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Article type: Cover
1985 Volume 21 Issue 1 Pages
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Article type: Cover
1985 Volume 21 Issue 1 Pages
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Article type: Appendix
1985 Volume 21 Issue 1 Pages
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Article type: Appendix
1985 Volume 21 Issue 1 Pages
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Article type: Appendix
1985 Volume 21 Issue 1 Pages
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Article type: Appendix
1985 Volume 21 Issue 1 Pages
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Article type: Appendix
1985 Volume 21 Issue 1 Pages
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Article type: Appendix
1985 Volume 21 Issue 1 Pages
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Article type: Index
1985 Volume 21 Issue 1 Pages
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Yoshiro Sasaki, Kenzo Okumura, Makiko Ohyama, Kazuaki Misugi, Hiroshi ...
Article type: Article
1985 Volume 21 Issue 1 Pages
1-8
Published: February 20, 1985
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Thirteen cases of immature teratomas from the various sites were studied by immunohistochemistry using antihuman alpha-fetoprotein (AFP) antibody.Of those, four cases were preoperatively known to have abnormal serum AFP level. The AFP were definitely positive in the tubular epithelium of various types, i. e. flat and single, cuboidal, tall columnar with or without Goblet cells, and on the small islands of hepatoid cells, all of which were the endodermal elements. Other immature components such as neuro-ectodermal or mesenchymal tissues were all negative for AFP. Cases with positive results of AFP in the tissue were the same to the cases who showed the abnormality of serum AFP level.
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Shinichi Okuzono, Keiichi Ikeda, Akira Nakagawara, Yoshio Zaizen, Koji ...
Article type: Article
1985 Volume 21 Issue 1 Pages
9-14
Published: February 20, 1985
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Recently the late effects have become an important problem in the treatment of pediatric malignant tumors. We performed follow up study of the long-term survivors (more than 5 years) in our hospital, with a particular reference to skeletal damages after radiation therapy. Among 46 survivors, 25 patients had a history of radiation therapy, and 5 of them suffered from the impairment of skeletal growth (3 ganglioneuroblastomas, 1 Wilms' tumor, 1 hemangiosarcoma of retroperitoneum). Four of these 5 patients were irradiate with a dose of more than 30 Gy of 60^Co and the late effects of radiation were scoliosis, kyphosis and the growth impairment of ribs. In this report, these cases are presented with a review of the literature. The results indicated that the careful long-term observation in neccessary for pediatric cancer survivors to find the late effects of multimodal treatments as early as possible.
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Takao Etoh, Hideyo Takahashi, Naomi Ohnuma, [in Japanese], [in Japanes ...
Article type: Article
1985 Volume 21 Issue 1 Pages
15-21
Published: February 20, 1985
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Stage IV-S neuroblastoma is considered especially as immunological relation in terms of spontaneous regression, differentiation, and remission. Peripheral blood lymphocytes (PEL) from Stage IV-S neuroblastoma can kill specifically human neuroblastoma cell lines (NB 1, NBGOTO, TN-1), and it does not kill human malignant melanoma cell line (P 39), or murine neuroblastoma cell line. (C-1300) The cytotoxic activity is markedly depressed by the treatment of PEL with anti-human Leu-1 monoclonal antibody plus rabbit complement. Furthermore, the activity of CTL is specifically blocked by anti-human Leu-2a monoclonal antiboby, but not by anti-human Leu-3a monoclonal antibody. This fact suggests that Leu-2a molecules which have been considered to be carried by human cytotoxic/suprresor T lymphocytes have responsivility for cell-mediated cytotoxicicty. We examined the kinetics of CTL in Stage IV-S neuroblastoma for three months. Surprisingly, we could detect CTL during preoperative and postoperative periods, in spite of tumor bearing condition. Furthermore, her mother had CTL, too, as level as patient. This experiments suggest that Stage IV-S neuroblastoma has high level CTL everytimes, and dominantly hereditary relation to immunology.
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Ryoji Ohi, Tsuneo Chiba, Masahiro Hanamatsu, Izumi Mochizuki, Morio Ka ...
Article type: Article
1985 Volume 21 Issue 1 Pages
22-29
Published: February 20, 1985
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Two hundred and thirty-eight patients with biliary atresia were treated at the 2nd Department of Surgery and Pediadric Surgery, Tohoku University Hospital during 31 years from 1953 to 1983 and 214 of them underwent corrective surgery. Since 1971, we have employed several modifications cf Roux-Y hepatic portojejunostomy (a) in order to prevent ascending cholangitis after operation. Main procedures were double Roux-Y hepatic porto-jejunostomy (b) in 68 cases, hepatic porto-jejunostomy with Roux-Y interposition between the porta hepatis and the ducdenum (c) in 12, hepatic porto-cholecystostomy (d) in 12, and conversion from Suruga II to double Roux-Y hepatic porto-jejunostomy (e) in 19. Incidence of postoperative cholangitis was 68% in original Roux-Y hepatic porto-jejunostomy, 56% in b), 100% in c), 0% in d) and 53% in e). Comparing the results of original Roux-Y with those of double Roux-Y procedure, incidence of chclangitis did not decrease markedly, but medical control of it became easier by use of modification. Consequently, the mortality from cholangitis decreased from 47% to 10/0. As another complications in 68 cases with double Roux-Y hepatic porto-jejunostomy, there were 9 intestinal obstruction and 5 leakages of intestinal anastomosis. From these results, we concluded that double Roux-Y modification was not an ideal procedure but was evidently contributing for the progress of surgical results of biliary atresia.
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Hideo Tachibana, Masahiro Yamaguchi, Yuhei Hosokawa, Hidetaka Ohashi, ...
Article type: Article
1985 Volume 21 Issue 1 Pages
30-38
Published: February 20, 1985
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During the last 12 years, 37 infants under three months of age have undergone systemic to pulmonary artery shunt for cyanotic congenital heart disease. The procedures were : Blalock-Taussig shunt (15), Waterston shunt (14), modified Blalock-Taussig shunt interposing a 5mm EPTFE graft between the divided subclavian artery and the pulmonary artery (3), modified Waterston shunt interposing a 4 mm EPTFE graft between the ascending aorta and the right pulmonary artery (5). There was no death in 10 infants who have undergone Black-Taussig shunt during the last three years. An excellent palliation has been achieved in eight of these patients for 8 to 27 months postoperatively. Of three patients with modified Blalock-Taussig shunt, two required an additional shunting operation for inadequacy of shunt after 13 to 18 months and in one patient an excellent palliation has been achieved for 35 months. Six of 14 infants with Waterston shunt were the long range survivors with an excellent palliation for more than four years. In five patients with modified Waterston shunt, there were two late deaths (not shunt related) but an excellent palliation has been achieved in three patients for 10 to 42 months. Our experience provided a conclusion that the modified Blalock-Taussig or Waterston shunt using an EPTFE graft is an effective and safe procedure when the classical shunt procedure is not feasible but the period of palliation provided by these modified procedures is relatively shorter than by the classical operation.
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Tsuneo Chiba, Seiichi Yaoita, E. Thomas Boles
Article type: Article
1985 Volume 21 Issue 1 Pages
39-43
Published: February 20, 1985
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In the measurement of the length of preserved intestine after massive resection of the length of intestine as it is at the time of operation may produce an error when compared to the length of the intestine at normal times. Therefore, attention was paid to the number of arteriae rectae of the intestinal artery and a comparison was made between such number and the length of the intestine at normal condition in rats and man. The length of the small intestine of the rats (177 rats) showed uniform in the rats of same age group. The number of arteriae rectae of rats fell within a narrow range of 280-326 and its mean value was 299. In human beings, the length of the intestine was observed to increase as the body length increases. The average number of the arteriae rectae was 433. As a result, the conclusion was drawn that the measurement of arteriae rectae of the intestinal artery is useful for the estimation of preserved intestine at normal condition.
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Yonejiro Nagai, Hideyo Takahashi, Masahiko Maie, Naomi Ohnuma, Takao E ...
Article type: Article
1985 Volume 21 Issue 1 Pages
44-50
Published: February 20, 1985
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Central total parenteral nutrition (TPN) has been used for nutritional support of the patients with malignant tumor in many institutes. However, it is well known that TPN often threatens the patient's life with severe complications such as sepsis, espescially under immunosuppresive state by aggressive chemo-radio therapy. During the past four years, sixty-six patients with malignant tumor were treated in our institute under enteral nutritional support using low residue diet. They were managed by nasogastric tubes inserted into the stomach. They could be accomplished the schedules of their modality therapy under the successful nutritional management. Chemotherapy often interrupted the enteral feeding because of vomiting, but the duration of vomiting was not verey long, so the patient's nutritional state was not severely supressed. Six patients were canulated for TPN because of uremia, intestinal obstruction and some other reasons, but four of them started again the enteral feeding after TPN. We recommend that enteral feeding is excellent method as a nutritional support for the patients with malignant tumor. Almost all patients can be kept in good nutritional condition without using of TPN. If enteral feeding was impossible for long period due to many reasons, TPN should be indicated, which, however, will be relatively rare.
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Masato Yamaguchi
Article type: Article
1985 Volume 21 Issue 1 Pages
51-64
Published: February 20, 1985
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Rectal mucosal biopsy specimen obtained from 110 infants with abdominal distention and constipation were examined by histochemical method (Acethylcholinesterase stain: Ach. E. Stain). Fifty-two patients were diagnosed as Hirschsprung's disease. In fourty-five of these patients, the diagnosis was confirmed by operation. In this study, we found that the pattern of nerve fiber proliferation was not uniform. The proliferating pattern of nerve fiber was classified into four types. I. total layer type (typical type) (15 cases), II. lamina propria mucosal type (10 cases), III. lamina submucosal type (15 cases), and IV. lamina propria mucosal and lamina submucosal type (5 cases). In seven of 52 cases, had not the size of the specimen was not adequate for this study. When the specimens showed the type I. by Ach. E. Staining, the diagnosis of Hirschsprung's disease was easy. However, the diagnosis was difficult in the types of II. III. & IV. In these groups, detection of the Meissner's ganglion cells is the most important factor for diagnose of Hirschsprung's disease. In order to find the Meissner's ganglion cells, a biopsy specimen which was taking at 5 to 10mm oral to the dentate line should be subjected to histochemical study of the submucosal layer.
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Takeshi Miyano, Keijiro Suruga, Koichi Suda
Article type: Article
1985 Volume 21 Issue 1 Pages
65-71
Published: February 20, 1985
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Anomalous pancreato-choledochal ductal junction (APCDJ) syndrome has become the matter of the interest concerning the etiology and pathogenesis of various biliary and pancreatic diseases. We classified this APCDJ into two types. Type I consists of long common channel formation which includes the majority of cases with APCDJ. Type II consists of other miscellaneous anomalous junctions. Furthermore Type I was divided into three subtypes. Type la consists of cystic dilatation of common bile duct. Type Ib consists of fusiform dilatation of common bile duct. Type la and Ib has been called as congenital biliary dilatation. The etiology of the dilatation of biliary tract in Type la and Type Ib is explained by the stricture of bile duct associated with these APCDJ, which based on our radiological and experimental studies. Type Ic consists of no dilatation of biliary tract, which was found in some cases of biliary tract carcinoma.
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Seishichi Yokoyama, Takao Fujimoto, Yutaka Tokuda, Teruji Sugita, Tomo ...
Article type: Article
1985 Volume 21 Issue 1 Pages
72-77
Published: February 20, 1985
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The complications related to central venous catheters for total parenteral nutrition were evaluated in 75 pediatric patients. 42 out of 105 catheters used in these patients developed complications such as catheter related sepsis, accidental dislodgement, occlusion, leakage, and so forth. This amounted to an incidence of 40%. In this study 16 pediatric Broviac catheters have been used in patients receiving prolonged parenteral nutrition and in bone marrow transplant recipients. The rate of catheter sepsis was 3 (19%) in 16 Broviac catheters, which was not different from the incidence of 17% in 89 conventional Silastic catheters. Accidental removal of the Broviac catheter was never seen in this series, which occurred 24 times (27%) in the conventional Silastic catheters. When total days of therapy are considered, catheter related sepsis occurred once every 372 Broviac-use-days, and once in 125 conventional Silastic-use-days. On the basis of these observations, the Broviac catheter should currently be considered the catheter of choice for long term central venous alimentation and for venous access of bone marrow transplant recipients.
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Hisami Ando, Takahiro Ito, Masahiro Nagaya, Kenji Iio, Noriji Niinomi, ...
Article type: Article
1985 Volume 21 Issue 1 Pages
78-84
Published: February 20, 1985
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71 biliary atresia patients were treated in the period from 1969 to March 1984. 11(19.6%) of 56 patients (the first group), who had been explored the ventral side of the bifurcation of the portal vein and underwent hepatic porto-enterostomy, had disappearance of jaundice (serum bilirubin 1. 0 mg/dl) postoperatively. On the other hand, 10 (66.7%) of 15 (the second group) patients who underwent extensive portal exploration including the dorsal and cranial side of the 1st branch of the portal vein and had the anastomosis which was made not to obstruct the explored area with the anastomosed intestine had disappearance of jaundice. Intrahepatic bile ducts were studies with pecutaneous transhepatic cholangiographies (PTC) in 7 jaundice free patients (3 of the first groups, 4 of the second groups). PTC showed anatomically normal intrahepatic bile ducts in all patients, though their walls were irregular. Intrahepatic bile ducts connected with the intestine with a narrow communications, which seemed to be finer than normal intrahepatic bile ducts and to follow a different course from the portal tracts. The length of communications was 0.6, 0.8, 1.5 and 1.9mm in 4 patients of the second group respectively, on the other hand, 2.4, 8.3 and 11.0mm in 3 patients of the first group. Their difference was significant. Extensive portal exploration towards intrahepatic bile ducts, may result in shorter distance between intrahepatic bile ducts and the anastomosed intestine. This may explain the better biliary drainage into the intestine in the modified operation.
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Yozen Fuse, Keiko Sato, Mitsumasa Shimizu, Naoki Uga, Toshi Fujie, Mun ...
Article type: Article
1985 Volume 21 Issue 1 Pages
85-88
Published: February 20, 1985
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The superior mesenteric artery syndrome is rare, especially in children. Recently, we experienced a premature infant with this syndrome. A two-day old premature female infant weighting 1, 625 g presented with vomiting. Duodenal obstruction due to the superior mesenteric artery was diagnosed. The baby was cured by mobilization of the duodenum and jejunum. This is the first case of this syndrome diagnosed in Japan in a premature infant, so far.
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Yoshikazu Matsumura, Yoshihiro Asakura, Tsugemi Kuwahara, Hirotaka Kat ...
Article type: Article
1985 Volume 21 Issue 1 Pages
89-96
Published: February 20, 1985
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This 3-year-old boy was referred to our hospital because of abdominal tumor. Examination of the abdomen revealed a hard nodular mass in the right hypochondrium. All laboratory studies were normal. A hepatic arteriogram disclosed a large vascular mass with tortous and enlarged arteries. The capillary phase demonstrated a well-demarcated mass with a dense homogenous stain. CT scan showed the tumor had hypodensity compared to the remaining liver tissues. At surgery, the tumor was found to be confined to the medial segment of the left lobe of the liver. Extended right hepatic lobectomy was done and pathologic examination revealed a mass with a central area of collagenous scarring which had fibrous septa radiating from it. Microscopically, the fibrous septa contained proliferating bile ductules and exhibited chronic imflammatory cell response. There were no central veins in the nodules of uniform hepatocytes. Kupffer cells were recognized. Pathological diagnosis was focal nodular hyperplasia of the liver. Postoperative course was uneventful. 20 other cases of focal nodular hyperplasia in Japanese literature were collected and reviewed.
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Eiso Hiyama, Takashi Yokoyama, Toru Ichikawa, Mitsuaki Okita, Michiko ...
Article type: Article
1985 Volume 21 Issue 1 Pages
97-102
Published: February 20, 1985
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A 23-day-old female baby was emergently admitted to our hospital with massive pulmonary hemorrhage due to penetration of staphylococcal abscess within left lung to pulmonary vein. Conservative therapy was so difficult that we performed left lower lobectomy on the supine position. After the operation, hypoxia continued because blood from the left lung had flown to the right lung before the operation. Pseudomonas cepacia pneumonia occurred for superinfection and developed into sepsis. On the 9th postoperative day, she died of Multiple Organ Failure. Staphylococcal lung abscess in neonate is rare, but its course is usually severe. Early diagnosis and adequate therapy is necessary. Semisynthetic-Penicillin and Cephazolin (CEZ) Resistant Staphylococcus aureus was detected in this patient, so this could have been one of the factors which led to increased severity of this infection. Semisynthetic Penicillin and CEZ Resistant Staphylococcus aureus has increased from 1980, especially in nosocomial infection. Recently we experienced twelve cases of neonatal staphylococcal infections. In these cases the resistant strain has increased. This resistant mechanism is mediated partially by β-lactamase, but mostly by abnormal Penicillin Binding Protein. Moreover there is a problem of tolerance by autolytic enzyme inhibitors (ex. Lipoteichoic acid etc.). So we use Cafmetazole or Fosfomycin as a first choice for neonatal staphylococcal infections.
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Y Watanabe, T Ito, M Nagaya, N Yamada, Y Ishiguro, [in Japanese]
Article type: Article
1985 Volume 21 Issue 1 Pages
103-110
Published: February 20, 1985
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Distal ureteral atresia (DUA) is rarely found with a megaureter. Two cases with distal ureteral atresia were reported with the review of 20 cases collected from literature. The first patient was a 1 year and 7 months old boy and the second was a 1 year and 7 months old girl. In both patients, an abdominal mass was found by a pediatrician when they were brought because of high fever or diarrhea. A large retroperitoneal cyst which occupied in the area between the kidney and the bladder was found by CT and US. The first patient was operated on with a preoperative diagnosis of retroperitoneal cyst. A diagnosis of distal ureteral atresia was made, however, preoperatively in the second patient. In literature only 2 cases were diagnosed correctly before operation. Symptoms and signs suggest DUA; 1) abdominal distension from infancy, 2) recurrent febrile episodes without pyuria, 3) abdominal mass, 4) abdominal pain. IVP shows that either renal pelvis is not visualized or displaced caudally and laterally. CT and US show a retoroperitoneal cyst involving the area between the kidney to the bladder. These clinical features and laboratory findings would be helpful to make a correct diagnosis of DUA preoperatively.
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Hitoshi Murakuni, Shinichiro Matsuo, Muneyuki Yamaguchi, Kiyoshi Watan ...
Article type: Article
1985 Volume 21 Issue 1 Pages
111-116
Published: February 20, 1985
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This is a report of a four-month-old male who was admitted complaining mainly of a mass in the left upper abdomen and abdominal distension, 219 cases of this disease collected from the Japanese literature are also reviewed. Retroperitoneal teratoma are often seen in the ovaries, testes and sacrococcygeal region, and they usually appear in the suckling period; 52.3% of the cases were under 6 months of age. Ultrasonic examinations, CT scans and measurement of alpha-fetoprotein are important in the diagnosis of this disease, and the preoperative diagnostic rate was 62.1%. The prognosis of the disease is generally good in benign cases, but 4.9% of the cases were malignant and these malignant cases still have a poor prognosis.
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The Committee on Malignant Tumor The Japanese Society of Pediatric Sur ...
Article type: Article
1985 Volume 21 Issue 1 Pages
117-142
Published: February 20, 1985
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In 1983, 711 pediatric malignant solid tumors were resistered to the Japanese Society of Pediatric Surgeons under the support of the Children's Cancer Association of Japan. Among those, there were 164 neuroblastoma group tumors, 56 malignant renal tumors, 49 liver tumors, 152 teratomas, 34 rhabdomyosarcomas and 256 other tumors. In 164 neuroblastoma group tumors, there were 109 neuroblastemas, 42 ganglioneuroblastomas and 13 ganglioneuromas. Eight cases were discovered under the nation-wide VMA mass screening system. Primary tumors were resected totally in 78 cases and subtotally in 14 cases. Second look operation was carried out in 23 cases. Among renal tumors, there were 49 Wilms' tumors, 4 adenocarcinomas and 2 mesoblastic nephromas. Tumors were resected except in 4 cases. Chemotherapy was given to all the Wilms' tumors. Among the liver tumors, there were 28 hepatoblastomas, 8 hepatocarcinomas and 3 undifferentiated sarcomas. In macroscopic findings, 24 were massive, 10 were multi-nodular and 5 were diffuse in type. In the stage distribution, 73% were in Stage III or IV. In teratoma group, 90 mature and immature teratomas were included. Twenty-three were head and neck tumors, including pineal teratomas, 7 mediastinal, 49 ovarian, 19 testicular and 29 sacrococcygeal. Tolal resection was carried out in 78%. VAC was the main chemotherapeutic method. In rhabdomyosarcoma, 10 were in pelvis, 6 in thoracax, 6 in extremities and 5 in abdominen. In other tumors, 70 malignant lymphomas and 96 brain tumors were included.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
143-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
143-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
143-
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[in Japanese], [in Japanese], [in Japanese]
Article type: Article
1985 Volume 21 Issue 1 Pages
143-
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[in Japanese], [in Japanese], [in Japanese]
Article type: Article
1985 Volume 21 Issue 1 Pages
143-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
143-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
Article type: Article
1985 Volume 21 Issue 1 Pages
143-144
Published: February 20, 1985
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
144-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
144-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
144-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
144-
Published: February 20, 1985
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
144-
Published: February 20, 1985
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
144-
Published: February 20, 1985
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
144-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
144-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
144-145
Published: February 20, 1985
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
145-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
145-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
145-
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[in Japanese], [in Japanese], [in Japanese]
Article type: Article
1985 Volume 21 Issue 1 Pages
145-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
145-
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[in Japanese], [in Japanese], [in Japanese]
Article type: Article
1985 Volume 21 Issue 1 Pages
145-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1985 Volume 21 Issue 1 Pages
145-146
Published: February 20, 1985
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
Article type: Article
1985 Volume 21 Issue 1 Pages
146-
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