Search PubMed⌕ Search

Biomedical subjects

S Mugiya

Publications and source records attributed to S Mugiya.

At least 37 records · Page 2Linked to original sources
PubMed1997

Retroperitoneoscopy assisted live donor nephrectomy: the initial 2 cases.

PURPOSE: We investigated retroperitoneoscopy assisted nephrectomy in living kidney donors. MATERIALS AND METHODS: Gasless surgery was performed with a 10 cm. upper abdominal pararectus skin incision and 2 trocars. The abdominal wall was lifted using special retractors and the kidney was removed via the pararectus incision. RESULTS: The operating time, blood loss, warm ischemic time and postoperative recovery period for the 2 donors were a mean of 210 minutes, 102 ml., 3.5 minutes and 4.5 days, respectively. There were no operative or postoperative complications. Postoperative recovery was significantly more rapid than after open donor nephrectomy. There were no differences with regard to graft biopsy findings or postoperative graft function between retroperitoneoscopy assisted and open donor nephrectomy. CONCLUSIONS: Retroperitoneoscopy assisted nephrectomy could be advantageous for healthy kidney donors since it is minimally invasive.

Female↗
PubMed1996

Laparoscopic adrenalectomy for nonfunctioning adrenal tumors.

Thirteen patients who underwent laparoscopic adrenalectomy for nonfunctioning adrenal tumors were compared with seven patients who underwent open adrenalectomy. Although a longer operating time was required for laparoscopic surgery, postoperative recovery was significantly more rapid. Performance of adrenalectomy for nonfunctioning adrenal tumors is controversial, but we cannot exclude the possibility of malignancy and the potential for hormone overproduction by presumably nonfunctioning small tumors. The minimally invasive nature of laparoscopic surgery may widen the indications for adrenalectomy in patients with nonfunctioning adrenal tumors.

Adolescent↗
PubMed1996

Renal blood flow and serotonin metabolism in tacrolimus treated rats.

BACKGROUND: Serotonin (5-HT) is a potent vasoconstrictor and activator of platelets, endothelial cells and vascular smooth muscle cells. The result of activation by serotonin is platelet aggregation and vasoconstriction. The aim of the present study was to evaluate the role of serotonin metabolism as a mediator of tacrolimus (FK 506) nephrotoxicity. METHODS: The whole blood and plasma levels of serotonin and its major metabolite (5-hydroxyindoleacetic acid: 5-HIAA) as well as renal cortical blood flow were investigated in rats administered FK 506 at doses of 4, 6 or 8 mg/kg b.w. for 14 consecutive days. RESULTS: Renal cortical blood flow declined in a dose-dependent manner in the rats given FK 506, whereas serum creatinine remained unaltered following FK 506 administration. Although there was no significant change in serotonin, the whole blood and plasma 5-HIAA levels increased significantly following FK 506 administration. CONCLUSION: FK 506 may cause acute nephrotoxicity by decreasing renal blood flow and the increase of 5-HIAA suggests some role of serotonin metabolism in the development of FK 506 nephrotoxicity.

Animals↗
PubMed1996

[Clinical experience with laparoscopy-assisted live donor nephrectomy].

PURPOSE: Laparoscopic nephrectomy has become widely performed because of its minimally invasive nature. We have performed laparoscopic nephrectomies for non-functioning kidneys and laparoscopy-assisted radical nephrectomies for renal carcinomas. Recently, we have successfully performed laparoscopy-assisted transperitoneal living related donor nephrectomy for kidney transplantation. To determine the efficacy of laparoscopy-assisted live donor nephrectomy, we investigated the clinical results of 2 patients operated upon with this new operation. PATIENTS: Case 1 was a 64-year-old healthy male and the left kidney was removed for his son who had a history of 4 months hemodialysis. Case 2 was 67-year-old healthy female who decided to donate her left kidney for her son with the history of 3 years and 2 months hemodialysis. METHODS: An upper abdominal midline incision of approximately 10 cm in length was made. Two retractors were attached to either side of the midline incision. The abdominal wall was raised by suspending these retractors from a special hanger. Then three trocars were introduced. The Gerota's fascia was incised and the kidney was suspended by grasping the perirenal fatty tissues. The renal artery and vein were carefully isolated without any manipulations of the kidney (non-touch method). After the transection of the ureter, the renal artery was ligated with a free tie of 1-0 silk and a suture ligature of 3-0 silk and the renal vain was clamped with a Satinski forceps. Immediately after the transection of the renal pedicle, the kidney was irrigated and transplanted to the right iliac fossa of the recipient in the usual fashion. A pen-rose drain was placed in the retroperitoneal space and the posterior peritoneal membrane was completely closed with 3-0 silk interrupted sutures. RESULTS: The mean operating time was 298 minutes and the mean blood loss was minimal. The average time of warm ischemia and cold ischemia of the graft were 4.5 minute and 37 minutes, respectively. There were no complications during either the operation or the postoperative period in both patients. The donors began oral intake and ambulation within 48 hours and resumed their normal daily activities by postoperative day 6.5 on average. Postoperative recovery of the patients were far faster than that of the patients receiving open donor nephrectomy. The graft functions were also excellent. The serum creatinine concentration of the recipients fell down to 0.82 mg/dl and 1.02 mg/dl at the third postoperative day. CONCLUSION: Laparoscopy-assisted live donor nephrectomy might be advantageous for kidney transplantation because of its minimally invasive procedure.

Female↗
PubMed1996

[Extraperitoneal laparoscopic adrenalectomy: the initial 9 cases].

(PURPOSE). To determine the efficacy of extraperitoneal laparoscopic adrenalectomy for patients with adrenal tumor, the clinical results of 9 patients treated with this procedure were analysed. (PATIENT AND METHOD). Between July 1994 and March 1995, we have performed extraperitoneal laparoscopic adrenalectomy using the modified Gaur technique of balloon dilatation of the retroperitoneum in 4 men and 5 women with unilaterla small adrenal tumor who were 30 to 79 years old (mean age 56 years). Preoperative diagnosis was primary aldosteronism in 2, 18-hydroxycorticosterone producing adnoma in 1, pre-Cushing syndrome in 5, and nonfunctioning adrenal tumor in 1 patient. The operations were performed with the patients on lateral position and 4 torocars were positioned. The retroperitoneal space was first dissected bluntly by the index finger and a balloon dissector through a small skin incision, and the retroperitoneal space was insufflated with carbon dioxide at the pressure of 10 to 12 mmHg. After the dissection of the adrenal gland, adrenal vein was clipped and transected. The completely freed adrenal gland was enclosed in an entrapment sack and removed en bloc through the open laparoscopy wound. (RESULTS). All 9 procedures were successfully performed. The mean estimated blood loss and the mean operating time were 53 ml and 168 min respectively. There was no intraoperative complication. A postoperative retroperitoneal hematoma was observed in one patient, however it spontaneously resolved without surgical management. (CONCLUSION). In open adrenalectomy, the benefit of the extraperitoneal approach (excluding patients with pheochromocytoma or bilateral lesions) have already been established elsewhere. Although the working space is smaller than that of peritoneal approach, and the surgical techniques are slightly more difficult, extraperitoneal laparoscopic adrenalectomy promises to be safe and a minimally invasive treatment for patients with unilateral small adrenal tumors except for pheochromocytoma.

Adrenal Gland Neoplasms↗
PubMed1996

[Laparoscopic adrenalectomy for Cushing's syndrome: a study of comparisons between laparoscopic and open adrenalectomy, and laparoscopic adrenalectomy for differing adrenal tumors].

In order to evaluate the utility of laparoscopic adrenalectomy for Cushing's syndrome, the results of 6 laparoscopic adrenalectomies for Cushing's syndrome were compared with those of 34 other laparoscopic adrenalectomies, consisting of 7 pre-Cushing's syndromes, 13 primary aldosteronisms, and 14 non-functioning adrenal tumors. The results were also compared with 5 open adrenalectomies for Cushing's syndrome. The results of the laparoscopic adrenalectomies for Cushing's syndrome were as follows: the mean operating time was 216 +/- 46 min, and the mean estimated blood loss was 180 +/- 194 ml. From the third patient, an ultrasonic surgical system was used and the estimated blood loss decreased significantly. The ultrasonic surgical system, together with a more experienced surgical technique, also cut down the operating times. During surgical intervention, 2 complications occurred; a hemorrhage of more than 500 ml in one patient, and splenic injury in another, which was treated by compression. Postoperative complications occurred in 2 patients; paralytic ileus in one, and abdominal pain due to the pneumoperitoneum in the other. All patients except 2 patients with vertebral fracture began oral intake and ambulation 1 to 4 days postoperatively, and resumed normal daily activity on postoperative day 5 to 7. Compared with the laparoscopic adrenalectomies for the other adrenal tumors, the operating time and estimated blood loss in the Cushing's syndrome patients was not substantially different, though postoperative recovery was slightly longer. When compared with the open adrenalectomies, the operating time was longer, but the postoperative recovery period was significantly shorter. We conclude that with careful surgical intervention, experience of technique, and the introduction of proper equipment, a laparoscopic adrenalectomy for Cushing's syndrome can be performed as less-invasively as a laparoscopic adrenalectomy is for the other adrenal tumors. Furthermore, our findings suggest that laparoscopic adrenalectomy for Cushing's syndrome is likelier to have better postoperative results than conventional procedures, including a more rapid recovery to normal daily activity.

Adrenal Gland Neoplasms↗
PubMed1996

[Retroperitoneal laparoscopic pelvic lymphadenectomy for patients with prostate cancer].

Between February 1994 and February 1995, we performed retroperitoneal laparoscopic pelvic lymphadenectomy on 7 patients with prostate cancer between 63 and 76 years old, consisting of 6 patients with clinical stage B2, and 1 patient with stage C. Retroperitoneal laparoscopic procedures were performed under general anesthesia. First, the prevesical space was separated by a balloon dissector to create the working space. Then, three trocars were inserted into the retroperitoneal space at the lower abdominal midline. Except for the first patient, only two surgeons were needed to dissect the obturator lymph nodes, under 5 mmHg CO2 insufflation. The mean operating time was 133 minutes for bilateral lymphadenectomy. The mean number of removed lymph nodes was 4.8 on the left side and 4.2 on the right side. The estimated blood loss ranged from 10 to 66 ml. As none of the patients showed node involvement on the microscopic examination of the frozen section, they immediately underwent total prostatectomy. Additionally removed lymph nodes were 0.8 on the left side and 1.5 on the right side. As for intraoperative complications, endotidal CO2 was elevated in the first patient, but the other patients had no complications. Retroperitoneal laparoscopic pelvic lymphadenectomy is a safe and useful procedure, and may facilitate a lymphadenectomy better than a peritoneal procedure.

Adenocarcinoma↗
PubMed1996

[Two successful deliveries within four years after cadaveric kidney transplantation: a case report].

A woman successfully delivered two children after cadaveric kidney transplantation. She received a kidney graft at the age of 18 years because of end-stage renal failure due to chronic glomerulonephritis. Eighteen months after surgery, she became pregnant. As she was receiving immunosuppressive therapy with cyclosporin, azathioprine, mizoribine and prednisolone, we discontinued mizoribine. The child was delivered by a caesarean section in week 30 of gestation. Both the increase of liver enzymes and the decrease of creatinine clearance were slight and transient. She successfully delivered another child just a few days before the 4th anniversary of her kidney transplantation. Including this patient, we have experienced 11 deliveries by women bearing kidney grafts. Intensive joint management with the obstetric service is necessary to achieve successful delivery without losing the graft.

Adult↗
PubMed1995

Efficacy of an ultrasonic surgical system for laparoscopic adrenalectomy.

PURPOSE: We determine the value of an ultrasonic surgical system for laparoscopic adrenalectomy. MATERIALS AND METHODS: We analyzed 16 patients who underwent laparoscopic adrenalectomy using the ultrasonic surgical system and compared the results with those of patients undergoing laparoscopic adrenalectomy without the system. RESULTS: The system simplified exposure of the renal pedicles and inferior vena cava, and facilitated adrenal separation from the perinephric fat as well as dissection and identification of the adrenal vessels. Operating time was shorter and blood loss was also less with use of the ultrasonic surgical system. CONCLUSIONS: The ultrasonic surgical system simplified laparoscopic adrenalectomy and made the operation much safer.

Adrenalectomy↗
PubMed1995

[Influence of pneumoperitoneum on respiratory function during urological laparoscopic surgery].

PURPOSE: To determine the influence of pneumoperitoneum on respiratory function during urological laparoscopic surgery. MATERIALS AND METHODS: We performed laparoscopic surgery on 82 patients, 45 of these patients were examined in detail of the effect of pneumoperitoneum on the respiratory function. Of these 45 patients, 14 patients received lymphadenectomy and 31 patients received adrenalectomy. For comparative analysis, 4 patients with laparoscopic cholecystectomies were also examined. Under general anesthesia, carbon dioxide tension (PaCO2) was analyzed before, during, and after the pneumoperitoneum. The data were analysed along with 4 factors; the patient's spirographic parameters, alveolar-arterial gas difference (AaDO2), insufflation pressure for the pneumoperitoneum, and operating time. RESULT: After starting the pneumoperitoneum, PaCO2 levels rose significantly. The PaCO2 levels of patients underwent laparoscopic adrenalectomy were higher than that of patients underwent laparoscopic cholecystectomy. The preoperative vital capacity and forced expiratory volume in one second (FEV1.0) did not show a significant difference of increase in the degree of PaCO2 increase. In contrast, the important factors that were closely related to the elevation of PaCO2 were preoperative AaDO2 and intraoperative insufflation pressure. Patients with high preoperative AaDO2 (> 10 torr) showed a significant increase in PaCO2 levels after pneumoperitoneum. When insufflation pressure was high (> = 10 mmHg), there was a significant rise of PaCO2 after pneumoperitoneum. In all patients whose operating time was 300 minutes or more, high levels of PaCO2 continued on the next day after surgery. CONCLUSION: We should still carefully observe the insufflation pressure, operating time, and other ventilation conditions during laparoscopic surgery.

Aged↗
PubMed1995

[A case of tacrolimus-induced glucose intolerance following renal allografting].

Living renal transplantation (Tx) was carried out on a 41-year-old male undergoing hemodialysis for a six-month period because of end-stage renal failure due to chronic glomerulonephritis. Tacrolimus (FK 506) was used as one of immunosuppressants. The graft worked immediately after Tx. However, his blood sugar level rose extremely high and use of insulin (IS) was required. At the second postoperative day, 0.3 mg/kg/day of FK506 was administered and the trough level (TL) was as high as 65 ng/ml. The serum IS level decreased from the pre-Tx value of 22 microU/ml to 12 microU/ml. With decrease in the dose of FK506, the TL was normalized, and the dose of IS could be decreased. FK506 has been reported to inhibit IS secretion. Therefore, we must be careful to evaluate the blood glucose level in the use of FK506 for patients with poor glucose tolerance.

Adult↗
PubMed1995

[Adrenalectomy for nonfunctioning adrenal tumors--comparison between open and laparoscopic surgery, and indication for operation].

Since 1977, we have operated on 18 nonfunctioning adrenal tumors. The pathological diagnosis included seven adrenocortical adenomas, three adrenocortical hypeplasias, three ganglioneuromas two adrenal cysts, two myelolipomas and one metastatic cancer. We successfully performed laparoscopic adrenalectomy in 11 of these patients and open surgery in the other 7 patients. In the patients undergoing laparoscopic adrenalectomy, post-operative recovery (fist oral intake, first ambulation, and total convalescence) was remarkably rapid. The indication of adrenalectomy for nonfunctioning adrenal tumors is controversial, but we can not exclude the possibility of malignancy even in small tumors. Therefore, because of the minimally invasive nature of laparoscopic surgery, the indications for operating on nonfunctioning adrenal tumors will be widened by introducing laparoscopic adrenalectomy.

Adrenal Gland Neoplasms↗
PubMed1994

[Living related kidney transplantation after removing the aneurysm of graft: a case report].

A case of living related renal transplantation using a kidney with renal arterial aneurysm is reported. The size of the renal arterial aneurysm was 15 mm in diameter. After ex vivo aneurysm removal, the graft was transplanted to the right iliac fossa. The total ischemic time was 79 minutes, and the urine flow started 5 minutes after declamping. In Japan, eight patients are reported to have successfully received a renal graft after removing its aneurysm extracorporeally. Renal transplantation is possible even when the donor kidney has a renal arterial aneurysm.

Adult↗
PubMed1993

[Results of combination chemotherapy with etoposide, ifosfamide, peplomycin for advanced prostatic cancer].

Between August, 1986 and August, 1992, 16 combination chemotherapies with etoposide (100 mg/body, day 1-5), ifosfamide (50 mg/kg, day 1, 3, 5), peplomycin (5 mg/body, day 1-5) were performed on 13 patients with endocrine therapy-relapsed advanced prostatic cancer. Seven trials were performed on 5 patients who received DESP (diethylstilbestrol diphosphate) (500 mg/body, day 1-5) with the chemotherapy. In 9 trials performed on 9 patients who did not receive DESP, there was no response case. In 7 trials with DESP, one trial had a partial response (PR) (14%) and 4 remained objectively stable (stable) (57%). As to adverse effects, myelosuppression was observed in all trials but there was no lethal toxicity. The one-year survival rate of these patients treated with the chemotherapy alone and combined DESP were both about 20%. Therefore we should find a more effective treatment for endocrine relapsed prostatic cancer.

Adenocarcinoma↗