Journal of the Japanese Society of Pediatric Surgeons

Using as subject a total of 75 newborn surgical cases who were admitted to this hospital during a period of 21/2 years from 1984, determination of serum IgG, serum IgA, serum IgM, plasma fibronectin and serum C3c was made. These cases were divided into non-infection group (n=5l), localized infection group (infection of skin and soft tissue) (n=10), severe infection group (sepsis or panperitonitis) (n=10) and postoperative infection group (n=7) and their pre-operative values were compared. The following results were obteined. 1) No difference could be observed in serum IgG, IgA and IgM values between the groups. 2) Plasma fibronectin value was significantly depressed in the severe infection group. 3) Serum C3c value was significantly low in the severe infection group. 4) The preoperative values of the postoperative infection group did not show any difference from those of the non-infection group. The foregoing findings demonstrated that the opsonic protein value was depressed in the newborn with severe infection. It is assumed that with increased severity of infection the consumption of opsonic protein in the blood exceeds the production level to bring rise to consumption opsoninopathy.

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Mouse CNM-5 IgM antibody which speficically was cytotoxic to neuroblastoma cells in the presence of compliment, was injected to tumor-bearing mice. In vivo localization was analyzed by gama ray scintigraphy every two days after intraperitoneal injection of 131I-labeled antibody. CNM-5 gave the hightest specific uptake at the tumor level 4 days after intraperitoneal injection. Uptake of radioiodinated antibody was analyzed by counting the tissue radioactivity. Tumor/blood ratios of radioactivity was higher than that of other organs. Therefore, this results suggests that imaging experiments confirmed the ability of CNM-5 IgM to detect the presence of neuroblastoma cells.

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Little is known about the significance of plasma proteins in various pediatric surgical conditions. Seventeen different varieties of plasma proteins were studied using single radial immunodiffusion method in patients with malnutrition, obstructive jaundice, and malignant tumors. Normal ranges for each age were determined by the measurement of otherwise healthy infants and children with inguinal hernia. The following results were obtained 1. The decrease of rapid turnover proteins was more remarkable in acute malnutrition (hypertrophic pyloric stenosis) than in chronic malnutrition (patients with ileostomy). 2. It was impossible to differentiate congenital biliary atresia from neonatal hepatitis before operation by means of the measurement of plasma proteins. Prealbumin, Albumin, β_2-Glycoprotein I, IgG, IgA, IgM showed significant changes in congenital biliary atresia with liver cirrhosis. It suggests that the severity of liver cirrhosis in congenital biliary atresia could be diagnosed by these plasma proteins. 3. Six to ten days after radical operation, Prealbumin, α_2-Macroglobulin significantly decreased, while α_1-Acid Glycoprotein, IgA, and IgM significantly increased. Acute phase response to surgical trauma was influenced by impaired hepatic function in the patients with obstructive jaundice. Hepatic function should be taken into account to diagnose postoperative complications by measurement of acute phase proteins. 4. Prealbumin and IgG showed significant decrease in infants with malignant tumors, while acute phase proteins (α_1-Antitrypsin, Haptoglobin, and Ceruloplasmin) had a tendency to increase. Serial measurements of these plasma proteins could be a useful diagnostic tool for detecting relapse or recurrence of malignant tumors.

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A retrospective review was carried out of 8 patients with thyroglossal duct remnants and 15 patients with branchial cleft anomalies who had visited the First Department of Surgery, Nagoya City University Medical Hospital from 1975 to 1984. In our series all of the patients with thyoglossal duct remnants and 10 of 15 patients with branchial cleft anomalies were male. At the time of diagnosis 22 of 23 patients with these anomalies were less than years of age. All of the patients with congenital sinuses or fistulae had a history of one or more episodes of local infection but, in contrast, almost all of the patients with congenital cysts complained of only a non-tender swelling on the neck. As to the surgical treatment for thyroglossal duct and branchial cleft anomalies to prevent recurrence, It is thought to be necessary to perform a more expanded and deeper excision of sinus tracts, especially in the patients with thyroglossal ducts and fistula, without sticking to Sistrunk procedure.

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