19 results on '"Kiyotaka Kawai"'
Search Results
2. Laparoscopic surgery for sigmoid colon cancer with complicated communication between the superior and inferior mesenteric arteries
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Satoru Kawai, Atsushi Ogura, Satoaki Kamiya, Kiyotaka Kawai, Ryutaro Kobayashi, Masanori Sando, Kenji Takagi, Takashi Maeda, Natsuki Nagano, and Konosuke Yogo
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Left colic artery ,medicine.medical_specialty ,business.industry ,General Medicine ,medicine.disease ,Inferior mesenteric artery ,Surgery ,Vascular anomaly ,03 medical and health sciences ,Stenosis ,Middle colic artery ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,medicine.artery ,medicine ,030211 gastroenterology & hepatology ,Superior mesenteric artery ,business ,Median arcuate ligament syndrome ,Mesenteric arteries - Abstract
To perform complete mesocolic excision with central vessel ligation, it is important to recognize the vessel anomaly and the location of the tumor. For left-sided colon cancer, the variations in the course of the left colic artery and accessary middle colic artery must be recognized preoperatively. Here, we describe our experience with a 57-year-old man who was diagnosed with sigmoid colon cancer with complicated inter-mesenteric connections between the inferior mesenteric artery (IMA) and superior mesenteric artery (SMA), possibly due to median arcuate ligament syndrome. We performed laparoscopic sigmoidectomy with low ligation of the IMA to preserve the extremely enlarged left colic artery. The total operative time was 155 minutes, and the estimated total blood loss was 10 mL. The patient was discharged on postoperative day 9 without any postoperative complications. For patients with vascular anomalies in the left-sided mesocolon, preoperatively ruling out SMA stenosis by using angiography and 3-D CT might be important.
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- 2020
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3. Gallbladder Carcinoma with Segmental Adenomyomatosis Causing Multicentric Carcinogenesis—A Case Report
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Satoaki Kamiya, Natsuki Nagano, Kiyotaka Kawai, Takashi Maeda, Satoru Kawai, and Kenji Takagi
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Pathology ,medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Gallbladder ,Carcinoma ,medicine ,Multicentric carcinogenesis ,medicine.disease ,business ,Adenomyomatosis - Published
- 2020
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4. Cranial-first approach of laparoscopic left colectomy for T4 descending colon cancer invading the Gerota’s fascia
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Atsushi Ogura, Kiyotaka Kawai, Natsuki Nagano, Satoaki Kamiya, Satoru Kawai, Takashi Maeda, Ryutaro Kobayashi, Kenji Takagi, and Tsukasa Aritake
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Gerota's fascia ,medicine.medical_specialty ,Cranial-first approach ,business.industry ,Colorectal cancer ,Left colectomy ,lcsh:Surgery ,Cancer ,Case Report ,Fascia ,lcsh:RD1-811 ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Resection margin ,medicine ,Descending colon cancer ,Pancreas ,business ,T4 colon cancer - Abstract
Background The safety and feasibility of laparoscopic colectomy for T4 colorectal cancer remain controversial. We believe that setting a “Goal” that will guide the surgeons in returning from the deep layer could be the key to safe en bloc resection of neighboring organs. For descending colon cancer, the cranial-first approach makes it possible to clearly visualize the pancreas and origin of the transverse mesocolon, leading to safe splenic flexure mobilization and complete mesocolic excision, which is the strongest advantage of this approach. Case presentation A 75-year-old woman was diagnosed with T4 descending colon cancer invading the Gerota’s fascia. We performed laparoscopic left colectomy using the cranial-first approach to set a “Goal” at the inferior border of the pancreas for safe resection of the Gerota’s fascia. The total operative time was 233 min, and the estimated blood loss was 98 ml. She was discharged after surgery without postoperative complications. Pathological findings revealed the invasion into the Gerota’s fascia, and the resection margin was negative for cancer. Conclusions The cranial-first approach of laparoscopic left colectomy appears to be safe and feasible and could be a promising method for selected patients with T4 descending colon cancer invading the Gerota’s fascia.
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- 2019
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5. Piezo-ICSI for Human Oocytes
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Takako Suhara, Akira Kuga, Manami Isuge, Masaru Hayashi, Kiyotaka Kawai, Tetsuya Kaji, Yuko Kamada, Kumi Ohuchi, and Kenichiro Hiraoka
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Male ,General Chemical Engineering ,medicine.medical_treatment ,Fertilization in Vitro ,General Biochemistry, Genetics and Molecular Biology ,Intracytoplasmic sperm injection ,Andrology ,Human fertilization ,medicine ,Humans ,Sperm Injections, Intracytoplasmic ,Zona pellucida ,reproductive and urinary physiology ,Assisted reproductive technology ,General Immunology and Microbiology ,urogenital system ,business.industry ,General Neuroscience ,Pipette ,Oocyte ,Spermatozoa ,medicine.anatomical_structure ,Membrane Breakage ,embryonic structures ,Oocytes ,Female ,business ,therapeutics - Abstract
Since the first successful pregnancies achieved by intracytoplasmic sperm injection (ICSI) were reported, ICSI has become an essential technique in assisted reproductive technology (ART). ICSI uses micropipettes with a spiking tip to penetrate the zona pellucida and membrane. Then, the cytoplasm is usually aspirated into the micropipette for membrane breakage (conventional-ICSI). The survival and fertilization rates of mouse oocytes after conventional-ICSI were as low as 16% and 8%, respectively. Kimura and Yanagimachi applied a piezo drive unit, mercury, and a micropipette with a flat tip for mouse ICSI. The membrane breakage could be performed semi-automatically by combining these types of equipment without cytoplasmic aspiration into the micropipette (piezo-ICSI). These authors reported significantly higher survival and fertilization rates (80% and 78%) compared to those of conventional-ICSI (16% and 8%). Therefore, the piezo-ICSI may be effective not only for mouse oocytes but also for human oocyte ICSI. However, only five papers are available that assessed the effectiveness of piezo-ICSI compared to conventional-ICSI for human oocytes. All of these five papers reported significantly higher fertilization rates compared to those of conventional-ICSI. The goal of the piezo-ICSI protocol described here is to improve the clinical results of ICSI compared to the conventional-ICSI.
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- 2021
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6. Argon plasma coagulation for successful treatment of bile leakage after subtotal cholecystectomy
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Ryutaro Kobayashi, Satoru Kawai, Tsukasa Aritake, Takashi Maeda, Kiyotaka Kawai, Kenji Takagi, Satoaki Kamiya, and Natsuki Nagano
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Gallbladder ,Subtotal cholecystectomy ,Perforation (oil well) ,lcsh:Surgery ,Argon plasma coagulation ,Hepatoduodenal ligament ,Case Report ,lcsh:RD1-811 ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Bile leakage ,Laparotomy ,Cauterization ,Cholecystitis ,Medicine ,Abdomen ,business - Abstract
Background Subtotal cholecystectomy is an effective surgical method to decrease the risk of complications for gallbladders that are difficult to remove. However, there is a risk for postoperative refractory bile leakage through the gallbladder stump. Here, we report a new management technique involving the use of argon plasma coagulation (APC) to stop bile leakage after a subtotal cholecystectomy. Case presentation A 74-year-old man was referred to our hospital for abdominal pain and fever. Contrast-enhanced computed tomography of the abdomen showed fluid collection, such as an abscess, surrounding the gallbladder and hepatic flexure colon. The patient was diagnosed with colonic perforative peritonitis, and he underwent emergency surgery. On laparotomy, the abscess was observed outside of the hepatic flexure colon and gallbladder necrosis was detected. The neck of the gallbladder and the area close to the hepatoduodenal ligament was severely inflamed prohibiting dissection. The hepatic flexure colon was part of the abscess wall, and resection was needed. A subtotal cholecystectomy and right hemicolectomy confirmed peritonitis caused by cholecystic perforation. The mucous membrane of the gallbladder neck that remained was necrotic or detached. Therefore, the stump of the gallbladder was closed by primary sutures without cauterization of the mucosa. On postoperative day 6, bile leakage from the gallbladder stump was revealed. Percutaneous and endoscopic retrograde cholangiography drainage were performed. However, the liquid, which seemed to be secreted from the mucosa of the remnant gallbladder, was continuously obtained. We used APC to cauterize the gallbladder mucosa through the fistula of the abdominal drainage tube. Bile leakage and mucus discharge were improved after three rounds of APC cauterization. Conclusions APC effectively treated refractory bile leakage from a gallbladder stump after subtotal cholecystectomy for severe cholecystitis.
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- 2020
7. Complete Resection without Any Ostomies by Laparoscopic Extended Surgery for Locally Advanced T4 Sigmoid Colon Cancer Invading the Urinary Bladder and Ureter
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Natsuki Nagano, Shigeki Yamamoto, Ryutaro Kobayashi, Atsushi Ogura, Kenji Takagi, Kiyotaka Kawai, Takashi Maeda, Satoaki Kamiya, Satoru Kawai, and Tsukasa Aritake
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Laparoscopic surgery ,medicine.medical_specialty ,Urinary bladder ,Colorectal cancer ,business.industry ,Urinary system ,medicine.medical_treatment ,Locally advanced ,lcsh:Surgery ,Case Report ,lcsh:RD1-811 ,medicine.disease ,Complete resection ,Surgery ,Extended surgery ,medicine.anatomical_structure ,Ureter ,medicine ,Pharmacology (medical) ,business - Abstract
The feasibility and safety of laparoscopic surgery for locally advanced colorectal cancer remain controversial due to the high rate of incomplete resection and conversion to open surgery. Especially for T4 colorectal cancer, laparoscopic techniques are still demanding mainly because of the difficulty in distinguishing between inflammation and tumor involvement, which often lead surgeons to do overtreatment in surgery. We believe laparoscopic magnified and multidirectional approach might be useful for pathologically complete resection and minimizing an unnecessary extended surgery for these cases. A 49-year-old man was diagnosed with locally advanced T4 sigmoid colon cancer invading the urinary bladder and ureter. We performed laparoscopic anterior resection with en bloc resection of the urinary bladder and the left ureter. Total operative time was 462 min, and the estimated blood loss was 50 ml. This patient was discharged on the 28th day after surgery without any ostomies and urinary functional disorders. The magnified view by laparoscopic techniques from multiple directions would enable surgeons to set surgical landmarks for another approach, which is the key for safe and feasible laparoscopic surgery in patients with locally advanced T4 colorectal cancer.
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- 2019
8. Random-start ovarian stimulation with aromatase inhibitor for fertility preservation in women with Japanese breast cancer
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Tatsuya Harada, Kiyotaka Kawai, Takashi Nakasuji, Shiho Takeuchi, Tomonori Ishikawa, Kazuko Nara, Nobuyuki Kidera, Naoyuki Miyasaka, Kaori Teraoka, and Tomoko Miyagawa
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0301 basic medicine ,endocrine system ,lcsh:QH471-489 ,medicine.drug_class ,fertility preservation ,Stimulation ,Luteal phase ,lcsh:Diseases of the endocrine glands. Clinical endocrinology ,Andrology ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,breast cancer ,Follicular phase ,medicine ,lcsh:Reproduction ,Fertility preservation ,030219 obstetrics & reproductive medicine ,Aromatase inhibitor ,lcsh:RC648-665 ,business.industry ,Cancer ,Cell Biology ,Original Articles ,medicine.disease ,Oocyte ,030104 developmental biology ,medicine.anatomical_structure ,Reproductive Medicine ,aromatase inhibitor ,Original Article ,double ovarian stimulation ,business ,random-start - Abstract
Purpose Fertility preservation is an important issue for young cancer patients. Random‐start controlled ovarian stimulation and double ovarian stimulation have been proposed for efficient oocyte retrieval within the limited time before cancer therapy. We aimed to clarify the efficacy of these new protocols within the Japanese population. Methods We performed a retrospective observational study at a multicenter from February 2012 to August 2017. The study entailed 50 cycles with 34 patients who underwent fertility preservation due to breast cancer. Follicular phase or luteal phase ovarian stimulation with aromatase inhibitor was performed. A second ovarian stimulation was started with or without waiting until the next menstruation. We measured the number of retrieved oocytes and cryopreserved oocytes/embryos, the ratio of mature oocytes, and the fertilization rate. Results The numbers of retrieved oocytes and frozen oocytes/embryos were not significantly different between follicular phase and luteal phase ovarian stimulation. The number of retrieved oocytes was not reduced at the second ovum pick up compared to the first ovum pick up in the double ovarian stimulation. Conclusions Random‐start controlled ovarian stimulation and double ovarian stimulation with aromatase inhibitor for breast cancer patients were effective protocols for retrieving a greater number of oocytes within the limited time.
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- 2018
9. Effects of sperm direction in Piezo-ICSI on oocyte survival, fertilization, embryo development and implantation ability in humans: A preliminary study
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Seiji Kitamura, Kiyotaka Kawai, Kenichiro Hiraoka, Tomonori Ishikawa, Yoshihito Otsuka, and Tatsuya Harada
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0301 basic medicine ,Pregnancy ,030219 obstetrics & reproductive medicine ,business.industry ,medicine.medical_treatment ,Embryogenesis ,Obstetrics and Gynecology ,Embryo ,Oocyte ,medicine.disease ,Sperm ,Intracytoplasmic sperm injection ,Andrology ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,medicine.anatomical_structure ,Human fertilization ,medicine ,business ,Live birth - Abstract
Aims The objective of this study was to investigate the effect of the head-first or tail-first injection of sperm into the cytoplasm by Piezo-ICSI (PICSI) on oocyte survival, fertilization, embryo development and implantation ability in humans. Methods We retrospectively investigated 632 mature oocytes retrieved from 152 infertile patients who attended our PICSI-ET program at the Niji Clinic between October 2010 and January 2014. Of these, 342 mature oocytes retrieved from 75 patients were injected with sperm head first, and 290 mature oocytes retrieved from 77 patients were injected with sperm tail first into the cytoplasm. The rates of oocyte survival, fertilization, good-quality day-3 embryos, pregnancy, implantation and live birth were evaluated in both groups. Results There were no differences among the two groups with respect to survival, fertilization, good-quality day-3 embryos, pregnancy, implantation and live birth rates. Conclusion Sperm direction (i.e., head first or tail first) does not influence the outcome of PICSI in human oocytes, including oocyte survival, fertilization, embryo development and implantation ability. These findings contribute to an understanding of factors that influence the success of human intracytoplasmic sperm injection (ICSI) techniques.
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- 2018
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10. Parental age and gene expression profiles in individual human blastocysts
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Toshiro Kubota, Rikikazu Sugiyama, Tomonori Ishikawa, Fumitoshi Ishino, Tatsuya Harada, Atsumi Yoshida, Osamu Tsutsumi, Takashi Kohda, Toshihiro Kawamura, and Kiyotaka Kawai
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0301 basic medicine ,Adult ,Male ,Parents ,Science ,medicine.medical_treatment ,Biology ,Intracytoplasmic sperm injection ,Article ,Transcriptome ,Andrology ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Blastocyst ,Epigenetics ,Gene ,030219 obstetrics & reproductive medicine ,Multidisciplinary ,Sequence Analysis, RNA ,Embryo ,Epigenome ,Middle Aged ,Oocyte ,030104 developmental biology ,medicine.anatomical_structure ,Medicine ,Female - Abstract
The epigenetic status of the genome changes dynamically from fertilization to implantation. In addition, the physiological environment during the process of gametogenesis, including parental age, may affect the epigenome of the embryo after fertilization. It is important to clarify the influence of parental age on gene expression in the embryo in terms of transgenerational epigenetics to improve the techniques currently used in assisted reproductive medicine. Here, we performed single-embryo RNA-seq analysis on human blastocysts fertilized by intracytoplasmic sperm injection, including from relatively elderly mothers, to elucidate the effects of parental age on the embryonic gene expression profile. We identified a number of genes in which the expression levels were decreased with increasing maternal age. Among these genes, several are considered to be important for meiotic chromosomal segregation, such as PTTG1, AURKC, SMC1B and MEIKIN. Furthermore, the expression levels of certain genes critical for autophagy and embryonic growth, specifically GABARAPL1 and GABARAPL3, were negatively correlated with advanced paternal age. In addition, levels of transcripts derived from major satellite repeats also decreased as the maternal age increased. These results suggest that epigenetic modifications of the oocyte genome may change with parental age and be transmitted to the next generation.
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- 2018
11. Effects of meiotic spindle imaging in human oocytes following PIEZO-ICSI on oocyte fertilization and embryo development
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Makiko Tajima, Kiyotaka Kawai, Tomonori Ishikawa, Takayuki Tatsumi, and Kenichiro Hiraoka
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Andrology ,Human fertilization ,medicine.anatomical_structure ,Reproductive Medicine ,Meiosis ,Embryogenesis ,medicine ,Obstetrics and Gynecology ,Biology ,Oocyte - Published
- 2019
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12. 15-Deoxy-Δ12,14-prostaglandin J2 prevents inflammatory response and endothelial cell damage in rats with acute obstructive cholangitis
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Kiyotaka Kawai, Takashi Seki, Tomomi Kitagawa, Katsutaka Watanabe, Toshio Kokuryo, Yukihiro Yokoyama, Akifumi Nakagawa, and Masato Nagino
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Lipopolysaccharides ,Male ,Cholangitis ,Physiology ,Gene Expression ,Nitric Oxide Synthase Type II ,Pharmacology ,chemistry.chemical_compound ,Hyaluronic Acid ,Receptor ,Prostaglandin D2 ,NF-kappa B ,Gastroenterology ,Alanine Transaminase ,Endothelial stem cell ,medicine.anatomical_structure ,Liver ,lipids (amino acids, peptides, and proteins) ,medicine.symptom ,Liver Circulation ,Nitric Oxide Synthase Type III ,Endothelium ,Prostaglandin ,Inflammation ,Cholestasis ,Physiology (medical) ,medicine ,Animals ,Aspartate Aminotransferases ,Rats, Wistar ,Ligation ,Hepatology ,Interleukin-6 ,Tumor Necrosis Factor-alpha ,business.industry ,Bilirubin ,NF-κB ,Cholestasis, Extrahepatic ,Liver Failure, Acute ,medicine.disease ,Survival Analysis ,Rats ,PPAR gamma ,Disease Models, Animal ,Eicosanoid ,chemistry ,Immunology ,Bile Ducts ,Endothelium, Vascular ,business - Abstract
Acute obstructive cholangitis is a common disease with a high mortality rate. Ligands for peroxisome proliferator-activated receptor-γ (PPARγ), such as 15-deoxy-Δ12,14-prostaglandin J2 (15D-PGJ2), have been proposed as a new class of anti-inflammatory compounds. This study investigated the effect of 15D-PGJ2 treatment on lipopolysaccharide (LPS)-induced acute obstructive cholangitis. The rats were randomly assigned to five groups: sham operation (Sham; simple laparotomy), sham operation with intraperitoneal saline infusion (Sham+Saline), sham operation with intraperitoneal LPS infusion (Sham+LPS), bile duct ligation (BDL) with saline infusion into the bile duct (BDL+Saline), and BDL with LPS infusion into the bile duct (BDL+LPS). Biochemical assays of blood samples, histology of the liver, portal venous pressure, hyaluronic acid clearance, and expression of inflammation-associated genes in the liver were evaluated. Furthermore, the Sham+LPS and the BDL+LPS group were divided into two groups (with and without 15D-PGJ2 treatment), and their survival rates were compared. Biochemical assays of blood samples, portal venous pressure, hyaluronic acid clearance, and expression of inflammation-associated genes in the liver were all significantly higher in the BDL+LPS group compared with those in the BDL+Saline group, indicating the presence of increased liver damage in the first group. However, preoperative administration of 15D-PGJ2 significantly improved these outcomes. Furthermore, the survival rate after establishment of cholangitis was significantly improved by the administration of 15D-PGJ2 in the BDL+LPS group. These results clearly demonstrate that 15D-PGJ2 inhibits the inflammatory response and endothelial cell damage seen in acute obstructive cholangitis and could contribute to improve the outcome of this pathology.
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- 2010
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13. ESTROGEN PROMOTES HEPATIC REGENERATION VIA ACTIVATING SEROTONIN SIGNAL
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Yukihiro Yokoyama, Toru Kawai, Kiyotaka Kawai, Katsutaka Watanabe, Toshio Kokuryo, Masato Nagino, and Tomomi Kitagawa
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Serotonin ,medicine.medical_specialty ,Ketanserin ,medicine.drug_class ,Critical Care and Intensive Care Medicine ,Internal medicine ,medicine ,Animals ,Serotonin receptor antagonist ,Rats, Wistar ,5-HT receptor ,Reverse Transcriptase Polymerase Chain Reaction ,Chemistry ,Regeneration (biology) ,Estrogens ,Liver regeneration ,Small intestine ,Liver Regeneration ,Rats ,medicine.anatomical_structure ,Endocrinology ,Gene Expression Regulation ,Liver ,Regional Blood Flow ,Estrogen ,Emergency Medicine ,Female ,Serotonin Antagonists ,Signal Transduction ,medicine.drug - Abstract
The aim of this study was to determine if estrogen plays any role in the process of hepatic regeneration of nonligated lobe after portal vein branch ligation (PBL). We also investigated whether estrogen has any association with serotonin action during liver regeneration. Ovariectomized female rats with (E group) or without (non-E group) estrogen pellet were subjected to PBL on the left and middle lobes. Thereafter, the rats were killed, and blood, liver, and small intestine were sampled and analyzed. Sham animals underwent only ovariectomy and laparotomy. The E group showed a significantly greater regeneration rate than the non-E group at days 1, 2, and 7 after PBL. The activation of hepatic regeneration-related genes (such as IL-6, TNF-alpha, hepatic growth factor, c-fos, and c-myc) was also significantly higher in the E group as compared with the non-E group. Gene expression of serotonin receptor (5-HT2A) in the liver and tryptophan hydroxylase 1 in the small intestine were also up-regulated in the E group, indicating an activation of serotonin system in the E group. Additionally, total intestinal flow, portal venous flow, and hepatic arterial flow determined by fluorescent microsphere were significantly higher in the E group compared with the non-E group. Moreover, serotonin receptor antagonist (ketanserin) significantly attenuated liver regeneration rate in the E group. These results indicated that estrogen plays an important role in the process of liver regeneration after PBL. Our results also indicated that estrogen is at least partly related to the activation of serotonin system, which is also important in the process of liver regeneration.
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- 2009
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14. EFFECTIVENESS AND LONG-TERM OUTCOMES OF LAPAROSCOPIC TRANSCYSTIC DUCT LITHOTOMY
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Seiji Natsume, Takasi Hiromatsu, Kiyotaka Kawai, Hiroshi Hasegawa, Taro Aoba, Shunnichiro Komatsu, Eiji Sakamoto, and Tomotake Tabata
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medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,medicine ,Long term outcomes ,business ,Duct (anatomy) ,Surgery ,Lithotomy position - Published
- 2006
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15. A SURGICAL CASE OF ESOPHAGEAL CANCER AFTER CORONARY ARTERY BYPASS GRAFTING USING THE RIGHT GASTROEPIPLOIC ARTERY
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Tomotake Tabata, Kiyotaka Kawai, Hiroshi Hasegawa, Eiji Sakamoto, Shunichiro Komatsu, and Takashi Hiromatsu
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medicine.medical_specialty ,medicine.anatomical_structure ,Bypass grafting ,business.industry ,medicine.artery ,Internal medicine ,Cardiology ,Medicine ,Esophageal cancer ,business ,medicine.disease ,Right gastroepiploic artery ,Artery - Abstract
症例は65歳,男性.既往歴に冠状動脈バイパス術あり. 7カ月前からつかえ感あり当院受診した.上部消化管内視鏡検査で中部食道に易出血性亜有茎性隆起性病変を認め,ルゴール染色では基部のみに下染域を認めた.基部からの生検結果はsquamous cell carcinomaであった.食道癌の術前診断で,食道亜全摘術, 2領域郭清を施行した.右胃大網動脈による冠状動脈バイパス術後のため胃管再建はできず,空腸間置再建とした.内腔に発育するポリープ状の腫瘍で,病理所見は大部分は紡錘形細胞の蜜な増殖からなる肉腫様病変からなり,周囲に扁平上皮癌が存在し,両者の移行像を認め, so-called carcinosarcomaと診断した.患者は術後多発肺転移と縦隔リンパ節転移が出現し,術後11カ月で永眠された.胃大網動脈による冠動脈バイパス術後に上腹部開腹手術を行う場合は,再建術式および術中操作に配慮が必要である.
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- 2006
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16. A Case of Pacreatic Endocrine Carcinoma That Invaded to the Main Pancreatic Duct with Difficulty in Diagnosis to Invasive Ductal Cancer
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Masatoshi Akita, Tomotake Tabata, Taro Aoba, Eiji Sakamoto, Hiroshi Hasegawa, Shunichiro Komatsu, Kiyotaka Kawai, Takashi Hiromatsu, and Toyonori Tsuzuki
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Pancreatic duct ,medicine.medical_specialty ,Pathology ,Endocrine carcinoma ,business.industry ,Gastroenterology ,Cancer ,medicine.disease ,medicine.anatomical_structure ,Internal medicine ,medicine ,Surgery ,business - Abstract
症例は30歳の男性で, 心窩部痛にて入院した. CT上, 膵体尾部に42×39mmの充実性腫瘍を認めた. Endoscopic retrograde pancreatography, magnetic resonance cholangiopancreatographyでは, 主膵管が完全途絶していた. 超音波内視鏡検査では内部不均一で周囲がlow, 腹部血管造影では腫瘍濃染像は認めず, 脾動脈にencasementを認めた. 確定診断のため, 超音波内視鏡検査下穿刺細胞診を行いendocrine tumorと診断された. 手術は膵体尾部脾合併切除術を施行した. 病理診断は低分化型膵内分泌細胞癌であり, CD56強陽性, synaptophysin強陽性, chromogranin A一部弱陽性であった. 主膵管は強度に浸潤を受け, 腫瘍細胞に置き換わり, 脾動静脈にも腫瘍浸潤を認めた. 術後14か月現在, 再発徴候は認めていない. 本症は30歳と若年発症であり, 内分泌細胞癌でありながら主膵管浸潤浸潤を認めたまれな症例である. 膵内分泌腫瘍と診断し, 主膵管閉塞を認めた場合には悪性を疑う必要がある.
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- 2006
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17. Repairs of Femoral Hernias Using PROLENE Hernia System with Partial Resection of Small Intestine through the Inguinal Operative Scar. Report of three Cases
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Eiji Sasaki, Eiji Takeuchi, Toshimitsu Sato, Kiyotaka Kawai, Tetsuya Okamoto, Shinya Yokoyama, and Toshio Tamauchi
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medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,General surgery ,Medicine ,Hernia ,Partial resection ,business ,medicine.disease ,Small intestine ,Prolene - Abstract
3例の大腿ヘルニアに対して鼠径部より開腹し腸切除後, PROLENE Hernia System®で修復術を行った.その内訳は男性が1例,女性が2例で平均年齢は74歳であった.いずれも腹部CT検査で小腸の嵌頓を伴う大腿ヘルニアと診断され,全身麻酔下に鼠径管後壁を切開し大腿ヘルニア嵌頓を確認した.続いて大腿輪を切開して臓器の絞扼を解除した後に,小腸部分切除術を施行した.修復はPHSを用いて鼠径法で行いonlay patchで大腿輪も閉鎖した.使用したPHSはLサイズが1例, extra Lサイズが2例であった.術後合併症については重篤なものはなく,全例再発を認めていない.
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- 2002
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18. SYNCHRONOUS DOUBLE CANCER OF THE LARGE INTESTINE AND KIDEY-REPORT OF THREE CASES
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Eiji Takeuchi, Kiyotaka Kawai, Makoto Kato, Fumihiko Yoneyama, Yoichiro Kobayashi, and Kanji Miyata
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medicine.medical_specialty ,business.industry ,Colorectal cancer ,medicine.medical_treatment ,Rectum ,Cancer ,medicine.disease ,Nephrectomy ,Surgery ,medicine.anatomical_structure ,medicine ,Ascending colon ,Abdomen ,Large intestine ,Radiology ,Double cancer ,business - Abstract
Patient 1, a 70-year-old man, was seen at the hospital because of blood stool and was found having rectal cancer at close examination. Preoperative contrast enhanced CT scan of the abdomen revealed left renal cancer. Low anterior resection of the rectum and a left nephrectomy were simultaneously performed. Patient 2, a 63-year-old woman, was seen at the hospital because of tarry stool. Close exploration revealed cancer of the ascending colon. Abdominal contrast enhanced CT scan before operation revealed a left renal cancer. Right hemicolectomy and a left nephrectomy were performed on an one-step approach. Patient 3, a 59-year-old woman, was seen at the hospital because a stool examination was positive to the guaiac test. Close exploration revealed cecal cancer. Abdominal contrast enhanced CT scan before surgery revealed right renal cancer. Right hemicolectomy and a right nephrectomy were performed on an one-step approach. We experienced three cases of synchronous colorectal cancer and renal cancer in which renal cancer was detected by preoperative contrast enhanced CT scan of the abdomen for the colorectal cancer and both cancers were successfully treated by simultaneous operation.
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- 2000
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19. Segmental cholangitis impairs hepatic regeneration capacity after partial hepatectomy in rats
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Akifumi Nakagawa, Tomomi Kitagawa, Takashi Seki, Yukihiro Yokoyama, Toshio Kokuryo, Katsutaka Watanabe, Kiyotaka Kawai, and Masato Nagino
- Subjects
Lipopolysaccharides ,Male ,Pathology ,Time Factors ,Cholangitis ,medicine.medical_treatment ,Gastroenterology ,Liver Function Tests ,Saline ,medicine.diagnostic_test ,Bile duct ,Reverse Transcriptase Polymerase Chain Reaction ,α-SMA ,Immunohistochemistry ,Liver regeneration ,medicine.anatomical_structure ,hepatocyte growth factor ,Liver ,hepatic regeneration rate ,Hepatolithiasis ,Inflammation Mediators ,hepatic stellate cells ,medicine.medical_specialty ,Enzyme-Linked Immunosorbent Assay ,Internal medicine ,medicine ,Mitotic Index ,Animals ,Hepatectomy ,RNA, Messenger ,Rats, Wistar ,Ligation ,Cell Proliferation ,Hepatology ,business.industry ,Original Articles ,medicine.disease ,Actins ,segmental bile duct ligation ,Liver Regeneration ,Rats ,Disease Models, Animal ,Gene Expression Regulation ,Hepatic stellate cell ,Bile Ducts ,Liver function tests ,business ,Biomarkers - Abstract
Background Patients with hilar cholangiocarcinoma or hepatolithiasis often develop segmental cholangitis (SC), but it is unclear whether hepatectomy for patients with SC can be performed safely. Methods Rats were subjected to segmental bile duct ligation (SBDL) with LPS (SC group) or a saline (Sham group) infusion into the bile duct of the ligated lobes. The rats were sacrificed at 3, 24 and 48 h after the SBDL. For another experiment, the rats were subjected to partial hepatectomy (PHx) for the ligated lobes. Hepatic regeneration rates and the expression of regeneration-associated genes were evaluated. Results In the SC group, severe parenchymal damage was observed in the acute phase (3 h). Altered gene expression in the liver in response to biliary infection occurred not only in the infected lobes but also in the non-infected lobes. In the rats of the SC group, both the hepatic regeneration rate and serum HGF levels were significantly lower than in the Sham group. Conclusion These results clearly demonstrate that SC impairs the regeneration capacity of the contralateral remnant liver. Therefore, hepatectomy should be avoided for patients with SC even if it occurs in the part of the liver to be resected.
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