Yano H, Ikegami T, Yoshizumi T
… +6 more, Akahoshi T, Tomikawa M, Uchiyama H, Soejima Y, Shirabe K, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Mar · PMID 23785753
The case was a 50 years old female, with history of multiple previous surgeries including living donor liver transplantation for primary biliary cirrhosis, pancreatoduodenectomy for carcinoma in the duodenal papilla Vate...The case was a 50 years old female, with history of multiple previous surgeries including living donor liver transplantation for primary biliary cirrhosis, pancreatoduodenectomy for carcinoma in the duodenal papilla Vater, revision of Roux-en-Y anastomosis for intractable cholangitis due to short Roux limb. She was hospitalized this time for decompensated liver cirrhosis due to recurrent cholangitis, with apparent hypersplenism and risky esophageal varices. After a few session of endoscopic treatment for esophageal varices, we applied total laparoscopic splenectomy for hypersplenism in a patient with multiple surgical histories, for seeking better surgical field for safety. The surgery was completed as planned preoperatively under good surgical field.
Ikeda T, Yoshiya S, Toshima T
… +7 more, Harimoto N, Yamashita Y, Ikegami T, Yoshizumi T, Soejima Y, Shirabe K, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Mar · PMID 23785752
BACKGROUND/AIMS: Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is expected to be less invasive than laparoscopic distal pancreatectomy with splenectomy. However, there are few reports regarding the details...BACKGROUND/AIMS: Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is expected to be less invasive than laparoscopic distal pancreatectomy with splenectomy. However, there are few reports regarding the details of the procedure for LSPDP, and its safety remains unclear. This study aimed to evaluate the feasibility and safety of LSPDP. METHODOLOGY: Six patients underwent LSPDP from March 2009 to February 2013 in our center, and their clinical data and outcomes were reviewed retrospectively. RESULTS: A total of six laparoscopic distal pancreatic resections were attempted in four female and two male patients. All of the operations were successful, with an average operative time of 290.7 min (range: 211-377 min) and an average blood loss of 43.5 g (range: 0-142 g). The mean hospital stay was 11.8 days (range: 9-17days). No obvious pancreatic fistulas occurred, although pseudocysts at the stump of the pancreas were recognized in three patients on CT scans performed at 7 days postoperatively. Postoperative pathological examinations revealed two cases of serous cystadenoma in the body and tail of the pancreas, one case of serous oligocystic adenoma, one case of mucinous cystadenoma, one case of neuroendocrine tumor, and one case of solid-pseudopapillary neoplasm. CONCLUSIONS: LSPDP is minimally invasive, safe, and feasible for the management of benign pancreatic tail tumors, with the advantages of earlier recovery and less morbidity from complications.
Tsuji A, Seitoku M, Sameshima N
… +3 more, Usumoto Y, Kudo K, Ikeda N
Fukuoka Igaku Zasshi
· 2013 Feb · PMID 23691599
In the present study, we detected a familial case of ABO phenotype-genotype discrepancy. Although the observed phenotypes were B and O, the corresponding ABO genotypes were AB and AOG, respectively, by routine examinatio...In the present study, we detected a familial case of ABO phenotype-genotype discrepancy. Although the observed phenotypes were B and O, the corresponding ABO genotypes were AB and AOG, respectively, by routine examination. Exons 6 and 7 of the ABO gene were sequenced and subsequently, the sequence of the allele responsible for ABO phenotype-genotype discrepancy was examined. Our results indicated that the Ax allele was present in 3 family members. By employing traditional serological methods, we further identified and confirmed that the allele Ax and the resulting Ax phenotype are responsible for ABO phenotype-genotype discrepancy.
Okano S, Kondoh H, Toshima T
… +7 more, Nakagawara H, Yoshizumi T, Soejima Y, Shirabe K, Harada M, Yoshikai Y, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Jan · PMID 23600321
Dendritic cell (DC)-based immunotherapy is a potent, active and specific cancer immunotherapy, as DCs are preferable professional APCs (pAPCs) that prime the tumor-associated antigen (TAA) -specific CD8+ T-cell response....Dendritic cell (DC)-based immunotherapy is a potent, active and specific cancer immunotherapy, as DCs are preferable professional APCs (pAPCs) that prime the tumor-associated antigen (TAA) -specific CD8+ T-cell response. In DC-based immunotherapy, allogeneic DCs may be an alternative source of DCs for patients in whom it is difficult to obtain a sufficient number of quality-guaranteed, autologous DCs. However, the usefulness of fully allogeneic DCs in DC-based immunotherapy is controversial, and many investigators have failed to demonstrate that fully allogeneic DCs can induce an efficient antitumor effect in various experimental settings. In this study, we found that the injection of Fas-deficient fully allogeneic DCs via an intratumoral injection route exerted efficient antitumor effects, as did syngeneic DCs, but wild-type fully allogeneic DCs did not. Intratumoral injection therapy using Fas-deficient syngeneic DCs does not show superior tumor growth suppression compared to that using wild-type syngeneic DCs, suggesting that the inhibition of functional Fas may be critical for overcoming the unfavorable factor related to allogeneic DCs, especially overcoming the rejection response to alloantigens, in therapy using fully allogeneic DCs. In addition, the intratumoral injection therapy using Fas-deficient fully allogeneic DCs induced the generation of a significant tumor-specific CD8+ T-cell response, which is restricted by a host-derived major histocompatibility antigen. Therefore, intratumoral injection therapy using fully allogeneic DCs of which functional Fas is inhibited may be an alternative in clinical DC-based immunotherapy, under circumstances that do not allow the use of autologous DCs.
Okano S, Matsumoto Y, Yoshiya S
… +7 more, Yamashita Y, Harimoto N, Ikegami T, Shirabe K, Harada M, Yoshikai Y, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Jan · PMID 23600320
The use of cancer immunotherapy as part of multidisciplinary therapies for cancer is a promising strategy for the cure of advanced cancer patients. In cancer immunotherapy, the effective priming of tumor-associated antig...The use of cancer immunotherapy as part of multidisciplinary therapies for cancer is a promising strategy for the cure of advanced cancer patients. In cancer immunotherapy, the effective priming of tumor-associated antigen (TAA)-specific CD8+ T cells is essential, and therefore, the appropriate selection of the best peptide for targeting the cancer is a most important concern. One criticism in the selection of a TAA is the immunogenicity of the TAA, the vaccination of which effectively elicits clinical responses. However, the critical basic immunological factors that affect the differences in the immunogenicity of TAAs remain to be elucidated. Here we found that CD4 T-cell responses suppressed the immunogenicity of the concomitant TAA in a murine melanoma model in which intratumoral activated dendritic therapy (ITADT) was used for treatment of the established cancer, and we observed that the antitumor effects were largely dependent on the CD8 T-cell response. CD4 T-cell depletion simply enhanced the tyrosinase-related protein (TRP)-2(180-188) peptide-specific cytotoxic T-cell (CTL) responses, and CD4 T-cell depletion provided immunogenicity for mgp100(25-33) peptide, to which a CTL response could not be detected at all in CD4 T-cell-intact mice in the early therapeutic phase. Further, the mgp100(25-33) peptide-specific CTL response again became undetectable after the recovery of CD4 T cells in previously CD4-depleted, tumor-eradicated mice, whereas the TRP-2(180-188) peptide-specific CTL response was still much stronger in CD4-depleted mice than in CD4-intact mice. These findings suggest that the CD4 T cell-mediated masking effects of the immunogenicity of tumor-associated antigens are qualitatively and quantitatively different depending on the individual antigens.
Okuyama T, Hirakawa K, Kishikawa M
… +4 more, Uchiyama H, Kawanaka H, Korenaga D, Takenaka K
Fukuoka Igaku Zasshi
· 2012 Dec · PMID 23441544
OBJECTIVE: The transition of emergency departments and the current situation of emergency medicine (EM) in Fukuoka City Hospital (FCH) were reviewed. METHODS: The data concerning emergency medicine, such as the transitio...OBJECTIVE: The transition of emergency departments and the current situation of emergency medicine (EM) in Fukuoka City Hospital (FCH) were reviewed. METHODS: The data concerning emergency medicine, such as the transition of intra-hospital emergency systems, were obtained from annual reports published in our hospital. Additionally, the data regarding educational programs for emergency room staff, the number of patients taken to the emergency room by ambulances, the activities regarding the Fukuoka Medical Rally (FMR) and the disaster relief team (DRT) were also reviewed and analyzed. RESULTS: Departments of neurology, neurosurgery, emergency, and cardiology were opened sequentially, starting in 2003, with an establishment of facilities of an emergency room (ER), intensive care unit (ICU), stroke care unit (SCU), and coronary care unit (CCU). Regarding educational programs, lectures and demonstrations on basic and advanced life support techniques were given to all staff annually starting in 2004, and resident doctors completed rotations in the ER and the ICU for three months. FCH staff consistently obtained excellent results at the FMR. Ambulance crews attended lectures and received training on EM and intra-tracheal intubation. The numbers of patients taken by ambulance to FCH increased from 129 in 2002 to 2,316 in 2011. The DRT was dispatched to respond to disasters that occurred in Japan. CONCLUSIONS: As a secondary emergency hospital, FCH has developed a system to accept emergency patients. This project will contribute to the improvement of the EM system in the area.
Soejima Y, Ikegami T, Ijichi H
… +10 more, Ikeda T, Shirabe K, Yoshizumi T, Uchiyama H, Yamashita Y, Harimoto N, Toshima T, Matsuura H, Okadome K, Maehara Y
Fukuoka Igaku Zasshi
· 2012 Nov · PMID 23397877
PURPOSE: Laparoscopic hepatic resection (LHR) is still a challenging and developing surgical modality because of technical difficulty and a lack of training opportunities and experience. In this study, we present the res...PURPOSE: Laparoscopic hepatic resection (LHR) is still a challenging and developing surgical modality because of technical difficulty and a lack of training opportunities and experience. In this study, we present the results of our initial experiences of LHR, focusing on technical evolution in the management of LHR. METHODS: Between April 2011 and March 2012, a total of 12 LHRs were performed. The first 5 of these LHRs were performed under laparoscopic assistance (hybrid-LHR), while the last 7 LHRs were performed totally laparoscopically (pure-LHR). Indications for LHR were hepatocellular carcinoma (n = 9) and metastatic liver cancer (n = 3). LHR procedures consisted of partial resection (n = 2), left lateral segmentectomy (n = 2), and left lobectomy (n = 1) in the hybrid-LHR group, and partial resection (n = 4), left lateral segmentectomy (n = 2), and right lobectomy (n = 1) in the pure-LHR group. Operative outcomes were compared between the groups and technical modifications were evaluated. RESULTS: The mean operative time, blood loss, and length of hospital stay in the hybrid- and pure-LHR groups were 3.8 and 6.1 hours, 220 and 611 ml, and 9.4 and 7.4 days, respectively. There were no postoperative complications in both groups. Tumor margins were negative in all cases. CONCLUSIONS: LHR is a feasible and effective procedure for patients with various types of liver tumors, although technical challenges still need to be overcome.
Matsuo M, Ikegami T, Morita K
… +9 more, Yano H, Hashimoto N, Kayashima H, Masuda T, Kondou N, Yoshizumi T, Taketomi A, Shirabe K, Maehara Y
Fukuoka Igaku Zasshi
· 2012 Sep · PMID 23367858
In right lobe-living donor liver transplantation (RT-LDLT), hepatic venous reconstruction of the graft is essential to prevent posttansplant graft congestion and have a good outcome. The patient was a 56-year-old man who...In right lobe-living donor liver transplantation (RT-LDLT), hepatic venous reconstruction of the graft is essential to prevent posttansplant graft congestion and have a good outcome. The patient was a 56-year-old man who had decompensated liver cirrhosis secondary hepatitis C with massive ascites, jaundice and hepatic encephalopathy. He underwent LDLT using his son's right lobe graft. Preoperative simulation by 3D-CT volumetry revealed that the right lobe graft needed multi-venous reconstruction for right inferior hepatic vein (RIHV) and middle hepatic venous tributaries. Preoperative CT scan revealed that the recipient had portal venous thrombus and stenosis, which meant that the recipient's explanted portal vein (EPV) was not suitable for the venous reconstruction of the right lobe graft. Therefore, the recipient's internal and external jugular veins (IJV and EJV) were procured for venous reconstruction. The multiple veins of the right lobe graft were reconstructed to have single co-orifice at the backtable, and the co-orifice was anastomosed to inferior vena cava in short time. The recipient discharged on postoperative day 22 with good venous patency. In RT-LDLT unavailable for recipient's EPV, recipient's IJV and EJV grafts are very useful for multi-venous reconstruction.
Matsubara Y, Tateishi M, Okuyama T
… +10 more, Edagawa A, Higashi T, Ishii H, Nagata S, Hashimoto K, Uchiyama H, Eguchi D, Kawanaka H, Korenaga D, Takenaka K
Fukuoka Igaku Zasshi
· 2012 Sep · PMID 23367857
A-89-year-old male patient who complained dry cough was detected lung mass of 3 cm size in diameter at the right upper lobe by CT. FDG-PET seemed to show hilar and mediastinum lymph nodes metastasis. After three weeks, t...A-89-year-old male patient who complained dry cough was detected lung mass of 3 cm size in diameter at the right upper lobe by CT. FDG-PET seemed to show hilar and mediastinum lymph nodes metastasis. After three weeks, the mass showed rapid growth with 5 cm diameter in size at CT. Therefore the original tumor was supposed to be undifferentiated carcinoma, above all, pleomorphic carcinoma. He had been done pulmonary resection after short period. The right upper lobectomy with combined resection of the partial middle lobe was performed. Hilar and mediastinum lymph nodes dissection was added. In pathological examination, the tumor was proved pleomorphic carcinoma, however, no lymph node metastasis was recognized. He did not refer any complications and discharged back home at the post-operative 11th day. Pleomorphic carcinoma of the lung is known to be difficult to obtain definite diagnosis in early stage because of rapid growth. Therefore many cases are detected in advanced stage. In addition, chemotherapy is generally not effective, so only operative resection seems to be useful. Our patient was 89-year-old, he tolerated the operation and was alive with no trouble during 6 months after resection. When complete resection seems to be possible, operation should be regarded as an initial treatment.
Motoshima S, Noguchi T, Kawashima M
… +5 more, Ooishi M, Irie H, Nishihara M, Matsushima T, Kudo S
Fukuoka Igaku Zasshi
· 2012 Oct · PMID 23327089
PURPOSE: Patients with moyamoya disease (MMD) exhibit narrowed internal carotid arteries (ICAs) because the distal ends of the bilateral ICAs have become progressively stenosed, starting mainly in childhood. Accordingly,...PURPOSE: Patients with moyamoya disease (MMD) exhibit narrowed internal carotid arteries (ICAs) because the distal ends of the bilateral ICAs have become progressively stenosed, starting mainly in childhood. Accordingly, the petrous carotid canals in MMD patients are suspected to be more hypoplastic than those in control subjects. In this study, the diagnostic value of conventional computed tomography for MMD patients was retrospectively evaluated by comparing the caliber of the bilateral carotid canals in MMD patients with that in control subjects. MATERIALS AND METHODS: Thirty-five patients with MMD (15 males, 20 females; age range/average age: 6-71 / 26.1 years old) and age- and sex-matched control subjects underwent conventional head computed tomography. The maximal petrous carotid canal diameters of the two groups were measured and compared. RESULTS: The maximal petrous carotid canal diameter was significantly smaller in the moyamoya patients (mean +/- standard deviation [mm] = 4.70 +/- 0.61) than in the control subjects (5.62 +/- 0.61, p < 0.01). CONCLUSION: Conventional head computed tomography revealed narrowed petrous carotid canals in the MMD patients. This basic information could be utilized to screen patients who will require further examination, especially among those with underlying MMD.
Atsumi K, Nakamura K, Yoshidome S
… +9 more, Shioyama Y, Sasaki T, Ohga S, Yoshitake T, Shinoto M, Asai K, Sakamoto K, Hirakawa M, Honda H
Fukuoka Igaku Zasshi
· 2012 Aug · PMID 23157128
We constructed a remote radiation planning support system between Kyushu University Hospital (KUH) in Fukuoka and Kyushu University Beppu Hospital (KBH) in Oita. Between two institutions, radiology information system for...We constructed a remote radiation planning support system between Kyushu University Hospital (KUH) in Fukuoka and Kyushu University Beppu Hospital (KBH) in Oita. Between two institutions, radiology information system for radiotherapy division (RT-RIS) and radiation planning system (RTPS) were connected by virtual private network (VPN). This system enables the radiation oncologists at KUH to perform radiotherapy planning for the patients at KBH. The detail of the remote radiation planning support system in our institutions is as follows: The radiation oncologist at KBH performs radiotherapy planning and the data of the patients are sent anonymously to the radiation oncologists at KUH. The radiation oncologists at KUH receive the patient's data, access to RTPS at KBH, verify or change the radiation planning at KBH: Radiation therapy is performed at KBH according to the confirmed plan by the radiation oncologists at KUH. Our remote radiation planning system is useful for providing radiation therapy with safety and accuracy.