89 results on '"Kobayashi H"'
Search Results
2. Fate of patent processus vaginalis: A case against routine contralateral exploration for unilateral inguinal hernia in children
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Kobayashi, H., primary
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- 1994
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3. Is it necessary to perform appendicectomy in the middle of the night in children?
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Kobayashi, H., primary
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- 1993
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4. Patchy distribution of rejection changes in small intestinal transplantation
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Yamataka, A., primary, Miyano, T., additional, Fukunaga, K., additional, Kobayashi, H., additional, Nozawa, M., additional, and Sasaki, K., additional
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- 1992
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5. Histology of the neobladder mucosa after sigmoidocolocystoplasty
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Miyano, T., Yamataka, A., Iwashita, K., Morioka, A., Lane, G.J., Kobayashi, H., and Okazaki, T.
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Purpose: The aim of this study was to examine the histopathology of neobladder mucosa biopsy specimens obtained routinely as part of postsigmoidocolocystoplasty (SCP) follow-up. Methods: One hundred cases of SCP (mean age at surgery, 10.6 years) performed by the authors were examined for the presence of dysplasia or malignant changes in the mucosa of the neobladder using H&E and proliferating cell nuclear antigen (PCNA) staining. Results: No dysplastic or malignant changes were identified in any case. Metaplasia was found in 5 cases and hyperplasia in 2. There were no major differences found on H&E and PCNA staining of specimens obtained after different periods of follow-up post-SCP; follow-up was short term (up to 5 years) in 44 cases, medium term (from 5 to 10 years) in 48 cases, and long term (over 10 years) in 8 cases. PCNA staining was significantly more intense in subjects who stopped regular bladder irrigations (Bl) post-SCP and in subjects in whom bladder stones developed (P < .05; Welch's t test), compared with subjects who continued Bl and subjects in whom bladder stones did not develop. Conclusions: After SCP, patients are advised to continue Bl. Regular biopsies should be part of routine follow-up, especially in subjects with bladder stones.
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- 2000
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6. Intraoperative pancreatoscopy for pancreatic duct stone debris distal to the common channel in choledochal cyst
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Yamataka, A., Segawa, O., Kobayashi, H., Kato, Y., and Miyano, T.
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Background/Purpose: Pancreatic duct stone debris is a recognised problem in patients with choledochal cyst (CC). The authors present the use of intraoperative pancreatoscopy (IP) in diagnosis and treatment of pancreatic duct stone debris distal to the common channel (distal PDSD). Methods: Sixty-seven patients with CC treated over the past 12 years were reviewed retrospectively. Distal PDSD was detected in 8 of these 67 cases (11.9%) using cholangiography. IP of the common channel or pancreatic duct at the time of surgery for CC was performed using a pediatric cystoscope in 7 of these 8 cases. Results: All 8 patients had a long common channel. All presented with acute pancreatitis. In 7 of these 8 patients, IP was efficient in detecting and for removing distal PDSD by irrigation: In the remaining case associated with annular pancreas, distal PDSD was identified in the proximal pancreatic duct and was removed directly after incision of the pancreatic duct. Postoperative pancreatitis occurred in only 1 case. All patients are well after a mean follow-up period of 7.3 years. Conclusion: Distal PDSD should not be ignored. IP allows direct examination of the pancreatic duct system and facilitates complete removal of distal PDSD, which may be the cause of relapsing pancreatitis or pancreatolithiasis after radical surgery for CC.
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- 2000
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7. Is intestinal neuronal dysplasia a disorder of the neuromuscular junction?
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Kobayashi, H., Hirakawa, H., and Puri, P.
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Intestinal neuronal dysplasia (IND) is a malformation of the enteric plexus and clinically resembles Hirschsprung's disease. The pathogenesis of IND is not known. There is no information available regarding the nature of the neuromuscular junction in this disease. The authors examined immunohistochemically full-thickness biopsy specimens from 14 patients (aged 3 weeks to 26 months) with IND and 10 age-matched controls, using monoclonal antibodies to growth associated protein-43 (GAP-43), synaptophysin, and neuralcell adhesion molecule (NCAM) as neuromuscular junction markers. In the normal bowel, GAP-43, synaptophysin, and NCAM immunoreactivity was abundant in the submucous and myenteric plexuses as well as in the muscularis mucosae and circular and longitudinal muscle layers. However, of the biopsy specimens from patients with IND, five had absence of GAP-43, synaptophysin, and NCAM immunoreactivity in muscularis mucosae and the circular and longitudinal muscle layers; five had no immunoreactivity in the longitudinal muscle; and four had no immunoreactivity in the muscularis mucosae. The submucous and myenteric plexuses of all patients with IND displayed strong immunoreactivity for GAP-43, synaptophysin, and NCAM. The findings demonstrate that patients with IND have defective innervation of the neuromuscular junction of the affected bowel.
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- 1996
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8. Serum basic fibroblast growth factor as a marker of reflux nephropathy
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KOBAYASHI, H
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- 2004
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9. Inflammatory changes secondary to postoperative complications of Hirschsprung's disease as a cause of histopathologic changes typical of intestinal neuronal dysplasia
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Kobayashi, H
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- 2004
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10. NADPH-diaphorase histochemistry: A reliable test for the intraoperative diagnosis of Hirschsprung's disease
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Kobayashi, H, Hirakawa, H, and Puri, P
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- 1996
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11. Mesenteric leiomyosarcoma in a 13-year-old boy.
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Iwasaki M, Kitaguchi K, and Kobayashi H
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- Adolescent, Humans, Male, Mesentery, Leiomyosarcoma surgery, Peritoneal Neoplasms surgery
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Mesenteric leiomyosarcoma occurs most commonly in middle-aged individuals. Primary tumors of the mesentery are uncommon in pediatric and adolescent patients, and primary mesenteric leiomyosarcoma is particularly rare. Accurate preoperative diagnosis of mesenteric soft tumor is generally difficult. We describe a case of leiomyosarcoma arising from the ileal mesentery in a 13-year-old boy. The diagnosis was based on histopathologic evaluation using immunohistochemical staining and gene analysis., (Copyright © 2010 Elsevier Inc. All rights reserved.)
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- 2010
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12. Umbilical cyst containing ectopic gastric mucosa originating from an omphalomesenteric duct remnant.
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Iwasaki M, Taira K, Kobayashi H, and Saiga T
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- Child, Choristoma pathology, Choristoma surgery, Female, Humans, Radiography, Abdominal, Radionuclide Imaging, Sodium Pertechnetate Tc 99m, Tomography, X-Ray Computed, Treatment Outcome, Ultrasonography, Umbilicus abnormalities, Umbilicus pathology, Umbilicus surgery, Urachal Cyst pathology, Urachal Cyst surgery, Vitelline Duct pathology, Vitelline Duct surgery, Choristoma diagnosis, Gastric Mucosa, Urachal Cyst diagnosis, Vitelline Duct abnormalities
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An umbilical cyst originating from an omphalomesenteric duct remnant is extremely rare, and to the best of our knowledge, it has scarcely been reported in medical literature. We present ultrasonographic manifestations and computed tomographic findings of an umbilical cyst originating from an omphalomesenteric duct remnant in a 6-year-old girl. In cases of umbilical cyst, radiographic evaluation alone may not differentiate an omphalomesenteric duct remnant with heterotopic gastric mucosa from a urachal remnant, and surgical intervention is required.
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- 2009
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13. Prognostic implications of bile lakes after surgery for biliary atresia.
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Inoue Y, Kato Y, Tamura T, Kobayashi H, Ichikawa S, Lane GJ, and Yamataka A
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- Bile Ducts pathology, Biliary Atresia diagnostic imaging, Biliary Atresia mortality, Cholangitis epidemiology, Female, Follow-Up Studies, Humans, Infant, Male, Postoperative Complications diagnostic imaging, Postoperative Complications epidemiology, Prognosis, Risk Factors, Survival Analysis, Treatment Outcome, Ultrasonography, Bile diagnostic imaging, Bile Ducts diagnostic imaging, Biliary Atresia surgery, Cholangitis etiology, Liver Transplantation, Portoenterostomy, Hepatic, Postoperative Complications etiology
- Abstract
Purpose: The aim of the study was to establish the natural history of bile lakes (BLs) in patients with postportoenterostomy biliary atresia (BA) and assess their prognostic implications, in particular, if they are a risk factor for cholangitis., Methods: One hundred twenty-one postsurgical BA patients were divided into 2 groups as follows: period 1, or preliver transplantation era group (n = 56), and period 2, or liver transplantation era group (n = 65). Presence of BL and outcome were examined in relation to the incidence of cholangitis., Results: In period 1, there were more multiple BLs (MBLs) in nonsurvivors than survivors. Non-BL survivors had significantly lower mean total number of episodes of cholangitis than MBL survivors (P < .01). In period 2, 58 survived (native liver in 35; transplanted liver in 23). Bile lakes were present in 9/58 (16%) survivors (single in five, multiple BLs in four), and 1/7 (14%) nonsurvivors had MBLs. Mean total number of episodes of cholangitis in the 4 MBL survivors and the 49 non-BL survivors were not significantly different., Conclusion: Our results suggest that presence of BL is a risk factor for cholangitis in the long-term but not in the short-term.
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- 2008
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14. The mechanism of intestinal motility in homozygous mutant Ncx/Hox11L.1-deficient mice--a model for intestinal neuronal dysplasia.
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Kobayashi H, Kusafuka J, Lane GJ, Yamataka A, Satoh K, Hayakawa T, Kase Y, and Hatano M
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- Acetylcholine pharmacology, Animals, Disease Models, Animal, Electric Stimulation, Female, Ganglia drug effects, Gastrointestinal Motility drug effects, Gastrointestinal Motility physiology, Hirschsprung Disease physiopathology, Homeodomain Proteins, Male, Mice, Mice, Inbred Strains, Mice, Neurologic Mutants, Muscle Contraction drug effects, Muscle Contraction physiology, Muscle, Smooth physiology, Random Allocation, Reference Values, Sensitivity and Specificity, Statistics, Nonparametric, Submucous Plexus physiology, Enteric Nervous System pathology, Gastrointestinal Motility genetics, Intestinal Diseases physiopathology, Muscle, Smooth innervation
- Abstract
Purpose: Homozygous mutant Ncx/Hox11L.1-deficient (Ncx-/-) mice develop mega-ileo-ceco-colon with a caliber change in the proximal colon. This study investigated the mechanism of intestinal motility in these mice., Method: Five-week-old male and female Ncx-/- mice with mega-ileo-ceco-colon (n = 8) were compared with age-matched male BDF1 mice used as controls (n = 8). All mice were sacrificed, and uniform-sized strips of jejunum, ileum, proximal colon, and distal colon were exposed to electrical field stimulation and pretreatment with atropine sulfate, guanethidine, or tetrodotoxin. Contractile responses were recorded and compared., Results: Longitudinal muscle from strips of jejunum and ileum from all mice (BDF1 and Ncx-/-) did not respond to electrical field stimulation, whereas ileal circular muscle contracted in BDF1 mice and contracted and relaxed in Ncx-/- mice. Pretreatment with atropine sulfate and guanethidine inhibited the responses of circular muscle of distal colon and ileum in BDF1 mice significantly (P < .05), but no effect was observed in Ncx-/- mice., Conclusion: In ileum, BDF1 mice have cholinergic and adrenergic dominant contraction patterns, whereas Ncx-/- mice have relaxation-dominant patterns because of nonadrenergic, noncholinergic nerves. Based on this, there would appear to be some kind of variation in the gastrointestinal nerve supply in Ncx-/- mice.
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- 2007
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15. A comparative study of laparoscopy-assisted pull-through and open pull-through for Hirschsprung's disease with special reference to postoperative fecal continence.
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Fujiwara N, Kaneyama K, Okazaki T, Lane GJ, Kato Y, Kobayashi H, and Yamataka A
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- Anastomosis, Surgical methods, Defecation physiology, Female, Follow-Up Studies, Hirschsprung Disease diagnosis, Humans, Infant, Male, Minimally Invasive Surgical Procedures methods, Pain, Postoperative physiopathology, Postoperative Complications diagnosis, Probability, Retrospective Studies, Risk Factors, Sensitivity and Specificity, Treatment Outcome, Colectomy methods, Fecal Incontinence prevention & control, Hirschsprung Disease surgery, Laparoscopy methods
- Abstract
Aim: The objective of this study is to compare laparoscopy-assisted pull-through (LPT) and open pull-through (OPT) for Hirschsprung's disease with special reference to postoperative fecal continence., Methods: Thirteen OPT patients (1991-1996) were reviewed retrospectively, and 22 LPT (1997-2002) were reviewed prospectively. A continence evaluation questionnaire (CEQ, max score = 10) assessing frequency of motions, severity of staining, severity of perianal erosions, anal shape, and requirement for medications was used. Severity of staining was graded as none = 2, occasional = 1.5, often = 1, always = 0.5, and soiling = 0, and severity of staining less than or equal to 1 was defined as moderate to severe incontinence. Presence of fever (peak and duration), raised white cell count (>10,000/microL), and C-reactive protein (>0.3 mg/dL) were used to assess surgical stress., Results: Pull-through was endorectal in all cases. Mean age at pull-through was not statistically different between the 2 groups. Annual CEQ scores for 7 years after LPT were 6.3, 6.9, 7.3, 7.7, 8.3, 8.9, and 9.0, and after OPT were 5.6, 6.4, 7.0, 7.5, 7.8, 8.3, and 8.4. Although CEQ scores were higher after LPT throughout, the difference was not statistically significant. The incidence of moderate to severe incontinence after 4 years was 54% (7/13) for OPT and 23% (5/22) for LPT, and after 6 years, it was 23% (3/13) for OPT and 0% for LPT. Duration/peak of raised C-reactive protein and duration of fever were significantly less for LPT (P < .01)., Conclusion: Our results suggest that LPT is less invasive and may provide better postoperative bowel management compared with OPT.
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- 2007
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16. The effectiveness of ureteric reimplantation during bladder augmentation for high-grade vesicoureteric reflux in patients with neurogenic bladder: long-term outcome.
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Hayashi Y, Kato Y, Okazaki T, Lane GJ, Kobayashi H, and Yamataka A
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- Adolescent, Child, Child, Preschool, Cystoscopy methods, Female, Follow-Up Studies, Humans, Male, Replantation methods, Retrospective Studies, Risk Assessment, Severity of Illness Index, Time Factors, Treatment Outcome, Urinary Bladder surgery, Urinary Bladder, Neurogenic complications, Urinary Bladder, Neurogenic diagnosis, Urodynamics, Vesico-Ureteral Reflux complications, Vesico-Ureteral Reflux diagnosis, Plastic Surgery Procedures methods, Ureter surgery, Urinary Bladder, Neurogenic surgery, Urinary Diversion methods, Vesico-Ureteral Reflux surgery
- Abstract
Purpose: The outcome of ureteric reimplantation (UR) during bladder augmentation (BA) for high-grade vesicoureteric reflux (HVUR) in patients with neurogenic bladder was assessed to determine the effectiveness of UR. A literature review of HVUR and BA was also performed., Methods: Twenty-two consecutive sigmoidocolocystoplasty patients were reviewed retrospectively; 10 had unilateral HVUR only, 3 had bilateral HVUR, and 9 had unilateral HVUR associated with low-grade VUR in the contralateral renal unit (RU). Preoperatively, VUR was grade V in 3 RU, grade IV in 22 RU, grade III in 5 RU, and grade II in 4 RU. Ureteric reimplantation was performed in the native bladder in 24 RU (16 patients) and in the colon cap in 10 RU (6 patients)., Results: Mean age at sigmoidocolocystoplasty/UR was 8.5 years (range, 2-15 years). Mean follow-up was 12.8 years (range, 2-22 years). Postoperatively, cystourethrography showed residual VUR (grade IV to grade III) in only 1 RU (3%); diethylenetriamine pentaacetic acid scintigraphy showed no obstruction in all RU; (99m)Tc-dimercaptosuccinic acid was improved in 13 RU, unchanged in 18 RU, and worsened in 3 RU; and serum creatinine remained normal in 20 patients and worsened in 2. Urinary tract infection, universal preoperatively, was seen postoperatively in only 2 patients. In the literature, 0% to 16.7% of HVUR persisted after BA alone, and no long-term data were available., Conclusions: Ureteric reimplantation during BA is safe and effective for treating HVUR in patients with neurogenic bladder.
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- 2007
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17. Maternal microchimerism in biliary atresia.
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Kobayashi H, Tamatani T, Tamura T, Kusafuka J, Yamataka A, Lane GJ, Kawasaki S, Ishizaki Y, Mizuta K, Kawarasaki H, and Gittes GK
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- Adult, Alagille Syndrome genetics, Autoimmune Diseases embryology, Autoimmune Diseases etiology, Autoimmune Diseases genetics, Autoimmune Diseases immunology, Autoimmunity, Bile Ducts immunology, Bile Ducts pathology, Biliary Atresia embryology, Biliary Atresia etiology, Biliary Atresia genetics, Biliary Atresia immunology, Biliary Atresia surgery, Diagnosis, Differential, Epithelial Cells immunology, Epithelial Cells pathology, Female, Graft vs Host Disease diagnosis, HLA Antigens immunology, Hepatocytes immunology, Hepatocytes pathology, Humans, In Situ Hybridization, Fluorescence, Infant, Newborn, Isoantibodies analysis, Male, Portoenterostomy, Hepatic, Pregnancy, Sex Factors, Syndrome, Autoimmune Diseases pathology, Biliary Atresia pathology, Chimerism, Liver pathology, Maternal-Fetal Exchange
- Abstract
Background: The aim of this study was to determine the existence and extent of maternal microchimerism in the livers of biliary atresia (BA) patients., Methods: Two series of investigations were performed based on the sex of our subjects. Subjects for series I were men, of which 6 had BA. Livers were analyzed using X and Y chromosome probes and fluorescent in situ hybridization. Subjects for series II were woman. Nine BA cases and their mothers were HLA typed (class I). Daughter livers were also tested for antibodies to maternal and other HLA. Two cases of neonatal hepatitis, 2 cases of Alagille syndrome, and 1 case of Byler syndrome acted as controls., Results: All male BA livers were found to contain a mixture of cells with 1 and 2 X chromosomes (ie, XY or XX). All livers from male controls had only 1 X chromosome (ie, XY). All female BA subjects had varying intensities of antimaternal HLA class I (HLA-A) antibodies in their bile duct epithelium and hepatocytes (strong, 5; mild, 3; weak, 1). The liver from the female control did not display any antimaternal HLA class I antibodies (HLA-Ab)., Conclusion: Our preliminary data appear to show that maternal microchimerism is present within the livers of patients with progressive postnatal type BA. We suggest that BA could in fact be a graft-vs-host disease masquerading as an autoimmune reaction triggered by maternal microchimerism, and we intend to pursue this hypothesis further to clarify the etiology of BA.
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- 2007
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18. Prospective study of antibiotic protocols for managing surgical site infections in children.
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Ichikawa S, Ishihara M, Okazaki T, Warabi K, Kato Y, Hori S, Lane GJ, Hiramatsu K, Inada E, Kobayashi H, and Yamataka A
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- Adolescent, Age Factors, Anti-Bacterial Agents administration & dosage, Child, Child, Preschool, Clinical Protocols, Drug Administration Schedule, Drug Evaluation, Drug Therapy, Combination, Elective Surgical Procedures, Emergencies, Female, Hospitals, University statistics & numerical data, Humans, Incidence, Infant, Infant, Newborn, Intraoperative Care, Male, Premedication, Prospective Studies, Retrospective Studies, Surgical Wound Infection epidemiology, Surgical Wound Infection prevention & control, Tokyo epidemiology, Anti-Bacterial Agents therapeutic use, Surgical Wound Infection drug therapy
- Abstract
Purpose: We adopted antibiotic (Ab) protocols for managing surgical site infections in children and assessed their effectiveness., Methods: We used our protocols on 1313 children between 2004 and 2005. All wounds were monitored for 30 days and classified as clean, clean-contaminated, contaminated, or dirty-infected. Infections were defined as superficial, deep, or organ/space. A retrospective study involving 721 children who had surgery in 2003 was also performed. Chi2 statistical analysis was performed., Results: Postprotocol, all Abs were administered accurately by anesthesiologists and infections developed in only 22 cases (1.7%): 0.2% (clean), 2.6% (clean-contaminated), 5.8% (contaminated), and 20.8% (dirty-infected), respectively; 21 were superficial or deep and 1 was organ/space. Age at surgery and sex did not influence incidence, neither did length of surgery for clean-contaminated, contaminated, and dirty-infected wounds; clean wounds were excluded because all surgery was minor. Overall, incidence of infections was 1.2% for elective surgery and 4.5% for emergency surgery (P < .01). Preprotocol, only 67% had Ab and infections developed in 27 cases (3.7%), which is significantly higher than in postprotocol (P < .01)., Conclusions: Accurate administration of Ab and careful supervision by an infection control team appear to be effective for preventing wound infections in children.
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- 2007
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19. Treatment of lymphangioma in children: our experience of 128 cases.
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Okazaki T, Iwatani S, Yanai T, Kobayashi H, Kato Y, Marusasa T, Lane GJ, and Yamataka A
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- Child, Preschool, Cohort Studies, Female, Follow-Up Studies, Head and Neck Neoplasms diagnosis, Head and Neck Neoplasms mortality, Head and Neck Neoplasms therapy, Humans, Infant, Lymphangioma diagnosis, Lymphangioma mortality, Male, Mediastinal Neoplasms diagnosis, Mediastinal Neoplasms mortality, Mediastinal Neoplasms therapy, Probability, Retrospective Studies, Risk Assessment, Sclerosing Solutions therapeutic use, Survival Rate, Treatment Outcome, Lymphangioma therapy, Picibanil therapeutic use, Sclerotherapy methods, Surgical Procedures, Operative methods
- Abstract
Purpose: The aim of this study is to investigate the optimal treatment for lymphangioma in children by analyzing the effectiveness and complications of treatment modalities., Methods: We reviewed 128 patients with lymphangioma treated at our institution between 1979 and 2005. Periods of treatment were divided arbitrarily into 2 groups: period I, from 1979 to 1988 (n = 53); and period II, from 1989 to 2005 (n = 75). According to radiological appearance, patients were grouped into 4 types: single cystic (SI; n = 23), macrocystic (MA; n = 11), microcystic (MI; n = 69), and cavernous (CA; n = 25)., Results: Sclerotherapy as primary treatment was performed in only 2 patients (3.8%) in period I using bleomycin but increased significantly in period II to 48 patients (64.0%) using OK-432 (P < .01). Nevertheless, primary surgical excision (69/78 patients, 88.5%) was significantly more successful than sclerotherapy (32/50, 64.0%) (P < .01). The following are the locations and types of lesions: head/neck (n = 69; SI, 11; MA, 5; MI, 42; CA, 11), trunk (n = 34; SI, 6; MA, 6; MI, 15; CA, 7), and extremities/other (n = 25; SI, 6; MI, 12; CA, 7). The effectiveness of sclerotherapy in SI, MA, MI, and CA types was 90.9%, 100%, 68.0%, and 10.0%, respectively. Seventeen patients (SI, 1; MI, 8; CA, 8) who received primary sclerotherapy required surgical excision with good outcome. Complications after primary surgical excision were more serious compared with sclerotherapy., Conclusion: Sclerotherapy with OK-432 was not as effective as reported in the literature. We recommend OK-432 injection therapy alone for SI and MA types and surgical excision after pretreatment with OK-432 for MI and CA types.
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- 2007
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20. Laparoscopy-assisted transanal pull-through at the time of suction rectal biopsy: a new approach to treating selected cases of Hirschsprung disease.
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Yamataka A, Kobayashi H, Hirai S, Koga H, Miyano G, Lane GJ, and Okazaki T
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- Acetylcholinesterase, Biopsy, Colectomy, Hirschsprung Disease pathology, Humans, Infant, Infant, Newborn, Laparoscopy, Staining and Labeling, Hirschsprung Disease surgery, Rectum pathology
- Abstract
Aim: We present a new approach to treating selected cases of Hirschsprung disease (HD) where suction rectal biopsy (SRBx) is performed in an operating room, and rapid acetylcholinesterase staining (RAST) is used to identify histopathology within 20 minutes, allowing primary laparoscopy-assisted transanal pull-through (PLTPT) to be commenced "immediately" (n = 7)., Materials and Methods: All subjects had an obvious caliber change in the rectum/sigmoid colon on barium enema and were strongly suspected of having HD., Results: Rapid acetylcholinesterase staining clearly demonstrated acetylcholinesterase-positive hypertrophic nerve trunks and absence of ganglion cells in all SRBx specimens, indicating that all 7 patients had HD. All 7 proceeded to uneventful PLTPT. By taking this approach, SRBx results were available extremely quickly, and hospital stay was reduced by 2 to 4 days., Discussion: Our approach enhanced the treatment of selected cases of HD by proceeding immediately to PLTPT after SRBx specimens were examined using RAST.
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- 2006
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21. The role of monocyte chemoattractant protein-1 in biliary atresia.
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Kobayashi H, Tamatani T, Tamura T, Kusafuka J, Koga H, Yamataka A, Lane GJ, Miyahara K, Sueyoshi N, and Miyano T
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- Adolescent, Biliary Atresia blood, Biliary Atresia complications, Child, Child, Preschool, Collagen Type IV blood, Digestive System Surgical Procedures, Disease Progression, Humans, Hypertension, Portal etiology, Hypertension, Portal physiopathology, Liver Cirrhosis etiology, Treatment Outcome, Biliary Atresia physiopathology, Chemokine CCL2 blood, Liver Cirrhosis physiopathology
- Abstract
Background: The aim of this study was to explain the role of monocyte chemoattractant protein-1 (MCP-1) in biliary atresia (BA)., Methods: Concentrations of serum MCP-1 and collagen type IV were measured in 38 patients with BA by using commercially available kits. MCP-1 was also assessed in liver biopsy specimens by using immunohistochemistry. Subjects were classified into groups. Group 1 comprised BA patients with normal liver function (n = 13), group II comprised BA patients with moderate liver dysfunction (n = 18), group III comprised BA patients older than 20 years awaiting liver transplantation (n = 7), and the control group comprised age-matched patients without evidence of liver disease (n = 23)., Results: Serum MCP-1 levels were significantly increased in group II compared with group I (P < .0001) and the control group (P < .0001). Serum MCP-1 levels in group III were lower than in the control group (P < .0001). There was a significant linear correlation between serum MCP-1 levels and type IV collagen levels in group II. Group II subjects with portal hypertension (PH) had higher MCP-1 levels than those without PH (P = .0009). Biopsy specimens showed MCP-1 was expressed mainly on biliary epithelial cells, vascular endothelial cells, and hepatocytes in group II., Conclusions: These findings suggest that MCP-1 probably plays a significant role in the development of progressive liver fibrosis in BA.
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- 2006
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22. Carbon dioxide pneumoperitoneum prevents intraperitoneal adhesions after laparotomy in rats.
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Miyano G, Yamataka A, Doi T, Okawada M, Takano Y, Kobayashi H, Lane GJ, and Miyano T
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- Animals, Male, Rats, Rats, Inbred Lew, Tissue Adhesions etiology, Tissue Adhesions prevention & control, Carbon Dioxide, Laparotomy adverse effects, Peritoneal Diseases etiology, Peritoneal Diseases prevention & control, Pneumoperitoneum, Artificial methods
- Abstract
Purpose: The aim of this study was to assess whether carbon dioxide insufflation (CDI) pneumoperitoneum prevents intraperitoneal adhesions (IPAs)., Methods: Laparotomy was performed in 40 8-week-old Lewis rats and their bowels delivered through the wound and manipulated. The rats were divided into 4 groups, namely, those that would have laparotomy (Lp group, n = 15), Lp with CDI (Lp-CDI group, n = 15), Lp and bowel anastomosis (LpBA group, n = 5), and LpBA with CDI (LpBA-CDI group, n = 5). LpBA and LpBA-CDI group rats had 1 cm of ileum excised and end-to-end anastomosis performed. To accelerate IPA formation, all rats then had their bowels heated to 45 degrees C for 40 seconds and 0.5 mL of Lewis rat blood spilled over them. Rats in the control group (n = 5) had Lp alone without heating or blood spillage. Pneumoperitoneum involved insufflating carbon dioxide into the peritoneal cavity through a cannula at the time of final abdominal closure to create pneumoperitoneum to a pressure of 5 mm Hg. All rats had relaparotomy 10 days after surgery and IPAs were assessed blindly using an IPA severity score (IPASS: 0 = no adhesions, 1 = no serosal tears during adhesiolysis, 2 = serosal tears during adhesiolysis, 3 = bowel perforation during adhesiolysis). Only the worst IPA in each rat was scored. Rats were killed after the peritoneum and bowels were excised for histopathology., Results: Pneumoperitoneum resolved in approximately 5 days. There were no associated side effects. The Lp-CDI group had significantly lower IPASS than the Lp group (0.23 +/- 0.46 vs 1.07 +/- 1.18, P < .05), and the LpBA-CDI group had significantly lower IPASS than the LpBA group (1.50 +/- 0.61 vs 2.40 +/- 0.55, P < .05). Histopathology showed pneumoperitoneum had no effect on the peritoneum or bowels., Conclusions: Our results suggest that CDI pneumoperitoneum appears to prevent IPA, especially between bowel-bowel IPA.
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- 2006
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23. Innovative modification of the hepatic portoenterostomy. Our experience of treating biliary atresia.
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Kobayashi H, Yamataka A, Urao M, Okazaki T, Yanai T, Koga H, Lane GJ, and Miyano T
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- Female, Humans, Infant, Male, Biliary Atresia surgery, Portoenterostomy, Hepatic methods
- Abstract
We modified conventional hepatic portoenterostomy by pulling the remnant fibrous mass caudally and placing 5 or 6 numbered and individually clamped absorbable 5-0 double-needle sutures horizontally in the liver surface of the posterior side of the remnant fibrous mass before excision and apposing the posterior and anterior margins of the hepatic portoenterostomy to resemble a flattened isosceles triangle. Our technique was used to treat 14 cases of biliary atresia. Good postoperative biliary excretion (serum total bilirubin, <2 mg/dL) was achieved in 13 (92.9%) of 14 patients.
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- 2006
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24. Basic fibroblast growth factor and granulocyte colony-stimulating factor enhance mucosal surface expansion after adult small bowel transplantation without vascular reconstruction in rats.
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Lee KD, Yamataka A, Kato Y, Kojima Y, Sueyoshi N, Lane GJ, Kobayashi H, and Miyano T
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- Age Factors, Animals, Rats, Rats, Inbred Lew, Fibroblast Growth Factor 2 physiology, Granulocyte Colony-Stimulating Factor physiology, Intestinal Mucosa physiology, Intestine, Small transplantation
- Abstract
Aim: We showed previously that adult small bowel could be transplanted successfully in rats without vascular reconstruction by removing the graft serosa. In this study, we assessed if granulocyte colony-stimulating factor (G-CSF) or basic fibroblast growth factor (bFGF) could improve graft survival in the same rat model., Method: A 10-mm-long adult small bowel graft from an adult 12-week-old Lewis rat was transplanted into a pouch created in the omentum of a 5-week-old Lewis rat (syngeneic bowel transplantation [SBTx], n = 49). Graft serosa was removed just before SBTx in the serosectomy group (n = 29) and left intact in the nonserosectomy group (n = 20). Each group was divided into 3 subgroups (sG): sG-1 had no G-CSF or bFGF; sG-2 had daily subcutaneous injections of G-CSF; and sG-3 had continuous infusion of bFGF around the graft in the omentum. All grafts were harvested 14 days after SBTx and studied histologically. A mucosal surface expansion score (MSES) was used where 0 = no mucosa on the graft, 1 = mucosa on one fourth of the graft, 2 = mucosa on one half of the graft, 3 = mucosa on three fourths of the graft, and 4 = mucosa on the whole graft. The density of CD34-positive capillaries per 1000 nuclei was also measured., Results: Serosectomy group MSES were significantly higher than nonserosectomy group MSES indicating that grafts survived (P < .0001). CD34-positive capillaries in serosectomy group subgroups for mucosa were 103.9 +/- 34.2, 130.2 +/- 52.0, and 132.3 +/- 37.7, respectively; for muscle, 74.4 +/- 38.0, 86.2 +/- 32.9, and 82.4 +/- 30.3, respectively; and for omentum, 73.8 +/- 30.1, 151.3 +/- 60.3, and 140.0 +/- 49.0, respectively. Mucosal surface expansion score and overall CD34-positive capillaries for sG-2 and sG-3 were significantly higher than for sG-1 (both, P < .05)., Conclusion: Our results suggest that G-CSF and bFGF enhance angiogenesis and mucosal surface expansion.
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- 2006
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25. Graft serosectomy in adult small bowel transplantation without vascular reconstruction in rats improves graft survival by induction of vascular endothelial growth factor.
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Lee KD, Yamataka A, Kato Y, Kobayashi H, Lane GJ, Maeda K, Kojima Y, Sueyoshi N, and Miyano T
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- Animals, Graft Rejection, Immunohistochemistry, Intestinal Mucosa chemistry, Intestinal Mucosa growth & development, Intestine, Small blood supply, Neovascularization, Physiologic, Polymerase Chain Reaction, RNA, Messenger, Rats, Vascular Endothelial Growth Factor A analysis, Graft Survival, Intestine, Small transplantation, Serous Membrane surgery, Vascular Endothelial Growth Factor A genetics
- Abstract
Purpose: The aim of this study was to assess whether adult small bowel grafts (ASBGs) can survive transplantation without vascular reconstruction if graft serosectomy (SS) is performed., Methods: Syngeneic ASBG transplants were performed in 85 Lewis rats. The entire serosa was removed just before transplantation in the SS group (n = 50) and left intact in the nonserosectomy group (n = 35). Transplanted ASBG was harvested 1, 3, 5, 7, 14, 21, or 28 days after transplantation and studied using staining with hematoxylin-eosin, immunohistochemistry for protein gene product 9.5, S-100, CD34 and vascular endothelial growth factor (VEGF), and quantification of VEGF messenger RNA (mRNA). Adult small bowel graft viability was assessed blindly using a mucosal surface expansion score (0, no mucosa; 1, mucosa on one fourth of graft; 2, mucosa on one half of graft; 3, mucosa on three fourths of graft; and 4, circumferential mucosa on graft)., Results: No rejection was identified in any ASBG. Average mucosal surface expansion score and VEGF mRNA expression were significantly higher in the SS group (both P < .01). Vascular endothelial growth factor protein was detected in enterocytes from day 3 posttransplant in the SS group. Distribution of protein gene product 9.5 and S-100 was normal in SS-group ASBG., Conclusions: Our results suggest that SS allows VEGF mRNA and, subsequently, VEGF protein in ASBG to be induced very soon after transplantation, which may contribute to the survival of ASBG transplanted without vascular reconstruction.
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- 2005
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26. Is serum prolyl 4-hydroxylase useful as noninvasive marker of liver fibrosis in patients with biliary atresia?
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Kobayashi H, Tamura T, Yamataka A, Lane GJ, and Miyano T
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- Biliary Atresia complications, Biomarkers blood, Case-Control Studies, Child, Collagen Type IV metabolism, Humans, Liver Cirrhosis blood, Liver Cirrhosis etiology, Liver Function Tests, Procollagen-Proline Dioxygenase metabolism, Prognosis, Biliary Atresia blood, Liver Cirrhosis enzymology, Procollagen-Proline Dioxygenase blood
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- 2005
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27. Bladder stone formation after sigmoidocolocystoplasty: statistical analysis of risk factors.
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Zhang H, Yamataka A, Koga H, Kobayashi H, Lane GJ, and Miyano T
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- Adolescent, Adult, Child, Child, Preschool, Female, Humans, Male, Middle Aged, Risk Factors, Surgical Flaps, Urinary Catheterization, Urinary Retention therapy, Urologic Surgical Procedures, Colon, Sigmoid surgery, Postoperative Complications, Urinary Bladder surgery, Urinary Bladder Calculi etiology, Urinary Retention complications
- Abstract
Purpose: Bladder stone formation (BSF) after sigmoidocolocystoplasty (SCP) is a major source of morbidity. The authors identify risk factors and analyze them statistically., Methods: Medical records of 106 patients who had SCP at our institute were reviewed to examine the incidence of post-SCP BSF, the stone removal method and length of follow-up. The primary underlying pathological conditions were myelomeningocele in 103 patients and other conditions in 3. Risk factors for BSF were statistically assessed by comparing cases with and without BSF., Results: Bladder stone formation occurred in 20 (18.9%) of 106 patients (BSF group). The remaining 86 did not have stones (NBSF group). Mean age at SCP was 11.7 years in the BSF group and 10.2 years in the NBSF group. Mean follow-up was 12.0 years in the BSF group and 11.0 years in the NBSF group. BSF developed after a mean of 30.3 +/- 25.6 months after SCP. Twenty-two stone removal procedures were performed in the BSF group and spontaneous evacuation occurred in 4 instances. Once stone free, BSF recurred in 4 patients. Although differences between the 2 groups with respect to sex, age at SCP, follow-up period, bladder capacity, bladder compliance, incidence of gram-negative bacteriuria, incidence of gram-positive coccus bacteriuria, electrolytes, frequency of urinary catheterization, post-SCP incidence of vesicoureteric reflux, and incidence of ureteric reimplantation were not statistically significant, differences in the incidence of spontaneous micturition, bladder neck tightening procedures, or gram-positive bacillus bacteriuria, or frequency of bladder irrigation were all statistically significant (P < .05 in all, Fisher's Exact test)., Conclusions: The authors are the first to statistically analyze a wide range of varying risk factors for BSF. BSF would appear to be common after SCP.
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- 2005
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28. Optimum prednisolone usage in patients with biliary atresia postportoenterostomy.
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Kobayashi H, Yamataka A, Koga H, Okazaki T, Tamura T, Urao M, Yanai T, Lane GJ, and Miyano T
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- Biliary Atresia complications, Bilirubin blood, Cholangitis blood, Cholangitis etiology, Clinical Protocols, Feces, Female, Humans, Infant, Injections, Intravenous, Jaundice blood, Jaundice drug therapy, Male, Postoperative Care, Anti-Inflammatory Agents administration & dosage, Biliary Atresia surgery, Cholangitis drug therapy, Portoenterostomy, Hepatic, Prednisolone administration & dosage
- Abstract
Purpose: Prednisolone is used routinely after portoenterostomy (PE) in patients with biliary atresia (BA). The authors reviewed their patients with BA post-PE to assess prednisolone protocols., Method: Severity of fibrosis at PE (moderate or severe), age at PE (30-70 days), size of bile ductules in the fibrotic biliary remnant at the porta hepatis (>100 microm), and type of BA (uncorrectable type) were used as criteria for selecting 63 subjects from our patients with BA post-PE. Subjects were divided into 5 groups according to prednisolone dosage: group 1, no prednisolone; groups 2 to 4, single courses of intravenous prednisolone commencing on day 7 post-PE administered in decreasing dose for 3 days each as follows: group 2, 6, 4, and 2 mg; group 3, 10, 5, and 2.5 mg; group 4, 20, 15, 10, 5, and 2.5 mg; group 5, same as group 4, but stool color was used to monitor bile excretion and a course was restarted from 20 mg whenever stools began to turn pale. If necessary, single courses were repeated until serum total bilirubin was less than 2.0 mg/dL. Protocol efficacy was assessed by comparing the number of patients who became jaundice free, the period taken to become jaundice free, and the incidence of side effects related to prednisolone., Results: The number of patients who became jaundice free in the no prednisolone group (group 1, 7/12 or 58.3%) was not significantly different from the number in the single-course groups (group 2, 8/12 or 66.6%; group 3, 10/13 or 76.9%; and group 4, 11/15 or 73.3%). The number in the stool-monitored group (group 5, 10/11 or 90.9%) was significantly greater (P < .05). The mean period taken to become jaundice free in group 1 (82.6 +/- 29.1 days) was not significantly different from the single-course groups (group 2, 74.5 +/- 29.3 days; group 3, 49.6 +/- 19.8 days; and group 4, 48.3 +/- 26.0 days). The mean period taken in the stool-monitored group (group 5, 33.3 +/- 6.4 days) was significantly shorter (P < .05). The number of subjects who developed cholangitis after becoming jaundice free was not significantly different (group 1, 2/7; group 2, 2/8; group 3, 2/10; group 4, 2/11; group 5, 2/10). There were no prednisolone-related complications identified in any subject., Conclusions: These results provide strong evidence that large-dose prednisolone therapy with stool color monitoring of bile flow has a positive impact on the time taken for patients with BA post-PE to become jaundice free and the number of patients who remain jaundice free.
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- 2005
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29. Laparoscopy-assisted surgery for prenatally diagnosed small bowel atresia: simple, safe, and virtually scar free.
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Yamataka A, Koga H, Shimotakahara A, Urao M, Yanai T, Kobayashi H, Lane GJ, and Miyano T
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- Cicatrix prevention & control, Female, Fetal Diseases diagnosis, Humans, Infant, Newborn, Intestinal Atresia diagnosis, Male, Pregnancy, Prenatal Diagnosis, Intestinal Atresia surgery, Intestine, Small abnormalities, Intestine, Small surgery, Laparoscopy
- Abstract
Purpose: The aim of this study was to describe a new technique for the surgical management of prenatally diagnosed small bowel atresia., Methods: Under general anesthesia, a 5-mm trocar was inserted using an open technique through an intraumbilical incision. The proximal atretic bowel end was identified using laparoscopy and mobilized toward the umbilicus using an additional 3-mm trocar inserted in the left lower quadrant. The umbilical trocar then was removed, and a ring retractor was inserted into the trocar site and used to expand the wound to deliver both atretic bowel ends. The bowel was repaired and returned to the abdomen through the umbilical wound. The umbilical fascia and skin were closed conventionally., Results: Three patients were reviewed. Two had minimal abdominal distension, and the atretic bowel ends could be identified easily; laparoscopy-assisted surgery was successful. The third case had significant dilatation, and laparotomy was required. Postoperatively, there was minimal abdominal scarring, and the umbilicus was normal in appearance., Conclusions: Although this experience is limited to 3 patients, this technique is simple, safe, and virtually scar free and can be applied for the treatment of neonates with prenatally diagnosed small bowel atresia, especially if there is minimal abdominal distension at birth.
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- 2004
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30. Giant, highly vascular sacrococcygeal teratoma: report of its excision using the ligasure vessel sealing system.
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Kaneyama K, Yamataka A, Kobayashi H, Lane GJ, Itoh S, Kinoshita K, and Miyano T
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- Humans, Infant, Newborn, Male, Sacrococcygeal Region, Teratoma blood supply, Hemostatic Techniques, Teratoma pathology, Teratoma surgery
- Abstract
Reports about giant, highly vascular sacrococcygeal teratoma (GHV-SCT) are uncommon. A boy with a prenatally diagnosed GHV-SCT was born at 34 weeks' gestation weighing 3,716 g. At birth, the GHV-SCT was 20 x 17 x 14 cm. After initial devascularization using an aortic snare, excision of the GHV-SCT was started using monopolar diathermy, but hemorrhage from cutaneous collateral vessels was difficult to control, and individual ligation of vessels was extremely time consuming. The authors then used the LigaSure (LS) vessel sealing system (Valleylab, Boulder, CO) to control intraoperative hemorrhage. Hemostasis was achieved easily with LS, without any need for vessel ligation; the operative field was dry and the efficiency of excision enhanced. Total operating time was 255 minutes, but excision of the GHV-SCT itself took only 16 minutes. The GHV-SCT weighed 1,208 g or 325.1 g/kg body weight. Total blood loss was 77 mL or 20.7 mL/kg body weight, which was minimal compared with other cases in the literature. At the last follow-up examination, 7 months after surgery, he remains well with no evidence of recurrence. LS was extremely useful for controlling intraoperative hemorrhage in this case, and we strongly recommend its selective use for excising highly vascular SCT.
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- 2004
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31. Laparoscopic injection of dermabond tissue adhesive for the repair of inguinal hernia: short- and long-term follow-up.
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Miyano G, Yamataka A, Kato Y, Tei E, Lane GJ, Kobayashi H, Sueyoshi N, and Miyano T
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- Animals, Follow-Up Studies, Injections methods, Male, Rats, Rats, Inbred Lew, Time Factors, Cyanoacrylates administration & dosage, Hernia, Inguinal therapy, Laparoscopy, Tissue Adhesives administration & dosage
- Abstract
Purpose: Is laparoscopic injection of 2-octyl-cyanoacrylate tissue adhesive (Dermabond: Db) into the inguinal hernia sac (IHS) effective for inguinal hernia repair?, Methods: Thirty male 4-week-old Lewis rats were used as subjects for this study. In the right Db (R-Db) group (n = 10), a fine catheter was passed through an 18-guage indwelling intravenous cannula inserted in the right lower quadrant, and 0.2 mL Db was injected into the right IHS under laparoscopic control. The left side was not treated. Both IHSs were treated in the bilateral Db (B-Db) group (n = 10). In the no Db (N-Db or control) group (n = 10), only laparoscope insertion was performed. Herniography was performed before death. B-Db and N-Db rats were mated 50 days after treatment. Half of all rats were killed 2 months after treatment and the remaining half 12 months after treatment., Results: All rats survived until killing. Macroscopic findings postdeath confirmed herniography results; treated IHS were closed, and untreated IHS were patent. There were minor adhesions in 3 of 20 treated rats. Sperm were identified in the vaginas of all mated rats., Conclusions: These results suggest that our new technique is simple, safe, and reliable as an alternative to standard operative repair for inguinal hernia.
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- 2004
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32. Acetylcholine-related bowel dysmotility in homozygous mutant NCX/HOX11L.1-deficient (NCX-/-) mice-evidence that acetylcholine is implicated in causing intestinal neuronal dysplasia.
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Yanai T, Kobayashi H, Yamataka A, Lane GJ, Miyano T, Hayakawa T, Satoh K, Kase Y, and Hatano M
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- Acetylcholine pharmacology, Animals, Barium Compounds pharmacology, Chlorides pharmacology, Colon drug effects, Dose-Response Relationship, Drug, Ganglia, Autonomic abnormalities, Ganglia, Autonomic pathology, Gastrointestinal Motility drug effects, Genes, Homeobox, Hirschsprung Disease genetics, Hirschsprung Disease pathology, Hirschsprung Disease physiopathology, Histamine pharmacology, Homeodomain Proteins genetics, Ileal Diseases congenital, Ileal Diseases etiology, Ileal Diseases genetics, Ileal Diseases pathology, Ileal Diseases physiopathology, Ileum drug effects, Jejunum drug effects, Mice, Mice, Inbred C57BL, Mice, Inbred DBA, Mice, Knockout, Muscle Contraction drug effects, Muscle, Smooth physiopathology, Serotonin pharmacology, Submucous Plexus pathology, Acetylcholine physiology, Gastrointestinal Motility physiology, Hirschsprung Disease etiology, Homeodomain Proteins physiology, Muscle, Smooth drug effects, Neurons pathology, Submucous Plexus abnormalities
- Abstract
Background/purpose: Homozygous mutant Ncx/Hox11L.1-deficient (Ncx-/-) mice develop mega-ileo-ceco-colon (mega-ICC) with a caliber change in the proximal colon. The authors investigated the mechanism of intestinal dysmotility in these mice., Methods: Five-week-old Ncx-/- mice with mega ICC were compared with age-matched BDF1 control mice. Jejunum, ileum, and colon were excised from all mice and 1.0-cm-long strips of each organ, each with a resting tension of 0.5g, were suspended in an organ bath filled with Tyrode's solution at 37 degrees C and bubbled with a mixture of 95% oxygen and 5% carbon dioxide. Contractile responses to acetylcholine chloride (ACh), histamine, serotonin, and barium chloride (BaCl2) were recorded isometrically., Results: For ACh, Ncx-/- mice had decreased distal colon circular muscle contraction only at lower doses and decreased distal colon longitudinal muscle contraction for all doses compared with controls (P <.05 or P <.01). In the proximal colon, Ncx-/- mice had increased circular muscle contraction only at higher doses and decreased longitudinal muscle contraction only at lower doses compared with controls (P <.01 or P <.05). ACh did not affect jejunum, and there were no significant effects on ileum. There was no response to histamine and serotonin by any part of the bowel, and the response to BaCl2 was the same for both Ncx-/- mice and controls., Conclusions: Only ACh differentially affected muscle contraction in Ncx-/- mice in the proximal and distal colon. Thus, ACh is implicated in causing the bowel dysmotility seen in Ncx-/- mice and human IND.
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- 2004
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33. Recommendations for preventing complications related to Roux-en-Y hepatico-jejunostomy performed during excision of choledochal cyst in children.
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Yamataka A, Kobayashi H, Shimotakahara A, Okada Y, Yanai T, Lane GJ, Urao M, and Miyano T
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- Adolescent, Child, Child, Preschool, Humans, Infant, Retrospective Studies, Anastomosis, Roux-en-Y, Choledochal Cyst surgery, Jejunostomy, Liver surgery, Postoperative Complications prevention & control
- Abstract
Purpose: The aim of this study was to review the outcome of a protocol the authors proposed for preventing Roux-en-Y hepatico-jejunostomy (RYHJ) related complications., Methods: In 1986 the authors adopted the following protocol for improving RYHJ to minimize risks for RY-related complications: (1) end-to-end anastomosis if possible; (2) if end-to-side anastomosis is unavoidable, the common hepatic duct should be anastomosed as close as possible to the closed end of the blind pouch (BP); (3) careful selection of the vascular supply to the RY jejunal limb; (4) length of the RY jejunal limb should not be predetermined, but individualized; (5) approximate the native jejunum to the RY limb. The authors reviewed 92 children who had surgery for CC (mean age at surgery, 4.1 years) at our institution between 1986 and 2002 to assess the effectiveness of their recommendations., Results: After the adoption of the authors' recommendations for RYHJ, they have experienced no RYHJ-related complications after a mean follow-up period of 7.6 years (range, 4 months to 16 years)., Conclusions: RYHJ in children is different from that in adults, because the RY limb or BP can grow and elongate as the child grows. The authors' recommendations appear to have successfully prevented RY-related complications up to the time of this review, and they highly recommend their use.
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- 2003
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34. Forme fruste choledochal cyst: long-term follow-up with special reference to surgical technique.
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Shimotakahara A, Yamataka A, Kobayashi H, Okada Y, Yanai T, Lane GJ, and Miyano T
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- Bile Ducts, Extrahepatic pathology, Child, Child, Preschool, Choledochal Cyst pathology, Duodenostomy, Female, Follow-Up Studies, Humans, Infant, Jejunostomy, Liver surgery, Male, Treatment Outcome, Bile Ducts, Extrahepatic surgery, Choledochal Cyst surgery
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Purpose: Forme fruste choledochal cyst (FFCC) is a choledochal cyst that has minimal or no dilatation of the extrahepatic bile duct (EHBD) and is associated with pancreaticobiliary malunion (PBMU). The authors reviewed the long-term outcome of their patients with FFCC., Methods: Inpatient and outpatient records of 281 patients with choledochal cyst were reviewed. In this study, minimal dilatation of the EHBD was defined as its maximum diameter being less than 10 mm., Results: There were 17 cases of FFCC identified. In all 17 patients, PBMU was present. The mean age at EHBD excision was 2.9 years. Fourteen patients had hepatico-jejunostomy, and three had hepatico-duodenostomy. The histology of the excised EHBD showed mucosal ulceration/sloughing (in 35.3% patients), fibrosis (52.9%), and inflammatory cell infiltration (41.2%). Over a mean postoperative follow-up period of 9.8 years, there have been no episodes of cholangitis or anastomotic stricture formation., Conclusions: The treatment of choice for FFCC in children is EHBD excision and hepatico-jejunostomy. There is little surgical morbidity if performed carefully.
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- 2003
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35. Experimental allogenic penile transplantation.
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Koga H, Yamataka A, Wang K, Kato Y, Lane GJ, Kobayashi H, Sueyoshi N, and Miyano T
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- Animals, Feasibility Studies, Graft Rejection, Graft Survival, Immunosuppressive Agents therapeutic use, Male, Penis anatomy & histology, Rats, Rats, Inbred BN, Rats, Inbred Lew, Tacrolimus therapeutic use, Transplantation, Homologous, Penile Transplantation
- Abstract
Purpose: The aim of this study was to assess the feasibility of allogenic penile transplantation (PTx) for creating a source of viable penile tissue for use in penile reconstruction., Methods: The entire penis from an adult Brown-Norway rat was transplanted into a pouch created in the omentum of an adult Lewis rat (fully allogenic PTx, n = 23). Recipients were divided into 2 groups according to immunosuppressant (FK506) usage: in the FK+ group, FK506 (0.6 mg/kg/d) was administered intraperitoneally until a predetermined day (day 3, 5, 7, 10, 14, or 21) after PTx, and then the grafts were harvested. No FK506 was used in the FK- group. Syngeneic PTx (n = 8) patients were used as controls. All grafts were stained with H&E for histologic examination., Results: At laparotomy, each successfully transplanted penis appeared as a cylindrical mass in the omentum. Grafts could be mobilized to the genital area because of a long omental pedicle. Graft survival in the control and FK+ groups was 100%. Rejection was minimal to moderate in FK+ grafts harvested on days 3 and 5 after PTx and minimal or absent in FK+ grafts harvested on days 7, 10, 14, and 21. Penile structure on H&E staining was normal in FK+ and control specimens. Rejection with massive cellular infiltration was observed in all FK- grafts., Conclusions: FK506 successfully prevented rejection in allogenic PTx, and the authors' technique has potential for creating viable penile tissue that could be used as an option for penile reconstruction.
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- 2003
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36. A novel technique for reinforcing the neourethra in hypospadias associated with bilateral undescended testis: use of the gubernaculum.
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Yamataka A, Kobayashi H, Okada Y, Tsukamoto K, Lane GJ, and Miyano T
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- Child, Preschool, Cryptorchidism complications, Humans, Hypospadias complications, Infant, Ligaments, Male, Scrotum surgery, Urologic Surgical Procedures, Male methods, Hypospadias surgery, Urethra surgery
- Abstract
The authors present 3 cases of proximal hypospadias associated with bilateral undescended testes (UDT) in which the gubernaculum was used to reinforce the neourethra to prevent urethrocutaneous fistula. This is the first report of the gubernaculum being used to reinforce the neourethra. The technique is simple and should be applicable to any hypospadias patient with concomitant UDT, especially in severe hypospadias. Good outcome is likely because of the excellent blood supply of the gubernaculum.
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- 2003
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37. Laparoscopically assisted anorectovaginoplasty for selected types of female anorectal malformations.
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Tei E, Yamataka A, Segawa O, Kobayashi H, Lane GJ, Tobayama S, Kameoka S, and Miyano T
- Subjects
- Anal Canal abnormalities, Anal Canal surgery, Cloaca surgery, Female, Humans, Infant, Infant, Newborn, Laparoscopy, Rectovaginal Fistula surgery, Vagina surgery, Rectal Fistula surgery, Rectum surgery, Urinary Bladder Fistula surgery, Vagina abnormalities
- Abstract
Purpose: The aim of this study was to describe laparoscopically assisted anorectovaginoplasty (LAARVP) for the repair of selected types of female anorectal malformation., Methods: Five cases (case 1, rectovaginal fistula with a high rectum; case 2, rectovestibular fistula with double vagina; case 3, rectovestibular fistula with absent vagina; case 4, anovestibular fistula with absent vagina; case 5, cloaca) were reviewed., Results: Patient 4 had undergone a posterior sagittal anorectoplasty without vaginoplasty at another hospital after misdiagnosis of simple anovestibular fistula. Mean age at LAARVP was 15.4 months. At LAARVP, the fistula was divided in cases 1 through 4 and dissected as low as possible in case 5. In cases 3 and 4, the distal fistula was used to create the neovagina. In cases 1 through 3, the proximal rectum was mobilized and brought through the pelvic floor sphincter muscles using Georgeson's laparoscopically assisted colon pull-through technique through a minimal perineal incision. A posterior sagittal incision was required in cases 4 and 5. However, the initial laparoscopic approach was very helpful in both cases. Currently, all patients are well after a mean follow-up period of 32.2 months. Mean current age is 4.0 years. Patients 1 through 3 are continent, patient 4 is incontinent with soiling, and patient 5 is too young to be evaluated., Conclusions: LAARVP helps to achieve low dissection of the fistula, gives optimal view of the pelvic organs, provides accurate placement of the anorectal pull-through, and minimizes abdominal perineal scars.
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- 2003
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38. The intussusception antireflux valve is ineffective for preventing cholangitis in biliary atresia: a prospective study.
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Ogasawara Y, Yamataka A, Tsukamoto K, Okada Y, Lane GJ, Kobayashi H, and Miyano T
- Subjects
- Anastomosis, Roux-en-Y instrumentation, Bile Reflux complications, Female, Humans, Infant, Intussusception, Jaundice etiology, Jaundice prevention & control, Male, Portoenterostomy, Hepatic instrumentation, Prospective Studies, Bile Reflux prevention & control, Biliary Atresia surgery, Cholangitis prevention & control, Portoenterostomy, Hepatic methods, Postoperative Complications prevention & control
- Abstract
Purpose: Cholangitis after Kasai portoenterostomy for biliary atresia (BA) strongly influences outcome, and an intussusception antireflux valve (IAV) in the Roux-en-Y limb has been advocated for the prevention of cholangitis without definitive evidence. The authors report a prospective study to evaluate the effectiveness of IAV in BA., Methods: Twenty-one consecutive patients with uncorrectable-type BA were the subjects for this study. IAV was included based on informed parental request to give 2 groups: IAV- (n = 11) and IAV+ (n = 10). The incidence/duration of episodes of cholangitis (temperature > 38 degrees C, elevated serum bilirubin level, and leukocytosis) during the first 6 months after Kasai were statistically compared between the 2 groups (P >.05 was regarded as not significant)., Results: Technical variations in surgical technique were minimized because the same surgeon supervised all procedures. There were no significant differences between the 2 groups for age and weight at the time of Kasai, mean size of bile ductules at the porta hepatis, and degree of liver cirrhosis present. Protocols for antibiotic and steroid therapy were the same for both groups. The total number of patients who had cholangitis in the IAV- group was 6 of 11 and 5 of 10 in the IAV+ group (P = NS). The total number of episodes of cholangitis was 16 in the IAV- group versus 17 in the IAV+ group (P value, not significant). The mean duration of an episode of cholangitis (number of days per number of episodes) was 12 +/- 6 days in the IAV- group versus 11 +/- 7 days in the IAV+ group (P value, not significant)., Conclusions: IAV does not make any significant impact on the incidence or duration of cholangitis in the early post-Kasai period.
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- 2003
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39. Role of immunologic costimulatory factors in the pathogenesis of biliary atresia.
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Kobayashi H, Li Z, Yamataka A, Lane GJ, and Miyano T
- Subjects
- Antigens, CD analysis, Autoimmune Diseases etiology, B7-1 Antigen analysis, B7-2 Antigen, Biliary Atresia etiology, CD40 Antigens analysis, Child, Dendritic Cells immunology, Dendritic Cells pathology, Female, Hepatocytes immunology, Hepatocytes pathology, Humans, Immunohistochemistry, Kupffer Cells immunology, Kupffer Cells pathology, Liver Function Tests, Male, Membrane Glycoproteins analysis, Antigens, CD physiology, B7-1 Antigen physiology, Biliary Atresia immunology, CD40 Antigens physiology, Membrane Glycoproteins physiology
- Abstract
Background: The authors studied the patterns of expression of immunologic costimulatory molecules (B7-1, B7-2, and CD40) in biliary atresia (BA) patients to confirm any correlation with clinical course/outcome., Methods: Based on clinical status 2 years postoperatively, 24 BA patients were divided into group I (n = 8, normal liver function), group II (n = 10, anicteric with moderate liver dysfunction), and group III (n = 6, icteric with severe liver dysfunction). Liver biopsies obtained at portoenterostomy and from 6 age-matched controls, were analyzed immunohistochemically using antibodies against B7-1, B7-2, and CD40., Results: There was no expression of B7-1, B7-2, or CD40 in any control liver specimen. In all BA specimens, B7-1, B7-2, and CD40 were expressed strongly in bile ductules in portal tracts. In groups with liver dysfunction, B7-1, B7-2, and CD40 were expressed strongly on the surfaces of Kupffer and dendritic cells and in hepatocyte cytoplasm. Positive staining cells were significantly fewer in patients with better clinical outcome. B7-1 was found in vascular and sinusoidal endothelial cells only in cases of postoperative portal hypertension., Conclusions: Costimulatory factors expressed on bile ductules, hepatocytes, and vascular endothelial cells appear to mediate autoimmune processes causing progressive liver fibrosis and portal hypertension in BA.
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- 2003
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40. Living-related partial bladder transplantation for bladder augmentation in rats: an experimental study.
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Yamataka A, Wang K, Okada Y, Kobayashi H, Lane GJ, Yanai T, and Miyano T
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- Anastomosis, Surgical methods, Animals, Omentum surgery, Rats, Rats, Inbred Lew, Tissue and Organ Harvesting methods, Transplantation, Isogeneic, Urinary Bladder surgery, Models, Animal, Transplantation, Heterotopic methods, Urinary Bladder transplantation
- Abstract
Purpose: To assess the feasibility of transplanting adult bladder tissue to its offspring as a source of neobladder tissue for bladder augmentation., Methods: The dome of the bladder of an adult Lewis rat was excised and transplanted into the omentum of a 6-week-old offspring (living-related partial bladder transplant: n = 15). The bladder remnant of the donor rat was closed. Two weeks after transplantation, a laparotomy was performed to mobilize the bladder graft with its omental pedicle into the pelvis. Bladder augmentation (BA) was performed by anastomosing the graft to the recipient's bladder. Thirty days after BA, the entire neobladder was excised and histopathologically examined., Results: At laparotomy, each bladder graft appeared macroscopically as a thin-walled cyst in the recipient's omentum. Each graft could be mobilized into the pelvis and anastomosed to the recipient's bladder. BA was successful in all 15 recipients, and histopathologic studies showed that the mucosa was normal throughout each neobladder. Postoperatively, donors and recipients were clinically well without any sign of urinary incontinence or obstruction., Conclusions: This is the first report of adult tissue being transplanted successfully into a recipient without vascular reconstruction in a rat. Living-related partial bladder transplantation for the purpose of BA is feasible using our technique and could have application as an alternative technique for BA in a rat.
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- 2003
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41. Fibroblast growth factor signaling in the developing tracheoesophageal fistula.
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Spilde TL, Bhatia AM, Marosky JK, Preuett B, Kobayashi H, Hembree MJ, Prasadan K, Daume E, Snyder CL, and Gittes GK
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- Abnormalities, Drug-Induced etiology, Abnormalities, Drug-Induced metabolism, Abnormalities, Drug-Induced pathology, Abnormalities, Multiple chemically induced, Abnormalities, Multiple metabolism, Abnormalities, Multiple pathology, Animals, Disease Models, Animal, Epithelium metabolism, Esophageal Atresia chemically induced, Esophageal Atresia embryology, Esophagus embryology, Esophagus metabolism, Female, Fetal Proteins biosynthesis, Fetal Proteins genetics, Fibroblast Growth Factor 7, Fibroblast Growth Factors biosynthesis, Fibroblast Growth Factors deficiency, Fibroblast Growth Factors genetics, Lung embryology, Lung metabolism, Mesoderm chemistry, Morphogenesis drug effects, Pregnancy, Rats, Rats, Sprague-Dawley, Receptor, Fibroblast Growth Factor, Type 2, Receptors, Fibroblast Growth Factor biosynthesis, Receptors, Fibroblast Growth Factor deficiency, Receptors, Fibroblast Growth Factor genetics, Reverse Transcriptase Polymerase Chain Reaction, Trachea embryology, Trachea metabolism, Tracheoesophageal Fistula chemically induced, Tracheoesophageal Fistula embryology, Abnormalities, Drug-Induced genetics, Abnormalities, Multiple genetics, Doxorubicin toxicity, Esophageal Atresia genetics, Fetal Proteins physiology, Fibroblast Growth Factors physiology, Gene Expression Regulation, Developmental drug effects, Receptors, Fibroblast Growth Factor physiology, Tracheoesophageal Fistula genetics
- Abstract
Background/purpose: The Adriamycin-induced rat model of esophageal atresia and tracheoesophageal fistula (EA/TEF) provides a reliable system for the study of EA/TEF pathogenesis. The authors previously hypothesized that faulty branching lung morphogenesis pathways were a critical component of its pathogenesis. The authors have found evidence for faulty fibroblast growth factor (FGF) signaling related to epithelial-mesenchymal interactions in the fistula tract. To better define FGF signaling, the differential expression of FGF ligands and their receptors between lung, fistula tract, and esophagus are described., Methods: Time-dated pregnant, Sprague-Dawley rats were injected with Adriamycin (2 mg/kg intraperitoneally) on days 6 through 9 of gestation. Tissues were processed for histology and reverse transcriptase polymerase chain reaction. FGF-1, -7 and -10 were measured from whole lung, fistula tract, and esophagus of TEF or normal embryos. Expression of FGF2RIIIb and FGF2RIIIc receptors was measured in isolated epithelium and mesenchyme of lung and fistula tract of TEF embryos as well as lung and esophagus from normal controls., Results: FGF-1 mRNA was present in the fistula tract and normal and Adriamycin-exposed lung but absent from whole esophagus. Interestingly, FGF-7 mRNA was present only in normal lung. FGF-10 was present in all tissues examined. FGF2RIIIb mRNA was absent in fistula mesenchyme but present in all other tissues examined. However, the splice variant FGF2RIIIc mRNA was present in all tissues examined., Conclusions: These findings support defective FGF signaling in the rat model of EA/TEF. Absence of FGF-7 mRNA in Adriamycin-exposed tissues suggests the primary effect of Adriamycin may be to inhibit FGF-7 expression. Moreover, absence of FGF2RIIIb in fistula mesenchyme may be caused by loss of positive feedback from FGF-7, its normal obligate ligand. Understanding these specific defects in FGF signaling may provide insight into faulty mechanisms of EA/TEF., (Copyright 2003, Elsevier Science (USA). All rights reserved.)
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- 2003
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42. Laparoscopy-assisted suction colonic biopsy and intraoperative rapid acetylcholinesterase staining during transanal pull-through for Hirschsprung's disease.
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Yamataka A, Yoshida R, Kobayashi H, Tsukamoto K, Lane GJ, Segawa O, Kameoka S, and Miyano T
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- Biopsy methods, Colon enzymology, Hirschsprung Disease pathology, Humans, Infant, Infant, Newborn, Intestinal Perforation prevention & control, Monitoring, Intraoperative, Suction methods, Acetylcholinesterase analysis, Colon pathology, Hirschsprung Disease surgery, Laparoscopy methods
- Abstract
Background: It is crucial to identify the exact level of transition to normal ganglion cells in instances of Hirschprung's disease. This report describes a technique for laparoscopy-assisted suction colonic biopsy during transanal pull-through., Methods: Laparoscopy-assisted suction colonic biopsy (SCBx) was used in 12 patients with Hirschsprung's disease affecting the rectosigmoid. Average age was 4.4 +/- 2.1 months with a mean operative weight 6.2 +/- 1.0 kg. The pull-through was performed as the primary operative procedure in 11 patients. Using a 2-team approach (laparoscopic team and transanal team), the site was chosen for transanal suction biopsy and marked externally by the laparoscopic team with a silver clip. Biopsies were processed for ganglion cells and rapid AChE technique., Results: There were no biopsy-induced perforations. Abnormal biopsies were repeated more proximally until ganglion cells were observed. Transanal pull-through was performed and an open full-thickness biopsy performed to confirm the presence of ganglion cells. All procedures were performed successfully., Conclusions: Laparoscopy-assisted SCBx can be used successfully in patients with Hirschsprung's disease affecting the rectosigmoid (80% of cases). The technique, when used with rapid AChE staining, provides accurate identification of the level of normoganglionosis., (Copyright 2002, Elsevier Science (USA). All rights reserved.)
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- 2002
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43. Intraoperative endosonography enhances laparoscopy-assisted colon pull-through for high imperforate anus.
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Yamataka A, Yoshida R, Kobayashi H, Lane GJ, Kurosaki Y, Segawa O, Kameoka S, and Miyano T
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- Anus, Imperforate diagnosis, Follow-Up Studies, Humans, Infant, Intraoperative Care methods, Magnetic Resonance Imaging, Male, Postoperative Care, Treatment Outcome, Anus, Imperforate diagnostic imaging, Anus, Imperforate surgery, Endosonography methods, Laparoscopy methods
- Abstract
Purpose: The authors used ultrasonographic endoprobes during laparoscopy-assisted colon pull-through (LACPT) for the repair of high imperforate anus to confirm the pull-through canal was surrounded symmetrically by pelvic floor muscles., Methods: Six patients with high imperforate anus were treated by LACPT (mean age at LACPT, 8.2 months). An endoscopic (12-MHz, 2.5-mm in diameter) and proctoscopic (7.5-MHz, 12-mm in diameter) probe were inserted into the proposed route of dissection intraoperatively to measure the thickness of the surrounding muscle tissue at at least 3 levels: the external anal sphincter, the levator ani muscle sling, and the intervening muscle complex., Results: The average thickness of the external anal sphincter was 2.3 +/- 0.4 mm anteriorly, 2.4 +/- 0.4 mm on the left, 2.4 +/- 0.5 mm posteriorly, and 2.6 +/- 0.6 mm on the right. The average thickness of the muscle complex was 2.3 +/- 0.6 mm anteriorly, 2.2 +/- 0.5 mm on the left, 2.1 +/- 0.4 mm posteriorly, and 2.2 +/- 0.5 mm on the right. The average thickness of the left crus of the levator ani muscle was 1.8 +/- 0.3 mm, the right crus was 1.9 +/- 0.4 mm, and the rim located posterior to the rectum was 2.0 +/- 0.3 mm. No statistically significant difference was found between the measurements taken at each level., Conclusion: Intraoperative endosonography during LACPT can greatly enhance the precision of positioning the pull-through canal., (Copyright 2002, Elsevier Science (USA). All rights Reserved.)
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- 2002
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44. Clinical evaluation of serum levels of matrix metalloproteinases and tissue inhibitors of metalloproteinases as predictors of progressive fibrosis in postoperative biliary atresia patients.
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Kobayashi H, Li ZX, Yamataka A, Lane GJ, and Miyano T
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- Adolescent, Child, Disease Progression, Humans, Liver Cirrhosis etiology, Biliary Atresia complications, Liver Cirrhosis blood, Liver Cirrhosis diagnosis, Matrix Metalloproteinase 1 blood, Matrix Metalloproteinase 2 blood, Tissue Inhibitor of Metalloproteinases blood
- Abstract
Background/purpose: The authors analyzed serum Metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in postoperative biliary atresia (POBA) patients to evaluate their usefulness for assessing progressive fibrosis., Methods: The authors measured serum MMPs (-1,2) and TIMPs(-1,2) using respective one-step sandwich enzyme immunoassays in 36 POBA patients (mean age, 12.3 +/- 6.5 years) and 13 age-matched controls. POBA patients were classified into 3 groups; group I: n = 12; normal liver function test (LFT); group II: n = 15; elevated LFT, anicteric; and group III: n = 9; elevated LFT, icteric., Results: Serum MMP-2 levels were higher in all BA groups(especially in group II and III) compared with controls (P <.01). However, MMP-1 in all POBA patients groups (especially in group II and III) was significantly decreased compared with controls (P <.01). There was no statistical difference between mean values for serum TIMP-1 and TIMP-2 in all POBA patients compared with controls., Conclusions: Serum MMPs levels might be useful for predicting the progress of fibrosis and the functional reserve in POBA patients with documented deterioration in liver function caused by fibrosis. Our finding that TIMPs do not rise as cirrhosis progresses and this imbalance may be a causal factor for the excessive accumulation of extracellular matrix, which, in turn, may contribute to the progression of fibrosis in BA., (Copyright 2002, Elsevier Science (USA). All rights reserved.)
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- 2002
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45. Levels of circulating antiinflammatory cytokine interleukin-1 receptor antagonist and proinflammatory cytokines at different stages of biliary atresia.
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Kobayashi H, Yamataka A, Lane GJ, and Miyano T
- Subjects
- Adolescent, Biliary Atresia classification, Child, Child, Preschool, Disease Progression, Humans, Interleukin 1 Receptor Antagonist Protein, Biliary Atresia blood, Interleukin-6 blood, Receptors, Interleukin-1 antagonists & inhibitors, Sialoglycoproteins blood, Tumor Necrosis Factor-alpha analysis
- Abstract
Background/purpose: Antiinflammatory cytokine (interleukin [IL]-1ra) and proinflammatory cytokines (tumor necrosis factor [TNF]- alpha and IL-6) appear to play important roles in the pathophysiology of liver disease. In this study, the authors attempt to identify the roles of IL-1ra, IL-6, and TNF-alpha at different stages in postoperative biliary atresia (POBA) patients., Methods: Serum concentrations of IL-1ra, IL-6, and TNF-alpha were measured in 34 POBA patients and 25 healthy controls using specific enzyme-linked immunosorbent assays (ELISA). POBA patients were classified into 5 groups: group I (n = 21), less than 3 years old; Ia, stable; Ib, mild liver dysfunction; Ic, severe liver dysfunction. Group II (n = 13), (more than 3 years old); IIa, stable; IIb, variable liver dysfunction., Results: For IL-1ra differences between controls and groups Ib, Ic, and IIa were statistically significant (P <.01), and for IL-6, differences between controls and groups Ia, Ib, Ic, and IIb were statistically significant (P <.01). Groups Ib and Ic (less than 3 years old subjects) had the highest levels in this series. Serum TNF-alpha was not detected in any groups., Conclusion: The relationship between serum levels of IL-6 and IL-1ra may be predictive of prognosis with respect to the progression of fibrosis in POBA patients., (Copyright 2002, Elsevier Science (USA). All rights reserved.)
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- 2002
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46. Semiquantitative polymerase chain reaction in RNase-producing tissues: Analysis of the developing pancreas.
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Hembree MJ, Prasadan K, Manna P, Preuett B, Spilde T, Bhatia A, Kobayashi H, Buckingham B, Snyder CL, and Gittes GK
- Subjects
- Animals, Cell Count, Cell Division, Gene Expression Regulation, Developmental, Gestational Age, Insulin analysis, Insulin metabolism, Mice, Pancreas cytology, Pancreas embryology, RNA, Messenger metabolism, Tubulin metabolism, Pancreas enzymology, RNA, Messenger analysis, Reverse Transcriptase Polymerase Chain Reaction, Ribonucleases analysis, Tubulin analysis
- Abstract
Background/purpose: Many studies in pediatric surgical research use a quantitative analysis of gene expression in microscopic quantities of tissue. The authors describe an analysis of the beta-tubulin mRNA content of the embryonic pancreas, which contains abundant endogenous RNases. A detailed analysis of this RNase-containing system will provide a good template for analysis of other potentially simpler systems., Methods: Embryonic mouse pancreases were harvested at serial gestational ages. DAPI nuclear staining allowed for counting of cells. cDNA was amplified using a fluoresceinated primer and the normalized fluorescence determined. Known numbers of molecules were amplified in parallel as a standard control., Results: The number of cells increased from 38,000 to 2,700,000 between embryonic day 10.5 (E10.5) and E18.5. mRNA for beta-tubulin did not increase proportionately. Assuming a yield of 100% at E10.5 when no RNases are present, the yield of expected mRNA was 65.3% at E12.5, 13.8% at E15.5, and 0.9% at E18.5, presumably because of the appearance of RNases., Conclusions: Several parameters must be considered in performing semiquantitative reverse transcription polymerase chain reaction: (1) the yield of RNA based on the projected amount of mRNA, (2) the number of cells in the tissue, and (3) a known number of template molecules amplified in parallel., (Copyright 2001 by W.B. Saunders Company.)
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- 2001
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47. Laparoscopic muscle electrostimulation during laparoscopy-assisted anorectal pull-through for high imperforate anus.
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Yamataka A, Segawa O, Yoshida R, Kobayashi H, Kameoka S, and Miyano T
- Subjects
- Humans, Infant, Infant, Newborn, Laparoscopes, Male, Rectum surgery, Anal Canal physiology, Anus, Imperforate surgery, Electric Stimulation methods, Laparoscopy, Muscle Contraction
- Abstract
Purpose: Our technique for laparoscopic muscle electrostimulation during laparoscopy-assisted anorectal pull-through (LAARPT) for high imperforate anus (HIA) in 3 patients is described., Methods: The distal rectum and rectourethral fistula is dissected laparoscopically. A muscle stimulator is passed through one of the trocars and used to identify the center of contraction of the levator ani. The same muscle stimulator is used to identify the center of the external sphincter muscle transcutaneously. An intravenous cannulation device (SURFLO Flash IV catheter, TERUMO, CO, Yamanashi, Japan) is inserted through this proposed anus and observed piercing the center of the levator ani. A guide wire is passed through the SURFLO, and a series of dilators are passed along it to create a canal for the colonic pull-through. An anoplasty then was performed., Results: Our technique was successful in all patients. Laparoscopic electrostimulation produced good levator ani contraction in patients I and II and weak contraction in patient III. Patients I and II have symmetrical anal contraction during rectal examination, but patient III has poor contraction. Stool frequency is decreasing in all., Conclusion: Direct laparoscopic observation of levator ani contraction allows intraoperative assessment of functional contractility and assists in the accurate placement of the colonic pull-through., (Copyright 2001 by W.B. Saunders Company.)
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- 2001
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48. Intestinal neuronal dysplasia-like pathology in Ncx/Hox11L.1 gene-deficient mice.
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Yamataka A, Hatano M, Kobayashi H, Wang K, Miyahara K, Sueyoshi N, and Miyano T
- Subjects
- Animals, Colonic Diseases pathology, Culture Techniques, Disease Models, Animal, Ganglia pathology, Ganglia physiology, Immunohistochemistry, Mice, Mice, Inbred C57BL, Mice, Inbred DBA, Mice, Transgenic, Neuropeptide Y analysis, Reference Values, Sensitivity and Specificity, Colon innervation, Colon pathology, Colonic Diseases genetics, Enteric Nervous System pathology, Gastrointestinal Motility genetics, Homeodomain Proteins genetics, Oncogene Proteins genetics
- Abstract
Background/purpose: Ncx/Hox11L.1-deficient (Ncx-/-) mice specifically created by the authors had mega-ileo-ceco-colon (mega-ICC) with a caliber change in the proximal colon. The authors studied the nerve distribution in the bowel of these Ncx-/- mice to determine the cause of their bowel dysmotility., Methods: Four-week-old Ncx-/- mice (n = 10; 5 with mega-ICC, 5 without mega-ICC) were killed and the bowel harvested. Half of each specimen was snap frozen for AchE and NADPH-diaphorase histochemistry, and the other half were fixed with 10% formalin for H&E staining and immunohistochemistry using PGP9.5 antibody (a marker for neurons), C-kit antibody (a marker for intestinal pacemaker cells), and stem cell factor antibody (a marker for C-kit ligand). Age-matched wild-type normal mice (n = 5) served as controls., Results: In the ileum, cecum, and proximal colon from all Ncx-/- mice (irrespective of the association of mega-ICC), typical findings of human intestinal neuronal dysplasia (IND) ie, obvious hyperganglionosis in neuronal plexuses on PGP9.5 immunohistochemistry, ectopic ganglia in the mucosal and muscular layers on AchE histochemistry, and ghostlike ganglia on NADPH-diaphorase histochemistry were found. Likewise, in normal caliber distal colon from these mice, the distribution of ganglion cells, C-kit, and stem cell factor was normal. In control specimens, there was no ectopic ganglia or hyperganglionosis., Conclusions: These findings suggest that the Ncx/Hox11L.1 gene is required for the proper innervation of the enteric nervous system in mice, and our deficient strain may be useful as a model for studying IND in humans., (Copyright 2001 by W.B. Saunders Company.)
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- 2001
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49. Transplantation of newborn esophagus: an experimental study.
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Yamataka A, Wang K, Kobayashi H, Unemoto K, Miyahara K, Sueyoshi N, and Miyano T
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- Animals, Animals, Newborn, Disease Models, Animal, Dose-Response Relationship, Drug, Graft Rejection prevention & control, Graft Survival, Probability, Rats, Rats, Inbred BN, Rats, Inbred Lew, Reference Values, Sensitivity and Specificity, Tissue and Organ Harvesting methods, Transplantation, Homologous, Treatment Outcome, Esophagus transplantation, Immunosuppressive Agents administration & dosage, Tacrolimus administration & dosage, Transplantation Immunology physiology
- Abstract
Purpose: The aim of this study was to see if allogeneic transplantation (Tx) of newborn esophagus can create viable esophageal tissue that may be used for treating long gap esophageal atresia., Methods: Specimens of thoracic esophagus from newborn Brown-Norway rats, each were transplanted into a pouch created in the distal omentum of 5-week-old Lewis rats. In group I no immunosuppressant was used. FK-506 was used in group II (0.2 mg/kg), group III (0.6 mg/kg), and group IV (1.2 mg/kg) until a predetermined day of graft harvesting (1, 2, 3, 4, 5, 6, and 8 weeks after Tx). FK-506 was used for only 2 weeks in group V (0.6 mg/kg), and group VI (1.2mg/kg), and transplanted esophageal grafts were harvested 1, 2, 3, and 4 weeks after cessation of 2 weeks course FK-506. Syngeneic esophagus transplants were used as controls. All grafts were examined by H&E staining to assess graft viability and degree of rejection., Results: Each successfully transplanted esophagus appeared macroscopically as a tube like mass. Each graft could be mobilized to the thoracic cavity, because of the long omental pedicle. Graft survival in the control group was 100%. Rejection was observed in all grafts from groups I, II, V, and VI. In contrast, grafts from groups III and IV showed only minimal or no rejection. There was no evidence of side effects of FK-506 in rats in groups III and IV, except significantly slower weight gain compared with controls (P <.05)., Conclusions: FK-506 successfully prevented rejection, although immunologic tolerance was not achieved. These observations suggest that the authors' procedure has the potential to produce viable esophageal tissue that could be a new option for treating long gap esophageal atresia., (Copyright 2001 by W.B. Saunders Company.)
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- 2001
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50. Serum concentration of adhesion molecules in postoperative biliary atresia patients: relationship to disease activity and cirrhosis.
- Author
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Kobayashi H, Horikoshi K, Long L, Yamataka A, Lane GJ, and Miyano T
- Subjects
- Adolescent, Biliary Atresia complications, Biliary Atresia pathology, Biliary Atresia surgery, Biomarkers analysis, Biopsy, Needle, Child, Enzyme-Linked Immunosorbent Assay, Female, Humans, Immunohistochemistry, Intercellular Adhesion Molecule-1 analysis, Liver chemistry, Liver pathology, Liver Cirrhosis complications, Liver Cirrhosis pathology, Liver Function Tests, Male, Postoperative Period, Prognosis, Reference Values, Sensitivity and Specificity, Severity of Illness Index, Vascular Cell Adhesion Molecule-1 analysis, Biliary Atresia blood, Intercellular Adhesion Molecule-1 blood, Liver Cirrhosis blood, Vascular Cell Adhesion Molecule-1 blood
- Abstract
Background/purpose: Biliary atresia (BA) is associated with progressive liver fibrosis, which may be mediated by immunologic abnormalities involving adhesion molecules. This study investigates the relationship between serum intercellular adhesion molecule-1 (sICAM-1), serum vascular cell adhesion molecule-1 (sVCAM-1), and the clinical and histologic severity of BA., Methods: Serum ICAM-1 and VCAM-1 levels were measured by enzyme-linked immunosorbent assay in 35 patients with BA and 20 healthy controls. Standard liver function tests (LFTs), and frozen section liver biopsy specimens were used to determine liver status. On the basis of LFT results, the BA patients were classified into group I (n = 10; normal LFTs), group II (n = 15; elevated LFTs, anicteric), and group III (n = 10; elevated LFTs, icteric). Eight subjects in group II, and all subjects in group III had portal hypertension (PH)., Results: sICAM-1 levels were significantly elevated in group III (1760.0 +/- 717.5 ng/mL) compared with group II (555.1 +/- 199.4 ng/mL), group I (272.1 +/- 59.9 ng/mL) and controls (256.3 +/- 71.6 ng/mL). Although sVCAM-1 levels were significantly elevated in group III (1932.9 +/- 282.6 ng/mL) compared with group II (1054.3 +/- 297.0 ng/mL), group I (605.4 +/- 112.4 ng/mL), and controls (616.0 +/- 112.0 ng/mL; P <.001), there was no statistically significant difference between groups I, II, or controls. sVCAM-1 levels were elevated significantly in BA subjects in group II with PH (1253.0 +/- 245.1 ng/mL) compared with those who did not have PH (827.3 +/- 151.7 ng/mL; P <.01). PH did not affect sICAM-1 levels. There was strong expression of ICAM-1 and VCAM-1 in proliferating bile ductules, endothelial cells, and liver cells in group III compared with group II and controls., Conclusions: In BA, sICAM-1 and sVCAM-1 levels could be useful as markers of end-stage liver disease, with sVCAM-1 being more specific for PH. Induction of ICAM-1 and VCAM-1 may be an important factor in the development of cirrhosis., (Copyright 2001 by W.B. Saunders Company.)
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- 2001
- Full Text
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