Publications (11)18.08 Total impact
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Article: Recanalization of post-transplant late-onset long segmental portal vein thrombosis with bidirectional transhepatic and transmesenteric approach.
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ABSTRACT: PV complications are the most frequent vascular complications in pediatric LT. We have experienced a case with chronic postoperative PVT that necessitates combined transhepatic and transmesenteric approach and have confirmed mid-term patency. An eight-yr-old boy had successful LDLT with a left lateral segment graft at the age of two months for HBV-related acute liver failure. Seven years after transplantation, the patient suddenly showed a melena with hypovolemic shock. Doppler ultrasound and CT revealed intrahepatic bile duct dilatation and main PVT with collateral formation at hepatic hilus and mesenterium of the Roux-en-Y jejunal loop. Urgent splenic artery embolization was performed to control the bleeding and was temporarily effective. Therefore, recanalization of PVO was attempted. Because of long segmental PVO and steep angle between the intrahepatic PV and the portal trunk, bidirectional transhepatic and transmesenteric approach was selected and resulted in deploying three metallic stents necessitating additional infusion thrombolytic therapy. The patient is now followed as an outpatient with patent stents for two yr since the procedure. For the rescue of these patients, recanalization of obstructed PV trunk with bidirectional approach would be feasible with better graft survival and less invasiveness than conventional surgical interventions.Pediatric Transplantation 03/2013; 17(2):E71-5. · 1.48 Impact Factor -
Article: Balloon-occluded retrograde transvenous obliteration for a portosystemic shunt after pediatric living-donor liver transplantation.
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ABSTRACT: Portosystemic shunts may cause steal phenomenon after liver transplantation, which can lead to graft loss without proper management. Portal vein stenosis is one of the causes for the occurrence of portosystemic shunts after liver transplantation. Recently, new interventional radiologic techniques have been developed in the field of liver transplantation. Balloon-occluded retrograde transvenous obliteration (B-RTO) is a novel interventional technique for gastric varices and portosystemic shunts and also is effective for increasing portal vein flow. We herein report a pediatric case of portal vein stenosis with a large shunt successfully treated with a combination of balloon dilatation and B-RTO. If enlarged collateral vessels cause steal phenomenon, then B-RTO should be considered as an additional therapy.Journal of Pediatric Surgery 06/2011; 46(6):e19-22. · 1.45 Impact Factor -
Article: Potential prognostic benefits of radiotherapy as an initial treatment for patients with unresectable advanced hepatocellular carcinoma with invasion to intrahepatic large vessels.
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ABSTRACT: To examine the efficacy and prognostic benefits of radiotherapy (RT) in patients who have unresectable advanced hepatocellular carcinoma (HCC) with invasion to intrahepatic large vessels (IHLVs). Sixty-eight patients who had advanced HCC with invasion to IHLVs were studied. Thirty-two consecutive patients initially received 3-dimensional conformal RT for HCC invasion to IHLVs. Tumor response, prognostic factors, and survival were studied in the patients given RT. Prognostic factors and survival were assessed in the study group as a whole. Data were analyzed using the Kaplan-Meier method, univariate analysis, and a Cox model. The rate of objective response to RT was 48%. Predictors of survival in the patients who received RT were a hepatic function of Child-Pugh class A (p = 0.0263) and a response to RT (p = 0.0121). In the study group as a whole, independent predictors of survival in a Cox model were multinodular HCC (p = 0.007), inferior vena caval invasion (p = 0.001), a serum alpha-fetoprotein level of >1,000 ng/ml (p = 0.032), and the performance of RT (p < 0.001). Notably, the median survival of the nonresponders to RT (n = 15) was significantly longer than that of the patients who received no treatment for HCC (n = 21; 7.0 vs. 3.4 months, p = 0.0014). RT is considered an effective initial treatment for HCC invasion to IHLVs, and may offer survival benefits, even in nonresponders, because of the induction of stable disease.Oncology 01/2007; 73(1-2):90-7. · 2.27 Impact Factor -
Article: Emergent endovascular stent-graft placement to treat ruptured Stanford type B acute aortic dissection.
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ABSTRACT: Uncomplicated Stanford type B acute aortic dissection, for which medical treatments are effective in most cases, is associated with a better prognosis than Stanford type A dissection. However, ruptured Stanford type B dissection still is associated with high mortality, because of the risks of open surgery and the complications of the disease. We report successful stent-graft placement in two patients with acute type B dissection with rupture, and discuss the advantages of stent-graft placement to treat ruptured acute type B dissection.Journal of Vascular Surgery 04/2004; 39(3):668-71. · 3.21 Impact Factor -
Article: Restoration of thrombopoietin production after partial splenic embolization leads to resolution of thrombocytopenia in liver cirrhosis.
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ABSTRACT: The aim of this study was to evaluate the relation between thrombopoietin (TPO) and thrombocytopenia in patients with liver cirrhosis and those with idiopathic portal hypertension (IPH) before and after partial splenic embolization (PSE). We examined changes in platelet counts, liver function, megakaryocyte function, and plasma TPO levels after PSE in 30 patients (20 with liver cirrhosis, and 10 with IPH). Platelet counts in both cirrhosis and IPH increased significantly 2 months after PSE (cirrhosis group, 4.0+/-1.9 vs. 7.5+/-4.4x10(4)/&mgr;l: P=0.0002; IPH group, 4.0+/-1.7 vs. 6.5+/-2.3x10(4)/&mgr;l: P=0.0042). Plasma TPO level and prothrombin time increased significantly and alanine aminotransferase level (ALT) and total bilirubin level decreased significantly 2 months after PSE in the cirrhosis group (plasma TPO level, 0.57+/-0.30 vs. 0.72+/-0.27 fmol/ml: P=0.024), but not in the IPH group (0.56+/-0.21 vs. 0.55+/-0.34 fmol/ml: P=0.94). Moreover, the score of megakaryocytes with platelet production, an index of platelet production by megakaryocytes in bone marrow, increased significantly in the cirrhosis group. TPO production in cirrhotic patients is restored after PSE, leading to the resolution of thrombocytopenia. But patients with IPH had no change in liver function, indicating that only decreased spleen volume was responsible for the improvement in platelet count.Hepatology Research 08/2002; 23(4):265. · 2.20 Impact Factor -
Article: Successful arterial embolization of arteriovenous fistula in the portal circulation
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ABSTRACT: We successfully performed arterial embolization of an arteriovenous fistula between the left gastric artery and vein. The increased blood flow in the portal vein via the left gastric vein and the arteriovenous fistula induced severe portal hypertension. After obliteration of the left gastric artery, the arteriovenous fistula was not opacified on angiography and the portal hypertension improved.Abdominal Imaging 11/1992; 17(1):324-326. · 1.73 Impact Factor -
Article: Superior mesenteric venous thrombosis treated by direct aspiration thrombectomy.
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ABSTRACT: A 69-year-old man, with hepatits C virus-related liver cirrhosis and hemophilia B, developed massive ascites and watery diarrhea after endoscopic injection sclerotherapy for esophageal varices. A multi detector row computed tomography revealed a superior mesenteric venous thrombus without bowel infarction. It was assumed that the thrombus was caused by transient congestion of the portal system after retrograde propagation of the sclerosant agent, in a condition where anticoagulation proteins, such as proteins C and S, had decreased. Because long systemic thrombolytic therapy was hazardous for the patient with hemorrhagic diathesis due to impaired coagulation, a direct thrombolysis was performed with urokinase followed by aspiration thrombectomy, with cannulation of the portal venous system using a transjugular intrahepatic approach. The patient had no complications in this procedure and subsequently diarrhea and refractory ascites were resolved. Direct thrombectomy via the transjugular intrahepatic route may be a useful therapy for mesenteric venous thrombus in the cirrhotic patient.Hepato-gastroenterology 55(82-83):367-70. · 0.66 Impact Factor -
Article: Stent-graft to treat intrahepatic portosystemic venous shunt causing encephalopathy.
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ABSTRACT: Spontaneous intrahepatic portosystemic venous shunts (IPSVS) are rare, and angiographic intervention to treat IPSVS has been limited. To our knowledge, we present the first case of an IPSVS between the right portal vein and inferior vena cava accompanied by intractable encephalopathy that was successfully obliterated using a stent-graft deployed in the inferior vena cava to disconnect the portal and systemic venous circulation. Our patient, a 58-year-old woman, has shown no evidence of recurrent portosystemic venous shunt or encephalopathy for 30 months. We believe this intervention to be a useful alternative therapy for this type of shunt.Hepato-gastroenterology 55(81):237-40. · 0.66 Impact Factor -
Article: New diagnostic imaging of gastointestinal tumors: a preliminary study of three-dimensional tumor structure and volumetry.
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ABSTRACT: The aim of the present report was to present preliminary results of the pre-operative evaluation of three-dimensional tumor structure and volumetry using three-dimensional computed tomography (3-D CT) and three-dimensional endoscopic ultrasonography (3-D EUS). Diagnostic imaging was performed for 2 patients (one with gastric cancer, one with a rectal tumor) using virtual endoscopy, 3-D CT for the patient with gastric cancer and 3-D EUS for the patient with the rectal tumor, for the pre-operative evaluation of tumor structure and volumetry. Computer-generated image analysis of resected tumors was also performed. The gastric tumor was successfully visualized using 3-D CT and the rectal tumor was successfully visualized using 3-D EUS. The values obtained for volume of the stomach tumor, calculated using 3-D CT and resected materials, were 15.1 cm3 and 11.4 cm3, respectively. The values obtained for volume of the rectal tumor, calculated using 3-D EUS and resected materials, were 2.3 cm3 and 3.9 cm3, respectively. The present findings demonstrate that clinically useful results can be obtained by using 3-D CT and 3-D EUS for the pre-operative evaluation of 3-D tumor structure and volumetry of gastrointestinal tumors. We expect that further studies of these methods will lead to the establishment of new diagnostic criteria for gastrointestinal tumors based on tumor volume in the near future.Anticancer research 25(4):2935-41. · 1.73 Impact Factor -
Article: Telangiectatic focal nodular hyperplasia of the liver in the perinatal period: case report.
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ABSTRACT: We report a case of congenital telangiectatic focal nodular hyperplasia, a rare variant form of the disease. The patient was a 2-month-old boy whose parents noticed abdominal distention about 2 weeks after birth, and ultrasonogram revealed a large mass in the liver. He underwent right lobectomy, and gross findings showed an ill-defined mass without any central scar. Histologic findings demonstrated proliferating hepatocytes without atypia arranged in cords of 1- or 2-cell thickness with marked sinusoidal dilatation and extramedullary hematopoiesis. In addition, a significantly increased Ki-67 labeling index in the tumor compared with non-tumor liver cells, and cytogenetic analysis of 23 G-banded metaphase preparations revealed 3 abnormal karyotypes, suggesting hyperplastic or neoplastic features. To the best of our knowledge, the present case is only the third documented case of congenital telangiectatic focal nodular hyperplasia.Pediatric and Developmental Pathology 8(5):581-6. · 0.99 Impact Factor -
Article: Intraperitoneal bleeding due to rupture of the left gastric vein (LGV) in a patient with liver cirrhosis: a case report.
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ABSTRACT: Intraperitoneal bleeding from ruptured ectopic varices is a rare and fatal complication in patients with portal hypertension. Although laparotomy with high mortality is performed, it is difficult to detect correct bleeding site and save the patient. This is probably the first case report of rupture from left gastric vein revealed by transjugular intrahepatic portosystemic shunt (TIPS). We propose the use of TIPS for diagnosing and treating intraperitoneal bleeding from ectopic varices.Abdominal Imaging 33(3):324-7. · 1.73 Impact Factor
