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Two separate thoroscopic segmentectomies with vessel sealing system.

Atsushi Watanabe, Masahiro Miyajima, Nobuyoshi Kawaharada, Tetsuya Higami

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 41 ( 4 ) e62-4 2012年04月 [国際誌]

Total thoracoscopic segmentectomy is an appealing concept in terms of providing a parenchyma-sparing treatment. We describe our technique of two seperate total thoracoscopic segmentectomies by using a vessel sealing system (VSS). A 76-year old female with four gradually enlarging ground glass lesions on the right segment 2 (10 and 3 mm) and segment 6 (8 and 3 mm) was admitted to our institute for surgical diagnosis and treatment. Preoperative three-dimensional computed tomography showed that the A2 is composed of descending A2 and ascending A2, branch of V6 coursed to V2 and B1a originated from B2 and B1b from B3. Two separate segmentectomies were subsequently scheduled. Pulmonary vessel division was performed with VSS after proximal ligation. Intersegmental division by VSS and electrocautery was performed with the use of inflation-deflation demarcation line and the pulmonary veins along the intersegmental plane (V2a and V2c for segment 2 and V6b and V6c for segment 6) as guides to confirm the intersegmental plane after pulmonary artery and bronchial divisions. The intraoperative frozen-section examinations revealed adenocarcinoma in situ. Two separate segmentectomies were successfully completed, with a total operative time of 240 min and blood loss of 30 ml. VSS is a very useful and safe device for intersegmental division and pulmonary vessel division.

DOI PubMed

Thoracoscopic mediastinal lymph node dissection for lung cancer.

Atsushi Watanabe, Jyunnji Nakazawa, Masahiro Miyajima, Ryo Harada, Shinji Nakashima, Tohru Mawatari, Tetsuya Higami

Seminars in thoracic and cardiovascular surgery 24 ( 1 ) 68 - 73 2012年 [国際誌]

In lung cancer, mediastinum lymphatic spread occurs. We review our technique and experience of thoracoscopic mediastinal lymphnode dissection (MLND). Between 1997 and 2011, 992 patients with primary lung cancer underwent thoracoscopic major pulmonary resection with MLND. Initially we used a combination of electrocautery and clips to divide blood vessels and lymphatic channels; our current technique relies on a vessel sealing system (VSS) which is expeditious and leads to less lymphorrhea. Furthermore, dissection of station 7 nodes is performed after each main bronchus or right intermediate bronchus is taped with a 0 silk suture, which is then brought out of the thorax through the access incision for antero-lateral retraction of the tracheal carina. We dissect between 3 and 4 N2 lymph node stations and a total of approximately 20 N2 lymph nodes. Postoperative complications related to MLND occurred in 35 of 992 patients (3.5%), 15 (1.5%) for recurrent laryngeal nerve injury, 3 (0.3%) for bilateral vagal injury, 14 (1.4%) for chylothorax and 3 (0.3%) for airway injury. However, none were lethal. Thoracoscopic mediastinal dissection is safe and feasible in treating lung cancer. We believe our technique and VSS are very useful for thoracoscopic MLND.

DOI PubMed

Successful treatment by fibrin glue sealant for pneumothorax with chronic GVHD resistant to autologous blood patch pleurodesis.

Satoshi Iyama, Tsutomu Sato, Kazuyuki Murase, Shohei Kikuchi, Yusuke Kamihara, Kaoru Ono, Kohichi Takada, Koji Miyanishi, Yasushi Sato, Rishu Takimoto, Masayoshi Kobune, Takuro Obama, Masahiro Miyajima, Atsushi Watanabe, Tetsuya Higami, Yasuo Hirayama, Junji Kato

Internal medicine (Tokyo, Japan) 51 ( 15 ) 2011 - 4 2012年 [国内誌]

Pneumothorax associated with chronic graft-versus-host disease (cGVHD) after stem cell transplantation is a rare complication. Autologous blood has been used successfully for pleurodesis, which was less toxic than chemical agents. However, when pneumothorax is resistant to pleurodesis, no other procedure is more effective and conservative. Here, we describe a case of myelodysplastic syndromes complicated with cGVHD-related pneumothorax. His pneumothorax has been resistant to pleurodesis using autologous blood and was treated successfully with fibrin glue sealant. In our limited experience, we believe the best success could be achieved when this method is used to treat persistent pneumothorax with cGVHD.

PubMed

Total thoracoscopic lung segmentectomy of anterior basal segment of the right lower lobe (RS8) for NSCLC stage IA (case report).

Masahiro Miyajima, Atsushi Watanabe, Mayuko Uehara, Takuro Obama, Junji Nakazawa, Tomohiro Nakajiima, Keishi Ogura, Tetsuya Higami

Journal of cardiothoracic surgery 6 115 - 115 2011年09月 [国際誌]

A 69-year-old woman with a pulmonary nodule in anterior basal segment of the right lower lobe (RS8) was referred to our department. The diameter of the tumor was 12 mm, and it had increased over a few months. First, video-assisted thoracoscopic lung surgery (VATS) biopsy of the pulmonary nodule was carried out. Frozen section examination of this nodule confirmed the diagnosis of bronchioloalveolar carcinoma (BAC). Segmentectomy of RS8 with lower mediastinal node dissection (ND2a-1) was performed. The intersegmental plane was identified using the intersegmental veins as landmarks and the demarcation between the resected (inflated) and preserved (collapsed) lungs. Electrocautery at 70 watts was used to divide the intersegmental plane. A vessel sealing system was used to seal and cut the pulmonary arteries. Postoperative histopathological examination revealed that the tumor was T1aN0M0 BAC, and the minimal distance between the surgical margin and the tumor edge was 15 mm. The patient was discharged from hospital on postoperative day 5 without any complications.

DOI PubMed

Early acceptance of renal allografts in mice is dependent on foxp3(+) cells.

Masahiro Miyajima, Catharine M Chase, Alessandro Alessandrini, Evan A Farkash, Patricia Della Pelle, Gilles Benichou, Jay A Graham, Joren C Madsen, Paul S Russell, Robert B Colvin

The American journal of pathology 178 ( 4 ) 1635 - 45 2011年04月 [国際誌]

Mouse renal allografts have a remarkable ability to promote acceptance across full major histocompatibility complex incompatibilities in certain strain combinations without immunosuppression. The mechanism is unknown but is believed to involve immunoregulation. This study tests whether Foxp3(+) T-regulatory cells are responsible in the early phase of graft acceptance, using B6.Foxp3(DTR) mice that express diphtheria toxin receptor (DTR) in Foxp3(+) cells. The administration of DT to B6.Foxp3(DTR) recipients with accepted DBA/2 kidneys, 3 weeks to 3 months after transplantation, caused a marked depletion of Foxp3 cells and triggered acute cellular rejection, manifested by a sudden increase in blood urea nitrogen within a week. None of the controls showed an increase in blood urea nitrogen, including DT-treated B6 wild-type recipients of DBA/2 kidneys or B6.Foxp3(DTR) recipients of isografts. Accepted DBA/2 allografts showed prominent lymphoid sheaths around arteries containing numerous CD3(+)Foxp3(+) cells, CD4(+) cells, dedritic cells, and B cells, which was independent of CCR4. The lymphoid sheaths disintegrate after Foxp3 depletion, accompanied by widespread CD8 interstitial mononuclear inflammation, tubulitis, and endarteritis. The Foxp3 depletion caused an increased frequency of donor-reactive cells in the spleen by interferon (IFN) γ enzyme-linked immunosorbent spot (ELISPOT) assays and increased expression of the maturation markers, CD86 and IA(b), on dendritic cells in the spleen and kidney. We conclude that Foxp3(+) cells are needed to maintain acceptance of major histocompatibility complex-incompatible renal allografts in the first 3 months after transplantation and may act by inhibiting DC maturation.

DOI PubMed

左下葉切除にて救命された体動脈左下葉静脈瘻による重症喀血症例―大動脈瘤手術後膿胸合併の既往との関連について—大動脈瘤手術後膿胸合併の既往との関連について

中島智博, 渡辺敦, 小濱卓朗, 宮島正博, 仲澤順二, 樋上哲哉

日本呼吸器外科学会雑誌 ( 特定非営利活動法人日本呼吸器外科学会 ) 25 ( 5 ) 497 - 501 2011年

患者は59歳，女性．2000年に他院で胸部下行大動脈瘤に対して人工血管置換術を受けた．しかし，術後膿胸を合併したため胸腔内洗浄を施行され軽快退院した．2010年4月に喀血を主訴に他院へ救急搬送された．血管造影検査にて体動脈から左肺下葉内に流入する血管が数本造影され，CTで中枢側吻合部仮性瘤が認められた．2010年6月に再度喀血を生じて当院に搬送された．開胸手術にて左肺下葉切除術を行った．肺組織に至るまでの結合組織には新生血管が豊富にあり動脈性出血の止血に難渋した．術後8日目に独歩退院した．また，仮性動脈瘤については1ヵ月後にステントグラフト内挿術で治療された．膿胸による慢性炎症によって胸壁から肺内に向かう血管が新生され，体動脈肺静脈瘻が形成され喀血に至ったと考えられた．血管新生に対する考察を加えて報告する．

DOI CiNii

Dendritic cell maturation occurs through the inhibition of GSK-3β.

Alessandro Alessandrini, Stephanie De Haseth, Michael Fray, Masahiro Miyajima, Robert B Colvin, Winfred W Williams, A Benedict Cosimi, Gilles Benichou

Cellular immunology 270 ( 2 ) 114 - 25 2011年 [国際誌]

Dendritic cell (DC) maturation results in changes in antigen processing and presentation, governing the fate of adaptive immunity. Understanding the intracellular signaling pathways governing DC maturation is therefore critical. In this study, we observed that the kinase, GSK-3β, is present in its active form in resting immature DCs isolated from the spleen and bone marrow of mice. Induction of DC maturation using GM-CSF, IL-4 and TNF-α resulted in GSK-3β inhibition, as reflected by increased phosphorylation of Serine 9 on the kinase, and concomitant stabilization of its substrate, β-catenin. Treatment of immature DCs with a GSK-3β inhibitor increased cell surface expression of CD80, CD86 and CD40 on DCs, enhancing their ability to present antigen and activating IL-2 secretion by T cells. GSK-3β inhibition also parallels dendritic cell maturation in vivo. Our results show that GSK-3β signaling controls DC maturation and suggest that this kinase could be manipulated to modulate adaptive immunity.

DOI PubMed

肝細胞癌肋骨転移に対する胸腔鏡補助下外科治療

中島智博, 渡辺敦, 小濱卓朗, 宮島正博, 仲澤順二, 樋上哲哉

日本呼吸器外科学会雑誌 ( 特定非営利活動法人日本呼吸器外科学会 ) 25 ( 6 ) 621 - 625 2011年

画像所見で肋骨腫瘍が疑われ，胸腔鏡補助下に肋骨切除術を行った1例を経験した．症例は74歳，男性で2010年に右側胸部痛があり近医整形外科を受診した．右第4肋骨背側に3cm超の腫瘤があり，全身精査の為に当院を紹介され受診した．CTにて肝臓S6に4cmの腫瘤影があり，肋骨部の腫瘤が肝細胞癌転移の可能性があるため，診断および切除目的に手術となった．胸腔鏡補助下に第4肋骨と第5肋骨を合併切除した．病理診断の結果は肝細胞癌の肋骨転移であった．肋骨腫瘍に対して胸腔鏡補助下の切除術を行うことで，皮膚および胸壁筋切開範囲を縮小し，同部への損傷を少なくすることが可能であった．

DOI CiNii

Delayed closure of postinfarction ventricular septal rupture.

Masahiro Miyajima, Toshiya Kawashima, Tatsuya Saito, Hideo Yokoyama, Katsumi Ohori, Kenji Kuwaki, Akihiko Sasaki, Tetsuya Higami

Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 16 ( 2 ) 128 - 30 2010年04月 [国内誌]

We present the case of a patient with postinfarction ventricular septal rupture (VSR) who underwent delayed repair using a modified infarction exclusion technique. The patient was taken to the operating room 21 days after the first incidence of acute myocardial infarction because the intra-aortic balloon pump maintained a stable circulatory condition without cardiogenic shock. In our procedure, a Dacron patch was sutured to the healthy endocardium to exclude the infarcted septum, and the VSR was subsequently closed with another Dacron patch. After three years of postoperation, the patient's condition remains normal with good ventricular kinesis and no residual shunt. We describe herein a novel procedure for repairing postinfarction VSR by using two Dacron patches.

PubMed

Suppression of alloreactivity and allograft rejection by SP600125, a small molecule inhibitor of c-Jun N-terminal kinase.

Akihiro Tabata, Masayuki Morikawa, Masahiro Miyajima, Brydon L Bennett, Yoshitaka Satoh, Jianhua Huang, Yasuaki Tamura, Noriyuki Sato, Tomio Abe

Transplantation 83 ( 10 ) 1358 - 64 2007年05月 [国際誌]

BACKGROUND: c-Jun N-terminal kinase (JNK) is reported to play crucial roles in T-cell activation and differentiation, and SP600125 is a small molecule that inhibits JNK. The aim of this study was to examine immunosuppressive action of this compound. METHODS: Rat heterotopic heart transplantation, popliteal lymph node (PLN) hyperplasia bioassay and lymphocyte proliferation assay. RESULTS: SP600125 treatment reduced histological rejection, and dose-dependently extended median survival time of cardiac allografts from 7 days (vehicle) up to 20 days (40 mg/kg/day). Alloantigen-induced PLN hyperplasia was also inhibited by SP600125 in a similar fashion. SP600125 suppressed mixed lymphocyte reaction and OX52-positive lymphocyte proliferation (IC50: 1.5-5.7 microM). Thus, SP600125 inhibits both T-lymphocyte expansion in vitro and T-cell-mediated alloimmune responses in vivo. In addition, SP600125 interacted with cyclosporine additively to prolong cardiac allograft survival. CONCLUSION: Our data provide the first evidence indicating the potential for JNK as a therapeutic target to inhibit the alloimmune response.

PubMed

胸部･気道損傷の治療穿通創肺･気管刺創に対する術式の工夫

田中明彦, 宮島正博, 小濱卓朗, 黒田陽介, 原田亮, 前田俊之, 村木里誌, 渡辺祝安, 松井俊尚, 牧瀬博

胸部外科 ( 南江堂 ) 59 ( 11 ) 1018 - 1022 2006年10月

DOI CiNii

Adamkiewicz artery demonstrated by MRA for operated posterior mediastinal tumors.

Satoshi Muraki, Akihiko Tanaka, Masahiro Miyajima, Ryo Harada, Noriyasu Watanabe, Hideki Hyodoh

Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 12 ( 4 ) 270 - 2 2006年08月 [国内誌]

In the thoracolumbar region, it is well known that the great anterior medullary artery (the artery of Adamkiewicz: AKA) is the dominant feeder of the spinal cord. During surgery for posterior mediastinal tumor adjacent to the lower thoracic aorta, perioperative distortion of the spinal cord blood supply could lead to neurological complication. To avoid postoperative paralysis, it would be useful to know the level of the intercostal artery from which the AKA originates. Recently, we have attempted to identify the AKA preoperatively using magnetic resonance angiography (MRA).

PubMed

JNK特異的阻害剤による免疫抑制の可能性とその機序

宮島正博, 森川雅之, 田畑哲寿, 一宮慎吾, 佐藤昇志, 安倍十三夫

日本外科学会雑誌 ( 一般社団法人日本外科学会 ) 107 ( 2 ) 709 2006年03月

CiNii

Concomitant mitral and tricuspid valve infective endocarditis: report of a case.

Yoshikazu Hachiro, Hideyuki Harada, Toshio Baba, Yukiko Honma, Masahiro Miyajima, Tomio Abe

Surgery today 34 ( 8 ) 695 - 7 2004年 [国内誌]

PubMed

Medical students' views on thoracic surgery residency programs in a Japanese medical school.

Kiyofumi Morishita, Shu-ichi Naraoka, Masahiro Miyajima, Takeshi Uzuka, Tatsuya Saito, Tomio Abe

The Japanese journal of thoracic and cardiovascular surgery : official publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai zasshi 51 ( 9 ) 475 - 7 2003年09月 [国内誌]

There has been a decline in the number of medical students applying for thoracic surgery training programs. We obtained knowledge of medical students' views on thoracic surgery residency programs. After completion of thoracic surgery clerkship, 17 students were asked to fill out questionnaires on first-year thoracic surgery residency programs. The majority of students considered thoracic surgery to be held in high regard by the general public, and felt that the salary was sufficient. However, only one student chose a thoracic surgery training program. The main reason for not applying for thoracic surgery residency was lifestyle issues. The factors in determining career choice included quality of education and work hours. Medical students are likely to select specialties other than thoracic surgery. Since the main factor influencing medical students' career is the quality of education in a residency program, efforts should be made to improve the quality of education.

PubMed

Descending or thoracoabdominal aortic aneurysm repair without intercostal vessel reconstruction using contrast magnetic resonance angiography: report of two cases.

Johji Fukada, Kiyofumi Morishita, Hideki Hyodoh, Nobuyoshi Kawaharada, Satoshi Muraki, Masahiro Miyajima, Tomio Abe

Surgery today 32 ( 2 ) 163 - 6 2002年 [国内誌]

Two high-risk patients underwent a graft replacement for descending thoracic or thoracoabdominal aortic aneurysms without the reconstruction of any intercostal and lumbar arteries. The first patient was an 81-year-old woman with asthma and renal dysfunction who was diagnosed to have a descending thoracic aortic aneurysm extending from the Th8 to Th12 level. Contrast magnetic resonance angiography (MRA) demonstrated the Adamkiewicz artery to originate from the left second lumbar artery. The second patient was a 59-year-old man with left ventricular dysfunction due to aortic and mitral stenoses who was diagnosed to have a Crawford type IV thoracoabdominal aortic aneurysm. Contrast MRA showed the Adamkiewicz artery to originate from the left ninth intercostal artery. In general, the reestablishment of the spinal cord's blood supply, whenever possible, is generally considered to be necessary in such patients to prevent spinal cord injury. However, the reimplantation of intercostal vessels is the most complex aspect of this surgical modality, and therefore, it may cause a substantial increase in the cardiopulmonary bypass time. However, at least in some cases, such as the two cases presented herein, the use of contrast MRA was found to reduce the risk in surgery for descending thoracic or thoracoabdominal aortic aneurysms by eliminating the need for any intraoperative management of the intercostal and lumbar arteries.

PubMed

3) 急性冠症候群による心停止症例に対する治療戦略

小柳哲也, 小松幹志, 宮島正博, 宇塚武司, 奈良岡秀一, 塚本勝, 安倍十三夫, 栗本義彦, 長谷守, 浅井康文

( 社団法人日本循環器学会 ) 65 585 2001年04月

CiNii

50) 再大動脈弁置換後に発生した左室-右室,右房交通症

宮島正博, 塚本勝, 小松幹志, 小柳哲也, 藤澤康聡, 奈良岡秀一, 安倍十三夫

( 社団法人日本循環器学会 ) 65 590 2001年04月

CiNii

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