The effect of the peripheral blood of normal syngeneic mice transfused to the mice of neuroblastoma (C-1300) was studied. The mice received transfusion at 48 hours after transplantation with 3×10^5 of C-1300 cells, and thereafter in every 2-3 days up to 10 doses. A single dose was consisted of 0.2 ml of peripheral blood of normal syngeneic mouse of 12-16 weeks of age. Successful rate of explant in the transfused group was 75%, being significantly lower in comparison to that of 100% in the contrast (p<0.01). The period of tumor appearance after transplantation was significantly prolonged to be 16.8±4.8 days, in comparison to 12.6±2.1 days of the contrast group (p=0.001). However, the mean survival time after appearance of the tumor was 18.8 days in the transfused group while it was 19.3 days in the contrast group. There was no significant difference. According to these results, the cause of anti-tumor effect of normal mouse blood was discussed, in relation to "natural" killer cell.
The purpose of this study is to clarify the possibility to differentiate congenital biliary atresia from other neonatal jaundice by means of an analysis on bilirubin isomers and its conjugates in serum. It was reported recently by Yamaguchi, et al., that bilirubin conjugate "C", which is isolated as the major bilirubin conjugates in normal human bile, is detected in serum from patients with obstructive jaundice. In the present study, the conjugate "C" in the serum was detected in all 5 cases of CBA and in one out of 3 cases of neonatal hepatitis. In the cases of neonatal physiological jaundice and premature birth no conjugate was detected in their serum. Thus, it is easy to differentiate the latter two neonatal jaundice from CBA or neonatal hepatitis. Differential diagnosis of CBA and neonatal hepatitis is not always easy by the present analysis, however, together with the results on experimental bile duct obstruction in rats, it was recommended that the analysis of serum bilirubin conjugates should be performed as soon as possible after birth in neonates with prolonged jaundice in order to differentiate these two pathological conditons.
The possibility to differentiate congenital bile duct atresia (CBA) from the other neonatal hyperbilirubinemia has been explored by detecting the bilirubin conjugate "C" in serum. The bilirubin conjugate "C" was reported to be the major bilirubin conjugate in normal human bile as evidenced by high-performance liquid chromatographic analysis by Yamaguchi, et al. (1979), and further shown to be never detected in normal human serum. In the present investigation, the bilirubin conjugate "C" determination was carried out in 12 patients of infantile hyperbilirubinemia. Four of 12 patients were congenital bile duct atresia and three of these four were positive to the bilirubin conjugate "C". Evidence hitherto obtained indicated that the detection of the bilirubin conjugate "C" in serum of icteric babies by means of high-performance liquid chromatography seems to be a clue to differentiate congenital bile duct atresia from the other neonatal or infantile jaundice.
Thirty-six infants with various types of cyanotic congenital heart desease [tetralogy of Fallot (11 infants), pulmonary atresia with ventricular septal defect (10), tricuspid atresia (5), transposition of great arteries (5), viscero-atrial heterotaxis (3), and pure pulmonary atresia (2)], underwent various systemic pulmonary shunts [Waterston shunt (22 procedures), Blalock-Taussig shunts (9), PTFE (polytetrafluoroethylene) shunts (2) and other shunts (4)]. All surviving patients have had satisfactory palliation of cyanosis and hypoxemia. In view of the pulmonary arterial kinking and stretching that will follow the Waterston shunt, it is concluded that the Blalock-Taussing and PTFE shunts are reliable and preferable techniques for palliation of pulmonary hypoplasia in infants.
Blood ketone bodies and plasma free fatty acid (FFA) were investigated in 87 pediatric surgical patients. These patients underwent herniorrhaphy, laparotomy or thoracotomy. Twenty five patients undergoing herniorrhaphy were used as the control because their general conditions were not seriously affected and were almost as normal as healthy children. Blood was withdrawn between meals on the day before operation. Ketone bodies in hole blood (AcAc ; acetoacetic acid 3-OHB ; D(-)-3-hydroxybutyric acid) were determined by the enzymic method of Williamson, Mellanby & Krebs (1962). Free fatty acid in plasma was determined by the colorimetric method of Itaya & Ui (1967). The normal values in controles were as follows : AcAc ; 0.056=0.22μ mole/ml, 3-OHB ; 0.065±0.019μ mole/ml, total ketone body ; 0.121±0.027μ mole/ml, FFA ; 0.36±0.09 mEq/l. Ages of children did not effect the blood level of ketone bodies significantly. Ketone bodies in patients with higher caloric intake (more than 50/cal/kg/day) were significantly lower than in those with lower caloric intake (under 50 cal/kg/day). On the other hand, no significant difference of FFA was obtained between the patients with higher and lower caloric intake. Ketone bodies in the patients with intestinal obstruction were higher than those of the control. There was low correlation between preoperative ketone bodies and plasma free fatty acid.
During the last 8 years, 31 premature infants developing respiratory distress, in whom the presence of patent ductus arteriosus (PDA) was confirmed, have been treated at the Kobe Children's Hospital. Eighteen patients weighed less than 1, 200 gm at birth (Group I). Of these 18 patients, 13 received medical management alone and 5 survived. Remaining 5 underwent ductus ligation. Of these patients, four had received indomethacine therapy prior to surgery. No mortality was seen related to surgery. Indomethacine therapy seems effective in about half of this group of patients. Thirteen patients weighing 1, 200-2, 000 gm at birth (Group II) received medical therapy alone. Ten patients survived. Of these 10 patients, four responded well to indomethacine. In other 4 patients, a spontaneous closure of PDA was observed and remaining 2 are with asymptomatic PDA. Our experience suggests that infants weighing more than 1, 200 gm will respond indomethacine respectively well and will rarely need surgery for PDA with respiratory distress. On the other hand, ligation of PDA should be considered in infants of less than 1, 200 gm of body weight, who do not respond to indomethacine therapy.
By using the small, wired, glass electrode diveloped by the auther for pediatric use, the intra-gastric pH mesurements were done and characteristcs of peptic ulcer in pediatric patients were studied. The subjects were 82 cases of pediatric group which included 31 cases of duodenal ulcer, 10 cases of gastric ulcer, and 41 non-ulcer children, and 173 cases of adult group which included 65 cases of duodenal ulcer, 87 cases of gastric ulcer, and 21 healthy peasons. The pH value in the fasting stomach early in the morning was taken as the basal pH value for this study. Results obtained were as follows : 1. It was found that both duodenal ulcer and gastric ulcer had the tendency of sudden increase in the age group over 8 years, and that the upper abdominal pain, abdominal distension and nausea and/or vomiting were the major symptoms of pediaric duodenal ulcer whereas upper abdominal pain and nausea and/or vomiting were the 2 major symptoms of pediatric ulcer. 2. The average basal pH values of non-ulcer group were 2.0±0.5 in neonates, 1.6±0.5 in infants, 1.9±0.5 in pre-school children, 1.5±0.3 in school children, 1.7±0.3 in middle school children, and 1.7±0.2 in adults. 3. The average basal pH value of peptic ulcer cases was in children of duodenal ulcer 1.1±0.2 which abnormally low against that of 1.7±0.5 in children of gastric ulcer. In adults, in the duodenal ulcer group, it was 1.4±0.4 while in gastric ulcer group, it was 2.4±1.1. These results revealed the fact that in children the aggresive factor was more strongly involved than in adult cases. 4. The blood gastrin levels in 17 cases of pediatric peptic ulcer, measured early in the morning under fasting condition, were average 72.9±10.7 pg/ml in duodenal ulcer and average 66.9 pg/ml in gastric ulcer group, respectively, which were higher than the values obtained of healthy children as reported by many investigators. 5. The changes of basal pH values by time passage of the 12 cases of peptic ulcer children given oral medication were studied. The oral medication had caused subjective symptoms to easily disappear and cure of ulcers, but none of the cases had the basal pH values reached the non-acid levels. 6. Out of 4 pediatric duodenal ulcer cases on which operation was performed, 3 cases showed the tendency of pH increase to the lowor non-acid levels soon after the operations. 7. The intragastric pH determination by using the small, wired electrode was very effective clinically not only for diagnosis of pediatric peptic ulcers but also for observing the effect of therapies.
The two cases with congengital diaphragmatic hernia, who had corrective surgery within 6 hr of birth, were reported. In both cases, the progressive hypoxia developed after operation in spite of 100% oxygen ventilation by a respirator. This state was induced by right to left shunting through the foramen ovale and the PDA producing a persistent fetal circulation. In the first case, a Swan-Ganz catheter inserted into the pulmonary artery recorded the pressure which was almost equal to the systemic arterial pressure. The pharmacologic treatment using tolazoline, chlorpromazine, and acetylcholine was done during 71 hrs, but their effects remained in minimal and the patient died. In the second case, the catheter was placed at the superior vena cava, because it could not be inserted into the pulmonary artery technically. Tolazoline (2 mg/kg/hr) was injected continuously into the superior vena cava. After 1 hr, the PaO_2 at the descendiag aorta rose from 60 to 224 mmHg with marked improvement in general condition. The drug had been acting effectively until discontinued at 74 hrs. An assisted ventilation was needed during next 56 days for prematurity (birth weight : 1, 350g) and for hypoplasia of the lung of the affected side. Through the experience of the two cases, it was suggested that there are some cases with congenital diaphragmatic hernia, in whom the pharmacologic treatment has a dramatic effect for the progressive hypoxia caused by PFC developing after the operation.
Clinical evaluation in 17 cases of congenital duodenal obstruction was done concerning the disease category, operative method and postoperative complications. Four cases died after operation with the mortality rate of 23.5% ; three of these died of associated cardiopulmonary anomalies. A duodenoduodenostomy was the procedure with the best postoperative result and the patient could have early oral intake. In two cases of membranous stenosis of duodenum, the bile duct orifice was noted in the membrane. An windsock web was noted in one of these two cases. It is very important to search for these associated anomalies during operation. Bill's stabilization operation seemed effective for prevention of ileus in cases with volvulus due to intestinal malrotation.
Seventy-seven infants and children with intussusception were treated during the period of October 1971 through December 1980. The clinical features of the disease, the indication, the methods and the results of treatment were described. Fifty-eight patients with ileo-cecal or ileo-colic type were successfully treated only by barium enema, and fourteen ileo-ileocolic and ileo-ileal types were reduced by barium enema together with "external Hutchinson's method" under general anesthesia. Only five ileo-ileocolic types were treated surgically.
The experience of 34 cases of congenital atresia and stenosis of the small intestine during the past 14 years was reviewed. The result was analyzed regarding the aspect of pathologic findings, operative procedure, associated anomalies, and survival rate. An adequate resection of the dilated proximal segment contributed to an improvement of survival rate in atresia of the jejunum and ileum. The most common cause of death was respiratory disorders. Thus, it was demonstrated that respiratory care was the most important factor to achieve better survival rate.
In our hospital, 23 infants with biliary atresia have been operated on during the past five years. Three of them had major malformations consisting of preduodenal portal vein, absent inferior vena cava, intestinal malrotation, partial annular pancreas and splenic anomalies. These findings led us to a statistical study of associated anomalies in patients with biliary atresia based on 758 cases in the file of the Annual of the Pathological Autopsy Cases in Japan during last 20 years. In 87 of 758 cases, associated anomalies were observed. Cardiovascular anomalies were the most common, such as ventricular septal defect, patent ductus arteriosus, absent inferior vena cava and preduodenal portal vein. Malrotation and common mesentery were the most common gastrointestinal anomalies. Associated anomalies of the spleen were surprisingly frequently observed in this series (23 cases) and situs inversus were present in 5 cases. Nine of 16 complex anomalies were suspected to be polysplenia syndrome. These anomalies, except malrotation develop during from the 4th to 6th week of fetal life and the biliary tracts also develop in the same period. It is suggested that the coexisting malformations have been caused by a teratogenic factor which is common with biliary atresia. It seems very likely that some cases of biliary atresia are etiologically related to developmental anomalies.
Although childhood rhabdomyosarcoma is relatively common, that of the gallbladder is extremely rare and only 2 adult cases were previously reported in the world literature. Recently we experienced a case of rhabdomyosarcoma arising from the gallbladder which is considered to be the first case in children. A 6-year-old girl was admitted with complaint of jaundice, fever and epigastric pain. At surgery, it was revealed that there were numerous botryoid masses in the gallbladder and common bile duct. The tumors were completely and easily removed with the gallbladder and the common duct and a hepaticojejunostomy was carried out. The postoperative diagnosis was embryonal rhabdomyosarcoma and there was no invasion toward the common bile duct histologically. She has been treated with combined radiotherapy and chemotherapy (VAC). There has been no evidence of recurrence or metastasis during the past 12 months. The long-term survival is expected because the complete excision was carried out at the early stage of the disease.
We report herein a patient (2-year-old girl) with Wilms' tumor (Stage III) in whom a relapse occurred 30 months after surgery and discuss together with 4 of 7 cases with Wilms' tumor reported by the Research Committee of Malignant Surgical Pediatric Tumors in the Kyushu Area, as deaths following a relapse. These patients had survived for over 3 years after the primary surgery. Of these four, two were evidently having relapse despite the absence of tumor for 17 months, and 18 months that was beyond the Collins' dangerous range. In 7 cases reported by the Committee, four had been diagnosed as Stage I or II at the primary surgery but all these patients died of pulmonary or hepatic metastases. These results imply the importance of adequate postoperative antineoplastic chemotherapy. Despite the evidence that manifestation of tumor recurrence is often retarded by postoperative chemotherapy and radiotherapy, nevertheless, there are recurrences even 2 years after the surgery or beyond the Collins' dangerous range. Thus, all such patients should be followed carefully at least 4-5 years postoperatively, as there are often recurrences.
A 6-month-old boy in whom inflammatory stricture of the extra-hepatic bile ducts was seen, was reported. After hepatic porto-jejunostomy with Roux-en-Y, jaundice subsided completely and hepatic dysfunction was improved dramatically. Histopathological findings of the liver were similar to those seen in congenital biliary atresia, whereas cholangiographic findings characterized by marked enlargement of the intrahepatic bile ducts were different from congenital biliary atresia.