The influence of massive colectomy upon growth and development, histological changes of residual gut, and mucosal enzyme activity were investigated in juvenile Rats (4-6 weeks old). Total colectomy manifests a great influence on growth and development in juvenile Rats, presenting a remarkable reduction in growth curve particularly in male Rats. The tendencies of polyphagia and polydipsia were observed corresponding to severe diarrhea and significant decrease of serum sodium, total protein and blood sugar. In the residual gut, remarkable distension of ileum and mucosal hypertrophic change were seen in the early stage (1 month after operation), which seem to be compensatory changes. Shortness in hight and increase in number of the villi were recognized in the ileum during middle and late stages (3-6 months after operation), which seem to be characteristic in juvenile Rats. The change of mucosal enzyme activity was studied to investigate functional effect on the residual gut. The decreased of alkalinephosphatase activity in the late stage corresponding to the number of epithel cells, the compensatory increase of Na-K-ATPase activity in the early stage and its decrease in middle and late stage, coincided with the histological findings. The growth, development, blood chemical findings and mucosal enzyme activity were less influenced by hemicolectomy than by total colectomy. Regarding the histological changes upon the residual guts, right side hemicolectomy was much more influential than left side hemicolectomy.
Murine C-1300 neuroblastoma has similar characters to human neuroblastoma and has been accepted as a model for investigation of human neuroblastoma. However the characters have not yet been clarified sufficiently. Establishment and characterization of the ascites form of C-1300 neuroblastoma were studied. Priming of the A/J mouse was performed with 0.5ml pristane nine days before implantation of the tumor. After dispersion of the C-1300 neuroblastoma cells, 1×10^6 cells were intraperitoneally inoculated. Ascites was accumlated after 13 days. It was serially transplantable with the ascites. The biological characteristics of the ascites tumor were as follows: 1. The ascites tumor cells appeared to the free cell type and were more anaplastic than those of the original solid tumor. 2. They maintained the same histopathological characters as the original solid tumor. 3. Tumor cell number of inoculated ascites could be completely controlled. Implantation rate was 100%, the survival days were almost constant. 4. Modal chromosome number of the ascites tumor cell was 93 with 8 maker chromosomes. 5. The generation time was about 22.3 hours by the BrdU-Acridine Orange method. 6. Research of cell kinetics and chromosome studies were easily performed. These results indicate that the C-1300 ascites tumor is a useful screening model for human neuroblastoma and may be applied for chemotherapy research and other cancer studies.
By affinity chromatography and crossed immuno-affinoeletrophoresis, lectin affinity of the serum AFP was investigated in 10 patients with pediatric neoplasms. AFP of the cord blood in normal neonates and the sera in patients with biliary atresia was also studied. Three major variants of AFP could be discriminated by concanavalin A and Lens culinaris Agglutinin They are AFP of 1) liver origin, 2) yolk sac origin and 3) undetermined origin. Cord blood and the sera of biliary atresia exclusively contained AFP of liver origin. Approximately 90% of AFP was liver origin in hepatoblastoma. In contrast, the sera of yolk sac tumor contained of almost the same amount of AFP of yolk sac origin and undetermined origin. If the yolk sac tumor were transplanted in nude mice, AFP from yolk sac origin increased to more than 70%. Two of our 4 cases with upper abdominal mass whose preoperative diagnoses were hepatoblastoma showed an AFP variant pattern of yolk sac tumor. Histology disclosed intraabdominal yolk sac tumor and pancreatic cancer, respectively. The remaining 2 cases with liver origin AFP had hepatoblastomas. This fact indicates the usefulness of the AFP variant analysis.
In the management of congenital biliary atresia (CBA), postoperative ascending cholangitis is one of the most serious complications which affect the prognosis. At our department, 45 cases of CBA have been experienced since 1972. In these patients, E. coli and Klebsiella had been thought as pathogens of ascending cholangitis. However, these have been seen in fewer number of cases. Instead of these strains, Enterobacter, Acinetobacter and Pseudomonas cepacia have recently often been detected from the enterostomy content in patients of ascending cholangitis. One of the causes of this alternation seems to be due to the antibiotics which have been usually used. For example, Cefazolin is sensitive to E. coli and Klebsiella, but not to Enterobacter, Acinetobacter, and Pseudomonas cepacia. In addition, many strains of Entrobacter have been resistant to gentamicin. The other cause of exchange of pathogens is thought to be due to disinfectants which are often used. In these years, the numbers of Hibitane resistant strains have increased. (i.e., Acinetobacter, Pseudomonas cepacia). At our department, Hibitane has often been used and then Hibitane resistant-strains are thought to increase. Both the bacterial killing activity and the superoxide production of neutrophils in patients of CBA were depressed, suggesting susceptibility to infection. By these observations, the choice of chemotherapeutics for prevention of cholangitis in CBA seems very important.
Congenital pyloric atresia is extremely rare. We have experienced the disease occurred in siblings (older and younger brothers). This paper reports a younger case of congenital pyloric atresia complicated with epidermolysis bullosa and the review of the literature concerning the familiar occurrence. A baby boy, antenately diagnosed as pyloric atresia by ultrasonography was delivered normally with 33 weeks gestation, weighning 2,450 gr. Since 26th week of pregnancy, hydramnios was noted. He was admitted to our department just after birth. Abdominal plain X-p showed single bubble sign. At on day of age, a laparotomy was performed. Pyloric atresia due to the cord structure was found and the resection of the pylorus with end-to-end gastroduodenostomy was performed. His postoperative course was uneventful, but mild epidermolysis bullosa was found in this case postoperatively. The investigation of HLA typing, and the pedigree will be needed to clarify the hereditary transmission, as the high incidence of familiar occurrence was noted.
Postoperative follow up studies were performed in 55 cases of congenital biliary dilatation who had been operated on at our department. None of postoperative complications was found in 40 cases in whom the cyst had been primarily excised. In contrary, three out of nine cases in whom the cyst had not been primarily excised developed postoperative cholangitis. Furthermore, postoperative cholangitis developed only in those of cystic biliary dilatation and not in those of fusiform dilatation. A hepaticojejunostomy (R-Y) following secondary excision of the dilated common bile duct was performed in nine cases including six who had undergone the first operation some where else. Secondary excision was difficult but dramatically effective except in one case who developed the stricuture of hepaticojejunostomy. These results strongly suggested that primary excision is mandantory in the early stage. If primary excision is impossible, early secondary excision is recommended after a temporary external biliary drainage without internal drainage operation.
The purpose of this paper is to describe the bile duct and the pancreatic duct anomalies associated with congenital upper intestinal obstruction based on the findings of the upper gastrointestinal series and the cholangiography. There were 3 cases with the reflux of the contrast media to the bile duct or the pancreatic duct on the upper gastrointestinal series. One case with the reflux to the bile duct had congenital duodenal membranous stenosis, and 2 cases to the pancreatic duct had annular pancreas. There were 4 cases with anomalies of the bile duct (2 cases with ectopic opening of ampulla, 1 case with choledocal dilatation and 1 case with abnormal cystic duct). We suppose that the reflux to the bile duct (duodeno-choledocho reflux) and to the pancreatic duct (duodeno-pancreatico reflux) may occur by duodenal dilatation and sphincter-anomaly of the choledocus and pancreatic duct, and these cases with the reflux may be associated with cholangitis or pancreatitis,
The choise of treatment for ulcerative colitis surgical indication and selection of operative method has been debatable. In this view point, a survey of nation wide was done including concerning 591 general hospitals throughout Japan regardiny the surgical results of this disease. Fourhundred and fifteen hospitals (70.2%) have responded. A total of 27 cases were included in this study. The result of the long term prognosis in these 27 cases was analysed objectively (27 cases, 100%) and subjectively (17 cases, 63%). To this analysis, previously reported 14 cases were added. Of 41 cases thus prepared, 9 sphincter preserving method was performed in 24 with an ileoanostomy in 9, ileorectostomy in 10 and ileocolostomy in 5. In the other 13 cases, a permanent ileostomy was carried out. The overall surgical mortality was 4.9%. Surgical complications were seen in 40% of those undergoing an endorectal ileal pull-througn operations and in 10% of ileorectostomy. Reoperation was carried out in 3 of 10 cases (30%) who had undergone an endorectal ileal pull-through method. Recurrence rate in the ileorectostomy was 50 percent. In regard to the cancer risk of the preserved rectal mucosa, no rectal carcinoma was found in these cases during follow-up period. All the 11 patients who had undergone a sphincter preserving operation have returned to normal life. Two of 6 patients with a permanent ileostomy can not enjoy a social life due to incontinence. The patients who had undergone an ileorectostomy have better continence than those of an endorectal ileal pull-through operation. In this survey, it has been suggested that a totalcolectomy with an ileorectostomy is better than an endorectal ileal pull-through operation, in view of easiness of surgical technique, lower incidence of complications and reoperation and excellence of continence.
In pediatric surgical field, creation of a double barrel colostomy is the most common surgical procedure to save the patient. In this procedure, distal colon is unused and it occasionally tends to be atrophic. Whereas, there is a high incidence of complications following closure of clostomy; i. e., wound infection, leakage or stenosis of the anastomosis, and fistula formation. Since one of the causative problems for these complications is considered to be the difference in the diameter between proximal and distal colon at the anastomosis, we then attempted the repeat installation of agar solution into the distal colon prior to colostomy closure for widening the unused colon. The patient who received agar installation was 5 months male infant. He had undergone a double barrel ileostomy for mechanical ileus caused by anastmotic disorder for the ileal atresia in other institution. Daily installations' of 10 or 20ml of agar solution three times a day was continued for 45 days before colostomy closure. Although the diameter of distal colon was not so large at colostomy closure, the colonic wall was thickened providing easier anastomotic procedure. No complication was experienced after the operation.
Pancreatic ductal system was examined morphologically on endoscopic retrograde pancreatocholangiography (ERCP), percutaneous transhepatic cholangiogiaphy (PTC) and intraoperative cholangiopancreatography in 17 cases of congenital dilatation of the bile duct. In all cases an abnormal long common channel with an anomalous junction of the pancreaticobiliary ductal system was demonstrated and in 4 cases dilatation, tortuosity and irregularity of main pancreatic duct were found as seen in chronic pancreatitis. These findings suggest various degree of pathological changes of pancreas under exsistence of an anomalous junction of the pancreaticobiliary ductal system.
This paper reportes a case of multiple jejunitis with submucosal vasculitis. The patient was a four year and six month old male. Colicy abdominal pain started 24 days before surgical treatment. Fecal occult blood was positive and leucocytosis was seen. Any skin eruption or urinary occult blood was not noticed. Barium meal examination of the small intestine showed a tumor like shadow defect, with irregularity in caliber and destruction of mucosal architecture in the jejunum. Antibiotics and steroid therapy did not releave abdominal pain. A laparotomy demonstrated segmental and multiple inflammation in the jejunum. There were four circular and segmental eroded or ulcerated lesions with edematouse mucosa in the resected jejunum. Histological examination revealed mucosal necrosis, bleeding, edema and infiltration of inflammatory cells with a few vasculitis. We diagnosed this anaphylactoid purpula. We pointed out several resembling factors of this disease with non specific multiple ulcer of the small intestine. If the submucosal ischemic lesion remaines after vasculitis of anaphylactoid purpula subsides, chronic, shallow and sharply demarcated multiple ulcerative lesions may remaine for long time. We implied that nonspecific multiple ulcers of the small intestine may be the result of anaphylactoid purpura.
The patient was transfered to Sendai Red Cross Hospital with an umbilical tumor from which urine overflowed. A catheter which was introduced in to the urethra came out through the umbilical tumor. A radical excision of the fistula was successfully performed 20 hours after birth. Postoperative diagnosis was a vesicoumbilical fistula with agenesis of the urachus. Pathogenesis and classfication of congenital disorders of the urachus have been discussed.
Twenty three cases of segmental dilatation of the intestine and colon have been reported in world literatures. This abnormality is often apt to be pre-operatively confused with Hirschsprung's disease and mechanical intestinal obstruction. During past 18 years, six cases of segmental dilatation of the intestine or colon have been treated at the National Children's Hospital. Sites of the segmentally dilated gut were the jejunum (1), ileum (3) and colon (2). Three were male and 3 female. Symptom of intestinal obstruction was not observed in all but one until at several months of age when vomiting and abdominal distension occured. Associated congenital anomalies were malrotatior of the intestine (2), Meckel's diverticulum (2), chromosomal disorder (1), congenital heart disease (1), meningomyelocele (1), aberrant gastric mucosa (1) and Hirschsprung's disease (1). Although microscopical abnormality of the intramural ganglion cells was not found in the dilated segment in any of these cases, we assume that some of congenital factors are involved in the etiology of segmental dilatation of the intestine. Regardless the etiology, resection of the dilated intestine employing an end-to-end anastomosis has always resulted in an excellent recovery and is thought to be a treatment of choice.
This is a case report of a premature female baby with congenital mesoblastic nephroma (CMN)complicated with hypertension, which was successfully treated by nephrectomy. Rennin activity and distribution of the rennin substance in the tumor tissue were histochemically evaluated. As the result of the study, it seemed that the renin did not originate from proper tissue element of CMN, but rather from stimulated nonneoplastic renal apparates. Correlation between the tumor histology and the rennin-secretion was discussed briefly.