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Mitsukawa N.,Chiba University | Saiga A.,St Marys Hospital | Akita S.,Chiba University | Kubota Y.,Chiba University | And 2 more authors.
Annals of Plastic Surgery | Year: 2015

One-stage repair is a conventional treatment of hypospadias. If hypospadias is severe as in the scrotal type and perineal type, penile curvature sometimes cannot be corrected by dorsal midline plication alone. In addition to resection of the urethral plate, ventral grafting becomes necessary for insufficient skin and subcutaneous tissue. In recent years, there has been renewed interest in 2-stage repair for such severe cases and salvage of failed cases with scarring. In the present study, novel 2-stage urethroplasty was performed in 6 cases to repair severe proximal hypospadias which required resection of the urethral plate. This novel method consisted of a combination of a modified Bracka method using oral mucosal grafts and a modified Byars flap of the dorsal foreskin. Good results were obtained using this novel method. Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.

Fukuda K.,Kochi Medical School | Ishida W.,Kochi Medical School | Uchiyama J.,Kochi Medical School | Rashel M.,Kochi Medical School | And 7 more authors.
PLoS ONE | Year: 2012

The therapeutic effects of bacteriophage (phage) KPP12 in Pseudomonas aeruginosa keratitis were investigated in mice. Morphological analysis showed that phage KPP12 is a member of the family Myoviridae, morphotype A1, and DNA sequence analysis revealed that phage KPP12 is similar to PB1-like viruses. Analysis of the phage KPP12 genome did not identify any genes related to drug resistance, pathogenicity or lysogenicity, and so phage KPP12 may be a good candidate for therapeutic. KPP12 showed a broad host range for P. aeruginosa strains isolated from clinical ophthalmic infections. Inoculation of the scarified cornea with P. aeruginosa caused severe keratitis and eventual corneal perforation. Subsequent single-dose administration of KPP12 eye-drops significantly improved disease outcome, and preserved the structural integrity and transparency of the infected cornea. KPP12 treatment resulted in the suppression of neutrophil infiltration and greatly enhanced bacterial clearance in the infected cornea. These results indicate that bacteriophage eye-drops may be a novel adjunctive or alternative therapeutic agent for the treatment of infectious keratitis secondary to antibiotic-resistant bacteria. © 2012 Fukuda et al.

Mibu K.,Kochi Medical School Hospital | Yatabe T.,Kochi Medical School | Hanazaki K.,Kochi Medical School
Journal of Artificial Organs | Year: 2012

Blood glucose management is one of the important therapies in the intensive care unit (ICU). However, blood glucose management using the sliding-scale method increases the workload of ICU nurses. An artificial pancreas, STG-22, has been developed to continuously monitor blood glucose levels and to maintain them at appropriate levels. In this study, we examined the hypothesis that compared to conventional methods, blood glucose management using the STG-22 reduces the workload of ICU nurses and has a positive impact on awareness regarding the management of blood glucose. This study included 45 patients who underwent elective surgery and were treated at the ICU postoperatively. The patients were separated into the following two groups: (1) blood glucose was maintained using the STG-22 (AP group) and (2) blood glucose was maintained using the sliding-scale method (SS group). In addition, a questionnaire was developed for an awareness survey of ICU nurses (N = 20). The frequency of blood sampling and number of double checks were significantly lower in the AP group (1.3 ± 1.4 vs. 8.9 ± 8.1 times/admission, P < 0.001; 1.0 ± 1.4 vs. 9.8 ± 8.5 times/admission, P < 0.001). The time needed for glucose management per admission was significantly shorter in the AP group (9 ± 13 vs. 27 ± 24 min/admission; P = 0.003). Use of STG-22 for glucose management in the ICU increased the degree of attention given by nurses to glucose management and contributed to an improved sense of security. In conclusion, using the STG-22 in the ICU reduces the workload of ICU nurses compared to using the sliding-scale method. It also contributed to the reduction of the ICU nurses' anxiety related to the management of blood glucose. © 2011 The Japanese Society for Artificial Organs.

Akita S.,Chiba Cancer Center | Mitsukawa N.,Chiba University | Rikihisa N.,Chiba Rosai Hospital | Kuriyama M.,Kochi Medical School Hospital | And 6 more authors.
Microsurgery | Year: 2014

Background Reconstruction of the great toe defect is difficult. The most distal point of the rotation arc of a retrograde-flow medial plantar flap is the plantar side of the proximal phalanx. The purpose of this report was to present a new procedure that extends the rotation arc of this flap. Results of anatomic study and application in two patients were presented. Methods An anatomical study was conducted on 10 freshly frozen cadavers to determine the rotation arc of the medial plantar flap based distally on the lateral plantar vessels. To enable anterograde venous drainage, two accompanying veins of the vascular pedicle were separated and anastomosed to each other. This surgical procedure was implemented in two clinical cases with the great toe defect. The maximum size of the elevated flap was 4 × 7 cm. The status of venous congestion of the flap was determined using the blood glucose measurement index. Results We confirmed that the rotation arc of the medial plantar flap based distally on the lateral plantar vessels could reach the tip of the great toe, preserving all lateral plantar nerves and plantar metatarsal arteries. In the two cases, the congestion of the flap improved with anterograde venous drainage and the flaps survived completely. Conclusion A pedicled medial plantar flap with anterograde venous drainage may be a useful alternative option for the reconstruction of relatively large great toe defects. © 2014 Wiley Periodicals, Inc. Microsurgery 34:398-403, 2014. © 2014 Wiley Periodicals, Inc.

Akita S.,Chiba Cancer Center | Mitsukawa N.,Chiba University | Kuriyama M.,Kochi Medical School Hospital | Hasegawa M.,Chiba University | And 5 more authors.
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2014

Background: The best therapeutic approach for patients with sub-clinical lymphoedema and symptomatic early-stage lymphoedema has not been determined yet. Methods: The prognosis of lymphatic function after lymphadenectomy for gynaecological cancer was observed in a cohort study of 192 lower limbs. Lymphatic function was evaluated by indocyanine green lymphography. Splash patterns were examined to determine if patients with this pattern tended to progress to symptomatic lymphoedema, and the efficacy of the compression therapy was also investigated. We also investigated the efficacy of lymphaticovenular anastomosis (LVA) in patients who exhibited a stardust pattern. Results: Patients with splash patterns on lymphography may progress to symptomatic lymphoedema with a significantly higher frequency compared with the others, with a relative ratio of 1.62. Compression therapy did not slow the progression of patients with splash patterns to stardust patterns. LVA for the patients who had recently shown stardust patterns eliminated the need for compression therapy in 44.8% of patients. Conclusion: Patients with splash patterns should be followed up carefully for sub-clinical lymphoedema. However, there is no method to completely prevent these patients from developing stardust patterns associated with symptomatic lymphoedema. When patients become symptomatic, their lymphatic function may be improved by LVA. However, the limited effectiveness of this procedure should be clearly explained to patients before surgery. © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

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