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Biomedical subjects

Akiyoshi Hirano

Publications and source records attributed to Akiyoshi Hirano.

At least 19 recordsLinked to original sources
PubMed2006

A polyurethane dressing is beneficial for split-thickness skin-graft donor wound healing.

Few comparative studies have been performed on the various wound-dressing materials or methods proposed for use. To clarify the efficacy of wound dressing, 35 patients (17 females, aged 44.8+/-26.86 years and 18 males, aged 35.4+/-29.70) were subjected to a prospective study comparing a polyurethane dressing and a hydrogel dressing for split-thickness skin donors from the lateral thighs. We examined their clinical usefulness such as accelerated healing time, frequency of changing the dressing, degree of pain, or amount of exudates, and performed moisture meter analysis at 1 month and 1 year after re-epithelialization, which reflects the quality of the stratum corneum and subsequent scarring. The polyurethane dressing was superior to hydrogel in the wound healing time, amount of exudates, and frequency of dressing changes: the hydrogel was better for regulating the degree of pain. There was a positive correlation between transepidermal water loss and the effective contact coefficient, which indicates skin barrier function and affected by skin surface electrolytes and reflects water content, in moisture meter analysis (r(2)=0.32, p<0.01). Transepidermal water loss returned to the control level at 1 year after healing with both dressings. The effective contact coefficient of the polyurethane wound was significantly lower than that of hydrogel at 1 month (p<0.01), while both dressing wounds demonstrated significantly higher values at both 1 month and 1 year compared to the control (p<0.01). The polyurethane dressing is therefore superior both clinically and in moisture meter analysis.

Adolescent↗
PubMed2006

Lower extremity reconstruction after necrotising fasciitis and necrotic skin lesions using a porcine-derived skin substitute.

Seven consecutive clinical cases of necrotising fasciitis or necrotic skin lesions (42-78 years old; average 65.0 years of age, three females and four males) due to group A Streptococcus, group B Streptococcus, methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa in the lower extremities, who demonstrated rapid systemic symptoms, were investigated for the usefulness of a bilayer artificial dermis, derived from porcine tendons, over 4 +/- 2.4 years (1-7 years). All surgical debridement was confirmed as sufficiently deep and wide for clinically infected lesions and artificial dermis was applied to all wounds. The average interval to secondary split-thickness skin grafting was about 17.5 days (17.5 +/- 2.44 days, 21 days max., 14 days min.) and the average thickness was 0.009 +/- 0.0022 in. (range: 0.006 - 0.012 in.). No clinical problems were noted during the application of the artificial dermis and the subsequent skin grafting. Since, the donated skin graft was thin, the morbidity was minimised. The use of artificial dermis after extensive surgical debridement in necrotising fasciitis was easy and effective. Local or systemic infection was negligible.

Adult↗
PubMed2006

Usefulness of simultaneous pre-maxillary osteotomy and bone grafting in the bilateral clefts.

Bilateral cleft lip and palate patients sometimes accompany with mal-positioned premaxilla, which adversely affect the upper lip morphology, especially widened naso-labial angle as well as functional deteriorations such as speech impairment though the fistula in between the alveolar segments. Usefulness of simultaneous premaxillary osteotomy and bone grafting was tested in respect of grafted bone resorption rate and required bone volume. Between January, 2001 and December, 2003, seven patients (seven years and eight months to 16 years old; average 9.7 +/- 2.87, 2 females and 5 males) with complete bilateral cleft lip and palate patients were performed the simultaneous premaxillary osteotomy and bone grafting, whereas in the same period of between January, 2001 and December, 2003, four patients (seven years and 11 months to 11 years old; average 9.2 +/- 1.01, 4 female and 6 males) with complete bilateral alveolus in order to compare cancellous bone volumes to relatively milder and less-protruded premaxilla. The bone grafting was performed in two-stage manner as one side and later, the other side. The bone volume required for cleft packing was significantly lower in osteotomized cases compared to those of non-osteotomized (3.5 +/- 0.69 mL vs. 5.6 +/- 0.70 mL, P < 0.01). There were twenty for non-osteotomized cases (10 bilateral clefts) and fourteen osteotomized (7 bilateral clefts) were evaluated. Overall, majority of both groups demonstrated the grade I (10/20 for non-osteotomized, 12/14 for osteotomized group). There was significant lower bone resorption rate in osteotomized group compared to the non-osteotomized group (1.1 +/- 0.36, 1.7 +/- 0.75, osteotimized, non-osteotomized, respectively, P < 0.05). The simultaneous premaxillary osteotomy and bone grafting is beneficial over staged bone grafting in bilateral cleft cases in requiring bone chio volume and subsequent bone resorption rate. The meticulous dissection and re-location of the premaxilla improves the overall lip morphology.

Adolescent↗
PubMed2006

Therapeutic choice for craniofacial venous malformations.

Even though the precise mechanisms related to venous malformation are still unclear, the clinical manifestations sometimes threaten vital signs such as mastication, airway and phonics. Our therapeutic modalities were reviewed, and their effectiveness and related complications were analyzed. Between March, 1998 and February, 2006, 11 patients (15-59 years old; average 32.4 +/- 13.60, 4 women and 7 men) with craniofacial venous malformation were included in this investigation. All cases experienced some kind of surgery at least once during clinical follow-up. Direct puncture scintigraphy with technetium-99m Sn colloid-labeled demonstrated low-flow malformations in all cases. Two cases underwent bone surgery and another two cases had static suspensions for facial nerve paralysis. Blood loss from surgery alone was 1352 +/- 1115.0 mL, simultaneous procedures yielded 400 +/- 244.9 mL blood loss and sclerotherapy alone resulted in 187 +/- 284.8 mL of blood loss (surgery alone versus sclerotherapy alone, P < 0.01). Excellent sclerotherapy cases were when the malformation was localized and the number of sclerotherapies was significantly fewer than good cases (1.3 +/- 0.58 times versus 3.6 +/- 1.15 times, excellent, good, respectively, P < 0.05). Although there are difficulties in understanding the mechanisms and multiple therapeutic interventions are required, there have been satisfactory outcomes so far and the development of better sclerosants or a real-time navigation system may benefit more precise therapeutic effects and lower morbidity.

Adolescent↗
PubMed2006

Cranial vault distraction: its illusionary effect and limitation.

BACKGROUND: Distraction osteogenesis has some advantages, such as less hazardous complications, less scarring, and fewer bone defects. However, it has not been fully accepted yet because of a unidirectional expansion along the distraction device. Because cranial expansion is limited by scalp tension and soft-tissue scarring, undercorrection of the cranium and relapse of the vault deformities have occasionally been seen on long-term follow-up. These patients also had so much bone defect that the donor bone was inadequate for immediate revisions, and dissection under the scalp was complicated. METHODS: The authors used distraction osteogenesis to treat 12 cases of craniosynostosis. Five patients were syndromic (two cases of Pfeiffer's syndrome, two cases of Crouzon's disease, and one case of Apert's syndrome), and seven were nonsyndromic (four cases of brachycephaly, two cases of scaphocephaly, and one case of plagiocephaly). RESULTS: After only unidirectional expansion without vertical reduction, the shape of the cranium was satisfactorily improved, which might have been an illusion caused by the relative reduction attributed to the elongation by the distraction osteogenesis and, in brachycephaly, alteration of the patient's head position resulting from inclination of the facial plane by forehead advancement. However, in scaphocephaly, the unique deformity in the occipital and frontal regions remained after simple distraction. Distraction osteogenesis should be applied for a narrow cranium because the bone defect and scalp closure could pose problems. Radical reshaping should be used in cases of sufficient donor bone and scalp closure. Although additional surgery is unavoidable for device removal, minor revisions can be performed for revision of the irregularity at that time. CONCLUSION: Except for prolonged treatment, based on minimally invasive operations, distraction cranioplasty might be applied extensively in cases of craniosynostosis.

Acrocephalosyndactylia↗
PubMed2006

Sleep disturbances detected by a sleep apnea monitor in craniofacial surgical patients.

Sleep apnea in craniofacial surgery was investigated. Between January 1999 and December 2003, 18 patients were measured at an at least 6-month interval before and after surgery. Eight patients underwent palatoplasty for cleft palate, and the other 10 patients underwent orthognathic surgery, syndromic craniosynostosis, and postpharyngeal flap surgery. All patients included in the study demonstrated clinical signs of obstructive sleep apnea, such as snoring and cessation of breathing during sleep. An apnomonitor was used for presurgical and postsurgical sleep apnea status by measuring: 1) position during sleep; 2) percutaneous oxygen saturation; 3) respiratory analysis, such as the type of apnea-hypopnea, frequency of the events, and duration of apnea-hypopnea; 4) heart rate; and 5) snore analysis, such as trains, time, mean, and minimal and maximal amplifications. The apnea-hypopnea index (AHI) was significantly improved after surgery, especially in cases other than palatoplasty (7.4 +/- 8.73/h and 1.6 +/- 0.43/h, before and after surgery, respectively; P < 0.05 excluding palatoplasty). The percentage of snoring to total sleep was also improved significantly (22.4 +/- 19.74% and 9.0 +/- 8.54%, before and after surgery, respectively; P < 0.01 in all patients). Therefore, changes in sleep apnea parameters were elucidated in craniofacial surgery. Palatoplasty did not necessarily worsen the sleep apnea status, although there were snoring and anatomic abnormalities. Detachment of the pharyngeal flaps improved sleep apnea, and bimaxillary advancement was effective in normalizing sleep apnea.

Adolescent↗
PubMed2006

Cranioplasty with auto-purified bone flap after infection.

Cranioplasty of cranial bone defects can generally be accomplished with autogeneous bones as well as with nonbiological materials. Autologous living-bone grafts are ideal but require sacrifice of donor bone, and synthetic materials might have possible exposure of the materials, delayed infection, and/or allergic reaction. The authors report cranioplasty with a bone graft after auto-purification by subcutaneous preservation of the contaminated bone fragment. A 47-year-old man was given a frontal cranioplasty with a split parietal bone and rib. Epidural abscess ensued, and debridement was performed to control the infection. The largest bone fragment was subcutaneously preserved in the chest wall and reused for cranioplasty. Subcutaneous preservation of bone is a promising strategy for cranioplasty after neurosurgery. The condition of the bone fragment can be inferred from the condition of the site at which it is preserved. If the bone flap is contaminated, it can be purified by the patient's immune system.

Frontal Bone↗
PubMed2006

Both nasal cerebral heterotopia and encephalocele in the same patient.

UNLABELLED: OBJECTIVE AND PATIENT: Both nasal cerebral heterotopia and encephalocele are rare congenital benign masses of neurogenic origin caused by an embryonic developmental abnormality. It is generally accepted that nasal heterotopia is a sequelae to encephalocele. This report presents an unusual case of nasal cerebral heterotopia and encephalocele arising in the same patient. The patient had a firm, solid mass measuring 1.5 x 1.0 cm on the bridge of the nose covered with normal skin and another mass in the nasal cavity obstructing the right nasal cavity. Computed tomography (CT) demonstrated that the nasal bone separated these masses. CT also showed a bony defect at the skull base. Surgery consisted of dividing the encephalocele and closure of the skull base fistulae, along with nasal subcutaneous mass enucleation. RESULTS: Intraoperative examination indicated the existence of a pit on the nasal bone where the pedicle of the nasal subcutaneous mass connected. Microscopic examination of the nasal cavity mass demonstrated meningoencephalocele, and examination of the nasal subcutaneous mass demonstrated nasal cerebral heterotopia, which was confirmed by immunohistochemical staining. After 10 months, complete removal of the subcutaneous nasal mass was recognized and there was no evidence of recurrence. CONCLUSION: Findings in this case suggest that the nasal cerebral heterotopias will result from encephalocele.

Brain↗
PubMed2005

Analysis of pediatric burns in Nagasaki University from 1983 to 2002.

Pediatric burns are frequently observed: twenty-year burn analysis was performed in a single department, and 354 cases, aged 0-6 years old. The major cause of pediatric burns was scalding (68%) and hot water comprised over half of the scald burns. At 1 year old and younger, the total burn surface area (TBSA) was significantly smaller than from 1 to 6 years old (4.8+/-9.56 versus 10.5+/-18.86%, respectively, p<0.001). TBSA of scald burns was significantly greater than contact burns (8.9+/-15.76 versus 0.9+/-2.0%, respectively, p<0.05). Surgery was performed for 65 patients (18%) and 126 patients were hospitalized (34%). Compared to the first decade of analysis, the second decade had fewer patients (222 versus 142 cases) and lower severity (7.4+/-14.6% versus 6.6+/-13.26%, TBSA). Pediatric burns in younger children should be studied closely as to their causes and with further follow-up.

Body Surface Area↗
PubMed2005

PAX9 and TGFB3 are linked to susceptibility to nonsyndromic cleft lip with or without cleft palate in the Japanese: population-based and family-based candidate gene analyses.

The prevalence of nonsyndromic cleft lip with or without cleft palate (CL/P) and cleft palate only (CPO) are believed to be higher in the Japanese than in Americans, Europeans or Africans. The purpose of this study was to investigate, in a Japanese population, relationships between CL/P or CPO and seven candidate genes (TGFB3, DLX3, PAX9, CLPTM1, TBX10, PVRL1, TBX22) that showed positive associations in other populations and are expressed in the oral/lip region in developing mice. We first searched for mutations in these genes among 112 CL/P and 16 CPO patients, and found a heterozygous missense mutation (640A > G, S214G) in exon 3 of PAX9 in two sibs with CL/P and their phenotypically normal mother from a Japanese family. A population-based case-control analysis and a family-based transmission disequilibrium test (TDT), using single nucleotide polymorphisms (SNPs), and two-SNP haplotypes of the genes, between the 112 CL/P cases with their parents and 192 controls indicated a significant association at one SNP site, IVS1 + 5321, in TGFB3 with a P-value of 0.0016. Population-based haplotyping revealed that the association was most significant for haplotype "A/A" consisting of IVS1 + 5321 and IVS1 - 1572; TDT also gave a P-value of 0.0252 in this haplotype.

Amino Acid Sequence↗
PubMed2005

A basic fibroblast growth factor improved the quality of skin grafting in burn patients.

To avoid hypertrophic scars in burn wounds, the simultaneous application of basic fibroblast growth factor (bFGF) with regular surgical debridement and skin grafting was investigated for skin hardness by clinical examination and instrumental measurement. As little is known about the role of bFGF in wounds, burn wound scars were tested for hardness. Burn scars in various anatomical locations at least 1 year after final wound healing clinically demonstrated a significantly lower hard score in bFGF-treated wounds than in non-bFGF wounds (0.95+/-0.51 versus 2.3+/-0.66, respectively, p<0.01). In addition, a durometer, which is widely used in industry to measure materials similar to skin, such as rubber and thread-balls, demonstrated a significantly lower reading in bFGF-treated wounds than in non-bFGF wounds (7.9+/-3.64 versus 15.5+/-4.39, bFGF versus non-bFGF, respectively, p<0.01). The results demonstrated that burn wounds treated with clinically approved bFGF might contribute to a better cutaneous wound quality, at least in terms of hardness.

Adult↗
PubMed2005

Malignant transformation of ameloblastic fibroma to ameloblastic fibrosarcoma: case report and review of the literature.

INTRODUCTION: Ameloblastic fibrosarcoma is a rare malignant odontogenic tumour and is regarded as the malignant counterpart of the ameloblastic fibroma. The epithelial component remains benign, but the mesenchymal component becomes malignant. The diagnosis is made by histopathology. PATIENT: The case of a 26-year-old man who underwent curettage of an ameloblastic fibroma and died of an ameloblastic fibrosarcoma is presented, and the course of malignant transformation is analysed retrospectively. CONCLUSION: One-third of ameloblastic fibrosarcoma cases seem to have developed from recurrent ameloblastic fibromas. Knowledge of the malignant potential in the mesenchymal spindle cells of ameloblastic fibroma will assist in determining the management of these benign tumours, and may prevent malignant transformation to ameloblastic fibrosarcoma.

Adult↗
PubMed2005

Microsurgical dermal-fat retransfer for progressive hemifacial atrophy.

Although the etiology of progressive hemifacial atrophy, Romberg's disease, is still unknown, it typically manifests during emotionally salient times, such as the period before the age of 20 years. It involves not only the subcutaneous tissue and skin but also the muscles and osteocartilaginous framework later. Treatment for the atrophy is, in general, recommended after progression of the disease ceases; otherwise, many augmentations will be required after re-atrophy. However, it has recently been reported that well-vascularized tissue might maintain its volume even in the progressive stage, and that progression might be interrupted by vascularized tissue transplantation. The authors report a case reconstructed with free vascularized dermal-fat re-transfer 13 years after a first reconstruction with free-flap transfer, because the primarily over-corrected region had gradually atrophied and the patient desired further treatment. Even though disease progression could not be completely controlled in this case, free vascularized tissue transfer should be considered for mentally fragile young patients, because the free flap is the best among the procedures for Romberg's disease for maintaining volume.

Adipose Tissue↗
PubMed2005

Post-traumatic severe trismus caused by impairment of the masticatory muscle.

Restriction of the mouth opening from a pathologic condition outside the temporomandibular joint is called a pseudo- or extra-articular ankylosis. The authors report two cases of severe post-traumatic pseudoankylosis. One case showed fibrous degeneration of the bilateral masseter muscles without a facial bone fracture, which caused severe trismus, a mouth opening of less than 2 mm, and gradually appeared after blunt injuries to the face. The other was a rare case accompanied with the bone formation in the masseter muscle and was diagnosed as myositis ossificans traumatica, which also presented as severe trismus, with a maximal mouth opening of 5 mm after facial violence. Both were surgically treated with dissection of the affected muscles. In addition, a hemicoronoidotomy was performed in the case of myositis ossificans traumatica. Although a conservative therapy with physical rehabilitation is the basic policy for the management of pseudoankylosis of the temporomandibular joint, a surgical treatment should be considered when the origin of the problems is an osteogenic character or severe extra-articular ankylosis resistant to conservative therapy before completion of true temporomandibular joint ankylosis.

Adolescent↗
PubMed2005

Surgical modifications for microform cleft lip repairs.

Microform cleft lips are very rare forms of cleft lips, and the timing and methods of surgical correction remain controversial. We reviewed our surgical methods used between 1991 and 2003. There were eight such cases, with patients ranging in age from 3 months to 9 years, who underwent primary repairs, and their outcomes were evaluated. Two different surgical procedures were used, either a conventional linear incision, lower small triangular flap insertion, and orbicularis oris muscle reconstruction, or the two small z-flap approach in which the central philtral muscles are repositioned over the affected philtrum by way of two small z-flaps. Six cases underwent the former procedure, and two cases received the latter. The two small z-flap method was used in milder and more subtle skin furrow cases. There was at least 18 months of follow-up with no noticeable sex distinction or timing of the surgery compared with other cleft lip types. Orbicularis oris muscle reconstruction by way of the intra-oral approach together with vermillion repairs using z-plasty demonstrated satisfactory postoperative results such as nostril symmetry, disappearance of the linear furrow and vermillion notches, and reduced prominence in comparison with conventional small triangular flap repairs, which are used for regular primary cleft repairs at our institute. Small z-flap and muscle repositioning cases, both surgically repaired in infancy, were successfully corrected without noticeable scars in most white lips. Our surgical modification for microform cleft lip repairs is recommended for infant patients to avoid cicatrices in most white lips, especially in milder cases.

Child↗
PubMed2003

Insulin-like growth factor-I enhances transforming growth factor-beta-induced extracellular matrix protein production through the P38/activating transcription factor-2 signaling pathway in keloid fibroblasts.

Keloids are benign dermal tumors, characterized by invasive growth of fibroblasts and concomitant increased biosynthesis of extracellular matrix components, with unclear etiology. We previously demonstrated that keloid fibroblasts overexpress insulin-like growth factor-I receptor. In investigating the role of insulin-like growth factor-I receptor overexpression, insulin-like growth factor-I and transforming growth factor-beta interaction was examined in relation to extracellular matrix protein production in cultured human and mouse fibroblasts. Western blotting revealed that collagen type I was expressed in keloid and normal fibroblasts, and its expression was increased by transforming growth factor-beta stimulation more significantly in keloid rather than in normal fibroblasts. Insulin-like growth factor-I and transforming growth factor-beta1 costimulation markedly increased extracellular matrix proteins (collagen type I, fibronectin, and plasminogen activator inhibitor-1) compared with cultures with transforming growth factor-beta1 alone. Insulin-like growth factor-I treatment alone had no stimulatory effect. Real-time reverse transcription-polymerase chain reaction confirmed parallel collagen type I messenger RNA level changes. Luciferase assays were conducted to investigate intracellular signaling pathways in this synergistic stimulation using a mouse fibroblast cell line. Transforming growth factor-beta1 (1 or 10 ng per ml) increased the specific signaling activity approximately 10-fold, whereas the increase with insulin-like growth factor-I (100 ng per ml) was less than 2-fold compared with basal activity; however, the combination of transforming growth factor-beta1 and insulin-like growth factor-I resulted in an approximately 25-fold increase. Insulin-like growth factor-I markedly enhanced transforming growth factor-beta-induced phosphorylation of p38 mitogen-activated protein kinase and activating transcription factor-2. Luciferase assay showed that this synergistic effect was attenuated by the p38 mitogen-activated protein kinase specific inhibitor SB203580 or phosphatidylinositol 3-kinase inhibitor wortmannin, but not by the mitogen-activated protein kinase/extracellular-signal-regulated protein kinase kinase inhibitor PD98059. These results indicate that insulin-like growth factor-I enhances transforming growth factor-beta-induced keloid formation through transforming growth factor-beta postreceptor signal cross-talk, mainly via the p38 mitogen-activated protein kinase/activating transcription factor-2 pathway.

3T3 Cells↗