Yoshimaru K

References (4)

Title : Acetylcholinesterase staining for the pathological diagnosis of Hirschsprung's disease - Yoshimaru_2021_Surg.Today_51_181
Author(s) : Yoshimaru K , Yanagi Y , Obata S , Takahashi Y , Irie K , Omori A , Matsuura T , Taguchi T
Ref : Surg Today , 51 :181 , 2021
Abstract : Hirschsprung's disease (HD) is a congenital disease manifesting various degrees of functional bowel obstruction caused by the absence of enteric ganglion cells, which are usually absent in the colonic segment of the HD patient. Because the aganglionic segment of HD always includes the rectum, pathological diagnosis can be made using a rectal sample. HD should be diagnosed as early as possible because serious complications, such as acute enterocolitis or toxic megacolon, can develop without a definitive diagnosis and appropriate treatment. In the mid-1900s, HD was diagnosed by HE staining of specimens obtained by full-thickness biopsy. Since then, the combination of rectal mucosal biopsy and rubeanic acid-amplificated AChE staining has been brought about by the following milestones: the discovery that the submucosal plexus and the intermuscular plexus had the same level of nerve migration; the findings of research on acetylcholine (ACh) and acetylcholinesterase (AChE) in the intestinal tract; and the establishment of a rubeanic acid amplification method. Consequently, the diagnostic rate of HD improved dramatically in the 1980s. This review outlines the history of diagnostic methods for HD, the roles of ACh and AChE in the intestine, and the method of AChE staining.
ESTHER : Yoshimaru_2021_Surg.Today_51_181
PubMedSearch : Yoshimaru_2021_Surg.Today_51_181
PubMedID: 32577882

Title : Reevaluation of Concurrent AChE and HE staining for Hirschsprung's disease - Yoshimaru_2021_Pediatr.Int__
Author(s) : Yoshimaru K , Matsuura T , Yanagi Y , Obata S , Takahashi Y , Kajihara K , Ohmori A , Irie K , Hino Y , Shibui Y , Tamaki A , Kohashi K , Oda Y , Taguchi T
Ref : Pediatr Int , : , 2021
Abstract : BACKGROUND: Acetylcholinesterase (AChE) histochemistry has been widely performed for the histopathological diagnosis of Hirschsprung's disease (HD). However, we occasionally come across diagnostic difficulties. We conducted concurrent AChE histochemistry and hematoxylin and eosin (HE) staining to validate the ancillary value of this technique. METHODS: Of 177 patients diagnosed using AChE histochemistry from January 2014 to December 2016, 90 patients underwent formalin-fixed paraffin-embedded HE staining. The histopathological findings and diagnostic abilities were retrospectively investigated and compared. RESULTS: The sensitivity, specificity, accuracy and Kappa index of AChE histochemistry and HE staining were 94.1%, 100%, 98.9% and 0.964 and 76.5%, 84.9%, 83.3% and 0.530, respectively, with the specificity, accuracy and Kappa index of AChE histochemistry significantly higher than those of HE staining (p<0.001, p<0.001 and p<0.05). HE staining supported the suspected diagnosis of total colon aganglionosis (TCA) at the initial biopsy; furthermore, HE staining helped confirm the distinct shape of ganglion cells and hypertrophic nerve bundles. CONCLUSION: We re-confirmed that AChE histochemistry is an excellent method for diagnosing HD. Although the diagnostic ability of HE staining is limited, it has acceptable utility as an ancillary method. Thus, AChE staining is a useful test and it should be performed together with HE staining.
ESTHER : Yoshimaru_2021_Pediatr.Int__
PubMedSearch : Yoshimaru_2021_Pediatr.Int__
PubMedID: 33417724

Title : The evaluation of rectal mucosal punch biopsy in the diagnosis of Hirschsprung's disease: a 30-year experience of 954 patients - Yoshimaru_2017_Pediatr.Surg.Int_33_173
Author(s) : Yoshimaru K , Kinoshita Y , Yanagi Y , Obata S , Jimbo T , Iwanaka T , Takahashi Y , Esumi G , Miyata JA , Matsuura T , Izaki T , Taguchi T
Ref : Pediatr Surg Int , 33 :173 , 2017
Abstract : PURPOSE: For 30 years, we have consecutively performed rectal mucosal punch biopsy to diagnose Hirschsprung's disease. The aim of this study was to evaluate the safety of our technique.
METHODS: Patients with suspected Hirschsprung's disease who underwent punch biopsy, including our original "K-PUNCH" method using an S-moid forceps and non-specific blood-collecting tube at our department and branch hospital between April 1986 and March 2016 were included in the present study. Our punch biopsy technique is characterized by excellent visibility and a direct grasping sensation. The backgrounds and complications of the patients were retrospectively investigated.
RESULTS: During this period, 954 patients (median age 4 months; range 1 day-73 years) underwent punch biopsy. Although there were no cases of severe complications (i.e., rectal perforation, infection or full-thickness biopsy), one (0.1%) of the 954 cases in the early period showed liver dysfunction and required transfusion due to bleeding. In addition, inappropriate specimens were obtained in 37 patients (3.9%). CONCLUSION: Punch biopsy including the "K-PUNCH" method is considered safe and feasible and is associated with a low rate of complications and inappropriate specimen harvesting among patients of all ages. Comorbidities, including the potential for hemorrhage, should always be considered.
ESTHER : Yoshimaru_2017_Pediatr.Surg.Int_33_173
PubMedSearch : Yoshimaru_2017_Pediatr.Surg.Int_33_173
PubMedID: 27832330

Title : Reevaluation of acetylcholinesterase staining for the diagnosis of hirschsprung disease and allied disorders - Budianto_2015_J.Pediatr.Gastroenterol.Nutr_60_606
Author(s) : Budianto IR , Obata S , Kinoshita Y , Yoshimaru K , Yanagi Y , Miyata J , Nagata K , Ieiri S , Taguchi T
Ref : J Pediatr Gastroenterol Nutr , 60 :606 , 2015
Abstract : OBJECTIVES: Acetylcholinesterase (AChE) staining has become the gold standard for definitively diagnosing Hirschsprung disease (HD), although some pitfalls have been reported. We reevaluated a large series at our institute in order to validate the accuracy of AChE staining for detecting HD.
METHODS: A retrospective study of the rectal mucosal specimens of all of the children with suspected HD during a 13-year period was performed. The specimens were stained according to the modified Karnovsky-Roots method for AChE staining. The final diagnosis, prognosis, and management after the histopathological diagnosis were analyzed with a questionnaire sent to the patient's original hospital.
RESULTS: Three hundred and fifty-eight specimens were collected. One hundred twenty-two (34%) specimens were diagnosed as HD, 198 (55%) as nonHD, 25 (7%) as "undetermined," and 13 (4%) as "inappropriate." The non-HD group contained 190 (96%) specimens with a normal appearance and 8 (4%) specimens with suspected intestinal neuronal dysplasia (IND). Three hundred and six of 358 questionnaires were returned. The final diagnosis showed that no specimens first diagnosed as HD were identified as non-HD and vice versa, for a sensitivity and specificity of 100%. Four cases were finally diagnosed as chronic idiopathic intestinal pseudo-obstruction (CIIP) in the non-HD group. All of the patients with HD underwent radical surgery. Most non-HD patients were managed conservatively, although some continued to have constipation.
CONCLUSIONS: AChE staining is an accurate tool for differentiating between HD and non-HD with high sensitivity and specificity. CIIP can be included in cases of non-HD; therefore, careful follow-up is mandatory.
ESTHER : Budianto_2015_J.Pediatr.Gastroenterol.Nutr_60_606
PubMedSearch : Budianto_2015_J.Pediatr.Gastroenterol.Nutr_60_606
PubMedID: 25522309