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Article type: Cover
1981 Volume 17 Issue 1 Pages
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Published: 1981
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Article type: Cover
1981 Volume 17 Issue 1 Pages
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Article type: Index
1981 Volume 17 Issue 1 Pages
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Haruo Ohkawa, Shigenori Sawaguchi, Yoji Yamazaki, Misao Sakaniwa, Yasu ...
Article type: Article
1981 Volume 17 Issue 1 Pages
13-21
Published: 1981
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The purpose of this study is to produce an ideal animal model, just similar to human anomalies and then to solve the pathologicol mechanism of the hepato-biliary disorders according to the pancreatic reflux into biliary tree. The canine models of pancreatic reflux were produced on 15 mongrel adult dogs (12-25 kg) and 10 mongrel puppies (1.5-2.5 kg). The anastomosing method of dorsal pancreatic duct and gall bladder fundus was to make enhanced activation of pancreatic juice in bile according to the secreted enterokinase from the anastomosed duodenal wall. The direct anastomosing method of the dorsal pancreatic duct and the choledochus was employed to make a very similar model to human anomalies. The ventral pancreatic duct was left free without manipulation. Trypsin and elastase have been proven here to be activated in bile, under the existence of enterokinase in pancreatico-cholecystostomy, and without enterokinase in pancreatico-choledochostomy. The mechanism of activation of trypsin without enterokinase has not been solved. With both type anastomoses, only the pathological changes of the choledochus with cylindrical dilatation was produced. With pancreatico-choledochostomy, changes in the choledochal wall was severer. There was only slight change with papilla of Vater, without sclerotic stenosis.
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Takashi Hashimoto, Jiro Yura, Hiroshi Narita, Yukitaka Murata, Shusaku ...
Article type: Article
1981 Volume 17 Issue 1 Pages
23-30
Published: 1981
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We have treated 32 patients of choledochal dilatation during a period from 1966 to 1979. Nine were male and 23 female. Thirty one were operated. Sixteen had anomalous pancreatico-biliary ductal junction. According to the form of the common bile duct and the junction of pancreatico-biliary ductal system, these 16 cases were classified three types ; Type 1 ; cylindrical dilatation, which had a stenosis at the junction of pancreatico-biliary ductal system. Type 2 ; fusiform dilatation, which had a long common channel. Type 3 ; cystic dilatation, in which the bile duct connected to the pancreatic duct. In cases of type 1, a new etiological consideration, the over rotation theory of the ventral pancreas was suggested from the evidence of intra panceatic anastmosis between the common bile duct and the dorsal pancreatic duct in the early antenatal periods. We also concluded that the detection of anomalous pancreatico-biliary ductal junction is based on one of following criterias and clinical symptoms. 1. Radiological finding of the bile duct to open into the pancreatic duct. 2. Stenosis of the common bile dudt at the junction of the pancreatic duct. 3. Evidence of dilated common bile duct or abnormal high amylase levels in the bile in cases with a long common channel.
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Tsuneo Chiba, Morio Kasai
Article type: Article
1981 Volume 17 Issue 1 Pages
31-35
Published: 1981
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Biological activities of SB-PC against pseudomonas aeruginosa in bile were determined by the serial dilution method in 11 cases of biliary atresia 10 to 14 days after the operation and in 4 who were doing well without jaundice, 3 to 4 years after operation. The results were compared with those of adults (control group). The changes in concentration of SB-PC in serum in biliary atresia were similar to those in the control group. The concentration of SB-PC in bile was always higher than that in serum, and the highest level of the SB-PC in bile was 1, 705μg/ml in the control group. It was, however, very low and lower than 100μg/ml in biliary atresia in the early postoperative period inspite of good excretion of bile. SB-PC level in bile was about 3 times higher after 3 or 4 years after the operation comparing with that in the early postoperative period, but still lower than that of the control group.
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Shunichi Makino
Article type: Article
1981 Volume 17 Issue 1 Pages
37-53
Published: 1981
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L-essential amino acid solutions (AMI-U, AMI-U-II) with hypertonic glucose (50-70%) were administrated to rabbits which were subjected to ligation of bilateral renal vessels. Same treatment was given to surgical patients with acute or chronic renal failure in an attempt to minimize azotemia. Prolongation of survival days was observed. Significant inhibition of elevation of blood urea nitrogen and serum potassium was observed in the experimental animals, in a condition that the non protein energy : nitrogen ratio (NEP kcal/Ng) of the solution ranges from 615 to 2, 052. The changes of guanidino-succinic acid (GSA) were measured in the control, AMI-U and AMI-U-II aministrated groups. The difference of elevation of GSA was not apparent among these three groups. Inhibition of elevation of blood urea nitrogen and serum creatinine was observed in adults and children with acute and chronic failure when NPE kcal/Ng of the solution was over 600.
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Yasushi Suganuma, Toshinori Furukawa, Sigenori Sawaguchi, Masanobu Fuk ...
Article type: Article
1981 Volume 17 Issue 1 Pages
55-58
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The artificial fertilization experiment was performed on mongrel dogs, in order to produce foetal and neonatal puppies for the experimental use in the basic field of pediatric surgery. For raising sexual excitement, Prostagrandin F_<2α>, Estrone, PMSG and HCG were given. Within 30 days after the administration of PGF_<2α>, 200 μg of Estrone was given im and thereafter the same doses were given every other day. On the day of confirmed vaginal bleeding and for following 8 days, 250 IU of PMSG and 1, 000 IU of HCG were given. In 12 and 14 days after the vaginal bleeding, an artificial semination was performed. As the result, 16 out of 22 dogs (73%) were artificially exicited, and 9 out of 16 dogs (56%) were conceived.
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Masahiro Ohta, Makoto Iwafuchi, Hiroo Hirai, Kohju Nitta, Masayuki Hir ...
Article type: Article
1981 Volume 17 Issue 1 Pages
59-64
Published: 1981
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Since congenital atresia of the colon is a relatively rare anomaly, no sufficient experience has been available for diagnosis and management. From 1969 to 1978, five patients with colon atresia have been treated at the Niigata University Hospital. This paper deals with these five cases and discusses the diagnosis and management. Bilious vomiting, abdominal distension and failure to pass meconium are the most common symtoms and signs of this anomaly, but these can not differentiate a colon atresia from jejunoileal atsesia. The plain rentgenograms give some important information. A loop of largely dilated intestine with air-fluid level in the right abdomen may be suggestive of ascending colon atresia, and then multiple loops may be of transverse colon atresia or descending colon atresia. The barium enema is most helpful for establishing diagnosis, but it is not without risk such as perforation of the blind end of the distal colon. Colon atresia will be managed safely by proximal end-colostomy and subsequent resection with end-to-end anastomosis at the age of 3 to 6 months.
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Hideo Hidai, Teruo Kohdaira, Keikoku Miyai, Shusuke Matsuyama
Article type: Article
1981 Volume 17 Issue 1 Pages
65-72
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47 cases of children with abdominal masses were evaluated regarding their diagnostic and therapeutic problems. They consisted of neoplastic disorders (51%), hydronephrotic disorders (26%), inflammatory disorders (9%), cystic disorders (4%) and other miscellaneous disorders (11%). Intravenous pyelography, B-scope ultrasonography and computed tomography scan were the most valuable and least invasive diagnostic methods for evaluating these children. In cases of neoplastic disorders, angiography gave further informations regarding diagnosis and therapeutic choices. Percutaneous direct pyelography was the most valid method in diagnosing hydronephrotic non-visualizing kidneys. As for therapeutic results, although marked improvement in survival rate was achieved in treating Wilms' tumor, poor prognosis was noted in cases of neuroblastoma. In children presenting with an abdominal mass of advanced hydronephrosis, primary or secondary nephrectomy was indicated in half of the cases. Cases of renal and perirenal abscess did not respond well to conservative treatment and needed surgical interventions.
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Kyoei Nonaka, Muneyuki Yamaguchi, Kazuo Masuda, Tatsuo Nozaki, Kiyoshi ...
Article type: Article
1981 Volume 17 Issue 1 Pages
73-80
Published: 1981
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A total of 769 cases of choledochal cyst in infancy and childhood comprising 3 of our cases and 766 others in Japan were analyzed. There was one case in which malignant change of the cyst occured. And 72 patients had malformation of the pancreatico-biliary system. Excision of the cyst is the best procedure for preventing cystic cancer, ascending cholangitis and the pancreatic reflux to the biliary system. Hepaticojejunostomy with a Roux-en-Y operation is considered effiective for reconstruction of the bile duct because it scarcely causes ascending cholangitis.
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Hiroaki Hazama, Takashi Hori, Hiromasa Nozawa, Yoshihiko Imaizumi
Article type: Article
1981 Volume 17 Issue 1 Pages
81-88
Published: 1981
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We reviewed and analysed 499 cases of torsion of the testis reported in Japanese literature including our 4 cases. The results are as follows. 1. The age distribution of 456 cases shows two peaks at newborn and 18 years of age. Of all cases, the frequency in children under 10 years of age is 16%. 2. The affected side in patients under 1 year of age shows no laterality, but left-sided predominance is recognized (1t : rt=2.5 : 1) in the group over 1 year of age. 3. The newborns are 28 cases. Because of the poor clinical findings except scrotal mass and discoloration, orchiectomy is performed in 87% of patients (20/23). 4. 50 cases (10%) of torsion of undescended testis are collected. The incidence of this lesion in children is 16% (28 cases), and an orchiectomy is performed in 88% of patients (22/25). 5. The early recognition and immediate correction are essential in the treatment of this disease. An exprolatory operation should be performed for the patient suspected having acute testicular torsion. It is desirable to preserve the affected testis by detorsion and orchidopexy even though the testis is suspected as nearly necrotic.
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Osamu Doi, Koji Aoyama, Yoshiteru Takada, Kouichiro Sato, Motomasa Mur ...
Article type: Article
1981 Volume 17 Issue 1 Pages
89-95
Published: 1981
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Branchial cyst is rarely found in neonates. This paper reports three neonatal cases with infected branchial cyst. Recurrent infections, though responsive to chemotherapy, rendered three cysts excised. Internal fistula was found in two cases, while one case had no fistula. We strongly feel that branchial cysts with infection in the newborn should be excised after infection is eradicated with chemotherapy, even when internal fistula is present. One case belongs to the common type of branchial cyst arising from the second branchial remnants. Internal fistula connected with the pharynx at the level of thyrohyoid membrane in two cases suggested that these were derived from the third branchial cleft and pharyngeal pouch.
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Toshihiro Muraji, Ken Kimura, Shinji Hashimoto, Chikara Tsugawa, Eiji ...
Article type: Article
1981 Volume 17 Issue 1 Pages
97-102
Published: 1981
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During a period from 1978 to 1979, nine infants who had undergone hepatic portoenterostomy for biliary atresia underwent percutaneous transhepatic cholangiodrainage (PTCD). PTCD was achieved in five patients. A 19G epidural catheter was used for PTCD sheathed on a 21G needle based on the PTC technique described by Hashimoto and Jura. The bile obtained directly from the intrahepatic biliary system was submitted for bacteriologic studies and biochemical analysis. Gravity drainage of the intrahepatic biliary system was effective to improve hepatic dysfunction in patient with persistent cholestasis. This technique is useful for : 1) demonstration of the reconstructed biliary system, 2) collection of bile from the intrahepatic biliary system for biochemical and bacteriologic studies, 3) direct aministration of antibiotics to the bile ducts for cholangitis, 4) decompression of the intrahepatic biliary system and relief of biliary stasis.
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Yoshiaki Tsuchida, Hiroaki Hazama, Sumio Saito, Toshiro Honna, Shunich ...
Article type: Article
1981 Volume 17 Issue 1 Pages
103-111
Published: 1981
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Follow-up results after surgical treatment of anorectal anomalies were assessed in 118 of 161 patients seen during the past 27 years at the University of Tokyo Hospital. Postoperative constipation, which is one of the major complications in this disease, has been successfully treated in all but one patient with our intensive follow-up management. Radiological and manometric studies for anorectal functions were performed in 43 cases. Amplitude of ano-rectal pressure difference, length of high pressure zone and presence of ano-rectal reflex, as well as radiographic findings, were found to correlate well with continence studied on a clinical basis. Patients were, finally, evaluated with clinical and objective (radiography and manometry) scores, and it was found that objective assessment is more important than clinical assessment.
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Shigeki Funaki, Akio Tsunoda, Toshiji Nishi, Ryoji Yamada, Hiroshi Yam ...
Article type: Article
1981 Volume 17 Issue 1 Pages
113-117
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A newborn baby was admitted to the Center presenting with vomiting, abdominal distension and cyanosis. The initial diagnosis was sepsis because of high fever, blood count and analysis, CRP test and other clinical signs. In the course of treatment congenital pyloric atresia was diagnosed by X-ray examination. He also presented with blisters at the forarm, groin and soles. After adequate infusion and antibiotics treatment, a laparotomy was performed at the age of 10 days. There was an induration at the pylorus. A gastrotomy revealed an interruption of the gastric and duodenal mucosal membrane at the site of the induration. A Finney type pyloromyotomy was successfully performed. Postoperative course was complicated again by blisters appearing in both extremities. The boy was discharged at 36 days of life with a few remaining but recovering blisters. The combination of congenital pyloric atresia and epidermolysis bullosa was reported in ten cases in the world literatures. This is the first report in Japan. The prognosis is determined by the type of the skin lesion. Epidermolysis bullosa of simplex type has better prognosis than that of dystrophyic type. The inevitability of the combination of the two congenital diseases and the clinical significance of epidermolysis as a pile mark to detect the congenital pyloric atresia were discussed.
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Yoshio Zaizen, Keichi Ikeda, Akira Nakagawara, Yuji Numaguchi, Takashi ...
Article type: Article
1981 Volume 17 Issue 1 Pages
119-127
Published: 1981
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A 1 year and 2 months old boy was hospitalized with high fever. A mass density was seen in the left lower lung field. Pulmonary perfusion scintigraphy showed a cold area in the left lower lung field. Ultrasonic echography showed tumor like mixed pattern. Preoperative aortography revealed that the mass was intralobar pulmonary sequestration whose aberant artery, about 5 mm in diameter, arose from the abdominal aorta just below the diaphrama. A lobectomy of the left lower lobe was succesfully performed after ligation and division of the aberant artery. The left lower lobe was infiltrated by the multicystic and inflamatory changes. A review of the literature has yielded additional 86 cases of pulmonary sequestration in infants and children since 1911, and discussion was made on these.
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Noboru Yamada, Takahiro Ito, Masahiro Nagaya, Tetsuyuki Sugito, Noriji ...
Article type: Article
1981 Volume 17 Issue 1 Pages
129-135
Published: 1981
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A case of gastroesophageal reflux (GER) following operation for esophageal atresia and tracheoesophageal fistula was presented. He suffered from vomiting after esophago-esophagostomy. Upper gastrointestinal series demonstrated a wide His angle and GER. Slight increase in intragastric pressure caused decrease in the pressure at high pressure zone and GER consequently. GER was diagnostic by using a 3 lumen tube which recorded pressures at 3 cm intervals in the lower esophagus, lower high pressue zone and stomach. Transabdominal gastroesophageal fundoplication after Nissen was performed. He was relieved of vomiting after operation. GER was not detected on radiographic and manometric study.
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[in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
137-155
Published: 1981
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1981 Volume 17 Issue 1 Pages
157-
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[in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
157-158
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[in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
158-
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[in Japanese], [in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
158-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1981 Volume 17 Issue 1 Pages
158-159
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
159-
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[in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
159-
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[in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
159-160
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[in Japanese], [in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
160-
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[in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
160-
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[in Japanese], [in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
160-
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[in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
160-161
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[in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
161-
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[in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
161-
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[in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
161-
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[in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
161-
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[in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
161-
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[in Japanese], [in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
161-162
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[in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
162-
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[in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
162-
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[in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
162-
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[in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
162-
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[in Japanese]
Article type: Article
1981 Volume 17 Issue 1 Pages
162-163
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Article type: Appendix
1981 Volume 17 Issue 1 Pages
165-
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Article type: Appendix
1981 Volume 17 Issue 1 Pages
165-
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