The blood of the A/J mouse, sensitized by BCG and tumor cells in various ways, was repeatedly transfused to the tumor bearing mouse. The anti-tumor effect of this treatment was studied. As the first step of sensitization, 1, 000μg of BCG was intravenously injected to the untreated mouse. The second step of sensitization was performed according to the following three methods, during 2 weeks thereafter. 1) Subcutaneous separate injections of BCG (250μg) and the tumor cells (3×10^5) preserved at -80℃. 2) Subcutaneous separate injections of BCG (250μg) and the live tumor cells (2×10^4). 3) Simultaneous subcutaneous injection of a mixture of BCG (250μg) and the live tumor cells (2×10^4). The sensitized fresh blood of 0.2 ml, drawn from the mouse 2 weeks after second sensitization, was daily injected to the tumor-bearing mouse for 10 days begun at 2 days the transplantation. The following results were obtained 1) The blood sensitized by the tumor cells preserved at -80℃ gave an effect of shortening the survival term for about 4 days in comparison to the contrast (p<0.05). 2) The blood with combined sensitization of BCG and live tumor cells provided a marked delay of the tumor appearance for 18 days (p<0.001) and prolongation of the survival term for 10 days (p<0.05). The effective sensitized blood transfusion was combined with a chemotherapy of Adriamycin and Cyclophosphamide, begining at 10 days after the tumor transplantation. The survival term of the group with combined treatment was prolonged for about 10 days in comparison to the contrast group (p=0.07).
In order to investigate pancreatic function in children, especially in infants and newborns during the surgery, the changes of plasma pancreatic glucagon (IRG), insulin (IRI), and blood glucose (BS) levels were examined in pre-, intra- and post-operative situations by the radio-immunoassay using specific antibody to pancreatic glucagon G-8, insulin antibody and technicon autoanalyzer. Lactated Ringer's solution and 5% glucose solution during the surgery and maintenance fluid including 5% glucose solution in the postoperative course were infused. Preoperative levels were obtained from the saphenous venous blood at 20 minutes after the initiation of anesthesia. In 8 infants (Group A) ; from 1 month to 2 years of age, anesthesia was performed with NLA (neuroleptanesthesia) for 5, GOF (gas-oxygen-fluothane) for 3. In all 6 newborns (Group B) ; from 1 day to 26 days of age, anesthesia was performed with NLA. During anesthesia, no episode of hypoxia or hypotention were observed. Operative procedures were major or moderate degree of the abdominal surgery. In infants (Group A), plasma pancreatic glucagon levels showed about a 100% rise at 30 minutes after the initiation of surgery, a gradual decrease at 90 minutes and a return to the preoperative level at 6 hours after the surgery. Blood glucose level markedly rose during operation, while insulin level did not change during surgery but increased slightly 6 hours postoperatively. In the infant cases, catecholamines increased by surgical stress may be the direct stimulator to increase the pancreatic glucagon level during surgery. Hyperglucagonemia on the 3th postoperative day may be provided by starvation and metabolic change due to surgical stress. On the other hand in the newborns (Group B), blood glucose level markedly increased during surgery as in the infants, but glucagon and insulin levels showed no statistical change. These results may suggest that the early newborns have no matured mechanism of pancreatic glucagon secretion in response to surgical stress.
Water, electrolytes, and nitrogen balances were studied in 20 postoperative newborn infants who received 10% glucose solution (80 mls/kg/day) with sodium and chloride (3.5 mEq/kg/day), postassium (1.5 mEq/kg/day) and crystalline amino acid (1 g/kg/day). The urine volume exceeded 60 mls/kg/day from the day of operation. There was a correlation between the volume of given water (X) and water balance (Y) : Y=0.811X-45.8 for the first 3 days and Y=0.267X+0.601 for the third and fifth days after operation. Urinary excretion of sodium and chloride is slightly depressed for the first 3 postoperative days. There was also a correlation between sodium (or chloride) intake and sodium (or chloride) balance : Y (sodium balance)=0.846X (sodium intake)-1.53 for the first 3 days after the operation, and Y=0.868X-2.78 for the third and fifth postoperative days. High urinary excretion of potassium was noted for the first 3 days after operation. Urinary excretion of potassium, however, decreased gradually during the third to fifth postoperative day. There was a correlation between potassium intake (X) and potassium balance (Y) : Y=0.866X-0.797 for the first 3 days after operation and Y=0.825X-0.332 for the third and fifth post-operative days. Positive nitrogen balance was observed in 51 of 100 examinations. This positive nitrogen balance was accompanid by positive patassium balance in most cases. Serum electrolytes, blood sugar, serum and urine osmotic pressures were all within normal limits.
Seventeen mongrel puppies, weighing 1.5 kg to 2.0 kg, were lightly anesthetized with pentobarbital. Portex tube was inserted through vocal cord and stroked against the ventral surface of the trachea. Two control tracheas and nine injured tracheas were examined by scanning electron microscopy and light microscopy. Two tracheas were removed immediately after injury to examine the extent of injury. The other seven tracheas were removed three days, five days and eight days after injury. The tracheal lumen, at three days after injury, was covered with the rounded and elongated cells. At five days, the lumen was covered with elongated, flattened and polygonal epithelium, which surfaces were overlying with dotted microvilli and cilia-like projections. At eight days, the tracheal surface of the selected area showed regeneration of the celia, but dotted microvilli and cilia-like projections of varing size were seen in other areas, which showed the incomplete ciliary regeneration.
The diagnostic value and limitation of "systemic hapatic angiographies" to evaluate the resectability of infantile hepatic tumors was studied. Eleven cases undergone hepatic angiograms for hepatic tumor were discussed and following conclusions were made. 1) The diagnostic rate of hepatic arteriogram, portogram and hepatic venogram was 54.5%, 100%, 50% respectively. 2) The main reasons of diagnostic failure were the following factors : 1. Difficulties in identification of feeding artery due to involvement of the arteries in the tumor vessels. 2. Poor visualization of the left portal branch. 3. Technical difficulties of middle hepatic vanography. 3) All cases except one could be diagnosed correctly, by comprehensive judgement using arteriogram, portogram, cavogram and venogram. One failure case was due to poor visualization. These results indicate that systemic hepatic angiographies are usuful to predict localization and extension of infantile hepatic tumors. Preoperative systemic hepatic angiographies are also needed in infants for safe and effective hepatic resection.
Esophageal atresia with tracheoesophageal fistula is uaually associated with illness or anomalies precluding repair of the tracheoesophageal fistula. Continued reflux of gastric contents into tracheobroncheal tree is likely to result in pneumonia and death. Preventation of gastroesophageal reflux subjects the morbid infant to radical operation of esophageal atresia. Nissen fundoplication was used as an antrireflux operation of gastroesophageal reflux and subsequent repair of the anomaly was carried out.
Since 1978, 32 children aged from 1 to 15 years with post operative intestinal obstruction have been treated with high-pressure oxygen therapy (OHP-therapy). 24 cases of them recovered by OHP-therapy, but 8 cases needed the surgical operation. In the operated cases, three were simple adhesive obstruction, four strangulated obstruction and one intussusception. The recovery rate in 27 intestinal obstruction cases without any circulatory disturbance was 89% by OHP-therapy. One man chamber (Vickers, Co. London, England) was used for this therapy. The condition for this therapy was 1.5 ATA (atmosphere absolute) as the maximal pressure for 30 minutes. Since many cases have recovered by three times trial of this therapy, we conclude that patients should be operated on if they do not show any improvement in spite of three times trial. Some authors reported that the recovery rate of the simple adhesive intestinal obstruction is about 40% under the conventional preservative therapy such as intravenous infusion and nasogastric suction. It is likely that our OHP-therapy is more effective than the conventional preservative therapy in the post-operative adhesive intestinal obstruction.
Congenital malformations of the infantile hepato-biliary system are classified into two major groups of biliary atresia and biliary dilatation. The former is represented by so-called congenital extra-hepatic biliary atresia, and the latter by congenital choledochal cyst or bile duct dilatation. However, there has been a controversy regarding the morphological concept and classification of the hapato-biliary malformation, as indicated by the resemblance of cystic formation at porta-hepatis seen in both biliary atresia and bile duct dilatation. Recently, a male infant who had an unusual complication of extra-hepatic biliary atresia with cystic dilatation of the hepatic duct and of two intra-hepatic biliary solitary cysts, was successfully operated on by hepatic porto-enterostomy at the 56 days, and incision and external drainage of the cysts at 13 months of age. The purpose of this paper concerns presentation of a case and a proposal of new clinical entity of infantile hepato-biliary dysplasia ; infantile cystic cholangiopathy as a name for understanding of the disorders.
Genetic background of neuroblastoma IV-S was studied, based upon the data on 380 cases of neuroblastomata, collected from 11 main facilities in Japan. Among 380 cases collected, 16 belonged to the group neuroblastoma IV-S. All the IV-S cases had the onset before 12 months. This is remarkably earlier than any other stages of this disease. There was no case with multiple origin of the tumor in this collected series of IV-S. But one case of IV-S with bilateral adrenal origin was experienced in the Pediatric Surgical Department of Tsukuba University, and moreover there were some reports on multiple origin in the literature. The familial occurrence rate of neuroblastoma IV-S was 1/16 (6.3%), while that of other stages were 1/364 (0.3%). The young onset and multiplicity, which were demonstrated as two important characteristics of familial tumor by Knudson, were well proven in the neuroblastoma IV-S in this study.
Fusion of the testis and epididymis, histological findings of the undescended testis and location of the testis were studied in 90 undescended testes of eighty-one cryptorchid patients. Abnormal fusion of the testis and epididymis in the undescended testis were classified into four types : a) fusion of the testis and epididymis at the testicular cranial side. b) fusion of the testis and epididymis at the testicular caudal side. c) abnormal mesorchial fusion. d) complete separation. Thirty one undescended testes (34 percent) had abnormal fusion of testis and epididyms. The more cranial was the location of undescended testes, the more frequent was abnormal fusion of the testis and the epididymis. The testicular dysgenesis, which was expressed by tubular fertility index, was observed more frequently in the undescended testes of abnormal fusion and more cranially located testes. There results suggested that normal testicular morphogenesis is essential to normal descent of the testis and normal fusion of the testis and epididymis.
We have studied on the causal and therapeutic aspects of postoperative intestinal obstruction in 25 of 395 children who have undergone laparotomy during the last 13 years. Postoperative ileus was noted more frequently in abdominal tumors (22%, 4/18), Hirschsprung's disease (14%, 4/37), and congenital biliary atresia (11%, 4/37) than in appendicitis (5%, 2/57) and intussusception (4%, 2/45). The specific mechadism of postoperative ileus was determined in 20 cases at laparotomy and one at autopsy. Four other cases were treated by conservative therapy. Adhesions and/or bendings were seen in 12, simple compression due to a cord in one, and strangling in 3 cases with one confirmed by autopsy. Obstruction of the intestinal lumen was seen in two and bending of the Roux-en Y anastomosis, ileal intussusception and hemorrahgic infarction of the jejunum were seen in one case for each. There was no significant difference in the incidence of adhesive obstruction among three groups classified as non-contaminated, semi-contaminated and contaminated groups according to infection of the abdominal cavity and operative procedures at initial laparotomy. As a cause of postoperative obstruction, operative manipulation was noted most frequently among original illnesses, operative procedures and manipulations. In our opinion, prophilaxis of adhesive obstruction requires meticulous surgical techniques. A great number of prtients with adhesive obstruction were treated by lysis of adhesions. Each case with extensive adhensions, strangulation, intraluminal obstruction, bending of Roux-en Y anastomosis and hemorrahgic infarction necessitated bowel resection. Postoperative intussusception of the ileum was manually reduced in laparotomy. Children were reoperated within two days after signs and symptoms of intestinal obstruction recovery followed but at child with resection of the ileum four days after intraluminal obstruction died of intestinal bleeding and pneumonia. If conservative therapy does not prone to be effective, we believe that postoperative ileus must be operated at an early stage.
A 1 yr and 9 mo old female with bilateral Wilms' tumor underwent alternative resections of the left and right tumors with an interval of 2 weeks. After excision of the left tumor, an IVP demonstrated normal function of the remaining kidney of the left side. Excision of the right side tumor was safely carred out with an extensive resection. A total of 17 series of Actinomycine D (3 before and 14 after excisions) were given. Two years after excision of the bilateral tumors, a relapse at the left side kidney required a nephrectomy. At present, 6 and a half years after left nephrectomy for relapse, the patient is free of desease and well. In this patient, the remaining kidney is only one third of the right side (one sixth of both kidneies), but the kidney functions are normally reserved. A long term chemotherapy (four years with AcD) with a combination of alternative excisions of giant tumors and an aggressive excision of the relapsing tumors was successful for a long range survival in this patient.
A case of prune belly syndrome associated with insufficiency of intestinal peristalsis was reported. The patient was hospitalized with a presence of lower abdominal distension. The abdominal wall was flaccid and thin. Bilateral undescended testes was also noticed. Bilateral hydronephrosis, hydroureter, megacystis and massive VUR were recognized by urological examinations. The patient was placed on the corset for the flaccid abdomen, a catheter inserted into the bladder and antibiotics administrated for urinary infection. Finally, because of repeated urinary infections and persistant ileus, bilateral cutaneoureterostomy, ileostomy, left orchiopexy and abdominopexy were performed on the 105th day of life. Postoperative microscopic examinations revealed hypoplasia of musculatures of the abdominal wall and lack of the muscle layer of the ureter. Fifty six cases of prune belly syndrome have ever been reported in the Japanese literature since Okuda's report in 1954, as far as we have been able to ascertain.
Abdominal diseases complicated with Schonlein-Henoch Purupura have been frequently reported lately. These include intussusception and hemorrhagic necrosis with perforation of the intestinal wall. A 5 yr old boy who had been treated for Schonlein-Henoch purupura with steroid for 34 days developed mechanical intestinal obstruction and underwent an emergency operation. At laparotomy, an intestinal stricture was observed due to the scar of ileal ulcer. such complication as an intestinal stricture in Schonlein-Henoch purupura has been reported considerably rarely in the past. Only two (2) cases of this disease have been reported previously in Japan. The operation should be performed for abdominal disease associated with S-H purpra as early as possible when initial steroid treatment is ineffective.
A case of three year-old-male with large abdominal cerebrospinal fluid pseudocyst as late complication of ventriculoperitoneal shunt was presented. When the patient was 8 months old, a V-P shunt procedure was performed for communicating hydrocephalus. The shunt had to be revised two times because of its migration. At the age of 3 years, he was readmitted for abdominal distension and vomiting. A diagnosis of intestinal obstruction was made, and he was treated concervatively. Several days later, lower abdominal mass was recognized on the abdominal plain x-ray film. Ultrasonotomography demonstrated the tip of catheter in the cystic cavity, and preoperative diagnosis of abdominal CSF preudocyst was made. Intra-abdominal complications following V-P shunt procedure are more common than previously reported, but abdominal CSF pseudocyst is rare, that is seem in about 1% of all V-P shunt cases. 44 cases were totalized in the literature including our case. Analysis of these cases shows some common aspects as follows. 1) Most cases have previous history of repeated shunt infections and/or shunt revisions. 2) 82% (28/34) of all cases are infants and children under 8 years of age. 3) Cultures of cystic fluid revealed Staphylococcus epidermidis or Staphylococcus aureus in most of cases. 4) Cyst walls are thick and fibrous, and directly surrounded by loops of intestine or other organs. 5) Recurrence of the cyst was found in the cases that V-P shunt was inserted simultaneously during the operation of the cyst. It is concluded that the pathogenesis of CSF pseudocyst is suspected to be the isolation of catheter tip resulting from inflammatory reaction or intra-abdominal procedures, and then the fluid accumulation and development of cyst wall will follow. Abdominal ultrasonotomography and computed tomography are much useful for the diagnosis of this disease, and the tip of catheter in the cystic cavity could be identified by these methods. Cystotomy and drainage with external ventricular drainage or V-A shunt are suggested for the treatment. Simultaneous replacement of a new V-P shunt should be avoided. Finally, abdominal CSF pseudocyst should be included in the differential diagnosis for every case of an acute abdominal complications with V-P shunt.
Case 1 : A 6 year-old girl had a right mandibular opening with chronic inflammatory induration. She has received four unsuccessful excision elsewhere since 2 years ago. At operation the pathway of the firstula was found to be extended from the jaw angle to the auditory canal. The upper part of the tract penetrated through deep to the facial nerve, which was dissected to avoid it's injury when completing excision of this part. The microscopic exmination revealed multiple components of the first branchial cleft remnant. Cases 2 : A 7 year-old girl had almost the same history and operation findings as the case 1, except a fact that the tract lay superficial to the facial nerve. The operative result of the two cases was excellent without any evidence of recurrence or facial nerve palsy. The first branchial cleft defect is a rare congenital anomaly. From the Japanese literatures we have collected 23 cases with this condition, 17 of which were recognized in the pediatric age. The first branchial cleft and sinus will remain unchanged with repeating inflammatory process until a complete excision of the tract is carried out. The early diagnosis and complete excision of the tract are important in the treatment of this anomaly. The details of the surgical technique how to protect the facial nerve were discussed.