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ABSTRACT: The aim of this study was to verify independent risk factors of pressure equalization problems associated with hyperbaric oxygen (HBO(2)) therapy.
We reviewed a single-institutional study of 1609 patients with 17604 treatments who had HBO(2) therapy in a multiplace chamber, in which the factors examined and their relationship to complications were assessed, using multivariate analyses, to determine the significantly independent risk factors of complications related to HBO(2) therapy.
The compression rate was 0.067 atmospheres absolute/min (6.8 kPa/min). Pressure equalization problems of the middle ear, expressed as pain or discomfort, such as cranial sinus pain, and teeth pain were observed in 156 patients (9.7%). Sixty-six of them could not continue HBO(2) therapy because of these problems. Peripheral circulatory disorders with refractory ulcers or nonhealing wounds and the interval between clinical symptoms and the first day of HBO(2) therapy were independent risk factors of pressure equalization problems. Independent risk factors of cessation due to pressure equalization problems were identified as age more than 61 years, female sex, and interval between symptoms and the first day of HBO(2) therapy.
It is suggested that chamber compression must be performed with particular care when patients have peripheral circulatory disorders and have short interval between clinical symptoms and the first day of HBO(2) therapy.
Journal of critical care 10/2008; 23(3):295-300. · 2.13 Impact Factor
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ABSTRACT: Postoperative hepatic insufficiency is a critical complication after extended hepatic resection in patients with biliary tract malignancies, the majority of whom suffer from obstructive jaundice. The aim of this study was to assess clinical parameters linked to this type of liver dysfunction.
A total of 111 patients were retrospectively reviewed. Patient background, pre- and intraoperative parameters, and a ratio of remnant liver volume/entire liver volume (RLV/ELV) as a volumetric parameter were compared between patients with and without postoperative hyperbilirubinemia and subsequent fatal outcome.
Logistic regression indicated that only RLV/ELV ratio was an independent factor influencing postoperative hyperbilirubinemia, and RLV/ELV ratio and indocyanine green retention rate at 15 minutes (ICG-R15) were factors affecting survival. Patients with RLV/ELV less than 40% had 7.6 times the risk of postoperative hyperbilirubinemia, while no patients with RLV/ELV greater than 40% and ICG-R15 less than 25% died of liver failure.
The RLV/ELV ratio was the factor with the greatest impact on liver dysfunction after extended hepatectomy in patients with biliary tract malignancies.
American journal of surgery 10/2008; 197(6):752-8. · 2.36 Impact Factor
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ABSTRACT: Nonoperative management of cases of adhesive intestinal obstruction would be ideal, especially for patients who have recently undergone surgery to relieve the same condition. We aimed to examine whether hyperbaric oxygen (HBO) therapy might have therapeutic potential for the treatment of postoperative paralytic ileus and recurrent adhesive intestinal obstruction soon after surgery, to relieve adhesive intestinal obstruction, because of its unique mechanisms in these contexts.
A total of 133 patients were enrolled in the present study. We examined non-per os periods, hospital stay, and clinical course according to the postoperative course of the 133 patients.
After surgical intervention, 75 patients left the hospital without morbidity. Nineteen patients were successfully administered prophylactic HBO therapy to facilitate intestinal motility and to prevent paralytic ileus. The remaining 39 patients suffered from postoperative paralytic ileus or early recurrence of obstruction during the same hospitalization period. The patients who underwent prophylactic HBO therapy had significantly shorter non-per os periods and hospital stays after surgery than those who were not initially given HBO therapy (P < 0.05). Similarly, there were significant differences in duration of hospital stay after surgery between patients with HBO therapy as treatment and those who received other conservative therapies (P < 0.05).
HBO therapy may have a prophylactic effect on postoperative paralytic ileus and may be of therapeutic benefit in the management of early recurrent adhesive intestinal obstruction following surgery to relieve adhesive intestinal obstruction.
Journal of Gastroenterology and Hepatology 06/2007; 23(8 Pt 2):e379-83. · 2.87 Impact Factor
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Fumio Kimura,
Hiroaki Shimizu,
Hiroyuki Yoshidome,
Masayuki Ohtsuka,
Atsushi Kato,
Hideyuki Yoshitomi,
Satoshi Nozawa,
Katsunori Furukawa,
Noboru Mitsuhashi,
Shigeaki Sawada,
Dan Takeuchi, Satoshi Ambiru,
Masaru Miyazaki
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ABSTRACT: Humoral mediators are potentially involved in the pathogenesis of postoperative complications following surgery. The aim of the present study is to evaluate the postoperative responses of circulating cytokines, chemokines, and stress hormones following liver resection, and their effects on postoperative infectious complications and organ dysfunction.
Perioperative plasma concentrations of interleukin (IL)-6, IL-10, IL-4, IL-8, macrophage chemoattractant protein (MCP)-1, cortisol, macrophage migration inhibitory factor (MIF), and leptin were measured by immunoassays in 128 consecutive patients undergoing liver resection.
Forty-three patients had postoperative infection and 11 had infection-related organ dysfunction. Plasma levels of all mediators except for IL-4 increased postoperatively. Postoperative levels of IL-6, IL-10, IL-8, MCP-1, cortisol, and leptin were significantly higher in patients with organ dysfunction than in those without organ dysfunction (P < 0.05). However, postoperative MIF levels were not affected by postoperative infection or organ dysfunction. Plasma levels of IL-6, IL-10, IL-8, and MCP-1 were positively correlated with operation time (P < 0.0001) or blood loss (P < 0.0001), and higher in patients with jaundiced liver (P < 0.05). In univariate logistic regression analyses, elevated IL-6, IL-10, IL-8, and MCP-1, advanced age, large volume of blood loss, long operation time, long hepatic ischemia time, and major liver resection were significantly correlated with postoperative infection (P < 0.05). In multivariate analyses, IL-6 and IL-10 were significant predisposing factors for postoperative infection (P < 0.05), and blood loss and IL-6 for organ dysfunction (P < 0.01).
These results suggest that IL-6, IL-10, IL-8, MCP-1, cortisol, and leptin are released after liver resection in response to surgical stress and correlated with postoperative infection and organ dysfunction, and that of these circulating mediators, IL-6 and IL-10, have a close relationship to the complications.
Journal of Surgical Research 06/2006; 133(2):102-12. · 2.25 Impact Factor
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Hironobu Makino,
Hiroaki Shimizu,
Hiroshi Ito,
Fumio Kimura, Satoshi Ambiru,
Akira Togawa,
Masayuki Ohtsuka,
Hiroyuki Yoshidome,
Atsushi Kato,
Hideyuki Yoshitomi,
Shigeaki Sawada,
Masaru Miyazaki
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ABSTRACT: To study the effects of obstructive jaundice on liver regeneration after partial hepatectomy.
Hepatocyte growth factor (HGF), its receptor, c-Met, vascular endothelial growth factor (VEGF) and transforming growth factor-beta1 (TGF-beta1) mRNA expression in both liver tissue and isolated liver cells were investigated after biliary obstruction (BO) by quantitative reverse-transcription polymerase chain reaction (RT-PCR) using a LightCycler. Immunohistochemical staining for desmin and alpha-smooth muscle actin (alpha-SMA) was also studied. Regenerating liver weight and proliferating cell nuclear antigen (PCNA) labeling index, and growth factor expression were then evaluated after 70% hepatectomy with concomitant internal biliary drainage in BO rats or sham-operated rats.
Hepatic TGF-beta1 mRNA levels increased significantly 14 days after BO, and further increased with duration of cholestasis. Meanwhile, HGF and VEGF tended to increase, but was not significant. In cell isolates, TGF-beta1 mRNA was found mainly in the hepatic stellate cell (HSC) fraction. Immunohistochemical studies revealed an increased number of HSCs (desmin-positive cells) and activated HSCs (alpha-SMA-positive cells) in portal areas after BO. In a hepatectomy model, liver regeneration was delayed in BO rats, as compared to sham-operated rats. TGF-beta1 mRNA was significantly up-regulated up to 48 h after hepatectomy, and the earlier HGF mRNA peak was lost in BO rats.
BO induces HSCs proliferation and activation, leading to up-regulation of TGF-beta1 mRNA and suppression of HGF mRNA in livers. These altered expression patterns may be strongly involved in delayed liver regeneration after hepatectomy with obstructive jaundice.
World Journal of Gastroenterology 05/2006; 12(13):2053-9. · 2.47 Impact Factor
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Fumio Kimura,
Hiroaki Shimizu,
Hiroyuki Yoshidome,
Masayuki Ohtsuka,
Atsushi Kato,
Hideyuki Yoshitomi,
Satoshi Nozawa,
Katsunori Furukawa,
Noboru Mitsuhashi,
Shigeaki Sawada,
Dan Takeuchi, Satoshi Ambiru,
Masaru Miyazaki
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ABSTRACT: Cytokines and chemokines potentially modulate postoperative immune response. Association of circulating cytokines and chemokines with postoperative infectious complications after pancreaticoduodenectomy was evaluated.
Plasma concentrations of interleukin (IL) 6, IL-10, IL-8, macrophage chemoattractant protein 1, heat shock protein 70, and amylase, as well as amylase levels in peritoneal exudative fluid, were measured perioperatively in 60 consecutive patients who underwent pancreaticoduodenectomy.
Of the 60 patients, 27 patients had surgical site infection (SSI), including peritoneal infection in all, intra-abdominal abscess in 14, and radiologically visualized pancreatic leakage in 6. Postoperative plasma levels of IL-6, IL-8, and macrophage chemoattractant protein 1, as well as peritoneal amylase levels, were significantly higher in patients with SSI than in those without SSI (P < 0.05). Nonpancreatic cancer as a histopathologic diagnosis, high pancreatic juice flow, and increased levels of IL-6 and IL-8 were independently associated with SSI (P < 0.05) in multiple logistic regression analysis. Plasma levels of IL-6 and IL-10 among patients with SSI were significantly higher in those with pancreatic leakage than in those without leakage.
These results suggest that, in addition to pancreatic exocrine function, IL-6 and IL-8 are associated with postoperative SSI, including pancreatic leakage after pancreaticoduodenectomy.
Pancreas 03/2006; 32(2):178-85. · 2.39 Impact Factor
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ABSTRACT: To study the regulatory mechanisms of sinusoidal regeneration after partial hepatectomy.
We investigated the expression of angiopoietin (Ang)-1, Ang-2, Tie-2, and vascular endothelial growth factor (VEGF) in regenerating liver tissue by quantitative reverse-transcription polymerase chain reaction (RT-PCR) using a LightCycler (Roche Diagnostics) and also immunohistochemical staining after 70% hepatectomy in rats. In the next step, we isolated liver cells (hepatocytes, sinusoidal endothelial cell (SEC), Kupffer cell, and hepatic stellate cells (HSC)) from regenerating liver tissue by in situ collagenase perfusion and counterflow elutriation, to determine potential cellular sources of these angiogenic factors after hepatectomy. Proliferation and apoptosis of SECs were also evaluated by proliferating cell nuclear antigen (PCNA) staining and the terminal deoxynucleotidyl transferase d-uridine triphosphate nick end labeling (TUNEL) assay, respectively.
VEGF mRNA expression increased with a peak at 72 h after hepatectomy, decreasing thereafter. The expression of Ang-1 mRNA was present at detectable levels before hepatectomy and increased slowly with a peak at 96 h. Meanwhile, Ang-2 mRNA was hardly detected before hepatectomy, but was remarkably induced at 120 and 144 h. In isolated cells, VEGF mRNA expression was found mainly in the hepatocyte fraction. Meanwhile, mRNA for Ang-1 and Ang-2 was found in the SEC and HSC fractions, but was more prominent in the latter. The PCNA labeling index of SECs increased slowly, reaching a peak at 72 h, whereas apoptotic SECs were detected between 120 h and 144 h.
Ang-Tie system, together with VEGF, plays a critical role in regulating balance between SEC proliferation and apoptosis during sinusoidal regeneration after hepatectomy. However, the VEGF system plays a more important role in the early phase of sinusoidal regeneration than angiopoietin/Tie system.
World Journal of Gastroenterology 01/2006; 11(46):7254-60. · 2.47 Impact Factor
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Jun Kawamoto,
Fumio Kimura,
Hiroaki Shimizu,
Hiroyuki Yoshitome, Satoshi Ambiru,
Masayuki Otsuka,
Atsushi Katou,
Hideyuki Yoshitomi,
Satoshi Nozawa,
Shigeaki Sawada,
Katsunori Furukawa,
Dan Takeuchi,
Masaru Miyazaki
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ABSTRACT: The patient was a 73-year-old man diagnosed with bile duct cancer. He underwent hepato-pancreatoduodenectomy and a combined resection of portal vein in July 2002. The post operative course was uneventful. In December 2003 he had a loss of consciousness, and was admitted to our hospital as an emergency patient. Abdominal CT scan and angiography revealed the presence of portal vein stenosis due to local recurrence of bile duct cancer resulting in portal hypertension. Thus, a metallic stent was placed in the portal vein to maintain portal blood flow. A non-covered metallic stent, 10 mm in diameter and 80 mm in length (SMART stent, Cordis Endovascular), was deployed through the stenotic portal vein. Portography after the stent placement showed a relief of the portal vein stenosis. Intravenous heparin administration was performed at a dose of 5,000 IU per day for 5 days after the stent placement, and this was followed by oral warfarin potassium administration. The clinical course was uneventful and the patient was discharged 21 days after portal stent placement. Portal stenting successfully improved portal hypertension due to stenosis of the portal vein without any complication. Our experience suggests that the portal vein stenting using the SMART stent is useful palliative therapy for portal vein stenosis.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2005; 32(11):1866-9.
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Masaru Miyazaki,
Hiroshi Ito,
Fumio Kimura,
Hiroaki Shimizu,
Akira Togawa,
Masayuki Ohtsuka,
Hiroyuki Yoshidome,
Atsushi Kato,
Hideyuki Yoshitomi,
Shigeaki Sawada, Satoshi Ambiru
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ABSTRACT: Surgical resection has been reported to be only hope for cure for the patients with hilar cholangiocarcinoma. Therefore, first of all, radical surgical resection should be considered to be a therapeutic option for hilar cholangiocarcinoma as much as possible. In preoperative staging for hilar cholangiocarcinoma, various extensive patterns of cancer such as the involvements of bile duct, portal vein, hepatic artery and lymph node etc, should be evaluated in each patient. As most patients are associated with obstructive jaundice at presentation, liver function has to be evaluated by appropriate tests for deciding the suitable surgical procedure. When the future remnant liver volume is less than 40% or severe liver functional damage exists or greater surgical stress is expected, preoperative portal vein embolization might have to be selected. On the other hand, if hilar cholangiocarcinoma involves limited region of the hilar bile duct confluence, parenchyma preserving hepatectomy such as S1 resection and S1 + S4 resection should be selected for avoiding the occurrence of liver failure. Combined portal vein resection should be done for the case of the cancer involvement of the portal vein without hesitation to improve the prognosis. However, hepatic artery resection and reconstruction in the involved case should be carefully performed only in severely selected cases. By using several useful pre-operative and intra-operative therapeutic modalities, hilar cholangiocarcinoma should be surgically resected with curative intent and without increasing surgical morbidity and mortality rates.
Nippon Geka Gakkai zasshi 05/2005; 106(4):291-6.
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ABSTRACT: Caval replacement after circumferential resection of the inferior vena cava remains controversial. The aim of the current study is to determine whether or not inferior vena cava replacement should be performed.
We reviewed 36 cases undergoing resection of the inferior vena cava concomitant with resection of malignant neoplasms. Our criteria for circumferential resection of the inferior vena cava were half or more of the circumference of the vessel wall invaded by tumor, a primary tumor of the caval wall, or massive intraluminal tumor thrombus suspected of adhering to the caval wall. We detailed 10 patients undergoing circumferential resection of the inferior vena cava.
Most of patients who did not undergo replacement of the inferior vena cava showed no sign of swelling of the lower limbs, but one showed persistent leg edema with oliguria. This patient had poor development of collateral circulation and mild obstruction of the inferior vena cava before surgery. Two patients who underwent replacement of inferior vena cava had no venous sequelae, although they had poor development of collateral circulation before surgery.
Caval replacement after circumferential resection of the inferior vena cava may be necessary in patients who have preoperative poor development of collateral circulation or who have oliguria or unstable hemodynamics intraoperatively.
The American Journal of Surgery 05/2005; 189(4):419-24. · 2.78 Impact Factor
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ABSTRACT: In inbred miniature swine, semi-identical liver allograft recipients survive up to 3 months without immunosuppression, whereas similarly mismatched kidney allografts are uniformly rejected within 2 weeks. The early biological and immunological events were assessed in this unique model. SLA(d/d) pigs (MGH, Harvard Medical School, Boston, MA, USA) received liver or kidney allograft from heterozygous SLA(c/d) miniature swine. Survival, graft function, histology, intragraft cytokines, peripheral lymphocyte and platelet count, plasma cortisol level and cellular/humoral anti-donor immune response were assessed. Kidney allografts were uniformly rejected within 2 weeks, whereas liver allografts survived for up to 87 days. After both liver and kidney transplantation, the peripheral lymphocyte count decreased during the first week concomitantly to a significant elevation of plasma cortisol level. Early decrease of peripheral platelet count was observed after liver but not renal transplantation. Up-regulation of transforming growth factor beta1 (TGF-beta1) and interferon-gamma (IFN-gamma) was observed during the first postoperative week in semi-identical liver allografts and IFN-gamma as well as IL-10 in kidney allografts. In liver recipients, labelled autologous lymphocytes accumulated in the liver graft and native spleen, whereas after renal allograft, lymphocytes accumulated in the native spleen and liver but never in the kidney allograft. Specific cellular anti-donor unresponsiveness was observed from the first post-transplant day in both liver and kidney recipients, while the humoral anti-donor response remained intact. In semi-identical liver allograft, recipient rejection is milder and slower than in similarly matched kidney allograft. The intragraft up-regulation of TGF-beta1 in semi-identical liver allograft might be one mediator to explain the modulation of rejection after liver transplant. The rapid, nonspecific accumulation of recipient lymphocytes in the liver allograft but not in kidney allograft might also play a role in the different survival time in this model.
Transplant International 02/2005; 18(1):78-88. · 2.92 Impact Factor
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Tsukasa Takayashiki,
Hiroyuki Yoshidome,
Fumio Kimura,
Masayuki Ohtsuka,
Yoshiaki Shimizu,
Atsushi Kato,
Hiroshi Ito,
Hiroaki Shimizu, Satoshi Ambiru,
Akira Togawa,
Masaru Miyazaki
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ABSTRACT: Liver failure associated with infections after hepatectomy remains a cause of mortality. It has recently been reported that toll-like receptor 4 (TLR4) is involved in recognizing lipopolysaccharides (LPS). The aim of this study was to investigate the role of TLR4 in endotoxin-induced liver injury after hepatectomy.
C3H/HeN and C3H/HeJ mice underwent 70% hepatectomy or sham surgery, and LPS was administered 48 h after surgery. Expression of TLR4 mRNA, nuclear factor-kappaB (NF-kappaB) activation, tumor necrosis factor-alpha (TNF-alpha) and serum ALT levels, histological findings, and myeloperoxidase content were examined. Survival after LPS administration was also determined.
Hepatic expression of TLR4 was significantly increased 6-72 h after hepatectomy. In mice with endotoxemia after hepatectomy, hepatic NF-kappaB activation was greatly increased. Hepatic mRNA and serum levels of TNF-alpha, and ALT levels were significantly elevated compared with sham operated controls. Focal necrosis with neutrophil infiltration was apparent, which is consistent with increased myeloperoxidase contents in endotoxemia after hepatectomy in C3H/HeN mice. These were completely absent in C3H/HeJ mice. Survival of C3H/HeN mice with endotoxemia after hepatectomy was significantly lower than that of C3H/HeJ mice.
Upregulated TLR4 expression and function after hepatectomy plays a pivotal role in endotoxin-induced liver injury after hepatectomy.
Journal of Hepatology 11/2004; 41(4):621-8. · 9.26 Impact Factor
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Hiroshi Ito,
Fumio Kimura,
Hiroaki Shimizu, Satoshi Ambiru,
Akira Togawa,
Masayuki Ohtsuka,
Hiroyuki Yoshidome,
Atsushi Kato,
Masaru Miyazaki,
Shigeru Yamada,
Hirohiko Tsujii
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ABSTRACT: Prognosis of pancreatic cancer is still remarkably poor, even if complete resection was performed by enlarged abscission. On the other hand, carbon-ion beam therapy is giving good results in some selected carcinoma such as small cell lung cancer, prostate cancer, uterus cancer, and soft tissue/bone tumor. In this report, we discuss four patients with pancreatic cancer treated by surgical pancreatectomy combined with preoperative carbon-ion beam irradiation. All patients were irradiated with 48 GyE carbon-iron beam by HIMAC (Heavy Ion Medical Accelerator in Chiba) to the pancreatic area including lymph nodes and nerve plexus. Severe cholangitis, as the postoperative complication, had occurred in one of the patients. However, there was no complication or disorder caused by carbon-iron radiation. All four patients are alive now, but two of them developed tumor recurrence, one with hepatic metastasis and the other with peritoneal dissemination. Surgical treatment for pancreatic cancer combined with preoperative carbon-ion irradiation is expected as a promising cure, but it is necessary to examine more cases in the future to evaluate the clinical outcome of this treatment.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2004; 31(11):1879-81.
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Fumio Kimura,
Hiroshi Itoh, Satoshi Ambiru,
Hiroaki Shimizu,
Akira Togawa,
Hiroyuki Yoshidome,
Masayuki Ohtsuka,
Fumihiko Shimamura,
Atsushi Kato,
Yuji Nukui,
Masaru Miyazaki
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ABSTRACT: Although extracellular heat-shock protein 70 (Hsp70) potentially mediates an inflammatory response, the association of circulating Hsp70 with complications after surgery is poorly understood.
Perioperative plasma concentrations of Hsp70 and interleukin-6 were measured by immunoassays in 64 consecutive patients undergoing liver resection.
Plasma concentrations of Hsp70 and interleukin-6 showed a striking increase immediately after surgery, and on postoperative day 1. The Hsp70 levels correlated significantly with operation time, hepatic ischemia time, postoperative alanine aminotransferase levels, and maximum interleukin-6 levels (P <0.01). The Hsp70 and interleukin-6 concentrations were associated significantly with postoperative infection (P <0.05); Hsp70 concentrations and blood loss but not interleukin-6 were associated significantly with postoperative organ dysfunction (P <0.05) in multivariate analyses.
These results suggest that circulating Hsp70 and IL-6 potentially play a pivotal role in pathophysiology of postoperative infection, and that circulating Hsp70 and blood loss may represent a prognostic marker for postoperative organ dysfunction.
The American Journal of Surgery 07/2004; 187(6):777-84. · 2.78 Impact Factor
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ABSTRACT: Long-term acceptance of semi-identical orthotopic liver transplants (OLTs) in inbred swine is induced by a 12-day course of FK506. To study whether acceptance is attributable to central or peripheral immune mechanisms, the effect of complete thymectomy was determined.
Total thymectomy was performed in 15 swine 3 to 4 weeks before OLT. Twelve of these animals received a 12-day course of FK506 after OLT, and three animals did not receive immunosuppression. Five additional nonthymectomized pigs received OLT and a FK506 regimen. Graft survival, liver function, histology, and cellular and humoral responses were assessed.
Nonthymectomized, FK506-treated animals uniformly showed long-term acceptance of OLT and developed stable donor unresponsiveness. Of the 12 thymectomized, FK506-treated pigs, seven died of non-immunologic causes within 3 postoperative months, and five maintained their OLT for more than 6 months (range 180-450 days). Among these survivors, two developed a complete anti-donor response (mixed lymphocyte reaction [MLR], cell-mediated lymphocytotoxicity [CML], and immunoglobulin [IgG] antibodies) and eventually rejected their OLT at postoperative day 180. The three remaining pigs kept their liver allografts up to 450 days and developed a donor-specific unresponsiveness (a transient anti-donor MLR was observed during the follow-up but never an anti-donor CML or IgG antibodies). All three thymectomized, untreated animals rejected their allografts acutely and displayed a complete anti-donor response (MLR, CML, and IgG antibodies).
Complete thymectomy before OLT impaired but did not uniformly abrogate long-term acceptance of semi-identical OLT, suggesting that peripheral immune mechanisms may be sufficient to induce long-term acceptance of liver allografts in some recipients.
Transplantation 05/2004; 77(8):1172-80. · 4.00 Impact Factor
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ABSTRACT: Serum-free preservation media such as University of Wisconsin (UW) may cause tissue damage through trophic factor (TF) deprivation. This study evaluated whether the addition of TFs to UW solution improves liver graft quality after extended cold preservation time in pigs. UW solution was supplemented with epidermal growth factor, insulin-like growth factor-1, nerve growth factor-beta, bactenecin, and substance P to create TF-supplemented (TFS) UW. Orthotopic liver transplantation was performed after 18 hr of static cold storage at 4 degrees C in UW (n=7) or TFS-UW (n=7) solution. Recipients of grafts preserved with TFS-UW demonstrated significantly better 5-day survival (57%) than those preserved with UW alone (14%) (P<0.05). Adenosine triphosphate content in grafts preserved in TFS-UW was significantly higher than in grafts preserved in UW (17.4+/-5.0 vs. 4.8+/-1.2 nmol/mg protein, respectively) (P<0.05). This study showed that the addition of TFs to UW solution allowed a significant extension of cold ischemic time in pigs.
Transplantation 01/2004; 77(2):302-19. · 4.00 Impact Factor
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ABSTRACT: There is controversy regarding the appropriate treatment for multiple hepatic malignancies. In hepatectomy it is sometimes impossible to resect all tumors because of a lack of sufficient hepatic functional reserve. We performed hepatectomy combined with intraoperative radiofrequency ablation (RFA) to treat multiple hepatic malignancies. Ten patients underwent hepatectomy + RFA, and none of the patients had any severe complications. Three year cumulative survival rate is 88% as of this writing. In conclusion, hepatectomy combined with RFA appears to be another promising modality.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2003; 30(11):1693-6.
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Fumio Kimura,
Hiroshi Ito,
Hiroaki Shimizu,
Akira Togawa,
Masayuki Otsuka,
Hiroyuki Yoshidome,
Fumihiko Shimamura,
Atsushi Kato,
Yuji Nukui, Satoshi Ambiru,
Masaru Miyazaki
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ABSTRACT: OBJECTIVE: Splenectomy is the standard surgical treatment for hereditary spherocytosis, but partial splenic embolization is another potential option. We retrospectively studied the therapeutic effects of partial splenic embolization as a treatment for hereditary spherocytosis. CONCLUSION: Partial splenic embolization is a safe and effective alternative to splenectomy or partial splenectomy in the treatment of hereditary spherocytosis.
American Journal of Roentgenology 11/2003; 181(4):1021-4. · 2.78 Impact Factor
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ABSTRACT: Although splenectomy is a standard surgical treatment for chronic idiopathic thrombocytopenic purpura, partial splenic embolization is another treatment option. We retrospectively studied the long-term results of initial and repeated partial splenic embolization.
Thirty-nine patients, 15 men and 24 women, underwent initial embolization; 12 of the 39 underwent a repeated embolization. The therapeutic effects of the initial and repeated embolization were classified as a complete response if the patient's platelet count rose to more than 10 x 10(4)/ micro L without medication 1 year after the initial or repeated embolization, as a partial response if the platlet count reached 5-10 x 10(4)/ micro L under the same circumstances, or as no response.
Twenty patients (51%) responded to the initial embolization (complete response in 11 and partial response in nine). No significant differences were found between those patients who responded to the treatment (responders) and those who did not respond to the treatment (nonresponders) in age, sex, lowest platelet counts, and steroid response before embolization. Peak platelet response was significantly higher in the responders (p = 0.029). One of the 11 complete responders and five of the nine partial responders relapsed after a median follow-up period of 34 months (range, 15-23 months) and underwent repeated embolization, resulting in complete response in one patient, partial response in the remaining four patients, and no response in one patient. However, in the six nonresponders (to the initial embolism), repeated embolization elicited a partial response in only one patient. The remission rate of 51% was maintained by means of repeated embolization for a median follow-up period of 76 months after the initial embolization.
Partial splenic embolization combined with repeated embolization may be an effective alternative to splenectomy in the treatment of chronic idiopathic thrombocytopenic purpura.
American Journal of Roentgenology 12/2002; 179(5):1323-6. · 2.78 Impact Factor
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ABSTRACT: Background and Aims: Advanced hepatocellular carcinoma (HCC) with extensive tumour growth through the hepatic vein still has an extremely poor prognosis, even after cancer chemotherapy and/or transarterial embolization. Although aggressive surgical treatments using extracorporeal circulation and liver transplantation have been performed by some authors, the reported results were still unsatisfactory. In this study, we report the favourable result of hepatic artery chemoembolization and subsequent surgical resection in three patients with advanced HCC with extensive tumour thrombus through the hepatic vein.Methods and Results: Three irresectable patients with HCC with extensive tumour thrombus through the hepatic vein underwent hepatic artery chemoembolization with aclarubicin, mitomycin C, lipiodol and/or Gelfoam. After the reduction of tumour extent with hepatic artery chemoembolization, two of the three patients underwent surgical resection. These two patients are still alive at 59 and 21 postoperative months, respectively. In the other case, the extent of the tumour and functional reserve of the liver prevented us from performing surgical resection, but the patient is doing well 62 months after the initial treatment.Conclusions: Hepatic artery chemoembolization with aclarubicin, mitomycin C, lipiodol and/or Gelfoam might be an effective treatment for irresectable advanced HCC with extensive tumour thrombus into the inferior vena cava or the right atrium through the hepatic vein. Radical surgical resection might be applicable for selected patients without high surgical risk after reducing tumour extent by hepatic artery chemoembolization.
Journal of Gastroenterology and Hepatology 12/2001; 14(9):922 - 927. · 2.87 Impact Factor
