Clinical Outcomes of Living Liver Transplantation According to the Presence of Sarcopenia as Defined by Skeletal Muscle Mass,Hand Grip,and Gait Speed

Background

Sarcopenia is an independent predictor of death after living-donor liver transplantation (LDLT). However, the ability of the Asian Working Group for Sarcopenia criteria for sarcopenia (defined as reduced skeletal muscle mass plus low muscle strength) to predict surgical outcomes in patients who have undergone LDLT has not been determined.

Effect of lateral lymph node dissection for mid and low rectal cancer: An ad-hoc analysis of the ACTS-RC (JFMC35-C1) randomized clinical trial

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.

In Situ Procurement of a Recipient's Portal Vein for a Right Lobe Liver Graft With Multiple Venous Orifices: A Case Report

Reconstruction of multiple venous orifices of a right lobe graft is a time-consuming and troublesome procedure in right lobe living-donor liver transplantation. In the current study, we present a new venous reconstruction technique for a right lobe graft with multiple and complex hepatic vein (HV) orifices, in which procurement of the recipient's left portal vein was performed in situ to keep the anhepatic period to a minimum. All of the HV orifices were reconstructed together at the back table, while maintaining patency of the recipient's systemic and splanchnic circulation. A homologous vein graft and veno-venous bypass were not necessary. All HVs were patent during the follow-up and the patient was free from complications. In conclusion, the present technique is readily available for reconstruction of complex and multiple HV tributaries, while avoiding a long anhepatic time and the use of veno-venous bypass.     

Duct-to-duct Biliary Reconstruction in Living-donor Liver Transplantation for Primary Sclerosing Cholangitis: Report of a Case

Although Roux-en Y hepaticojejunostomy was previously recommended for the biliary reconstruction in liver transplantation for primary sclerosing cholangitis (PSC), some recent reports showed no difference in the graft survival between Roux-en Y and duct-to-duct anastomosis in deceased-donor liver transplantation. On the other hand, considering the risk of recurrence and the short length of the bile duct of the graft, duct-to-duct biliary anastomosis has never been reported in a patient undergoing living-donor liver transplantation (LDLT) for PSC. A 45 year-old male underwent LDLT using a left-lobe graft donated from his brother. Cholangiography showed no lesion in his common bile duct and duct-to-duct anastomosis was chosen for him. Fifteen months later, he suffered cholangitis due to PSC recurrence and endoscopic retrograde cholangiography was performed. The stents were inserted into his B2 and B3, and he remains well. Because of the ability to easily manage biliary complication, duct-to-duct biliary reconstruction may become the first choice in LDLT for PSC without common bile duct lesions.     

Evaluation of humeral head cartilage using magnetic resonance imaging T1 rho mapping for patients with small-to-medium rotator cuff tears: A pilot study

Background

It is unclear whether smaller rotator cuff tears cause cartilage degeneration. This study was designed to detect early humeral head cartilage degeneration in patients with small-to-medium cuff tears using magnetic-resonance-imaging T1 rho mapping.

Successful Recombinant Thrombomodulin Treatment for Thrombotic Microangiopathy After Liver Transplantation: A Case Report

Transplant-associated thrombotic microangiopathy (TA-TMA) is a rare but severe complication after liver transplantation. In contrast to other thrombotic microangiopathies, treatment for TA-TMA has yet to be clarified. A 52-year-old male patient with liver cirrhosis due to hepatitis C underwent split liver transplantation from a deceased donor. His clinical course was without complication until 4 days after transplantation, when he experienced impaired consciousness, hemolytic anemia with fragmented erythrocytes, and marked thrombocytopenia. TA-TMA was diagnosed, and recombinant thrombomodulin was administered for 4 days. The patient's clinical symptoms and laboratory data rapidly improved. He has been followed up for 6 months and has not shown any complications. The pathogenesis of TA-TMA is endothelial damage in the vasculature. Recombinant thrombomodulin, an endothelial cell–protecting agent, is a promising new therapeutic choice for TA-TMA after liver transplantation.     

In Situ Posterior Graft Segmentectomy for Large-for-Size Syndrome in Deceased Donor Liver Transplantation in Adults: A Case Report

Large-for-size syndrome (LFSS) is controversial in pediatric living donor liver transplantation patients and is associated with a poor graft outcome. Similar situations in deceased donor liver transplantation (DDLT) in adults have not been reported frequently, and there are no official guidelines worldwide. Deceased donation is extremely limited in Japan, and when a larger liver is allocated for a very sick small recipient in Japan, transplantation with a plan to address LFSS might be necessary. The patient is a 58-year-old female patient who had acute liver failure with coma. The graft-recipient weight ratio (GRWR) was 2.74%. Although the graft was enlarged by reperfusion, the intraoperative Doppler ultrasound, performed after reperfusion, showed sufficient graft in-flow and out-flow. However, when the liver graft was situated appropriately into the right phrenic space supported by the rib cage and diaphragm, the blood flow in the hepatic vein and portal vein was significantly reduced. Graft blood flow did not improve without removing it from the right subphrenic space. Therefore, we decided to perform an in situ graft posterior segmentectomy, so that the graft right lobe was properly accommodated in the patient's right subphrenic space. After the segmentectomy of the graft, an intraoperative Doppler sonogram showed significantly improved blood flow. LFSS could be a significant operative challenge in adult DDLT, especially in areas with limited chances of DDLT. In situ posterior segmentectomy in the demarcated area could be a solution for treating patients with LFSS.     

Clinical outcomes of conservative treatment with a non-weight-bearing abduction brace for Legg–Calvé–Perthes disease

Background

Treatment with a brace is the first choice as conservative treatment via the containment method for Legg–Calvé–Perthes disease (LCPD). The purpose of this study is to evaluate clinical outcomes and influential factors of conservative treatment with the non-weight-bearing abduction brace for LCPD.

Laparoscopy-Assisted Spleen-Preserving Distal Pancreatectomy for Living-Donor Pancreas Transplantation

Background

Living pancreas transplantation plays an important role in the treatment of patients with severe type 1 diabetes. However, pancreatectomy is very invasive for the donor, and less-invasive surgical procedures are needed. Although some reports have described hand-assisted laparoscopic surgery for distal pancreatectomy in living-donor operations, less-invasive laparoscopy-assisted (LA) procedures are expected to increase the donor pool. We herein report the outcomes of four cases of LA spleen-preserving distal pancreatectomy (Warshaw technique [WT]) in living pancreas donors.

Surveillance of patients with intraductal papillary mucinous neoplasm with and without pancreatectomy with special reference to the incidence of concomitant pancreatic ductal adenocarcinoma

Background

The presence of an intraductal papillary mucinous neoplasm is important in the detection of concomitant pancreatic ductal adenocarcinoma. The aim of this study was to elucidate the incidence and timing of development of concomitant pancreatic ductal adenocarcinoma in patients with and without pancreatectomy for intraductal papillary mucinous neoplasm.

Initial stability of a highly porous titanium cup in an acetabular bone defect model

Backgrounds

The purpose of this study was to quantify the initial stability of a highly porous titanium cup using an acetabular bone defect model.

A safer and more reliable operative technique for esophageal reconstruction using a gastric tube

A safer and more reliable method of esophageal reconstruction, using a gastric tube, is described. The procedure to create an elongated gastric tube involves separate cutting of the seromuscular and mucosal layer along the line extending parallel to and 4 cm from the greater curvature of the stomach. The end of the cervical esophagus is anastomosed to the posterior wall of the gastric tube in end-to-side fashion. In addition, circumferential cutting of the seromuscular layer of the gastric tube about 5 cm from the anastomotic line is performed to avoid tension resulting from postoperative shrinkage of the gastric tube due to muscle contraction. Combination of these methods resulted in complete elimination of anastomotic leakage.     

Preformed C1q-binding Donor-specific Anti-HLA Antibodies and Graft Function After Kidney Transplantation

Background

De novo complement-binding donor-specific anti-human leukocyte antigen antibodies (DSAs) are reportedly associated with an increased risk of kidney graft failure, but there is little information on preformed complement-binding DSAs. This study investigated the correlation between preformed C1q-binding DSAs and medium-term outcomes in kidney transplantation (KT).

Analysis of wound healing time and wound-free period as outcomes after surgical and endovascular revascularization for critical lower limb ischemia

Background

Traditional end points, such as amputation-free survival, used to assess the clinical effectiveness of lower limb revascularization have shortcomings because they do not account independently for wound nonhealing and recurrence or patient survival. Wound healing process and maintenance of a wound-free state after revascularization were not well-studied. The aim of this study was to elucidate the long-term clinical course of ischemic wounds after revascularization. We focused on initial wound healing process as well as the maintenance of a wound-free state after achievement of wound healing. We introduced a wound-free period (WFP; the period during which limbs maintained an ulcer-free state) and Wound Recurrence and Amputation-free Survival (WRAFS) as parameters and tested their effectiveness in evaluating clinical outcomes of limbs treated using endovascular therapy (EVT) and surgical revascularization.

In vivo hemodynamics of prosthetic St. Jude Medical and Ionescu-Shiley heart valves analyzed by computer

Using a method of our own design, we evaluated intraoperatively the function of prosthetic heart valves. The changing hemodynamics induced by a stress test were assessed by simultaneously measuring the mean transvalvular pressure gradient and the stroke volume. The effective orifice area (EOA) of the valves was determined for each stroke by computer analysis, and this value was compared with the actual orifice area. Data were collected from 19 patients undergoing aortic or mitral valve replacement or both with 17 St. Jude Medical and 12 Ionescu-Shiley valves. The mean pressure gradient increased with tachycardia and an increase in mean left atrial pressure in the mitral position, but decreased with a decrease in cardiac output and peak left ventricular pressure in the aortic position. The St. Jude Medical valve had a smaller mean pressure gradient than the Ionescu-Shiley bioprosthesis. For both valves, the EOA increased with valve size. The St. Jude Medical valve had a greater EOA than the Ionescu-Shiley bioprosthesis, regardless of the valve size (p less than 0.005). However, the performance of prosthetic leaflets was better with the Ionescu-Shiley bioprosthesis than with the St. Jude Medical mechanical valve (p less than 0.001). This method involving computer analysis of each cardiac cycle proved to be useful for evaluating prosthetic heart valve function in the presence of changing hemodynamics.     

Influence of perfusion pressure on oxygen supply and demand in beating empty hypertrophied dog hearts

As cardiopulmonary bypass is frequently accompanied by hypotension, the effect of varying perfusion pressure (30, 60, and 90 mm Hg) on the adequacy and distribution of coronary flow was studied under conditions of a normothermic beating empty state, of normal and hypertrophied hearts of 20 mongrel dogs, using the radioactive microsphere technique. In the normal hearts, 30 mmHg caused a 47% (P < 0.005 to prebypass) reduction of left ventricular coronary flow but did not change flow distribution (ENDO/EPI flow ratio: 1.01); increasing mean perfusion pressure from 30 to 90 mm Hg did not alter the oxygen consumption but did increase the coronary flow and decrease the oxygen extraction ratio. In the hypertrophied hearts, 30 and 60 mm Hg perfusion pressures resulted in a redistribution of flow away from the subendocardium (ENDO/EPI flow ratio: 0.82 and 0.87, respectively, P < 0.02 to prebypass). An increase in perfusion pressure from 30 to 60 mm Hg resulted in a significant increase in oxygen uptake (4.0 vs 5.6 cc/100 g/min, respectively, P < 0.02). An increased perfusion pressure of 90 mmHg resulted in a sufficient subendocardial flow and an augmentation of the oxygen uptake. These results indicate that subendocardial underperfusion occurs in the beating empty hypertrophied heart, under conditions of lower perfusion pressures (30 and 60 mm Hg), but that such can be improved by increasing the perfusion pressure to 90 mmHg. In contrast, the subendocardial underperfusion does not occur with a perfusion pressure of 30 mm Hg in normal hearts.