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Haruki Akasu

Publications and source records attributed to Haruki Akasu.

At least 19 recordsLinked to original sources
PubMed2006

Photodynamic identification of human parathyroid glands with 5-aminolevulinic acid.

Tumors synthesize fluorescent and photosensitizing endogenous protoporphyrin after administrations of 5-aminolevulinic acid (5-ALA). Localization of tumors and tumor-like lesions in various organs that are labeled with fluorescing porphyrins has thus developed into a diagnostic method. Intraoperative photodynamic detection of malignant gliomas is the most common application, and has been widely performed since 1998. Although several methods to identify parathyroid glands have been employed, photodynamic methods have not yet been used for this application. In 2004, Shimizu et al. showed that human parathyroid glands could be identified photodynamically with 5-ALA. We have performed photodynamic identification of human parathyroid glands in an additional 19 cases. In hyperparathyroidism, detection of morbid parathyroid glands is extremely important. On the other hand, the identification and preservation of normal parathyroid glands is important for preventing hypoparathyroidism after thyroid surgery. Our method allows the visualization of both morbid and normal parathyroid glands. We believe that intraoperative photodynamic identification of human parathyroid glands is feasible and practical, allowing less-invasive, more-precise neck surgery.

Aminolevulinic Acid↗
PubMed2004

Adenolipoma of the thyroid gland: report of a case.

We report a case of adenolipoma of the thyroid gland, which is very unusual because thyroid adenoma rarely contains mature adipose tissue. A 55-year-old Japanese woman presented with a 1-month history of a neck mass. A blinded fine-needle aspiration biopsy showed benign follicular cells with no adipose cells, and we performed a left hemithyroidectomy. The specimen measured 7.0 x 4.4 cm and weighed 59.9 g. The cut surface of the tumor revealed a solid yellowish mass, and hematoxylin-eosin staining showed that the solid tumor was well separated from the adjacent thyroid tissue by a thin fibrous capsule. The tumor was found to be follicular adenoma composed of epithelial cells arranged in monotonous microfollicular patterns, intermingled with mature adipose tissue. No adipose tissue was found outside the tumor, and there were no signs of amyloid deposits in the tumor or adjacent thyroid tissue. The pathological diagnosis was adenolipoma of the thyroid gland. We discuss the pathogenesis of this entity and review the previously documented cases.

Adipose Tissue↗
PubMed2003

[Endocrine surgery: the tenth report. Diagnosis, surgical indications and operative strategy of renal hyperparathyroidism].

In Japan, there are many dialysis patients because of the successful development and wide application of dialysis techniques. Almost all patients require long-term hemodialysis treatment because kidney transplantation is performed rarely. Renal hyperparathyroidism is one of the serious complications for hemodialysis patients. According to the overview of regular dialysis treatment reported by the Japanese Society for Dialysis Therapy, parathyroidectomy is required in 9.2%of patients who remain on hemodialysis more than 10 years and in 33.5%of those who so remain for more than 25 years. In this paper, we will describe the diagnosis, surgical indications, and operative strategy of renal hyperparathyroidism. The symptoms and biochemical variables were high serum parathyroid hormone (PTH) level, hyperphosphatemia, bone and joints pain, itching, irritability, muscle weakness, severe skeletal deformity, progression of ectopic calcification, and anemia. The clinical indications for performing parathyroidectomy to treat renal hyperparathyroidism in our institute are based on the indications reported by Tominaga et al. These are 1) high serum PTH level, 2) detection of enlarged parathyroid glands, 3) detection of osteitis fibrosa cystica on radiography or detection of high bone turnover by bone metabolic markers or bone scintigram, 4) resistance of symptoms to medical treatment. The routine operative procedure for renal hyperparathyroidism is total parathyroidectomy with forearm autograft. For autotransplantation, 30 pieces sliced 1x1x3 mm of diffuse hyperplasia are implanted into 30 pockets in the forearm without arteriorvenous (A-V) fistula for hemodialysis. In any surgical procedure for renal hyperparathyroidism, it is crucial to identify all parathyroid glands, including supernumerary glands and ectopic glands. At the initial operation for renal hyperparathyroidism, the surgeon must remove all parathyroid glands to avoid persistent and recurrent hyperparathyroidism and choose proper and adequate parathyroid tissue for autograft.

Humans↗
PubMed2003

Surgical therapy in Hashimoto's thyroiditis.

Hashimoto's thyroiditis (HT) is usually considered to be manageable by levothyroxine (L-T4) administration, which can reduce the thyroid volume and supplement the lack of hormone. However, we sometimes encounter a huge goiter that has not shrunk in response to L-T4 therapy. These goiters continue to produce symptoms of compression and an unsightly appearance. Here we discuss the surgical indication and procedure for HT. Thirteen patients with clinically diagnosed Hashimoto's thyroiditis involving a huge diffuse goiter that produced pressure symptoms or nodular lesions were treated with surgery. The gender, age distribution, total dose and period of L-T4 administration prior to the operation, and clinical symptoms caused by the large goiter were evaluated in each case. The titer of antibodies was extremely elevated in 8 HT patients with a diffusely enlarged goiter. The total period of L-T4 medication ranged from 6 to 25 years. A subtotal thyroidectomy in which a small amount of thyroid was left in the posterior area of the bilateral lobes was performed in the 8 cases of diffusely enlarged goiter. Pressure symptoms and the unsightly appearance caused by the goiter were relieved by the surgery in all cases. No surgical complications developed. In conclusion, the surgery is an effective therapy for HT patients who have persistent compression symptoms and/or an unsightly neck appearance due to a large goiter despite long-term L-T4 treatment.

Aged↗
PubMed2003

[Endocrine surgery. The ninth report: the latest data on and clinical characteristics of the epidemiology of thyroid carcinoma].

Thyroid disease is comparatively prevalent, and it is important to perform careful palpation of the anterior neck when patients are first examined. In this paper, the latest data on and clinical characteristics of the epidemiology of thyroid carcinoma are described. According to Japanese cancer statistics, in 1996, the number of cases of thyroid carcinoma was 1,390 men and 5,437 women. The female to male ratio was 3.91: 1. The crude rate of thyroid carcinoma per 100,000 population was 2.3 men and 8.5 women. The age-adjusted incidence rate showed a gradual increase with age, and the peak of the age-adjusted incidence rate was over 80 years old among men, and from 70 to 80 years old among women. According to the Japanese Thyroid Cancer Registration Committee, from 1977 to 1999, papillary thyroid carcinoma accounted for more than 85% (30,256) of thyroid carcinomas among 35,312 patients. Medullary thyroid carcinoma (1.4%) and anaplastic thyroid carcinoma (1.6%) were rare. The female to male ratio of thyroid carcinoma was 6.1: 1. Registration was made in accordance with the general rules issued by the Japanese Society of Thyroid Surgery. According to the vital statistics, mortality related to thyroid carcinoma among all cancer-related deaths was 0.23% among men (411) and 0.76% among women (887) in 2000. The female to male ratio of mortality was 2.16: 1. The peak of mortality was from 70 to 80 years old among men, and from 80 to 90 years old among women. Most patients with differentiated thyroid carcinoma had a low mortality rate, but anaplastic carcinoma had a poor prognosis. Lung and bone were the main distant metastatic sites, and respiratory insufficiency was the most common specific fatal condition.

Adolescent↗
PubMed2003

Radioguided parathyroidectomy for renal hyperparathyroidism.

BACKGROUND: The usefulness of radioguided parathyroidectomy for primary hyperparathyroidism has been demonstrated in recent years, however, its applicability to renal hyperparathyroidism is uncertain. We report a case in which radioguided parathyroidectomy was used to treat renal hyperparathyroidism and was found to be helpful in preventing persistent and recurrent hyperparathyroidism. CASE REPORT: The patient was a 55-year-old Japanese woman who had received hemodialysis for 67 months. Three enlarged parathyroid glands were identified preoperatively by ultrasonography. Two hours before the operation, the patient received an intravenous injection of 600 MBq 99mTc-sestamibi and radioguided parathyroidectomy was performed. The three enlarged parathyroid glands were resected easily by the use of radioguided surgery. However, the localization of the residual parathyroid gland was uncertain. The operative field was analyzed using an intraoperative gamma probe, and the upper mediastinum was found to have higher radioactivity than the other regions. The upper mediastinum was dissected and the enlarged parathyroid gland was identified in the anterosuperior mediastinum in front of the trachea. The target parathyroid gland was then removed. The pathological diagnosis was hyperplasia of the parathyroid. No complications were observed and a follow-up examination 30 months later did not show any recurrence. CONCLUSIONS: An intraoperative gamma probe can be used to locate supernumerary and ectopic parathyroid glands. Radioguided parathyroidectomy for renal hyperparathyroidism can theoretically decrease the risk of persistent and recurrent hyperparathyroidism that is due to remaining parathyroid tissue.

Female↗
PubMed2003

Radioguided parathyroidectomy for primary hyperparathyroidism using the solid-state, multi-crystal gamma camera.

BACKGROUND: Minimally invasive radioguided parathyroidectomy (MIRP) offers several cosmetic and surgical advantages. Intraoperative 99m-Tc sestamibi scintigraphy using a solid-state, multi-crystal gamma camera was used to perform the MIRP. We report a case of primary hyperparathyroidism treated with this surgical procedure and discuss the usefulness of intraoperative scintigraphy. CASE REPORT: The patient was a 58-year-old Japanese woman was given a diagnosis of primary hyperparathyroidism. One hour before the operation, 99m-Tc sestamibi was injected intravenously and scintigraphy was performed in the operating room before the skin incision. Sestamibi imaging revealed an abnormal uptake close to the lower right lobe of the thyroid gland and MIRP was performed. After the tumor behind the right recurrent laryngeal nerve close to the lower right lobe of the thyroid gland was removed, intraoperative scintigraphy still revealed an abnormal uptake. MIRP was continued and an abnormal parathyroid gland behind the right carotid artery near the right recurrent laryngeal nerve was identified. After removing a parathyroid adenoma from this second location, intraoperative sestamibi imaging revealed no abnormal uptake. RESULTS: The operation time was 80 minutes and the amount of bleeding was 12 ml. Postoperatively, serum calcium and PTH levels were within normal range. No complications were observed. CONCLUSIONS: Intraoperative sestamibi imaging using a portable gamma camera is useful for locating abnormal parathyroid glands.

Female↗
PubMed2002

Video-assisted endoscopic thyroid and parathyroid surgery using a gasless method of anterior neck skin lifting: a review of 130 cases.

PURPOSE: Endoscopic endocrine neck surgery is desirable from a cosmetic viewpoint. We compared the effectiveness of our new technique with that of conventional surgery in a clinical study. METHODS: We performed our original endoscopic method of video-assisted neck surgery (VANS) on 130 patients: 126 with thyroid tumors and 4 with parathyroid tumors. The percentage of patients who underwent VANS among all those who underwent neck surgery and the procedure involved were analyzed. Operating time and blood loss were compared between the first 40 patients and last 39, and all factors were statistically analyzed in the most recent 20 patients who underwent the VANS method and the most recent 20 who underwent conventional surgery. RESULTS: More than 60% of benign thyroid tumors and 5.3% of malignant thyroid tumors were operated on by the VANS method. Nearly total lobectomy was the most common procedure (57.7%), followed by total lobectomy (26.1%), for benign tumors. Malignancy was defined as papillary carcinoma less than 1 cm in diameter. Total lobectomy with lymph node clearance was performed for all malignant tumors. There was less bleeding when the VANS method (P < 0.001) was used than when conventional surgery was performed, and the operating time has been reduced with experience. CONCLUSION: The VANS method is feasible, practical, and safe, and has great cosmetic benefits.

Humans↗
PubMed2002

Video-assisted minimally invasive endoscopic thyroid surgery using a gasless neck skin lifting method--153 cases of benign thyroid tumors and applicability for large tumors.

Endoscopic surgery is often considered to be 'minimally invasive surgery' in the light of recent developments. In particular, endoscopic endocrine neck surgery is desirable from a cosmetic viewpoint. Here we compared the usefulness of our original endoscopic method of video-assisted neck surgery (the VANS method) with conventional surgery when challenged with the removal of thyroid tumors measuring more than 5 cm in diameter, based on our experience with 167 cases (162 thyroid tumors, five parathyroid tumors). The percentage of patients who underwent the VANS method of the total number of patients who underwent neck surgery was determined and the operative procedures used in the different surgeries were analyzed. The operating time and blood loss for 153 benign thyroid tumors were statistically compared between the small-tumor group (n = 130, < 5 cm) and the large-tumor group (n = 23, > or = 5 cm). More than 60% of the benign and 5.3% of the malignant thyroid tumors were operated on by the VANS method. Near- or subtotal lobectomy was the most common procedure (64.1%) for benign tumors. Malignancy was defined as papillary carcinoma less than 1 cm in diameter. Total lobectomy with lymph node clearance was performed for all malignant tumors. Although the operating time and the blood loss were statistically greater in the large-tumor group than the small-tumor group, with increased experience it was possible to remove tumors of up to 7.4 cm safely. Our findings support the idea that the VANS method is feasible, practical, and safe, and has great cosmetic benefits, even for the removal of large benign tumors.

Humans↗
PubMed2002

Trial of autotransplantation of cryopreserved thyroid tissue for postoperative hypothyroidism in patients with Graves' disease.

BACKGROUND: Some patients with Graves' disease who select surgical therapy so they can discontinue antithyroid medication require lifelong levo-thyroxin (l-T4) replacement therapy because of irreversible postoperative hypothyroidism. The aim of this study was to enable the replacement of absent thyroid hormone through autotransplanted thyroid tissue that had been cryopreserved since the initial thyroid operation, and to release these patients from lifelong l-T4 administration. STUDY DESIGN: At the time of subtotal thyroidectomy for Graves' disease, the surgical specimen was partially cryopreserved at -196 degrees C until it was used for autotransplantation. After obtaining sufficient informed consent, four patients with postoperative hypothyroidism underwent autotransplantation of cryopreserved thyroid tissues. These patients required 50 to 150 microg/day of l-T4 at 1.8, 3.4, 3.5, and 2.8 years after operation. For the transplantation, 2.5 to 3.5 g of cryopreserved thyroid tissue was autotransplanted into the forearm muscle of each patient. RESULTS: In three of the patients, l-T4 administration could be discontinued and the clinical symptoms of hypothyroidism disappeared because of an improved serum thyroid-stimulating hormone level. Pathologic and immunohistochemical examinations of the thawed cryopreserved tissue demonstrated well-preserved thyroid structure and thyroglobulin-positive follicular cells and colloids, suggesting that the transplanted material was functional. In addition, 123I scintiscanning in patients 1 and 2 indicated an accumulation of radioactive iodine at the transplantation sites. One patient, who was able to discontinue l-T4 administration for 6 months, subsequently required l-T4 again because of recurrent hypothyroidism. BACKGROUND: Despite a few remaining uncertainties that must be resolved before this procedure is optimized, autotransplantation of cryopreserved thyroid tissue promises to be a useful therapeutic procedure for treating permanent postoperative hypothyroidism in patients with Graves' disease.

Adult↗
PubMed2002

Immunohistochemical, biochemical and immunoelectron microscopic analysis of antigenic proteins on neuroendocrine cell tumors using monoclonal antibody HISL-19.

The monoclonal antibody HISL-19 was originally generated after immunizing BALB/c mice with human islet cells. We used this antibody to study a wide variety of neuroendocrine (NE) and non-NE tumors by immunohistochemical, immunoelectron microscopic, and biochemical (Western blotting) techniques. Of the thyroid tumors, HISL-19 specifically immunoreacted with medullary carcinoma of the thyroid (MCT); of the pancreatic tumors, it reacted with islet cell tumors such as insulinomas and a gastrinoma; of the adrenal tumors, it reacted with pheochromocytoma. HISL-19 showed particularly strong immunoreactivity to a gross granular material at the perinuclear area in the MCT and malignant pheochromocytoma but not in the benign pheochromocytoma, although the latter cells showed a faint and homogenous positive reactivity in the cytoplasm. The strongly HISL-19-positive material was found to consist of newly synthesized antigenic proteins with a molecular weight between 60 and 65 kilodaltons (kDa) by Western blotting. Immunoelectron microscopic analysis revealed that this antigenic protein was located in the secretory granules that appear markedly in malignant endocrine tumors, usually located close to the nucleus. Thus, HISL-19 is a useful and specific marker for the immunohistochemical diagnosis of NE cell tumors. The specific antigenic proteins of HISL-19 were defined in MCT and malignant pheochromocytoma. These proteins are speculated to be actively synthesized and more highly produced in the secretory granules of malignant endocrine tumors than benign ones. Thus, a preoperative immunohistochemical study using HISL-19 might be useful for predicting the grade of malignancy of endocrine malignant tumors and thus help determine an appropriate operative procedure, in addition to being a useful marker of neuroendocrine cell tumors.

Adenoma, Islet Cell↗
PubMed2002

Radioguided parathyroidectomy for reexploration of primary hyperparathyroidism-- a case report.

BACKGROUND: We report a case of radioguided parathyroidectomy using a hand-held gamma probe for the reexploration of primary hyperparathyroidism. CASE REPORT: The patient was a 66-year-old Japanese woman. She had previously undergone surgical exploration for primary hyperparathyroidism due to a left inferior parathyroid tumor detected by 99mTc-methoxyisobutylisonitrile (MIBI) scintigraphy. However, the pathological diagnosis of the resected tumor was adenomatous goiter. 99mTc-MIBI scintigraphy was performed again and revealed an abnormal uptake close to the right lower lobe of the thyroid. However, venous sampling for PTH measurements did not support this finding. Sestamibi was injected and the radioactivity was measured pre- and intraoperatively with a hand-held gamma probe. With the patient under general anesthesia, the tumor, which was adjacent to the right recurrent laryngeal nerve, was resected, but it contained only a low level of radioactivity ex vivo, indicating that it was not a parathyroid tumor. A hand-held gamma probe accurately located the radioactive parathyroid tumor in the right lower neck. The resected tumor measured 15 x 6 mm and weighed 331 mg. The pathological diagnosis was parathyroid adenoma. CONCLUSIONS: Radioguided parathyroidectomy is useful to localize parathyroid tumors not only in primary hyperparathyroidism at the initial neck exploration but also for reexploration.

Adenoma↗
PubMed2002

[Indications for and limitations of endoscopic thyroid surgery].

Endoscopic thyroid surgery has become a common procedure in recent years, mainly because of its cosmetic advantages. Generally two methods are used to obtain a working space: CO2 insufflation and anterior neck skin lifting. The incision sites for approaching the thyroid are the chest wall, mammary areolar area, axillary and submandibular area, in addition to the neck. Among the new operative devices, the ultrasonically activated scalpel has contributed to the development of endoscopic thyroid surgery. Based on our experience of more than 180 cases using our original endoscopic method, video-assisted neck surgery(the VANS method), we here report the clinical outcome and usefulness of the method. The operating time and blood loss in patients with 161 benign thyroid tumors were statistically compared between the small-tumor group (n = 138, < 5 cm) and the large-tumor group (n = 23, > or = 5 cm). More than 60% of the benign and 7.1% of the malignant thyroid tumors were operated on using the VANS method. Near or subtotal lobectomy was the most common procedure (64.4%) for benign tumors. Malignancy was defined as a papillary carcinoma < 1 cm in diameter. Total lobectomy with lymph node clearance was performed for all malignant cases. Although the operating time and blood loss were statistically greater in the large-tumor group than the small-tumor group, with increased experience it was possible to remove tumors of up to 7.4 cm safely. Our findings show that the VANS method is feasible, practical, and safe, and has great cosmetic benefits. However, it must be remembered that the intrinsic surgical goal of treatment should not be compromised in the pursuit of less-invasive surgery. Care must be taken to select appropriate patients carefully and to train surgeons sufficiently in the techniques required.

Adolescent↗
PubMed2002

Evaluation of an alternative, subclavicular approach to thyroidectomy.

BACKGROUND: After presenting with the common finding of a nodular goiter, many patients refuse surgery because of the potential for a conspicuous anterior neck scar. Despite the development of endoscopic approaches to neck dissections, it can be difficult to remove a large thyroid tumor using such approaches. MATERIAL/METHODS: We attempted thyroid lobectomies via a subclavicular approach in three cases - three women whose ages ranged from 36-45 years old. Each patient was diagnosed with a cytologically-benign nodular goiter with a diameter greater than 60 mm. Subclavicular incisions were made with the length being determined by the size of the tumor and with the thyroid being approached laterally for resection. RESULTS: Despite a maximum tumor diameter of greater than 70 mm, our operative technique was comparable to conventional methods with respect to surgical exposure, safety and operation time. Cosmetically, each patient was satisfied with the post-operative results. CONCLUSIONS: We believe that the subclavicular approach to thyroidectomy is a safe and cosmetically-superior alternative to conventional surgery, even in cases that are too large to approach endoscopically.

Adult↗