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1.
Y. Tomita T. Tojimbara K. Iwadoh I. Nakajima S. Fuchinoue 《Transplantation proceedings》2017,49(1):45-48
The number of recipients waiting for a transplant is increasing. In Japan, there is more frequent use of organs from expanded-criteria donors (ECDs) after circulatory death. We retrospectively analyzed long-term outcomes of kidney transplantation (KT) from expanded-criteria donation after circulatory death (DCD). From 1995 to 2013, 97 cases of KT from DCD donors were performed in our department. Death-censored graft survival rates of ECD kidneys (n = 50) versus standard-criteria deceased-donor (SCD) kidneys (n = 47) for 1, 5, and 10 years after transplantation were 84.0% vs 97.9%, 74.8% vs 95.6%, and 70.2% vs 81.8%, respectively. No significant difference was found between the 2 groups (P = .102). Kidneys from donors with a history of hypertension (HTN) and cerebrovascular events (CVE) and contribution from older donors had significantly lower 10-year graft survival rates (P values of .010, .036, and .050, respectively). Cox proportional hazard regression analyses showed donor age to be significantly associated with long-term graft survival independently from other factors. These results suggest that ECD kidneys remain an acceptable alternative to dialysis under certain conditions. Increased donor age was a significant risk factor determining long-term graft function. Moreover, comorbidities of HTN and CVE could become significant risk factors, especially in older donors. 相似文献
2.
K. Iwamoto J. Iizuka Y. Hashimoto T. Kondo T. Takagi K. Hata K. Unagami M. Okumi H. Ishida K. Tanabe 《Transplantation proceedings》2018,50(8):2539-2544
Objectives
We aimed to evaluate the feasibility and efficacy of surgical prostatectomy in renal transplant recipients (RTRs).Methods
Between January 2008 and February 2017, we identified 13 RTRs who were diagnosed with localized prostate cancer and underwent radical prostatectomy. We reviewed all available clinicopathologic data for these 13 patients.Results
The median patient age was 61 years and median serum prostate-specific antigen (PSA) was 8.79 ng/mL. The mean period between transplantation and diagnosis of prostate cancer was 136 months. The sources for the kidney transplants included 10 living and 3 deceased donors. Biopsies indicated that the Gleason scores were 7 in 10 patients and 8 to 10 in 3 patients. Meanwhile, the D'Amico risk classification indicated an intermediate risk in 9 patients and a high risk in 4 patients. Eight patients were at stage cT1 and 5 were at stage cT2. The surgical procedure was retropubic radical prostatectomy in one recipient, laparoscopic radical prostatectomy in 3 recipients, and robot-assisted radical prostatectomy in 9 RTRs. Intraoperative complications were not noted in any patient, although one patient demonstrated postoperative complications (Clavien grade ≥ 3). An indwelling urinary catheter was required in 3 patients for over 3 weeks due to delayed wound healing. Biochemical recurrence evaluated by PSA monitoring occurred in four patients. Postoperative graft function was stable in all but one patient who required resumption of dialysis before prostatectomy; however, all patients are alive at the time of publication with 12 patients showing well-functioning renal allografts.Conclusion
Prostatectomy may be a feasible and effective technique as an initial treatment for RTRs with localized prostate cancer. 相似文献3.
Rie Akaho Akiko Otsu Aiko Igarashi Yuko Aoki Takaubu Takemura Sayaka Kobayashi Kazuteru Ohashi Katsuji Nishimura 《Transplantation proceedings》2019,51(6):1990-1993
BackgroundThe psychological distress experienced by patients scheduled for hematopoietic stem cell transplantation (HSCT) is of clinical concern. However, distress experienced by patients scheduled for HLA-haploidentical HSCT vs that of patients scheduled for other types of matched HSCT is unknown. We conducted a retrospective study to clarify whether the type of HSCT influences the appearance of psychological distress in patients anticipating HSCT.MethodsOne hundred fifty-seven patients who had undergone any of 4 types of HSCT at Tokyo Metropolitan Komagome Hospital between October 2013 and September 2016 and had completed the Profile of Mood States (POMS) questionnaire within 2 weeks before the procedure were included. We computed T-scores for the tension-anxiety (TA) and depression (D) subscales, took scores ≥ 60 to represent mood disturbance of clinical concern, and examined scores and other clinical variables in relation to each procedure.ResultsTwenty-two (14.0%) patients had a POMS-TA score ≥ 60, and 26 (16.6%) had a POMS-D score ≥ 60. The numbers of POMS-TA and POMS-D scores ≥ 60 did not differ significantly with respect to age, sex, leukemia type, number of previous transplants, disease status, comorbidity index, or transplant type. A multivariate logistic regression analysis confirmed the absence of an influence of the type of HSCT on the incidence of POMS-TA or POMS-D scores ≥60.ConclusionAttention should be paid to the matter of psychological distress in patients with leukemia who will be treated by HSCT, even HLA-haploidentical HSCT. Such patients need psychological support, especially during the waiting period immediately prior to the transplantation procedure. 相似文献
4.
Keiji Wada Ryo Tamaki Mitsuru Yui Daisuke Numaguchi Yasuaki Murata 《Journal of orthopaedic science》2017,22(2):213-217
Background
C1 lateral mass screw was widely used for fixation of the upper cervical spine. However, massive bleeding from the C1–2 venous plexus is sometimes encountered. In this study, we proposed an alternate method for C1 lateral mass screw insertion, which involves insertion of the screws caudally from the C2 nerve root to reduce bleeding from C1–2 venous plexus.Methods
Seven patients with atlantoaxial lesions were included in this study. The mean age at surgery was 65.9 (34–82) years. The mean follow-up period was 23.1 (12–38) months. All patients underwent atlantoaxial fusion with C1 lateral mass screws, which were inserted caudally from the C2 nerve root. All screws were inserted using O-arm based navigation system. Operative time, blood loss, C2 nerve root injury and perioperative complications were investigated. The accuracy of C1 screws and bone union were evaluated using postoperative computed tomography.Results
A total of 13 C1 lateral mass screws were inserted using this method. The mean operative time was 224 (144–305) min. The mean blood loss was 209 (100–357) g. One perioperative complication was observed, which was recurrent laryngeal nerve palsy. There were no vertebral artery or spinal cord injuries. No case of massive bleeding from the C1–2 venous plexus was observed. One patient complained of postoperative occipital neuralgia, which disappeared in 2 weeks. No malposition of C1 lateral mass screws was observed on postoperative computed tomography. Bone union was observed in all patients.Conclusion
The C1 lateral mass screw insertion caudally from the C2 nerve root may become an alternate method for insertion of C1 screws. 相似文献5.
K. Hata J. Iizuka Y. Hashimoto T. Takagi T. Kondo K. Omoto T. Shimizu M. Okumi M. Inui H. Ishida K. Tanabe 《Transplantation proceedings》2018,50(8):2338-2341
Introduction
With the increasing number of elderly kidney donor candidates due to the lack of available donors, prostate cancer has sometimes been detected in these candidates during pretransplant screening examinations. There are currently no guidelines or consensus on prostate cancer screening and treatment in donors. We retrospectively evaluated the clinical course of donor candidates with prostate cancer.Methods
Between January 2006 and December 2016, 9 donor candidates for living related kidney transplantation were incidentally diagnosed with prostate cancer at our institution. All male kidney transplant donor candidates routinely received prostate-specific antigen (PSA) testing. The patients with PSA levels > 4.0 ng/mL underwent prostate biopsies. For future kidney transplantation, treatment for localized prostate cancer was prostatectomy.Results
Seven low- or intermediate-risk patients according to the D'Amico risk classification underwent endoscopic prostatectomy, while 2 high-risk patients underwent high dose-rate brachytherapy to prioritize prostate cancer treatment. Of the 7 who underwent surgery, 3 patients ultimately became living related kidney transplantation donors for their wives. There was no recurrence of PSA elevation after treatment.Conclusion
This study showed that donor candidates with prostate cancer could safely donate a kidney after a thorough evaluation to exclude those with high-risk prostate cancer. Transmission of prostate cancer through kidney transplantation seems unlikely and robot-assisted laparoscopic prostatectomy may be feasible for donor candidates with localized prostate cancer. 相似文献6.
Constricting the tricuspid annulus to an optimal size and ensuring competency of the suture in situ are essential to the performance of a successful de Vega annuloplasty. An approach to this goal is presented. Important maneuvers include placement of the inside suture just on the ring portion, use of a 33 mm or 35 mm valve obturator to obtain an annulus of the desired size, and ligation of the knots at their roots to prevent potential loosening. 相似文献
7.
From 1955 to 1975, 417 patent ductus arteriosus (PDA) operations were performed at Sapporo Medical University. The last 118 operations (28.3%) were done by division through the left axillary incision without mortality.Forty patients were less than 2 years old and 14 were less than 1 year old. The ratio of girls to boys was 3.5:1. Because the majority of patients with PDA are girls, parents commonly show considerable concern over the size of the operative scar. Our clinical experience demonstrates clearly the feasibility and safety of an axillary incision in dividing a PDA, even in premature infants. A minithoracotomy through the axilla is recommended. 相似文献
8.
Yusuke Tomita Kazuhiro Iwadoh Akiko Hoshino Yuichi Ogawa Akihito Sannomiya Ichiro Nakajima Shohei Fuchinoue 《Transplantation proceedings》2019,51(8):2523-2526
BackgroundThe need for donor pool expansion remains an important task for kidney transplantation. The aim of this study is the evaluation of primary nonfunction (PNF) from donation after circulatory death (DCD) kidneys.MethodsBetween 1996 and 2017, 100 kidney transplants from DCD donors were conducted in our department. We retrospectively analyzed PNF of kidney transplant recipients from DCD donors in terms of donors’ and recipients’ epidemiologic characteristics.ResultsOf 100 grafts, 95 recipients (95.0%) had discontinued hemodialysis at the time of hospital discharge. Only 5 recipients (5.0%) developed PNF. All 5 PNF recipients received a single graft from an expanded criteria donor (ECD). The mean donor age in the PNF group was 65.0 (SD, 6.2) years. Significant differences between the PNF group and discontinued dialysis group were found for donor age (P < .01) and for the use of ECD kidneys (P < .02). Nevertheless, no significant difference was found between groups for several factors: a history of hypertension and cerebrovascular events, terminal creatinine levels, and graft weight.ConclusionThe incidence of PNF from DCD kidneys was very low. Although ECD kidneys in older donors might be a significant risk factor for PNF, these findings suggest that DCD kidneys should be used more frequently for donor expansion. 相似文献
9.
S. Matsumura K. Unagami S. Okabe H. Fukuda A. Suzuki S. Fuchinoue K. Tanabe H. Ishida 《Transplantation proceedings》2018,50(10):3321-3328
Background
There have been few studies that have reported the influence of kidney transplantation on the quality of life (QOL) of patients of preemptive kidney transplantation (PKT) and nonpreemptive kidney transplantation (NPKT).Material and Methods
Fifty patients of PKT and 49 patients of NPKT were employed as study subjects. A questionnaire survey using Short Form 36 and Kidney Disease QOL on patients' physical and psychological QOL was performed for these patients prior to transplantation and 1 month, 3 months, and 1 year after transplantation.Results
The analysis of results has revealed that transplantation clearly has improved the physical and psychological QOL in patients with end-stage renal disease. For the items regarding physical burdens incurred by the transplantation, patient QOL deteriorated on a single occasion 1 month after the transplantation while it was improved 1 year after the transplantation. For the items regarding psychological burdens, the mental condition of the patients was improved overall without deterioration over time. Concerning the “Effect of Kidney Disease” and “Burden of Kidney Disease,” QOL was significantly better in PKT than NPKT at baseline before transplantation, although the significant difference gradually decreased 1 month and 3 months after the transplantation and disappeared after 1 year.Conclusion
Transplantation certainly improved the QOL of patients with end-stage renal disease. Before transplantation, PKT was clearly better than NPKT in the QOL items associated with “Burden of Kidney Disease.” This indicated that patients of PKT have improved QOL compared to patients of NPKT, and that the overall awareness of kidney disease is decreased. A postoperative gap in mental and bodies was observed especially in PKT, however, could be overcome by nursing interventions. 相似文献10.
N. Masaki K. Iwadoh A. Kondo I. Koyama I. Nakajima S. Fuchinoue 《Transplantation proceedings》2017,49(5):959-962
Aim
We investigated clinical outcomes of patients in Japan with a history of long-term dialysis treatment.Methods
We conducted 1171 kidney transplantations between 2000 and 2015. Sixty of the patients had undergone dialysis therapy for >20 years before the transplantation. We compared graft and patient survivals between the recipients with >20 years of dialysis (long dialysis group [LGD]) and those with <20 years (control group [CG]) in a case-control study, in which sex and age of both donors and recipients, ABO compatibility, and calendar year of transplantation were matched.Results
Average age of LDG was 52.8 ± 8.9 years, and that of CG was 54.2 ± 12.6 (P > .05). Durations of dialysis were 25.4 ± 1.57 vs 5.8 ± 5.8 years, respectively (P < .05). The graft survival rates were 91.6%, 89.9%, and 81.8% at 3, 5, and 10 years in LDG vs 90.71%, 84.8%, and 78.3% in CG, respectively (P > .05). The patient survival rates were 96.6%, 93.2%, and 88.6% in LDG vs 94.5%, 91.0%, and 83.9%, respectively (P > .05). There was no significant difference in mean estimated glomerular filtration rates for post-transplant 10 years between them.Conclusion
LDG showed satisfying clinical outcomes comparable to those of CG both in graft and patient survivals and renal function. 相似文献11.
N. Masaki K. Iwadoh A. Kondo I. Koyama I. Nakajima S. Fuchinoue 《Transplantation proceedings》2018,50(4):978-981
Background
Even if a living donor candidate exists, there are some cases that do not result in kidney transplantation (KTx) due to problems on the recipient side. The aim of this study was to clarify causes of ineligibility for KTx in these cases, so as to make RTx more applicable for patients.Methods
We targeted 470 patients with end-stage renal disease who applied for the primary kidney KTx from 2010 to 2012. Then we selected those who were not applicable for KTx and investigated recipient causes of ineligibility for KTx or not receiving KTx.Results
The average age of recipients was 47.6 ± 12.9 (7–82) years. A majority of the 470 patients were male (n = 305, 64.9%). Two hundred ninety-seven patients intended to receive a living donor KTx and the others hoped for a deceased donor KTx. Of the 297 patients, 207 (70.0%) underwent KTx and 9 (1.9%) were being prepared for KTx at the time of the survey. Eighty-three patients (27.9%) did not receive a living KTx, with 59 of these due to recipient-related problems and 30 due to donor-related problems. We further classified the reasons for these 59 recipients not undergoing KTx as follows: (1) unclear reasons (35.6%); (2) insufficient intention to receive transplant (13.6%); (3) heart disease (10.2%); (4) malignancy (8.5%); (5) immunologic risks (5.1%); (6) death during the waiting period (5.1%); (7) cerebrovascular events (5.1%); (8) cardiovascular problems (5.1%); (9) psychiatric disorders (3.4%); and (10) infections (3.4%).Conclusion
Nearly 50% of the reasons for ineligibility as a recipient were related to their intention to receive KTx, with 94.9% of the nontransplanted cases due to nonimmunologic reasons. Thanks to the recent advances in immunosuppressive therapy, there were only 3 patients who could not undergo KTx due to immunologic risks. Based on these results, transplant surgeons should not only emphasize physical evaluation but should also pay careful attention to the recipient's intention to receive KTx. 相似文献12.
Shinji Horie Yasuhito Takahashi Takaaki Shishido Toshinori Masaoka Toshiyuki Tateiwa Kengo Yamamoto 《Journal of orthopaedic science》2017,22(3):524-530
Background
The aim of the present study is to simulate and better understand the long-term interplay between alumina matrix composite (AMC) femoral head and aqueous environment. In particular, we focused on clarifying the role of alumina grains on zirconia phase stability and mechanical equilibrium in AMC head during aging processes in a clinically-relevant time frame.Methods
The tested AMC head consists of an alumina matrix (82 vol.%) reinforced by yttria-stabilized zirconia (17 vol.%), chromium oxide (0.5 vol.%), and strontium aluminate (0.5 vol.%). The accelerated hydrothermal aging testing (at 134 °C, 2-bars pressure) was conducted up to 20 h. According to ASTM standard, 1-h aging under these conditions corresponds approximately to 2 yrs in vivo exposure. Confocal Raman and fluorescence spectroscopy were applied to quantify surface tetragonal-to-monoclinic phase transformation of zirconia and surface stresses in the AMC head. The Mehl–Avrami–Johnson (MAJ) theory was applied, which allowed modeling the micromechanisms of nucleation and growth of monoclinic sites during the transformation process. The obtained results were compared to those of monolithic zirconia (3Y-TZP) femoral heads.Results
The 3Y-TZP head showed a rapid increase of transformation rate beyond the aging time of 5 h (simulated as ~10 yrs in vivo), suggesting the initiation of the transformation cascade toward the neighboring zirconia grains (growth mechanism). On the other hand, MAJ analysis revealed that the growth mechanism was completely absent and the nucleation of the monoclinic phase was partially prevented in the AMC head even after the 20-h aging (~40 yrs in vivo). In addition, the stress accumulation in the AMC head was restricted at a quite low level throughout the aging simulation.Conclusion
Those results suggest that the presence of stable and hard alumina in the AMC can play a considerable role in slowing down the destabilization processes by spatially encompassing zirconia grains. 相似文献13.
A new method of external cardiac massage to improve diastolic augmentation and prolong survival time. 总被引:1,自引:0,他引:1
Experiments were performed on 50 dogs to determine the reason for unsatisfactory survival rates following closed-chest cardiac massage and to help develop new means for increasing survival following acute myocardial infarction and other causes of cardiac arrest. A new technique, named the countermassage method, was subsequently developed. Coronary and carotid flows after use of countermassage following cardiac arrest were increased 1.4 and 2 times, respectively, in contrast to flows obtained during manual closed-chest cardiac massage. These increases brought flows up to normal levels. We also tried to determine whether survival could be extended by this method to facilitate clinical treatment such as defibrillation or placing a temporary pacemaker catheter under fluoroscopic control, which are hard to accomplish during the brief time permitted by conventional closed-chest cardiac massage. 相似文献
14.
Eiji Oki Mototsugu Shimokawa Koji Ando Akihiko Murata Takao Takahashi Kiyoshi Maeda Tetsuya Kusumoto Yoshinori Munemoto Ryota Nakanishi Yuichiro Nakashima Hiroshi Saeki Yoshihiko Maehara 《Surgery》2019,165(3):586-592
Background
Lateral lymph node dissection has been 1 of the standard treatments for mid and ow rectal cancer in Japan. The aim of this ad-hoc analysis was to evaluate the impact of lateral lymph node dissection on outcomes in the randomized clinical trial, referred to as the Adjuvant Chemotherapy for Stage II/III Rectal Cancer trial.Methods
The Adjuvant Chemotherapy for Stage II/III Rectal Cancer trial was a randomized, phase III trial of adjuvant chemotherapy of 2 different oral fluoropyrimidines; 445 patients with lower rectal cancer were studied in this ad-hoc analysis out of 959 patients in total, 215 of whom underwent lateral lymph node dissection and 230 did not.Results
There were no significant differences in background characteristics of the patients in the group, except for in age and number of dissected lymph nodes, between the lateral lymph node dissection and without lateral lymph node dissection groups. The age of the younger patients was often used to select candidates for lateral lymph node dissection (lateral lymph node dissection versus non–lateral lymph node dissection; 63.5 ± 8.9 vs 60.7 ± 9.4 [P?=?.0017]). Lateral lymph node dissection had no impact on relapse-free survival (hazard ratio?=?0.941, 95% confidence interval: 0.696–1.271) or overall survival (hazard ratio?=?0.858, 95% confidence interval: 0.601–1.224) in all patients with mid and low rectal cancer. In subset analysis, lateral lymph node dissection improved relapse-free survival in female patients and in patients with stage B/C or N3/4 disease. For cumulative recurrence across all patients, the proportion of patients with distant recurrence was slightly greater in the lateral lymph node dissection group but there was no difference in local recurrence.Conclusion
This exploratory analysis did not show that lateral lymph node dissection improves relapse-free survival and overall survival in patients with mid and low rectal cancer. Lateral lymph node dissection may, however, have a prognostic impact on patients with highly invasive rectal cancer. 相似文献15.
Ryohei Takada Tetsuya Jinno Kazumasa Miyatake Masanobu Hirao Akimasa Kimura Daisuke Koga Kazuyoshi Yagishita Atsushi Okawa 《Journal of orthopaedic science》2018,23(5):783-787
Background
The difference in clinical results between the direct anterior approach (DAA) and the anterolateral approach (ALA) for total hip arthroplasty (THA) is still unclear. The purpose of this study was to compare clinical results, including nerve injuries, between DAA and ALA in one-stage bilateral THA in a prospective, randomized controlled trial.Methods
Thirty patients were recruited for primary bilateral THAs from 2014 to 2016. The left and right hips of each patient were randomly assigned to DAA and the others to ALA. We prospectively compared the clinical results, incidence of lateral femoral cutaneous nerve (LFCN) injury, and tensor fascia lata (TFL) atrophy considered to be related to superior gluteal nerve injury between both approaches.Results
No significant difference was found in the clinical results between both sides at postoperative 1 year. Temporary symptom of LFCN injury was observed only in DAA sides (7/30, 23.3%). The ratio of 3-month postoperative to preoperative cross-sectional area of TFL on computed tomography was significantly lower on the side subjected to DAA (DAA side, 78.8 ± 22.8%) than on the side subjected to ALA (ALA side, 90.7 ± 17.7%) (p < 0.01). In magnetic resonance imaging at postoperative 1 year, the mean grade of fatty atrophy of TFL by Goutalier classification was significantly higher in DAA sides (2.00 ± 1.6) than in ALA sides (1.1 ± 1.3) (p = 0.03).Conclusions
Excellent clinical results for both DAA and ALA were achieved. LFCN injury was found only in DAA sides. Although TFL atrophy was found in both approaches, it was found significantly more in DAA sides. Our study suggested that ALA should be used rather than DAA in terms of the risk of nerve injuries. 相似文献16.
17.
Juro Wada Masayoshi Yokoyama Akimasa Hashimoto Yasuharu Imai Nobuo Kitamura Atsuyoshi Takao Kazuo Momma 《The Annals of thoracic surgery》1980,29(6):519-521
Forty-nine artificial cardiac valves implanted in 44 patients less than 15 years old were reviewed. Out of 49 valves, 16 were mechanical and 33 were xenografts. Average follow-up was 2 years 5 months. Marked valvular stenosis developed in 11 out of the 33 xenografts, an incidence of 15% per patient-year. In patients with a xenograft valve, the incidence of sepsis was found to be 4% per patient-year and brain accidents, 4% per patient-year. In patients with mechanical valves, the incidence of stenosis was only 2% per patient-year and brain accidents, 2% per patient-year. There was no sepsis. From these follow-up results, mechanical valves seem to be superior to xenografts when used in patients less than 15 years old. 相似文献
18.
Anne M. Dinaux Lieve Leijssen Liliana G. Bordeianou Hiroko Kunitake Ramzi Amri David L. Berger 《Surgery》2018,163(4):784-788
Introduction
Lymph node involvement is a well-known predictor of recurrent rectal cancer in patient who did not undergo neoadjuvant therapy patients. The role of persistent lymph node disease after neoadjuvant treatment, however, is debatable. This study compares outcomes of patients with clinical, stage III rectal cancer who had nodal disease on surgical pathology after neoadjuvant treatment to patients with negative nodes.Methods
We reviewed retrospectively a consecutive cohort of all clinical, American Joint Committee on Cancer stage III rectal cancer patients who received neoadjuvant chemoradiotherapy and had an R0 resection at the Massachusetts General Hospital between 2004 and 2015.Results
A total of 166 patients met the inclusion criteria, of whom 53 had persistent nodal disease on pathologic examination. This group had a greater rate of local and distant disease recurrence and a shorter median recurrent disease-free survival than patients with a complete nodal response. In multivariable analyses for disease recurrence, disease free survival was greater for patients without positive results in lymph nodes on pathologic examination.Conclusion
Persistent nodal involvement after neoadjuvant therapy is associated with an increased risk of distant metastases and a shorter disease-free survival. Identifying patients with treatment-resistant lymph nodes preoperatively and adjusting neoadjuvant treatment might result in better outcomes. 相似文献19.
20.
Akira Mibu Tomohiko Nishigami Katsuyoshi Tanaka Masahiro Manfuku Satoko Yono Saori Kajiwara Akihito Tanabe Masahiko Shibata 《Journal of orthopaedic science》2018,23(6):895-901