Anorectal manometric studies employing an infused open-tip method were performed on 30 children with myelomeningocele. The studies were proven to be valuable in the assessment of bowel functions in these patients. The recto-anal inhibitory reflex was demonstrated in all cases. According to the character-istic patterns, the reflex was classified into three types; normal-reflex, hyper-reflex and spon-taneous-reflex type. Normal reflex was observed in 16 cases. The reflex with large rhythmical activity and hypersensitivity to the rectal stimulation was observed in 7 cases of hyper-reflex type. The rhythmical activities had the exaggerated fluctuations as if the reflex were bursting in 6 cases of spontaneous-reflex type. Anorectal pressure profiles were also obtained. According to their shapes, they were classi-fied into three types; normal, hypotonic and patulous type. Normal profile was observed in 10 cases. The higher pressure zone disappeared in 11 cases of hypotonic type. There were poor pressure gradients in 9 cases of patulous type. Hypotonic and patulous types were more frequently observed in those patients whose levels of neurologic involvement were in the sacral region. The type of reflex was shown to have little correlation with the clinically evaluated bowel functions, but a remarkable correlationship was demonstrated between the type of pressure profile and the bowel functions.
Hepaticoduodenostomy or Roux-en-Y hepaticojejunostomy is currently used for surgical treatment of congenital dilatation of the bile duct. Hepaticoduodenostomy using jejunal interposition proposed by Grassi et al. seems to be rational as regards anatomical and functional standpoint. We have performed this operation in recent 8 cases. Postoperative result was satisfactory. Anoperative procedure was described in detail.
Fourty children with ureteral ectopia experienced during the last 10 years at Hokkaido University Hospital were reported. 27 cases were associated with duplex system and 13 cases were seen in the single system. All were subjected to surgical therapy in one stage. Renal conserving procedures were performed in 18 cases (reimplantation of ureters in 17 cases and urinary diversion in 1 cases) while renal ablative procedures were done in 22 cases (heminep-hroureterectomy in 13 cases and simple nephrectomy in 9 cases). In 31 cases where the ectopic ureter was terminating in the urinary system, particular emphasis was placed in complete excision of the ectopic ureteral stump to avoid various postoperative problems arising from its persistence. Our method of total excision of the ectopic ureteral stump and complete closure of its hiatus were described by demonstrating several representative cases. Importance of knowing the mode of ureteral insertion in the urinary system by evaluating the types of ureteral hiatus was stressed as a mandatory preoperative procedures for the safe one stage repair of these intricate problems.
Fourteen patients with congenital biliary atresia were operated on from June 1972 to November 1980. The enhanced computed tomography with biligrafin was taken to study the intrahepatic bile ducts in postoperative state in 7 of eight patients who are alive. In 5 of these seven patients, intrahepatic bile ducts were recognized having a narrow and straight lineal configuration which is quite different from the normal. By our experience, the computed tomographic evaluation is usefull for the follow up studies in postoperative state of congenital biliary atresia.
A method is described for a long-term intravenous infusion in weanling rats. A specially deviced harnessing technique as well as a fluid infusion swivel assembly allowed a long-term parenteral nutrition over six weeks in weanling rats with a satisfactory body weight gain in an excellent condition. The solution for parenteral nutrition is composed on the basis of commercially available rat chow. Average daily body weight gain was 4.46±0.12 g. (n=6) in the rats fed exclusively by vein for six weeks, whereas about 5.4g. in the same age control groups. No statistically significant differences between the harnessed and non-harnessed rats in control groups were observed in food intake, body weight gain and caloric efficiency. Thus, our technique and solution for TPN in weanling rats will provide a satisfactory experimental model for the basic research of TPN.
The mechanism of the recto-anal reflex (R.A.R), i.e, transient fall of anal canal pressure induced by rectal distension, is still obscure. In order to elucidate the role of the sacral nerves to R.A.R., the effects of denervation and stimulation of the sacral nerves were examined experimentally in dogs. A laminectomy was done to expose the sacral nerve roots in each dog. Each and/or all sacral nerves were tied and devided or stimulated extradurally. In chronic experiments, R.A.R was examined repeatedely over two weeks after operation. R.A.R was not obtained when all sacral nerves were devided, but when any indivisual sacral nerve was remained undivided, R.A.R was elicited in all dogs. In acute experiments, electrical stimulation of the sacral nerve (especially S_1 and S_2) brought about a transient fall of the anal canal pressure and a marked inhibition of sustained electrical activity of the internal anal sphincter muscle. Both were identically seen in pressure and muscle while the rectum was distended by a balloon. The results indicate that the recto-anal reflex is dependent not only on the intramural pathway but also on the sacral nerve pathway when this reflex action is elicited in a physiological condition.
Anorectal manometric studies, histochemicsl examinations, and measurement of erythrocyte acetyl-cholinesterase (AchE) and serum cholinesterase (ChE) activities were carried out in 11 patients of Hirschsprung's disease, comparing with those in 25 normal subjects. Anorectal reflex was absent and AchE positive nerve fibers of the rectal mucosa were observed in all 11 patients with Hirschsprung's disease. Erythrocyte AchE Activity in patients of Hirschsprung' disease was significantly higher (p<0.01) than in normal subjects. On the other hand, serum ChE activity in Hirschsprung's disease patients was higher than in normal subjects, but there was no statistical significance (0.05<p<0.1). These results suggest that anorectal manometric study, histochemical examination, and an assay of erythrocyte AchE activity are all reliable for the diagnosis of Hirschsprung's disease. Anorectal manometric study should be performed at first as a simple screening test for the diagnosis of Hirschsprung's disease. Barium enema and histochemical examination of the rectal wall are performed next and then erythrocyte AchE & serum ChE are measured in the case of an absence of reflex relaxation or an inadequate response of the sphincter to rectal distension.
Immune response to mouse neuroblastoma (C1300) was analysed in this report. Cell-mediated immune reactivity of A/J mouse spleen cells to syngeneic neuroblastoma cells was studied by using antibody-dependent cell-mediated cytotoxicity (ADCC), natural killer (NK) and killer T activity. The results are summarized as follows: 1. NK activity of A/J spleen cells to C1300 demonstrated quite low grade irrespective of age. 2. Killer T activity could be induced by innoculation of C1300 to syngeneic A/J mouse. The activity was time-dependent and gradually increased by week 2 and then decreased by week 4. 3. The time course of killer T activity coincided with that of host tumor viability. 4. Rabbit anti-Cl300 antibody could be obtained by subcutaneous injection of C1300(2x10_7 cells). The specificity was satisfactory by testing, with complement-dependent cytotoxicity and immunofluorescence technique.
A 22 hour old female infant was successfully treated for aplasia of urachus associated with hernia into the umbilical cord. At operation, a thick-walled, thumb's sized bladder-like structure was found protruding into the umbilical cord covered with the amniotic membrane. Pathological findings of the excised bladder-like structure were those of the bladder. The authors reviewed the embryogenesis of the urachal aplasia and obtained a suggestion that unusual structure when encountered at omphalocele repaire should be carefully examined. If urachal aplasia is identified, a partial resection of the bladder should be done. Association of urachal aplasia and hernia into the umbilical cord has been described in only 7 cases in Japanese literature and this paper constitutes the 8th report.
Ectopic ureterocele (EUC) were rarely seen in Japan. Only 35 cases of EUC in infants and children and four adult cases were reported in Japan. Additional four cases of infants and children have been treated at our hospital since April 1977. In this article, age, sex, symptoms at onset, radiological findings, histology of the removed kidney and operative procedures were mentioned. The ectopic orifice opens at the bladder neck in 14 caces (35.8%), at urethra in 15 (38.5%), and at external urethral meatus in 2 (5.1%), and the blind endnig ureter was seen in 3 cases (7.7%). Complete duplex collecting system was seen in 37 of 39 patients (94.9%). The other two had the single dysplastic kidney. Thirty-three patients (84.6%) were younger than 6 years of age at presentation. Thirty-four patients were female and 5 male. Twenty cases had the left, 15 the right and 1 the bilateral EUC. Pathological examination showed dysplastic change in 23 of resected kidneys (88.5%) with pyelonephritic change. One stage repair is recommended in general, but staged operation will be indicated in young or severely ill conditiondc baby.
Two cases presenting vith ascites of unexplainded etiology were reported. Case 1 was an 8-year-old female with chylous ascites. Lymphangiographic studies revealed an evidence of a possible obstruction of the thoracic duct, retrograde flow and leakage of chyle. About About 11/2years later, the ascites subsided spontaneously. Case 2 was a 5-year-old female with cholesterin ascites. Brownish colored fluid, cholesterol crystals and degenerating erythrocytes were found on microscopic examination of the aspirated aecites. After aepeating parecentsis, the ascites decreased.
A ten-month-old girl with immature teratoma of the ovary, in whom an alpha-fetoprotein (AFP) in serum showed a high level, was presented. She had also peritoneal gliomatosis. The histological examination revealed a typical teratoma, immature type consisted of the predominant neural elements such as the immature glia, the neuroepithelium and so on. After removal of the tumor, the AFP level in serum decreased and tapered gradually. However, the AFP level has begun to increase again three months postoperatively and the abdomen distended increasingly. At the fifth postoperative month she underment a laparotomy which revealed the recurrent tumors in the abdomen. Three of them were fist or hen's egg in sized and numerous nodules were found in the peritoneum.
An eight-year old boy noted frequent episodes of loss of consciousness and clonic convulsion. The fasting blood sugar level remained always low ranging from 8 to 50mg/dl. A selective celiac angiogram demonstrated an opacified tumor stain measuring 2×2 cm with its feeding artery at the head of the pancreas. The tumor was removed, under diagnosis of insulin-secreting pancreatic tumor. After the operation, no more hypoglycemic attacks heve been observed. Histopathological and ultrastructural studies of the tumor revealed a malignant insulinoma. The diagnosis of malignancy was made in view of the presence of tumor cells within the small vessels, and their capsular invasion. The patient has not been placed on anticancer agents, but has been doing well 3 years after operation without evidence of recurrence.
Fifty-four critically ill infants with congenital heart disease had operative treatment at less than three months of age. Twenty of them were within 4 weeks of age at operation. The anatomical and physiological diagnoses were made preoperatively by cardiac catheterization and angiography. Thirty-eight of palliative and sixteen of corrective surgery were performed for the cardiac anomalies. Twenty-six (48%) survived for at least 30 days after operation and at present, sixteen (30%) are alived at 5 months to 10 years postoperatively. Although the operative mortality rate is still high, none of these patients would have survived without surgical procedures during early infancy.
The clinical diagnosis of blunt abdominal injuriy is particularly inexact in children. Since unrecognized abdominal injuries are frequently lethal and the morbidity and mortality of abdominal injuries are increased by delays in treatment, the prompt diagnosis of blunt abdominal injuries is essential. Quantitative peritoneal lavage was performed in 31 children with blunt abdominal trauma to determine the presence of intraabdominal injuries. A positive lavage was 100% accurate in diagnosing an intraabdominal injury requiring opration. A negative lavage demonstrated absence of a significant intrapertoneal injuries with 100% accuracy. Peritoneal lavage is safe and much more accurate method than other examinations for the diagnosis of significant intraabdominal inguries.
Although duodeno-jejunostomy has been accepted as a standard operation for congenital intrinsic duodenal obstruction, dilatation of the duodenum is persistent in some of the cases. Duodeno-duodenostomy is considered as a more preferable operation recently. In our 24 cases with intrinsic duodenal obstruction treated during 1969-1979 with an average follow-up period of 3 years and 8 months, 13 underwent duodeno-jejunostomy, 10 duodeno-duodenostomy and one excision of diaphragmatic membrane. All patients were well without symptom at the time of evaluation. But on the roentgenological study, a marked dilatation of the duodenum was observed in 11 patients with duodeno-jejunostomy (85%) and in 5 with duodeno-duodenostomy (50%). More remarkable dilatation of the duodenum was recognized in the patients with duodeno-jejunostomy than those with duodeno-duodenostomy. In conclusion, careful postoperative roentgenological study should be performed in long-term follow-up of the patients with congenital intrinsic duodenal obstruction, even without any symptom.
Continuous esophageal pH monitoring was carried out in 18 patients with symptomatic GER and in six controls. The reliability of this technique for the diagnosis of GER was discussed. The studies were designed as to determine (1) the ratio of the time for total measuring time, during which the esophageal pH remains below 4.0 (percent time of GER) and (2) the frequency of GER, reflecting the decrease of esophageal pH below 4.0 which lasts for more than 5 minutes. The result was compared with those of the controls. In patients with symptomatic GER, the percent time of GER was greater than 5% ranging from 3.2 to 36.0%, while it was 0-1.2% in the controls. The frequency of GER ranged from 4 to 20 in the symptomatic GER patients. In some of these patients, there was a tremendous delay in recovery of esophageal pH, that means the duration of decrease of esophageal pH below 4.0 ranged from 10 to 30 minutes. This observation was not seen in the controls. In our series, it was suggested that it is diagnostic of GER when the parcent time of GER is greater than 5%, the frequency of GER more than 5 and the presence of delay in recovery of esophageal pH is observed. The studies substantiated the quantitative measurements of esophageal pH will provide more accurate diagnosis of GER.