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Systemic hemodynamics in advanced cirrhosis: Concerns during perioperative period of liver transplantation

World Journal of Hepatology 2016年第25期8卷 1047-1060页

作者： tomohide hori Yasuhiro Ogura Yasuharu Onishi Hideya Kamei Nobuhiko Kurata Motoshi Kainuma Hideo Takahashi Shogo Suzuki Takashi Ichikawa Shoko Mizuno Tadashi Aoyama Yuki Ishida Takahiro Hirai Tomoko Hayashi Kazuko Hasegawa Hiromu Takeichi Atsunobu Ota Yasuhiro Kodera Hiroyuki Sugimoto Taku Iida Shintaro Yagi Kentaro Taniguchi Shinji Uemoto Department of Transplant Surgery Nagoya University Hospital Department of Intensive Care Unit Nagoya University Hospital Second Department of Surgery Nagoya University Hospital Department of Transplant Surgery Kyoto University Hospital First Department of Surgery Mie University Hospital

Advanced liver cirrhosis is usually accompanied by portal hypertension. Long-term portal hypertension results in various vascular alterations. The systemic hemodynamic state in patients with cirrhosis is termed a hyperdynamic state. This peculiar hemodynamic state is characterized by an expanded blood volume, high cardiac output, and low total peripheral resistance. Vascular alterations do not disappear even long after liver transplantation(LT), and recipients with cirrhosis exhibit a persistent systemic hyperdynamic state even after LT. Stability of optimal systemic hemodynamics is indispensable for adequate portal venous flow(PVF) and successful LT, and reliable parameters for optimal systemic hemodynamics and adequate PVF are required. Even a subtle disorder in systemic hemodynamics is precisely indicated by the balance between cardiac output and blood volume. The indocyanine green(ICG) kinetics reflect the patient's functional hepatocytes and effective PVF, and PVF is a major determinant of the ICG elimination constant(kICG) in the well-preserved allograft. The kICG value is useful to set the optimal PVF during living-donor LT and to evaluate adequate PVF after LT. Perioperative management has a large influence on the postoperative course and outcome; therefore, key points and unexpected pitfalls for intensive management are herein summarized. Transplant physicians should fully understand the peculiar systemic hemodynamic behavior in LT recipients with cirrhosis and recognize the critical importance of PVF after LT.

关键词： Liver cirrhosis Portal hypertension Liver transplantation Indocyanine green Hyperdynamic

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Comprehensive and innovative techniques for livertransplantation in rats: A surgical guide

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World Journal of Gastroenterology 2010年第25期16卷 3120-3132页

作者： tomohide hori Justin H Nguyen Yasuhiro Ogura Toshiyuki Hata Shintaro Yagi Ann-Marie T Baine Norifumi Ohashi Christopher B Eckman Aimee R Herdt Hiroto Egawa Yasutsugu Takada Fumitaka Oike Seisuke Saka-moto Mureo Kasahara Kohei Ogawa Koichiro Hata Taku Iida Yukihide Yonekawa Lena Sibulesky Kagemasa Kuribayashi Takuma Kato Kanako Saito Mie Torii Naruhiko Sahara Naoko Kamo Tomoko Sahara Motohiko Yasutomi Shinji Uemoto Department of Neuroscience Mayo Clinic Jacksonville Florida FL 32224 United States Division of Hepato-Pancreato-Biliary Transplant and Pediatric Surgery Department of Surgery Kyoto University HospitalSakyo-ku Kyoto 606-8507 Japan Division of Transplant Surgery Department of Transplantation Mayo Clinic Jackson-ville Florida FL 32224 United States Institute for Laboratory Animal Science and Ex-perimental Surgery RWTH-Aachen University D-52074 AachenGermany Department of Cellular and Molecular Immu-nology Mie University Graduate School of Medicine Tsu Mie514-8507 Japan New Zealand Liver Transplant Unit Auckland City Hospital Auckland 92024 New Zealand

AIM: To investigate our learning curves of orthotopic liver transplantation (OLT) in rats and the most important factor for successful surgery. METHODS: We describe the surgical procedures for our rat OLT model, and determined the operator learning curves. The various factors that contributed to successful surgery were determined. The most important surgical factors were evaluated between successful and unsuccessful ***: Learning curve data indicated that 50 cases were required for operator training to start a study. Operative time, blood loss, warm ischemic time, anhepatic phase, unstable systemic hemodynamic state, and body temperature after surgery significantly affected surgery success by univariate analysis, while the anhepatic phase was the most critical factor for success by multivariate analysis. CONCLUSION: OLT in rats is the only liver transplantation model that provides clinically relevant and reliable results. Shortened anhepatic phase is key to success in this model.

关键词： Animal model Liver transplantation Microsurgery Rat Reperfusion injury Ultra-microsurgery

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Fatal arterial hemorrhage after pancreaticoduodenectomy:How do we simultaneously accomplish complete hemostasis and hepatic arterial flow?

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World Journal of Hepatology 2021年第4期13卷 483-503页

作者： Yasuyuki Kamada tomohide hori Hidekazu Yamamoto Hideki Harada Michihiro Yamamoto MasahiroYamada Takefumi Yazawa Ben Sasaki Masaki Tani Asahi Sato Hikotaro Katsura Ryotaro Tani RyuheiAoyama Yudai Sasaki Masaharu Okada Masazumi Zaima Department of Surgery Shiga General HospitalMoriyama 524-8524ShigaJapan Department of Cardiovascular Medicine Shiga General HospitalMoriyama 524-8524ShigaJapan

BACKGROUND Although arterial hemorrhage after pancreaticoduodenectomy(PD)is not frequent,it is *** hemorrhage is caused by pseudoaneurysm rupture,and the gastroduodenal artery stump and hepatic artery(HA)are frequent culprit *** procedures and imaging modalities are associated with certain *** accomplishment of complete hemostasis and HA flow preservation is difficult after *** complete hemostasis may be obtained by endovascular treatment(EVT)or surgery,liver infarction caused by hepatic ischemia and/or liver abscesses caused by biliary ischemia may *** herein discuss therapeutic options for fatal arterial hemorrhage after *** To present our data here along with a discussion of therapeutic strategies for fatal arterial hemorrhage after *** We retrospectively investigated 16 patients who developed arterial hemorrhage after *** patients’clinical characteristics,diagnostic procedures,actual treatments[transcatheter arterial embolization(TAE),stent-graft placement,or surgery],clinical courses,and outcomes were *** The frequency of arterial hemorrhage after PD was 5.5%.Pancreatic leakage was observed in 12 *** onset of hemorrhage occurred at a median of 18 d after *** bleeding was observed in five *** initial EVT procedures were stent-graft placement in seven patients,TAE in six patients,and combined therapy in two *** rate of technical success of the initial EVT was 75.0%,and additional EVTs were performed in four *** approaches including arterioportal shunting were performed in eight *** infarction was observed in two patients after *** patients showed a poor outcome even after successful *** four patients with poor clinical courses and outcomes had a poor clinical condition before *** patients were successfully *** Transcatheter placement of a covered stent may be useful for simultaneous a

关键词： Pancreaticoduodenectomy Endovascular treatment Stent-graft Covered stent Transcatheter arterial embolization Arterioportal shunting

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Hematogenous umbilical metastasis from colon cancer treated by palliative single-incision laparoscopic surgery

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World Journal of Gastrointestinal Surgery 2013年第10期5卷 272-277页

作者： tomohide hori Noriyuki Okada Masaya Nakauchi Shuji Hiramoto Ayako Kikuchi-Mizota Masahisa Kyogoku Fumitaka Oike Hidemitsu Sugimoto Junya Tanaka Yoshiki Morikami Kaori Shigemoto Toyotsugu Ota Masanobu Kaneko Masato Nakatsuji Shunji Okae Takahiro Tanaka Daigo Gunji Akira Yoshioka Department of Surgery Mitsubishi Kyoto Hospital Department of Medical Oncology Mitsubishi Kyoto Hospital Department of Histopathology Mitsubishi Kyoto Hospital Department of Gastroenterology Mitsubishi Kyoto Hospital Department of Radiology Mitsubishi Kyoto Hospital Department of Internal Medicine Mitsubishi Kyoto Hospital

Sister Mary Joseph’s nodule(SMJN)is a rare umbilical nodule that develops secondary to metastatic *** malignancies are located in the abdomen or *** with SMJN have a poor *** 83-year-old woman presented to our hospital with a1-month history of a rapidly enlarging umbilical *** findings revealed advanced transverse colon *** tomography and fluorodeoxyglucose-positron emission tomography revealed tumors of the transverse colon,umbilicus,right inguinal lymph nodes,and left *** feeding arteries and drainage veins for the SMJN were the inferior epigastric *** findings of the left lung tumor allowed for identification of the primary lung cancer,and a diagnosis of advanced transverse colon cancer with SMJN and primary lung cancer was *** patient underwent local resection of the SMNJ and subsequent single-site laparoscopic surgery involving right hemicolectomy and paracolic lymph node ***-abdominal dissemination to the mesocolon was confirmed during ***,the transverse colon cancer was confirmed to be moderately differentiated tubular *** suspect that SMJN may occur via a hematogenous *** chemotherapy for colon cancer and thoracoscopic surgery for the primary lung cancer were scheduled,the patient and her family desired home *** months after surgery,she died of rapidly growing lung cancer.

关键词： Umbilicus Sister Mary Joseph Singleincision laparoscopic surgery Palliative operation Hematogenous metastasis

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A Probabilistic Liquefaction Hazard Assessment for Urban Regions Based on Dynamics Analysis Considering Soil Uncertainties

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Journal of Earth Science 2021年第5期32卷 1129-1138页

作者： Jian Chen Hideyuki O-tani tomohide Takeyama Satoru Oishi Muneo hori Japan Agency for Marine-Earth Science and Technology Yokohama 236-0001Japan RIKEN Center for Computational Science Kobe 650-0047Japan Department of Civil Engineering Kobe UniversityKobe 657-8501Japaw

Earthquake induced liquefaction is one of the main geo-disasters threating urban regions, which not only causes direct damages to buildings, but also delays both real-time disaster relief actions and reconstruction activities. It is thus important to assess liquefaction hazard of urban regions effectively and efficiently for disaster prevention and mitigation. Conventional assessment approaches rely on engineering indices such as the factor of safety(FS) against liquefaction, which cannot take into account directly the uncertainties of soils. In contrast, a physics simulation-based approach, by solving soil dynamics problems coupled with excess pore water pressure(EPWP) it is possible to model the uncertainties directly via Monte Carlo simulations. In this study, we demonstrate the capability of such an approach for assessing an urban region with over 10 000 sites. The permeability parameters are assumed to follow a base-10-lognormal distribution among 100 model analyses for each site. A dynamic simulation is conducted for each model analysis to obtain the EPWP results. Based on over 1 million EPWP analysis models, we obtained a probabilistic liquefaction assessment. Empowered by high performance computing, we present for the first time a probabilistic liquefaction hazard assessment for urban regions based on dynamics analysis, which consider soil uncertainties.

关键词： liquefaction hazard assessment soil uncertainties soil dynamics analysis automatic modeling high performance computing

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