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Y Inomata

Publications and source records attributed to Y Inomata.

At least 127 records · Page 7Linked to original sources
PubMed1996

[Liver transplantation--present status].

Living related liver transplantation (LPLT) as well as reduced sized graft or split liver transplantation has come from the situation with donor shortage for conventional whole liver transplantation from brain dead donors (cadaveric liver transplantation; CLT). To date, about fifty thousands liver transplants have been undergone all over the world. CLT has much diversity of the original diseases, but mainly liver cirrhosis in adults and biliary atresia in children. Original diseases for LRLT have been deviated to cholestatic diseases in childhood, but now LRLT for adults and other diseases in children, i.e. fulminant hepatitis and metabolic disorders, are increasing. The survival rate of LRLT in Kyoto University for first 230 consecutive cases was 79.5%. The main cause of death was infection-related events. There are several problems in LRLT to be resolved; perioperative management of infectious complications, how to deal with the unavoidable ABO incompatible matching transplants, how to expand the national capacity of LRLT to respond the urgent transplantations. Earlier establishment of CLT program in Japan will be necessary to make the liver transplantation the beneficial procedure for more people with end stage liver diseases.

Adult↗
PubMed1995

Inhibitory effect of plasma FKBP12 on immunosuppressive activity of FK506.

To evaluate the roles of extracellular FKBP12, we examined the effect of extracellular FKBP12 on the immunosuppressive activity of FK506 in vitro and clinically. The ability of FK506 to suppress phytohemagglutinin-induced proliferative response of human peripheral blood mononuclear cells was inhibited in the presence of recombinant FKBP12 dose-dependently. We measured plasma levels of FKBP12 using a newly developed enzyme-linked immunosorbent assay system in 34 patients receiving FK506 after liver transplantation. In 7 patients with acute cellular rejection, plasma FKBP12 increased significantly at the onset of rejection compared with 1 week before onset (P < 0.05) and further increased to or remained at more than 250 ng/ml 1 week after onset. In 22 of 27 patients without acute cellular rejection, plasma FKBP12 was less than 70 ng/ml during the 4 weeks after transplantation. In the other 5 of 27 patients without acute cellular rejection, plasma FKBP12 exceeded 250 ng/ml. Rapid increase of plasma FKBP12 was observed in only one of these 5 patients, at the onset of high fever due to a liver abscess. There was no significant difference in whole blood trough levels of FK506 between the patients with or without acute cellular rejection. These results suggest that the rapid increase in plasma levels of FKBP12 may contribute to the occurrence and progress of acute cellular rejection probably by inhibiting the immunosuppressive activity of FK506.

Adolescent↗
PubMed1995

A proposal of FK506 optimal dosing in living related liver transplantations.

We analyzed the relation between FK506 trough levels (ELISA: patients 1-41, IMx: patients 42-70) and rejection and/or viral infection episodes, retrospectively, in the first 70 consecutive cases of living related liver transplantation. Twenty patients (28.6%) had rejection episodes. Of the 13 patients who had evidence of rejection during the first 3 months, 6 patients without infection and 7 patients with viral infection showed low concentrations of FK506 (< 5 ng/ml). Twelve patients were treated and improved with high dose steroid administration and an increase in the FK506 dosage. One patient died of refractory rejection. Nine patients had evidence of rejection after the first 3 months. In 3 patients, weaning from FK506 initiated the rejection episodes. Five patients repeated rejection and 4 patients required a third immunosuppressant (azathioprine). Viral infection included CMV (11 cases), EBV (13 cases), HZV (3 cases), and HSV (1 case). Excess immunosuppression might have been the cause, but no clear correlation was found. We propose that the optimal dosage of FK506 obtained by monitoring the trough levels using the IMx method should maintain a 10-20 ng/ml level during the first month, and a 5-10 ng/ml level at the second and third months.

Adolescent↗
PubMed1995

Influence of spontaneous portosystemic collateral pathways on portal hemodynamics in living-related liver transplantation in children. Doppler ultrasonographic study.

We investigated the influence of spontaneous portosystemic collateral pathways on the portal hemodynamics and examined the necessity for ligating these vessels in pediatric liver transplantation from living donors. We assessed portal blood flow before, during, and after surgery in 82 pediatric recipients (mean age, 4.2 years), using Doppler ultrasonography. When blood flow in the reconstructed portal vein was decreased (< 10 ml/min/kg body weight) and portosystemic collaterals persisted during surgery, those vessels were ligated and Doppler flowmetry was examined again. Spontaneous portosystemic collaterals were detected at one or more sites in 67 patients before transplantation. These collaterals had been ligated in 17 patients before intraoperative flowmetry. Among the remaining 50 patients, initial Doppler studies revealed a decrease in portal blood flow in 22 patients. Nine patients had hepatofugal splenic venous flow and 6 had no significant flow signals from the intrahepatic portal vein. Ligation of collaterals resulted in a remarkable increase in portal blood flow in 20 patients, all of whom are alive. The remaining 2 patients died of graft failure due in part to portal hypoperfusion. On the other hand, the collaterals were not ligated in 24 patients because adequate portal blood flow was confirmed by intraoperative flowmetry. Postoperatively, flow signals from the unligated collateral vessels gradually diminished, but they still persisted in 3 patients at 12 months after transplantation. Hepatofugal blood flow through the portosystemic collateral pathways may persist after implantation of a normal graft. If the patent collaterals significantly reduce the effective portal blood flow, these vessels should be ligated in order to avoid graft failure.

Adolescent↗
PubMed1995

Recovery of graft circulation following percutaneous transluminal angioplasty for stenotic venous complications in pediatric liver transplantation: assessment with Doppler ultrasound.

Percutaneous transluminal angioplasty was performed for venous stenosis after living related liver transplantation in three children. Two of them had hepatic vein stenosis and one had stenosis of both the hepatic and portal veins. Progressive development of ascites and deterioration of liver function were found in all cases. Serial Doppler ultrasound studies showed that the flow velocity in the hepatic vein gradually decreased with a flattened velocity waveform, followed by a decrease in portal blood flow. After a successful hepatic vein angioplasty, the velocity in the hepatic and portal veins increased and the Doppler waveform in the hepatic vein became pulsatile in two cases. In the remaining case, a remarkable recovery of both graft perfusion and clinical findings was achieved via combined hepatic vein and portal vein angioplasty. We conclude that balloon angioplasty is an effective alternative to surgery for post-transplant vascular stenosis and that Doppler ultrasound is useful in monitoring graft circulation.

Angioplasty, Balloon↗
PubMed1995

Desmoplastic fibroma. Aggressive curettage as a surgical alternative for treatment.

In this article, the authors present 5 patients with desmoplastic fibroma and review the literature. Four patients had aggressive curettage with bone graft, and 1 had aggressive curettage alone. Although the literature reports that many patients have recurrence after curettage, there have been no recurrences in these 5 patients during followup periods ranging from 5 years 6 months to 9 years. Although wide excision has been recommended in the literature, treatment with aggressive curettage achieved clinical and radiographic control of the lesions for at least an intermediate duration of followup.

Adolescent↗
PubMed1994

Infectious complications in living related liver transplantation.

During the last 31 months, 50 children between 3 months and 15 years of age have undergone living related liver transplantation (LRLT) for end-stage liver diseases (39 biliary atresia, 2 Budd-Chiari syndrome, 2 progressive intrahepatic cholestasis, 3 liver cirrhosis, 1 Wilson disease, 1 protoporphyria, 1 tyrosinemia, and 1 fulminant hepatitis). Combined FK-506 and low-dose steroids were routinely used for immunosuppression. There were seven deaths, two of which were related to infection (Candida pneumonia and Epstein-Barr virus [EBV]-associated lymphoproliferative syndrome [LPS]). Five patients had a bacterial infection, all of which were associated with surgical complications. Three patients had Candida infection, all of which were malnourished, had biliary atresia, and had been managed with prolonged antibiotics against obstinate ascending cholangitis. There were 14 symptomatic viral infections (1 herpes simplex virus, 1 herpes zoster virus, 5 cytomegalovirus [CMV], 6 EBV, and 1 EBV-associated LPS). Three of the five CMV infections appeared in patients whose graft was ABO-incompatible, who were managed with prophylactic OKT-3. Most of the viral infections (except 1 EBV-associated LPS) were minor and were treated successfully. The low incidence and successful treatment of CMV infection are related to the high compatibility and low incidence of allograft rejection in LRLT. Bacterial and fungal infections can be decreased by greater refinement of surgical technique and more aggressive preoperative management. Treatment of EBV infection is still an unsolved problem.

Adolescent↗
PubMed1994

Immunohistochemical demonstration of collagen types III and IV and myofibroblasts in the liver of patients with biliary atresia.

To clarify the pathogenesis of pericholangitis in biliary atresia, immunohistochemical and ultrastructural methods were used to quantify the amount of collagen types III and IV, and alpha-smooth muscle actin-positive myofibroblast present in the pericholangial tissue. Patients were divided into two groups: the early-stage group (n = 7; 15 to 30 days old at the time of the Kasai operation), and the advanced-stage group (n = 14; 8 months to 6 years old at the time of liver transplantation). The liver specimen was harvested at the time of the Kasai operation in the early-stage group, and during liver transplantation in the advanced-stage group. Liver tissue from the donor was used as the control. The specimen was visually inspected and classified into three grades to express the extent of proliferation. An increase of collagen types III and IV, and myofibroblast in the pericholangial area was seen even in 2- to 4-week-old patients, which became marked with the progression of the fibrotic disease process. This suggests that pericholangitis occurs in the very early stage of biliary atresia, perhaps before the development of bile duct obstruction.

Biliary Atresia↗
PubMed1994

Living-related liver transplantation for fulminant hepatic failure in children.

Liver transplantation is increasingly accepted as a choice of treatment for fulminant hepatic failure (FHF) since it has been proved to significantly improve the survival rate in these patients compared with other therapeutic modalities. We have successfully performed a total of 76 living related liver transplantations (LRLT) three of which were for FHF. The first case was an 11-year-old boy with FHF due to an unidentified cause. He had required plasmapheresis a total of 24 times and haemofiltration to save his life before LRLT. He was transplanted with a left lobe (420 g) graft, calculated as 1.05% of his weight (40 kg). He recovered hepatic function uneventfully and was discharged from hospital after 7 weeks. The second case was a 13-year-old girl who developed FHF with grade III encephalopathy due to acute Wilson's disease, and was referred to us. She underwent LRLT with a left lobe graft (440 g), estimated as 0.95% of her weight (47 kg), which functioned well after surgery. The third case was a 13-year-old girl with grade II encephalopathy due to acute Wilson's disease. She was 27% obese with a body weight of 58 kg. She underwent LRLT with ABO blood group incompatibility with a left lobe (352 g), estimated as 0.80% of her weight (modified 44 kg). She was discharged with sensorimotor neuropathy due to vitamin B deficiency. The present results suggest that LRLT is feasible for FHF both clinically and ethically, and that a partial liver graft weighing around 1% of the recipient's weight can maintain the recipient's life. We limit the diagnostic indication for LRLT to chronic liver disease, since an urgent situation may affect a voluntary decision for the patient's parents to donate the partial liver. However, LRLT is thought to be an acceptable choice of treatment provided it is requested by the patient and family. Furthermore, it is a potential option for resolving the graft shortage in paediatric liver transplantation, being independent of cadaver donor availability.

Adolescent↗
PubMed1994

Preparation of DNA-carrying affinity latex and purification of transcription factors with the latex.

We have developed DNA-carrying latex particles for the separation and purification of transcription factors. These particles consist of styrene (St), glycidyl methacrylate (GMA) and divinylbenzene (DVB). It was confirmed that the ethanolamine-treated surface of these particles suffered no nonspecific adsorption of proteins. To the latex particles sequence-specific DNA oligomers were immobilized via covalent coupling. A transcription factor, E4TF3, was efficiently purified to homogeneity using the latext particles. In contrast, the purification using DNA-carrying Sepharose gel yielded poor results. Compared to DNA-carrying Sepharose gel, the latex particles exhibited several times higher efficiency in the purification of E4TF3 from the crude nuclear extract.

Adsorption↗
PubMed1994

Cytomegalovirus infection in living related liver transplantation: rapid diagnosis by human monoclonal antibody staining of blood leucocytes.

Symptomatic cytomegalovirus (CMV) infection is a major cause of morbidity and mortality following orthotopic liver transplantation. Early detection and prompt treatment with appropriate medicine are crucial for successful outcome. As an early detection method, we used the CMV antigenemia test which is based on immunocytochemical detection of CMV immediate early antigens in blood leucocytes. CMV immediate early antigens were detected in blood leucocytes with direct immunoperoxidase technique using a horseradish peroxidase (HRP)-conjugated F(ab')2 fragment of human monoclonal antibody (humab C7), designated HRP-C7. Of the 37 living related liver transplantations we performed on pediatric patients between June 1990 and August 1992, we experienced four cases (10.8%) of symptomatic CMV infection: three CMV hepatitis and one CMV peritonitis. They were all treated successfully with a combination of ganciclovir and immunoglobulins. In ABO-incompatible cases ganciclovir was administered prophylactically. Early detection using this method is though to have led to these successful outcomes. It is concluded that HRP-C7 staining of blood leucocytes is useful for the rapid diagnosis of CMV infection.

ABO Blood-Group System↗
PubMed1994

[Home infusion chemotherapy in patients with relapsed or recurred stomach and colorectal cancer].

Five patients with distant metastasis from colorectal cancer who had good nutrition were treated with continuous intravenous administration of 5-FU infusion (400-450 mg/body/day) by infusor. The other five patients with advanced stomach cancer who could not have so good nutrition were receiving home parental nutrition (HPN, 1,200 kcal/day) and continuous or intermittent 5-FU infusion (250-500 mg/body/day) using Lentinan at the same time. In colorectal cancer, one partial response (PR) and one complete response (CR) were obtained. And in stomach cancer, only one NC were obtained but we could perform these HPN and chemotherapy for 13 months at home. According to our trial, we thought these chemotherapy and nutrition at home were useful to improve the quality of life of patients with GI tract cancer.

Adult↗
PubMed1993

Response properties of primary somatosensory cortical neurons responsive to cold stimulation of the facial skin and oral mucous membrane.

The distribution and response characteristics of the primary somatosensory cortical (SI) neurons activated by cold stimulation of the facial skin and oral mucous membrane were studied in cats. The discharge activities of 53 cold-sensitive SI neurons that responded to a decrease in temperature of the facial skin and/or oral mucous membrane were recorded. Each of these neurons was classified according to its responsiveness to mechanical stimulation as follows: LTM (low-threshold mechanoreceptive, 14/53), WDR (wide dynamic range, 39/53) and NS (nociceptive-specific, none identified). Encoding and non-encoding SI cold-sensitive neurons were identified, according to their responsiveness to decremental thermal stimulation. Only 14 cold-sensitive SI neurons demonstrated increased firing frequencies when subjected to incremental stimulus intensity increases and were classified as the encoding-type, whereas 39 non-encoding-type neurons did not.

Animals↗