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Immunohistochemical evaluation for outflow reconstruction using opened round ligament in living donor right posterior sector graft liver transplantation: A case report

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World Journal of Gastroenterology 2016年第34期22卷 7851-7856页

作者： Yukihiro Sanada Yasunaru Sakuma Hideki Sasanuma Atsushi Miki Takumi Katano Yuta Hirata Noriki Okada Naoya Yamada Yoshiyuki Ihara Taizen Urahashi Naohiro Sata Yoshikazu Yasuda Koichi Mizuta Department of Transplant Surgery Jichi Medical University Department of Surgery Jichi Medical University

Utilizing the opened round ligament as venous grafts during liver transplantation is useful but controversial,and there are no pathological analyses of this procedure. Herein,we describe the first reported case of a pathological analysis of an opened round ligament used as a venous patch graft in a living donor liver transplantation(LDLT). A 13-year-old female patient with biliary atresia underwent LDLT using a posterior segment graft from her mother. The graft had two hepatic veins(HVs),which included the right HV(RHV; 15 mm) and the inferior RHV(IRHV; 20 mm). The graft RHV and IRHV were formed into a single orifice using the donor's opened round ligament(60 mm × 20 mm) as a patch graft during bench surgery; it was then anastomosed end-to-side with the recipient inferior vena cava. The recipient had no post-transplant complications involving the HVs,but she died of septic shock with persistent cholangitis and jaundice 86 d after LDLT. The HV anastomotic site had no stenosis or thrombus on autopsy. On pathology,there was adequate patency and continuity between the recipient's HV and the donor's opened round ligament. In addition,the stains for CD31 and CD34 on the inner membrane of the opened round ligament were positive. Hepatic venous reconstruction using the opened round ligament as a venous patch graft is effective in LDLT,as observed on pathology.

关键词： Opened round ligament Venous patch graft Hepatic venous reconstruction Living donor liver transplantation All-in-one venoplasty

Clearance of the liver remnant predicts short-term outcome in patients undergoing resection of hepatocellular carcinoma

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World Journal of Gastroenterology 2022年第38期28卷 5614-5625页

作者： Atsushi Miki Yasunaru Sakuma Hideyuki Ohzawa Akira Saito Yoshiyuki Meguro Jun Watanabe Kazue Morishima Kazuhiro Endo Hideki Sasanuma Atsushi Shimizu Alan Kawarai Lefor Yoshikazu Yasuda Naohiro Sata Department of Surgery Jichi Medical UniversityShimotsuke 329-0498TochigiJapan

BACKGROUND Estimation of the functional reserve of the remnant liver is important to reduce morbidity and mortality.AIM To estimate the functional reserve of the remnant liver in patients with hepatocellular carcinoma(HCC).METHODS We reviewed the medical records of 199 patients who underwent resection of HCC.Hepatic clearance of the remnant liver was calculated using fusion images of 99mTc-labelled galactosyl-human serum albumin liver scintigraphy and computed tomography.Posthepatectomy liver failure(PHLF)was classified according to the International Study Group of Liver Surgery.Complications was classified according to Clavien–Dindo classification.We analyzed by the risk factors for PHLF,morbidity and mortality with multivariate analysis.RESULTS Twenty-seven(30%)patients had major complications and 23(12%)developed PHLF.The incidence of major complications increased with increasing albumin–bilirubin(ALBI)grade.The area under the curve values for hepatic clearance of the remnant liver,liver to heart-plus-liver radioactivity at 15 min(LHL15),and ALBI score predicting PHLF were 0.868,0.629,and 0.655,respectively.The area under the curve for hepatic clearance of the remnant liver,LHL15,and ALBI score predicting major complications were 0.758,0.594,and 0.647,respectively.The risk factors for PHLF and major complications were hepatic clearance of the remnant liver and intraoperative bleeding.CONCLUSION The measurement of hepatic clearance may predict PHLF and major complications for patients undergoing resection of HCC.

关键词： Liver function Hepatectomy Cirrhosis Fusion image Complication Mortality

Laterally spreading tumors:Limitations of computed tomography colonography

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World Journal of Gastroenterology 2014年第46期20卷 17552-17557页

作者： Kazutomo Togashi Kenichi Utano Shigeyoshi Kijima Yosuke Sato Hisanaga Horie Keijirou Sunada Alan T Lefor Hideharu Sugimoto Yoshikazu Yasuda Department of Coloproctology Aizu Medical CenterFukushima Medical UniversityAizuwakmatsu-cityFukushima 969-3492Japan Department of Surgery Jichi Medical UniversityShimotsukeTochigi 329-0498Japan Department of Radiology Jichi Medical UniversityShimotsukeTochigi 329-0498Japan Department of Gastroenterology Jichi Medical UniversityShimotsukeTochigi 329-0498Japan

AIM:To prospectively investigate the detection rate of laterally spreading tumors(LSTs)of the colorectum by computed tomography(CT)colonography(CTC).METHODS:Patients with LSTs measuring≥20 mm detected during colonoscopy were prospectively enrolled in the study.All patients underwent colonoscopy and subsequent CTC on the same day.CTC was performed using multi-detector CT without contrast in the prone and supine positions.Two radiologists blinded to the existence of LSTs read the virtual endoscopic images as well as 2-D images.LSTs were classified into granular and non-granular types based on colonoscopic appearance.RESULTS:Forty-seven pathologically proven LSTs were evaluated prospectively.Histology included adenomas in 19,mucosal cancers in 19 and T1 cancers in 9.The mean diameter of the LSTs was 35.1 mm.Twenty-eight(60%)LSTs were correctly identified by CTC,and the configuration was similar to the colonoscopic appearance in most cases.Detection rate for the granular type was significantly higher than that for the nongranular type(71%vs 31%,P=0.013).Detection rate of adenomas was significantly lower than mucosal cancers(32%vs 79%,P=0.008)and T1 cancers(32%vs 78%,P=0.042).CONCLUSION:The detection rate of LSTs by CTC,particularly the non-granular type was not acceptable.Practitioners should be aware of the relatively low detection rate when using CTC.

关键词： Computed tomography colonography Laterally spreadi

Hepatic portal venous gas after endoscopy in a patient with anastomotic obstruction

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World Journal of Gastrointestinal Surgery 2015年第2期7卷 21-24页

作者： Ai Sadatomo Koji Koinuma Rihito Kanamaru Yasuyuki Miyakura Hisanaga Horie Alan T Lefor Yoshikazu Yasuda Department of Surgery Jichi Medical University

A 72-year-old male underwent a laparoscopic low anterior resection for advanced rectal cancer.A diverting loop ileostomy was constructed due to an anastomotic leak five days postoperatively.Nine months later,colonoscopy performed through the stoma showed complete anastomotic obstruction.The mucosa of the proximal sigmoid colon was atrophic and whitish.Ten days after the colonoscopy,the patient presented in shock with abdominal pain.Abdominal computed tomography scan showed hepatic portal venous gas(HPVG) and a dilated left colon.HPVG induced by obstructive colitis was diagnosed and a transverse colostomy performed emergently.His subsequent hospital course was unremarkable.Rectal anastomosis with diverting ileostomy is often performed in patients with low rectal cancers.In patients with anastomotic obstruction or severe stenosis,colonoscopy through diverting stoma should be avoided.Emergent operation to decompress the obstructed proximal colon is necessary in patients with a blind intestinal loop accompanied by HPVG.

关键词： Portal venous gas Abdominal computedtomography Colonoscopy Anastomotic obstruction Bacterial translocation

Late-onset severe biliary bleeding after endoscopic pigtail plastic stent insertion

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World Journal of Gastroenterology 2017年第4期23卷 735-739页

作者： Muneji yasuda Hideki Sato Yuki Koyama Tomoki Sakakida Takumi Kawakami Takeshi Nishimura Hideki Fujii yoshikazu Nakatsugawa Shinya Yamada Naoya Tomatsuri Yusuke Okuyama Hiroyuki Kimura Takaaki Ito Hiroyuki Morishita Norimasa Yoshida Department of Gastroenterology and Hepatology Japanese Red Cross Kyoto Daiichi Hospital Department of Radiology Japanese Red Cross Kyoto Daiichi Hospital

Here, we report our experience with a case of severe biliary bleeding due to a hepatic arterial pseudoaneurysm that had developed 1 year after endoscopic biliary plastic stent insertion. The patient, a 78-year-old woman, presented with hematemesis and obstructive jaundice. Ruptured hepatic arterial pseudoaneurysm was diagnosed, which was suspected to have been caused by long-term placement of an endoscopic retrograde biliary drainage(ERBD) stent. This episode of biliary bleeding was successfully treated by transarterial embolization(TAE). Pseudoaneurysm leading to hemobilia is a rare but potentially fatal complication in patients with long-term placement of ERBD. TAE is a minimally invasive procedure that offers effective treatment for biliary bleeding.

关键词：胆汁的 stent 塑料 stent 胆汁的流血 Pseudoaneurysm 辫子 stent

Blockade of high mobility group box-1 protein attenuates experimental severe acute pancreatitis

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World Journal of Gastroenterology 2006年第47期12卷 7666-7670页

作者： Hidehiro Sawa Takashi Ueda Yoshifumi Takeyama Takeo yasuda Makoto Shinzeki Takahiro Nakajima yoshikazu Kuroda Department of Gastroenterological Surgery Kobe University Graduate School of Medical Sciences Kobe 650-0017 Japan Department of Surgery Kinki University School of Medicine Osaka-sayama 589-8511 Japan

AIM: To examine the effects of anti-high mobility group box 1 (HMGB1) neutralizing antibody in experimental se-vere acute pancreatitis (SAP).METHODS: SAP was induced by creating closed duode-nal loop in C3H/HeN mice. SAP was induced immediately after intraperitoneal injection of anti-HMGB1 neutralizing antibody (200 μg). Severity of pancreatitis, organ injury (liver, kidney and lung), and bacterial translocation to pancreas was examined 12 h after induction of SAP.RESULTS: Anti-HMGB1 neutralizing antibody significant-ly improved the elevation of the serum amylase level and the histological alterations of pancreas and lung in SAP. Anti-HMGB1 antibody also significantly ameliorated the elevations of serum alanine aminotransferase and cre-atinine in SAP. However, anti-HMGB1 antibody worsened the bacterial translocation to pancreas.CONCLUSION: Blockade of HMGB1 attenuated the development of SAP and associated organ dysfunction, suggesting that HMGB1 may act as a key mediator for inflammatory response and organ injury in SAP.

关键词：急性胰腺炎十二指肠细菌易位丙胺酸

Comparison between SiC- and Si-Based Inverters for Photovoltaic Power Generation Systems

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Journal of Power and Energy Engineering 2017年第1期5卷 30-40页

作者： Yuji Ando Yasuhiro Shirahata Takeo Oku Taisuke Matsumoto Yuya Ohishi Masashi yasuda Akio Shimono yoshikazu Takeda Mikio Murozono Department of Materials Science The University of Shiga Prefecture Shiga Japan Collaborative Research Center The University of Shiga Prefecture Shiga Japan Kyoshin Electric Company Limited Kyoto Japan Clean Venture 21 Corporation Kyoto Japan

100-W class power storage systems were developed, which comprised spherical Si solar cells, a maximum power point tracking charge control-ler, a lithium-ion battery, and one of two different types of direct current (DC)-alter- nating current (AC) converters. One inverter used SiC met-al-oxide-semicon-ductor field-effect transistors (MOSFETs) as switching devices while the other used Si MOSFETs. In these 100-W class inverters, the ON resistance was considered to have little influence on the efficiency. Nevertheless, the SiC-based inverter exhibited an approximately 3% higher DC-AC conversion efficiency than the Si-based inverter. Power loss analysis indicated that the higher efficiency resulted predominantly from lower switching and reverse recovery losses in the SiC MOSFETs compared with in the Si MOSFETs.

关键词： Silicon Carbide Solar Cell Inverter Photovoltaic Device Maximum Power Point Tracking Lithium-Ion Battery