Three cases of sequential liver-kidney transplantation from living-related donors.
Explore the source record for details and available documents.
Child, Preschool↗
Biomedical subjects
K Takasaki
Publications and source records attributed to K Takasaki.
Histopathologic study of temporal bone and eustachian tube in oculoauriculovertebral spectrum.
Bilateral temporal bone specimens from a 21-month-old girl and a left temporal bone-eustachian tube (ET) specimen from a full-term female newborn, both with oculoauriculovertebral spectrum, were studied histopathologically. The external and middle ears demonstrated severe anomalies, similar to those of previous reports describing the histopathologic findings of this syndrome. In addition, despite having a normal auricle, the 21-month-old child had bilateral hypoplastic cochleas as seen in Mondini dysplasia. The newborn had several anomalies of the ET, including a widely opened cartilaginous portion of the ET lumen and absence of the lateral lamina of the ET cartilage. We discuss the implications of the observed anomalies with regard to developmental and clinical issues.
Eustachian Tube↗
A case of bilateral middle-ear squamous cell carcinoma.
Only eight cases of bilateral middle-ear squamous cell carcinoma (SCC) have been reported to date. We present the case of a 75-year-old male with bilateral middle-ear SCC and review the previously reported cases. The patient was diagnosed as having moderately-differentiated SCC in the left middle ear in February 1995 and well-differentiated SCC in the right middle ear in September 1997. He initially received radiation therapy with (60)Co pendulum (64 Gy) in the left ear and was subsequently treated by Liniac irradiation (50 Gy) in the right ear. He has now been followed up at our ENT clinic for 29 months without vertigo or facial nerve palsy since the second radiation therapy. Although he has a residual tumour in the right middle ear invading the middle cranial fossa dura, no sign of recurrence has been detected in the left ear.
Aged↗
Changes in intratumoral thymidylate synthase (TS) and dihydropyrimidine dehydrogenase (DPD) mRNA expression in colorectal and gastric cancer during continuous tegafur infusion.
Thymidylate synthase (TS) is the target enzyme of 5-fluorouracil (5-FU), and dihydropyrimidine dehydrogenase (DPD) is the key enzyme in the 5-FU catabolic pathway. We wanted to determine whether the TS and DPD mRNA expression levels of gastric and colorectal cancer patients would be affected by tegafur (futrafur:FT)-based chemotherapy and whether changes in their expression might be responsible for patient outcome. Thirty-five patients with resectable advanced primary gastric cancer and 36 patients with resectable advanced primary colorectal cancer were the subjects of this study. They all underwent neoadjuvant chemotherapy with protracted infusion of FT alone or FT plus low doses of cisplatin. The TS and DPD mRNA expression levels of endoscopic biopsy specimens before chemotherapy and surgical specimens after chemotherapy were measured by TaqMan reverse transcription-PCR assay using glyceraldehyde-3-phosphate dehydrogenase (GAPDH) as the internal standard. There was a significant difference in the DPD mRNA levels during chemotherapy in the colorectal cancers. Although the TS and DPD levels were unrelated to any conventional histopathological grade factors, colorectal cancer patients whose surgical specimens contained lower TS and DPD mRNA levels had longer disease-free intervals. The results of this study suggest that FT may affect DPD mRNA expression in colorectal cancer patients, that TS/DPD expression can be regarded as an independent prognostic factor, and that colorectal cancer patients with low TS and low DPD mRNA are candidates for FT-based adjuvant chemotherapy. In addition, quantitative analysis of the change in TS/DPD mRNA in surgical specimens during FT-based chemotherapy might be a more accurate means of predicting the post-operative disease-free interval of colorectal cancer patients than analysis of endoscopic specimens before chemotherapy. There also seems to be a relation between regulation of TS and DPD during FT chemotherapy. Elucidation of the mechanisms regulating TS and DPD mRNA expression might make it possible to predict sensitivity and/or toxicity to FT.
Antineoplastic Agents↗
[Indications for and operative outcome of hepatopancreatoduodenectomy in the treatment of gallbladder carcinoma].
Hepatopacreatoduodenectomy (HPD) was initially performed to resect highly advanced gallbladder carcinoma with direct invasion of the liver and head of the pancreas. High operative morbidity and mortality rates and early recurrence were major problems of this procedure. However, the operative outcome gradually improved with progress in surgical procedures and perioperative management. Recently, HPD has been indicated not only for direct invasion of the liver and pancreas but also for intensive dissection of peripancreatic lymph nodes and resection of occult liver metastasis to subsegments IV and V. Evaluation of all cases in which HPD was performed in our institute suggests that advanced gallbladder carcinoma with lymph node metastasis and without high-grade infiltration of the hepatoduodenal ligament (binf) is the most suitable indication for HPD.
Gallbladder Neoplasms↗
[Hepatocellular carcinoma in patients who has survived more than 10 years without recurrence after surgery].
Explore the source record for details and available documents.
Carcinoma, Hepatocellular↗
Change of the involvement of 5-HT3 receptor in the gastric motor stimulating actions of KW-5139 (Leu13-motilin acetate) in the recovered and post-operative periods in dogs.
We have previously reported that KW-5139, a motilin analogue, evokes gastrointestinal motor stimulating action in the post-operative period as well as in the recovered period of conscious dogs. In this report, we compared the mechanisms of the KW-5139-induced contractions in the post-operative period with those in the recovered period using beagle dogs implanted force transducers in the gastric antrum, duodenum, jejunum, ileum and colon. In addition, we also examined the mechanisms of the prostaglandin F2alpha-induced contractions in both periods. The gastric contractions evoked by KW-5139 (0.5 microg kg(-1), i.v.) were inhibited by the pretreatment of ondansetron (0.1 mg kg(-1), i.v.), a 5-HT3 receptor antagonist, in the recovered period, but were not affected in the post-operative period even by higher doses of ondansetron (0.3-1 mg kg(-1), i.v.). The KW-5139-induced contractions in the small and large intestine were not inhibited by ondansetron in the both periods. The contractions evoked by KW-5139 (0.5 microg kg(-1), i.v.) in the gastric antrum, duodenum, jejunum and colon were significantly inhibited by the pretreatment with atropine (0.05 mg kg(-1), i.v.), a muscarinic receptor antagonist, in the recovered period as same extent as in the post-operative period. The contractions evoked by prostaglandin F2alpha (50 microg kg(-1), i.v.) in the any recording sites were not affected by the pretreatment with ondansetron (0.1 mg kg(-1), i.v.) in the recovered period. On the other hand, atropine (0.05 mg kg(-1), i.v.) tended to inhibit the gastric and colonic contractions. These effects of ondansetron and atropine on the prostaglandin F2alpha-induced contractions were not different between in the post-operative and recovered periods. The present results indicate that 5-HT3 receptors are involved in the KW-5139-induced motor stimulating action in the recovered period but not in the post-operative period. The mechanisms of the alteration were discussed.
Anesthesia Recovery Period↗
Serum levels of des-gamma-carboxy prothrombin measured using the revised enzyme immunoassay kit with increased sensitivity in relation to clinicopathologic features of solitary hepatocellular carcinoma.
BACKGROUND: Des-gamma-carboxy prothrombin (DCP) is an established marker for hepatocellular carcinoma (HCC), but the conventional enzyme immunoassay (EIA) kit lacks adequate sensitivity. Thus, a revised EIA kit with increased sensitivity has been developed. In this kit, the sensitivity has increased while high specificity to HCC has been maintained. The authors have already reported the clinical usefulness of this revised EIA kit. In this study, they examined the serum levels of DCP measured by this revised EIA kit in relation to the clinicopathologic features of solitary HCC. METHODS: Fifty-six patients with solitary HCC who underwent hepatectomy were studied. The relation between the greatest dimension and the histologic differentiation of HCC was investigated in these 56 patients, as were the serum levels of DCP measured by the revised EIA kit (Sensitive DCP), alpha-fetoprotein (AFP), and DCP measured by the conventional EIA kit (DCP). The cutoff value for Sensitive DCP was set at 40 mAU/mL, and the values for AFP and DCP were 20 ng/mL and 100 mAU/mL (0.1 AU/mL), respectively. RESULTS: The positivity rates for Sensitive DCP, AFP, and DCP (n = 56) were 53.6%, 53.6%, and 35.7%, respectively, and the rate was 73.2% when Sensitive DCP was used in combination with AFP (Sensitive DCP + AFP). The positivity rates for these markers were as follows: 1) When the greatest dimension of HCC was more than 3 cm (n = 16) and less than 2 cm (n = 23), the rates were 81.3% and 30.4% for Sensitive DCP, 68. 8% and 39.1% for AFP, 56.3% and 13.0% for DCP, and 93.8% and 56.5% for Sensitive DCP + AFP. 2) When HCC was moderately to poorly differentiated (n = 41) and well differentiated (n = 15), the rates were 68.3% and 13.3% for Sensitive DCP, 61.0% and 33.3% for AFP, 48. 8% and 0% for DCP, and 85.4% and 40% for Sensitive DCP + AFP. 3) When HCC was either more than 3 cm or moderately to poorly differentiated (n = 42) and either less than 2 cm or well differentiated (n = 27), the rates were 69.0% and 29.6% for Sensitive DCP, 61.9% and 37.0% for AFP, 47.6% and 11.1% for DCP, and 85.7% and 51.9% for Sensitive DCP + AFP. CONCLUSIONS: DCP measured by the revised EIA kit with increased sensitivity has a stronger correlation than AFP with size and histologic differentiation of HCC. This Sensitive DCP is a very useful marker for HCC and should be used in combination with AFP.
Adult↗
Postnatal development of eustachian tube cartilage. A study of normal and cleft palate cases.
Infants with cleft palate (CP) display eustachian tube (ET) dysfunction. This study compared the postnatal development of the volume of ET cartilage in 34 normal cases and 10 CP cases using a personal computer. In cases with age under 1 month old, the total volume of ET cartilage was 61.94+/-20.89 mm(3) (mean+/-S.D.) in 16 normal control cases and 50.07+/-24.69 mm(3) in nine CP cases (t-test, not significantly different from normal). The ratio of lateral lamina (LL) to medial lamina (ML) volume (LL/ML) was reduced significantly (t-test, P<0.001) from 0.23+/-0.07 in 16 normal control cases to 0.09+/-0.05 in nine CP cases under 1 month old. In 34 normal ET cases whose ages were under 20 years, statistically significant positive correlations were found between the total volume of ET cartilage (y1) and age (x), volume of LL (y2) and age, and volume of ML (y3) and age (P<0.01, r=0.731, 0.614, 0.719). The regression lines were y1=20.37x+95.57, y2=2.02x+15.60, and y3=18. 35x+79.97. With the result obtained from this study, it is assumed that immaturity of the ET cartilage in infants, especially that of LL of the ET cartilage in CP infants, may be a significant risk factor for developing otitis media with effusion.
Adolescent↗
Histopathologic study of the human eustachian tube and its surrounding structures following irradiation for carcinoma of the oropharynx.
OBJECTIVE: To describe a histopathologic analysis of a human temporal bone demonstrating patulous changes of the eustachian tube (ET) and its surrounding structures following radiation therapy. DESIGN: Retrospective histopathologic case review and comparison with an age-matched control. SETTING: Elizabeth McCullough Knowles Otopathology Laboratory, University of Pittsburgh School of Medicine, Pittsburgh, Pa. RESULTS: A widened patulous ET was verified by demonstrating fibrous tissue replacement of the surrounding supporting structures related to the ET. The ET lumen was patulous and wider than the control case. Ostmann fatty tissue, the levator veli palatini muscle, and submucosal glands around the ET cartilage were replaced by dense connective tissue. CONCLUSION: This is the first histopathologic report, to our knowledge, demonstrating the effects on the ET lumen and supporting structures following acute weight loss, possible tumor infiltration, and radiation changes for carcinoma of the oropharynx.
Carcinoma, Squamous Cell↗
Factors affecting survival after living-related liver transplantation.
The purpose of this study was to determine the perioperative factors that influence patient and graft outcome in living-related liver transplantation (LRLT). Between April 1995 and October 1998, we performed a series of 46 LRLT procedures, including 11 adult cased, at our institute. Mean age and weight of the recipients were 12.0 +/- 2.3 years and 23.7 +/- 2.6 kg, respectively. Seven out of the 46 patients had renal failure and received hemodialysis therapy before and after LRLT or kidney transplantation. The recipients were divided into two groups: those who survived for 7-48 months after LRLT (group 1, n = 36), and those who died within 4 months after surgery (group 2, n = 10). Factors analyzed included recipient age and weight, graft/recipient body weight ratio (G/R ratio), emergent vs elective surgery, United Network for Organ Sharing (UNOS) status, presence of preoperative plasmapheresis (PEX) and renal failure, and so on. Recipients in group 1 compared with group 2 had less advanced liver disease (i. e., a lower rate of emergent surgery, 14% vs 50%, and fewer patients with UNOS status 1, 14% versus 70%; P < 0.05 and P < 0.001, respectively). Group 1 recipients also had a lower percentage of preoperative treatment with plasmapheresis (22% vs 70%, P < 0.01). However, neither the G/R ratio nor the presence of renal failure affected the patient survival rate. In conclusion, factors independently associated with reduced patient survival after LRLT include emergent surgery, Child-Pugh class, UNOS status 1, and preoperative plasmapheresis.
Adolescent↗
Multicentric hepatocellular carcinomas tend to grow in more damaged segments of the liver.
In 115 patients (68 with liver cirrhosis and 47 without) who underwent curative resection of hepatocellular carcinoma (HCC) caused by hepatitis C virus (HCV)-related chronic liver diseases, we separated the liver into three segments (right, middle, and left) according to the three secondary branches of the Glissonean pedicle. We examined the weight of each resected segment. We also examined the histological findings of the segments in the same liver in 24 other patients with HCV-related chronic liver diseases. The average weight of the segments did not vary significantly in patients without liver cirrhosis. However, the average weight of the segments was significantly different in patients with liver cirrhosis (P = 0.0414) and the weight of the middle segment was lower than that of the other segments. In another group, of 246 patients with curative resection of HCC, of the 90 patients with single nodular HCCs, 45 nodules (50%) were located in the middle segment (P = 0.0004); in the 156 patients with synchronous multicentric HCCs (total, 401 nodules), 220 nodules (54.9%) were located in the middle segment. In 74 of the 156 patients with synchronous multicentric HCCs (47.4%), the HCCs were located in the same segment. The grade, stage of hepatitis, and number of sites of irregular regeneration were significantly different in each segment (P < 0.05), and the middle segment had more advanced hepatitis than the other segments. The rate of occurrence of HCC in the middle segment was higher than that in the other segments. The difference among the segments of the liver in regard to the degree of damage done by hepatitis may be related to the differences in HCC occurrence among the liver segments.
Carcinoma, Hepatocellular↗
Coagulopathy after bilirubin adsorption in a living-related partial liver transplant recipient.
Explore the source record for details and available documents.
Adsorption↗
Suppressive effect of saprogrelate hydrochloride on Raynaud's phenomenon and respiratory failure in patients with systemic sclerosis.
OBJECTIVE: In seven patients with systemic sclerosis (SS), we evaluated the clinical effectiveness of oral administration of saprogrelate hydrochloride (SH: 300 mg/day) for 2 months on Raynaud's phenomenon (RP) and respiratory failure estimated by Hugh-Jones classification. METHODOLOGY: We evaluated laboratory data (arterial blood gas (pH, PaO2 and PaCO2), pulmonary function tests (%VC, FEV1/FVC and %DL(CO)), mean pulmonary arterial pressure (mPAP), white blood cell count, C-reactive protein and the plasma levels of fibrinopeptide A (FPA), beta-thrombogloblin (beta-TG), platelet factor 4 (PF4) and thrombomodulin (TM)) before and after SH administration. RESULTS: The frequency and duration of RP, as well as the coldness, numbness and pain of RP were significantly decreased after SH administration (P < 0.05, P < 0.01 and P < 0.001). Respiratory failure estimated by Hugh-Jones classification was also significantly decreased after SH administration (P < 0.05), and the %DL(CO) was significantly increased (P < 0.01). The mPAP decreased significantly after SH administration (P < 0.05). Plasma FPA, beta-TG and PF4 significantly decreased after administration (P < 0.05 and P < 0.01). CONCLUSIONS: SH therapy could prevent RP and respiratory failure in patients with SS.
Adult↗
Ossification of eustachian tube cartilage and Ostmann's fatty tissue in chronic renal failure.
Ossification of the eustachian tube (ET) cartilage in 2 cases of chronic renal failure is reported for the first time. In both cases, the ossification was observed in the medial lamina of the ET cartilage. In addition, ossification of Ostmann's fatty tissue was observed in case 1, and ossification of the lateral lamina of the ET cartilage was seen in case 2. Correlation between ossification in chronic renal failure and dysfunction of the ET caused by ossified ET cartilage and Ostmann's fatty tissue is discussed.
Adipose Tissue↗
Histopathologic findings of the inner ears with Alport, Usher and Waardenburg syndromes.
Explore the source record for details and available documents.
Adult↗
Length of the eustachian tube and its postnatal development: computer-aided three-dimensional reconstruction and measurement study.
Eleven normal human temporal bone-eustachian tube (ET) specimens obtained from 11 individuals whose ages were 3 months to 88 years were studied to investigate the path length along the ET lumen and its postnatal development by means of a computer-aided 3-dimensional reconstruction and measurement method. The path length of the ET lumen of the 3-month-old infant was 21.2 mm, and its growth was in correlation with age to attain its adult length (average, 37.00 +/- 4.16 mm). The ratio of the length of the cartilaginous portion together with the junctional portion to the length of the bony portion was 8:1 in an infant at the age of 3 months and 4:1 in adults. That the bony portion of the ET develops relatively more than the cartilaginous and junctional portions may cause this finding. In addition, there is a developmental shift in the orientation of the cartilaginous portion with respect to the bony portion of the ET. In children, the cartilaginous and bony portions are both aligned with the line that connects the pharyngeal orifice and the tympanic orifice. In adults, however, the cartilaginous portion is angled inferiorly and laterally from the bony portion. This change may reflect the relative growth of the face.
Adolescent↗
Nasal lipoma.
Several lipomas of the nasal cavity and paranasal sinus have previously been reported to date. We present a 21-year-old case with nasal lipoma situated on the left posterior of part of the nasal septum, operated on endoscopically. The present case is, to our knowledge, the first report on nasal lipoma in the adult.
Adult↗