There are many reports regarding the relation of the prognosis of neuroblastoma to various factors such as the age of onset, stage of the disease, the histological type and the site of the tumor. However, there have been no reports on the comprehensive analysis of all these factors. In our research group, we worked out the prediction equation for the estimation of prognosis of neuroblastoma, using the multivariate analysis, based upon the factors considered to be related with the prognosis of neuroblastoma. Of 380 cases included in this survey received from 11 facilities in Japan, only 138 cases were available for analysis with all these 11 items. The following prediction equation was obtained from theses 138 cases: Y = the histological type + the site of tumor + factor E + factor V + factor BM + factor H + factor D - (0.1962 × age in month) -2.91429. It showed high multiple correlation coefficient of R = 0.8000 (P < 0.001), and when this formula was used, the accuracy rate of forecast of survivals and deaths turned out to be 93% in these 138 cases. When five other items of RBC, WBC, ESR in 1 and 2 hours and LDH, were added as a preoperative clinical data, higher correlation was obtained. Complete data including all items was obtainable from only 37 cases. If adequate data of clinical tests are available in all future cases, we believe that a prediction equation for estimation of prognosis of neuroblastoma will be more reliable.

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Based on a fact that intra-abdominal pressure elevation compromizes peripheral perfusion, in the postoperative course of omphalocele and diaphragmatic hernia experimental studies were carried out using puppies. Abdominal pressure was raised by on nitrogen gass inflation of the abdominal cavity, which was controlled by monitoring peripheral venous pressure (PVP). Dogs were divided into two groups: the low pressure group and the high pressure group with PVP three and seven foldo higher than the initial pressure respectively. Abdominal nitrogen gass inflation was maintained for 90 min. and then released. During the course of experiment, the muscle surface pH (PHM) in the upper and lower limbs and the cardiac out-put were measured. Following results were abstained. In the high pressure group, the PHM of lower limb decreased more rapidly than the PHM of upper limb during abdominal inflation. Even after the abdominal inflation was released, the PHM of upper limb continued to decrease constantly. On the other hand, the PHM of lower limb recovered by release of the abdominal inflation until reading the same value of the upper limb PHM, then thereafter gradually decreased along with the upper PHM. Cardiac out-put decreased immediately after the abdominal distention and showed temporary increase following release of the abdominal inflation. These change of cardiac out-put correlated with the PHM of lower limb, but there was no reflecting relation of the PHM of upper limb to the cardiac out-put. In conclusion: 1. The peripheral circlulation of the lower extremities is more disturbed than that of the upper experimities by the an increase of intra-abdominal pressure. 2. The PHM of lower limb decreased remarkably by the intra-abdominal pressure. 3. The PHM of the upper limb does not have a reflecting relation to cardiac out-put. 4. The PHM reflected regional peripheral insofficiency and tissue metabolic disturbances.

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In this report we have reviewed our results in 45 patients with atrial septal defect primum (ASD primum) who were operated upon between 1955 and 1978. Analysis of early and late results of these operated patients has focused on factors affecting operative risk and prognosis. Age at operation was one year-old to forty-six year-old (mean age was 12.7 year-old). Operative mortality was 4.4% and late mortality was 8.9% including reoperative death of two cases. We have originally classified the type of mitral and tricuspid cleft into I acd IV groups from the preoperative ffndings of cardiac murmur, cardiac size, E.K.G. and left ventriculogram and the findings at operation. This classiffcation provided the evaluations of late surgical results and prognosis in ASD primum. Preoperative cardiac enlargement and pulmonary hypertension due to mitral regurgitation and ASD primum were the most significant factors related to late surgical results. Surgical repair for mitral and tricuspid valve cleft should be performed in cases of a smalceft regurgitation in ASD primurn

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Eleven patients with recto-cloacal fistula treated in the past 11 years were reviewed. The following results and conclusions were obtained. 1.Invertogram was little useful to evaluate the anatomical level of the rectal pouch. Particular attension should be paid not to misjudge "pneumocolpos" as rectal pouch. 2.Associated anomalies were found in all patients with recto-cloacal fistula. 3.Simultaneoues visualization of the bladder,vagina and rectal pouch with fistula are necessary for making a decision of radical operation. 4.Eleven cloacal lesions were classified into three subtypes according to four factors; the location of the fistulous orifice, the outlet of the vagina, the length of the urethra between the bladder and urogenital sinus (proper urethra), and the form of urogenital sinus. 5.Incidence of urinary infection seemed to be correlated closely to the length of the proper urethra. Urinary infections were treated successfully by vaginal washout and dilation of urogental sinus. Urinary diversion was not carried out in any case. 6.Vaginoplasty is indicated in some cases in whom the proper uretura is with an adequate length.

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Study Group on Neuroblastoma in 1977 and 1978, granted by the Ministry of Health and Welfare This study included 330 cases of neuroblastoma, excluding 24 cases of ganglineuroma and 26 cases of neuroblastoma under 2 years of follow-up period, that our research group experienced in 11 facilities. We investigated on the occurrence rate and survival rate of these 330 cases from the analysis, on the relationship between the age and the various factors, such as the histological type, the site of origin, the site of metastasis and the results of hematological and chemical examinations. We summerized some new facts as follows: (1) The survival rate of the group over 4 years of age in the initial exmination was significantly higher than that between 3 and 4 years. (2) The survival rate of female was significantly higher than male. (3) The age distribution among the tumor of adrenal origin gave a convex type with a peak between 12 and 18 months. (4) The rosette forming type in histology had lower occurrence rate in accordance with age, while the round cell type had higher occurrence. (5) The survival rate of the H_3, D_2 group with the more advanced metastasis of liver and skin was higher than that of the H_1, H_2, D_0 group with the less advanced metastasis. Seventy per cent of the H_3, D_1, D_2 group, occured in the age under 6 months of age, with better prognosis. (6) The groupwith the preoperative positive urinary VMA had higher survival rate than that with negative urinary VMA. This was reversal among the cases between 1 and a half and 4 years of age. The ratio with positive urinary VMA had a tendency of increase in accordance with age.

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An 18 day old infant was referred with right pyothorax secondary to distal esophageal perforation. Drainage of the thoracic cavity had been done by a referring pediatrician. After admission a gastrostomy was created for duodenal tube feeding and she was successfully managed. The subsequent upper gastrointestinal X-ray series revealed no leakage at the distal part of the esophagus, but a gastroesophageal reflux was found. Twenty-four-hour pH monitoring of the distal esophagus was carried out. A reflux of the gastric juice into the distal esophagus was present when the patient strained. A combined procedure of fundplication and gastropexy with a repair of esophageal perforation was performed. The pH monitorihg of the esphagus performed after operetion showed no evidence of reflux. This paper summarizes our experience with this patient inducing the etiological consideration of neonatal esophageal perforation and discusses the appraisal of pH monitoring for gastroesophageal reflux.

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Pre-operative diagnosis of intestinal duplication is not easy because of its varieties. We experienced 3 children with interesting intestinal duplication, only one of whom was diagnosed as the intestinal duplication pre-operatively. Case 1: Esophageal Duplication A three month old girl was presented with dyspnea and scoliosis. She was operated upon as a diagnosis of split notochord syndrome (esophageal duplication). Mediastinal duplication including intestinal mucosa was excised. The cyst had no communication with esophagus and subdural cavity. Post-operative course was uneventful. Case 2: Duodenal Duplication A four month old girl was presented with abdominal pain and an abdominal tumor. Cyst-jejunostomy was done as a diagnosis of choledochal cyst. At one year and two month of age she visited our hospital for the investigation of frequent rectal bleedings. Large cystic duplication which was communicated with jejunum at the first operation was successfully excised. Post-operative course was uneventful. The total resection of the duplication cyst seemed to be the best method for the duodenal duplication as for the choledocal cyst. Case 3: Ileocaecal Duplication A two day old boy was presented with rectal bleeding and vomiting. Ileocolic intussusception lead by the duplication cyst was found at operation. An uncommunicated cystic duplication was excised without resection of the valve. Post-operative course was uneventful.

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Ten cases of necrotizing enterocolitis have been reviewed. The diagnosis was based on clinical courses, operative findings or post-mortem examinations. Three of 6 premature cases survived. In these 3 patients, the lesion was localized in the ileal end and an operation was indicated for pneumoperitoneum. As symptoms and signs were less characteristic in premature than in matured patients before operation, the diagnosis of localized necrotizing enterocolitis was difficult. Closed observation in high risk neonates is, therefore, very important.

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A 8 Year old boy with retroperitoneal leiomyosarcoma is reported. At surgery, the tumor was not completely resected. Although chemotherapy and irradiation with 3800 rads, there was a recurrence 5 months after aurgery with an extra-dural invation at the Th 10-12 vertebrae with neurological distur-bances. The metastatic lesion was surgically removed but neurological signs did not improve. A multidisciplinary treatment reported by Ghavimi with irradiation to the metastatic lesion and combined administration of Dactinomycine, Adriamycine, Vincristine and cyclophosphamide was attemped. This aggressive treatment was temporarily effective to reduce the size of the metastatic tumor in the chest and there was an improvement of clinical symptoms. Finally, the patient died one year after the initial surgery. This experience suggested that an aggressive therapy with a combination of irradiation and chemotherapy may be effective to reduce the advance of the metastatic lesions of leiomyosarcoma.

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The effectiveness of immunochemotherapy to a patient with neuroblastoma at stage IV was investigated. He was 4 years and 2 months of age at the time of diagnosis. He received surgery for partially resecting a primary tumor originating from R-adrenal gland and the histological diagnosis was rosette-forming type of neuroblastoma. At the same time, hepatic, bone marrow and bony metastases were noticed. He was treated by a modification of the immunochemotherapy schedule which was reported by Necheles et al.. He received intradermal injection of BCG instead of MER/BCG and 3M KC1 tumor extract of his own tumor cells obtained at surgery. During 10 months after initial diagnosis, he has been treated with 3 courses of chemotherapy of adriamycin, vincristine and cyclophosphamide and 6-7 administrations of tumor extract and BCG. During treatments, humoral immune responses were followed by measuring levels of serum IgG, IgA and IgM and cellular immune responses were followed serially by in vitro lymphoblastogenesis stimulated by PHA and tumor extract, and in vivo, skin tests of PHA, tumor extract and so forth. In conclusion, the patient's immunological competence has been maintained in good condition during treatment and results of skin tests of tumor extract gradually became more significant. No side effects were observed locally and systemically. At present, he is well without any metastases and with normal levels of VMA and HVA excretions into urine. In this paper, we discussed the possibility of immunochemotherapy as a new treatment for a patient with advanced neuroblastoma.

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Gastric and duodenal ulcer in infants and children is not so rare as was expected previously. In this paper, the characteristic findings of x-ray examination and endoscopy are presented. Of 40 patients consisted of 31 male and 9 femal, 13 were diagnosed as gastric ulcer, 25 were duodenal ulcer and 2 were gastroduodenal ulcer. Chief complaints were so varied in pediatric ulcer that we had to take good care of gastrointestinal symptoms. Eleven patients, all of whom were more than 10 years of age, had to undergo operation. And, it was noteworthy that 27.3% of the patients showed multiple ulcer and further 2 patients had to undergo reoperation. On x-ray examination in pediatric patients, not only direct findings on ulcer but also indirect findings on intestinal function were proved to be important. In addition, importance of diagnosis applying endoscopy in pediatric field was emphasized.

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A case of a 5 month old girl who showed unstable vital signs thought to be caused by the unsteady output of an infusion pump was reported. The characteristics and safety features of 13 different types of infusion pumps which are currently in use at our institution were examined and compared. The syringe type infusion pump is recommended for catecholamine infusion. The proper selection of infusion pumps for certain purposes is emphasized.

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[in Japanese]

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