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Mizuta K.,Jichi Medical University | Urahashi T.,Jichi Medical University | Ihara Y.,Jichi Medical University | Sanada Y.,Jichi Medical University | And 5 more authors.
Transplantation Proceedings | Year: 2012

Objectives: The aim of this study was to evaluate patients who developed varicella zoster virus (VZV) disease after pediatric living donor liver transplantation (PLDLT). Methods: Two hundred fifty-five patients who underwent PLDLT between 1995 and 2010 were included in this study. Pretransplantation vaccination of VZV was performed for all recipients except emergency PLDLTs. Posttransplantation VZV vaccination was administered to the patients with a low VZV antibody titer 2 years or more after transplantation. The clinical course and outcomes of VZV disease in cases were reviewed with the transplant database and hospital medical records. Results: Sixty-three patients developed VZV disease (chicken pox in 61, herpes zoster in 2) at a median onset of 36 months after PLDLT and at a median age of 4 years old, with a cumulative incidence of 25%. All chicken pox occurred in VZV antibody-negative patients. The onset of herpes zoster in the two patients occurred within 3 months after PLDLT; in addition, these patients were VZV antibody-positive patients. The clinical presentations of most patients were not serious and there were no disseminated infections. Although only 3 patients (5%) were hospitalized, the other 60 patients (95%) all showed a good response to oral antiviral therapy. Conclusions: Although VZV disease is an infectious disease with a high morbidity rate after PLDLT, it can normally be successfully managed on an outpatient basis at home. Pre- and posttransplantation vaccinations are effective for delaying the onset of chicken pox after PLDLT and to prevent it from developing into a serious illness. © 2012 Elsevier Inc. All rights reserved.

Sanada Y.,Jichi Medical University | Mizuta K.,Jichi Medical University | Nakata M.,Jichi Medical University | Urahashi T.,Jichi Medical University | And 6 more authors.
Acta Hepatologica Japonica | Year: 2010

[Background] In patients with a congenital extrahepatic portosystemic shunt (CEPS), surgical treatments are indicated for those patients who are refractory to medical treatment. We herein report our experience with 2 patients who successfully underwent ligation of the shunt vessels for symptomatic CEPS. [Case 1] An 8-year-old male patient who diagnosed with ductus venosus and multiple liver tumors during a school examination was observed to have enlarged tumors, and ligation of the ductus venosus was therefore performed. Liver tumors were found to be reduced at the time of the 1.5-year of follow-up examination. [Case 2] A 1.3-year-old female patient who at birth was found to have a shunt vessel, in which mesenteric venous blood drained directly into the suprarenal inferior vena cava, was observed to have progressive hepatopulomonary syndrome, and ligation of the shunt vessel was therefore performed. The patient's hepatopulomonary syndrome considerably improved at the time of the 0.8- year of follow-up examination. [Conclusion] Surgical treatments for patients with symptomatic CEPS should be performed without delay because of radical treatment for various complications. Pre-operative assessment of intrahepatic portal vein and measurement of portal vein pressure are essential for choosing the optimal surgical treatment. © 2010 The Japan Society of Hepatology.

Saito I.,Keio University | Kario K.,Jichi Medical University | Kushiro T.,Nihon University | Teramukai S.,Kyoto University | And 4 more authors.
Hypertension Research | Year: 2013

On the basis of the studies that investigated the relationship between baseline clinic blood pressure (CBP) or home blood pressure (HBP) values and cardiovascular (CV) events, HBP has been reported to have a stronger prognostic ability. However, few studies have compared the prognostic ability of on-treatment CBP and HBP. The relationship between on-treatment HBP, measured twice in the morning and twice at bedtime, and CV events was investigated in over 20 000 patients in the HONEST (Home blood pressure measurement with Olmesartan Naive patients to Establish Standard Target blood pressure) Study, a prospective, 2-year observational study of treatment with an angiotensin receptor blocker, olmesartan (OLM), in OLM-naive hypertensive patients. This report summarizes the study protocol, the baseline characteristics of the patients and CBP and HBP at 16 weeks. A total of 22 373 patients were registered across Japan; baseline data from 22 162 patients were collected. Baseline HBP (mean±s.d.) in the morning (the first measurement) was 151.6±16.4/87.1±11.8 mm Hg and at bedtime was 144.3±16.8/ 82.8±11.9 mm Hg, whereas CBP was 153.6±19.0/87.1±13.4 mm Hg. At 16 weeks, morning HBP was 135.0±13.7/78.8±9.9 mm Hg and bedtime HBP was 129.7±13.8/74.7±10.1 mm Hg, whereas CBP was 135.6±15.4/77.6±10.9 mm Hg. The follow-up period for each patient ends on 30 September 2012. The HONEST Study is expected to provide evidence showing the relationship between baseline and on-treatment CBP and HBP levels (both first and second measurements) and CV events. © 2013 The Japanese Society of Hypertension All rights reserved.

Ishizawa M.,Juntendo Tokyo Koto Geriatric Medical Center | Matsumoto S.,Juntendo Tokyo Koto Geriatric Medical Center | Tajima K.,Juntendo Tokyo Koto Geriatric Medical Center | Konishi R.,Oyama Municipal Hospital | Mitsuhata H.,Juntendo Tokyo Koto Geriatric Medical Center
Japanese Journal of Anesthesiology | Year: 2012

A 51-year-old woman was scheduled for emergency enterectomy and vascular repair under general anesthesia for active bleeding from internal iliac artery caused by repeated radiotherapy for cervical cancer and subsequent hypovolemic shock. For the first two hours of operation, the blood loss exceeded 6,000 ml and the hemoglobin level decreased to a low of 3.8 g·dl-1 despite administration of 38 units of packed red cells. Intraoperative blood salvage was used in order to minimize further loss of hemoglobin. Mild hypothermia technique was also introduced to prevent brain ischemia. Total bleeding volume was approximately 10,000 ml, and total transfused volume was 8,740 ml. No neurological deficit and no systemic infection were found during the postoperative course. Although clinical risks of cell salvage in patients undergoing surgery for malignant tumor remain controversial, we conclude intraoperative blood salvage using Cell Saver® could be utilized as a life-saving means and mild hypothermia might have been efficacious for protecting the brain from ischemia in our case.

Mizuta K.,Jichi Medical University | Urahashi T.,Jichi Medical University | Ihara Y.,Jichi Medical University | Sanada Y.,Jichi Medical University | And 10 more authors.
Transplantation Proceedings | Year: 2012

Objectives: Cholestatic liver disease (CLD) is the main indication for liver transplantation in children. This retrospective study evaluated the outcomes of living donor liver transplantation (LDLT) in children with CLD. Methods: One hundred fifty-nine children with CLD who underwent 164 LDLT between May 2001 and May 2011 were evaluated. Their original diseases were biliary atresia (n = 145, 91%), Alagille syndrome (n = 8, 5%), primary sclerosing cholangitis (n = 2), and the others (n = 4). The mean age and body weight of the recipients at LDLT was 42 ± 53 months and 14.0 ± 11.0 kg, respectively. Results: Parents were living donors in 98%. The left lateral segment was the most common type of graft (77%). There were no reoperations and no mortality in any living donor. Recipients' postoperative surgical complications consisted mainly of hepatic arterial problems (7%), hepatic vein stenosis (5%), portal vein stenosis (13%), biliary stricture (18%), intestinal perforation (3%). The overall rejection rate was 31%. Cytomegalovirus infection and Epstein-Barr virus disease were observed in 26% and 5%, respectively. Retransplantation was performed five times in four patients; the main cause was hepatic vein stenosis (n = 3). Four patients died; the main cause was gastrointestinal perforation (n = 2). The body height of Alagille syndrome patients less than 2 years old significantly improved compared with older patients after LDLT. The 1-, 5-, and 10-year patient survival rates were 98%, 97%, and 97%, respectively. Conclusions: LDLT for CLD is an effective treatment with excellent long-term outcomes. © 2012 by Elsevier Inc. All rights reserved.

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