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Harada K, Yamanaka K, Kurimoto M, Aoki H, Shinkura A, Hanabata Y, Kayano M, Tashima M, Tamura J. Effect of emergency general surgery on postoperative performance status in patients aged over 90 years. Surg Open Sci 2024; 17:1-5. [PMID: 38187005 PMCID: PMC10770739 DOI: 10.1016/j.sopen.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/17/2023] [Accepted: 09/17/2023] [Indexed: 01/09/2024] Open
Abstract
Background Functional deterioration following emergency general surgery (EGS) poses a significant challenge in super-elderly patients. However, limited research has focused on assessing the deterioration in postoperative performance status (PS). This study aimed to investigate the impact of EGS on PS deterioration in super-elderly patients, and the extent to which deteriorated PS is recovered. Methods This historical cohort study comprised 77 super-elderly patients who underwent EGS between July 2015 and December 2020. Functional deterioration was evaluated by comparing preoperative and postoperative Eastern Cooperative Oncology Group Performance Status (ECOG-PS). The Emergency Surgical Score (ESS) was used as a risk-adjustment tool. Questionnaires were mailed to the patients and their families to assess post-discharge PS and obtain their impressions of EGS. Results Postoperative PS deteriorated in 35/77 patients (45.5 %). Significant differences were observed between the groups in terms of sex, serum C-reactive protein (CRP) levels, ESS scores, preoperative ECOG-PS, duration of operation, and major complications. Multivariate analysis of preoperative factors showed that ESS ≥7 (OR: 3.7, 95 % CI: 1.0-13), preoperative ECOG-PS ≤2 (OR: 5.9, 95 % CI: 1.7-21), and female sex (OR: 5.8, 95 % CI: 1.6-21) were associated with postoperative ECOG-PS deterioration. According to the questionnaire results, PS recovery post-discharge was observed in 6/36 (17 %) patients, and 34/36 (94 %) patients and their families expressed positive impressions of EGS. Conclusions EGS in super-elderly patients highly caused a deterioration in their PS, particularly in patients with maintained preoperative PS. PS hardly recovered; however, most patients and their families had positive impressions of the EGS. Key message We assessed the pre- and postoperative performance status of super-elderly patients who underwent emergency general surgery. Surgery caused a marked deterioration in patients' functional performance, which seldom recovered postoperatively.
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Affiliation(s)
- Kaichiro Harada
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa, Amagasaki, Hyogo, Japan
| | - Kenya Yamanaka
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa, Amagasaki, Hyogo, Japan
| | - Makoto Kurimoto
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa, Amagasaki, Hyogo, Japan
| | - Hikaru Aoki
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa, Amagasaki, Hyogo, Japan
| | - Akina Shinkura
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa, Amagasaki, Hyogo, Japan
| | - Yusuke Hanabata
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa, Amagasaki, Hyogo, Japan
| | - Masashi Kayano
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa, Amagasaki, Hyogo, Japan
| | - Misaki Tashima
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa, Amagasaki, Hyogo, Japan
| | - Jun Tamura
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa, Amagasaki, Hyogo, Japan
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Munakata K, Kamata K, Yamanaka K. Gaiter of pellagra. QJM 2023; 116:134-135. [PMID: 36106995 DOI: 10.1093/qjmed/hcac222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Munakata
- Department of General Internal Medicine, Aizu Medical Center, Fukushima Medical University, Fukushima, 21-2. Maeda, Tanisawa, Kawahigashi-machi, Aizuwakamatsu-shi, Fukushima 969-3492, Japan
| | - K Kamata
- Department of General Internal Medicine, Aizu Medical Center, Fukushima Medical University, Fukushima, 21-2. Maeda, Tanisawa, Kawahigashi-machi, Aizuwakamatsu-shi, Fukushima 969-3492, Japan and Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata city, Niigata 951-8510, Japan
| | - K Yamanaka
- Department of General Internal Medicine, Aizu Medical Center, Fukushima Medical University, Fukushima, 21-2. Maeda, Tanisawa, Kawahigashi-machi, Aizuwakamatsu-shi, Fukushima 969-3492, Japan
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Iida S, Nakanishi T, Momose F, Ichishi M, Mizutani K, Matsushima Y, Umaoka A, Kondo M, Habe K, Hirokawa Y, Watanabe M, Iwakura Y, Miyahara Y, Imai Y, Yamanaka K. 356 IL-17A Is the Critical Cytokine for Liver and Spleen Amyloidosis in Inflammatory Skin Disease. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kurimoto M, Yamanaka K, Hirata M, Umeda M, Yamashita T, Aoki H, Hanabata Y, Shinkura A, Tamura J. Emergency open drainage of massive hemoperitoneum and early stage left hepatectomy for abdominal compartment syndrome due to hepatocellular carcinoma rupture: a case report. Surg Case Rep 2022; 8:122. [PMID: 35731449 PMCID: PMC9218022 DOI: 10.1186/s40792-022-01478-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/16/2022] [Indexed: 11/11/2022] Open
Abstract
Background Spontaneous rupture is one of the most life-threatening complications of hepatocellular carcinoma (HCC). Transcatheter arterial embolization (TAE) effectively achieves hemostasis in patients with hemodynamic instability. However, there have been no reports of abdominal compartment syndrome (ACS) caused by massive intra-abdominal hematoma after TAE. We report emergency open drainage of a massive hematoma for abdominal decompression and early stage left hepatectomy at the same time. Case presentation A 75-year-old woman was transported to our emergency department with hypovolemic shock. Dynamic contrast-enhanced computed tomography revealed extravasation of contrast medium from a HCC lesion in the medial segment of the liver and a large amount of high-density ascites. TAE was immediately performed to achieve hemostasis. Three hours after the first TAE, we decided to perform a second TAE for recurrent bleeding. After the second TAE, the patient’s intra-abdominal pressure increased to 35 mmHg, her blood pressure gradually decreased, and she had anuria. Thus, she was diagnosed with ACS due to spontaneous HCC rupture. Twenty-seven hours after her arrival to the hospital, we decided to perform open drainage of the massive hematoma and left hepatectomy for ACS relief, prevention of re-bleeding, tumor resection, and intraperitoneal lavage. The operative duration was 225 min, and the blood loss volume was 4626 g. Postoperative complications included pleural effusion and grade B liver failure. She was discharged on postoperative day 33. The patient survived for more than 3 years without functional deterioration. Conclusions Even after hemostasis is achieved by TAE for hemorrhagic shock due to spontaneous rupture of HCC, massive hemoperitoneum may lead to ACS, particularly in cases of re-bleeding. Considering the subsequent possibility of ACS and the recurrence of bleeding, early stage hepatectomy and removal of intra-abdominal hematoma after hemodynamic stabilization could be a treatment option for HCC rupture.
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Morita A, Okubo Y, Imafuku S, Tada Y, Yamanaka K, Yamaguchi Y, Yasuda M, Tsuchihashi H, Saitoh M, Okuyama R. 113 Flare frequency and patient characteristics in generalized pustular psoriasis (GPP) - A multicenter observational study. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Aoki H, Yamanaka K, Kurimoto M, Hanabata Y, Shinkura A, Harada K, Kayano M, Tashima M, Tamura J. Evaluating the outcomes of primary anastomosis with hand-sewn full-circular reinforcement in managing perforated left-sided colonic diverticulitis. Ann Med Surg (Lond) 2022; 82:104728. [PMID: 36268302 PMCID: PMC9577872 DOI: 10.1016/j.amsu.2022.104728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/18/2022] [Indexed: 11/29/2022] Open
Abstract
Background It is a challenge to avoid stoma formation in emergency surgery of perforated left-sided diverticulum. The hand-sewn full-circular reinforcement of the colorectal anastomosis is used during complete pelvic peritonectomy to avoid a diverting ileostomy. This study examined the effect of applying the reinforcement method to perforated left-sided colonic diverticulitis with respect to the permanent stoma rate and cost-effectiveness. Materials and methods This historical cohort study examined all patients who underwent emergency surgery for perforation of a left-sided diverticulum at the Hyogo Prefectural Amagasaki General Medical Center between July 2015 and September 2019. The cohort was divided into two groups: those who underwent conventional method (Group F) and those for whom the hand-sewn full-circular reinforcement method was actively performed (Group L). Results The number of patients who underwent emergency surgery which did not lead to an ostomy increased significantly from 12% (3/25) in Group F to 42% (11/26) in Group L (P = 0.0015). The rate of permanent stoma decreased from 80% in Group F to 27% in Group L (P < 0.001). Total treatment costs for patients under the age of 80 in Group L were significantly lower than those in Group F (2170000 ± 1020000 vs 3270000 ± 1960000 JPY; P = 0.018). Conclusions In emergency surgery for left-sided perforated colonic diverticulitis, applying the hand-sewn full-circle reinforcement of the anastomotic site may reduce stoma formation at the initial surgery and consequently decrease permanent stoma rate and contribute to cost-effectiveness without increasing complications such as anastomotic leakage. Primary anastomosis was used as an emergency approach to perforated diverticulitis. Primary anastomosis was reinforced by a hand-sewn serosal suture. Full-circle reinforcement of the anastomosis may decrease the permanent stoma rate. Full-circle reinforcement of the anastomosis may be cost effective in approach to perforated diverticulitis.
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Fukunaga N, Wakami T, Fujiwara Y, Shimoji A, Maeda T, Mori O, Matsuyama T, Yoshizawa K, Okada T, Yamanaka K, Tamura N. [Primary Volvulus of the Small Intestine Mimicking Nonocclusive Mesenteric Ischemia Following Open-heart Surgery]. Kyobu Geka 2022; 75:663-666. [PMID: 36156513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A 73-year-old female who underwent aortic valve replacement with a biological valve, coronary artery bypass, and left atrial appendage closure had sudden onset of nausea and abdominal pain 43 days after surgery. She had a history of nonocclusive mesenteric ischemia on 4th postoperative day, for which conservative management was successfully carried out. A contrast-enhanced computed tomography(CT) was performed because a recurrence of nonocclusive mesenteric ischemia was suspected. It revealed a whirl sign in the small intestine, suggestive of small intestine volvulus. At the subsequent emergency laparotomy, volvulus caused severe congestion in the small intestine, aproximately 40 cm from the cecum. However, there was no evidence of transmural necrosis, and reduction of torsion notably improved blood supply to the small intestine. Her regular diet was resumed on 4th postoperative day, and her postoperative course was uneventful. Volvulus should be considered as a differential diagnosis in the setting of acute abdominal pain after open-heart surgery.
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Affiliation(s)
- Naoto Fukunaga
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
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Yamanaka K, Iizuka N, Kitai T. A case of pancreaticoduodenectomy and partial hepatic resection as repeat cytoreductive surgery for recurrent pseudomyxoma peritonei. Surg Case Rep 2021; 7:251. [PMID: 34862939 PMCID: PMC8643391 DOI: 10.1186/s40792-021-01332-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background For recurrent pseudomyxoma peritonei (PMP), repeat cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) can provide survival benefits if patients are carefully selected. We describe a case of pancreaticoduodenectomy and partial liver resection (HPD) as the repeat CRS for a recurrent tumor that infiltrated the pancreatic head around the hepatic hilum. This is the first report of HPD for recurrent PMP. Case presentation The patient was a 58-year-old male without comorbidities. In 2001, he was diagnosed with PMP at the time of laparoscopic cholecystectomy. In 2004, CRS, including total peritoneal resection, pyloric gastrectomy, splenectomy, and right hemicolectomy with HIPEC was performed (peritoneal cancer index (PCI) = 28). In 2008, the first repeat CRS with HIPEC was performed (PCI = 14). In 2016, fourth repeat CRS, including partial hepatectomy with HIPEC for recurrence of the round ligament of the liver, was performed. In 2017, a tumor of 5 cm in size was observed from the hepatic hilum to the pancreatic head, which infiltrated the main pancreatic duct. Other tumors 2 cm in size were observed (PCI = 7). We performed the fifth repeat CRS, including HPD. The adhesions of the small intestine from around the liver to the lower abdomen were detached for the reconstruction of pancreatojejunostomy and cholangiojejunostomy. The uncinate approach was applied for the pancreatic head resection because it was difficult to identify the cranial part of the pancreas due to adhesions in the hepatoduodenal ligament and the omental bursa. We approached to the origin of the extrahepatic Glissonean pedicle by resecting a part of the liver around the hepatic hilum using transhepatic hilar approach. A complete cytoreduction was achieved. The postoperative pathological diagnosis was a recurrence of PMP, which is equivalent to peritoneal mucinous carcinomatosis. He was discharged on the 22nd postoperative day without major postoperative complications. The patient survived without recurrence four years after HPD. Conclusions Even for recurrence around the hepatic hilum and the pancreatic head, repeat CRS can be safely performed by applying the techniques of hepatobiliary pancreatic surgery.
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Affiliation(s)
- Kenya Yamanaka
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa, Amagasaki, Hyogo, Japan.
| | - Norishige Iizuka
- Department of Pathology, Kishiwada City Hospital, Kishiwada, Japan
| | - Toshiyuki Kitai
- Peritoneal Surface Malignancy Treatment Center, Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan
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Hanabata Y, Yamanaka K, Shinkura A, Kurimoto M, Aoki H, Harada K, Kayano M, Tashima M, Tamura J. Clinical impact of bloodstream infection on acute cholecystitis indicated for emergency cholecystectomy. J Hepatobiliary Pancreat Sci 2021; 29:322-328. [PMID: 34717046 DOI: 10.1002/jhbp.1069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The significance of blood culture for acute cholecystitis remains unclear. METHODS A retrospective cohort study was conducted on patients who underwent emergency cholecystectomy at Hyogo Prefectural Amagasaki General Medical Center to examine the clinical impact of bloodstream infection (BSI), focusing on the association of BSI with bactibilia and severity grade based on the Tokyo guidelines 2018 (TG18). RESULTS Among 177 patients included in the study, 32 had positive and 145 had negative BSI. Significant differences were observed between the positive and negative BSI in terms of age, body mass index (BMI), the American Society of Anesthesiologists physical status (ASA-PS) and TG18 severity score. The odds ratios of BSI for patients aged ≥72 years, with a BMI of ≤21.8, an ASA-PS of ≥3E, and grade III acute cholecystitis were 3.45, 3.23, 2.43 and 4.51, respectively. In the multivariate analysis, lower BMI and grade III were significantly associated with BSI with odds ratios of 2.53 (95% confidence interval: 1.07-6.21, P = .037) and 3.03 (95% confidence interval: 1.02-8.82, P = .041). Bacterial species that could not be isolated in the bile culture alone were identified in blood culture on 10 (38.5%) of 26 patients. CONCLUSIONS Bloodstream infection is associated with grade III acute cholecystitis. Blood culture enables the identification of bacteria that cannot be isolated in bile culture. Blood culture should be obtained for patients with grade III acute cholecystitis who undergo emergency cholecystectomy.
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Affiliation(s)
- Yusuke Hanabata
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kenya Yamanaka
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Akina Shinkura
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Makoto Kurimoto
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Hikaru Aoki
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kaichiro Harada
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Masashi Kayano
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Misaki Tashima
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Jun Tamura
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
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Yamashita T, Yamanaka K, Izumi A, Matsui J, Kurimoto M, Aoki H, Tamura J. Endovascular repair using a covered stent for a ruptured infected aneurysm of the superior mesenteric artery after pancreaticoduodenectomy: a case report. Surg Case Rep 2020; 6:270. [PMID: 33074371 PMCID: PMC7573079 DOI: 10.1186/s40792-020-01047-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/11/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Delayed arterial hemorrhage after pancreaticoduodenectomy is a life-threatening complication. There are no reports about infected aneurysms of the superior mesenteric artery after pancreaticoduodenectomy without clinically relevant pancreatic fistula. CASE PRESENTATION A 78-year-old woman with borderline resectable pancreatic ductal adenocarcinoma involving the superior mesenteric arterial nerve plexus underwent pancreaticoduodenectomy with en bloc resection of the superior mesenteric vein and the superior mesenteric arterial nerve plexus after neoadjuvant chemotherapy. On postoperative day 14, she had bacteremia and sudden fever with chills. During the postoperative course, macroscopic abscesses or distinct infectious signs, including pancreatic fistula or bile fistula, were not present, but pylephlebitis was observed. After the antimicrobial treatment course, the patient was discharged. After 17 days, she was hospitalized for melena. Contrast-enhanced computed tomography showed a ruptured aneurysm of the superior mesenteric artery into the small intestine without a major intraabdominal abscess. E. coli was isolated from blood cultures. The patient was diagnosed with a ruptured infected aneurysm of the superior mesenteric artery. She was treated successfully with a covered stent by the cardiology team. There was no recurrence of bleeding at the 4-month follow-up, and the stent was patent in all subsequent computed tomography scans. CONCLUSIONS Endovascular repair using a covered stent was effective in palliating acute bleeding from an infected aneurysm of the superior mesenteric artery.
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Affiliation(s)
- Tokuyuki Yamashita
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa, Amagasaki, Hyogo, Japan
| | - Kenya Yamanaka
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa, Amagasaki, Hyogo, Japan.
| | - Ai Izumi
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa, Amagasaki, Hyogo, Japan
| | - Jun Matsui
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa, Amagasaki, Hyogo, Japan
| | - Makoto Kurimoto
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa, Amagasaki, Hyogo, Japan
| | - Hikaru Aoki
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa, Amagasaki, Hyogo, Japan
| | - Jun Tamura
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa, Amagasaki, Hyogo, Japan
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Kawamoto T, Ogasawara M, Mastuki-Muramoto Y, Kawaguchi T, Ando S, Matsushita M, Yamanaka K, Yamaji K, Tamura N. SAT0262 PROPOSAL FOR OPTIMIZATION OF DIAGNOSTIC IMAGING FOR GIANT CELL ARTERITIS USING THREE-DIMENSIONAL COMPUTED TOMOGRAPHY ANGIOGRAPHY IMAGE AND CONSTRUCTING VASCULAR MAPPING FROM VASCULAR ULTRASONOGRAPHY AS REFERENCES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The development of rapid and accurate methods of diagnosing giant cell arteritis (GCA) is critical to prevent blindness and stroke, which may develop rapidly in patients with GCA. In 2018, EULAR published recommendations that the first imaging modality for GCA should be vascular ultrasonography without biopsy. However, many institutions still consider biopsy to make an important contribution to the diagnosis of GCA.Objectives:Our purpose is to eliminate blindness and stroke among GCA patients by optimizing diagnostic imaging and method to diagnose GCA employed by vascular ultrasonography (V-US), CT Angiography (CTA), MRI/A, and PET/CT without biopsy.Methods:We evaluated the clinical and serological characteristics of 20 patients who were diagnosed with GCA at our hospital from 2012 to 2018, and compared the image and biopsy findings of these patients. We then evaluated the effect of optimizing diagnostic imaging and methods for patients with suspected GCA who visited our hospital during 2019. Vascular mapping was carried out using V-US for 3DCTA and other imaging methods as references.Results:Table 1 shows the clinical characteristics of the study population. The sensitivity of CTA for GCA was 85.7% (12 of 14 patients), which was the highest of the studied imaging methods. All biopsy-positive cases were diagnosed as GCA, and we compared these cases with cases with positive imaging findings. This revealed that CTA findings were correct (i.e., positive) in 66.7% (four of six patients), MRI/A findings were correct in in 33.3% (three of nine), V-US findings were correct in 50.0% (three of six). Therefore, CTA exhibited the highest sensitivity for positive findings. Comparison of biopsy-positive cases with cases in which imaging findings were negative revealed that CTA findings were correct (negative) in 33.3% (two of six patients), MRI/A findings were correct in 55.6% (five of nine), V-US was correct in 50.0% (three of six). Thus, CTA had the lowest sensitivity for negative findings. Comparison of CTA findings of positive cases with other imaging modalities which reported positive findings revealed MRI/A findings to be correct in 44.4% (four of nine patients), PET/CT findings to be correct in 50.0% (one of two), V-US to be correct in 63.3% (five of eight). Thus, V-US had the highest agreement with CTA. We carried out vascular mapping by V-US using 3DCTA and other imaging methods and produced references to improve the accuracy of diagnosis. Using these references, we diagnosed five cases of GCA among the 20 patients; the positive predictive value of V-US was 80% (four of five patients) and negative predictive value was 86.7% (13 of 15 patients).Table 1.Baseline characteristics of the study sample The number of biopsies performed decreased from 50% (10 of 20 patients) from 2012 to 2018 to 15% (3 of 20 patients) in 2019. Two cases in the present study had positive findings in both biopsy and V-US; in one case, biopsy, CTA, and MRI/A were negative while V-US revealed positive findings. No patients with GCA developed blindness or stroke during 2019.Conclusion:We propose that V-US should be performed as the first examination for the diagnosis of GCA by the creation of vascular mappings when GCA is suspected in order to prevent blindness and stroke.References:[1]Christian Dejaco et al.EULAR recommendations for the use of imaging in large vasculitis in clinical practice.Annals of the Rheumatic Diseases,2018 May;77(5):636-643[2]Kawamoto T et al.Diagnosis of giant cell arthritis by head-contrast three-dimensional computed tomography angiography.Journal of Medical Case Reports2019 Sep 11;13(1):285.Figure 1.Left side is before, right side is after thrapy. (A) 3DCTA finding, (B) determination of V-US arrangement with vascular location to evaluate wall thickening of V-US, compression sign, stenosis and stoppage of vessels.Disclosure of Interests:None declared
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Matsushita M, Amano H, Nozawa K, Ogasawara M, Tada K, Kempe K, Kusaoi M, Kawamoto T, Minowa K, Ando S, Nemoto T, Abe Y, Hayashi E, Murayama G, Tsukahara T, Yamanaka K, Morimoto S, Yang K, Matsudaira R, Katagiri A, Nakiri Y, Takasaki Y, Yamaji K, Tamura N. FRI0179 A STUDY ON THE ACHIEVEMENT OF LUPUS LOW DISEASE ACTIVITY STATE AND QUALITY OF LIFE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: FROM THE JUNTENDO UNIVERSITY SLE PROSPECTIVE REGISTRY STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology that affects mostly young women. Multiorgan complications and prolonged treatment significantly cause physical and mental stress in patients. Improving patients’ quality of life (QOL) in SLE treatment is essential. We examined the treatment effects on disease activity and QOL of SLE patients.Objectives:In recent years, lupus low disease activity state (LLDAS) has been proposed as a treatment target for SLE. Patients who achieve LLDAS have a low recurrence rate for lupus and a low risk of serious complications (1). The aim of this study is to investigate whether achieving LLDAS reduces not only recurrence rate and complications of SLE but also improves patients’ QOL.Methods:A total of 104 SLE patients were enrolled in our prospective SLE registry study (Juntendo, Multi-center, Prospective cohort for investigation of clinical course and outcome in SLE: JUMP) conducted at our institution. SLE was diagnosed using the American College of Rheumatology (ACR) 1982 criteria (revised in 1997). QOL was evaluated using the standard version of the 36-item short form health survey version 2 (SF36v2). Participants were divided into the LLDAS achievement and non-achievement groups, and the characteristics of each group including results of SF36v2 were examined.Results:This study included 104 SLE patients, 94 female and 10 male, and the average age and disease duration were 46.4±13.8 and 14.5±11.3 years, respectively. The average corticosteroid dose was 8.0±17.4 mg/day in terms of prednisolone, and anti-dsDNA antibody titer was 16.8±38.5 IU/ml. Of the 104 patients, 57 achieved LLDAS. The subscale’s standard scoring using SF36v2 for role physical (RP) was 78.9±24.0 and 64.6±27.6 (P<0.01), general health (GH) was 50.0±17.0 and 42.0±19.3 (P<0.05), vitality (VT) was 55.8±15.8 and 38.0±24.1 (P<0.01), social functioning (SF) was 82.0±20.7 and 66.5±26.3 (P<0.01), role emotional (RE) was 89.0±16.1 and 73.4±28.1 (P<0.01), and mental health (MH) was 72.4±15.9 and 58.3±21.8 (P<0.01) in the LLDAS achievement and non-achievement groups, respectively. Furthermore, scoring based on the national standard value in the LLDAS achievement group showed that two categories were >50. However, in the LLDAS non-achievement group, all categories were <50. In particular, RP, GH, VT, SF, RE, and MH of the LLDAS achievement group had significantly higher scores than the LLDAS non-achievement group (RP and GH: p<0.05 and VT, SF, RE and MH: p<0.01).Conclusion:Results of examining the association between LLDAS and QOL using SF36v2 in SLE patients showed that patients who achieved LLDAS had significantly better standard statistical scores in many subscale categories. Thus, LLDAS achievement as a treatment target for SLE patients greatly contributes to improving patients’ QOL.References:[1]Franklyn K, et al. Definition and initial validation of a Lupus Low Disease Activity State (LLDAS).Ann Rheum Dis. 2016 Sep;75(9):1615-21.Disclosure of Interests:None declared
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Yokawa K, Ikeo U, Henmi S, Yamanaka K, Okada K, Okita Y. Impact of Shaggy Aorta on Outcomes of Open Thoracoabdominal Aortic Aneurysm Repair. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ihara Y, Tatakura K, Wada Y, Kawahara H, Yamanaka K. 34 Effect of polysaccharide from Flammulina velutipes on the vitrification of bovine oocytes. Reprod Fertil Dev 2020. [DOI: 10.1071/rdv32n2ab34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The developmental competence of oocytes after cryopreservation is compromised by the physical injury due to the ice crystallisation. Recent studies have reported that polysaccharide (xylomannan) derived from the mycelium and fruit body of the basidiomycete Flammulina velutipes inhibits the ice recrystallisation in the cryopreserved Chinese hamster ovary cells. In this study, we aimed to clarify the effect of xylomannan from Flammulina velutipes on the developmental competence of bovine vitrified oocytes. Bovine ovaries were obtained from a local abattoir, and cumulus-oocyte complexes (COCs) were aspirated from follicles (2-6mm in diameter) using a 19-gauge needle attached to a syringe. The COCs were matured for 22h in tissue culture medium-199 supplemented with 5% fetal bovine serum (FBS), 0.02IUmL−1 FSH, and 10μgmL−1 gentamycin. After maturation, COCs were incubated in base solution (BS: 10% FBS-tissue culture medium-199, control group; n=149) or BS supplemented with 100μgmL−1 xylomannan (xylomannan group; n=175) for 1h before vitrification. All vitrification procedures were performed at room temperature. The COCs were equilibrated in BS with 3% ethylene glycol for 12min and then in vitrification solution (BS with 30% ethylene glycol, 1.0M sucrose) for 1min. The COCs were loaded on a Cryotop (Kitazato) and transferred into liquid nitrogen. The warming procedure was performed on a warm plate (42°C). The COCs were placed into BS supplemented with 0.5, 0.25, 0.125, and 0M sucrose for 5min each. After washing with IVF100 solution (Research Institute for the Functional Peptide), COCs were applied for IVF. The viability of putative zygotes was morphologically evaluated following IVF, and ones that survived were cultured in CR1aa supplemented with 5% FBS. The cleavage pattern was evaluated at 28h after IVF as follows: embryos with blastomeres of the same size without fragmentation were classified as normal cleavage; embryos with 2 blastomeres and several small fragments, direct cleavage from the 1-cell stage to 3 or 4 blastomeres, or 2 blastomeres of different size were classified as abnormal cleavage. The rates of cleavage and blastocyst formation were calculated on 2 and 8 days after culture, respectively. Total cell number and apoptosis of blastocysts were measured by terminal deoxynucleotidyl transferase dUTP nick end labelling assay. All data were obtained from more than four replicates. Viability and invitro development data were analysed using the chi-squared test. Total cell number and apoptosis data were analysed by a Student's t-test. Although no significant differences in viability, cleavage pattern, and cleavage rate (85.8 vs. 80.3%, 17.2 vs. 14.8%, and 35.4 vs. 36.7%, respectively) were observed, the developmental rate to blastocysts in the xylomannan group was significantly higher than that in the control group (68.6 vs. 42.2%; P<0.01). The present results suggest that co-incubation with xylomannan before vitrification is an effective method to improve the vitrification outcome in bovine oocytes.
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Hashimoto H, Nakanishi R, Mizumura S, Hashimoto Y, Okamura Y, Yamanaka K, Ikeda T. P175 Prognostic value of 99mTc-ECD brain perfusion SPECT in patients with atrial fibrillation and dementia. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and those afflicted have reduced quality of life, functional status, and cardiac performance. The patients with AF have a high risk of coronary heart disease and cardiovascular disease. Although the prevalence of AF is increasing, cognitive disorders are also on the rise in tandem with the aging of the population. The patients with dementia have also experienced lower the quality of life and have increased mortality. Technetium 99m ECD brain perfusion single photon emission computed tomography (99mTc-ECD brain perfusion SPECT) is a useful modality for diagnosing dementia and identifying high risk patients with mild cognitive impairment. However, there are few reports about the relationship between the value of Z score calculated by 99mTc-ECD brain perfusion SPECT and prognosis of patients with AF and dementia.
Purpose
The aim of this study was to evaluate the prognostic values of brain perfusion using 99mTc-ECD SPECT in patients with AF and dementia.
Methods
Among 405 consecutive patients who were diagnosed as AF in cardiac outpatients and subsequently diagnosed as dementia using Mini-Mental State Examination by neurologists or psychiatrists, we identified 170 patients (81 ± 10 years) who underwent 99mTc-ECD brain perfusion SPECT for the current study. Of those, 73, 73, and 24 were diagnosed as Alzheimer’s dementia (AD), vascular dementia (VD), and non-specified dementia respectively. Multivariate Cox model was used to assess if higher Z score by 99mTc-ECD brain perfusion SPECT and clinical parameters were associated with major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction, hospitalization for heart failure, and stroke. Sub-analyses of multivariate Cox models by AD or VD were also assessed. The cut-off values of Z score were determined using area under the curve by a receiver operating characteristic analysis based on MACE occurrences.
Results
During a mean follow-up of 1258 ± 1044 days, 62 MACE occurred. There was not significant difference of MACE between AD and VD (33%, vs. 44%, p = 0.153). By multivariable Cox model, the higher Z score of temporal-occipital-pariental lobe was associated with increased MACE compared to the lower group (HR 2.521, 95% CI 1.465–4.337, p < 0.001). In a sub-analysis of patients with AD, Z score was the most significant prognostic factor for MACE (HR 3.969, 95% CI 1.374–11.468, p = 0.011). The similar trend was observed in those with VD (HR 2.247, 95% CI 1.028–4.913, p = 0.043). Conclusion: This study demonstrated that the Z score of temporal-occipital-pariental lobe by 99mTc-ECD brain perfusion SPECT could be a potential prognostic value among patients with AF and dementia, regardless of type of dementia.
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Affiliation(s)
- H Hashimoto
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - R Nakanishi
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - S Mizumura
- Toho University Faculty of Medicine, Radiology, Tokyo, Japan
| | - Y Hashimoto
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - Y Okamura
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - K Yamanaka
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - T Ikeda
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
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Papp K, Maari C, Cauthen A, Gooderham M, Spelman L, Yamanaka K, Polzer P, Zhang L, Osuntokun O, Augustin M. An indirect comparison of long-term efficacy of every-2-week dosing vs. recommended dosing of ixekizumab in patients who had static Physician's Global Assessment > 1 at week 12. Br J Dermatol 2019; 183:52-59. [PMID: 31545506 DOI: 10.1111/bjd.18550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Long-term efficacy and safety of ixekizumab [160 mg at week 0, then 80 mg every 2 weeks (Q2W) for 12 weeks, followed by every 4 weeks (Q4W) thereafter (i.e. Q2W/Q4W), which is the labelled psoriasis dosing where approved, except in Japan] have been established for the treatment of adults with moderate-to-severe plaque psoriasis. However, some patients may benefit from remaining on Q2W dosing beyond 12 weeks. METHODS Among patients who had static Physician's Global Assessment (sPGA) > 1 at week 12, efficacy through week 52 of continuous Q2W dosing in the IXORA-P study was compared indirectly with Q2W/Q4W in the integrated data from the UNCOVER-1, UNCOVER-2 and UNCOVER-3 studies. The continuous Q4W dose group, which had comparable results across studies, was used as the common comparator. RESULTS In the IXORA-P study, among patients with sPGA > 1 at week 12, 64% of patients in the continuous Q2W group achieved sPGA ≤ 1 at week 52, which was statistically significantly higher than the 36% of patients with sPGA > 1 in the Q2W/Q4W group based on the integrated data from the UNCOVER studies (P = 0·0007). There were no clinically meaningful differences in frequencies of safety events between patients with sPGA ≤ 1 and patients with sPGA > 1 at week 12 in the IXORA-P study. CONCLUSIONS Among patients who did not have clear or almost clear skin at week 12, nearly 30% more patients who were treated continuously with ixekizumab Q2W in IXORA-P had clear or almost clear skin at week 52 when compared indirectly with those who were treated using the labelled psoriasis dosing in integrated UNCOVER studies. What's already known about this topic? Most patients with moderate-to-severe psoriasis who were given the labelled psoriasis dosing of ixekizumab [160-mg loading dose at week 0, 80 mg every 2 weeks (Q2W) through week 12, and 80 mg every 4 weeks (QW4) thereafter] respond quickly with a high percentage of skin clearance. Additionally, patients who achieve static Physician's Global Assessment (sPGA) ≤ 1 by week 12 tend to maintain this response, even after switching to Q4W. What does this study add? Here, we assessed whether patients with sPGA > 1 at week 12 benefited from receiving more frequent dosing beyond the first 12 weeks. The results showed that Q2W dosing beyond 12 weeks resulted in more patients achieving sPGA ≤ 1 by week 52 than the labelled psoriasis dosing among patients with sPGA > 1 at week 12.
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Affiliation(s)
- K Papp
- K. Papp Clinical Research and Probity Medical Research, Waterloo, ON, Canada
| | - C Maari
- Innovaderm Research, Montreal, QC, Canada
| | - A Cauthen
- MidState Skin Institute, Ocala, FL, U.S.A
| | - M Gooderham
- SkiN Centre for Dermatology and Probity Medical Research, Peterborough, and Queens University, Kingston, ON, Canada
| | - L Spelman
- Veracity Clinical Research, Brisbane, Queensland, Australia
| | - K Yamanaka
- Department of Dermatology, Graduate School of Medicine, Mie University, Tsu, Mie, Japan
| | - P Polzer
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - L Zhang
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - O Osuntokun
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center, Hamburg, Germany
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Kitai T, Yamanaka K, Sugimoto N, Inamoto O. Surgical management for peritoneal carcinomatosis of appendiceal origin with a high-tumor burden. Surg Today 2019; 50:171-177. [PMID: 31363844 DOI: 10.1007/s00595-019-01856-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 07/17/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is the active treatment for peritoneal carcinomatosis of appendiceal origin. However, surgical management is sometimes difficult in patients with a high-tumor burden. METHODS A high-tumor burden was defined as a peritoneal cancer index (PCI) ≥ 28. Among 49 patients receiving CRS + HIPEC, 29 had a PCI ≥ 28. RESULTS Complete cytoreduction (CC-0/1) was achieved in 20 of the 29 patients with a PCI ≥ 28 and in all 20 patients with a PCI < 28. Among the patients achieving CC-0/1, gastrectomy or total colectomy was performed more frequently, the hospital stay was longer and postoperative complications were more frequent in those with a PCI ≥ 28 than in those with a PCI < 28. If CC-0/1 was achieved, the overall survival was comparable between patients with a PCI ≥ 28 and a PCI < 28. However, the recurrence-free survival was significantly worse for patients with a PCI ≥ 28 than for those with a PCI < 28 (5-year survival: 73.7% vs. 5.9%). Patients with recurrence who underwent repeat CRS showed a better overall survival than those without repeat CRS. Among patients with a PCI ≥ 28, a performance status (PS) of 2/3 was a significant prognostic factor (hazard ratio = 5.132). CONCLUSIONS In patients with a high-tumor burden undergoing CRS + HIPEC, postoperative complications were more frequent, and the recurrence rate was higher than in those without a high-tumor burden. Repeat CRS improved the survival of patients with recurrence. The PS was a key indicator when selecting patients suitable for aggressive resection.
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Affiliation(s)
- Toshiyuki Kitai
- Department of Surgery, Kishiwada City Hospital, 1001 Gakuhara-cho, Kishiwada, Osaka, 596-8501, Japan.
| | - Kenya Yamanaka
- Department of Surgery, Kishiwada City Hospital, 1001 Gakuhara-cho, Kishiwada, Osaka, 596-8501, Japan
| | - Naoko Sugimoto
- Department of Surgery, Kishiwada City Hospital, 1001 Gakuhara-cho, Kishiwada, Osaka, 596-8501, Japan
| | - Osamu Inamoto
- Department of Surgery, Kishiwada City Hospital, 1001 Gakuhara-cho, Kishiwada, Osaka, 596-8501, Japan
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Hirata M, Shirakata Y, Yamanaka K. Duodenal intussusception secondary to ampullary adenoma: A case report. World J Clin Cases 2019; 7:1857-1864. [PMID: 31417932 PMCID: PMC6692261 DOI: 10.12998/wjcc.v7.i14.1857] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/13/2019] [Accepted: 05/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Because the duodenum is fixed onto the retroperitoneum, duodenal intussusception is usually impossible except in cases of malrotational abnormality. Although cases of duodenal intussusception without malrotational abnormalities have been reported, it is unclear whether they constitute true intussusception or simple mucosal prolapse.
CASE SUMMARY A 66-year-old woman presented with whole-body edema and malaise. Blood analysis indicated severe anemia and cholestasis. Endoscopic examination revealed a pedunculate polyp on the second part of the duodenum that migrated distally with mucosal elongation. Computed tomography showed duodenal intussusception. A tumor as the lead point and retroperitoneal structure, including the head of the pancreas and fat, invaginated beyond the duodenojejunal flexure. She was diagnosed with ampullary adenoma caused repeated intussusception that reduced spontaneously and underwent pancreaticoduodenectomy. Laparotomy showed tumor prolapse beyond the duodenojejunal flexure without intussusception. There was no evidence of malrotational abnormality. She was discharged with no complications.
CONCLUSION We report true duodenal intussusception without malrotational abnormality. This phenomenon was also associated with mucosal prolapse.
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Affiliation(s)
- Masaaki Hirata
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo 660-0892, Japan
| | - Yoshiharu Shirakata
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo 660-0892, Japan
| | - Kenya Yamanaka
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo 660-0892, Japan
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Muro K, Uetake H, Tsuchihara K, Shitara K, Yamazaki K, Ota M, Oki E, Sato T, Naitoh T, Komatsu Y, Kato T, Yamanaka K, Mori I, Soeda J, Hihara M, Yamanaka T, Akagi K, Ochiai A, Yoshino T. PARADIGM study: A multicenter, randomized, phase III study of mFOLFOX6 plus panitumumab or bevacizumab as first-line treatment in patients with RAS (KRAS/NRAS) wild-type metastatic colorectal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Okada K, Yamanaka K, Matsushima Y, Mizutani K, Umaoka A. 511 Gut microbiome of the inflammatory skin model mouse. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mizutani K, Matsushima Y, Habe K, Yamanaka K, Okada K, Kondo M. 038 Gastrointestinal amyloidosis by long-lasting inflammatory skin disease. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chafino JA, Yamanaka K, Mercier F, Rivory P, Balvay S, Hartmann DJ, Chiba A, Fabregue D. The influence of temperature during water-quench rapid heat treatment on the microstructure, mechanical properties and biocompatibility of Ti6Al4V ELI alloy. J Mech Behav Biomed Mater 2019; 96:144-151. [PMID: 31035065 DOI: 10.1016/j.jmbbm.2019.04.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 02/22/2019] [Accepted: 04/11/2019] [Indexed: 10/27/2022]
Abstract
This study investigates the influence of a rapid heat treatment followed by water-quenching on the mechanical properties of Ti6Al4V ELI alloy to improve its strength for use in implants. Prior to the experiment, a dilatometry test was performed to understand the progressive α-to β-phase transformation taking place during heating. The results were then used to carry out heat treatments. Microstructure was analysed using SEM, EBSD, EDX and XRD techniques. Vickers micro-hardness, tensile and high cycle rotating bending tests were used to analyse the influence of the $\alpha'$-phase fraction on the strength of the studied alloy. Results show that this process can provide a Ti6Al4V ELI alloy with a better Yield Strength (YS)/uniform deformation (εu) ratio and improved high cycle fatigue strength than those observed in the current microstructure used in medical implants. Lastly, cytotoxicity tests were performed on two types of human cells, namely MG63 osteoblast-like cells and fibroblasts. The results reveal the non-toxicity of the heat-treated Ti6Al4V ELI alloy.
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Affiliation(s)
- J A Chafino
- Univ Lyon, INSA-Lyon, MATEIS, UMR CNRS 5510, 20 Avenue Einstein, 69621, Villeurbanne, France.
| | - K Yamanaka
- Institute for Materials Research, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai, 980-8577, Japan
| | - F Mercier
- Univ Lyon, INSA-Lyon, MATEIS, UMR CNRS 5510, 20 Avenue Einstein, 69621, Villeurbanne, France
| | - P Rivory
- Univ Lyon, Universite Claude Bernard Lyon1, MATEIS, UMR CNRS 5510, 8 avenue Rockefeller, 69373, Lyon, France
| | - S Balvay
- Univ Lyon, Universite Claude Bernard Lyon1, MATEIS, UMR CNRS 5510, 8 avenue Rockefeller, 69373, Lyon, France
| | - D J Hartmann
- Univ Lyon, Universite Claude Bernard Lyon1, MATEIS, UMR CNRS 5510, 8 avenue Rockefeller, 69373, Lyon, France
| | - A Chiba
- Institute for Materials Research, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai, 980-8577, Japan
| | - D Fabregue
- Univ Lyon, INSA-Lyon, MATEIS, UMR CNRS 5510, 20 Avenue Einstein, 69621, Villeurbanne, France.
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Egashira J, Tatemoto H, Wada Y, Yamanaka K. 136 Efficient in vitro embryo production system using in vivo-matured oocytes from superstimulated Japanese black cows. Reprod Fertil Dev 2019. [DOI: 10.1071/rdv31n1ab136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In this study, we examined whether in vivo matured oocytes collected by ovum pickup (OPU) from superstimulated Japanese black cows can improve the productivity and quality of in vitro-produced embryos. Cows in the stimulated group received an intravaginal progesterone-releasing device (Day 0), administration of 100μg of GnRH on Day 5, a single administration of 30 Armour units of FSH on the evening of Day 8 and prostaglandin F2α on the evening of Day 10. The progesterone device was removed on the morning of Day11, and then 100μg of GnRH was administered on the morning of Day 12 (0 h). The OPU and IVF were conducted at 25~26 and 30h, respectively. Cows in the control group received no treatment before OPU, and collected oocytes were subjected to in vitro maturation followed by IVF. The cortical granules distribution of oocytes at metaphase II stage, the cleavage pattern of embryos at the first cell cycle, the developmental rate, and the quality of blastocysts were compared between the stimulated and control groups. Oocytes with cortical granules distributing cortical cytoplasm were classified as normal distribution. The cleavage pattern was evaluated at 28h after IVF as follows: embryos with blastomeres of the same size without fragmentation were classified as normal cleavage; embryos with 2 blastomeres and several small fragments, direct cleavage from the one-cell stage to 3 or 4 blastomeres, or 2 blastomeres of different size were classified as abnormal cleavage. The developmental rate to blastocyst stage was measured on Day 9 of culture. The morphological quality of blastocysts was evaluated based on the IETS manual. All data were obtained from more than 3 replicates. In vitro development and cortical granules distribution data were analysed using chi-squared test. Other data were analysed using Student’s t-test. Normal cortical granules distribution rate in the stimulated group was higher than that in the control group (90.3v. 23.1%; P<0.01). Although no differences in the developmental rate to blastocyst stage (51.5v. 58.6%) was observed, the normal cleavage rate (73.4v. 51.2%) and the transferable embryo rate (98.3v. 88.0%) in the stimulated group were significantly higher (P<0.01) than those in the control group. The ratio of embryos from normal cleavage among the transferable embryos in the stimulated group was also significantly higher than in the control group (82.2v. 57.2%; P<0.01). In addition, the freezable embryo ratio (71.7v. 58.1%; P<0.072) and the total production number of embryos per head (28.0v. 15.5; P<0.106) showed a tendency to be higher in the stimulated group than in the control group. These results suggest that high quality embryos can be efficiently produced by the use of in vivo matured oocytes collected by OPU from superstimulated Japanese black cows.
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Yamanaka K, Inoue S. In reply to "Animal models for neurotoxicity assessment in cardiac arrest". Med Intensiva 2018; 43:451. [PMID: 30522871 DOI: 10.1016/j.medin.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/14/2018] [Accepted: 10/16/2018] [Indexed: 10/27/2022]
Affiliation(s)
- K Yamanaka
- Division of Intensive Care, Nara Medical University, Japan
| | - S Inoue
- Division of Intensive Care, Nara Medical University, Japan.
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Kishikawa H, Kinoshita T, Hashimoto M, Fukae S, Taniguchi A, Yamanaka K, Nakagawa M, Nishimura K. Class II HLA Eplet Mismatch Is a Risk Factor for De Novo Donor-Specific Antibody Development and Antibody-mediated Rejection in Kidney Transplantation Recipients. Transplant Proc 2018; 50:2388-2391. [DOI: 10.1016/j.transproceed.2018.02.183] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
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Yamanaka K, Inoue S, Naito Y, Kawaguchi M. Amiodarone does not affect brain injury in a rat model of transient forebrain ischemia. Med Intensiva 2018; 43:457-463. [PMID: 30029951 DOI: 10.1016/j.medin.2018.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/26/2018] [Accepted: 05/18/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Although amiodarone may cause neurotoxicity that can affect patient outcomes when used during cardiopulmonary resuscitation (CPR), it has been commonly prescribed during CPR. This study investigated the possible neurotoxic effects of amiodarone in a rat model of transient forebrain ischemia. DESIGN A prospective laboratory animal study was carried out. SETTING Animal laboratory. MATERIALS Male Sprague-Dawley rats. INTERVENTION Eight minutes of forebrain ischemia was induced in rats by bilateral carotid occlusion and hypotension (mean arterial pressure=35mmHg) under isoflurane (1.5%) anesthesia. Amiodarone (0, 50, 100 and 150mg/kg) with saline was injected intraperitoneally 10min after ischemia. Rats given 0mg/kg of amiodarone were used as saline-treated controls. Sham operated rats received no treatment. VARIABLES OF INTEREST Animals were evaluated neurologically on postoperative days 4-7, and histologically after a one-week recovery period. RESULTS The greatest improvement in water maze test performance corresponded to the sham operated group (p=0.015 vs. saline-treated controls). No differences in performance were seen in amiodarone-treated rats compared with saline-treated controls. In the control group, 45% of the CA1 hippocampal neurons survived, compared with 78% in the sham operated group (p=0.009). Neuron survival after ischemia in the amiodarone treatment groups (50, 100 and 150mg/kg) (58%, 40% and 36%, respectively) and in the control rats did not differ significantly. CONCLUSIONS The administration of amiodarone immediately after transient forebrain ischemia did not worsen spatial cognitive function or neuronal survival in the hippocampal CA1 region in rats. The current results must be applied with caution in humans. However, they indicate that the potential neurotoxicity induced by amiodarone during resuscitation after cardiac arrest may be negligible.
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Affiliation(s)
- K Yamanaka
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - S Inoue
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan.
| | - Y Naito
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - M Kawaguchi
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
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Houben P, Hohenberger R, Yamanaka K, Büchler MW, Schemmer P. Evaluation of Graft Effluent High Mobility Group Box-1 (HMGB-1) for Prediction of Outcome After Liver Transplantation. Ann Transplant 2018; 23:475-480. [PMID: 30002362 PMCID: PMC6248035 DOI: 10.12659/aot.909165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Pre-transplant assessment of the graft for liver transplantation is crucial. Based on experimental data, this study was designed to assess both nuclear high mobility group box-1 (HMGB-1) protein and arginine-specific proteolytic activity (ASPA) in the graft effluent. Material/Methods In a non-interventional trial, both HMGB-1 and ASPA were measured in the effluent of 30 liver grafts after cold storage before transplantation. Values of HMGB-1 and ASPA levels were compared with established prognostic parameters such as the donor risk index, balance of risk score, and Donor-Model for End-Stage Liver Disease. Results The early allograft dysfunction (EAD) was best predicted by recipient age (p=0.026) and HMGB-1 (p=0.031). HMGB −1 thresholds indicated the likelihood for initial non-function (1608 ng/ml, p=0.004) and EAD (580 ng/ml, p=0.017). The multivariate binary regression analysis showed a 21-fold higher (95% CI: 1.6–284.5, p=0.022) risk for EAD in cases with levels exceeding 580 ng/ml. The ASPA was lower in cases of initial non-function (p=0.028) but did not correlate with the rate of EAD (p=0.4). Conclusions This study demonstrates the feasibility of HMGB-1 detection in the graft effluent after cold storage. Along with conventional prognostic scores, it may be helpful to predict the early fate of a graft in human liver transplantation.
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Affiliation(s)
- Philipp Houben
- Department of General, Visceral, and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ralph Hohenberger
- Department of General, Visceral, and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Kenya Yamanaka
- Department of General, Visceral, and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral, and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Schemmer
- Department of General, Visceral, and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Matsushima Y, Mizutani K, Kato S, Kawakita F, Fujimoto M, Okada K, Kondo M, Habe K, Suzuki H, Mizutani H, Yamanaka K. 955 Stenotic changes of cerebral arteries and impaired brain glucose metabolism by long-lasting inflammatory cytokine release from dermatitis, but rescued by anti-IL-1 therapy. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Mizutani K, Okada K, Matsushima Y, Kondo M, Kakeda M, Habe K, Yamanaka K. 960 Hypoalbuminemia and inflammatory skin condition: Long-lasting inflammatory cytokine release from dermatitis may be related. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Farthing J, Ozeki T, Clement Lorenzo S, Nakajima N, Sartori F, De Tommasi G, Manduchi G, Barbato P, Rigoni A, Vitale V, Giruzzi G, Mattei M, Mele A, Imbeaux F, Artaud JF, Robin F, Noe J, Joffrin E, Hynes A, Hemming O, Wheatley M, O’hira S, Ide S, Ishii Y, Matsukawa M, Kubo H, Totsuka T, Urano H, Naito O, Hayashi N, Miyata Y, Namekawa M, Wakasa A, Oshima T, Nakanishi H, Yamanaka K. Status of the ITER remote experimentation centre. Fusion Engineering and Design 2018. [DOI: 10.1016/j.fusengdes.2018.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shimada H, Endo S, Sasahara Y, Shinmura T, Ozawa T, Majima H, Hara T, Imase R, Yamauchi S, Sakakibara Y, Kobayashi A, Yamazaki K, Jin Y, Yamanaka K, Matsubara O. P2.03-032 Efficacy and Safety of Osimertinib as Third-Line or Later Therapy for T790M-Positive Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Imase R, Endo S, Sasahara Y, Shinmura T, Ozawa T, Majima H, Hara T, Shimada H, Yamauchi S, Sakakibara Y, Kobayashi A, Yamazaki K, Jin Y, Yamanaka K, Matsubara O. P1.03-010 Efficacy and Safety of Anaplastic Lymphoma Kinase (ALK) Tyrosine Kinase Inhibitors in ALK-Positive Non-Small Cell Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mizutani K, Matsushima Y, Okada K, Yamagiwa A, Akeda T, Kondo M, Kakeda M, Habe K, Yamanaka K. 376 Is neutrophil the dominant IL-17 producer in psoriasis? J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Endo F, Kurita T, Yamanaka K. Astrocyte-derived extracellular vesicles contribute to the propagation of pathogenic protein in ALS. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Matsushima Y, Okada K, Mizutani K, Kondo M, Habe K, Yamanaka K. 507 Skin inflammation leads immunoglobulin G aggregation and deposition in multiple organs. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Fukuzawa S, Okino S, Kuroiwa N, Iwata Y, Uchiyama T, Yamanaka K, Inagaki M. 4779Myocardial uptake of bone scintigraphic agents associated with cardiac amyloidosis in daily practice. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.4779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yamanaka K, Yamagiwa A, Akeda T, Kondo M, Kakeda M, Habe K, Mizutani H. 179 Neutrophil is not the dominant IL-17 producer in psoriasis. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fuji H, Hatano E, Seo S, Arimoto A, Okabe M, Fujikawa T, Nishitai R, Ishii T, Kaihara S, Matsushita T, Oike F, Ichimiya M, Ohta S, Yamanaka K, Taura K, Yasuchika K, Uemoto S. Prospective registry for laparoscopic liver resection. Asian J Endosc Surg 2017; 10:173-178. [PMID: 27976516 DOI: 10.1111/ases.12351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/24/2016] [Accepted: 11/06/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Laparoscopic liver resection (LLR) has been widely performed throughout the world. Although prospective registry studies to clarify the safety of LLR have been feasible, no prior multicenter prospective study has addressed this issue. We have conducted a multicenter prospective cohort study to reveal the current status of LLR in Japan. METHODS From April 2015 to March 2016, candidates for LLR were preoperatively enrolled at 12 institutions. The primary end-point was surgical safety, which was evaluated based on surgical factors and on short-term and midterm outcomes. RESULTS A total of 102 patients were enrolled. Planned laparoscopic procedures included 96 pure laparoscopies, 1 hand-assisted laparoscopy, and 5 hybrid techniques. Non-anatomical partial resection or left lateral sectionectomy were performed in almost all cases. The median duration of surgery was 221 min. The median blood loss was 80.5 mL. Conversion was required for four patients (3.9%). The 90-day postoperative morbidities with grades more severe than II in the Clavien-Dindo classification were observed in six patients (5.9%). The median postoperative hospital stay was 9.5 days. No cases involved reoperation or mortality. CONCLUSION Minor resection of LLR has been performed safely. To ensure the safe dissemination of LLR, including for major resection, a larger multicenter prospective study is required.
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Affiliation(s)
- Hiroaki Fuji
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Satoru Seo
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Arimoto
- Department of Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Michio Okabe
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | | | - Ryuta Nishitai
- Department of Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Takamichi Ishii
- Department of Surgery, Nishi Kobe Medical Center, Kobe, Japan
| | - Satoshi Kaihara
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takakazu Matsushita
- Department of Surgery, National Hospital Organization Himeji Medical Center, Himeji, Japan
| | - Fumitaka Oike
- Department of Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Masato Ichimiya
- Department of Surgery, Japan Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Shuichi Ohta
- Department of Surgery, Osakafu Saiseikai Noe Hospital, Osaka, Japan
| | - Kenya Yamanaka
- Department of Surgery, Kishiwada City Hospital, Kishiwada, Japan
| | - Kojiro Taura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kentaro Yasuchika
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Yoh T, Hatano E, Yamanaka K, Nishio T, Seo S, Taura K, Yasuchika K, Okajima H, Kaido T, Uemoto S. Is Surgical Resection Justified for Advanced Intrahepatic Cholangiocarcinoma? Liver Cancer 2016; 5:280-289. [PMID: 27781200 PMCID: PMC5075804 DOI: 10.1159/000449339] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUNDS Prognosis for patients with advanced intrahepatic cholangiocarcinoma (ICC) with intrahepatic metastasis (IM), vascular invasion (VI), or regional lymph node metastasis (LM) remains poor. The aim of this study was to clarify the indications for surgical resection for advanced ICC. METHODS We retrospectively divided 213 ICC patients treated at Kyoto University Hospital between 1993 and 2013 into a resection (n=164) group and a non-resection (n=49) group. Overall survival was assessed after stratification for the presence of IM, VI, or LM. RESULTS Overall median survival times (MSTs) for the resection and non-resection groups were 26.0 and 7.1 months, respectively (p<0.001). After stratification, MSTs in the resection and non-resection groups, respectively, were 18.7 vs. 7.0 months for patients with IM (p<0.001), 23.4 vs. 5.7 months for those with VI (p<0.001), and 12.8 vs. 5.5 months for those with LM (p<0.001). CONCLUSION When macroscopic curative resection is possible, surgical resection can be justified for some advanced ICC patients with IM, VI, or LM.
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Affiliation(s)
| | - Etsuro Hatano
- *Etsuro Hatano, MD, PhD, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 (Japan), Tel. +81 75 751 4323, E-Mail
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Sekiya A, Kono M, Tsujiuchi H, Kobayashi T, Nomura T, Kitakawa M, Suzuki N, Yamanaka K, Sueki H, McLean W, Shimizu H, Akiyama M. Compound heterozygotes for filaggrin gene mutations do not always show severe atopic dermatitis. J Eur Acad Dermatol Venereol 2016; 31:158-162. [DOI: 10.1111/jdv.13871] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/16/2016] [Indexed: 12/24/2022]
Affiliation(s)
- A. Sekiya
- Department of Dermatology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - M. Kono
- Department of Dermatology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - H. Tsujiuchi
- Department of Dermatology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - T. Kobayashi
- Department of Dermatology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - T. Nomura
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - M. Kitakawa
- Department of Dermatology; Showa University School of Medicine; Tokyo Japan
| | - N. Suzuki
- Department of Dermatology; Toyohashi Municipal Hospital; Toyohashi Japan
| | - K. Yamanaka
- Department of Dermatology; Mie University School of Medicine; Tsu Japan
| | - H. Sueki
- Department of Dermatology; Showa University School of Medicine; Tokyo Japan
| | - W.H.I. McLean
- Centre for Dermatology and Genetic Medicine; College of Life Sciences and College of Medicine; Dentistry & Nursing; University of Dundee; Dundee UK
| | - H. Shimizu
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - M. Akiyama
- Department of Dermatology; Nagoya University Graduate School of Medicine; Nagoya Japan
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Affiliation(s)
- Helge Bruns Chair
- University Department of General and Visceral Surgery, European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany
| | - Hans-Rudolf Raab Chair
- University Department of General and Visceral Surgery, European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany
| | - Kenya Yamanaka
- Department of Surgery, Kishiwada City Hospital, Osaka, Japan
| | - Kestutis Strupas
- Center of Abdominal Surgery, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | - Peter Schemmer
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Kurokawa I, Senba Y, Kakeda M, Nishimura K, Hakamada A, Isoda K, Yamanaka K, Mizutani H, Tsubura A. Cytokeratin Expression in Subungual Squamous Cell Carcinoma. J Int Med Res 2016; 34:441-3. [PMID: 16989503 DOI: 10.1177/147323000603400416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cytokeratin expression in subungual squamous cell carcinoma was investigated in order to evaluate the origin and state of differentiation of the tumour. The tumour nests contained cytokeratin 14, 16 and 17, which were also expressed in the nail bed. Therefore, cytokeratin expression in subungual squamous cell carcinoma may reflect its indolent clinical prognosis.
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Affiliation(s)
- I Kurokawa
- Department of Dermatology, Mie University Graduate School of Medicine, Mie, Japan.
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Affiliation(s)
- K Yamanaka
- Department of Dermatology, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - H Mizutani
- Department of Dermatology, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Ito K, Kadoya N, Chiba M, Sato K, Nagasaka T, Yamanaka K, Dobashi S, Takeda K, Matsushita H, Jingu K. SU-F-I-24: Feasibility of Magnetic Susceptibility to Relative Electron Density Conversion Method for Radiation Therapy. Med Phys 2016. [DOI: 10.1118/1.4955852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Yamanaka K, Kakuta Y, Nakazawa S, Kato T, Abe T, Imamura R, Okumi M, Ichimaru N, Kyo M, Kyakuno M, Takahara S, Nonomura N. Induction Immunosuppressive Therapy With Everolimus and Low-Dose Tacrolimus Extended-Release Preserves Good Renal Function at 1 Year After Kidney Transplantation. Transplant Proc 2016; 48:781-5. [PMID: 27234735 DOI: 10.1016/j.transproceed.2015.12.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 12/07/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Utilization of everolimus (EVR) has been increasing in recent years for patients undergoing renal transplantation to reduce calcineurin inhibitor (CNI) levels. However, an optimum regimen has yet to be established. METHODS We retrospectively examined 12 renal transplant recipients who underwent an induction immunosuppressive protocol; the protocol comprises 5 agents, including EVR plus low-dose tacrolimus extended-release (TAC-ER) treatment. We compared those findings from those of 14 patients who underwent a conventional protocol without EVR. Clinical outcome and pathologic changes were assessed by using protocol graft biopsy findings obtained at 3 months and 1 year after transplantation. RESULTS The estimated glomerular filtration rate was significantly higher for the EVR group at both 3 months and 1 year compared with the conventional group (P < .01 and P = .03, respectively). TAC-ER trough levels were also significantly lower at 3 months and 1 year (both, P < .01). Histologic findings of the 3-month protocol biopsy samples in the EVR group revealed 4 cases of borderline change and 2 of acute cellular-mediated rejection. The findings from the 1-year biopsy samples revealed 10 cases with normal findings with no evidence of CNI toxicity. Patients in the EVR group developed subclinical borderline change and acute cellular-mediated rejection after 3 months at a significantly higher rate than the conventional group (P = .02). CONCLUSIONS Use of the present therapeutic strategy successfully maintained the trough of each drug at a lower level, and it also kept renal function stable up to 1 year after transplantation.
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Affiliation(s)
- K Yamanaka
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Kakuta
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - S Nakazawa
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - T Kato
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - T Abe
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - R Imamura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - M Okumi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - N Ichimaru
- Department of Advanced Technology for Transplantation, Osaka University Graduate School of Medicine, Osaka, Japan
| | - M Kyo
- Sakurabashi Iseikai Clinic, Osaka, Japan
| | - M Kyakuno
- Department of Renal Transplantation, Takatsuki General Hospital, Osaka, Japan
| | - S Takahara
- Department of Advanced Technology for Transplantation, Osaka University Graduate School of Medicine, Osaka, Japan
| | - N Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
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Ichimaru N, Obi Y, Nakazawa S, Yamanaka K, Kakuta Y, Abe T, Kaimori JY, Imamura R, Nonomura N, Moriyama T, Takahara S. Post-Transplant Anemia Has Strong Influences on Renal and Patient Outcomes in Living Kidney Transplant Patients. Transplant Proc 2016; 48:878-83. [DOI: 10.1016/j.transproceed.2016.01.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/14/2016] [Indexed: 10/21/2022]
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Ichimaru N, Nakazawa S, Yamanaka K, Kakuta Y, Abe T, Kaimori JY, Imamura R, Nonomura N, Takahara S. Adherence to Dietary Recommendations in Maintenance Phase Kidney Transplant Patients. Transplant Proc 2016; 48:890-2. [DOI: 10.1016/j.transproceed.2015.12.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/30/2015] [Indexed: 11/15/2022]
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Wu TH, Hatano E, Yamanaka K, Seo S, Taura K, Yasuchika K, Fujimoto Y, Nitta T, Mizumoto M, Mori A, Okajima H, Kaido T, Uemoto S. A non-smooth tumor margin on preoperative imaging predicts microvascular invasion of hepatocellular carcinoma. Surg Today 2016; 46:1275-81. [DOI: 10.1007/s00595-016-1320-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/24/2015] [Indexed: 12/22/2022]
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Tanabe K, Taura K, Koyama Y, Yamamoto G, Nishio T, Okuda Y, Nakamura K, Toriguchi K, Takemoto K, Yamanaka K, Iwaisako K, Seo S, Asagiri M, Hatano E, Uemoto S. Migration of splenic lymphocytes promotes liver fibrosis through modification of T helper cytokine balance in mice. J Gastroenterol 2015; 50:1054-68. [PMID: 25724556 DOI: 10.1007/s00535-015-1054-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 02/07/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sustained liver injury causes liver fibrosis and eventually cirrhosis. Understanding the pathophysiological mechanisms of liver fibrosis and interventions in the fibrotic process is crucial for improving the prognosis of patients with chronic liver diseases. Although studies have shown that splenectomy suppresses liver fibrosis, the mechanism by which this occurs is poorly understood. The present study focuses on the immunological functions of the spleen to investigate its role in liver fibrosis. METHODS BALB/c and severe combined immunodeficiency (SCID) mice underwent splenectomies or sham operations prior to induction of liver fibrosis with carbon tetrachloride or thioacetamide. RESULTS Sirius red staining and hydroxyproline assays showed that splenectomy suppressed liver fibrogenesis in BALB/c mice. Reverse transcription PCR analysis of T helper type 1 (Th1) and T helper type 2 (Th2) cytokines demonstrated that splenectomy shifted the Th1/Th2 balance in the liver towards Th1 dominance. In SCID mice, the inhibitory effect on liver fibrosis was abrogated. The number of CD4(+) T helper lymphocytes in the spleen decreased after liver injury. Green fluorescent protein positive (GFP(+)) splenocytes were transplanted into the spleens of syngeneic wild-type mice to trace their destination after fibrosis induction. GFP(+)CD4(+) lymphocytes appeared in the liver after induction of fibrosis, and flow cytometry revealed the vast majority of them were Th2 lymphocytes. Transfer of splenocytes via the portal vein into syngeneic splenectomized mice cancelled the suppressive effect of splenectomy on liver fibrosis. CONCLUSIONS The present study demonstrated that Th2-dominant splenic lymphocytes migrate into the liver and promote liver fibrosis by shifting the cytokine balance towards Th2 dominance. Splenectomy suppresses the progression of fibrosis at least partly by restoring the Th1/Th2 balance.
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Affiliation(s)
- Kazutaka Tanabe
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 6068507, Japan.
| | - Kojiro Taura
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 6068507, Japan.
| | - Yukinori Koyama
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 6068507, Japan
| | - Gen Yamamoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 6068507, Japan
| | - Takahiro Nishio
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 6068507, Japan
| | - Yukihiro Okuda
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 6068507, Japan
| | - Kojiro Nakamura
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 6068507, Japan
| | - Kan Toriguchi
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 6068507, Japan
| | - Kenji Takemoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 6068507, Japan
| | - Kenya Yamanaka
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 6068507, Japan
| | - Keiko Iwaisako
- Department of Target Therapy Oncology, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Satoru Seo
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 6068507, Japan
| | - Masataka Asagiri
- Innovation Center for Immunoregulation and Therapeutics, Graduate School of Medicine, Kyoto University, Yoshida Konoe, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 6068507, Japan
| | - Shinji Uemoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 6068507, Japan
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Iguchi K, Hatano E, Yamanaka K, Tanaka S, Taura K, Uemoto S. Validation of the Conventional Resection Criteria in Patients with Hepatocellular Carcinoma in Terms of the Incidence of Posthepatectomy Liver Failure and Long-Term Prognosis. Dig Surg 2015; 32:344-51. [PMID: 26227974 DOI: 10.1159/000431189] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 05/05/2015] [Indexed: 12/10/2022]
Abstract
BACKGROUND/AIMS Resection criteria in hepatocellular carcinoma (HCC) should be established based on the risk of posthepatectomy liver failure (PHLF) and the survival benefit from hepatectomy. This study aimed at verifying the validity of the conventional criteria regarding the incidence of PHLF and the long-term prognosis of HCC patients. METHODS A retrospective study was performed on 265 patients who underwent major hepatectomy. Makuuchi's criteria and the future liver remnant plasma clearance rate of indocyanine green (ICGK-rem) ≥0.05 criterion were evaluated. RESULTS A total of 107 and 158 patients were within and beyond Makuuchi's criteria, respectively. Makuuchi's criteria were associated with the incidence of PHLF (p = 0.03) but not with its severity (p = 0.12). No differences in disease-free survival (DFS) or overall survival (OS) were observed between the groups (p = 0.75 and p = 0.94, respectively). Using the ICGK-rem ≥0.05 criterion, 223 and 42 patients were within and beyond the criterion, respectively. ICGK-rem was correlated with both the incidence of PHLF (p = 0.002) and its severity (p = 0.03). No differences in DFS or OS were observed between the groups (p = 0.75 and p = 0.29, respectively). CONCLUSIONS Strict criteria are likely to preclude some patients from obtaining the greater survival benefits of hepatectomy. New criteria that consider patient prognosis are needed.
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Affiliation(s)
- Kohta Iguchi
- Department of Surgery, Graduate School of Medicine, Kyoto University Hospital, Kyoto, Japan
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