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Hayashi K, Sasaki H, Mugita T, Tomiyama T, Koizumi S, Kurokawa I, Matsubara E, Saito K, Fuji K, Ishikawa K, Fukagai T. Effect of long-term administration of Tadalafil on arteriosclerosis: A prospective cohort study. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.03.481] [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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Hayashi K, Sasaki H, Mugita T, Tomiyama T, Koizumi S, Kurokawa I, Saito K, Fuji K, Ishikawa K, Fukagai T. Association between vascular lesion and penile erection hardness in Japanese patients with erectile dysfunction. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.03.455] [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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Furiya Y, Tomiyama T, Oba N, Ikeda M, Ueno S. Rivastigmine improves patients’ appetite by increasing serum active ghrelin and cortisol in Alzheimer’s disease. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.928] [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: 11/25/2022]
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Hehenberger P, Vogel-Heuser B, Bradley D, Eynard B, Tomiyama T, Achiche S. Design, modelling, simulation and integration of cyber physical systems: Methods and applications. COMPUT IND 2016. [DOI: 10.1016/j.compind.2016.05.006] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Umeda T, Ramser EM, Yamashita M, Nakajima K, Mori H, Silverman MA, Tomiyama T. Erratum: Intracellular amyloid β oligomers impair organelle transport and induce dendritic spine loss in primary neurons. Acta Neuropathol Commun 2016; 4:7. [PMID: 26822851 PMCID: PMC4731904 DOI: 10.1186/s40478-016-0273-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 01/06/2016] [Indexed: 11/10/2022] Open
Abstract
The original version of this article unfortunately contained a mistake in the presentation of Fig. 1 in both the PDF and HTML versions of this manuscript [1]. In the right panel of the corrected Fig. 1d, the images of Mock cells, which were visualized with GFP and stained with Abeta oligomer-specific antibody 11A1, were replaced with those of APPWT cells, and instead the images of APPWT cells were replaced with those of Mock cells. These images had been incorrectly placed in the original Fig. 1. The correct version of Fig. 1 is presented below.
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Tanaka H, Yang GX, Tomiyama T, Tsuneyama K, Zhang W, Leung PSC, Coppel RL, Joh T, Nadler SG, Ansari AA, Bowlus C, Gershwin ME. Immunological potential of cytotoxic T lymphocyte antigen 4 immunoglobulin in murine autoimmune cholangitis. Clin Exp Immunol 2015; 180:371-82. [PMID: 25581259 DOI: 10.1111/cei.12581] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 12/13/2022] Open
Abstract
Cytotoxic T lymphocyte antigen 4 (CTLA-4) immunoglobulin (Ig) is an important regulator of T cell activation and a fusion protein directed at CD80 and CD86; it blocks co-stimulatory signalling and T cell activation. We have taken advantage of a murine model of human primary biliary cirrhosis (PBC), mice expressing a transforming growth factor (TGF)-β receptor II dominant negative (dnTGF-βRII) transgene to address the potential therapeutic efficacy of CTLA-4 Ig. To mimic patients with PBC at different stages or duration of disease, we treated mice with either CTLA-4 Ig or control IgG three times weekly from 3 to 12 or 24 weeks of age, or from 12 to 24 weeks of age. CTLA-4 Ig treatment from 3 weeks of age significantly reduced liver inflammation to 12 weeks of age. Treatment initiated at 12 weeks of age also ameliorated the autoimmune cholangitis at 24 weeks of age. However, in mice treated at 3 weeks of age, suppression of liver inflammation was not sustained and colitis was aggravated when treatment was extended to 24 weeks of age. Our data indicate that, in dnTGF-βRII mice, CTLA-4 Ig treatment has short-term beneficial effects on autoimmune cholangitis, but the effect varies according to duration of treatment and the time in which therapy was initiated. Further dissection of the events that lead to the reduction in therapeutic effectiveness of CTLA-4 Ig will be critical to determining whether such efforts can be applied to human PBC.
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Affiliation(s)
- H Tanaka
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA.,Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - G-X Yang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - T Tomiyama
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA.,Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - K Tsuneyama
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA.,Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama, Toyama, Japan
| | - W Zhang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - P S C Leung
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - R L Coppel
- Department of Microbiology, Monash University, Melbourne, Victoria, Australia
| | - T Joh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - S G Nadler
- Department of Immunology, Bristol Myers Squibb, Princeton, NJ, USA
| | - A A Ansari
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - C Bowlus
- Division of Gastroenterology and Hepatology, University of California at Davis School of Medicine, Sacramento, CA, USA
| | - M E Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
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Tanaka H, Zhang W, Yang GX, Ando Y, Tomiyama T, Tsuneyama K, Leung P, Coppel RL, Ansari AA, Lian ZX, Ridgway WM, Joh T, Gershwin ME. Successful immunotherapy of autoimmune cholangitis by adoptive transfer of forkhead box protein 3(+) regulatory T cells. Clin Exp Immunol 2014; 178:253-61. [PMID: 25041369 DOI: 10.1111/cei.12415] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 01/01/2023] Open
Abstract
Treatment of primary biliary cirrhosis (PBC) has lagged behind that of other autoimmune diseases. In this study we have addressed the potential utility of immunotherapy using regulatory T cells (Treg ) to treat murine autoimmune cholangitis. In particular, we have taken advantage of our ability to produce portal inflammation and bile duct cell loss by transfer of CD8(+) T cells from the dominant negative form of transforming growth factor beta receptor type II (dnTGF-βRII) mice to recombination-activating gene (Rag)1(-/-) recipients. We then used this robust established adoptive transfer system and co-transferred CD8(+) T cells from dnTGF-βRII mice with either C57BL/6 or dnTGF-βRII forkhead box protein 3 (FoxP3(+) ) T cells. Recipient mice were monitored for histology, including portal inflammation and intralobular biliary cell damage, and also included a study of the phenotypical changes in recipient lymphoid populations and local and systemic cytokine production. Importantly, we report herein that adoptive transfer of Treg from C57BL/6 but not dnTGF-βRII mice significantly reduced the pathology of autoimmune cholangitis, including decreased portal inflammation and bile duct damage as well as down-regulation of the secondary inflammatory response. Further, to define the mechanism of action that explains the differential ability of C57BL/6 Treg versus dnTGF-βRII Treg on the ability to down-regulate autoimmune cholangitis, we noted significant differential expression of glycoprotein A repetitions predominant (GARP), CD73, CD101 and CD103 and a functionally significant increase in interleukin (IL)-10 in Treg from C57BL/6 compared to dnTGF-βRII mice. Our data reflect the therapeutic potential of wild-type CD4(+) FoxP3(+) Treg in reducing the excessive T cell responses of autoimmune cholangitis, which has significance for the potential immunotherapy of PBC.
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Affiliation(s)
- H Tanaka
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA; Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Tomiyama T. Sexual dimorphism in scales of marbled flounder Pseudopleuronectes yokohamae (Pleuronectiformes: Pleuronectidae), with comments on the relevance to their spawning behaviour. J Fish Biol 2013; 83:1334-1343. [PMID: 24580668 DOI: 10.1111/jfb.12232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 08/15/2013] [Indexed: 06/03/2023]
Abstract
Variation of scales on the blind side of Pseudopleuronectes yokohamae in relation to sex, maturity and body size was examined. Immature males often have cycloid scales, while mature males have mostly ctenoid scales. Large females also often have ctenoid scales (but with fewer spines compared with males), and small females have mostly cycloid scales. The number of spines (ctenii) on the blind-side scale increases with body size in both sexes, indicating an ontogenetic change in scale morphology. As P. yokohamae spawn demersal eggs with males positioning themselves above the females on the ocular side, it is hypothesized that ctenoid scales on the blind side in mature males function for maintaining contact with females during spawning.
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Affiliation(s)
- T Tomiyama
- Soma Branch, Fukushima Prefectural Fisheries Experimental Station, Soma, Fukushima, 976-0022, Japan
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Abstract
The diet of juvenile (0 year old) stone flounder Platichthys bicoloratus after settlement was investigated in an estuarine habitat. The principal prey items included harpacticoids and palps of polychaetes in February and March and thereafter shifted to siphons of the bivalve Nuttallia olivacea from April to June. This seasonal change in diet occurred irrespective of body size, suggesting that other factors, such as morphological development of the predator or vulnerability of prey, induced the diet shift.
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Affiliation(s)
- T Tomiyama
- Graduate School of Agricultural Science, Tohoku University, Sendai 981-8555, Japan.
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Li F, Ozkaya E, Akula K, De Sutter P, Oktay K, Rives N, Milazzo JP, Perdrix A, Bironneau A, Travers A, Mace B, Liard A, Bachy B, Elbaz V, Vannier JP, Delle Piane L, Dolfin E, Salvagno F, Molinari E, Gennarelli G, Marchino GL, Revelli A, Durmaz A, Komurcu N, Sanchez-Serrano M, Dolmans MM, Greve T, Pellicer A, Donnez J, Yding Andersen C, Vlismas A, Sabatini L, Edwards C, Mohamed M, Caragia A, Pepas L, Al-Shawaf T, Sanhueza P, Carrasco I, Rios M, Donoso P, Salinas R, Enriquez R, Saez V, Gonzalez P, Aydin Y, Cepni I, Ocal P, Aydin B, Aydogan B, Salahov R, Idil M, Akman L, Akdogan A, Sahin G, Terek C, Ozsaran A, Dikmen Y, Goker ENT, Tavmergen E, Grynberg M, Poulain M, Sebag Peyrelevade S, Treves R, Frydman N, Fanchin R, Borras A, Manau D, Espinosa N, Calafell JM, Moreno V, Civico S, Fabregues F, Balasch J, Kim MK, Lee DR, Cha SK, Lee WS, Kim YS, Won HJ, Han JE, Yoon TK, Torgal M, Bravo I, Metello JL, Sanches F, Sa e Melo P, Silber S, Ernst E, Andersen C, Naasan M, Oluyede G, Kirkham C, Ciprike V, Mocanu E, Martinez-Madrid B, Encinas T, Tinetti P, Jimenez L, Gilabert JA, Picazo RA, Wiweko B, Maidarti M, Bastings L, Liebenthron J, Westphal JR, Beerendonk CCM, Gerritse R, Braat DDM, Montag M, Peek R, Bernstein S, Wiesemann C, Karimi M, Omani Samani R, Labied S, Delforge YVES, Munaut C, Blacher S, Colige A, Delcombel R, Henry L, Fransolet M, Perrier d'Hauterive S, Nisolle M, Foidart JM, Sakai H, Sakamoto E, Kuchiki M, Doshida M, Toya M, Kyono K, Kyoya T, Ishikawa T, Nakamura Y, Shibuya Y, Tomiyama T, Kyono K, Sakamoto E, Sakai H, Kuchiki M, Sato K, Nakajo Y, Kyono K, Hashemifesharaki M, Falcone P, Lofiego V, Pisoni M, Ricci S, Pilla F, Mereu L, Mencaglia L, Westphal JR, Gerritse R, Beerendonk CCM, Bastings L, Braat DDM, Peek R, Schmidt KT, Nyboe Andersen A, Yding Andersen C, Noyes N, Melzer K, Fino ME, Druckenmiller S, Smith M, Knopman JM, Devesa M, Coroleu B, Tur R, Gonzalez C, Rodriguez I, Veiga A, Barri PN, Courbiere B, Decanter C, Bringer-Deutsch S, Rives N, Mirallie S, Pech JC, De Ziegler D, Carre-Pigeon F, May-Panloup P, Sifer C, Amice V, Schweitzer T, Porcu-Buisson G, Gook D, Archer J, Edgar DH, Maldonado I, Varghese A, Lopez P, Cervantes E, Gongora A, Sharma R, Granja J, Marquez MT, Agarwal A. MALE AND FEMALE FERTILITY PRESERVATION. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.82] [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: 11/14/2022] Open
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Yoshihara E, Takahashi T, Otsuka N, Isayama T, Tomiyama T, Hiraga A, Wada S. Heel movement in horses: comparison between glued and nailed horse shoes at different speeds. Equine Vet J 2011:431-5. [PMID: 21059041 DOI: 10.1111/j.2042-3306.2010.00243.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
REASONS FOR PERFORMING STUDY It has been suggested that the heel of the horse's hoof expands in the stance phase and this reduces the concussion at impact and helps pump blood into the hoof. Therefore, farriers usually leave a gap in the heel region when using the traditional nailed shoe. Recently glued shoes which are attached firmly to the heel have been developed and these could restrict heel movement. OBJECTIVE To compare the degree of mediolateral heel movement between glued and nailed shoes. METHODS Seven Thoroughbreds were used. Either their fore- or hind hooves were shod with plain aluminium shoes, attached first with glue and later with nails. Measurements were collected continuously with a displacement sensor fixed between the medial and lateral hoof walls at the heel. The horses ran on a treadmill at a walk (1.8 m/s), trot (3.5 m/s), canter (8 m/s) and gallop (12 m/s). The mediolateral heel movement in a nonweightbearing position was set at zero for each hoof and thus positive and negative numbers represented expansion and contraction, respectively. Average values of 10 consecutive strides at each speed were compared between the 2 shoeing methods by paired t test. RESULTS At all running speeds, the heels expanded in the first 70-80% of the stance phase and contracted at breakover. The total heel movement calculated as the sum of the maximum expansion and contraction value was less with glued shoeing than with nailed shoeing for walking (all limbs), trotting (all limbs), cantering (leading forelimb and both hindlimbs) and galloping (both hindlimbs). CONCLUSIONS Glueing restricted heel movement, suggesting possible interference with shock absorption and blood pumping in the hoof. Further study is needed to evaluate the influence of glued shoeing on hoof mechanics.
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Affiliation(s)
- E Yoshihara
- Equine Research Institute, Japan Racing Association, Tokami-cho, Utsunomiya, Tochigi, Japan.
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Tomiyama T, Watanabe M, Kawata G, Ebe K. Post-release feeding and growth of hatchery-reared Japanese flounder Paralichthys olivaceus: relevance to stocking effectiveness. J Fish Biol 2011; 78:1423-1436. [PMID: 21539551 DOI: 10.1111/j.1095-8649.2011.02949.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The feeding and growth of hatchery-reared (HR) Japanese flounder Paralichthys olivaceus of c. 100 mm total length (L(T) ) released off the coast of Fukushima, Japan, were investigated. From 2 to 15 days after release, the HR P. olivaceus frequently exhibited high empty-stomach frequency (>40%), low stomach-content mass (<1% of body mass), reduced somatic condition from release (c.-10%) and negligible growth. Thereafter, empty-stomach frequency decreased, the stomach-content mass of HR fish increased to 2-8% of body mass, the somatic condition recovered and growth rate increased to 0·5-1·5 mm day(-1) . Prey items were initially mysids, shifting thereafter to fishes such as the Japanese anchovy Engraulis japonica, as observed similarly in wild counterparts. The proportion of mysids decreased with time after release irrespective of size at release, indicating the importance of mysids for adaptation to natural food. Recapture rates at age 1 year, derived from fish market surveys, varied greatly among release years (4-11%). The variation in the recapture rates was largely accounted for by the post-release growth rates (r(2) = 0·5), suggesting a relationship between the post-release growth of HR fish and their survival and subsequent stocking effectiveness.
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Affiliation(s)
- T Tomiyama
- Fukushima Prefectural Fisheries Experimental Station, Iwaki, Fukushima 970-0316, Japan.
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Naruishi K, Omori K, Maeda H, Sonoi N, Funakoshi K, Hirai K, Ishii M, Kubo K, Kobayashi H, Tomiyama T, Yamamoto D, Tanimoto I, Kunimatsu K, Takashiba S. Immune responses to porphyromonas gingivalis infection suppress systemic inflammatory response in experimental murine model. J BIOL REG HOMEOS AG 2011; 25:195-202. [PMID: 21880208] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Periodontitis is a localized infectious disease caused by periodontopathic bacteria such as Porphyromonas gingivalis (P. gingivalis), and the severity correlates to significance of immune responses. Recently, it has been reported that periodontitis is associated with the development of systemic disease such as diabetes and atherosclerosis because of increasing invasion of oral pathogens to the circulation. However, the association between local and systemic infectious responses is still unclear. In the present study, we examined the differences of biological responses in animals with or without bacterial infection. After Balb/c mice were infected subcutaneously with live P. gingivalis W83, serum, skin and liver were collected according to experimental protocol. The skin and liver tissues were observed pathologically by haematoxylin-eosin staining, and serum IL-6 levels were measured using ELISA method. Throughout the experimental period, conditions of the mice were observed continuously. As expected, severe infiltration of leukocytes were observed at inflamed skin corresponding to the number of bacterial challenges. Although no inflammatory appearance of skin was observed, serum IL-6 levels were increased dramatically (P <0.01, Student's t-test) and liver tissues were injured in the mice without bacterial challenge. Interestingly, although severe inflammatory appearance of the skin was observed, serum IL-6 levels were not increased and no inflammatory responses were observed in the liver of the 3-times bacterially challenged group. Importantly, immunoglobulin G against P. gingivalis W83 was detected in the blood of mice with 3-times bacterial challenge corresponding to improvement of weight loss and survival. In conclusion, although multiple infections develop severe localized inflammation, the immune system should be sufficient to protect the systemic inflammatory responses.
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Affiliation(s)
- K Naruishi
- Division of Endodontology, Iwate Medical University, Department of Conservative Dentistry and Oral Rehabilitation, Morioka, Japan.
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Tomiyama T, Schmidt CL. THE SOLUBILITIES OF l-PROLINE AND l-HYDROXYPROLINE IN WATER, THE CALCULATED HEATS OF SOLUTION, AND THE PARTIAL MOLAL VOLUME OF l-HYDROXYPROLINE. ACTA ACUST UNITED AC 2010; 19:379-82. [PMID: 19872934 PMCID: PMC2141437 DOI: 10.1085/jgp.19.2.379] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- T Tomiyama
- Division of Biochemistry, University of California Medical School, Berkeley
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Tomiyama T, Ebe K, Kawata G, Fujii T. Post-release predation on hatchery-reared Japanese flounder Paralichthys olivaceus in the coast of Fukushima, Japan. J Fish Biol 2009; 75:2629-2641. [PMID: 20738512 DOI: 10.1111/j.1095-8649.2009.02456.x] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
To determine the predators of 100 mm total length hatchery-reared juvenile Japanese flounder Paralichthys olivaceus, fishes and crabs were collected using gillnets and a small trawl net off the coast of Fukushima Prefecture, Japan. Predation on juvenile P. olivaceus by older conspecifics, the snailfish Liparis tanakai, ocellate spot skate Okamejei kenojei and the swimming crab Ovalipes punctatus, was detected based on analogical observation and molecular techniques. These predators are nocturnal feeders except for P. olivaceus. Liparis tanakai with body sizes large enough to consume juveniles only appeared in winter, whereas the large O. punctatus was abundant in early summer and in late autumn. Such seasonal variation in predator abundance indicates that the release season can be optimized for reducing predation mortality.
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Affiliation(s)
- T Tomiyama
- Fukushima Prefectural Fisheries Experimental Station, Iwaki, Fukushima 970-0316, Japan.
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Miyata H, Fukutomi N, Matsuba J, Koizumi A, Matsubayashi H, Tomiyama T. Are there any differences for hatching by assisted hatching to blastocyst between at near or the opposite site of the ICM? Fertil Steril 2009. [DOI: 10.1016/j.fertnstert.2009.07.1243] [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: 11/24/2022]
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Tomiyama T, Watanabe M, Kurita Y. Rapid fluctuation in infection levels of Neoheterobothrium hirame (Monogenea) in Japanese flounder Paralichthys olivaceus in the Joban area, Japan. J Fish Biol 2009; 75:172-185. [PMID: 20738490 DOI: 10.1111/j.1095-8649.2009.02278.x] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Neoheterobothrium hirame a haematophagous monogenean parasite on Japanese flounder Paralichthys olivaceus occurred at high prevalences (> 70%) from 1999 to 2002 but thereafter declined and remained low (< 20%) from 2003 to 2005 in the Joban area, Japan. In 2006, N. hirame became abundant again reaching a prevalence of 63%. Generalized linear models explained these rapid fluctuations in infection in relation to inshore water temperature, which affected the reproductive success of the parasite, and also the encounter rate between host and parasite through changes in their respective population densities. Severely anaemic fish were few, 2.4% even in 1999-2002 and 2006, suggesting that the effect of N. hirame infection on the P. olivaceus population was small in this area.
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Affiliation(s)
- T Tomiyama
- Fukushima Prefectural Fisheries Experimental Station, Iwaki, Fukushima 970-0316, Japan.
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Miyata H, Tomiyama T, Fukutomi N, Matsuba J, Koizumi A, Yokota M. Comparison of number of cell at the time of confirmation of early cleavage is useful criteria in selecting good embryos. Fertil Steril 2008. [DOI: 10.1016/j.fertnstert.2008.07.603] [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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Miyata H, Fukutomi N, Matsuba J, Yokota M, Koizumi A, Tomiyama T. Differences of the forms of hatching and pregnancy rates, between laser-assisted ICSI and non-laser ICSI. Fertil Steril 2007. [DOI: 10.1016/j.fertnstert.2007.07.385] [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: 11/16/2022]
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Matsuba J, Fukutomi N, Miyata H, Koizumi A, Yokota M, Tomiyama T. The effect of cumulus co-culture in ICSI. Fertil Steril 2007. [DOI: 10.1016/j.fertnstert.2007.07.393] [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: 11/30/2022]
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Mutoh H, Sakurai S, Satoh K, Osawa H, Tomiyama T, Kita H, Yoshida T, Tamada K, Yamamoto H, Isoda N, Ido K, Sugano K. Pericryptal fibroblast sheath in intestinal metaplasia and gastric carcinoma. Gut 2005; 54:33-9. [PMID: 15591501 PMCID: PMC1774373 DOI: 10.1136/gut.2004.042770] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 05/27/2004] [Accepted: 06/03/2004] [Indexed: 12/08/2022]
Abstract
BACKGROUND AND AIMS In the progression of chronic gastritis, gastric mucosal cells deviate from the normal pathway of gastric differentiation to an intestinal phenotype which is closely related to gastric carcinoma. However, to date, it has not been elucidated whether the intestinal metaplasia is merely a change in the epithelium or whether the underlying mesenchyme also changes from gastric type to intestinal type. We have investigated the relationship between intestinal metaplasia and the pericryptal fibroblast sheath (PCFS) in the mesenchyme. In addition, we also examined PCFS in gastric carcinoma. METHODS We determined the existence of PCFS in the intestinal metaplastic mucosa and carcinoma of both human and Cdx2 transgenic mouse stomach. PCFS was determined using the antibody against alpha-smooth muscle actin and electron microscopic observations. RESULTS PCFS formed an almost complete layer around the small and large intestinal crypts while it did not exist around the normal gastric glands in both mice and humans. PCFS was seen around the glands of intestinal metaplastic mucosa in both Cdx2 transgenic mouse and human stomachs. However, PCFS was virtually absent in the intestinal-type gastric adenocarcinoma area. CONCLUSION We successfully demonstrated that the epithelium as well as the mesenchyme changed from the gastric type to the intestinal type in intestinal metaplasia and that PCFS disappeared in intestinal-type gastric carcinoma.
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Affiliation(s)
- H Mutoh
- Department of Gastroenterology, Jichi Medical School, Yakushiji 3311-1, Minamikawachimachi, Kawachigun, Tochigi 329-0498, Japan.
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Kai T, Uchiyama S, Nishi Y, Kobayashi Y, Tomiyama T. Two States of the Triple Helix in the Thermal Transition of the Collagen Model Peptide (Pro-Pro-Gly)10. J Biomol Struct Dyn 2004; 22:51-8. [PMID: 15214805 DOI: 10.1080/07391102.2004.10506980] [Citation(s) in RCA: 5] [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: 10/28/2022]
Abstract
The collagen model peptide (Pro-Pro-Gly)10 is known to fold into a triple helix in solution. So far, the triple helix has been considered to exist as a single state. However, our previous study of (Pro-Pro-Gly)10 in solution has indicated the presence of two different states of the triple helix, a lower (HL) and a higher temperature state (HH). In the present study, these triple-helical states were investigated in more detail by NMR. Complete stereospecific assignments of the methylene protons of the proline residues were accomplished by the use of NOESY and TOCSY spectra. The temperature dependence of the 1H chemical shifts showed that the HL-to-HH thermal transition can be attributed to a conformational change of the first proline (Pro1) residues of the (Pro-Pro-Gly) triplets. Since TOCSY spectra with a 10 ms mixing-time confirmed a down puckering of these Pro residues in the HL state, but interconverting down and up puckerings in the HH state, the HL-to-HH thermal transition corresponds to conformational changes of the pyrrolidine rings of the Pro1 residues from an uniform down puckering to a more flexible state. The results confirm that thermal unfolding of the triple helix proceeds through the intermediate HH state.
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Affiliation(s)
- T Kai
- Department of Chemistry, Graduate School of Science, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, 464-8602, Japan
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Mukaida T, Nakamura S, Tomiyama T, Wada S, Oka C, Kasai M, Takahashi K. Vitrification of human blastocysts using cryoloops: clinical outcome of 223 cycles. Hum Reprod 2003; 18:384-91. [PMID: 12571178 DOI: 10.1093/humrep/deg047] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.7] [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: 11/14/2022] Open
Abstract
BACKGROUND The need to cryopreserve human blastocysts is increasing. The successful birth has been reported of a baby from a blastocyst vitrified using the cryoloop technique. The present study expands on this earlier report to confirm the effectiveness of this vitrification procedure. METHODS In patients undergoing IVF at one of three clinics, supernumerary blastocysts on day 5 or 6 at various stages of development were vitrified using cryoloops. RESULTS Of 725 vitrified blastocysts, 583 (80.4%) survived. After the transfer of 493 blastocysts in 207 cycles, 76 women (37%) became clinically pregnant. Among these women, 21 pregnancies ended in miscarriage, 23 healthy babies were born in 18 deliveries, and 37 pregnancies are ongoing. The survival rate of day 5 blastocysts (87%) was higher than that of day 6 blastocysts (55%), but implantation rates and pregnancy rates were not statistically significantly different. CONCLUSIONS Clinical outcomes with 725 blastocysts and 207 transfers showed that vitrification using cryoloops is effective and practical for the cryopreservation of human blastocysts. Early blastocysts on day 5 seem to be the most suitable in terms of stage and age for cryopreservation, but developed and day 6 blastocysts can also be cryopreserved.
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Affiliation(s)
- T Mukaida
- Hiroshima HART Clinic, 5-7-10 Ohtemchi, Naka-ku, Hiroshima, Osaka HART Clinic, Snowcrystal 10F 2-6-20, Umeda, Kita-ku, Osaka, Japan
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Ozawa K, Tomiyama T, Maat-Schieman ML, Roos RA, Mori H. Enhanced Abeta40 deposition was associated with increased Abeta42-43 in cerebral vasculature with Dutch-type hereditary cerebral hemorrhage with amyloidosis (HCHWA-D). Ann N Y Acad Sci 2002; 977:149-54. [PMID: 12480745 DOI: 10.1111/j.1749-6632.2002.tb04810.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 12/01/2022]
Abstract
Cerebrovascular deposition of the amyloid beta-protein (Abeta) is a common pathologic event in patients with Alzheimer's disease (AD) and certain related disorders. Such an Abeta vascular deposition occurs primarily in the medial layer of the cerebral vessel wall in an assembled fibrillar state. These deposits are associated with several pathological responses, including degeneration of the smooth muscle cells in the cerebral vessel wall. Severe cases of cerebrovascular Abeta deposition are also accompanied by loss of vessel wall integrity and hemorrhagic stroke. Although the reasons for this pathological consequence are unclear, altered proteolytic mechanisms within the cerebral vessel wall may be involved. We analyzed cerebral Abeta deposition in brains with AD and Dutch-type hereditary cerebral hemorrhage with amyloidosis (HCHWA-D) on the basis of two amyloid species of Abeta(40) and Abeta(42/43) using specific monoclonal antibodies. Compared to Abeta deposition in senile plaques, the molecular composition of Abeta was distinguishable, indicating that the Abeta(40) species is the main component for vascular amyloid. Furthermore, we found Abeta(42/43) immunoreactivity was also much increased in amyloid angiopathy of all cases with HCHWA-D. Taken together, amyloid angiopathy in HCHWA-D may share an Abeta(42)-driven deposition mechanism with plaque amyloid, resulting in enhanced Abeta(40) deposition.
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Affiliation(s)
- K Ozawa
- Department of Neuroscience, Institute of Gerontology, Osaka City University, 1-4-3 Asahimachi, Abenoku, Osaka 545-8585, Japan
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Tamada K, Tomiyama T, Wada S, Ohashi A, Ido K, Sugano K. Safe percutaneous canalization of the biliary tree using a sheath in patients with malignant biliary stenosis. Abdom Imaging 2002; 27:549-51. [PMID: 12172995 DOI: 10.1007/s00261-001-0083-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Percutaneous canalization of the bile duct is essential for radiologic interventions of the biliary tract. This study discusses technical considerations for safe approaches for canalization of the bile duct when using a sheath. METHODS During early and late periods, percutaneous canalization was performed in 104 patients and 79 patients with malignant biliary stenosis, respectively. The late period differed from the early period in that the bile duct was canalized with a previously placed sheath to prevent catheter dislodgement during the procedure. RESULTS During the early and late periods, catheter dislodgement during canalization occurred in three of 104 patients (3%) and none of 79 patients (0%), respectively. The success rate of canalization without cholangioscopy in the late period (99%) was better than that in the early period (89%; p < 0.05). CONCLUSION Placement of a sheath into the biliary tree increases the safety and success of canalization in patients with malignant stenosis.
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Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi 329-0498, Japan
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Tamada K, Tomiyama T, Wada S, Ohashi A, Satoh Y, Ido K, Sugano K. Endoscopic transpapillary bile duct biopsy with the combination of intraductal ultrasonography in the diagnosis of biliary strictures. Gut 2002; 50:326-31. [PMID: 11839709 PMCID: PMC1773153 DOI: 10.1136/gut.50.3.326] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND When endoscopic retrograde cholangiopancreatography (ERCP) guided bile duct biopsy fails to demonstrate malignancy, it remains unclear how to manage patients with presumably malignant strictures. AIMS To evaluate the value of intraductal ultrasonography (IDUS) when bile duct biopsy is negative. METHODS Sixty two patients with strictures of the bile duct were studied prospectively. During ERCP, IDUS was performed using an ultrasonic probe (diameter 2.0 mm; frequency 20 MHz). Following IDUS, a bile duct biopsy was performed using forceps (diameter 1.8 mm). The IDUS images of the tumour were classified as polypoid lesions, localised wall thickening, intraductal sessile tumours, sessile tumour outside of the bile duct, or absence of apparent lesion. The bile duct wall structures at the site of the tumour as well as the maximum diameter of the tumour were also analysed. The IDUS findings were compared with the histological findings or clinical course. RESULTS When the IDUS images showed a polypoid lesion (n=19), localised wall thickening (n=8), intraductal sessile tumour (n=13), and sessile tumour outside of the bile duct (n = 20), the sensitivities of the biopsy were 80%, 50%, 92%, and 53%, respectively. Multiple regression analysis showed that the presence of sessile tumour (intraductal or outside of the bile duct: p<0.05), tumour size greater than 10.0 mm (p<0.001), and interrupted wall structure (p<0.05) were independent variables that predicted malignancy. CONCLUSION When biopsy fails to demonstrate evidence of malignancy, the presence of sessile tumour (intraductal or outside of the bile duct), tumour size greater than 10.0 mm, and interrupted wall structure on IDUS images are factors that can predict malignancy.
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Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi 329-0498, Japan
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Abstract
BACKGROUND To clarify the cholangiographic findings of early-stage (T1, tumor confined to the mucosal or fibromuscular layer) extrahepatic bile duct carcinoma. METHODS Cholangiographic images were retrospectively analyzed without other information in 55 patients with extrahepatic bile duct carcinoma who underwent surgical treatment. Tumor stages were T1 (n = 10). T2 (n = 17), and T3 (n = 28). Cholangiographic findings were classified as "diffuse sclerosis," "stenosis," "papillary polypoid filling defect," or "nodular polypoid filling defect". "Papillary polypoid filling defect" was the term used when the width of the base was smaller than the width of the polypoid filling defect. RESULTS T1 patients showed papillary polypoid filling defects (n = 8) or nodular polypoid filling defects (n = 2) on cholangiography. When cholangiography showed papillary polypoid filling defects, 8 of the 14 resected patients showed T1 stage tumor histologically. CONCLUSIONS In this study, 57% (8/14) of resected patients with papillary polypoid filling defects showed T1 stage tumor. No T1 stage tumor showed stenosis or diffuse sclerosis.
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Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan
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Tamada K, Kanai N, Wada S, Tomiyama T, Ohashi A, Satoh Y, Ido K, Sugano K. Utility and limitations of intraductal ultrasonography in distinguishing longitudinal cancer extension along the bile duct from inflammatory wall thickening. Abdom Imaging 2001; 26:623-31. [PMID: 11907728 DOI: 10.1007/s002610000208] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND We wanted to distinguish wall thickening caused by cancer extension from that caused by inflammation after placing a biliary catheter on intraductal ultrasonography (IDUS). METHODS We studied 51 patients with biliary tract malignancies who had undergone placement of biliary drainage catheters before IDUS. IDUS was performed from a transhepatic (n = 34) or transpapillary (n = 17) route with a thin-caliber ultrasonic probe (2.0 mm in diameter, 20-MHz frequency). At the hepatic side of the tumor, the thickness, asymmetry, outer margin, inner margin, and internal echoes of the bile duct wall were reviewed prospectively and correlated with the histologic findings of the surgically resected specimens in all cases. RESULTS When IDUS showed wall thickening in a semicircular fashion, notched outer margin, rigid inner margin, papillary inner margin, and heterogeneous internal echoes, each finding had a positive predictive value for diagnosing cancer extension (100%, 100%, 83%, 100%, and 90%, respectively). When these factors were used as the diagnostic criteria of cancer extension, IDUS accurately demonstrated suitable surgical margins in 76% of all patients and 71% of patients with bile duct carcinoma. CONCLUSION Wall thickening in a semicircular fashion, notched outer margin, rigid or papillary inner margin, and heterogeneous internal echoes are specific for cancer extension. However, surgical margins can be inaccurately assessed in some patients.
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Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan
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Cao B, Hasegawa M, Okada K, Tomiyama T, Okazaki T, Suenaga K, Shinohara H. EELS and 13C NMR characterization of pure Ti2@C80 metallofullerene. J Am Chem Soc 2001; 123:9679-80. [PMID: 11572692 DOI: 10.1021/ja016484w] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- B Cao
- Department of Chemistry, Nagoya University, Nagoya 464-8602, Japan
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Mukaida T, Takahashi K, Kasai M, Tomiyama T, Nakamura S, Wada S. Pregnancies and deliveries after transfer of vitrified human blastocysts using a cryoloop container-less technique. Fertil Steril 2001. [DOI: 10.1016/s0015-0282(01)02248-8] [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: 11/17/2022]
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Mukaida T, Nakamura S, Tomiyama T, Wada S, Kasai M, Takahashi K. Successful birth after transfer of vitrified human blastocysts with use of a cryoloop containerless technique. Fertil Steril 2001; 76:618-20. [PMID: 11532492 DOI: 10.1016/s0015-0282(01)01968-9] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.0] [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: 11/24/2022]
Abstract
OBJECTIVE Clinical application of vitrification for the cryopreservation of human blastocysts. DESIGN Clinical trial of vitrification of human blastocysts. SETTING Private assisted reproductive technology clinic. PATIENT(S) Supernumerary blastocysts after fresh blastocyst transfer were vitrified for subsequent transfer. INTERVENTION(S) Culture of pronuclear embryos to the blastocyst stage in sequential media and subsequent vitrification of supernumerary blastocysts using a cryoloop technique. MAIN OUTCOME MEASURE(S) Clinical outcome after transfer of vitrified blastocysts. RESULT(S) A total of 60 vitrified blastocysts from 21 patients were warmed, and the survival rate at 2 hours after warming was 63%. Six clinical pregnancies were achieved after 19 transfers. One healthy baby was born, four pregnancies are ongoing, and one ended in miscarriage. CONCLUSION(S) Human blastocysts can be successfully vitrified by suspension on a small nylon loop and a direct plunge into liquid nitrogen. A delivery and ongoing pregnancies prove the safety of this method. This report documents the first successful pregnancy and delivery achieved by blastocyst vitrification using the cryoloop containerless technique.
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Abstract
A case of symptomatic duodenal duplication cyst is reported. The patient underwent endoscopic partial resection of the cystic wall using the O-ring ligation kit. After resection, the abdominal pain disappeared. Endoscopic partial resection is useful for diagnosis and treatment of duodenal duplication cyst.
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Affiliation(s)
- S Wada
- Dept. of Gastroenterology, Jichi Medical School, Tochigi, Japan.
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Ishii K, Lippa C, Tomiyama T, Miyatake F, Ozawa K, Tamaoka A, Hasegawa T, Fraser PE, Shoji S, Nee LE, Pollen DA, St George-Hyslop PH, Ii K, Ohtake T, Kalaria RN, Rossor MN, Lantos PL, Cairns NJ, Farrer LA, Mori H. Distinguishable effects of presenilin-1 and APP717 mutations on amyloid plaque deposition. Neurobiol Aging 2001; 22:367-76. [PMID: 11378241 DOI: 10.1016/s0197-4580(01)00216-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Both APP and PS-1 are causal genes for early-onset familial Alzheimer's disease (AD) and their mutation effects on cerebral Abeta deposition in the senile plaques were examined in human brains of 29 familial AD (23 PS-1, 6 APP) cases and 14 sporadic AD cases in terms of Abeta40 and Abeta42. Abeta isoform data were evaluated using repeated measures analysis of variance which adjusted for within-subject measurement variation and confounding effects of individual APP and PS-1 mutations, age at onset, duration of illness and APOE genotype. We observed that mutations in both APP and PS-1 were associated with a significant increase of Abeta42 in plaques as been documented previously. In comparison to sporadic AD cases, both APP717 and PS-1 mutation cases had an increased density (measured as the number of plaques/mm(2)) and area (%) of Abeta42 plaques. However, we found an unexpected differential effect of PS-1 but not APP717 mutation cases. At least some of PS-1 but not APP717 mutation cases had the significant increase of density and area of Abeta40-plaques as compared to sporadic AD independently of APOE genotype. Our results suggest that PS-1 mutations affect cerebral accumulation of Abeta burden in a different fashion from APP717 mutations in their familial AD brains.
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Affiliation(s)
- K Ishii
- Department of Molecular Biology, Tokyo Institute of Psychiatry, Tokyo, Japan
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Tamada K, Isoda N, Wada S, Tomiyama T, Ohashi A, Satoh Y, Ido K, Sugano K. Intraductal ultrasonography for hepatocellular carcinoma with tumor thrombi in the bile duct: comparison with polypoid cholangiocarcinoma. J Gastroenterol Hepatol 2001; 16:801-5. [PMID: 11446890 DOI: 10.1046/j.1440-1746.2001.02527.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIM Tumor thrombi in the bile duct caused by hepatocellular carcinoma (HCC), and cholangiocarcinoma show polypoid lesions on cholangiographic findings. This study prospectively compared the images of intraductal ultrasonography between HCC and polypoid cholangiocarcinoma. METHODS In five patients with tumor thrombi in the bile duct caused by HCC, a 2.0 mm diameter ultrasonic probe with a frequency of 20 MHz was inserted into the bile duct via the transpapillary route (n = 4) or the transhepatic route (n = 1). The images were compared to that of 65 patients with cholangiocarcinoma. RESULTS In all patients with HCC, intraductal ultrasonography showed a 'polypoid tumor with a narrow base'. In 16 of 65 patients with cholangiocarcinoma, it showed a 'polypoid tumor with a narrow base'. When intraductal ultrasonography showed a 'polypoid tumor with a narrow base', the findings of a positive 'nodule within a nodule' (40 vs 0%; P < 0.05), and the absence of a 'papillary-surface pattern' (80 vs 13%; P < 0.05) were more highly associated with tumor thrombi caused by HCC than to polypoid-type cholangiocarcinoma. CONCLUSIONS Intraductal ultrasonography was useful to distinguish between tumor thrombi caused by HCC and polypoid-type cholangiocarcinoma.
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Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan.
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Higashizawa T, Tamada K, Tomiyama T, Wada S, Ohashi A, Satoh Y, Gotoh Y, Ido K, Sugano K. Looping technique for transpapillary selective biopsy of the left hepatic duct. J Gastroenterol 2001; 36:492-4. [PMID: 11480794 DOI: 10.1007/s005350170073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Because biopsy forceps tend to turn towards the right hepatic duct during endoscopic retrograde cholangiopancreatography (ERCP), selective access to the left hepatic duct is difficult. METHODS In this study, we managed to insert biopsy forceps selectively into the left hepatic duct, by using a looping technique, in three patients. Biopsy forceps were inserted into the right hepatic duct by the conventional method. The elevator of the endoscope was kept down, and the shaft of the biopsy forceps was then advanced to the duodenal cavity until it formed a loop between the endoscope and the papilla. During the procedure, the tip of the forceps was kept at the hepatic hilus. RESULTS In this condition, we were able to slowly rotate the tip of the forceps and direct the forceps towards the left. Sufficient material from the left hepatic duct was obtained in all patients. CONCLUSIONS The looping technique was useful for selective access to the left hepatic duct.
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Affiliation(s)
- T Higashizawa
- Department of Gastroenterology, Jichi Medical School, Tochigi, Japan
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Abstract
We herewith report an unusual case of primary hyperparathyroidism whose parathyroid adenoma strongly accumulated technetium (Tc)-99m pertechnetate. A 41-year-old woman was referred to our department under the tentative diagnosis of primary hyperparathyroidism. Scintigraphy by thallium-201 chloride showed homogeneous uptake in the whole thyroid, whereas Tc-99m image revealed a strong local accumulation in the middle portion of the right thyroidal lobe. Neck exploration revealed a 12x8x5 mm tumor in the posterolateral region of the right thyroidal lobe, the pathology of which was parathyroid adenoma. In addition, a small nodule (8 mm in diameter) with pathological findings revealing follicular adenoma of the thyroid, was found within the medial portion of the right thyroidal lobe. Both lesions were removed by surgery, and a postoperative Tc-99m scintigraphy no longer demonstrated a significant uptake in the right thyroidal lobe. Since the thyroid adenoma was too small to be detected by any scintigraphic study and located much closer to the median line than the site of the marked accumulation of Tc-99m pertechnetate, it was considered very likely that the parathyroid adenoma concentrated Tc-99m. Search of literature revealed that there have been only thirteen cases of parathyroid tumor reported to date which significantly accumulated Tc-99m pertechnetate. The present patient represents another rare case of parathyroid adenoma showing sueh an unusual scintigraphic image.
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Affiliation(s)
- T Kikuchi
- First Department of Internal Medicine, Aomori City Hospital, Katta
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Gotoh Y, Tamada K, Tomiyama T, Wada S, Ohashi A, Satoh Y, Higashizawa T, Miyata T, Ido K, Sugano K. A new method for deep cannulation of the bile duct by straightening the pancreatic duct. Gastrointest Endosc 2001; 53:820-2. [PMID: 11375604 DOI: 10.1067/mge.2001.113387] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [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] [Indexed: 12/12/2022]
Affiliation(s)
- Y Gotoh
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan
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Ohashi A, Tamada K, Tomiyama T, Wada S, Higashizawa T, Gotoh Y, Satoh Y, Miyata T, Tano S, Ido K, Sugano K. Epinephrine irrigation for the prevention of pancreatic damage after endoscopic balloon sphincteroplasty. J Gastroenterol Hepatol 2001; 16:568-71. [PMID: 11350556 DOI: 10.1046/j.1440-1746.2001.02483.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM Endoscopic balloon sphincteroplasty (EBS) is an alternative to sphincterotomy for the treatment of bile duct stones. The purpose of this study was to determine if epinephrine irrigation of the papilla can prevent the pancreatic damage associated with EBS. METHODS A total of 173 patients with bile duct stones were treated by EBS. After conventional endoscopic retrograde cholangiography, EBS was performed by using a biliary dilatation catheter (balloon diameter: 8 mm). The duct was then cleared by using Dormia baskets or retrieval balloon catheters. Mechanical lithotripsy was performed before extraction when the stones were greater than 8 mm in diameter. In 81 patients, the dilated orifice was irrigated with 40-120 mL (50 +/- 37 mL) of 1:1,000,000 epinephrine (epinephrine group). In the remaining 92 patients, epinephrine irrigation was not performed (control group). Acute pancreatitis was defined by a serum amylase concentration fivefold greater than the upper limits of normal in association with abdominal pain. RESULTS After EBS, serum amylase concentrations were significantly increased in both groups. However, the degree of hyperamylasemia was less in the epinephrine group than in the control group (617 +/- 611 vs 1037 +/- 1491 IU/L, P < 0.05). The incidence of pancreatitis was lower in the epinephrine group than in the control group (1.2 vs 7.6%, P < 0.05). CONCLUSIONS Epinephrine irrigation is a simple and useful method to prevent post-EBS pancreatic damage and pancreatitis.
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Affiliation(s)
- A Ohashi
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan.
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Kudaka M, Kudaka H, Tomiyama T, Yogi M, Inafuku Y, Kawano K, Yamashiro K, Ooshiro K, Teruya T, Taira K, Higa T, Sunagawa H. Surgical treatment of a sigmoid volvulus associated with megacolon: report of a case. Surg Today 2001; 30:1115-7. [PMID: 11193746 DOI: 10.1007/s005950070012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/29/2022]
Abstract
Sigmoid volvulus occurring concomitantly with megacolon is an uncommon cause of bowel obstruction, and various approaches to treatment have been proposed. We report herein a case of sigmoid volvulus with megacolon that was successfully treated by elective surgery following endoscopic reduction during the same hospital stay. A 70-year-old woman was admitted to our hospital with abdominal pain, distension, and severe constipation. Physical examination, plain abdominal X-ray, and barium enema confirmed a sigmoid volvulus and further examinations revealed concomitant megacolon. An elective sigmoid colectomy was performed following successful endoscopic decompression. The postoperative course was uneventful and there was no residual colonic dysmotility. Histologically, no aganglionic tissue was observed in the resected specimen.
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Affiliation(s)
- M Kudaka
- Department of Surgery, Naha City Hospital, Okinawa, Japan
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Tamada K, Satoh Y, Tomiyama T, Ohashi A, Wada S, Ido K, Sugano K. Multiple bile duct biopsies using a sheath with a side port: usefulness of intraductal sonography. AJR Am J Roentgenol 2001; 176:797-802. [PMID: 11222229 DOI: 10.2214/ajr.176.3.1760797] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 11/18/2022]
Abstract
OBJECTIVE We clarified the number of biopsies required to determine malignancy of the biliary tract on the basis of the type of bile duct tumor. SUBJECTS AND METHODS Patients with a biliary tract malignancy (n = 33) and a benign biliary stenosis (n = 3) underwent biopsy via the percutaneous transhepatic route. We performed intraductal sonography using a 20-MHz probe with a 2.0-mm diameter. The sonographic findings were prospectively classified as polypoid, circular, or semicircular. The tip of a long 9-French sheath with a side port was wedged into the stenosis, and six specimens were obtained with a 1.8-mm-diameter forceps with serrated cups. RESULTS When cholangiography or intraductal sonography showed a polypoid lesion, the sensitivity of two biopsies was 100% (6/6). When cholangiography showed a stenotic lesion, the sensitivity of nine biopsies (96%, 26/27) was superior to that of two biopsies (74%, 20/27; p < 0.05). When intraductal sonography showed a circular lesion, the sensitivity of three biopsies (100%, 14/14) was superior to that of a single biopsy (64%, 9/14; p < 0.05). When it showed a semicircular lesion, the sensitivity of nine biopsies (92%, 12/13) was superior to that of two biopsies (54%, 7/13; p < 0.05). CONCLUSION Bile duct biopsy using a sheath with a side port has a high sensitivity. However, the number of biopsies required depends on the cholangioscopic and intraductal sonographic appearance of the tumor.
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Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi 329-0498, Japan
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Tamada K, Nagai H, Yasuda Y, Tomiyama T, Ohashi A, Wada S, Kanai N, Satoh Y, Ido K, Sugano K. Transpapillary intraductal US prior to biliary drainage in the assessment of longitudinal spread of extrahepatic bile duct carcinoma. Gastrointest Endosc 2001; 53:300-7. [PMID: 11231387 DOI: 10.1016/s0016-5107(01)70402-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The utility of intraductal US via the transpapillary route prior to biliary drainage in the assessment of longitudinal extension of extrahepatic bile duct carcinoma was investigated. METHODS In 19 patients with extrahepatic bile duct carcinoma who underwent surgical resection, an ultrasonic probe (diameter, 2.0 mm; frequency, 20 MHz) was inserted into the bile duct via the transpapillary route prior to biliary drainage. Longitudinal cancer extension along the bile duct was prospectively determined and compared with the histologic findings in the resected specimens. RESULTS Results on the hepatic side were as follows: Intraductal US demonstrated more extensive longitudinal cancer spread than cholangiography in 9 of 19 patients with one instance of overdiagnosis. The accuracy of intraductal US in assessing the extent of spread (84%) was superior to that of cholangiography (47%) (p < 0.05). Results on the duodenal side were as follows: In patients with suprapancreatic bile duct cancer (n = 14), intraductal US demonstrated more extensive longitudinal cancer spread than cholangiography in 8 of 14 patients. The accuracy of intraductal US in assessing the extent of the spread (86%) was superior to that of cholangiography (43%) (p < 0.05). CONCLUSIONS Transpapillary intraductal US prior to biliary drainage is useful in demonstrating longitudinal extension of bile duct cancer. However, the surgical margins were inaccurate in some patients.
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Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School,Yakushiji, Tochigi, Japan
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Tamada K, Tomiyama T, Ohashi A, Wada S, Satoh Y, Higashizawa T, Gotoh Y, Ido K, Sugano K. Intraductal ultrasonography for evaluating the patency of biliary metallic stents: correlation with cholangioscopic findings. Abdom Imaging 2001; 26:210-4. [PMID: 11178703 DOI: 10.1007/s002610000125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This is the first study to correlate intraductal ultrasonography (IDUS) with cholangioscopy in evaluating the patency of biliary metallic stents. METHODS The findings of IDUS (probe 2.0 mm in diameter and 20-MHz frequency) through a percutaneous transhepatic (n = 24) or transpapillary (n = 2) approach were retrospectively reviewed without other information. Criteria for IDUS are as follows: type 1, the inside of the stent is free; type 2, the inner edge is smooth; type 3, the inner edge is irregular; type 4, the inside of the stent is totally occupied; type 5, the solid echo is connected to the outside mass; type 2+D, a hypoechoic line is seen between the bile duct wall and the inside solid component and the inner edge of the bile duct wall is smooth; type 3+D, an irregular hypoechoic line is seen between the bile duct wall and the inside solid component. RESULTS In the control group (n = 11), IDUS showed type 1 (n = 9) or type 2 (n = 2). In the occluded group (n = 15), when IDUS showed type 3 or 5, the patients (n = 5) required additional stents (n = 3), microwave coagulation of the tumor (n = 1), or transient external drainage (n = 1). When IDUS showed type 4 (n = 5), after washing, the findings changed to type 2+D (n = 4). When IDUS after washing showed a smooth inner edge (type 2+D), the patients were treated without additional stents more frequently than the other groups (eight of nine vs. two of six), a significant distinction (p < 0.05). CONCLUSION IDUS is useful in assessing the patency of metallic stents. When the inside of the stent is totally occupied, however, examination after washing is necessary.
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Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi 329-0498, Japan
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Tamada K, Wada S, Tomiyama T, Ohashi A, Satoh Y, Miyata T, Higashizawa T, Gotoh Y, Ido K, Sugano K. Percutaneous recanalization of the bile duct along an endoscopic naso-biliary catheter. J Gastroenterol 2001; 35:622-6. [PMID: 10955601 DOI: 10.1007/s005350070062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Percutaneous recanalization of the bile duct is essential for placing biliary stents and carrying out other interventions. This prospective study was performed to establish safe approaches for percutaneous recanalization of the bile duct when it had previously resulted in failure. Between July 1995 and July 1999, percutaneous recanalization of the bile duct was attempted in 58 patients with a malignant biliary stenosis. When recanalization failed, an endoscopic naso-biliary drainage (ENBD) catheter was placed across the stenosis. The procedure was again attempted along the ENBD catheter. In the period of the study, four patients underwent successful recanalization after ENBD, although attempts prior to ENBD had been unsuccessful. As a result, the success rate of recanalization in the period was 100% (58/58). When recanalization fails, the use of an ENBD catheter may provide access to the biliary tree, and the biliary stenosis can be recanalized safely.
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Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Tochigi, Japan
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Tamada K, Ohashi A, Tomiyama T, Wada S, Satoh Y, Higashizawa T, Ido K, Sugano K. Comparison of intraductal ultrasonography with percutaneous transhepatic cholangioscopy for the identification of residual bile duct stones during lithotripsy. J Gastroenterol Hepatol 2001; 16:100-3. [PMID: 11206304 DOI: 10.1046/j.1440-1746.2001.02384.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND An imaging modality that can be used to identity small stones after a biliary lithotripsy is required. Intraductal ultrasonography was evaluated by using percutaneous transhepatic cholangioscopy as the gold standard. METHODS Lithotripsy, under percutaneous transhepatic cholangioscopy guidance, was performed in 20 patients. A thin-caliber ultrasonic probe (2.0 mm in diameter and 20 MHz frequency) was inserted into the bile duct through the percutaneous tract after lithotripsy, and residual stones were identified. This was followed by percutaneous transhepatic cholangioscopy. RESULTS In the extrahepatic bile ducts, intraductal ultrasonography provided images of all the stones demonstrated on cholangioscopy (n = 11). The sensitivity was superior to that of cholangiography (P < 0.005). However, in the intrahepatic bile ducts, intraductal ultrasonography only visualized the stones located in the cannulated lobe. Extrahepatic stones smaller than 5.0 mm in diameter or in a common hepatic duct larger than 15.0 mm in diameter were missed by cholangiography, but were visualized by the use of intraductal ultrasonography (P < 0.05). CONCLUSIONS Intraductal ultrasonography is equivalent to cholangioscopy in the extrahepatic bile ducts. Cholangiography and intraductal ultrasonography should be used in combination to image intrahepatic and extrahepatic stones.
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Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan.
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Abstract
BACKGROUND Transpapillary procurement of bile duct biopsy specimens is an effective diagnostic technique in cases of biliary structure. The utility of new ropeway-type bile duct biopsy forceps with a side slit for a guidewire was investigated in this study. METHODS The 12 patients in this study had bile duct cancer (n = 3), cancer of the head of the pancreas (n = 4), gallbladder cancer (n = 1), and benign bile duct stenosis (n = 4). After endoscopic retrograde cholangiography, a guidewire was placed in the bile duct across the stenosis. The new forceps (1.8-mm diameter clamshell-type biopsy forceps without needle) was then introduced through the intact papilla along the guidewire. RESULTS In all patients, sufficient tissue for histopathologic evaluation was obtained without complication. In one patient, biopsy specimens were selectively obtained of the left hepatic duct, which was impossible with conventional forceps. In another patient, histologic examination of specimens obtained by using this new forceps showed adenocarcinoma, whereas specimens obtained with a conventional forceps did not contain adenocarcinoma. However, in another patient, biopsy specimens obtained with a conventional forceps contained adenocarcinoma that was not evident in specimens obtained with the new forceps. Dislodgement of the guidewire during procurement of biopsy specimens occurred in 1 patient. In the other 11 patients, an endoscopic biliary drain was inserted over the guidewire. CONCLUSION The new ropeway-type biopsy forceps is useful for selectively obtaining biopsy specimens of the bile duct. With this system, access for subsequent endoscopic biliary drainage is maintained.
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Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan
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Tamada K, Tomiyama T, Wada S, Ohashi A, Satoh Y, Higashizawa T, Gotoh Y, Ido K, Sugano K. Hyperechoic lines as a sonographic confirmatory sign during percutaneous transhepatic biliary drainage. Abdom Imaging 2001; 26:39-42. [PMID: 11116358 DOI: 10.1007/s002610000099] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND In ultrasonically guided percutaneous transhepatic biliary drainage, we often can recognize hyperechoic lines at the tip of the needle when the duct is penetrated successfully. We evaluated the frequency of this phenomenon and analyzed whether it was a useful sign for confirming successful bile duct puncture. METHODS In 65 patients with biliary tract diseases, 84 catheters were placed in the course of 108 attempts at puncture. Results of puncture and the presence of hyperechoic lines were investigated prospectively. RESULTS When the ultrasonographic findings showed hyperechoic lines, successful puncture was significantly more frequent than when the findings did not show hyperechoic lines (53/55, 96%, vs. 31/59, 53%; p < 0.0001). When we judged the hyperechoic lines as the sign of successful puncture, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 63%, 93%, 96%, 48%, and 71%, respectively. CONCLUSION Hyperechoic lines are a useful confirmatory sign of successful puncture. However, absence of these lines was not invariably associated with unsuccessful puncture.
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Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi 329-0498, Japan
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Tamada K, Yasuda Y, Nagai H, Tomiyama T, Wada S, Ohashi A, Satoh Y, Ido K, Sugano K. Limitations of three-dimensional intraductal ultrasonography in the assessment of longitudinal spread of extrahepatic bile duct carcinoma. J Gastroenterol 2000; 35:919-23. [PMID: 11573728 DOI: 10.1007/s005350070006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We investigated the utility and limitations of three-dimensional intraductal ultrasonography (3D-IDUS), for the assessment of the extent of longitudinal cancer spread to the hepatic side by extrahepatic bile duct carcinoma. In eight patients with extrahepatic bile duct carcinoma. 3D-IDUS was used to assess longitudinal cancer extension to the hepatic side prior to resection. When the linear dimension of 3D-IDUS showed bile duct wall thickening that was connected to the tumor and which became thin at a point, it was determined to be the front formation of longitudinal cancer extension. The findings were examined in relation to histologic information from the resected specimen. Although 3D-IDUS showed front formation of wall thickening in two patients, it accurately reflected the histological margin of the longitudinal cancer extension in only one patient. In the other patient, the wall thickening was longer than the histological margin. When 3D-IDUS showed bile duct wall thickening without front formation (n = 2), the wall thickening was longer than the histological margin of the longitudinal cancer extension. Even when 3D-IDUS did not show wall thickening (n = 4), one of these patients showed cancer spread histologically. As a result, the accuracy in assessing longitudinal cancer extension by 3D-IDUS was only 50%. Even if the linear dimension of 3D-IDUS demonstrated front formation of thickening of the bile duct, it reflected not only cancer extension but also inflammatory wall thickening.
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Affiliation(s)
- K Tamada
- Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan
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