The Spleen in neonate a higher microbicidal activity comparing with adult. Its function decreases as the age advances. If adult mouse spleen is activated by complete Freunds adjuvant, the spleen regaines its function. Therefore, a removal of the neonate or activated spleen will cause severe infection. Autotransplantation of the spleen was carried out in mice for protection of infection after splenectomy. The autotransplanted spleen easily regenerated in the subcutaneous region, peritoneal cavity, liver, kidney and brain. In the environments rich in vascularity such as kidney provided faster regeneration of the spleen. On day 14 after autotransplantation of the spleen, the T-cells and phagocytes of the autografts began to restore and microbicidal activity of the splenic cells occured. But the B-cells did not appear at the time. These results show that it is dangerous to remove the activated spleen and it is reasonable to autotransplant the spleen for protection of infection after splenectomy.

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Liver damage formed by ligation of the bile duct secondarily causes splenomegaly. The spleen had the higher microbicidal activity with a decrease in the number of T-cells as seen in neonate. Removal of the spleen in this condition may cause postsplenectomy overwhelming infection as in neonate. The autografts of the mouse spleen regenerated faster in the host with liver damage and had the more phagocytes and higher microbicidal activity than the control group. These sesults suggest the usefulness of splenic autotransplantation after splenectomy in the host with liver damage.

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Urinary excretion of catecholamines (CA) and their metabolites were measured in 18 cases with neuroblastomas (NB), 10 with ganglioneuroblastomas (GNB) and 3 with ganglioneuromas (GN). CA contentss in the resected tumor tissues of 10 NB, 7 GNB and 4 GN were also determined. On the other hand ultrastructural studies were done in 20 NB, 7 GNB and 4 GN, with special interest in neurosecretory granules of tumor cells. These biochemical data and morphological findings were analyzed and following results were obtained: 1) Measurements of all of VMA, HVA and dopamine in urine were most reliable to make diagnosis of NB, GNB and GN. 2) Initial urinary VMA/HVA. ratio and the level os urinary dopamine closely related to the prognosis of the patients with NB and GNB. 3) The amount of catecholamine contents in the tumor tissues correlated to both the level of urinary CA metabolites and the numbers of neurosecretory granules found in the tumor tissue. 4) CA metabobism in NB and GNB was generally more active than the one in GN. Norepinephrine and dopamine were main catecholamines detected in these tumor tissues, whereas epinephrine was scarce in amount. In urine, VMA, HVA and dopamine were mainly detected. Low levels of Dopamine β-Hydroxylase and small numbers of coated neurosecretory vesicles in tumor tissues were causative of the above metabolic features. 5) Coated vesicles were classified into 5 types according to their size and form. They tended to become larger and to transform into oval in the area where they densely gathered, namely in the presence of high level catecholamine synthesis. 6) In a VIP secreting ganglioneuroma, two types of coated vesicles were seen : the large sized ones (about 130 m/μ) presenting low electron density were presumably relevant to VIP.

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Cholangiography through the enterostomy was performed on 15 patients and 2 autopsy cases who have undergone Suruga II method for uncorrectable type of biliary atresia. The age at the time of the examination ranged from 5 months to 15 years. Radiologic findings of intrahepatic bile ducts were classified into three types. The first group showed main intrahepatic bile ducts of nearly normal shape although some hypoplastic findings were seen (9 cases). This group showed enough bile flow and good postoperative recovery. The second group showed fine numerous bile ducts radiating from the porta hepatis (6 cases). Some of this group showed uneventful postoperative course but there are a few cases with decreased bile flow and persistent jaundice. The third group showed no visible bile ducts connected to the porta hepatis. In this group, bile flow was insufficient and jaundice persisted. The radiologic classification of intrahepatic bile ducts correlated well to the postoperative course of biliary atresia. The changes of intrahepatic bile ducts of the radiating group were suspected to be related to the hypoplastic abnormality of biliary atresia.

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A modified technique of Asopa's one stage urethroplasty was carried out in ten patients with hypospadias (1 distal penile, 5 proximal penile and 4 penoscrotal type). The modified technique is: 1) Hypospadia is repaired in one stage, providing a better result with reduced morbidity and hospitalization cost. 2) Both of a complete chordectomy used in many multiple stage techniques and a skinlysis recently proposed by Smith, Allen and King are accompolished in the same stage, making this technique applicable to the hypospadias from distal penile type to penoscrotal type. 3) A construction of neourethra using a vascularized flap of prepucial hairless skin provides the considerable advances as mentioned by Hodgson. 4) A completion of the urethra to the tip of glans accompanies the glans plasty, making a normal appearance of penis. 5) No urinary diversion is necessary. 6) A fistula can be formed at the junction of old and neourethra, but can be closed easily. (4 patients developed fistulas and surgical closure was done successfully). 7) Penile rotation could occur rarely but can be prevented by careful design to close skin.

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Orchiopexy was performed to 17 patients with unilateral cryptorchidism who had previously received inguinal or retroperitoneal surgeries. Types and numbers of the initial surgeries were : inguinal herniorrhaphy (5), inguinal herniorrhaphy and orchiopexy (3), inguinal herniorrhaphy and hydrocelectomy (1), orchiopexy (6) and radical operation for anorectal anomalies (2). Of 17 patients, 14 had true cryptorchidism initially, and 3 iatrogenic cryptorchidism resulted following herniorrhapy. The orchiopexy was difficult because of dense adhesions and scars around spermatic cord and testis. Meticulous and timeconsuming surgery was required to mobilize them from the surrounding tissue. Traction of the testis was necessary in 7 patients after orchiopexy. Postoperatively, all of the 17 testes were located in normal scrotal position, but testicular growth was good in 14, fair in 2 and poor in 1 patients. It is mandatory to check testicular position at the completion of herniorrhaphy so that the testis should be positioned well down in the scrotum. If hernia is associated with cryptorchidism, both herniorrhaphy and orchiopexy must be done simultaneously. It is strongly desirable that general surgeon can perform an ordinary orchiopexy.

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The usefullness of non-invasive imaging technics namely CT and ultrasonography was evaluated in pediatric surgical abdominal diseases, under the categoly of A) inflammatory masses (10), B) biliary abnormalities (6), C) neoplasms (12), and D) blunt abdominal traumas (8), which were experienced at St. Marianna University Hospital from April 1978 to January 1982. According to the results of the clinical study, the plan of useful diagnostic approaches in each group by means of several imaging technics was outlined. In group A and B, ultrasonography is usually suffice for diagnosis and therapy planning, whereas in group C and D, in addition to the ultrasound, CT is sometimes required for evaluating the involvement of vascular structures and sorrounding vital structures in cases of neoplasm, and coexisting injuries in the traumas.

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The rectal mucosal biopsy and histochemical examination of the specimen by acetylcholinesterase staining are essential for the diagnosis of aganglionosis. However, this histochemical examination has been used in only 30% of the pediatric institutions in Japan. One of the reason for the infrequent performance of the histochemical study might be the lack of suitable instruments for the biopsy. Mutoh's suction biopsy forceps, which had been developed for adults, were reformed for children and were used in a screening study of constipated patients. One hundred and two specimens were obtained from 51 patients, which consisted of 30 patients with chronic constipation, 9 with aganglionosis, and other allied disorders. Biopsied specimen must contain the muscularis mucosae for correct interpretation, because nerve proliferation can be observed in the lamina propria in certain normoganglionic conditions. The specimens were obtained adequately in 98% of the patients by using this instrument. Five percent of specimens obtained from patients with chronic constipation was inadequate for correct interpretation. In contrast, specimens from the postoperative patients were inadequate in 33% for diagnosis. The confirmation of the ganglion cells was non-essential in 90% of the patients in whom nerve proliferation in the muscularis mucosae was reliable for differential diagnosis between normo- and aganglionosis. In the remaining patients, 10%, which showed a small number of nerve fibers with low activity of AChE in both normo- and aganglionic specimens, the ganglion cells had to be identified for diagnosis. In conclusion, the rectal mucosal biopsy by the reformed Mutoh's forceps was useful in obtaining adequate specimens. Only 2.1% of the patients had inadequate specimens.

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Twenty-five patients with congenital biliany atresia were experienced in our department from 1970 to 1982. In 13 (52%) out of 25 patients their jaundice had been disappeared postoperatively and 7 cases are living without jaundice. Six out of those 7 patients were particularly reviewed in this paper. The results are summerized as follows: 1) Elevation of serum alkaline phosphatase and LDH was observed in all cases. 2) The hepatobiliary scintigrams with <99m>^Tc-EHIDA in two cases with portal hypertension showed a poor liver uptake and the delayed excretion of RI from the liver. 3) In the 2 cases above mentioned, the percentage of sulfated bile acid to total bile acid in urine was 12% and 22% respectively, and those were lower compared to the other four cases. It is suggested that urinary sulfated bile acid may be more sensitive index than conventional liver function testes for biliary atresia. 4) The fecal fatty acid concentrations in 6 cases ranged from 0.2 to 1.2 g/day. A steatorrhea was not observed in those cases.

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Cardiac function was evaluated in two patients with transposition of the great arteries after anatomical correction (Jatene operation). One (case 1) was a 6-year-old boy with transposition of the great arteries with ventricular septal defect, 5 years and 11 months after Jatene operation. The other (case 2) was 2-year-old boy with a Taussig-Bing anomaly of the type of transposition of the great arteries, 1 year and 9 months after Jatene operation. Pressure gradient between right ventricle and pulmonary artery was 18 mmHg in case 1, but there were no pressure gradients between ventricles and great arteries in case 2. Aortic regurgitation and stenosis at the anastomosed sites of pulmonary arteries, aorta, and coronary arteries were not found angiographically. Small aortic aneurysm was found in both cases. Mild degree of mitral regurgitation, which was detected preoperatively, still remained in case 2. Cardiac index was 3.80l/min/m^2 and 4.31l/min/m^2 respectively. Left ventricular end-diastolic volume was 115% and 160% of the normal value. Left ventricular ejection fraction was 0.59 and 0.52. Right ventricular end-diastolic volume was 129% and 299% of normal. Right ventricular ejection fraction was 0.50 and 0.40. Left ventricular volume and ejection fraction was within normal range in case 1. Left ventricle was dilated and its ejection fraction was slightly depressed in case 2. This was due to volume over load by mitral regurgitation. The right ventricular volume was increased slightly in case 1 and significantly in case 2. Its ejection fraction was depressed slightly in case 1 and severely in case 2. This seemes to be due to large right ventriculotomy in both cases and pulmonary hypertension as high as systemic pressure in case 2. Cardiac function after anatomic correction for transposition of the great arteries was almost normal in the absence of residual disease or pulmonary hypertension.

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We report a multilocular lymphangioma of the spleen which was preoperatively diagnosed by CT scan, in addition to ullrasonography by using contact compound scan (B-mode) and real-time ultrasound. We demonstrated the unique ultrasonographic appearance of lymphangioma of the spleen, and investigated differential diagnosis by the ultrasonocraphic features.

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In most of cases of diaphragmatic hernia, the direct closure can be easily performed. However, in a large defect, the direct closure is difficult and the use of a suitable tissue substitute is needed for repair. A female of 3,240 gram and 41 weeks gestational age was born with respiratory distress on July 7, 1982. A chest roentgenogram taken 1 hour after birth revealed a huge diaphragmatic hernia in the left side which filled the entire thorax. At operation, it was obvious that a prosthesis have to be used. It was decided to use a dura mater prosthesis (Lyodura^[○!R]). The postoperative course was uneventful. The child continued to improve and was discharged from the hospital on the 45th postoperative day. Six months after operation, a chest roentgenograms in inspiration and expiration were normal. The prosthesis in the left diaphragm was the child's growth. At <99m>^Tc-MAA, 81m Kr, radioisotope scintigram and radiospiratory revealed normal perfusion of the left lung. However, the left lobe showed a decreased blood flow measured by lung scan. At 12 months of age, she is doing well at home. In experimental study, some small dogs were used. The 2×2 centimeter segments of the rectus muscle, the rectus sheath, and the peritoneum were excised. The defects were repaired using the dura mater and the silastic sheet. They were followed clinically. The margin of the surrounding tissue was excised for microscopic study. An acute and chronic foreign body reaction was observed in both prosthesis. The dura mater provided considerably less foreignbody reaction than the silastic sheet. The fibroblasts were observed to invade in the dura mater at 4 weeks. In the silastic sheet, such ingrowth was not evident. A dura mater prosthesis is a satisfactory material for the diaphragmatic substitute for newborn patient.

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We experienced a case of splenic torsion with a sudden onset of left abdominal pain and frequent vomiting in a 3-year-old girl. Before surgery, leukocytosis, thrombocytosis and elevated LDH were noted. Although CT of the abdomen revealed aspleen-like mass. Tc-99m scintiscan did not delineate the spleen at all. On operation, a 720counter-clockwise rotation of the spleen was found and the spleen was removed. Histologically, thrombus formation in the splenic artery and vein and coagulative necrosis of the splenic parechyma were found. In Japan, 29 cases of splenic torsion, including our case, have been reported; 10 of them in patients aged 10 years or below. In reviewing these 10 cases, we assumed that the fixability of the splenic ligament was congenitally poor in these cases and found that splenic tosion in children frequently developed with a sudden oneset of abdominal pain, vomiting, fever, etc. without prior recognition of a mass representing the floating spleen.

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A 538 gm female baby, gestational age 25 weeks 5 days, was born on July 5, 1982. She was transferred to the authors' hospital because of low birth-weight. Two days after birth, abdominal distension was noted. Abdominal X-ray films and enema using contrast material revealed an intestinal obstruction. On laparotomy, ileal volvulus and peritonitis due to ileal perforation were noted. Ileostomy was performed. After the operation, mechanical ventilation was done and continued. Extubation was possible on 87 days after birth. On the 5 days after operation, naso-gastric tube-feeding was started and the volume was gradually increased. On the 165 days after birth, her body weight became 1.0kg. Unfortunately, however, the patient died due to respiratory disorder before closure of ileostomy.

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A four-day-old male infant was admitted lo Kanazawa Medical Univ. Hospital with a history of vomiting, abdominal detention, and hematochezia of four days duration. His birth weight was 1,700gm. Roentgenologically, volvulus of small intestine was suspected and the emergent laparotomy was performed. Upon opening the peritoneum, twisted ileum with necrosis which was adherent to parietal peritoneum just bihind the umbilicus was exposed. As intestinal viability was not recovered after release of the torsion, 9cm length of the ileum was resected and end to end anastomosis was performed. At this time, there were leukocytopenia (3,400/mm^2) and thrombocytopenia (89,000/mm^2). Because septicemia due to Gram-negative microorganism was suggested, exchange transfusion with citrated fresh whole blood was performed in addition to antibiotics, plasma volume expander, and vasoactive drug. The blood culture yielded Pseudomonas cepacia for succeeding two months. Although no bleeding tendency was observed during the whole course, fibrinogen measured 88mg/dl and FDP above 40μg/ml. Exchange transfusion was repeated up to five times and the laboratory data such as platelet count, white blood cell count, fibrinogen, and FDP showed improvement twenty days after the institution of the therapy, and the patient ultimately survived. There was no complication of exchange transfusion in our case. Serial laboratory examination is helpful for the early diagnosis of septicemia and/or DIC in especially premature infants after surgery. Our experience suggests that exchange transfusion decreases the mortality of surgically critical premature infants. It is important that when septicemia and/or DIC are suspected even if clinical signs and symptoms are minimal, therapy with antibiotics and exchange transfusion of early stage should performed.

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This paper reports a case of immature ovarian teratoma which is thought to be consistent with malignant neuroectodermal tumor of Aguiree, In addition, clinico-pathological findings of five other cases of immnauire ovarian teratoma were reviewed and compared with those of the present case. A 7-year and 8-month-old girl complained of lower abdominal pain and an ovarian tumor was suspected. She had high serum α-fetoprotein level (280ng/ml) and lactic dehydrogenase level (774 units). Laparotomy disclosed right ovarian tumor, measuring 11×9.5×6cm in size and weighing 380 g. It was well encapsulated except for small perforation. Cut surface revealed heterogenous, solid and cystic appearance with foci of hemorrhage and calcification. On detailed microscopical examination, majority of the tumor consisted of primitive neuroectodermal tissue. Undifferentiated cells showed slight to marked nuclear pleomorphism. Some foci showed marked resembrance to various types of neoplasm of nervous system, such as neuroblastoma, medulloblastoma, ependymoma, astrocytoma and oligodendroglioma. As poor prognosis was anticipated, she was treated with combination chemotherapy of cis-platin, vinblastine, bleomycin, endoxan and actinomycin-D. The patient demonstrated no clinical evidence of recurrence so far seven months after surgery. Five other cases of immature ovarian teratoma were studied histologically with particular reference to the amount of immature nervous tissue and their tumorous growth pattern. Although all the cases contained nervous tissue, the amount of immature element was much less than that of the present case. Only one case possessed few limited neuroblastomatous foci. All of them have been well without postoperative chemotherapy. Immature teratoma of the ovary in adult is generally believed to be malignant, while immature tissue elements in children are not considered to be malignant. The authors, however, believe that the case such as the present one has strong possibility of malignancy and should be treated with special care.

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