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Biomedical subjects

Y Inomata

Publications and source records attributed to Y Inomata.

At least 109 records · Page 6Linked to original sources
PubMed1996

The evolution of immunosuppression with FK506 in pediatric living-related liver transplantation.

The effects of three FK506 induction regimens on pediatric living-related liver transplantation (LRLT) were studied retrospectively in terms of patient survival and adverse side effects. The patients consisted of 120 children, ranging from 3 to 210 months of age, who underwent a total of 122 LRLTs with a minimum follow-up of 6 months. Immunosuppression consisted of FK506 and low-dose steroids. FK506 was given in 3 ways: (1) high-dose intravenous (i.v.) induction, with FK506 begun at a dose of 0.15 mg/kg/day for the first 16 patients; (2) low-dose i.v. induction, with FK506 begun at a dose of 0.06 mg/kg/day for the next 45 patients; and (3) per os (p.o.) induction, with FK506 begun orally from the day prior to LRLT and continued postoperatively. Whole-blood trough levels of FK506 were monitored daily. Trough levels in the high induction group were often as high as 100 ng/ml compared with the level of 20 ng/ml in the p.o. induction group. Patient survivals were 75%, 89%, and 80% in the high-i.v. vs. low-i.v. vs. p.o. groups. The incidences of acute rejection were 12.5%, 22.2%, and 26.4%, and the incidences of viral infection were 56%, 38%, and 11% in the respective groups. Major adverse effects occurred with higher frequency in the high-i.v. induction group. Oral FK506 induction therapy at a dose of 0.15 mg/kg/day starting from the day before LRLT was safer and associated with a lower incidence of viral infection than therapy with i.v. FK506.

Administration, Oral↗
PubMed1996

Living related liver transplantation in children with hypoxemia related to intrapulmonary shunting.

Living related liver transplantation (LRLT) was performed in seven children with hypoxemia related to intrapulmonary shunting. Based on the degree of the shunt ratio calculated by technetium 99m macroaggregated albumin (MAA) scintigraphy, the seven patients were classified in the moderate (shunt ratio under 40%, n = 4) or severe group (shunt ratio over 40%, n = 3). While PaO2 was maintained over 60 mmHg in the moderate group, that in the severe group continued at a low level of under 40 mmHg in the early postoperative period. However, 48 h after surgery the arterial ketone body ratio recovered to a safe level of 1.0 in both groups. Values of aspartate aminotransferase and serum total bilirubin decreased at a constant rate in both groups. Six patients survived, but one died of portal vein thrombosis on the 53rd postoperative day. Five of six surviving patients recovered from hypoxemia. We concluded that the transplanted liver can tolerate the stress of severe hypoxemia after LRLT.

Adolescent↗
PubMed1996

Extension of the indication for living related liver transplantation from children to adults based on resolution of graft size mismatch in relation to tissue oxygenation and metabolic load: a case report.

We extended the indication for living related partial liver transplantation from pediatric to adult cases. Our first case was a 49-year-old woman with primary biliary cirrhosis. Her sister's left lobe, weighing 280 g, was employed as a graft, and the graft weight/recipient's body weight ratio was calculated as 0.59%. To decrease the metabolic load to the relatively small graft, the total bilirubin was decreased from a maximum value of 75.0 mg/d1 to the most recent preoperative value of 36.2 mg/dl by plasma exchange. Intraoperative recovery of tissue oxygenation and its heterogeneity were satisfactory due to a relatively high blood supply. A postoperative decrease in bilirubin and increase in cholesterol esterification were facilitated, concomitant with regeneration of the graft, which weighed 280 g, to 860 cm3 at 3 weeks. Linear regression analysis with respect to tissue oxygenation and metabolic capacity obtained in pediatric cases were applied to this adult case.

Child↗
PubMed1996

Guidelines for donor selection and an overview of the donor operation in living related liver transplantation.

Guidelines for donor selection and an overview of the donor operation are reported on the basis of our experience with 120 cases of living related liver transplantation (LRLT) in pediatric patients. Once the parents had clearly expressed their desire to serve as donors, tests were performed to functionally and anatomically screen the donor livers to determine whether or not the parents' general physical condition allowed them to serve as donors. We then evaluated which of the two parental candidates was more suitable as a donor. The wishes of the family as to which parent should serve as donor was considered secondary and taken into account only in a few cases in which certain functional and/or anatomical abnormalities were uncovered that made the prime candidate less suitable. For the 120 LRLTs, 135 candidates were evaluated as potential donors, 15 (11.1%) of whom were rejected for various reasons. The mean volume of blood loss during the donor operation decreased significantly from 489 g in the first 60 LRLTs to 390 g in the latter 60 LRLTs; this was accompanied by a significant decrease in the mean volume of autologous blood transfused from 449 g to 390 g. Mean cold ischemia time of the graft increased significantly from 71.4 to 128.0 min, while mean operation time conversely decreased from 6.7 to 6.2 h. Bile leakage from the cut surface of the remnant liver, which was the only post-operative surgical complication encountered, was noted in five cases. We conclude that donor candidates should be strictly selected according to basic guidelines, taking into account both the results of preoperative screening and the wishes of the family. With this accumuled experience, we have been able to simplify our LRLT operative procedure, resulting in decreases in blood loss volume, blood transfused, and operation time.

ABO Blood-Group System↗
PubMed1996

Graft size-matching in living related partial liver transplantation in relation to tissue oxygenation and metabolic capacity.

The influence of graft size-matching on tissue oxygenation and metabolic capability was studied in living related partial liver transplantations for 47 pediatric patients. Their age ranged from 4 months to 17 years 3 months, their body weight from 4.0 to 58.0 kg, graft weight from 191 to 440 g, and graft weight/recipient body weight ratio from 0.61% to 6.0%. Tissue oxygenation and its heterogeneity were investigated by measuring oxygen saturation of hemoglobin in the liver sinusoid (SO2), coefficient of variation of SO2, and arterial ketone body ratio. The metabolic capacity of the graft was investigated by measuring bilirubin clearance, recovery of cholesterol esterification, and ketone body production. In infants with a relatively large liver graft, both intra- and extracellular oxygenation remained low soon after reperfusion but recovered to the control value by the end of the operation. In adolescent recipients of a relatively small graft, by contrast, synthetic and detoxification capacities were relatively deficient; however, these improved with time. These results indicate that sufficient tissue oxygenation and liver regeneration are essential for successful liver transplantation with relatively large and small grafts, respectively.

Adolescent↗
PubMed1996

Bipolar electrode implantation for myoelectrical recordings of rat bowel.

This report describes a technique to implant bipolar electrodes into the rat bowel. We implanted a total of 129 pairs of bipolar electrodes into the bowel of rats. 124 pairs of electrodes (96.3%) have continuously functioned allowing repeated myoelectrical readings. Of these, 69 electrodes functioned over 8 weeks. Only 5 electrodes (3.7%) failed. The advantage of our technique includes: (1) high success rate in implantation, (2) long term durability, and (3) less technical difficulty.

Animals↗
PubMed1996

Perioperative respiratory management with fiberoptic bronchoscopy in pediatric living-related liver transplantation.

BACKGROUND: Perioperative respiratory complications have been one of the largest obstacles to pediatric management of pediatric liver METHODS: The roles of fiberoptic bronchoscopy in perioperative respiratory management of pediatric liver transplantation were studied retrospectively. RESULTS: In a group of 162 children who underwent pediatric living-related liver transplantation, 44 underwent 222 bronchoscopic procedures for diagnostic and therapeutic purposes during the perioperative period. Major indications for bronchoscopy were atelectasis/retention of airway secretion (n = 27), pneumonia (n = 19), pulmonary edema (n = 8), airway stenosis (n = 7), and airway bleeding (n = 6). Visualization of the airway was helpful in diagnosing respiratory complications; in seven infants, bronchoscopy revealed tracheobronchial stenosis that other diagnostic modalities failed to detect. In 16 of 19 patients with pneumonia, specimens taken by bronchoscopy were positive for specific pathogens. Bronchoscopy also proved to have significant therapeutic value, especially in airway cleaning; bronchial suctioning resulted in immediate reexpansion of the collapsed lung in 16 of 20 cases of atelectasis. No complications were noted other than severe hypoxia and bradycardia in one infant. CONCLUSIONS: Fiberoptic bronchoscopy is a safe and useful modality for perioperative respiratory management in pediatric liver transplantation.

Adolescent↗
PubMed1996

Living related liver transplantation for children younger than one year old.

UNLABELLED: Living related liver transplantation (LRLT) is an effective modality to overcome the donor shortage in small children. We evaluated the safety of LRLT in case of recipients younger than 1 year of age. PATIENTS AND METHODS: In 149 children who underwent LRLT, 44 were younger than 1 year. Original diagnosis were biliary atresia (42) and metabolic disorder (2). The body weight ranged from 3.1 to 9.3 kg. Preoperative risk factors, technical innovations, and survival rate were reviewed in comparison with those of older children. RESULTS: Encephalopathy and respiratory disturbance due to massive ascites or bronchotracheal malacia were leading risk factors which demanded ICU care preoperatively. In reconstruction of the portal vein venous graft was necessary more often in infants than in the older children. Incidence of vascular complications was not higher in infants than in the older children. Biliary complications were more frequent in the infants. Survival rate was 81.9%, which was comparable to that of the older recipients. Incidence of rejection and infection was not different between the infants and the older children. CONCLUSION: LRLT in recipients younger than 1 year can be safely done with some precautions.

Biliary Atresia↗
PubMed1996

[A nationwide investigation needs for rehabilitation of schizophrenic outpatients--the patients' attribute and actual conditions of living].

In Japan we are very short of community resources for persons with mental disability. The authors, a board of resettlement, thought patients' actual conditions of living and needs for rehabilitation to let them live in the community had to be evaluated. Then in March 1993 the actual conditions of living and needs for rehabilitation of schizophrenic outpatients were investigated nationally. This article is the report on the patients' actual conditions of living. Investigation papers were sent to 358 institutions (286 hospitals and 72 clinics) which agreed to cooperate with the investigation. The 5186 investigation papers were received from 313 institutions. All of the papers except 18, which were lack of their ages, were analyzed. All of the schizophrenic outpatients, who consulted psychiatrists on one day during investigation, were considered objects of this research. Those who consented were included the research and psychiatrists filled in investigation papers. These institutions had a policy of intensive social resettlement activities and so on. Male patients were 55% and females were 45%. There were patients in the forties and females were older than males. Thirty-nine percent of them had been hospitalized once or twice. Thirty-four percent of them had been hospitalized for less than one year. Eighteen percent of them had not been hospitalized. Fifty percent of patients answered there was no friend and acquaintance, and had a tendency to stand alone. Fifty-three percent of patients lived with their parents, 21% with their spouses, and 17% alone. But 32% of females lived with their husbands. Sixteen percent worked for full-time jobs, 8% worked part-time jobs, 12% attended day care center 4% went to sheltered-workshops and only 1% went to rehabilitation-workshops for outpatients. While 13% didn't have a right to receive disability pension, the sources of income were job (30%), disability pension (30%), and welfare benefits (12%). Regarding the ability for living, both socially independent patients and daily independent were 36%. On the other hand, patients who needed support in daily life were 27%. This ability wasn't related to sex and age significantly (chi-square test). It is clear most of the patients were in isolation and depended on their families, so they needed support in income, accommodation and daily life.

Adult↗
PubMed1996

Anatomical and physiological problems of Segment IV: liver transplants using left lobes from living related donors.

We reviewed the problem of Segment IV in using left lobes from living related donors, in 18 left-lobe transplants performed on pediatric patients who ranged in age from 6.0 to 17.3 yr, and in body weight from 19.8 to 58.0 kg. The separate monitoring of oxygen saturation of hemoglobin in the liver sinusoid of segments, using a spectrophotometric technique, demonstrated a delay in re-oxygenation of Segment IV after the portal reflow, and revealed its return to comparable oxygenation with Segments II and III by the re-arterialization. Hemoglobin content, which was determined by the same technique, occasionally increased in Segment IV during the operation, implying sluggish microcirculation caused by inadequate hepatic venous drainage. These characteristic profiles on tissue oxygenation and hemodynamics in Segment IV should be considered when using left lobes as living related liver grafts.

Adolescent↗
PubMed1996

[Liver transplantation as a therapeutic modality of biliary atresia].

One hundred fifty eight patients with biliary atresia (BA) have undergone living related liver transplantation (LRLT) in our institution since June 1990. Since the start of our LRLT program we have not experienced any death of BA patients who were initially treated in our hospital. All the 158 patients have been transplanted after Kasai operation. Re-do Kasai after failed cases should be very carefully indicated because of potentially bad effect on the following transplantation. Poor body weight gain is the first sign of liver failure in infants, and indicates the timing for LRLT. In older children, there are many kinds of indications, including itching of skin, frequent absence of the school due to admission, and intrapulmonary shunt. One third of the transplanted patients necessitated LRLT before 1 year old. LRLT in infantile period is the first step to save all patients with BA. Technically, portal vein plasty and enterolysis are the key factors in transplants for BA patients. Main cause of death after transplantation was infection. Bacterial culture at the porta hepatis is important to know the pathogen in the posttransplant infection. Posttransplant bone-densitmetry disclosed that physical growth is enhanced after 3 months, when steroid is weaned off. For the best quality of life, first Kasai and following LRLT is going to be a widely accepted therapeutic modality for BA patients.

Biliary Atresia↗