[in Japanese]

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[in Japanese]

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The anorectal resting pressure and defecation sensory pressure were measured in 61 infants and children consisting of 18 with Hirschsprung's disease, 6 with suspected Hirschsprung's disease, 19 with imperforate anus, and 22 controls. The results obtained were as follows : 1) Anorectal reflex was observed in all controls and the patients with suspected Hirschsprung's disease. 2) The reflex was not observed in any of the patients with Hirschsprung's disease. 3) The rectal pressure, anal canal pressure, and pressure difference between rectum and anal canal of the patients with Hirschsprung's disease were similar to those of the controls. The anal canal pressure and pressure difference between rectum and anal canal of the patients with suspected Hirschsprung's disease were higher than those of the controls. 4) Anorectal reflex was observed in 38% of the surgically treated Hirschspung's disease patients. There was no close correlation between clinical improvement and occurrence of the reflex. 5) The rectal pressure of the patients with Hirschsprung's disease measured after operation was hardly different from that obtained before operation. The anal canal pressure and pressure difference between rectum and anal canal of the patients with Hirschsprung's disease taken after operation were lower than those measured before operation; and they were lower in patients who showed excellent clinical improvement than in those who did not. 6) After operation for imperforate anus, anorectal reflex was observed in patients with low anomalies, but not in patients with intermediate or high anomalies. Clinical improvement was excellent in the patients who had postoperative reflex. 7) After operation for imperforate anus, the rectal pressure did not differ according to type of anomaly or clinical results. The anal canal pressure and pressure difference between rectum and anal canal were lower in patients with hign or intermediate anomalies and with poor surgical results. 8) The defecation sensory pressure of the patients with Hirschsprung's disease was similar to that of the controls, and was lower than the pressure difference between rectum and anal canal. (normal relation : defecation sensory pressure<pressure difference between rectum and anal canal.) The defecation sensory pressure of the surgically treated imperforate anus patients was similar to that of the controls except for those with high anomalies. In patients with good surgical results, the sensory pressure was lower than the pressure difference (normal relation). In patients with incontinentia, the sensory pressure was higher than the pressure difference (reversed relation).

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[in Japanese]

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[in Japanese]

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[in Japanese]

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In general lymphangioma, if infected, may have a specific feature of swelling. We have experienced two cases of retroperitoneal lymphangioma which showed positive inflammatory findings by laboratory work-up. In one case, a one-year-old girl, lymphangioma was found attached medially to the ascending colon, and in another case, a four-year-old boy, it was found in the retroperitoneal space near the pancreatic tail. By antibiotherapy the tumors both subsided in size, to a great extent in the former case, and to some extent in the latter case. Large retroperitoneal lymphangiomas being reduced in size, the operative maneuvers were rather simple, and complete removal of lymphangiomas could be accomplished.

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A five years old boy was admitted to the Children's Medical Center of Osaka City with abdominal pain lasting for a weak. He had been affected by thrombosis of the superior sagital sinus 10 months prior to this admission. He was explored on an emergency base soon after admission. Operative findings disclosed a presence of superior mesenteric venous thrombosis with no specific cause. The infarcted jejunum was removed and an end to end anastomosis was performed. Inspite of a postoperative anticoagulant therapy, a reccurence of venous thrombosis distal to the initial anastomosis required the second operation 5 days after. Anticoagulant therapy had to be discontinued, because of multiple reccurrences of intra abdominal hematoma which required re-explorations. As the causes of mesenteric venous thrombosis, hypercoagulability due to oral contraceptives, platelet hyperfunction, low Antithrombin III, low fibrinolytic activity in vein itself, have been proposed in the recent reports. In our case, an elevated antifibrinolytic factors (α_2-Macroglobulin and α_1-Antitripsin) were determined as significance, which was considered as one of the potential causative factors of mesenteric venous thrombosis. Since determination of coagulative and fibrinolytic factors has been difficult, these were hardly considered as the cause of mesenteric venous thrombosis. Recent improvement of labo ratory techniques enabled us to detect these abnormalities. Our experience suggested that an elevated antifibrinolytic factors may be a cause of mesenteric venous thrombosis.

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Most of the congenital diaphragmatic hernia can be easily classified into three major categories from the location of the hernia orifice, but in a case with atypical location of the orifice and with non-muscular membranous sac, one may be embarrassed to define it. This is a case report of one-day-old female infant with a left sided diaphragmatic hernia whose initial symptom was hematemesis. She started to vomit caffee ground material from the next day of life. There was neither dyspnea nor cyanosis. A scout film of the abdomen revealed a large gas shadow with an air-fluid level in the upper quadrant of the abdomen (Fig. 1). No other abdominal gas shadow was visible except in the rectum. Gastrografin examination disclosed the dilated esophagus with tapered narrowing in the distal end and the up-sidedown stomach with complete obstruction of the outlet showing a beak (Fig. 3). At laparotomy, the anterior portion of the left diaphragm was thin and membranous but the posterior half was seemed normal. The anterior half was imbricated and sutured to the posterior half of the diaphragm (Fig. 5). Excised portion of the anterior half of the diaphragm had no muscular layer. The postoperative course of the patient was uneventful. There are many arguments about the histological findings and the definition of localized eventration of the diaphragm and diaphragmatic hernia with sac. It seems unable and unnecessary to distinguish these two conditions clinically. It is postulated that acute volvulus of the stomach is a cause of gastric rupture associated with diaphragmatic hernia including eventration.

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During the past nine years, 48 patients were admitted to our department of pediatric surgery under the suspicion of obstructive jaundice. 28 cases were congenital biliary atresia (C. B. A.) and the other 17 cases were neonatal hepatitis (N. H.). Two cases of C. B. A. were investigated too long time for radical operation for follow up. Nine of the 17 cases, N. H. were diagnosed by means of exploratory laparotomy. Two of these nine cases showed no intrahepatic bile duct by operative cholangiography, but were diagnosed N. H. because of absence of fibrosis of the liver and extrahepatic bile ducts. Satisfactory bile excretion was obtained in all cases. Since there was no significant difference between C. B. A. and N. H. by measuring serum bilirubin, Al-p, GOT, GPT and alfa-fetoprotein, immediate exploratory laparotomy should be performed in case of difficult to diagnose. Considering the close similarity of clinical feature and laboratory data between C. B. A. and N. H. in some cases, Landing's theory of obstructive cholangiopathy is agreeable.

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[in Japanese]

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From a point of respiratory management, pulmonary function was retrospectively investigated in 11 infants and 3 babies who had operated on in early time at birth for correction of Bochdalek hernia. 14 cases were classified into two groups by means of the preoperative PaCO_2 value, group 1 had high PaCO_2 more than 50mmHg, and group 2 had PaCO_2 values less than 49mmHg. The results were as follows, 1) PaCO_2 in group 1 revealed still high in postoperative period. 2) Efficacy of the oxygenation in the lung indicated by the M index were equally improved both in group 1 and 2. 3) These results were not clearly related to degrees of expansion of the ipsilateral lung. 4) It is supposed that high PaCO_2 in postoperative period is caused by injury of the contralateral lung, so that respiratory management of Bochdalek hernia should be based on improvement of the contralateral pulmonary function.

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Recurrent TEF is not rare as a postoperative complication of esophageal atresia with TEF. According to the literature, the incidence of the complication is between 5 and 20 percent. In our 36 cases of esophageal atresia with TEF, we reported 4 cases with recurrent TEF (11.1%), of which 3 cases survived thoracotomy with re-ligation of recurrent TEF, but one case died of pneumonia and was found recurrent TEF at autopsy. From our experience, it was concluded as follows; 1)Early diagnosis is the most important for obtaining good prognosis. As it is difficult to find recurrent TEF on repeated esophagography or the various methods described in the literature, we thought that thoracotomy could be indicated to any patients who had a history of small leakage and frequent episodes of bronchitis and/or pneumonia, even if the recurrent TEF was not diagnosed on these investigations. 2) Operation must be tried soon after improvement of lung findings and general conditions because the mortality is high with conservative therapy.

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[in Japanese]

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