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原稿種別: 表紙
1981 年 17 巻 7 号 p.
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発行日: 1981/12/20
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原稿種別: 表紙
1981 年 17 巻 7 号 p.
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原稿種別: 付録等
1981 年 17 巻 7 号 p.
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原稿種別: 付録等
1981 年 17 巻 7 号 p.
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原稿種別: 付録等
1981 年 17 巻 7 号 p.
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原稿種別: 目次
1981 年 17 巻 7 号 p.
Toc1-
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葛西 洋一
原稿種別: 本文
1981 年 17 巻 7 号 p.
1147-1154
発行日: 1981/12/20
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植田 隆
原稿種別: 本文
1981 年 17 巻 7 号 p.
1155-1164
発行日: 1981/12/20
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Stephen L. Gans, Edward Austin
原稿種別: Article
1981 年 17 巻 7 号 p.
1165-1169
発行日: 1981/12/20
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Dale G. Hall
原稿種別: Article
1981 年 17 巻 7 号 p.
1171-1179
発行日: 1981/12/20
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角田 昭夫, 田辺 達三
原稿種別: 本文
1981 年 17 巻 7 号 p.
1181-
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古味 信彦, 斎藤 純夫
原稿種別: 本文
1981 年 17 巻 7 号 p.
1182-1183
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小松 作蔵, 城谷 均
原稿種別: 本文
1981 年 17 巻 7 号 p.
1183-1184
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沢口 重徳, 沢田 淳
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1981 年 17 巻 7 号 p.
1184-1185
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高橋 英世, 矢野 博道
原稿種別: 本文
1981 年 17 巻 7 号 p.
1185-1186
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中条 俊夫, 勝俣 慶三
原稿種別: 本文
1981 年 17 巻 7 号 p.
1186-1187
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平井 慶徳, 岡田 正
原稿種別: 本文
1981 年 17 巻 7 号 p.
1187-1188
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井之川 孝一, 森本 雅己, 池田 裕, 津金 次郎, 杠 英樹, 志田 寛
原稿種別: 本文
1981 年 17 巻 7 号 p.
1189-1193
発行日: 1981/12/20
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The effects of simple deep hypothermia and surface cooling combined cardiopulmonary bypass with circulatory arrest on the brain were evaluated by electroencephalogram (EEG) and computerized tomography (CT) of the brain. In 69 children with congenital heart diseases undergoing open-heart surgery, 60 patients were operated on under simple deep hypothermia and 9 under surface cooling combined bypass method with hypothermic circulatory arrest. The following results were obtained. 1)The appearance time of EEG after resuscitation in simple hypothermia was required two times as long as circulatory arrest time. On the other hand, in the combined bypass method, it was so shortened that there seemed the good results for cerebral functions. 2) Judging from the postoperative EEG and CT findings, the safe limited times of hypothermic circulatory arrest should be within 60 min. at 20℃ of the lowest esophageal temperature in simple deep hypothermia. 3) Among all the patients, the postoperative cerebral disorders were found in 6 children (10%) by simple hypothermia. Four patients out of them showed abnormal changes of CT scans of the brain. However, their CT changes recovered from 6 months to 1 year after operation.
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横田 通夫, 村岡 隆介, 青嶋 實, 曲 入伸, 野本 慎一, 小林 彰, 北条 博厚
原稿種別: 本文
1981 年 17 巻 7 号 p.
1195-1200
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Effects of hypothermic circulatiory arrest on brain morphology were evaluted by computed tomography(CT). Three of 24 patients(12.3±6.1 months)undergoing deep hypothermic open heart surgery with circulatory arrest showed worsening in CT scans performed 38±18 days postoperatively when the patients Were totally free from fluid restriction and administration of cardiotonics or diuretics. None of them had clinical symptoms and signs of neurologic disorders. In those 3 patients, the nasopharyngeal-rectal temperature gradients, blood pressure, PaO2 and and PaCO2 during surface and perfusion cooling were not significantly different from those in the other patients. Also, in those 3 patients, the lowest nasopharyngeal temperature and the length of perfusion using membrane oxygenator and 20μ filter in the arterial line were not significantly deifferent from those in the unaffected patients. However, the duration of total circulatory arrest (60.3±8.1minutes)was significantly longer than that in the unaffected patients(45.4±9.8 minutes) (p<0.01). Serial CT scans in those 3 patients showed full recovery to the preoperative level by 12 months postoperatively. We advise not to extend the circulatory arrest time beyond 60 minutes(to be more secure 50 minutes)to prevent possible occurrence of clinically undetectable brain disorder even at the temperatures of 16-18℃.
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楠原 健嗣, 三木 成仁, 臼井 典彦, 上田 裕一, 松本 雅彦, 大北 裕, 田村 時緒, 三浦 端徳
原稿種別: 本文
1981 年 17 巻 7 号 p.
1201-1206
発行日: 1981/12/20
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Aorta-main pulmonary artery shunt with expanded polytetrafluoroethylene tube graft, Goretex^[○!R], (3-6mm in diameter) was undergone in consecutive 21 patients with complex cyanotic congenital heart disease aged 14 days to 12 years during the period of 1978 to 1981. There were three early deaths (mortality rate 14%). In 16 patients of them the shunt flow was measured with an electromagnetic flow meter of which probe was attached around the graft (QB) or around the proximal aorta (QS) to the graft and the distal portion (QD). (QB=QS-QD)There were five patients with severe cardiac failure including one early death and two late deaths, whose shtmt flows showed extremely high (QB/QS>40%, QB index>3l/min/m^2). The means of QB/QS and QB index of the patients without cardiac failure were 26±12%(n=10) and 1.65±0.70l/min/m^2 (n=12). In conelusion, the optimal shunt flow, QB/QS or QB index should be controlled in the range of 20 to 40% or not exceed 3l/min/m^2, and the optimal size of tube graft diameter (D) was calculated by the formula; D(mm) = 1.22ln BW(kg)+1.9 or D(mm)=1.57 ln BSA(m^2)+5.9, where BW and BSA were body weight and body surface area.
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中田 誠介, 高梨 吉則, 本多 正知, 今井 康晴, 高見沢 邦武, 中沢 誠, 安藤 正彦, 門間 和夫, 高尾 篤良
原稿種別: 本文
1981 年 17 巻 7 号 p.
1207-1211
発行日: 1981/12/20
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Total correction for Tetralogy of Fallot was performed in 100 consecutive patinents from July 1978 to December 1980, with 2 hospital 1 late death. Preoperative angiographic findings were useful for the evaluation of severity of Tetralogy of Fallot. From the RVgraphy, we caluculated PA index as follows; PA index=(r-PA diameter)^2 + (l-PA diameter)^2/4ヂSA The incidence of LOS was significantly higher in one group (preoperative PA index<200) than another group (preoperative PA index<200). The was a good correlation between preoprative PA index and cardiac index at 24 hour after repair. C.I.=0.0043×PA index+1.9 (r=0.69) 1 month after total correction, PA index increasing significantly especially in hypoplastic group, and there were no significant differences. We consider that PA index can be a good indicator to estimate the development of pulmonary pulmonary artery left heart.
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北村 惣一郎, 大西 健二, 松田 暉, 賀来 克彦, 島崎 靖久, 奥田 彰洋, 中田 精三, ハ木原 俊克, 康 重雄, 大山 朝賢, ...
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1981 年 17 巻 7 号 p.
1213-1218
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Surgical experiences with 25 patients who had congenital heart disease associated with both atrioventricular and arterioventricular discordance were reviewed. Total correction was performed in 22 of 25 patients. The main factors deteriorationg the surgical results were surgically induced complete heart block(CHB), anatomical(systemic)tricuspid regurgitation(TR), myocardial failure, iatrogenic aortic regurgitation(AR) following aortotomy approach to ventricular septal defects(VSD), arrhythmias and residual pulmonary stenosis (PS). The CHB occurred frequently when the VSD was approached through the anatomical left ventricle. Myocardial failure resulting in chronic heart failure observed in 3 patients was secondary to systemic right ventriculotomy for VSD closure. A low grade of AR resulted from traumatic retraction of the aortic valve for VSD closure through aortotomy, but this could be eliminated. PS should be relieved by means of an extracardiac conduit unless it is relieved by pulmonic valvotomy only. While in small children, significant PS should be treated by a palliative procedure. TR was also a major abnomality in this disease, which was noted in 44% of our patients. TR was severe in some children with Ebstein-type anomaly of the tricuspid valve and in others, TR deteriorated after surgery with right ventriculotomy approach. TR was one of the main factors compromizing the postoperative status. Right ventriculotomy is a good approach for the prevention of CHB, but can not be recommended as far as the late results are concerned, since deterioration of TR and myocardial failure may appear more frequently in the late postoperative period.
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田宮 達男, 山城 敏行, 西沢 直, 鈴木 一郎, 北川 素
原稿種別: 本文
1981 年 17 巻 7 号 p.
1219-1224
発行日: 1981/12/20
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Surgical BBBB was surveyed in our series of intracadiac surgery consisting of 254 with VSD, 48 with TOF and 4 with TGA III, from Jan., 1970 through March, 1981. Of surgical BBBB, LAHB with RBBB was commonest and LPHB(LBBB)with RBBB was next: they were usually transient and benign. Two cases with trifascicular block following surgical CAVB, developed to CAVB later:impairment of the bundle of His was suspected. In our clinical study, LAHB with RBBB often followed trauma to the lower rim of VSD near the muscle of Lancisi or the Lancisi equivalent structure, while LPHB with RBBB followed thar to the more posterior lower rim. Electrophysiological delineation of the conduction system revealed relatively tight correlations of the RB with the Lancisi equivalent strucure, little affected by the type of VSD and TOF. This result was worthwhile for presuming the bifurcated site of the His bundle, and for reducing the incidence of surgical BBBB.
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藤原 直, 今井 康晴, 高梨 吉則, 本多 正知, 沢渡 和男, 松尾 浩三, 飯田 吉彦, 小柳 仁
原稿種別: 本文
1981 年 17 巻 7 号 p.
1225-1229
発行日: 1981/12/20
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The early postoperative results for 10 patients who had Senning opeartion performed for transposition of the great arteries with intact ventricular septum were compared with the results for the most resent 11 patients who underwent Mustard operation. The averaged age and weight were not significantly different in the Senning or Mustard groups.(average 7.9 vs 7.7kg and 12.2 vs 12.5 months) In the Senning group, 8 patients underwent a modified Senning operation, including pedicled pericardial patch enlargement of the pulmonary venous pathway, and 2 patients underwent a Senning I operation. There were two hospital deaths with low cardiac output and one late death with congestive heart failure in the Mustard group, and no hospital and one late deaths with pulmonary venous obstruction in the Senning group. At the immediate postoperative period we found more stable hemodynamics, easier respiratory care and fewer transient arrythmias in the Senning than in the Mustard group. Eight patients in the Mustard group and three patients in the Senning group had immediate postoperative transient arrythmias, but all of the two groups were in regular sinus rhythm at the discharge. Postoperative catheterization was performed in eight patients of the each group and showed no systemic and pulmonary venous obstruction and normal corrected pacemaker recovery time in all patients.
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内藤 泰顕, 藤田 毅, 富野 哲夫, 康 義治, 菊池 利夫, 磯部 文隆, 上間 利一, 谷本 猛, 広瀬 修, 神谷 哲郎, 曲直部 ...
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1981 年 17 巻 7 号 p.
1231-1235
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Rastelli operation has been exclusively performed for the patient over 3 years of age with transposition of the great arteries(TGA), ventricular septal defect(VSD), and left ventricular outflow obstruction(LVOTO). We have adopted successfully this operative method as one stage correction using the left ventricule as the systemic ventricle for 3 infants with TGA and VSD, without LVOTO(TGA group II), considering the finding that the right ventricular function after Mustard operation for such a infant was known to be seriously decreased. In all of them, VSD was enlarged by excising conus septum to avoid obstruction of interventricular tunnel and Dacron coduit of 18 mm in diameter with modified Hancock porcine valve was used for the reconstruction of pulmonary artery. As far as our knowledge, this report will be the first successful cases in Rastelli operation for such young infant with TGA and VSD. Their postoperative left ventricular functions were proved to be better than the right ventricular function after Mustard procedure for TGA groupII
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山田 昂
原稿種別: 本文
1981 年 17 巻 7 号 p.
1237-1248
発行日: 1981/12/20
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Seventeen patients of 8 months to 8 years of age were studied after successful repair of esophageal atresia and tracheoesophageal fistula. Each patient was interviewed clinically and and underwent esophageal manometric studies, and the results were compared to those of mormal 28 infants. Lower esophageal sphincter pressure (LES) in the two groups did not differ in resting pressure and length. Fifteen of 22 normal infants had normal peristalsis of esophagus, while all but two of esophageal atresia group patients had abmormal esophageal motor function showing either simultaneous contraction, spastic contraction or no contraction. Normal relaxation of LES was observed in 8 of 14 patients investigated. Esophageal symptoms including vomiting, regurgitation and dysphagia were found in 4 of 17 patients. No significant difference in resting pressure of LES was noted between symptomatic and asymptomatic patients. But the length of LES in 4 symptomatic patients was significantly shorter than in asymptomatic patients. No peristalsis was recorded in those three of 4 symptomatic patients and no relaxation of LES was observed in all of them. Two patients demonstrated gastroesophageal reflux and required anti-reflux operation.
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矢倉 政則
原稿種別: 本文
1981 年 17 巻 7 号 p.
1249-1262
発行日: 1981/12/20
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Postoperative changes of cellular immunity were studied in 90 infants and children. Thirty-one patients were between one and six months of age, of whom 10 underwent operation for inguinal hernia or other minor procuderes, 16 minor abdominal surgery and 5 surgery for obstructive jaundice. Thirty patients were between 7 months and 3 years of age, of whom 13 underwent operation for inguinal hernia or other minor procedures, 6 minor abdominal surgery and 11 major abdominal surgery. Twenty-nine patients were above 3 years of age, of whom 21 underwent operation for inguinal hernia or other minor procedures and 8 major abdominal surgery. Sixty-seven patients were studied before and after operation and 7 non-surgical patients were also studied as age-matched control, PHA skin test, PHA induced lymphocyte transformation index, number of lymphocytes, T-cell % and number of T-cell were examined as parameters of cellular immunity. The present studies provided the following results; 1. There were changes of cellular immunity proportional to the age at the time of the examinations. PHA skin test showed significantly low value in the younger infants. 2. There was no significant change of cellular immunity after operation for inguinal hernia or other minor procedures in all age groups. 3. There was no significant change of cellular immunity after minor abdominal surgery in both younger and older infants. 4. Slight decrease of cellular immunity was found in younger children after major abdominal surgery, but the recovery was noted in the early postoperative period. 5. Changes of cellular immunity in older children after major abdominal surgery were similar to those seen in adults after a subtotal gastrectomy. 6. Cellular immunity of infants with obstructive jaundice improvd markedly afte disappearance of jaundice by the operation.
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松岡 潔, 伊藤 保憲, 江原 和男, 浜脇 光範, 吉川 清志, 大村 勉, 岩田 克美, 米花 正晴
原稿種別: 本文
1981 年 17 巻 7 号 p.
1263-1269
発行日: 1981/12/20
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A 17-month-old male infant was referred to our hospital, with a complaint of gradually increasing abdominal distension. A huge, tense, fluctuated and smooth mass was palpated occupying most of the abdomen. An abdominal plain film showed a displacement of the intestinal gases to the right, and a CT scanning revealed a cystic mass of water-density below the left lobe of the liver. An aortographic study demonstrated avascular nature of the mass, and displacement of the splenic artery upward and of the aorta to the right side. Laboratory data were all within normal limits. The diagnosis of a mesenteric or pancreatic cyst was made. The child was operated upon. A huge cyst arising from the tail of the pancreas was extirpated completely with a partial resection of the pancreas. No evidence of cystic lesions in the other abdominal organs was present. The cyst measured 16 by 15 by 11 cm and weighed 1,850g. It was unilocular with multiple small cysts in its wall, and contained 1,450ml darkgreen fluid (amylase 189I.U.). The inner surface was roughened by fibrous tag in most part of the main cyst, but was smooth on the walls of the small cysts. Microscopically, much of the epithelial lining of the inner surface was denuded, but partly covered by a single layer of columnar epithelium. There were connective tissue of embryonal nature and sporadic acinar gland and ductal structures of the pancreas, and therefore a diagnosis of congenital pancreatic cyst was made. Congenital pancreatic cysts, especially single cysts of the pancreas are very rare. Ten cases have been reported in the Japanese literature, of which infant cases were only two.
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大島 宏之, 中島 進, 鮫島 夏樹
原稿種別: 本文
1981 年 17 巻 7 号 p.
1271-1276
発行日: 1981/12/20
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Esophageal achalasia is rare in children and only four to five percent of patients have been reported to be younger than the age of fifteen years. This paper is a report of a male infant with esophageal achalasia. Since three months of age, frequent postprandial regurgitation and respiratory distress have been seen. Any conservative treatment was not effective and the infant was admitted to our clinic at 12 months after birth. A chest X-ray film and a preoperative esophagogram revealed a shadow of pneumonia in the right lung and a narrowing of the esophagus at the gastroesophageal junction. At thirteen months of age, a transabdominal modified Heller's operation with a fundic patch formation was performed. After operation dilatations using Tucker's dilator were performed two times because the infant sometimes vomited at eating of solid foods. Postoperative course was uneventful and the development of the infant was well.
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内藤 春彦, 内野 純一, 泰 温信, 葛西 洋一, 日野 和雄, 森田 穣
原稿種別: 本文
1981 年 17 巻 7 号 p.
1277-1284
発行日: 1981/12/20
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A 1-year-2-month old male had two hepatic masses with elevation of serum alpha fetoprotein (AFP). Laparotomy disclosed a massive tumor (830g) in the lateral segment of the left lobe and a nodular one (50g) in the anterior segment of the right lobe. No other tumor could not be found out. A left segmentectomy and an wedge resection of the right anterior segment were performed. Pathological diagnosis was the well differentiated hepatoblastoma in both. The left tumor showed massive necrosis and was bordered with the fibrous septum, which was partly broken down by the tumor cells. In the right tumor, an intraportal tumor cell thrombosis was found and an active infiltration of the tumor cells was noticed into the liver tissue without fibrous capsule. Electron microscopical examinotion revealed many intracellular organs and remarkable microvilli between the tumor cells. Adjuvant chemotherapy was started on the 12 th day after the operation with FT207 supository 250mg/day for 10 days and was followed with 5-FU dry syrup 40mg/day for 2 years. AFP level was 59,360ng/ml on the day of operation and sharply decreased thereafter. The half life time was 53 hours. The patient has been doing well and is considered to be cured based on the level of AFP, laboratory tests and liver scintigram indicating no tumor at all for 2 years and 4 months.
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後藤 誠一, 池田 恵一, 金子 隆, 吉家 清貴, 舟越 美知子
原稿種別: 本文
1981 年 17 巻 7 号 p.
1285-1290
発行日: 1981/12/20
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Constipation, abdominal distension and megecolon are well known clinical findings with hypothyroidism. As these findings may strongly resemble that ot Hirschsprung's disease, ileus due to hypothyroidism is called to be "pseudo-Hirschsprung's disease". A 53 days old baby girl was admitted to Kyushu University Hospital with abdominal distension and vomitting. A plain abdominal X-ray film showed a dilation of the intestinal loops. However, a barium enema showed the normal sized colon. The recto-anal reflex was absent in manometry. Histochemical staining of acetylcholinesterase activity showed no increased nerve fibers. Blood culture revealed Proteus morganii. Thyroid function test showed hypothyroidism pattern: low T3 and T4 and high TSH. Chromosomal analysis showed 21 trisomy. No surgical intervention was required. The clinical symptoms disappeared by conservative therapy. In recovery stage, recto-anal reflex in manometry was present. Thyroid function test showed normal pattern. This case was considered to be sepsis and transient hypothyroidism with Down's syndrome. So ileus due to hypothyroidism and the association with Down's syndrome and respiratory distress syndrome were briefly discussed.
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土居 治, 青山 興司, 高田 佳輝, 小野田 康雄, 田中 嶺太郎, 村上 元正, 戸谷 拓二, 渡辺 泰宏
原稿種別: 本文
1981 年 17 巻 7 号 p.
1291-1298
発行日: 1981/12/20
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In two male siblings aged 1 year and 8 months and 2 years and 7 months, malignant testicular tumor was observed. The preoperative serum alpha-fetoprotein was increased in both patients' and was diagnostic of malignancy. The excised tumors were histologically a yolk sac tumor which was proposed by Teilum and Huntington. We report here the rare family of brothers with malignant testicular. Tumor arised in brothers, at the age of 1 year and 8 months and 2 years and 7 months respectively. AFP was positive in each of them and histological findings of these tumor were compatible to yolk sac tumor proposed by Teilum and Huntington.
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三好 新一郎, 池田 正人, 城戸 哲夫, 松田 康雄, 深田 隆三, 中島 邦也, 伊豆蔵 豊大, 信貴 邦夫, 黒瀬 裕史, 辻野 芳弘 ...
原稿種別: 本文
1981 年 17 巻 7 号 p.
1299-1304
発行日: 1981/12/20
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The yolk sac, which norishes the growing embryo in the very early stages of development, receives the paired vitelline arteries from the aorta. In turn, the vitelline veins arise from the yolk sac and lead to the sinus venosus. As the placental circulation becomes dominant, the vitelline circulation atrophies and disappears. Abnormal persistence of the vitelline circulation, so-called mesodiverticular band, produces clinical problems. Abnormal persistence of the right vitelline artery, the left vitelline artery and the left vitelline vein have already been reported, but no discussion of the right vitelline vein is found in literature. We recently experienced a case of intestinal obstruction due to a mesodiverticular band. The patient was a 3-yr-old boy, who underwent an emergency operation. At laparotomy, a segment of the ileum had become trapped by a root of Meckel's diverticulum, from the tip of which a band was running to the posterior leaf of the mesentery. The band was divided and the strangulated segment of the ileum was resected and an end to end anastomosis was performed. A photomicrograph of a cross-section of the excised band revealed that the artery, the vein and nerve fibers were present in the band. Reviewing case reports in literature, it was suggested that the vein found in the band is the right vitelline vein remnant and that this is an important fact which proves the hypothesis that the superior mesenteric vein derives from the right vitelline vein.
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北谷 秀樹, 宮本 正俊, 中村 紘一郎, 梶本 照穂
原稿種別: 本文
1981 年 17 巻 7 号 p.
1305-1311
発行日: 1981/12/20
公開日: 2017/01/01
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VTR-endscopic examinations were carried out in 3 patients who had undergone Martin's procedure for entire colon aganglionosis. In the area in which aganglionic colon was left, stool accumulated persistantly, and further cleansing was necessary to get satisfactory view. Two kinds of mucosal surface were distinguised by the difference of mucosal folds and intestinal motility. The enlargement of the size of the ileum was much more than colon. The histology showed only moderate inflammatory changes in the colon, and inflammatory changes in the lieum with the leveled villi, decreased Paneth cells and increased goblet cells. Enlarged absorption surface and elongated absorption time which came from the stagnation of stool seemed to take the most important role in Martin's operation.
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松山 四郎, 長嶋 起久雄, 鈴木 則夫, 原澤 信雄, 倉繁 徹昭, 北村 龍彦
原稿種別: 本文
1981 年 17 巻 7 号 p.
1313-1316
発行日: 1981/12/20
公開日: 2017/01/01
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Of 55 infants with hypertrophic pyloric stenosis treated at our institution during the period from 1959 to 1981, three (5.45%) were low-birth-weight. They were all pre-term, appropriate for gestational age infants and two of them were female. Average age at onset was about 10 days later than full-term control patients and vomiting was not forcible in two. There was no relationship between the age of onset and the birth weight or gestational age. A patient died of respiratory distress after the operation. Hypertrophic pyloric stenosis is rare among low-birth-weight infants and presents atypical and milder clinical picture. It is very interesting that contrary to the full-term infants, the disease occurs predominantly in females in this group of patients.
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原稿種別: 付録等
1981 年 17 巻 7 号 p.
App4-
発行日: 1981/12/20
公開日: 2017/01/01
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原稿種別: 目次
1981 年 17 巻 7 号 p.
1332-1336
発行日: 1981/12/20
公開日: 2017/01/01
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原稿種別: 付録等
1981 年 17 巻 7 号 p.
1337-
発行日: 1981/12/20
公開日: 2017/01/01
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原稿種別: 表紙
1981 年 17 巻 7 号 p.
Cover3-
発行日: 1981/12/20
公開日: 2017/01/01
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