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Yamamura A, Sekiyama K, Otsuki M, Abe A, Kashihara Y, Kozono Y, Okuda A, Yoshioka Y, Higuchi T. Coexistence of ovarian cancer and peritoneal tuberculosis: a case report. Int Cancer Conf J 2024; 13:124-128. [PMID: 38524650 PMCID: PMC10957811 DOI: 10.1007/s13691-023-00649-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 12/14/2023] [Indexed: 03/26/2024] Open
Abstract
Peritoneal tuberculosis (TB) is known to mimic advanced ovarian cancer. In this case report, we describe a unique case of ovarian cancer (endometrioid carcinoma grade 3) at the International Federation of Gynecology and Obstetrics (FIGO) stage IC1 with pulmonary and peritoneal TB, which was suspected preoperatively to be a coexistence of advanced ovarian cancer and pulmonary TB. A 68-year-old woman presented with a prominent abdominal mass and fever. Laboratory investigations, imaging, and sputum analysis indicated a probable diagnosis of ovarian cancer at FIGO stage IIIC, characterized by peritoneal dissemination and para-aortic lymph node metastasis, which was further complicated by coexisting pulmonary TB. Surgical management included total abdominal hysterectomy, bilateral salpingo-oophorectomy, and partial omentectomy. Intraoperatively, the tumor was localized to the right ovary with significant peritoneal thickening and adhesions indicative of peritoneal TB. The surgery was completed without apparent complications. Postoperative histopathological evaluation confirmed grade 3 endometrioid carcinoma in the right ovary along with evidence of peritoneal TB. Given the extent of adhesions attributed to TB, lymph node dissection for staging was deemed challenging and was thus not pursued. Initiation of anti-TB treatment on postoperative day 2 resulted in marked regression of the preoperatively identified pulmonary nodules and para-aortic lymph node enlargement, suggesting their inflammatory origin from TB. Although postoperative chemotherapy is typically advocated for patients with stage IC1 endometrioid carcinoma grade 3, the patient opted against it. Consequently, no adjuvant therapy was administered and the patient remained under close observation.
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Affiliation(s)
- Akitoshi Yamamura
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, 2-4-20, Ogimachi, Kita-Ku, Osaka, 530-8480 Japan
| | - Kentaro Sekiyama
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, 2-4-20, Ogimachi, Kita-Ku, Osaka, 530-8480 Japan
| | - Miki Otsuki
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, 2-4-20, Ogimachi, Kita-Ku, Osaka, 530-8480 Japan
| | - Akiko Abe
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, 2-4-20, Ogimachi, Kita-Ku, Osaka, 530-8480 Japan
| | - Yuki Kashihara
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, 2-4-20, Ogimachi, Kita-Ku, Osaka, 530-8480 Japan
| | - Yuki Kozono
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, 2-4-20, Ogimachi, Kita-Ku, Osaka, 530-8480 Japan
| | - Akiko Okuda
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, 2-4-20, Ogimachi, Kita-Ku, Osaka, 530-8480 Japan
| | - Yumiko Yoshioka
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, 2-4-20, Ogimachi, Kita-Ku, Osaka, 530-8480 Japan
| | - Toshihiro Higuchi
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, 2-4-20, Ogimachi, Kita-Ku, Osaka, 530-8480 Japan
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Kashihara Y, Sekiyama K, Abe A, Yamamura A, Kozono Y, Okuda A, Yoshioka Y, Higuchi T. Successful fertility preservation in stage II endometrial carcinoma with long-term progestin therapy: A case report. Gynecol Oncol Rep 2024; 52:101357. [PMID: 38469132 PMCID: PMC10925927 DOI: 10.1016/j.gore.2024.101357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/24/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024] Open
Abstract
Progestin therapy is a fertility-sparing treatment option for well-differentiated stage IA endometrioid carcinomas without myometrial invasion. Here, we present a case of successful pregnancy and live birth following long-term progestin therapy in a patient with stage II well-differentiated endometrioid carcinoma. A 30-year-old nulliparous woman with an unremarkable medical history presented with abnormal uterine bleeding. A 45 mm mass was identified in the lower uterine segment. An endometrial biopsy revealed grade 1 endometrioid carcinoma, leading to a diagnosis of stage II uterine corpus cancer based on hysteroscopic findings. The patient refused surgical treatment and underwent oocyte retrieval and cryopreservation at another hospital. A subsequent endometrial biopsy revealed a marked reduction in the Ki-67 index from approximately 60 % to less than 10 %, suggesting the possibility of a hormone-sensitive tumor. The patient persistently refused surgery. Therefore, progestin therapy with medroxyprogesterone acetate (MPA) at a dose of 400 mg/day was initiated as a temporary measure until the patient would accept surgery. The tumor gradually reduced in size and eventually disappeared after 9 months. The MPA therapy was discontinued uneventfully after 20 months. Sixteen months after the discontinuation of MPA therapy, atypical endometrial hyperplasia was detected, and a second round of MPA therapy was initiated. Progestin retreatment was successful and was discontinued at 6 months. Four years after the initial treatment, the patient achieved pregnancy through timed intercourse and delivered a healthy baby at 38 weeks of gestation.
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Affiliation(s)
- Yuki Kashihara
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
- Department of Gynecology and Obstetrics, Kyoto University Hospital, Kyoto, Japan
| | - Kentaro Sekiyama
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
| | - Akiko Abe
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
| | - Akitoshi Yamamura
- Department of Gynecology and Obstetrics, Kyoto University Hospital, Kyoto, Japan
| | - Yuki Kozono
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
| | - Akiko Okuda
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
| | - Yumiko Yoshioka
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
| | - Toshihiro Higuchi
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
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Takemasa I, Hamabe A, Takenaka A, Kobayashi H, Mandai M, Kinugasa Y, Saika T, Shimbo M, Morizane S, Sekiyama K, Togami S, Hanaoka M, Inoue S, Nagaishi K, Sakai Y, Watanabe M. Standardization of robot-assisted pelvic lymph node dissection-Development of a common understanding of regional anatomy and surgical technique based on cross-disciplinary discussion among colorectal surgery, urology, and gynecology. Asian J Endosc Surg 2024; 17:e13274. [PMID: 38212269 DOI: 10.1111/ases.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/15/2023] [Accepted: 12/08/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Pelvic lymph node dissection is a procedure performed in gastroenterological surgery, urology, and gynecology. However, due to discrepancies in the understanding of pelvic anatomy among these departments, cross-disciplinary discussions have not been easy. Recently, with the rapid spread of robotic surgery, the importance of visual information in understanding pelvic anatomy has become even more significant. In this project, we attempted to clarify a shared understanding of pelvic anatomy through cross-disciplinary discussions. METHOD From May 2020 to November 2021, a total of 11 discussions were held entirely online with 5 colorectal surgery specialists, 4 urologists, and 4 gynecologists. The discussions focused on evidence from each specialty and surgical videos, aiming to create a universally understandable pelvic anatomical illustration. RESULTS The common area of dissection recognized across the three departments was identified as the obturator lymph nodes. A dynamic illustration of pelvic anatomy was created. In addition to a bird's-eye view of the pelvis, a pelvic half view was developed to enhance understanding of the deeper pelvic anatomy. The following insights were incorporated into the illustration: (1) the cardinal ligament in gynecology partly overlaps with the vesicohypogastric fascia in colorectal surgery; (2) the obturator lymph nodes continue cephalad into the fossa of Marcille in urology; and (3) the deep uterine vein in gynecology corresponds to the inferior vesical vein in colorectal surgery. CONCLUSION Based on the dynamic illustration of pelvic anatomy from cross-disciplinary discussions, we anticipate advancements in pelvic lymph node dissection aiming for curative and safe outcomes.
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Affiliation(s)
- Ichiro Takemasa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Hamabe
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Takenaka
- Division of Urology, Faculty of Medicine, Department of Surgery, Tottori University, Yonago, Japan
| | - Hiroaki Kobayashi
- Faculty of Medicine, Department of Obstetrics and Gynecology, Kagoshima University, Kagoshima, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Saika
- Department of Urology, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Masaki Shimbo
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Shuichi Morizane
- Division of Urology, Faculty of Medicine, Department of Surgery, Tottori University, Yonago, Japan
| | - Kentaro Sekiyama
- Department of Obstetrics and Gynecology, Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Shinichi Togami
- Faculty of Medicine, Department of Obstetrics and Gynecology, Kagoshima University, Kagoshima, Japan
| | - Marie Hanaoka
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sena Inoue
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kanna Nagaishi
- Second Department of Anatomy, Sapporo Medical University, Sapporo, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
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Mizuta Y, Kozono Y, Asai M, Sekiyama K, Yoshioka Y, Higuchi T. Vaginal malignant peripheral nerve sheath tumor treated with complete surgical resection and postoperative radiation therapy. J Obstet Gynaecol Res 2024; 50:133-138. [PMID: 37844578 DOI: 10.1111/jog.15817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/08/2023] [Indexed: 10/18/2023]
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) are neoplasms originating from or differentiating into nerve sheaths of peripheral nerves. Vaginal origin is rare, with only six vaginal primary cases reported to date. A 55-year-old woman presented to our hospital with a 7 cm vulvar mass. Tumor biopsy results were suspicious of sarcoma, and pelvic magnetic resonance imaging and hysterofiberscopy showed that the tumor originated from the lower vagina. The mass was transvaginally excised, and histological examination confirmed the diagnosis of a vaginal MPNST with negative surgical margins. The patient underwent radiotherapy because the risk of recurrence was high, owing to the large tumor size and high mitotic index. The patient remained recurrence-free for 1 year after the primary treatment. This is the first case of a high-risk vaginal MPNST that avoided early disease recurrence with additional radiotherapy after complete tumor resection.
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Affiliation(s)
- Yuka Mizuta
- Department of Obstetrics and Gynecology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Yuki Kozono
- Department of Obstetrics and Gynecology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Mayu Asai
- Department of Obstetrics and Gynecology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Kentaro Sekiyama
- Department of Obstetrics and Gynecology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Yumiko Yoshioka
- Department of Obstetrics and Gynecology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Toshihiro Higuchi
- Department of Obstetrics and Gynecology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
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Yamauchi K, Sekiyama K, Otsuki M, Nakamura S, Kawai E, Kojima M, Kozono Y, Okuda A, Yoshioka Y, Higuchi T. Multidirectional Traction Method Using SURGICEL NU-KNIT and Surgical Suture in Robot-assisted Laparoscopic Surgery for Endometrial Cancer. J Minim Invasive Gynecol 2024; 31:12-13. [PMID: 37875212 DOI: 10.1016/j.jmig.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE To describe a novel approach to robot-assisted laparoscopic total hysterectomy (RH) for endometrial cancer that minimizes cancer sell spillage and develops a stable surgical field. DESIGN Demonstration of the multidirectional traction method with narrated video footage. SETTING Many reports have indicated that RH for endometrial cancer has the same or superior short-term results compared with conventional laparoscopic hysterectomy (LH), and the long-term prognosis is the same [1,2]. However, there are no randomized controlled trials of RH versus LH, and some previous reports [3] have suggested that RH has a worse prognosis than LH, so the long-term prognosis should be considered with caution. Factors that may affect the long-term prognosis include the use of uterine manipulators [4] and compression of the uterine body with robotic forceps without tactile sensation [3]. However, to the best of our knowledge, no surgical technique capable of avoiding these factors has been established yet. Herein, we report a multidirectional traction method using SURGICEL NU-KNIT (Ethicon; Johnson & Johnson Medical Ltd., Tokyo, Japan), a local hemostatic agent, and surgical sutures. INTERVENTION Cut 2-0 Prolene (Ethicon; Johnson & Johnson Medical Ltd., Tokyo, Japan) with straight needles (ST-70) thread to 35 cm, stick a 1 × 2 cm piece of SURGICEL NU-KNIT, and make knots Fig. 1. This implement is used to puncture the incisional margins of the peritoneum and then the abdominal wall to bring the thread to the surface of the body, where it is grasped with forceps and fixed. By repeating this operation, multidirectional traction can be obtained Fig. 2. A manipulating suture is also attached to the uterus to minimize the compression of the uterine body with robotic forceps. CONCLUSION The multidirectional traction method allows for reproducible stable surgical field development and minimizes cancer cell spillage by reducing uterine grasping by robotic forceps without the use of uterine manipulators.
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Affiliation(s)
- Kota Yamauchi
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan.
| | - Kentaro Sekiyama
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Miki Otsuki
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Shihori Nakamura
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Eri Kawai
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Machiko Kojima
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Yuki Kozono
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Akiko Okuda
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Yumiko Yoshioka
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Toshihiro Higuchi
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
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Sekiyama K, Fujii S, Mandai M. Anatomical location of the surgically identifiable bladder branch of the inferior hypogastric plexus for nerve-sparing radical hysterectomy. Gynecol Oncol Rep 2023; 46:101152. [PMID: 36873857 PMCID: PMC9978464 DOI: 10.1016/j.gore.2023.101152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
Objective We aimed to demonstrate the entire structure of the inferior hypogastric plexus in the female pelvis focusing on surgically identifiable nerve bundles to the urinary bladder. Methods Surgical videos of transabdominal nerve-sparing radical hysterectomy for 10 patients with cervical cancer at International Federation of Gynecology and Obstetrics (FIGO 2009) stage IB1-IIB were retrospectively analyzed. The paracervical tissue dorsal to the ureter was separated into the lateral component (dorsal layer of the vesicouterine ligament) and medial component (paracolpium) using Okabayashi's technique. Any bundle-like structures in the paracervical area were isolated and divided using cold scissors, and each cut edge was inspected to determine whether the bundle was a blood vessel or a nerve. Results In all cases, the surgically identifiable nerve bundle of the bladder branch was identified on the rectovaginal ligament running parallel and dorsal to the vaginal vein of the paracolpium. The bladder branch was revealed only after complete division of the vesical veins in the dorsal layer of the vesicouterine ligament where no definitive nerve bundles were observed. The bladder branch was derived laterally from the pelvic splanchnic nerve and medially from the inferior hypogastric plexus. Conclusions The surgical identification of the nerve bundle of the bladder branch is essential for a safe and secure nerve-sparing radical hysterectomy. The preservation of the surgically identifiable bladder branch from the pelvic splanchnic nerve as well as from the inferior hypogastric plexus can provide satisfactory postoperative voiding function.
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Affiliation(s)
- Kentaro Sekiyama
- Department of Obstetrics and Gynecology, Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Shingo Fujii
- Kyoto Okamoto Memorial Hospital, Kyoto, Japan.,Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
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Yamamura A, Okuda A, Abe A, Kashihara Y, Kozono Y, Sekiyama K, Yoshioka Y, Higuchi T. The impact of assisted reproductive technology on the risk of postpartum hemorrhage: Difference by the mode of delivery and embryo transfer. J Obstet Gynaecol Res 2023; 49:1167-1172. [PMID: 36727662 DOI: 10.1111/jog.15572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/18/2023] [Indexed: 02/03/2023]
Abstract
AIM The frequency of postpartum hemorrhage (PPH) is increasing in developed countries, and some reports suggest that assisted reproductive technology (ART) increases various perinatal complications, including PPH. We investigated whether the effect of ART pregnancies on the incidence of PPH is modified by the mode of delivery. METHODS A retrospective cohort study was performed. We analyzed the medical records of 2914 pregnant women, including 411 pregnancies achieved by ART, which were delivered in our hospital from 2017 to 2020. PPH was defined as hemorrhage exceeding the 90th percentile of blood loss per the mode of delivery and number of fetuses. Multivariable logistic regression analysis was used to assess the association between ART and PPH. Propensity score-matched analyses were used to assess the difference in the incidence of PPH by the mode of delivery. RESULTS As previously reported, multivariable logistic regression analysis showed that ART pregnancy is an independent risk factor for PPH. Propensity score-matched analysis for with and without ART showed a 3.39-fold higher incidence of PPH for ART pregnancy in the vaginal delivery group (p < 0.001). CONCLUSIONS The effect of ART pregnancies on the incidence of PPH differed depending on the mode of delivery. Only in vaginal delivery, ART pregnancy increased the incidence of PPH.
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Affiliation(s)
- Akitoshi Yamamura
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
| | - Akiko Okuda
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
| | - Akiko Abe
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
| | - Yuki Kashihara
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
| | - Yuki Kozono
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
| | - Kentaro Sekiyama
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
| | - Yumiko Yoshioka
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
| | - Toshihiro Higuchi
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan
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Yamano K, Sekiyama K, Ukita M, Chigusa Y, Minamiguchi S, Mandai M. A case of dedifferentiated carcinoma associated with grade 1 endometrioid carcinoma with prominent squamous differentiation at the lower uterine segment. Int Cancer Conf J 2023; 12:63-68. [PMID: 36605834 PMCID: PMC9807689 DOI: 10.1007/s13691-022-00579-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022] Open
Abstract
Locally advanced cervical squamous cell carcinoma is a rare indication for surgery. In this report, we describe the case of a patient with presumed locally advanced cervical squamous cell carcinoma who underwent surgical treatment and was postoperatively diagnosed with endometrial cancer with prominent squamous differentiation. A 41-year-old woman presented with squamous cell carcinoma that was detected via Pap smear and confirmed by histological diagnosis of cervical biopsy. Magnetic resonance imaging showed a bulky cervical mass that spread to the lower uterine segment, vaginal wall, and rectum. The initial diagnosis was cervical cancer stage IVA. The patient underwent neoadjuvant chemotherapy followed by radical hysterectomy with combined rectal resection. Postoperative histopathology revealed a dedifferentiated carcinoma of the uterine corpus with prominent squamous differentiation. Immunohistochemistry of the surgical specimen showed loss of expression of mismatch repair proteins. The patient was informed of the possibility of Lynch syndrome and was recommended genetic counseling.
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Affiliation(s)
- Kazuki Yamano
- Department of Obstetrics and Gynecology, Kurashiki Central Hospital, Okayama, Japan
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Kentaro Sekiyama
- Department of Obstetrics and Gynecology, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka, Japan
| | - Masayo Ukita
- Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Graduate School of Medicine Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
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Mandai M, Yamaguchi K, Hamanishi J, Sekiyama K, Kondoh E. Superradical Hysterectomy for Cervical Cancer as an Alternative to the Usual Okabayashi-Type Radical Hysterectomy. Surg J (N Y) 2021; 7:S108-S114. [PMID: 35111937 PMCID: PMC8799309 DOI: 10.1055/s-0041-1736177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Radical hysterectomy is a standard operation for invasive cervical cancers. However, if the invasion to the parametrium is more advanced than estimation in the operation, it is difficult to perform usual radical hysterectomy. Superradical hysterectomy was developed by Prof. Ryukichi Mibayashi of Kyoto University and was published in 1941, and has been performed for the limited cases by a part of Japanese gynecologic surgeons. Superradical hysterectomy is a procedure in which the soft tissues in the pelvis are removed en bloc by sequential processing of the internal iliac vessels, which leads to a complete dissection of the lymphatic tissue in the pelvis to the pelvic wall.
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Affiliation(s)
- Masaki Mandai
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Ken Yamaguchi
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Junzo Hamanishi
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Kentaro Sekiyama
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
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Sekiyama K, Ando Y, Taga A, Kozono Y, Higuchi T, Fujii S. Laparoscopic technique for step-by-step nerve-sparing Okabayashi radical hysterectomy. Int J Gynecol Cancer 2019; 30:276-277. [DOI: 10.1136/ijgc-2019-000726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2019] [Indexed: 11/03/2022] Open
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11
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Yamamoto R, Sekiyama K, Higuchi T, Ikeda M, Mikami M, Kobayashi Y, Nagase S, Yokoyama M, Enomoto T, Katabuchi H. Value and limitation of conization as a diagnostic procedure for cervical neoplasm. J Obstet Gynaecol Res 2019; 45:2419-2424. [PMID: 31576641 DOI: 10.1111/jog.14118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/25/2019] [Indexed: 11/29/2022]
Abstract
AIM In the recent years, the number of cervical conization procedures performed for diagnostic or therapeutic purposes is increasing, accompanied by increased cervical neoplasia among young women. This study aimed to analyze the clinical data of patients who underwent conization in Japan. METHODS Among the 14 832 cases of conization registered in 205 facilities over 2 years (2009-2011), the data of 2409 and 12 417 patients who underwent conization for diagnostic and therapeutic purposes, respectively, were retrospectively analyzed. RESULTS The median age of the patients in diagnostic and therapeutic conization groups was 44 and 37 years, respectively. When comparing the diagnostic and therapeutic groups, 25.5% of the patients in the former were suspected with invasive cancer preoperatively, which is higher than that in the latter (2.7%). About 25.7% in the diagnostic and 14.1% in the therapeutic group had positive margin in the conization specimens. Additional treatment was required for 36.0% and 5.5% of the patients in the diagnostic and therapeutic groups, respectively, which are high figures for both. The risk factors of pathological upgrade in the conization specimens were diagnostic purpose, postmenopausal status and glandular lesion. Additional hysterectomy was performed in 1304 patients after conization, and pathological diagnosis was upgraded in 550 cases. Multivariate analysis revealed that postmenstrual status was an independent risk factor. CONCLUSION This study revealed that cervical lesions of glandular lineage and patients with postmenopausal status benefit from diagnostic conization. However, in postmenopausal patients, the underlying disease cannot be excluded in the preserved uterus even by diagnostic conization.
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Affiliation(s)
- Rumiko Yamamoto
- Department of Obstetrics and Gynecology, Kitano Hospital, The Tazuke Kohukai Medical Research Institute, Osaka, Japan
| | - Kentaro Sekiyama
- Department of Obstetrics and Gynecology, Kitano Hospital, The Tazuke Kohukai Medical Research Institute, Osaka, Japan
| | - Toshihiro Higuchi
- Department of Obstetrics and Gynecology, Kitano Hospital, The Tazuke Kohukai Medical Research Institute, Osaka, Japan
| | - Masae Ikeda
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan
| | - Yoichi Kobayashi
- Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Mitaka-shi, Japan
| | - Satoru Nagase
- Department of Obstetrics and Gynecology, Yamagata University, Faculty of Medicine, Yamagata-shi, Japan
| | - Masatoshi Yokoyama
- Department of Obstetrics and Gynecology, Saga University Hospital, Saga-shi, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Medical School, Niigata-shi, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Faculty of Life Science, Kumamoto University, Kumamoto-shi, Japan
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Matsuoka M, Taga A, Hata S, Yamamoto R, Ando Y, Kozono Y, Tsuji N, Sekiyama K, Higuchi T, Nagano T. Abnormal menstruation after radical trachelectomy and its effects on fertility. J Obstet Gynaecol Res 2019; 45:1906-1912. [DOI: 10.1111/jog.14032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 05/25/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Mari Matsuoka
- Department of Gynecology, IVF Namba Clinic Osaka Japan
| | - Atsuko Taga
- Department of Obstetrics and GynecologyThe Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Saori Hata
- Department of Obstetrics and GynecologyThe Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Rumiko Yamamoto
- Department of Obstetrics and GynecologyThe Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Yukiko Ando
- Department of Obstetrics and GynecologyThe Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Yuki Kozono
- Department of Obstetrics and GynecologyThe Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Natsuki Tsuji
- Department of Obstetrics and GynecologyThe Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Kentaro Sekiyama
- Department of Obstetrics and GynecologyThe Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Toshihiro Higuchi
- Department of Obstetrics and GynecologyThe Tazuke Kofukai Medical Research Institute, Kitano Hospital Osaka Japan
| | - Tadayoshi Nagano
- Department of GynecologyKansai Electric Power Hospital Osaka Japan
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13
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Sekiyama K, Yamada S, Nakagawa T, Nakayama Y, Kajiwara T. Partially Filled Flow Simulation Using Meshfree Method for High Viscosity Fluid in Plastic Mixer. INT POLYM PROC 2019. [DOI: 10.3139/217.3727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
A novel simulation technique for the flow in plastic mixers based on Element-free Galerkin Method (EFGM) has been developed in this study. To improve the simulation accuracy, a “rearrangement” scheme has been employed which eliminates errors caused by the irregular distribution of data points. Through several numerical tests, the new simulation technique has been validated to be applicable to high viscosity fluid flow with enough accuracy. Furthermore, simulation examples for realistic mixers were carried out using the developed technique. From the results, it was found that the developed technique is capable to investigate the relationship between flow behavior inside realistic mixers and operating conditions.
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Affiliation(s)
- K. Sekiyama
- Mechanical Engineering Research Laboratory , Kobe Steel, Ltd., Hyogo , Japan
- Department of Chemical Engineering , Faculty of Engineering, Kyushu University, Fukuoka , Japan
| | - S. Yamada
- Mechanical Engineering Research Laboratory , Kobe Steel, Ltd., Hyogo , Japan
| | - T. Nakagawa
- Mechanical Engineering Research Laboratory , Kobe Steel, Ltd., Hyogo , Japan
| | - Y. Nakayama
- Department of Chemical Engineering , Faculty of Engineering, Kyushu University, Fukuoka , Japan
| | - T. Kajiwara
- Department of Chemical Engineering , Faculty of Engineering, Kyushu University, Fukuoka , Japan
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14
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Jimi T, Yamamoto R, Seo K, Matsuoka M, Hata S, Ando Y, Miyata H, Kozono Y, Tsuji N, Okuda A, Sekiyama K, Terakawa K, Nagano T. A case of laparoscopy-assisted vaginal cuff suturing for vaginal cuff dehiscence after total laparoscopic hysterectomy. Int J Surg Case Rep 2017; 41:110-113. [PMID: 29059609 PMCID: PMC5651540 DOI: 10.1016/j.ijscr.2017.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/09/2017] [Accepted: 10/13/2017] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Vaginal cuff dehiscence after hysterectomy is a rare complication and occurs in less than 1% of patients. It can present with serious complications, such as bowel evisceration and peritonitis. PRESENTATION OF CASE A 51-year-old multigravida Korean woman underwent total laparoscopic hysterectomy for leiomyoma. Six months later, she reported lower abdominal pain and vaginal bleeding. Physical examination revealed rebound tenderness in the lower abdomen, and pelvic examination showed a small amount of vaginal bleeding with an evisceration of the small intestine through the vagina that exhibited healthy peristalsis. The eviscerated bowel, which seemed to be a part of the ileum, was carefully manually reduced transvaginally into the abdominal cavity. Laparoscopic observation revealed adhesions between the omentum, small intestine, and the peritoneum. Specifically, the small intestine was adhered around the vaginal cuff. An abdominal abscess was found in the left lower abdominal cavity. An adhesiotomy was performed and the abdominal abscess was removed and irrigated. Complete separation of the anterior and posterior vaginal cuff edges was obtained. The vaginal cuff was closed with interrupted 0-polydioxanone absorbable sutures without bowel injury. A 6-month follow-up examination revealed complete healing of the vaginal cuff. DISCUSSION In this case, we were able to make use of both laparoscopic and transvaginal methods to perform a successful repair with a minimally invasive and safe technique. CONCLUSION Laparoscopically assisted vaginal cuff suturing for vaginal cuff dehiscence after total laparoscopic hysterectomy was found to be effective, safe, and minimally invasive.
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Affiliation(s)
- Tomoatsu Jimi
- Department of Obstetrics and Gynecology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
| | - Rumiko Yamamoto
- Department of Obstetrics and Gynecology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
| | - Koji Seo
- Department of Obstetrics and Gynecology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
| | - Mari Matsuoka
- Department of Obstetrics and Gynecology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
| | - Saori Hata
- Department of Obstetrics and Gynecology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
| | - Yukiko Ando
- Department of Obstetrics and Gynecology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
| | - Hiromi Miyata
- Department of Obstetrics and Gynecology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
| | - Yuki Kozono
- Department of Obstetrics and Gynecology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
| | - Natsuki Tsuji
- Department of Obstetrics and Gynecology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
| | - Akiko Okuda
- Department of Obstetrics and Gynecology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
| | - Kentaro Sekiyama
- Department of Obstetrics and Gynecology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
| | - Koichi Terakawa
- Department of Obstetrics and Gynecology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
| | - Tadayoshi Nagano
- Department of Obstetrics and Gynecology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
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15
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Honda M, Sekiyama K, Baba T, Matsuura K, Seino N, Gokan T. Abstract No. 88: Balloon-Occluded retrograde transvenous obliteration for portosystemic encephalopathy in patients with liver cirrhosis. J Vasc Interv Radiol 2010. [DOI: 10.1016/j.jvir.2009.12.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Sekiyama K, Yamanishi T, Yoshida K, Tobe T, Kaibuchi T, Mori I. MP-12.12: A Randomized, Controlled Trial Comparing the Efficacies of Alarm Treatment and Behavioural Modification in Enuresis. Urology 2009. [DOI: 10.1016/j.urology.2009.07.899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Tercero C, Okada Y, Ikeda S, Fukuda T, Sekiyama K, Negoro M, Takahashi I. Numerical evaluation method for catheter prototypes using photo-elastic stress analysis on patient-specific vascular model. Int J Med Robot 2008; 3:349-54. [DOI: 10.1002/rcs.166] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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18
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Jatmiko W, Sekiyama K, Fukuda T. A pso-based mobile robot for odor source localization in dynamic advection-diffusion with obstacles environment: theory, simulation and measurement. IEEE COMPUT INTELL M 2007. [DOI: 10.1109/mci.2007.353419] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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19
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Inoue K, Sekiyama K, Yamada M, Watanabe T, Yasuda H, Yoshiba M. [Combined interferon α2b and cyclosporin A in the treatment of chronic hepatitis C: controlled trial]. Reumatismo 2005; 57:128-129. [PMID: 21608298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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20
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Abstract
OBJECTIVE A new DNA virus, which has been designated the TT virus, was discovered in 1997. It is not clear whether TT virus is a cause of any of the types of hepatitis. We conducted a case-control study to test the hypothesis that the presence of TT virus is a necessary condition for the development of fulminant hepatic failure in people who have non-A, -B, or -C hepatitis. METHODS We studied 55 patients with fulminant hepatic failure [28 men, 27 women, mean (+/- SD) age, 47 +/- 15 yr], 32 patients with acute hepatitis (18 men, 14 women, mean age, 38 +/- 15 yr), and 200 healthy subjects (106 men, 94 women, mean age, 42 +/- 14 yr). TT virus DNA was detected in sera by a nested polymerase chain reaction using a primer set for genotype 1. RESULTS TT virus was more frequently detected in patients with fulminant hepatic failure [in 33 of 55 (60%); 95% confidence interval (CI), 47-73%] than in those with acute hepatitis [in 8 of 32 (25%); 95% CI, 10-40%; p = 0.0016] or in healthy subjects [in 50 of 200 (25%); 95% CI, 19-31%; p < 0.0001]. TT virus was detected at a significantly higher rate in non-A, -B, or -C fulminant hepatic failure [in 18 of 22 (82%); 95% CI, 66-98%] than in fulminant hepatic failure of A, B, or C type [45%, 28-62%, 15/33; p = 0.007] or in non-A, -B, or -C acute hepatitis [24%, 3-44%, 4/17; p = 0.0003]. The logistic regression analysis selected TT virus (p = 0.0009), age (p = 0.0116), and etiology (p = 0.0309) as independent variables associated with fulminant hepatic failure (coefficient of determination, 0.2335). CONCLUSIONS TT virus comparatively plays a role in the pathogenesis of non-A, -B, or -C fulminant hepatic failure.
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Affiliation(s)
- M Shibata
- Second Department of Internal Medicine, Showa University, School of Medicine, Tokyo, Japan
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21
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Sekiyama K, Miyauchi S, Imaruoka T, Egusa H, Tashiro T. Body image as a visuomotor transformation device revealed in adaptation to reversed vision. Nature 2000; 407:374-7. [PMID: 11014192 DOI: 10.1038/35030096] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
People adapt with remarkable flexibility to reversal of the visual field caused by prism spectacles. With sufficient time, this adaptation restores visually guided behaviour and perceptual harmony between the visible and tactile worlds. Although it has been suggested that seeing one's own body is crucial for adaptation, the underlying mechanisms are unclear. Here we show that a new representation of visuomotor mapping with respect to the hands emerges in a month during adaptation to reversed vision. The subjects become bi-perceptual, or able to use both new and old representations. In a visual task designed to assess the new hand representation, subjects identified visually presented hands as left or right by matching the picture to the representation of their own hands. Functional magnetic resonance imaging showed brain activity in the left posterior frontal cortex (Broca's area) that was unique to the new hand representations of both hands, together with activation in the intraparietal sulcus and prefrontal cortex. The emergence of the new hand representation coincided with the adaptation of perceived location of visible objects in space. These results suggest that the hand representation operates as a visuomotor transformation device that provides an arm-centred frame of reference for space perception.
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Affiliation(s)
- K Sekiyama
- Division of Cognitive Psychology, Future University-Hakodate, Kameda Nakano, Japan.
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Abstract
BACKGROUND/AIMS Whether GB virus C causes serious liver diseases remains controversial. The aim of the present study was to determine whether there is an etiological relationship between GB virus C and fulminant hepatitis. METHODS The level of GB virus C RNA in the sera of three patients with fulminant hepatitis was quantitatively determined using the newly developed real-time detection polymerase chain reaction method, which is based on Taq Man chemistry. The NS 3 region of the viral genome isolated from the sera was sequenced at several time points to confirm whether the same virus was responsible for fulminant hepatitis during the patients' clinical courses. RESULTS The sensitivity of the PCR was comparable to that of nested PCR and a linear relationship between RNA copy number and threshold cycle was observed for 10(1) and 10(6) RNA copies/ml (r = 0.99). The serum level of GB virus C RNA closely paralleled that of ALT in all patients. Sequence analysis of the NS3 region isolated from the patients' sera revealed that the same GB virus C strain infected the patients during their entire clinical courses, despite plasma exchange therapy. CONCLUSIONS These observations suggest that GB virus C may be etiologically associated with fulminant hepatic failure, and is not merely an inactive bystander introduced by therapeutic plasma exchange.
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Affiliation(s)
- K Inoue
- Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
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23
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Obuchi M, Yoshiba M, Sekiyama K, Homda M, Takizawa K, Uchiyama K, Doai K, Kuniyasu Y. [Serial hepatic and splenic volumetry in acute severe hepatitis]. Nihon Shokakibyo Gakkai Zasshi 1999; 96:147-53. [PMID: 10087886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
In this study, we elucidate a relationship between final outcome and changes in hepatic and splenic volume in patients with acute severe hepatitis. The subjects were 40 patients: 10 with sever acute hepatitis (prothrombin time < 40%) and 30 with fulminant hepatic failure (acute type in 12 and subacute type in 18). Liver and spleen volume were measured by CT initially on hospitalization and subsequently 1 to 40 days after hospitalization, and the scans were analyzed retrospectively. Liver volume decreased in 15 of 26 survivors, and all 14 non-survivors. Among 15 survivors and 14 non-survivors whose liver volume decreased, spleen volume increased in none of the survivors, whereas it increased in 11 of the 14 non-survivors. In survivors there was a close parallelism between changing rates of the liver volume and that of the spleen volume (r = 0.82, p < 0.0001). These observations suggest that the decrease of liver volume accompanied by that of spleen volume implies a good prognosis, while the decrease without such accompaniment implies a bad prognosis.
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Affiliation(s)
- M Obuchi
- Department of Radiology, Showa University Fujigaoka Hospital
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24
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Handa K, Inoue K, Sekiyama K, Yoshiba M, Fujita R, Takahashi Y. [Successful treatment of an HB carrier developing severe hepatitis using lamivudine--case report]. Nihon Shokakibyo Gakkai Zasshi 1998; 95:1136-40. [PMID: 9805932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- K Handa
- Division of Gastroenterology, Showa University Fujigaoka Hospital
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25
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Higuchi D, Sekiyama K, Yoshiba M, Inoue K, Fujita R. [A close association of prognosis with effect of interferon in HBV carriers developing acute severe exacervation]. Nihon Shokakibyo Gakkai Zasshi 1998; 95:1001-7. [PMID: 9785889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
We have treated 19 HBV carriers who developed acute severe exacerbation using interferon and immunosuppressive agents. Of these 14 patients developed fulminant hepatic failure. Of 10 patients with positive result for serum HBV DNA polymerase before the start of te treatment, five patients in whom HBV DNA polymerase turned negative and one patient whose HBV DNA polymerase level fluctuated in a low abnormal range after the start of the treatment survived. While, four patients whose HBV DNA polymerase level remained high after the start of interferon treatment died. Thus, it is suggested that suppression of HBV virus replication is closely related to prognosis in HB carriers developing acute severe exacervation of hepatitis.
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Affiliation(s)
- D Higuchi
- Department of Medicine, Showa University Fujigaoka Hospital
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26
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Inoue K, Yoshiba M, Sekiyama K, Okamoto H, Mayumi M. Clinical and molecular virological differences between fulminant hepatic failures following acute and chronic infection with hepatitis B virus. J Med Virol 1998. [PMID: 9580884 DOI: 10.1002/(sici)1096-9071(199805)55:1<35::aid-jmv7>3.0.co;2-p] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Clinical and molecular biological characteristics were compared between patients who presented with fulminant hepatic failure following acute infection with hepatitis B virus (HBV) and those who developed hepatic failure during they carried HBV. The 11 patients with acute HBV infection had higher levels of alanine aminotransferase (mean +/- SD: 4943 +/- 2867 vs 1157 +/- 678 IU/L, P < 0.01), more often with a single peak (91% vs. 0%, P < 0.001), and lower total bilirubin level (15.3 +/- 4.4 vs 28.1 +/- 14.3 mg/1000 ml, P < 0.01) than the 13 patients with chronic HBV infection. Hepatitis B surface antigen was detected less often (55% vs. 100%, P < 0.05) and viral DNA polymerase less frequently (0% vs. 46%, P < 0.05) in the patients with acute than chronic HBV infection. Hepatitis B e antigen was detected in one (9%) patient with acute infection, less frequently than in six (46%) patients with chronic infection (P < 0.05). Mutations in the precore region was detected in HBV DNA clones from ten (91%) patients with acute infection and only in those from eight (62%) patients with chronic infection. All HBV DNA clones from the five (38%) patients with chronic infection that did not have precore mutations, however, possessed mutations in the core promoter. These results indicate that HBV mutants incapable of translating hepatitis B e antigen would play a major role in fulminant hepatic failure occurring after acute HBV infection. In contrast, HBV variants with core promoter mutations for reducing the transcription of hepatitis B e antigen would play an additional role in fulminant hepatic failure developing during chronic infection.
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Affiliation(s)
- K Inoue
- Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
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27
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Inoue K, Yoshiba M, Sekiyama K, Okamoto H, Mayumi M. Clinical and molecular virological differences between fulminant hepatic failures following acute and chronic infection with hepatitis B virus. J Med Virol 1998; 55:35-41. [PMID: 9580884 DOI: 10.1002/(sici)1096-9071(199805)55:1<35::aid-jmv7>3.0.co;2-p] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Clinical and molecular biological characteristics were compared between patients who presented with fulminant hepatic failure following acute infection with hepatitis B virus (HBV) and those who developed hepatic failure during they carried HBV. The 11 patients with acute HBV infection had higher levels of alanine aminotransferase (mean +/- SD: 4943 +/- 2867 vs 1157 +/- 678 IU/L, P < 0.01), more often with a single peak (91% vs. 0%, P < 0.001), and lower total bilirubin level (15.3 +/- 4.4 vs 28.1 +/- 14.3 mg/1000 ml, P < 0.01) than the 13 patients with chronic HBV infection. Hepatitis B surface antigen was detected less often (55% vs. 100%, P < 0.05) and viral DNA polymerase less frequently (0% vs. 46%, P < 0.05) in the patients with acute than chronic HBV infection. Hepatitis B e antigen was detected in one (9%) patient with acute infection, less frequently than in six (46%) patients with chronic infection (P < 0.05). Mutations in the precore region was detected in HBV DNA clones from ten (91%) patients with acute infection and only in those from eight (62%) patients with chronic infection. All HBV DNA clones from the five (38%) patients with chronic infection that did not have precore mutations, however, possessed mutations in the core promoter. These results indicate that HBV mutants incapable of translating hepatitis B e antigen would play a major role in fulminant hepatic failure occurring after acute HBV infection. In contrast, HBV variants with core promoter mutations for reducing the transcription of hepatitis B e antigen would play an additional role in fulminant hepatic failure developing during chronic infection.
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Affiliation(s)
- K Inoue
- Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
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28
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Inoue K, Yoshiba M, Sekiyama K. [Causal relationship between GBV-C and fulminant hepatitis]. Nihon Rinsho 1997; 55:578-82. [PMID: 9086761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
GBV-C is recently discovered RNA virus which appeared to be member of Flaviviridae. We previously reported the possible involvement of GBV-C in the etiology of fulminant hepatitis(FH). It is still controversial whether GBV-C cause FH. So far, the only reliable tool for the diagnosis of GBV-C is the detection of the viral genome using PCR. Detection of GBV-C in serum of patient with FH dose not necessarily mean that GBV-C is causal virus. Serial quantification of serum GBV-C RNA in patient with FH may reveal a pathogenetic role of GBV-C. Further study is needed to elucidate the relationship between FH and a specific strain of GBV-C.
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Affiliation(s)
- K Inoue
- Showa University Fujigaoka Hospital, Division of Gastroenterology
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Abstract
We report on a case of primary hepatic lymphoma that developed in a patient with chronic hepatitis C. Given that Japan is an area endemic for both hepatitis B and C viruses, we reviewed 51 Japanese cases of primary hepatic lymphoma, addressing the question as to whether the Japanese cases have unique characteristics and whether there is a causal relationship to the presence of chronic liver disease. Primary hepatic lymphoma most commonly affected middle-aged males. Presenting symptoms and physical findings were non-specific. Aminotransferases tended to stay in the low range compared with marked increases in lactate dehydrogenase. Sixteen patients (31%) had chronic liver disease, eight had liver cirrhosis and eight had chronic hepatitis, suggesting that there is a possible aetiological link between chronic liver disease and primary hepatic lymphoma.
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Affiliation(s)
- T Higuchi
- Division of Hematology, Showa University Fujigaoka Hospital, Yokohama, Japan
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30
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Abstract
Hepatitis A virus (HAV) usually causes an acute self-limited illness. This report describes a patient with hepatitis A whose serum aminotransferase activities remained above normal and whose serum was persistently positive for immunoglobulin (Ig) M class anti-hepatitis A 31 months after the onset of hepatitis. Liver biopsy carried out 11 months after the onset of hepatitis showed histological changes consistent with chronic hepatitis of moderate severity. HAV RNA was detected by polymerase chain reaction (PCR) in feces collected at the time of the liver biopsy. Furthermore, the patient developed esophageal varices 25 months after the onset of hepatitis. We believe this to be the first reported case in which persistent replication of HAV is implicated in chronic hepatitis with the potential to develop into liver cirrhosis.
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Affiliation(s)
- K Inoue
- Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
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31
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Abstract
PURPOSE To determine the imaging characteristics of fulminant hepatic failure at serial computed tomography (CT) and to assess if any CT findings have prognostic value. MATERIALS AND METHODS In 40 patients, 207 CT scans were analyzed retrospectively. Thirty-four patients had fulminant hepatic failure (acute in seven and subacute in 27), and six had late-onset hepatic failure. Twenty-one patients died of hepatic failure. CT was performed soon after the onset of coma and repeated weekly. Liver volume was measured by tracing the hepatic contour and summing the areas to estimate whole-liver volume. RESULTS Liver volumes in survivors (n = 19) and nonsurvivors (n = 21), respectively, were 1,090 cm3 +/- 300 and 830 cm3 +/- 240 at initial CT and 1,130 cm3 +/- 310 and 700 cm3 +/- 280 at last CT (P = .0001). III-defined hypoattenuating areas were noted in 20 patients and were distributed in a solitary (n = 13), multiple (n = 6), or diffuse (n = 1) pattern. At follow-up CT, the area of hypoattenuation increased in six patients (five nonsurvivors) and disappeared or markedly decreased in four survivors. An increase in or late occurrence of ascites was noted in 15 patients (14 nonsurvivors, P = .0001). CONCLUSION Liver volumes at the initial and last CT examinations and an increase in or late occurrence of ascites are useful prognostic findings.
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Affiliation(s)
- Y Itai
- Department of Radiology, University of Tsukuba, Japan
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32
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Abstract
The "McGurk effect" demonstrates that visual (lip-read) information is used during speech perception even when it is discrepant with auditory information. While this has been established as a robust effect in subjects from Western cultures, our own earlier results had suggested that Japanese subjects use visual information much less than American subjects do (Sekiyama & Tohkura, 1993). The present study examined whether Chinese subjects would also show a reduced McGurk effect due to their cultural similarities with the Japanese. The subjects were 14 native speakers of Chinese living in Japan. Stimuli consisted of 10 syllable (/ba/, /pa/, /ma/, /wa/, /da/, /ta/, /na/, /ga/, /ka/, /ra/) pronounced by two speakers, one Japanese and one American. Each auditory syllable was dubbed onto every, visual syllable within one speaker, resulting in 100 audiovisual stimuli in each language. The subjects' main task was to report what they thought they had heard while looking at and listening to the speaker while the stimuli were being uttered. Compared with previous results obtained with American subjects, the Chinese subjects showed a weaker McGurk effect. The results also showed that the magnitude of the McGurk effect depends on the length of time the Chinese subjects had lived in Japan. Factors that foster and alter the Chinese subjects' reliance on auditory information are discussed.
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33
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Abstract
Hepatitis A virus (HAV) usually causes an acute self-limited illness. This report describes a patient with hepatitis A whose serum aminotransferase activities remained above normal and whose serum was persistently positive for immunoglobulin (Ig) M class anti-hepatitis A 31 months after the onset of hepatitis. Liver biopsy carried out 11 months after the onset of hepatitis showed histological changes consistent with chronic hepatitis of moderate severity. HAV RNA was detected by polymerase chain reaction (PCR) in feces collected at the time of the liver biopsy. Furthermore, the patient developed esophageal varices 25 months after the onset of hepatitis. We believe this to be the first reported case in which persistent replication of HAV is implicated in chronic hepatitis with the potential to develop into liver cirrhosis.
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Affiliation(s)
- K Inoue
- Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
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34
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Abstract
The two most serious symptoms of fulminant hepatic failure are bleeding and hepatic coma. To overcome these problems, we developed an artificial liver support system comprising a combination of plasma exchange and hemodiafiltration using a high performance membrane. We treated 67 patients with fulminant hepatic failure. Of these, 65 patients (97.0%) regained normal consciousness, and 55 patients (80.9%) were kept alert as long as we continued to apply this system. All 7 patients (100%) with fulminant hepatitis caused by hepatitis A virus infection and 9 of 12 patients (75%) with fulminant hepatitis caused by acute hepatitis B (HB) virus infection survived. In addition, 7 of 15 HB virus carriers (46.7%) who developed fulminant hepatitis and 11 of 29 patients (37.9%) with fulminant hepatitis caused by non-A, non-B hepatitis viruses survived. The overall survival rate was 37 of 67 patients (55.2%). Our artificial liver support system allows as high a survival rate as liver transplantation.
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Affiliation(s)
- M Yoshiba
- Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama City, Japan
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35
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Yoshiba M, Inoue K, Sekiyama K. Hepatitis GB virus C. N Engl J Med 1996; 335:1392-3. [PMID: 8927065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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36
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Inoue K, Yoshiba M, Sekiyama K, Koh I, Fujita R. [Pathogenic mechanism of fulminant hepatic failure in HBs Ag carrier after withdrawal of cytotoxic chemotherapy]. Nihon Rinsho 1995; 53 Suppl:467-72. [PMID: 12442428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Affiliation(s)
- K Inoue
- Division of Gastroenterology, Showa University, Fujigaoka Hospital
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37
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Sekiyama K, Inoue K, Yoshiba M, Fujita R. [Clinical and immuno-virological aspects in type C fulminant hepatitis]. Nihon Rinsho 1995; 53 Suppl:534-40. [PMID: 7563817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- K Sekiyama
- Department of Medicine, Showa University Fujigaoka Hospital
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38
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Abstract
The prognosis of fulminant hepatitis due to non-A, non-B virus infection and acute reactivation of hepatitis B virus in HB carriers is generally poor, and the treatment of choice in Western countries is recognized as liver transplantation. In countries such as Japan where liver transplantation is not readily available, however, these intractable types of fulminant hepatitis have to be treated medically. Based on the assumption that persistent replication of causal viruses and enhanced host immune responses, especially cellular immunity, to eradicate the viruses are the key mechanism in progressive liver cell destruction and the poor prognosis, we attempted a combination treatment with interferon and cyclosporin A for these types of fulminant viral hepatitis. Subjects in the present study consisted of 1 patient with acute severe hepatitis without coma and 13 patients with coma (13 with fulminant hepatic failure) due to non-A, non-B virus and acute reactivation of hepatitis B virus. The patients were given interferon-beta, 300 x 10(4) U daily, and cyclosporin A, at an initial dose of 3 mg/kg, with tapering. Fourteen patients with coma received artificial liver support that we devised. The patient with acute severe hepatitis survived, showing histologically remarkable liver regeneration. Eight of the 14 patients with hepatic coma, all of whom were indications for liver transplantation according to the criteria of the King's College group, survived. Decreased transaminase level, increased liver volume, and histological liver regeneration were observed in all the survivors. The combination of interferon and cyclosporin A is worth attempting in fulminant hepatitis caused by non-A, non-B virus and acute reactivation of hepatitis B virus in HB carriers.
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Affiliation(s)
- M Yoshiba
- Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
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39
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Yoshiba M, Inoue K, Sekiyama K. [Interferon treatment of type C fulminant hepatitis]. Nihon Rinsho 1994; 52:1857-1864. [PMID: 7521431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
On the contrary to Western countries, there are a substantial number of patients with type C fulminant hepatitis (FH) including coinfection on type A and type B hepatitis in Asian countries. The pathogenesis of FH is not fully understood, however, recent clinical observations suggest that enhanced host immune responses contribute to hepatocyte destruction in type C FH. In contrast to type B FH, type C FH is characterized by gradual and continuous liver necrosis probably duo to persistent infection of hepatitis C virus. Administration of interferon with immunosuppressive agents is the treatment of choice. Prognosis may be improved if the treatment is started in the early stage of the disease.
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Affiliation(s)
- M Yoshiba
- Division of Gastroenterology, Showa University Fujigaoka Hospital
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40
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Isoyama K, Tada J, Ishikawa A, Sekiyama K, Yoshiba M, Yoshida M [corrected to Yoshiba M]. Surgical or medical treatment for fulminant hepatic failure in children. Lancet 1994; 343:859. [PMID: 7908107 DOI: 10.1016/s0140-6736(94)92063-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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41
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Abstract
Serial hepatic volumetry calculated from the liver area on abdominal computed tomography was performed in 19 patients with fulminant hepatic failure to determine a relationship between liver volume and prognosis. All patients received intensified artificial liver support comprised of plasma exchange and hemodiafiltration using high-performance membranes, and 10 patients survived. Liver volume was significantly larger in survivors than in nonsurvivors, both in an initial volumetry performed at the onset of coma and in subsequent volumetry performed 10-20 days after the onset of coma. The difference became more significant in the subsequent volumetry because of the recovery of liver size in some of the survivors and progressive liver shrinkage in all nonsurvivors. All patients with a liver volume greater than 656 ml at 10-20 days after the onset of coma survived, whereas all but one patient with a liver volume less than that died. Multivariate analysis revealed only liver volume in subsequent volumetry had discriminatory power upon prognosis among six prognostic factors. These observations imply that in order to obtain an accurate prediction of fulminant hepatic failure by hepatic volumetry, serial studies at least until 10-20 days after the onset of coma are necessary.
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Affiliation(s)
- K Sekiyama
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
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44
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Yoshiba M, Sekiyama K, Iwabuchi S, Takatori M, Tanaka Y, Uchikoshi T, Okamoto H, Inoue K, Sugata F. Recurrent fulminant hepatic failure in an HB carrier after intensive chemotherapy. Dig Dis Sci 1993; 38:1751-5. [PMID: 8359090 DOI: 10.1007/bf01303187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- M Yoshiba
- Division of Gastroenterology, Showa University, Fujigaoka Hospital, Yokohama, Japan
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Yoshiba M, Sekiyama K, Iwamura Y, Sugata F. Development of reliable artificial liver support (ALS)--plasma exchange in combination with hemodiafiltration using high-performance membranes. Dig Dis Sci 1993; 38:469-76. [PMID: 8444078 PMCID: PMC7101817 DOI: 10.1007/bf01316501] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A new artificial liver support system (ALSS) consisting of plasma exchange (PE) in combination with hemodiafiltration (HDF) using high-performance membranes of polymethyl methacrylate (PMMA) and cellulose triacetate (CTA) was developed to efficiently remove middle molecules from plasma and treat fulminant hepatic failure (FHF) complicated by the onset of hepatic coma. Twenty-seven patients with FHF due to viral hepatitis, two with type A (HA), nine with type B (HB), and 16 with type non-A, non-B (NANB) underwent therapy with this new ALSS over the last five years. Three patients with an exacerbation of chronic HB and 15/16 with type NANB hepatitis were treated with interferon (IFN) also. Of these, 25 patients (92.6%) regained consciousness and 15 (55.6%) [1/2 (50%) with type A, 6/9 (66.7%) with type B and 8/16 (50%) with type NANB hepatitis] survived. Including four patients who survived with intensive care and plasma exchange alone, 19/31 (61.3%) patients survived. Because of its biocompatibility, both survivors and nonsurvivors could be sustained with the ALSS without complications for long periods (19.3 days for the survivors and 32.4 days for nonsurvivors). With this ALSS the ability to sustain life for such prolonged periods allows hepatic regeneration to occur and result in patient survival. It is anticipated that this new ALSS will not only be of value in cases of fulminant hepatic failure but that it may also play a role in sustaining life for those awaiting liver transplantation.
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Affiliation(s)
- M Yoshiba
- Department of Medicine, Showa University Fujigaoka Hospital, Yokohama City, Japan
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46
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Yoshiba M, Sekiyama K, Sugata F, Okamoto H, Yamamoto K, Yotsumoto S. Reactivation of precore mutant hepatitis B virus leading to fulminant hepatic failure following cytotoxic treatment. Dig Dis Sci 1992; 37:1253-9. [PMID: 1499451 DOI: 10.1007/bf01296569] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Three hepatitis B virus carriers who were HB(e)Ag negative and having normal liver function developed fulminant hepatitis with evidence of HBV replication following intensive chemotherapy for non-Hodgkin's lymphoma. Each was continuously negative for HB(e)Ag. Analysis of the precore region of HBV isolated from each demonstrated that the HBV of each had a point mutation in the precore region that inhibited the synthesis and the release of hepatitis B(e) antigen. This observation suggests that all HB carriers receiving either immunosuppressive or cytotoxic therapy should be monitored closely even if standard assays suggest that viral replication is not present. Sudden enhanced replication of a HBV mutant as a result of such therapy can be a cause of either very severe hepatitis or occasionally fulminant hepatitis.
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Affiliation(s)
- M Yoshiba
- Division of Gastroenterology, Showa University, Fujigaoka Hospital, Yokohama, Japan
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47
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Tsubouchi H, Kawakami S, Hirono S, Miyazaki H, Kimoto M, Arima T, Sekiyama K, Yoshiba M, Arakaki N, Daikuhara Y. Prediction of outcome in fulminant hepatic failure by serum human hepatocyte growth factor. Lancet 1992; 340:307. [PMID: 1353217 DOI: 10.1016/0140-6736(92)92396-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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48
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49
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Yoshiba M, Sekiyama K, Sugata F, Kawamoto Y, Muraoka H, Aoyama M. Post-transfusion fulminant hepatitis B after screening for hepatitis B virus core antibody. Lancet 1992; 339:253-4. [PMID: 1346219 DOI: 10.1016/0140-6736(92)90067-d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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50
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Yoshiba M, Sekiyama K. [Plasmapheresis for chronic liver failure]. Nihon Rinsho 1992; 50 Suppl:229-35. [PMID: 1578683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- M Yoshiba
- Division of Gastroenterology, Showa University, Fujigaoka Hospital
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