Publications (11)18.17 Total impact
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Article: Single-site laparoscopic herniorrhaphy using needle instruments for inguinal hernias in children: a novel technique.
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ABSTRACT: We describe our new technique for laparoscopic herniorrhaphy with subumbilical single-site access to treat inguinal hernias in children. First, we inserted a transparent 3-mm trocar and a 2-mm minitrocar at the umbilicus. We then inserted a 3-mm 45° camera through the 3-mm trocar and needle-grasping forceps through the 2-mm trocar. We closed the hernia defect by using a 19-gauge hooked injection needle with a nonabsorbable suture. We treated 11 consecutive female children with inguinal hernia using this operation. The mean operating time was 26.7 min (range 21-36 min) and the procedure was technically successful, without the need for additional trocars, in all 11 patients. There were no intraoperative complications and all the patients were discharged on the same day after the surgery. Single-site laparoscopic herniorrhaphy using needle instruments is feasible and seems to be safe. Further studies are required to determine whether this approach would benefit patient compared with standard laparoscopic herniorrhaphy.Surgery Today 11/2011; 42(1):100-3. · 1.22 Impact Factor -
Article: Graft fibrosis in patients with biliary atresia after pediatric living-related liver transplantation.
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ABSTRACT: Although an LDLT can successfully treat biliary atresia (BA), some patients develop liver fibrosis or inflammation. To study the incidence and risk factors associated with these complications, we performed serial protocol biopsies. Twenty-four patients with BA who received a pediatric LDLT underwent protocol biopsies. All patients received standard tacrolimus-based immunosuppression and steroids. The last available biopsies were assessed. The mean age at the time of transplant was 4.8yr and the follow-up period ranged from 1.2 to 12.3yr. The GRWR ranged from 0.8% to 4.5%. The mean time from transplantation to the latest biopsy was 4.7yr. No complications occurred with the biopsy protocol. The last available biopsies for 13 (54%) and 4 (17%) patients indicated grade 1 and grade 2 portal fibrosis, respectively, and 14 patients (54%) had inflammation. No ductopenia was detected. A younger age at LDLT was significantly correlated with graft fibrosis (p=0.036). These results indicate that biopsy-proven fibrosis can be detected in patients with BA after LDLT, even in the context of normal liver function blood tests. Therefore, a serial biopsy is a safe and effective follow-up procedure for pediatric LDLT.Pediatric Transplantation 08/2011; 15(5):470-5. · 1.48 Impact Factor -
Article: Effects of a calcineurin inhibitor, FK506, and a CCR5/CXCR3 antagonist, TAK-779, in a rat small intestinal transplantation model.
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ABSTRACT: The effects of FK506, and TAK-779, antagonists of CCR5 and CXCR3, were investigated using a rat intestinal transplantation model. Small intestines from DA rats were heterotopically transplanted into LEW rats. The recipients were treated with FK506 (1mg/kg/day, day 0-5) and TAK-779 (10mg/kg/day, day 0-10). Graft survival and immunological responses to these materials were estimated by mixed lymphocyte reactions and IFN-γ production. The expression of chemokine receptors on lymphocytes was also examined. The average duration of survival was 7.0±0.3, 12.0±1.0, 9.8±0.5 and 18.0±1.5days in the allogeneic, FK506, TAK-779 and the two-drug combined groups, respectively. Cell proliferative responses and IFN-γ production were suppressed to a significant extent in the FK506 group compared with the TAK-779 group. In addition, the two-drug combination showed a tendency for stronger suppression than FK506 alone, correlated with in vivo and histopathological data. The numbers of both CD4(+) and CD8(+) cells were significantly suppressed in the blood of the recipients of both the FK506 and the TAK-779 groups, and in Peyer's patches of the graft of the TAK-779 group, but the FK506 group was not, as evidenced by FACS analysis. In addition, double-staining of graft-infiltrating lymphocytes showed a significant reduction in lymphocyte numbers, expressing CCR5 and CXCR3 in the TAK-779 group, but not evident in the FK506 group, compared to the allogeneic group. While FK506 suppresses cell proliferation and effecter function, it has less effect on the expression of CCR5 and CXCR3 in lymphocytes. Further exploration of the effects of a combined therapy with TAK-779 could represent a novel treatment for intestinal transplantation.Transplant Immunology 04/2011; 25(1):49-55. · 1.46 Impact Factor -
Article: Effects of blocking the chemokine receptors, CCR5 and CXCR3, With TAK-779 in a rat small intestinal transplantation model.
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ABSTRACT: The effect of blocking lymphocyte chemokine receptors with TAK-779 was investigated using a rat intestinal transplantation model. Dark Agouti rat small intestines were heterotopically transplanted into Lewis rats. The recipients were treated with TAK-779 (10 mg/kg per day) by subcutaneous injection. Graft survival, histologic changes, mixed lymphocyte reaction, and antibody production were examined. Furthermore, expression of the chemokine receptors on the graft-infiltrating lymphocytes in the mesenteric lymph node (MLN) and Peyer's patches (PP) were measured using fluorescence-activated cell sorter analysis. Average duration of survival was greater for group T (with TAK-779: 9.8+/-1.4) than group A (without TAK-779: 7.0+/-0.6). Histologic findings and immunohistochemistry of the graft were consistent with the prolonged survival in group T. In the fluorescence-activated cell sorter analysis, several CD4+ and CD8+ cells were significantly suppressed in the blood, spleen, and MLN of the recipient and in the PP of the graft on postoperative day (POD) 6, but recovered in recipient spleen and MLN by POD 9. However, double-staining of graft-infiltrating lymphocytes in MLN and PP showed a significant reduction in the numbers of T cells expressing CCR5 and CXCR3 by POD 9. On the other hand, mixed lymphocyte reaction and cytokine production, and the antidonor antibody titer were suppressed on POD 6 but not on POD 9. TAK779 diminished not only the number of the graft-infiltrating cells and their expression of CCR5 and CXCR3, but also the total number of recipient T cells that play a role in graft rejection. Further exploration of these effects will provide the novel treatment of the intestinal transplantation.Transplantation 01/2009; 86(12):1810-7. · 4.00 Impact Factor -
Article: Successful living related liver transplantation in a case with biliary atresia associated with corrected transposition of the great arteries.
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ABSTRACT: Little is known about the safety of LRLTx in children with end stage liver disease associated with congenital cardiac anomalies. We report the successful LRLTx in a case with extrahepatic biliary atresia associated with cTGA, VSD, and PS. Preoperative cardiac function was evaluated by cardiac echogram and cardiac catheterization. The recipient's cardiac function was preserved (EF; 54%); however, because of the left to right shunt disease, oxygen saturation was 91%. At operation, carbon dioxide insufflation into the abdominal cavity was attempted to prevent sudden air embolism. Hemodynamic variables were stabilized during partial clamping of the inferior vena cava, and at reperfusion of the portal vein. However, a sudden decrease in blood oxygenation was observed during hepatico-jejunostomy, which was easily normalized by graft mobilization. Post-operatively, neither heart failure nor cerebral infarction because of air embolism was observed. In conclusion, together with preserved cardiac function and carbon dioxide insufflation, LRLTx was successful. Further studies are required to establish the algorithm for the strategy of treating both congenital cardiac anomalies and liver failure.Pediatric Transplantation 09/2007; 11(5):540-2. · 1.48 Impact Factor -
Article: Effect of blocking the mucosal addressin cell adhesion molecule-1 (MAdCAM-1) in a rat small intestinal transplantation model.
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ABSTRACT: The effect of blocking the expression of the mucosal addressin cell adhesion molecule-1 (MAdCAM-1) in a graft by an antibody, and immunohistochemical changes in the graft were monitored, using a rat small intestinal transplantation model. Dark Agouti (DA) rat small intestines were heterotopically transplanted into Lewis (LEW) rats. The graft was treated with or without an anti-MAdCAM-1 antibody, F(ab')(2), during the operation. The survival of the grafts and histological changes, such as lymphocyte infiltration and destruction of the intestinal architecture in epithelium villus thickness, villus height and submucosal thickness of the graft, were examined. The expression of MAdCAM-1 and beta 7 integrin in the graft was also checked by immunostaining. Furthermore, graft infiltrating lymphocytes, in mesenteric lymph nodes (MLN) and Peyer's patches (PP) were measured by FACS analysis. Survival was prolonged in the DA graft with anti-MAdCAM-1 F(ab')(2) treatment; DA to LEW: 7.0+/-3.3, DA to LEW with the antibody: 24.6+/-8.4 days (p<0.05). Histological findings and scoring of the grafts were consistent with this conclusion. Moreover, MAdCAM-1 expression itself was suppressed in grafts of the antibody-treated group. While a FACS analysis showed no difference in the % of CD4+ T cells and CD8+ T cells in the PP of the graft, CD4+ T cells in the MLN of the antibody-treated graft were significantly low. A strategy directed at blocking the adhesion molecule, MAdCAM-1, in the small intestinal grafts could be useful in the prevention of acute rejection.Transplant Immunology 06/2007; 17(4):271-7. · 1.46 Impact Factor -
Article: Living-related liver transplantation with removal of inferior vena cava for unresectable hepatoblastoma.
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ABSTRACT: We report a case of a two-yr-old boy with hepatoblastoma resectable only by total hepatectomy including the vena cava. Successful LTx was performed with a living donor segment without vena cava reconstruction. The tumor was located in the bilateral lobe, surrounding the IVC. In spite of the high-dose chemotherapy, the tumor did not become resectable. LTx was performed using left lateral segment after removal of the IVC combined with total hepatectomy. Because the collaterals were well developed, the patient tolerated the procedure well. The serum AFP level decreased from 186 699 to 8 ng/mL in 11 months after LTx without local recurrence or distant metastasis.Pediatric Transplantation 07/2006; 10(4):521-4. · 1.48 Impact Factor -
Article: Feasibility of duct-to-duct biliary reconstruction in pediatric living related liver transplantation: report of three cases.
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ABSTRACT: Feasibility of duct-to-duct biliary reconstruction in adult living related liver transplantation (LRLTx) has been recently reported; however, little has been known of its surgical outcome in children. To assess the feasibility and safety of duct-to-duct biliary reconstruction in children, the surgical outcomes of duct-to-duct biliary reconstruction were retrospectively analyzed. The subjects were three children who underwent LRLTx in our hospital each utilizing allografts with a right lobe, a left robe and a lateral segment, respectively. The cause of end-stage liver disease in each of them was fulminant Wilson's disease, fulminant hepatic failure and unresectable hepatoblastoma. Duct-to-duct anastomosis was performed in younger patients and adolescents with interrupted and continuous sutures, respectively. The diameter of bile duct in allografts was from 4 to 6 mm and 12 or 13 stitches were required for anastomosis. Post-operative choledochography from the external tube showed neither stenosis nor leakage and the tube was evacuated within 3 months after LRLTx. No biliary complications were observed with the median follow-up of 28 months. In conclusion, our results show that duct-to-duct biliary reconstructions in pediatric LRLTx seemed to be feasible and safe. Further studies are required to elucidate its real impact on pediatric LRLTx.Pediatric Transplantation 04/2006; 10(2):248-51. · 1.48 Impact Factor -
Article: Histological classification of liver fibrosis and its impact on the postoperative clinical course of patients with congenital dilatation of the bile duct.
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ABSTRACT: Infants and children with congenital dilatation of the bile duct (CDBD) usually also have some degree of liver fibrosis, which occasionally persists after diversion surgery, leading to liver cirrhosis. We conducted this study to evaluate the histological degree of liver fibrosis using intraoperative biopsy and to determine whether it affects the postoperative clinical course. The subjects were 43 infants and children with CDBD. The age at operation ranged from 1 month to 14 years. Histological classification was defined as follows: grade 0, no fibrosis; grade 1, fibrosis confined to the portal area; grade 2, bridge formation with the neighboring portal area; grade 3, widened bridging fibrosis; and grade 4, pseudolobule formation, representative of cirrhosis. There were 21 (48.8%) patients with grade 0, 17 (39.5%) with grade 1, 4 (9.3%) with grade 2, 1 (2.3%) with grade 3, and 0 (0%) with grade 4 fibrosis. There were no differences in preoperative serum total bilirubin, total bile acid, aspartate aminotransferase, or gamma-glutamyl transpeptidase levels among the four groups. On the other hand, the grade 2 and 3 groups tended to include patients with a lower age at operation, and lower amylase levels in the serum and bile. Postoperatively, clinical symptoms resolved and laboratory data normalized in all patients. Two patients underwent liver biopsy for other reasons 3 and 4 years after surgery, which confirmed disappearance of the liver fibrosis. These patients had originally had grade 1 and grade 2 fibrosis, respectively. Mild to moderate liver fibrosis is present in almost half of all children with CDBD; however, if it is graded as less than moderate, it will probably not affect the postoperative clinical course.Surgery Today 02/2006; 36(2):151-4. · 1.22 Impact Factor -
Article: Endoscopic membranectomy with a high-frequency-wave snare/cutter for membranous stenosis in the upper gastrointestinal tract.
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ABSTRACT: As endoscopic equipment and instruments have been improved, the indication for endoscopic surgery has been extended. The authors achieved endoscopic membranectomy for congenital membranous stenosis in the upper gastrointestinal tract. Case 1 was a 3-year-old girl with membranous stenosis in the descending duodenum. Case 2 was a 1-year-old boy with esophageal membranous stenosis. In case 1, a flexible endoscope with a banding chamber, the inside of which had a tiny groove for a high-frequency-wave snare, was inserted into the duodenum. The diaphragm was drawn into the chamber by endoscopic suction and tied with the snare around its base, then dissected by electrifying the snare. In case 2, the diaphragm was resected with a high-frequency-wave cutter, assisted by a balloon catheter pulling up the diaphragm from the distal side. In both cases, the stenosis was released adequately without complications, and oral feeding was restarted in a day after the procedure. Endoscopic membranectomy using a high-frequency wave snare/cutter was achieved safely and effectively in 2 children with congenital membranous stenosis in the upper gastrointestinal tract.Journal of Pediatric Surgery 10/2005; 40(9):1486-8. · 1.45 Impact Factor -
Article: Surgical management for posterior laryngeal cleft developing subglottic airway obstruction.
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ABSTRACT: A 3-year-old boy associated with Opitz syndrome including hypospadias and anorectal anomaly was transferred to Osaka University Hospital with orotracheal intubation because of respiratory distress after respiratory infection. He had laryngeal cleft diagnosed in the neonatal period because of symptoms including stridor and aspiration. After 2 attempts at extubation, tracheostomy was performed. Fiberscopic examination demonstrated obstruction of the airway from the vocal cord to subglottic space by inspired esophageal redundant mucosa. There was no improvement observed for 3 months. He underwent anterior repair of cleft, anterior laryngotracheoplasty with costal cartilage graft, closure of tracheostomy, and endoscopic Nissen fundoplication. The postoperative course during the subsequent year was uneventful without feeding or speaking disorders. Subglottic airway obstruction caused by inspired redundant mucosa is a rare complication in laryngeal cleft. Anterior laryngotracheoplasty and Nissen fundoplication should be considered for this complication, in addition to the usual procedure for cleft repair.Journal of Pediatric Surgery 04/2005; 40(3):E15-6. · 1.45 Impact Factor
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2005–2011
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Osaka City University
Ōsaka-shi, Osaka-fu, Japan
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