Noboru Ide

Nagasaki University, Nagasaki-shi, Nagasaki-ken, Japan

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Publications (14)21.21 Total impact

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    ABSTRACT: Because acute rejection is the most important cause of chronic rejection in lung transplantation, the use of conventional systemic immunosuppression to improve long-term survival needs to be reassessed. The aim of this study was to investigate the efficacy and safety of inhaled tacrolimus for preventing acute rejection of rat lung allografts. Orthotopic left lung transplantation was performed in rats that were divided into 6 groups: control group received no treatment; groups 1.0-IM, 0.5-IM, and 0.3-IM received tacrolimus by intramuscular injection at 1.0, 0.5, and 0.3 mg/(kg.d), respectively; and groups 12-IT and 6-IT received 12 and 6 puffs of inhaled tacrolimus 3 times per day, respectively. Allografts were studied histologically. Whole blood and allograft tacrolimus concentrations were determined. In groups 1.0-IM and 12-IT, histologic grade of the graft showed significantly less rejection than in the other groups. The blood tacrolimus concentration in group 12-IT (4.87 ng/mL) was significantly lower than that in group 1.0-IM (13.05 ng/mL, P = .0017) on postoperative day 7. Higher allograft tacrolimus concentrations were achieved in group 1.0-IM (478.0 ng/g) than in group 12-IT (270.4 ng/g, P = .009). Weight loss and diarrhea in group 12-IT were less severe than in the groups that received systemic tacrolimus. The proliferating cell nuclear antigen index in bronchus-associated lymphoid tissue cells was significantly lower in group 12-IT than in group 1.0-IM (P = .0209). Local immunotherapy with inhaled tacrolimus has great potential for controlling pulmonary allograft rejection in clinical lung transplantation because it has fewer side effects than systemic immunosuppressive agents.
    The Journal of thoracic and cardiovascular surgery 03/2007; 133(2):548-53. · 3.41 Impact Factor
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    ABSTRACT: Thoracoabdominal approach might be safe and facilitate hepatic resection for tumors located in the right lobe. To evaluate the clinical usefulness of the thoracoabdominal approach using oblique incision for the right-side hepatectomy, we compared the perioperative data with those of the abdominal approach. The oblique incision for the thoracoabdominal approach was placed along the intercostal space (Oblique group, n=13). The J-shape incision for abdominal approach consisted of an upper median incision and transverse incision (J-shape group, n=13). Patient demographics were similar in the two groups. Operation time was significantly shorter in the oblique group (292 +/- 122 min) than in the J-shape group (450 +/- 137 min, p < 0.01). The difference was noted regardless of the extent of hepatic resection. Clamping time and blood loss were similar in the two groups. The postoperative period of use of analgesia tended to be shorter in the oblique group (9 +/- 3 days) than in the J-shape group (15 +/- 11 days) but not significant (p = 0.08). Postoperative liver function tests, complications and clinical outcome were not significantly different between the two groups. Thoracoabdominal approach using oblique incision was useful for resection of liver tumors located in the hepatic dome and posterior segment.
    Hepato-gastroenterology 01/2007; 54(73):148-51. · 0.77 Impact Factor
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    ABSTRACT: To clarify the relationship between morphological measurements of hepatic volume by computed tomography (CT-vol) and functional volume (RI-vol) by technetium-99m galactosyl human serum albumin (99mTc-GSA) scintigraphy, and its clinical significance, we examined 16 patients with a background liver status of either normal liver function (n=4), chronic hepatitis or cirrhosis (n=7), or obstructive jaundice (n=5). In five patients who underwent preoperative portal vein embolization (PVE), volumetric measurement was performed 2 weeks after PVE. The mean values of CT-vol and RI-vol of the right lobe were 692+/-147 cm3 (66.1+/-10.7%) and 668+/-159 cm3 (67.8+/-13.2%), respectively, and those of the left lobe were 329+/-138 cm3 (33.9+/-10.6%) and 328+/- 170 cm3 (32.2+/-13.2%), respectively. There were no significant differences in the volume measurements between the two volumetric techniques. Correlations between CT-vol and RI-vol in the right and left lobes were positive and significant (r=0.912 and 0.903, respectively; both P's<0.001). The mean values of post-PVE CT-vol and RI-vol of the right lobe in five patients were significantly different (628+/-149 and 456+/-211 cm3, respectively; P=0.033). However, the mean values of post-PVE CT-vol and RI-vol of the left lobe were not different (496+/-124 and 483+/-129 cm3, respectively). We propose that volumetric measurement by 99mTc-GSA scintigraphy is useful for detecting changes in functional volume of individual lobes of the liver and is a more dynamic method compared with detection of morphological changes by CT scan.
    Digestive Diseases and Sciences 07/2006; 51(7):1190-5. · 2.26 Impact Factor
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    ABSTRACT: alpha-Fetoprotein (AFP) has been used as a marker for hepatocellular carcinoma (HCC). However, AFP levels are often high in patients with chronic hepatitis or cirrhosis. Protein-induced vitamin K absence or antagonist II (PIVKA-II) is more sensitive for the diagnosis of HCC and prediction of patient survival. Changes in these markers after treatment may reflect treatment curability and patient outcome. We conducted a retrospective analysis of prognosis of 63 HCC patients with high preoperative levels of AFP and PIVKA-II who underwent hepatectomy and examined the relationship between postoperative changes in both markers at 1 month and patient survival. Subjects were divided into three groups according to changes in these tumour markers after hepatectomy: normalization (N) group, decreased but still above the normal level (D) group and unchanged (U) group. There were no significant differences in the numbers of patients who developed tumour recurrence between changes in AFP and PIVKA-II. Survival analysis showed no significant differences in tumour-free and overall survivals between groups with respect to AFP level. The PIVKA-II-N group showed significantly better tumour-free and overall survival compared with the D and U groups (p<0.01). Multivariate analysis that included other prognostic factors identified changes in PIVKA-II level as a significant and independent prognostic factor associated with overall survival. Although changes in AFP did not correlate with patient prognosis, normalization of PIVKA-II was significantly associated with good patient survival after hepatectomy. Normalization of PIVKA-II after hepatectomy reflected the efficacy of treatment and is a suitable predictor of prognosis in HCC patients.
    HPB 02/2006; 8(2):137-41. · 1.94 Impact Factor
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    ABSTRACT: In a previous pilot study, we reported the usefulness of the modified the Cancer of the Liver Italian Program (CLIP) score for patients with hepatocellular carcinoma (HCC). To determine the best staging system for predicting the survival of HCC patients, we conducted a comparative analysis of prognosis using multivariate analysis in 210 Japanese HCC patients who underwent hepatic resection. We compared the survival as predicted by various staging systems, including tumour node metastasis (TNM) stage of the American Joint Commission on Cancer (AJCC) and the Liver Cancer Study Group of Japan, the Japan Integrated Staging (JIS) score (Japanese TNM and Child-Pugh classification), CLIP score and our modified CLIP score using protein induced by vitamin K absence or antagonist II (PIVKA-II). Univariate analysis showed that discrimination of disease-free survival in the early and advanced stages by the JIS score and modified CLIP score was clearer than by the Japanese or AJCC TNM or the original CLIP score. Discrimination between stages of overall survival by all staging systems was significant. Multivariate analysis showed that the JIS, CLIP and modified CLIP scores were better staging systems for predicting survival than the Japanese and AJCC TNM. The modified CLIP score showed the lowest Akaike information criteria statistical value for disease-free and overall survival, which means the best discrimination ability for patient survival compared with the JIS score and CLIP score. A staging system that combines tumour factors, sensitive tumour marker(s) and hepatic function is the best predictor of prognosis of HCC patients.
    European Journal of Surgical Oncology 11/2005; 31(8):882-90. · 2.61 Impact Factor
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    ABSTRACT: Since 1980, we have performed plasmapheresis before thymectomy for patients with generalized symptoms in order to protect against myasthenic crisis and to improve patient outcomes after thymectomy. The aim of this study was to evaluate an immediate and a long-term results of plasmapheresis before thymectomy for myasthenia gravis, retrospectively. Between January 1980 and December 1997, 51 patients with Osserman class IIA or IIB symptoms were treated with transsternal thymectomy. Nineteen patients (group 1) were treated with plasmapheresis before thymectomy and 32 patients (group 2) were treated with thymectomy alone. In group 1, the time of plasmapheresis prior to thymectomy was 3.2 +/- 1.5. Nine (28.1%) patients in group 2 had crisis within 1 year after thymectomy as compared with only one (5.3%) patient in group 1 had crisis (p = 0.049). There was no evidence of crisis within 30 days after thymectomy in group 1 and 5 (15.6%) patients in group 2 (p = 0.0724). There was no postoperative death among patients in group 1. Responses to thymectomy in group 1 improved significantly, the improvement and pharmacologic remission rate had increased up to 100% and 79% at 5-7 years after operation, while the improvement and pharmacologic remission rate of group 2 had increased to 81.3% (p = 0.0466 vs. group 1) and 50.0% at that time (p = 0.0427 vs. group 1). The present study demonstrated that preoperative plasmapheresis may facilitate improved outcomes of patients with myasthenia gravis after thymectomy.
    The Japanese Journal of Thoracic and Cardiovascular Surgery 02/2005; 53(1):2-7.
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    ABSTRACT: The aim of our retrospective study was to compare the factors contributing to postoperative complications according to the extent of hepatectomy. We examined 166 patients with hepatobiliary carcinoma who underwent hepatectomy. Patients were divided into three groups according to the type and extent of hepatectomy: 1) left lobectomy (n=27), 2) right lobectomy or posterior segmentectomy (n=55) and 3) other hepatectomies (n=84). Patient demographics, major complications (infection, ascites, pleural effusion, atelectasis, static symptoms of the stomach, biliary leakage and hepatic failure) after hepatectomy were analyzed. In patients with obstructive jaundice, lobectomy was the most commonly performed operation due to the extent of tumor along the main hepatic duct. Prolonged ascites or massive pleural effusion was frequently observed after right lobectomy (p=0.001) and posterior segmentectomy (p=0.002). However, the incidences of these complications were similar in patients with chronic viral hepatitis. Symptoms related to gastric stasis and biliary leakage were significantly more common after left lobectomy than other surgeries. The incidence of hepatic failure was higher (p<0.05) after major hepatectomy, particularly right lobectomy, than other surgeries. Our results emphasize the need to understand characteristics of specific complications occurring after different types of hepatic resection surgery to prevent post-hepatectomy complications.
    Hepato-gastroenterology 01/2005; 52(63):844-8. · 0.77 Impact Factor
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    ABSTRACT: Photodynamic therapy (PDT) is a new palliative option in patients with non-resectable bile duct carcinoma (BDC). Here, we assessed the efficacy of adjuvant photodynamic therapy in eight patients with BDC who underwent surgical resection. Five patients had extrahepatic BDC, two had intrahepatic cholangiocarcinoma, and one had ampullary carcinoma. Cancer cells were microscopically detected in the stump of the hepatic duct in six patients, and biliary stenosis caused by remnant tumor was observed in one patient. One patient had tumor recurrence with occlusion of the bile duct. At 48 h prior to PDT, porfimer sodium was injected intravenously. A pulse laser by an eximer dye laser (50-100 J/cm2) with a wavelength of 630 microm was applied through an endoscope to the hepatic stump or tumor lesion. Marked destruction of the tumor and ductal epithelium was observed on day 1 after PDT. After PDT, four patients developed mild dermatitis, but no severe morbidity or mortality was noted. In patients who underwent PDT for the stump, one patient showed distant metastasis at 31 months, and four patients did not show tumor recurrence at 17, 12, 12, and 6 months, respectively. However, one of the eight patients died at 2 months, of an unrelated cause. In two patients with occlusion caused by tumor growth, resolution of bile duct stenosis was noted on day 7. These patients showed re-occlusion by tumor at 20 and 8 months. Adjuvant PDT is a safe and useful option for a better survival benefit in patients with BDC undergoing surgical resection.
    Journal of Gastroenterology 12/2004; 39(11):1095-101. · 3.79 Impact Factor
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    ABSTRACT: The new Japanese staging system for hepatocellular carcinoma (HCC), the Japan integrated staging (JIS) score, accounts for both Child-Pugh classification and Japan tumour node metastasis (TNM) staging. However, in HCC patients who undergo hepatectomy, liver function is relatively good and a better prognostic classification of hepatic function is necessary. The present study was designed to analyse the modified JIS score using liver damage grade by the Liver Cancer Study Group of Japan instead of the Child-Pugh classification (using the category indocyanine green retention rate at 15 min [ICG(R15)] instead of encephalopathy), and to compare the Japan TNM stage in 101 patients who underwent resection of HCC. The liver damage grade showed significantly better discrimination of disease-free and overall survival than did the Child-Pugh classification. The modified JIS score system showed significant differences of disease-free and overall survivals in each score and this system was superior for discriminating survivals compared with the TNM staging. The combined staging system of hepatic function, particularly ICG(R15), and tumour stage provides a better prediction of prognosis. The JIS score using the liver damage grade was a useful predictor of prognosis of HCC patients who underwent hepatic resection.
    European Journal of Surgical Oncology 10/2004; 30(7):765-70. · 2.61 Impact Factor
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    ABSTRACT: The clinical significance of and discrepancy between the indocyanine green retention rate at 15min (ICGR15) and liver activity at 15min (LHL15) by technetium-99m galactosyl human serum albumin ( [Formula: see text] -GSA) scintigraphy and clinical outcome were examined in 140 patients who underwent hepatectomy. Both ICGR15 and LHL15 were significantly associated with portal pressure and liver function tests, fibrotic degree and regeneration of the remnant liver ( [Formula: see text] ). The significance of the correlation between LHL15 and liver functions and HAI score appeared to be better than that with ICGR15. A significant correlation was observed between ICGR15 and LHL15 ( [Formula: see text] 0.591, [Formula: see text] ) for all but 12 patients (8.6%). Of three patients with LHL15 better than ICGR15, two had obstructive jaundice and one had an intrahepatic shunt. Patient outcome was relatively good. In nine patients with LHL15 worse than ICGR15, the HAI score was higher (=7) and six of the nine had hepatic failure or uncontrolled ascites. Complications were frequently observed in patients with LHL15 below 0.875 (80% versus 30%, [Formula: see text] ). Our results indicate that [Formula: see text] -GSA scintigraphy is a reliable auxiliary test of hepatic functional reserve combined with ICGR15 for selecting the extent of hepatectomy and predicting patient outcome.
    Hepatology Research 05/2004; 28(4):184-190. · 2.07 Impact Factor
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    ABSTRACT: We evaluated the efficiency of measuring hyaluronic acid (HA) levels preoperatively in patients with injured liver disease as a predictor of complications after hepatectomy. We examined patients who underwent hepatectomy for liver tumors secondary to chronic viral liver diseases or obstructive jaundice. The preoperative HA level correlated significantly with the indocyanine green retention rate at 15 min, liver activity at 15 min by technetium-99m galactosyl human serum albumin scientigraphy, and the histopathological activity index. It was also significantly elevated in patients with severe fibrosis caused by cirrhosis. After hepatectomy, the HA level was increased on postoperative day (PODS) 7, but had normalized by POD 28. The preoperative HA level tended to correlate with the regeneration rate on POD 28, and was significantly higher in patients with prolonged ascites or hepatic failure postoperatively. Multivariate analysis identified a serum HA level above 200 or 150 ng/ml as the only significant predictor of postoperative hepatic failure or long-term ascites, respectively (P < 0.05). Our findings indicate that the preoperative serum HA level is a good predictor of postoperative complications in patients who undergo hepatectomy for injured liver disease.
    Surgery Today 01/2004; 34(11):913-9. · 0.96 Impact Factor
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    ABSTRACT: To clarify the relationship between resected (RSV) or remnant hepatic volume (RMV) in major hepatectomy, and standard liver volume (SLV) and its clinical significance, the RSV/SLV, RMV/SLV and the volume of regeneration (RGV)/RMV were examined in 41 patients including 19 with chronic hepatitis and 5 with obstructive jaundice who underwent lobectomy or extended lobectomy. The hepatic function was maintained in all patients. SLV was calculated by the body-surface area using Urata's formula. RGV was calculated by subtracting the RMV from the remnant liver volume at day 28 after hemi-hepatectomy. Measurement of the hepatic volume was performed by computed tomography. The means of RSV, RMV, RGV and SLV were 591 ツア 173, 459 ツア 119, 667 ツア 129 and 1128 ツア 129cm3, respectively. The means of RSV/SLV, RMV/SLV and RGV/RMV were 0.52 ツア 0.14, 0.41 ツア 0.12 and 1.54 ツア 0.47, respectively. RGV was inversely correlated with RMV/SLV (p<0.001) but not with the other parameters. RSV/SLV and RMV/SLV were not associated with long-term ascites and hepatic failure. The tendency of these results was similar in each patient with a normal liver, obstructive jaundice and chronic viral hepatitis. If the hepatic functional reserve is maintained, a liver with lower hepatic volume has potentially sufficient regeneration even in patients with an injured liver
    01/2003;
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    ABSTRACT: To identify the effect of local treatments for hepatocellular carcinoma (HCC) in our associated institutes in Nagasaki prefecture, we performed a comparative study of hepatic resection and local ablative therapies, including alcohol injection, microwave coagulation and radio-frequency ablation. We examined the patient demographics, outcomes and tumor-free and overall survival between a hepatectomy group (n=210) and a local ablative therapy group (n=52). In the ablative therapy group, there were significantly more patients with cirrhosis and poorer hepatic function than in the hepatectomy group (p<0.001). Larger tumors and vascular involvement in the hepatectomy group were significantly more frequent than in the ablative therapy group (p<0.001 and p=0.002, respectively). The multivariate Cox regression analysis indicated no significant difference either in the time to the first recurrence of tumor after surgery or in mortality between ablative therapy and hepatectomy. By making full use of various modalities in each specialty, the satisfactory HCC treatment could be achieved at this stage
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    ABSTRACT: This study was designed to provide an immunohistochemical analysis of tumor biological factors in 28 patients who underwent hepatectomy for cholangiocellular carcinoma (CCC). Analyzed factors were microvessel counts (stained by CD34) and proliferating cell nuclear antigen (PCNA). PCNA L.I. was correlated with serum level of CA19-9, which was correlated with a higher recurrence rate and shorter patient survivals. Microvessel counts were negatively correlated with tumor size. Furthermore, the microvessel count in CCC with mass-forming (MF) plus periductal infiltrating (PI) type associated with poorer survivals, was significantly lower compared to that of CCC with MF type or PI type. Neither microvessel counts nor PCNA L.I. were associated with any other clinicopathologic factors or cancer recurrence. The five-year overall and cancer-free survival rates were 26% and 13%, respectively. Patients with MF plus PI type, poorer differentiated carcinoma, stage 4A and higher CA19-9 level had shorter cancer-free and overall survivals after hepatectomy (p<0.05). Cancer-free and overall survivals in patients with lower microvessel counts tended to be slightly worse but were not significantly different. Although tumor microvessel count and proliferating activity were correlated with prognostic clinicopathologic parameters, both factors might not be prognostic markers for predicting CCC recurrence and patient survival