K, Kondo S, Kawamura M, Koike Y, Otake K, Fujikawa H, Inoue M, Ohi M, Inoue Y, Uchida K, Mohri Y, Kusunoki M. Predictive factors for development of chronic pouchitis after ileal pouch-anal anastomosis in ulcerative colitis. Digestion 2014; 88:101-9. [PMID: 23949485 DOI: 10.1159/000353151] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/15/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND No previous studies have examined predictive factors for chronic pouchitis after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) with consideration of changes in pouchitis subtypes during follow-up. This study evaluated the independent predictive factors for chronic pouchitis. METHODS A total of 244 consecutive patients who underwent IPAA were enrolled. We assessed the possible associations between pouchitis and clinical factors using Cox proportional hazard regression. RESULTS 231 patients met the inclusion criteria. 66 (28.5%) patients developed pouchitis. In 9 of 44 (20.4%) patients, antibiotic-responsive pouchitis at the first episode changed into chronic pouchitis after the occurrence of a subsequent episode. The median duration from occurrence of antibiotic-responsive pouchitis to alteration into chronic pouchitis was 502 (range 147-1,697) days. Overall pouchitis was finally classified into 35 acute pouchitis and 31 chronic pouchitis cases. Multivariate analysis revealed that a ≥ 7.5-g cumulative steroid dose before colectomy and a ≥ 500-mg monthly steroid dose just before colectomy were significant predictive factors for chronic pouchitis (p = 0.0001 and 0.0095, respectively). CONCLUSION Patients with UC and a higher cumulative steroid dose before colectomy or higher monthly steroid dose just before colectomy may have a predictive factor for developing chronic pouchitis.
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Koike Y, Uchida K, Inoue M, Ohtsu K, Tanaka T, Otake K, Tanaka K, Kusunoki M. Hairy polyp can be lethal even when small in size. Pediatr Int 2013; 55:373-6. [PMID: 23782369 DOI: 10.1111/j.1442-200x.2012.03715.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 06/11/2012] [Accepted: 07/25/2012] [Indexed: 11/30/2022]
Abstract
A case of sudden cardiopulmonary arrest in a 3-month-old girl is presented. The patient had barely recovered from hypoxic encephalopathy when she presented with repeated respiratory distress. Computed tomography and endoscopic analysis revealed a shiny polyp in the lateral wall of the nasopharynx, and this polyp was suspected to be the main cause of respiratory distress. After referral to our hospital, surgical removal was performed, and the histopathological diagnosis was hairy polyp. Hairy polyp is a rare congenital benign tumor that sometimes induces respiratory distress. This polyp can potentially induce a life-threatening event. In a systematic review of 40 reported cases, polyps of ≤ 3.0 cm in diameter have a higher risk of respiratory distress than do those >3.0 cm in diameter (P = 0.01). Small hairy polyps may be lethal because of delayed diagnosis. To locate small hairy polyps, physicians should not hesitate to perform further examination because there is the possibility of oversight with only physical examination.
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Tanaka K, Kawamura M, Otake K, Toiyama Y, Okugawa Y, Inoue Y, Uchida K, Araki T, Mohri Y, Kusunoki M. Trehalose does not affect the functions of human neutrophils in vitro. Surg Today 2013; 44:332-9. [PMID: 23700245 DOI: 10.1007/s00595-013-0625-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 12/17/2012] [Indexed: 12/26/2022]
Abstract
PURPOSE Trehalose, naturally occurring disaccharide, has been reported to prevent postoperative abdominal adhesions in animal models. We investigated whether trehalose affects the function of human polymorphonuclear neutrophils (PMNs) in vitro to assess the feasibility of its clinical application as an anti-adhesive barrier. METHODS Human PMNs were obtained from 17 healthy volunteers. Escherichia coli and Staphylococcus aureus were used for the bacterial infection model, whereas lipopolysaccharide (LPS) and interleukin (IL)-1β were used for inflammation induction model. The PMN phagocytosis rates of bacteria and apoptosis/necrosis were assessed on trehalose, maltose, and control media. Cytokines; namely, tumor necrosis factor-α, IL-1α, IL-1Ra, IL-6, and IL-8; and PMN-elastase were measured on each medium in both models. RESULTS There were no significant differences in the phagocytosis rates, apoptosis/necrosis rates, or levels of all cytokines or PMN-elastase among the three media in the bacterial infection model. There were also no significant differences in the levels of all cytokines and PMN-elastase among the three media in the IL-1β inflammation induction model. PMN-elastase was lower in trehalose and maltose medium after LPS stimulation, at 3 and 24 h. CONCLUSIONS Our results suggest that trehalose does not affect the cellular function, cytokine production, or release of PMN-elastase of human PMNs in an in vitro bacterial infection model.
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Uchida K, Kawamata A, Hashimoto K, Inoue M, Otake K, Koike Y, Matsushita K, Fujikawa H, Okita Y, Araki T, Tanaka K, Kusunoki M. Self-reported assessment of health-related quality of life in children who underwent restorative proctocolectomy with ileal J-pouch anal anastomosis for ulcerative colitis. Pediatr Surg Int 2013. [PMID: 23184266 DOI: 10.1007/s00383-012-3224-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To clarify health-related quality of life (HRQOL) by self-evaluation after restorative proctocolectomy with ileal J-pouch anal anastomosis (IPAA) in children with ulcerative colitis, a questionnaire using the Pediatric Quality of Life Inventory™ 4.0 (PedsQL) was administered. METHODS The PedsQL was administered to 13 consecutive children (mean age 14.5 years) who underwent IPAA between 2005 and 2010 in our hospital and age-matched healthy controls. The mean duration after IPAA was 2.5 years (range 0.08-6 years) at the time of this study. Healthy children completed the same questionnaire by retrospective imaging during the past 1 month by the PedsQL evaluation policy. RESULTS Patients' total score and each functioning score after IPAA reached the same levels as those in healthy controls. Soiling, pouchitis occurrence, and bowel movements had no significant relationship to the PedsQL total score and each functioning score. CONCLUSIONS Interference of physical activity, emotional status, and social life caused by refractory ulcerative colitis (UC) worsens patients' HRQOL. IPAA could resolve these problems in children with UC and result in an HRQOL comparable with that in healthy children.
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Uchida K, Otake K, Tanaka K, Hashimoto K, Saigusa S, Matsushita K, Koike Y, Inoue M, Ueeda M, Okugawa Y, Inoue Y, Mohri Y, Kusunoki M. Clinical implications of CES2 RNA expression in neuroblastoma. J Pediatr Surg 2013; 48:502-9. [PMID: 23480903 DOI: 10.1016/j.jpedsurg.2012.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 10/02/2012] [Accepted: 10/03/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND/PURPOSE Human carboxylesterase 2 (CES2) is the key enzyme for metabolic activation of irinotecan (CPT-11). The aim was to evaluate the clinical implications of CES2 RNA expression in neuroblastoma cells. METHODS CES2 RNA expression was determined by real-time reverse transcription-polymerase chain reaction in five neuroblastoma cell lines and 42 clinical samples of untreated neuroblastoma. Sensitivity to CPT-11 was assessed by WST-8 colorimetric assays. Induction of apoptosis was evaluated by flow cytometry after CPT-11 exposure. Protein expression of CES2 was evaluated by Western blotting analysis. CES2 RNA expression in clinical samples was investigated for its associations with the clinicopathological characteristics. RESULTS CES2 RNA expression was observed in neuroblastoma cells, and its expression in neuroblastoma cell lines was positively correlated with sensitivity to CPT-11 and apoptosis after CPT-11 exposure in vitro. CES2 RNA expression was correlated with the protein levels of CES2 in vitro. CES2 RNA expression was significantly higher in patients with a characteristic related to advanced disease. CONCLUSIONS Our results suggest the potential of clinical application of CPT-11 in neuroblastoma treatment for patients with advanced disease.
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Inoue M, Uchida K, Otake K, Okigami M, Okita Y, Hiro J, Araki T, Kusunoki M. Transumbilical single-incision laparoscopic ileocecal resection for Crohn's disease in a child. Asian J Endosc Surg 2013; 6:48-51. [PMID: 23347707 DOI: 10.1111/j.1758-5910.2012.00162.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/29/2012] [Accepted: 09/03/2012] [Indexed: 11/30/2022]
Abstract
We report the pediatric case of ileal Crohn's disease in which the patient underwent transumbilical single-incision laparoscopic ileocecal resection. A 14-year-old boy with severe growth disturbance presented with intestinal obstruction. Transanal double-balloon enteroscopy and contrast study during endoscopy revealed a cobble stone appearance and a severe stricture 15 cm in length located slightly proximal to the ileocecal valve. There was no evidence of fistula or abscess formation. Ileocecal resection was performed via an umbilical incision with conventional laparoscopic instruments, and the postoperative course was uneventful. Single-incision laparoscopic ileocecal resection is a good procedure for uncomplicated Crohn's disease patients in childhood.
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Uchida K, Inoue M, Otake K, Koike Y, Kusunoki M. Complementary and alternative medicine use by Japanese children with pediatric surgical diseases. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojped.2013.32010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Uchida K, Otake K, Inoue M, Koike Y, Matsushita K, Hashimoto K, Saigusa S, Tanaka K, Inoue Y, Kusunoki M. Unique capsule endoscopic appearance of segmental intestinal dilatation in a child. Pediatr Int 2012; 54:727-9. [PMID: 22845690 DOI: 10.1111/j.1442-200x.2012.03704.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Matsushita K, Uchida K, Saigusa S, Ide S, Hashimoto K, Koike Y, Otake K, Inoue M, Tanaka K, Kusunoki M. Glycolysis inhibitors as a potential therapeutic option to treat aggressive neuroblastoma expressing GLUT1. J Pediatr Surg 2012; 47:1323-30. [PMID: 22813791 DOI: 10.1016/j.jpedsurg.2011.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 12/07/2011] [Accepted: 12/08/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND/PURPOSE Increased glycolysis is among the biochemical characteristics of cancerous tissue. The glucose transporter isoform 1 (GLUT1) gene encodes a key factor for glucose transport into cancerous tissue. However, the expression and functional significance of GLUT1 in neuroblastoma have not been fully characterized. Therefore, we investigated the association of GLUT1 expression with clinical outcomes in patients with neuroblastoma using immunohistochemical staining for GLUT1 in neuroblastoma tissues. We also assessed the efficacy of glycolysis inhibition as an anticancer treatment in neuroblastoma cell lines with altered expression of GLUT1. METHODS We obtained total RNA from cancerous tissue by microdissection in 47 patients with neuroblastoma. GLUT1 expression levels were evaluated by quantitative real-time polymerase chain reaction. We analyzed the association of GLUT1 expression levels with clinical outcomes. We also examined changes in GLUT1 expression and proliferative responses in vitro using 4 neuroblastoma cell lines treated with a glycolysis inhibitor, 3-Bromopyruvate acid. RESULTS Elevated GLUT1 expression was associated with poor prognosis. Moreover, elevated GLUT1 expression independently predicted overall survival. Immunohistochemical analysis showed that GLUT1 expression tended to be localized to the centers of neuroblastoma cell nests. Our in vitro studies showed that 3-Bromopyruvate acid significantly suppressed the proliferation of neuroblastoma cells with high GLUT1 gene expression compared with those with low expression. CONCLUSION Glycolysis inhibitors are a potential therapeutic option for treating aggressive tumors expressing GLUT1.
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Inoue M, Uchida K, Otake K, Ishino Y, Koike Y, Kusunoki M. Use of Endoscopic Surgical Spacer to Improve Safety During Thoracoscopic Repair of Congenital Diaphragmatic Hernia. J Laparoendosc Adv Surg Tech A 2012; 22:304-6. [DOI: 10.1089/lap.2011.0304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Uchida K, Otake K, Inoue M, Koike Y, Matsushita K, Araki T, Okita Y, Tanaka K, Uchida K, Yodoya N, Iwamoto S, Arai K, Kusunoki M. Chronic intestinal pseudo-obstruction due to lymphocytic intestinal leiomyositis: Case report and literature review. Intractable Rare Dis Res 2012; 1:35-9. [PMID: 25343071 PMCID: PMC4204587 DOI: 10.5582/irdr.2012.v1.1.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 01/25/2012] [Indexed: 11/05/2022] Open
Abstract
Lymphocytic intestinal leiomyositis is a rare entity, which causes chronic intestinal pseudo-obstruction (CIPO) in children. We present the first case of a boy who had pure red cell anemia 1 year before onset. Prolonged ileus developed after gastroenteritis and the patient was diagnosed using a biopsy of the intestinal wall. Findings from the present case indicate that there are three important factors for accurate diagnosis: history of enteritis, positive serum smooth muscle antibody, and lymphocyte infiltration with muscle destruction in the muscularis propria in the intestinal wall. Earlier diagnosis and induction of immunosuppressive therapy may be essential for a better outcome.
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Uchida K, Araki T, Inoue M, Otake K, Kusunoki M. [Surgical indication and consideration for inflammatory bowel disease in children]. NIHON RINSHO. JAPANESE JOURNAL OF CLINICAL MEDICINE 2012; 70 Suppl 1:500-504. [PMID: 23126141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Okita Y, Miki C, Yoshiyama S, Otake K, Araki T, Uchida K, Kusunoki M. Neutrophil dysfunction in steroid-overdosed patients with ulcerative colitis: potential relevance of macrophage migration inhibitory factor to increased postoperative morbidity. Surg Today 2011; 41:1504-11. [PMID: 21969153 DOI: 10.1007/s00595-010-4505-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 08/24/2010] [Indexed: 12/15/2022]
Abstract
PURPOSE We studied macrophage migration inhibitory factor (MIF)-related neutrophil dysfunction in patients with ulcerative colitis (UC), under conditions of surgical stress, focusing in particular on total preoperative steroid dosages. METHODS Neutrophils were isolated from peripheral blood samples obtained from 21 UC patients soon after radical surgery for UC. The patients were divided into two subgroups according to their total preoperative prednisolone dosages. The neutrophil phagocytosis, viable cell, and cell necrosis rates after exposure to Escherichia coli were evaluated by flow cytometry. The supernatant concentrations of mediators after exposure to E. coli were evaluated by enzyme-linked immunosorbent assay. RESULTS There was a significant positive correlation between the levels of MIF and the total preoperative dosage of prednisolone. More viable neutrophils from the high-dosage steroid group patients than from the low-dosage steroid group patients tended to undergo necrosis, followed by the release of neutrophil elastase after exposure to E. coli. The levels of anti-inflammatory cytokines were not enhanced after E. coli stimulation, but the levels of proinflammatory cytokines in the supernatants of neutrophils from the high-dosage steroid group patients were increased significantly. CONCLUSION Steroid-overdosed UC patients with MIF-related neutrophil dysfunction may be at increased risk of destructive local inflammation following surgery.
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Inoue M, Uchida K, Otake K, Kawamoto A, Okita Y, Hiro J, Ohi M, Kusunoki M. Laparoscopic detorsion and colopexy for splenic flexure volvulus in an infant. J Pediatr Surg 2011; 46:E25-8. [PMID: 22008358 DOI: 10.1016/j.jpedsurg.2011.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 06/08/2011] [Accepted: 06/10/2011] [Indexed: 10/16/2022]
Abstract
Primary splenic flexure volvulus is a rare entity. We describe the first case of splenic flexure volvulus managed by a laparoscopic approach. A previously healthy 32-month-old girl presented with constipation, appetite loss, and nonbilious vomiting of 15 days of duration. Contrast enema and 3-dimensional computed tomography revealed a "bird's beak" sign at the splenic flexure, consistent with the diagnosis of splenic flexure volvulus. Attempted detorsion during colonoscopy was unsuccessful, and a laparoscopic procedure was performed, and 180° torsion of the splenic flexure with a distal caliber change was observed. After detorsion of the volvulus, the splenic flexure and descending colon were fixed to the peritoneum. The postoperative course was uneventful, and there was no recurrence during the subsequent 16 months of follow-up. Laparoscopic colopexy is a minimally invasive and effective method of managing splenic flexure volvulus, especially in patients without an underlying disease that causes constipation.
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Otake K, Uchida K, Inoue M, Matsushita K, Hashimoto K, Ide S, Matsubara T, Tanaka K, Mohri Y, Kusunoki M. Efficacy of Seprafilm® in abdominal surgery for ventriculoperitoneal shunt malfunction: a report of two pediatric cases. Pediatr Neurosurg 2011; 47:214-6. [PMID: 22041544 DOI: 10.1159/000331570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 08/04/2011] [Indexed: 11/19/2022]
Abstract
Temporary external drainage with adequate antibiotic treatment followed by ventriculoperitoneal (VP) shunt reinsertion is necessary to treat VP shunt malfunction with infection. In surgeries for VP shunt reinsertion, the key factors that determine whether the reinserted VP shunt will function sufficiently are adequate adhesiolysis and safe placement of the VP shunt within a satisfactory peritoneal location. Based on these factors, the prevention of postoperative adhesions after surgery for VP shunt malfunction is very important. We present two cases of shunt malfunction related to infection and report their successful treatment using Seprafilm®. Seprafilm may improve the safety of VP shunt reinsertion and preserve the function of the reinserted VP shunt after VP shunt malfunction with infection.
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Uchida K, Otake K, Inoue M, Koike Y, Matsushita K, Tanaka K, Inoue Y, Mohri Y, Kusunoki M. Bacteriostatic Effects of Hyaluronan-Based Bioresorbable Membrane. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/ss.2011.29094] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Inoue M, Uchida K, Otake K, Koike Y, Miki C, Kusunoki M. Congenital segmental dilatation of the duodenum: report of a case. Pediatr Int 2010; 52:e184-6. [PMID: 20958859 DOI: 10.1111/j.1442-200x.2010.03117.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Uchida K, Araki T, Inoue M, Otake K, Yoshiyama S, Koike Y, Matsushita K, Okita Y, Miki C, Kusunoki M. Poor catch-up growth after proctocolectomy in pediatric patients with ulcerative colitis receiving prolonged steroid therapy. Pediatr Surg Int 2010; 26:373-7. [PMID: 20182750 DOI: 10.1007/s00383-010-2577-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2010] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of the present study was to review the complications and growth after proctocolectomy and ileal J-pouch anal anastomosis (IPAA) in pediatric ulcerative colitis (UC) patients receiving prolonged steroid therapy. PATIENTS AND METHODS We experienced 209 patients with UC who received IPAA between September 2000 and June 2009, and reviewed the medical records of 16 pediatric (<15 years of age at operation and >1 year follow-up) patients. RESULTS The total dose of preoperative prednisolone (PSL) was 9,829 +/- 9,283 mg (mean +/- 1SD 880-30,000 mg). The dose of preoperative PSL was significantly related to the occurrence of preoperative major steroid-related complications (SRC). Older patients (>11 years at operation) grew more slowly compared with younger patients (< or =11 years at operation) for 5 years. There was a significant difference in height between PSL high-dose (>10,000 mg) and PSL low-dose (< or =10,000) patients for 5 years after colectomy. The mean height of PSL high-dose patients did not reach the standard level during the 5-year follow-up. CONCLUSION Preoperative prolonged high steroid therapy may disturb growth recovery of pediatric patients with UC, while early induction of colectomy allowed pediatric patients with PSL dependency to become free of steroids and get normal growth.
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Yasuda H, Inoue M, Uchida K, Otake K, Koike Y, Fujikawa H, Miki C, Kusunoki M. Wandering spleen causing intestinal obstruction after repair of congenital diaphragmatic hernia. Eur J Pediatr Surg 2010; 20:121-3. [PMID: 19548195 DOI: 10.1055/s-0029-1220708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Otake K, Uchida K, Inoue M, Koike Y, Matsushita K, Miki C, Sugiyama T, Kusunoki M. Congenital diaphragmatic hernia with a pure duplication of chromosome 1q: report of the first surviving case. Pediatr Surg Int 2009; 25:827-31. [PMID: 19629498 DOI: 10.1007/s00383-009-2421-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2009] [Indexed: 11/25/2022]
Abstract
Congenital diaphragmatic hernia (CDH) occurs in multiple malformation syndromes and associations, and has been associated with cytogenetic aberrations on almost every chromosome arm. However, CDH with a duplication of chromosome 1q is very rare in the literature, and all previously reported cases with detailed clinical courses died soon after birth. We present the first surviving case of CDH with a duplication of 1q12-q23, who had arthrogryposis multiplex congenita and hypertrophic cardiomyopathy. CDH patients with a proximal duplication of chromosome 1q may have a chance for survival, and CDH with a duplication of chromosome 1q is not necessarily a lethal association.
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