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Yukihiro Inomata

Publications and source records attributed to Yukihiro Inomata.

At least 19 recordsLinked to original sources
PubMed2006

Automated hepatic volumetry for living related liver transplantation at multisection CT.

PURPOSE: To prospectively compare in vivo hepatic automated volumetry with manual volumetry and measured liver volume. MATERIALS AND METHODS: The study was conducted in accordance with the guidelines of the Institutional Review Board of Kumamoto University (Japan). Patient informed consent was obtained. Preoperative multisection computed tomography (CT) was performed in 35 consecutive patients (21 men, 14 women; mean age, 42.8 years; range, 28-72 years) with hepatic disease awaiting living related liver transplantation. The CT scans covered the entire liver at a section thickness of 2.5 mm. Liver volume was estimated by using both the automated and the manual methods. Actual liver weight was obtained for all patients and was converted to hepatic volume on the basis of a predetermined relationship between actual liver weight and volume. Processing time required for both methods was also recorded. Two-tailed paired t test, correlation coefficient, and Bland-Altman tests were used for statistical analyses. RESULTS: Mean liver weight was 881.7 g +/- 249.8 (standard deviation), and mean measured liver volume was 956.00 cm(3) +/- 280.10. Volumetry performed with the automated and manual methods provided liver volumes of 982.99 cm(3) +/- 301.98 and 937.10 cm(3) +/- 301.31, respectively. There was good correlation between measured and estimated volumes obtained with the automated method (r = 0.792, P < .01). The manual and automated methods required 32.8 minutes +/- 6.9 and 4.4 minutes +/- 1.9, respectively. CONCLUSION: The automated method reduced the time required for volumetry of the liver and provided acceptable measurements.

Adult↗
PubMed2006

Ectopic cervical thymus in an infant.

We report a case of accessory cervical thymus presenting as a unilateral neck mass in a 2-month-old boy. Ultrasonography (US) showed a mass isoechogenic to muscle in the left neck. Computed tomography (CT) revealed a well-defined, mildly enhanced mass located anterior to the sternocleidomastoid muscle, anterolateral to the carotid sheath, and posterior to the submandibular gland. On magnetic resonance imaging (MRI), the mass was isointense to muscle on T1-weighted images and hyperintense to muscle on T2-weighted images. Diffusion-weighted images showed relatively low apparent diffusion coefficient (ADC) values, and the mass was slightly enhanced after administration of contrast material. We suspected ectopic thymus, but we could not exclude the possibility of a malignant lesion. Therefore, the tumor was surgically resected. The histological diagnosis was ectopic cervical thymus. Ectopic thymus should be included in the differential diagnosis of a submandibular or cervical mass in infants. US and MRI can provide useful information for the diagnosis of ectopic cervical thymus.

Biomarkers, Tumor↗
PubMed2006

Clinical characteristics and outcome of Wilms tumors with a favorable histology in Japan: a report from the Study Group for Pediatric Solid Malignant Tumors in the Kyushu Area, Japan.

BACKGROUND/PURPOSE: Since 1996, the standard treatment of Wilms tumors in Japan has been based on the regimen of the Japanese Wilms Tumor Study. However, in Japan, there have been no reports about Wilms tumors that analyzed the clinical features and patient outcome in a large series until now. This study aims to assess the clinical characteristics of patients with Wilms tumor with a favorable histology from a retrospective standpoint in the Kyushu area in Japan and, furthermore, to analyze the historical changes of clinical features and outcome from the 1980s to the 1990s. METHODS: Between 1982 and 1996, 90 cases of Wilms tumors with a favorable histology were registered in the Kyushu area. Regarding the clinical feature and outcome, they were divided into 2 groups (group A, 1982-1989, n = 50; group B, 1990-1996, n = 40). The outcome was analyzed based on the 5-year overall survival rate. RESULTS: The clinical features (age, sex, initial symptom, location, stage) demonstrated no definite differences between group A and group B. Regarding the operation, the rate of an initial complete resection in the early stages was significantly higher in group B than in group A. All stage V cases in group B undewent a bilateral tumor biopsy instead of a radical nephrectomy as the initial operation. The 5-year overall survival rate throughout the whole period was 87.8%, whereas the rates were 84.0% for group A and 90.0% for group B (P = NS), respectively. Of particular note, the outcome of patients with stage I and stage V in group B substantially improved in comparison to that in group A. However, in advanced cases, no significant improvement in the outcome was noted. CONCLUSIONS: This is the first report about the clinical features and outcome for Wilms tumors with a favorable histology in Japan from the 1980s to the 1990s. The present study suggested that in the early-stage cases, an initially complete resection followed by standard postoperative chemotherapy substantially improved the outcome of the patients in group B. In the stage V cases, the performance of renal salvage surgery may have positively contributed to the improvement in the outcome in group B. However, in the advanced stage cases, no definite improvement was noted. In the future, an improved efficacy of the treatments for Wilms tumors based on the standard protocol established by the Japanese Wilms Tumor Study in 1996 is expected in Japan.

Child, Preschool↗
PubMed2006

Response of heavily treated and relapsed hepatoblastoma in the transplanted liver to single-agent therapy with irinotecan.

We describe here a patient with relapsed hepatoblastoma after LDLT who developed heart failure, which was treated with irinotecan hydrochloride (CPT-11). His native liver was replaced by a liver graft from his mother at 26 months from the onset. However, LDLT failed to induce complete remission and he was diagnosed as relapsed hepatoblastoma six months after LDLT. We again administered cisplatin and doxorubicin. After six courses of chemotherapy, he developed congestive heart failure because of anthracycline toxicity. The chemotherapy regimen was therefore switched to irinotecan at 35 mg/m2 daily for three days/wk for two consecutive weeks, and repeated every 28 days. After four courses of irinotecan, metastatic lesions were remarkably reduced in size, and the serum level of AFP decreased from 0.7 million to 927 ng/mL. No severe side effects were documented and congestive heart failure improved. These results suggest that irinotecan may be safely given to a patient with relapsed hepatoblastoma after LDLT without serious side effects and may contribute to prolonging the survival.

Antineoplastic Agents, Phytogenic↗
PubMed2006

Effect of tacrolimus and partial hepatectomy on transthyretin metabolism in rats.

Liver transplantation, which serves as treatment of familial amyloidotic polyneuropathy (FAP), and domino liver transplantation, which utilizes resected livers from patients with FAP for treatment of liver diseases, may induce changes in transthyretin (TTR), a pathogenic FAP-related protein. To evaluate this possibility, we performed a 70% hepatectomy or administered tacrolimus to Dark Agouti (DA) rats for 7 days and then measured changes in liver TTR mRNA levels and changes in serum TTR concentrations. After hepatectomy, TTR mRNA levels decreased by 77%; at day 3, they returned to preoperative levels. Except for slightly elevated serum TTR concentrations 12 h after operation, serum TTR levels remained unchanged. Thus, partial hepatectomy did not influence serum TTR concentrations. After tacrolimus administration, TTR mRNA declined by 56% 12 h after the experiment started; however, after day 3, a rebound phenomenon occurred until day 7. Tacrolimus may facilitate serum TTR degradation, although production of TTR in the liver also increased. This finding -- that TTR, the source of FAP-inducing amyloid, did not increase after transplantation -- may help post-transplantation treatment of patients who have FAP and other liver diseases.

Animals↗
PubMed2005

Hepatitis B virus infection in lymphatic tissues in inactive hepatitis B carriers.

BACKGROUND/AIMS: Hepatitis B virus (HBV) infection in extrahepatic tissues is controversial. To clarify whether episomal HBV can infect nonhepatic tissues, we investigated the molecular forms of HBV in the lymphatic cells of inactive HBV carriers who lacked viremia, thus avoiding contamination with HBV genomes originating from the viral particles present in the serum. METHODS: We assessed HBV genome, replicative forms, and viral integrants in the liver, serum, peripheral blood mononuclear cells (PBMC), and lymph nodes of 21 inactive HBV carriers who tested positive for antibodies against the HBV core antigen (anti-HBc). RESULTS: Of the 21 anti-HBc positive individuals, HBV-DNA was detected in liver samples of 15 (71.4%), in the lymph nodes of 11 (52.4%), and in PBMC of three (14.3%). However, none of the detected HBV genomes from lymphatic tissues included the replicative forms of HBV. In one case, integrated HBV was present in the lymphatic tissues and the host-viral junction was present in the intronic sequences of chromosome 17. CONCLUSIONS: These data suggest that human lymphatic tissues cannot support viral replication in anti-HBc positive inactive HBV carriers, while retaining the viral genome as an integrated form.

Adult↗
PubMed2005

Feasibility of using the cystic duct for biliary reconstruction in right-lobe living donor liver transplantation.

Duct-to-duct biliary reconstruction has been introduced in adult living donor liver transplantation (LDLT). In right-lobe grafts, however, the presence of two or three separated bile duct orifices is not rare and makes an alternative approach for reconstruction necessary. We used the cystic duct for one of the anastomoses in biliary reconstruction for 5 right-lobe living donor liver transplants with two separated ducts. Before the anastomosis, the inside lumen of the cystic duct was straightened with a metal probe. Two external drainage tubes were placed in all recipients, and posttransplant cholangiography through the tubes approximately one month after transplantation showed no leakage or stricture at any of the anastomotic sites. The drainage tubes were removed between 17 and 37 weeks after transplantation. All of the patients except one who died of chronic rejection have been doing well without any late biliary complications during follow-up periods ranging from 10 to 28 months after transplantation. In conclusion, our results indicate that biliary reconstruction using the cystic duct is feasible and safe for living donor liver transplantation and that external drainage tubes may be effective for prevention of complications.

Adolescent↗
PubMed2005

Living domino liver transplantation in an adult with congenital absence of portal vein.

Congenital absence of the portal vein (CAPV) is a rare malformation of the splanchnic venous system. Although CAPV is usually detected in the pediatric age group, our patient was a 35-year-old woman. She had been diagnosed with CAPV in 1996 when she was 27 years old. In 1998, she was placed on hemodialysis due to chronic renal failure. After several episodes of encephalopathy in 2002, liver transplantation (LT) was recommended to her and her family. Since there was no suitable living donor candidate, she was put on the waiting list for a deceased donor liver transplant in Japan. In 2004, her ammonia level increased to around 300 microg/dl, and she went into a coma lasting for three days. After recovering from this event, she underwent a living domino transplantation using a whole liver donated by a familial amyloid polyneuropathy (FAP) patient. Her portal vein, which had drained directly into the inferior vena cava (IVC), was transected together with a cuff of the IVC wall and anastomosed to the graft liver portal vein in an end-to-end fashion. In conclusion, liver transplantation proved to be a safe and effective way to save this patient and improve her quality of life.

Adult↗
PubMed2005

Duct-to-duct biliary reconstruction in pediatric living donor liver transplantation.

The results of duct-to-duct biliary reconstruction in six pediatric patients who received a living donor liver transplant aged from 2 months to 11 yr old are reported. The graft was either entire or a part of the left lateral segments. The orifice of the bile duct of the graft was anastomosed to the recipients' hepatic duct in an end-to-end fashion by interrupted suture using 6-0 absorbable material. A transanastomotic external stent tube (4 Fr) was passed through the stump of the recipients' cystic duct. Mean time for reconstruction was 24 min. All the recipients survived the operation and reinitiated oral intake on postoperative day 3. There were no early biliary complications. One 5-yr-old boy suffered from an anastomotic stenosis 9 months after transplantation. He underwent re-anastomosis by Roux-en Y (R-Y) procedure and recovered uneventfully. Duct-to-duct anastomosis in pediatric living donor liver transplantation has benefits while the complication rate is comparable to R-Y reconstruction.

Anastomosis, Surgical↗
PubMed2005

[Practical application of nutritional assessment protein and inflammatory marker in the nutrition support team (NST)].

Recently nutrition support team (NST) has been established for the purpose of prevention of complications which are caused by nutrition disorders and reduction of the medical expenses. Although physical examinations and blood biochemical data had been used as the indexes evaluating nutritional of patients, they were not suitable for the evaluation for the short-term in-patient. On the contrary, serum albumin (ALB) has been wildly used as a nutritional marker. However, it is impossible to evaluate nutrition state for the short-term in-patient and acute phase disease patient accurately, because the plasma half-life is 21 days and it takes long time to detect the change in nutritional state by its value. Rapid turnover proteins (RTP), whose plasma half-life is shorter, has paid attention to evaluate nutritional state for the short-term in-patients and acute phase disease patients. Although, prognostic inflammatory and nutritional index (PINI) was considered as a useful maker for evaluating inflammatory and nutritional states using the concentrations of transthyretin (TTR), a RTP, alpha1-acid glycoprotein (alpha1-AG), a chronic inflammation marker, C reactive protein (CRP), a acute inflammation marker, and ALB, However, it has several pitfalls. We newly made serum amyloid A (SAA) index using SAA instead of CRP. When we compared SAA index with PINI in many diseases, it turned out that SAA index became a more effective index which reflected the patient condition than did PINI. As for this index, it is expected to be used by NST while further alternation may be needed.

C-Reactive Protein↗
PubMed2005

[Current status and perspective of pediatric liver transplantation in Japan].

In Japan, the annual number of pediatric liver transplantation (LT) has been stable around 140 in the last few years. Almost all of them are from living donors. Three fourth are indicated for cholestatic liver diseases, mainly biliary atresia. One year patient survival rate after pediatric LT in Japan is 85 %. In comparison to other indications, patient survival of the infants with fulminant hepatic failure is quite poor. Weaning protocol of immunosuppression in pediatric LT in Japan is going in many institutions, and has succeeded to obtain some number of recipients with complete tolerance. More attenuated immunosuppresion and intimate monitoring for EB virus infection using the real-time PCR has been effective to decrease the incidence of post-transplant lymphoproliferative disorder.

Adolescent↗
PubMed2004

Rescue for rare complications of the hepatic artery in living donor liver transplantation using grafts of autologous inferior mesenteric artery.

This report describes two rescued cases with rare complications of the hepatic artery in living-donor liver transplantation (LDLT). In both cases a segment of the autologous inferior mesenteric artery (IMA) was successfully used as an arterial graft for re-vascularization under microsurgery. The first case was that of a pseudoaneurysm of the hepatic artery, which caused massive gastrointestinal bleeding. The hepatic arteries of the pre- and post-aneurysm were divided, and the arterial graft from the recipient's IMA was interposed for reconstruction. The second case was that of an intimal dissection of the recipient's hepatic artery. Because the dissection extended to the root of the common hepatic artery, the autologous IMA was interposed between the donor's hepatic artery and the proximal stump of the recipient's splenic artery. Reconstruction using the arterial graft of the autologous IMA is feasible for re-vascularization of the hepatic artery in liver transplantation.

Adult↗
PubMed2004

A different amyloid formation mechanism: de novo oculoleptomeningeal amyloid deposits after liver transplantation.

BACKGROUND: Liver transplantation has served as a treatment for patients with familial amyloidotic polyneuropathy (FAP) because variant transthyretin (TTR), the pathogenic protein of FAP, is predominantly produced by the liver. However, the effect on amyloid formation of TTR that is synthesised by the retina and the choroid plexus remains to be elucidated in FAP patients with liver transplants. OBJECTIVE: To investigate changes in ocular tissues and the central nervous system (CNS) of FAP patients after liver transplantation. DESIGN: Clinical study. SETTING: Graduate School of Medical Sciences, Kumamoto University, Japan. INTERVENTION: Transplantation of livers from cadaveric or living donors. MEASUREMENTS: Preoperative measures and postoperative (16-108 months) follow-up of clinical data, including routine ophthalmologic, neurologic, and laboratory evaluations. RESULTS: In 22 patients with FAP related to the amyloidogenic TTR (ATTR) Val30Met and 3 patients with FAP ATTR Tyr114Cys, after liver transplantation, 3 patients began to show evidence of de novo glaucoma, and 1 had vitreous opacity that was caused by the variant TTR. Another three patients showed new amyloid deposits in the pupillary margin, which could lead to glaucoma and vitreous opacity. As for changes in the CNS and levels of total protein and TTR in cerebrospinal fluid (CSF), after liver transplantation, two FAP ATTR Tyr114Cys patients exhibited de novo amyloid deposition in the leptomeninges, and total protein and TTR levels in CSF were significantly increased. CONCLUSIONS: Oculoleptomeningeal involvement in FAP was not prevented by liver transplantation because variant TTR produced by the retina and the choroid plexus forms amyloid fibrils in situ.

Adult↗
PubMed2004

Early graft failure due to a veno-occlusive disease after a pediatric living donor liver transplantation.

A 10-month-old boy with biliary atresia after Kasai procedure underwent a living donor liver transplantation (LDLT). Five days after the LDLT, high fever and increased ascites followed by poor bile drainage was accompanied by elevation of serum liver enzymes. Liver biopsy showed occlusion of the central veins by fibro-edematous endothelium and submassive necrosis of the parenchyma. Veno-occlusive disease (VOD) was suspected, and re-LDLT was urgently performed because of deterioration of hepatic failure. There are few cases of VOD after liver transplantation and this is the first one in an infant after LDLT.

Graft Occlusion, Vascular↗
PubMed2004

Induction of molecular chaperones in carbon tetrachloride-treated rat liver: implications in protection against liver damage.

Carbon tetrachloride (CCl4) induces liver damage, apparently through the formation of free-radical metabolites. Molecular chaperones such as heat shock protein (Hsp) of 70 kDa have been found to protect cells from various stresses. We previously found that cytosolic chaperone pairs of the Hsp70 family and their DnaJ homolog cochaperones prevent nitric oxide-mediated apoptosis and heat-induced cell death. Expression of cytosolic chaperones, including Hsp70; heat shock cognate (Hsc) 70; and DnaJ homologs dj1 (DjB1/Hsp40/hdj-1), dj2 (DjA1/HSDJ/hdj-2), dj3 (DjA2), and dj4 (DjA4), in the liver of CCl4-treated rats was analyzed. Messenger ribonucleic acids for all these chaperones were markedly induced 3-12 hours after CCl4 treatment with a maximum at 6 hours. Hsp70 and dj1 proteins were markedly induced at 6-24 hours with a maximum at 12 hours, whereas dj2 and dj4 were moderately induced at around 12 hours. Hsc70 was weakly induced after treatment, and dj3 was little induced. To better understand the significance of the induction of chaperones, the effect of preinduction of chaperones on CCl4-induced liver damage was analyzed. When chaperones were preinduced in the liver by heat treatment, increase in serum alanine aminotransferase activity after CCl4 treatment was significantly attenuated. Hsp90, another major cytosolic chaperone, also was induced by heat treatment. On the other hand, Mn- and Cu/Zn-superoxide dismutase were not induced by heat treatment or by CCl4 treatment. These results suggest that cytosolic chaperones of Hsp70 and DnaJ families or Hsp90 (or both) are induced in CCl4-treated rat liver to protect the hepatocytes from the damage being inflicted.

Alanine Transaminase↗
PubMed2004

[A case report of the local treatment against hepatocellular carcinoma (HCC) in consideration of the prospective living donor liver transplantation (LDLT)].

Various local cancer treatments became possible in the cure of hepatocellular carcinoma. Percutaneous ethanol injection (PEIT), a local ablation therapy such as microwave and radiofrequency were added to the transcatheter arterial chemoembolization (TACE) and hepatectomy. However, it is also a well-known fact to repeat hepatic carcinogenesis by the conditions of a background liver whereas to originate in the viral hepatitis. In this point of view, liver transplantation is one of the ultimate treatments to get rid of the carcinogenic factor. A 54-year-old man patient diagnosed as HCC strongly hoped for the prospective liver transplantation surgery from the beginning. Therefore, we had to treat a liver cancer in consideration of the prospective liver transplantation. A local ablation therapy and TACE treatment were carried out with being careful not to have an influence to the transplantation surgery. Because recurrence was repeated, a patient chose a transplantation medical treatment after one year and nine months. We reported the process of local treatments against HCC in consideration of the prospective liver transplantations.

Carcinoma, Hepatocellular↗
PubMed2003

Living-related liver transplantation for Alagille syndrome.

Alagille syndrome (AGS) is an autosomal dominant genetic disorder characterized by chronic cholestasis, congenital heart disease, peculiar facies, butterfly-like vertebrae, and posterior embryotoxon. Liver dysfunction is the common presentation of AGS, and liver transplantation may be indicated. This study examines the outcome of living-related liver transplantation (LRLT) for AGS. Twenty patients with AGS (median age 5.0 years, range 0.6-12.9) underwent LRLT at Kyoto University Hospital between June 1990 and February 2002. Five potential donors were excluded because of paucity of intrahepatic bile ducts diagnosed by preoperative liver biopsy and one because of a hepatic vascular anomaly. The overall 5-year patient survival was 80.4%. Three patients died as the result of the following: complications related to surgery, heart failure caused by progressive pulmonary artery stenosis, and a graft with unsuspected bile duct paucity. Liver dysfunction was improved in all successful cases, and catch-up growth occurred in 90% of patients. LRLT is an efficacious treatment modality for AGS if donors are selected by cautious evaluation to rule out unsuspected bile duct paucity.

Alagille Syndrome↗