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1988 Volume 24 Issue 6 Pages
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1988 Volume 24 Issue 6 Pages
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1988 Volume 24 Issue 6 Pages
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1988 Volume 24 Issue 6 Pages
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1988 Volume 24 Issue 6 Pages
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1988 Volume 24 Issue 6 Pages
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1988 Volume 24 Issue 6 Pages
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1988 Volume 24 Issue 6 Pages
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1988 Volume 24 Issue 6 Pages
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1988 Volume 24 Issue 6 Pages
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Article type: Index
1988 Volume 24 Issue 6 Pages
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Naobumi Endo, Ryoji Ohi, Makoto Goto, Takashi Sawai
Article type: Article
1988 Volume 24 Issue 6 Pages
1229-1236
Published: October 20, 1988
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Infiltrating pattern of Inflammatory cells in the extrahepatic bile duct of biliary atresia (BA) was examined immunohistochemically. Specimens were obtained from 7 cases at the time of radical opera-tion. The monoclonal antibodies used in this study were T4 (CD4), T8 (CD8), Leu-15 (CD11), MY4 (CD14#), M1 (CD15), ILR2 (HLA D/DR) and IL-1. The infiltrating pattern of inflammatory cells were divided into two groups according to cell number infiltrated. In one group, most of cells were com-posed by T4^+ (helper/inducer T) cells and T8^+, Leu-15^- (Cytotoxic T) cells and, in some cases, Leu-M1^+ cells were also observed. But B1^+ (B) cells were hardly detected in this area except for lymph follicle. In the other group of less numbers of cells, bile ducts were enclosed by mature fibrous tissues and only MY4^+ cells were left as scavenger. As for regional differences, hepatic hilus showed more severe inflammatory features comparing to other portions of the extrahepatic bile duct. Postoperative bile flow in patients with rich inflammatory cells were more active than that of patients with scanty inflammatory cells. Therefore, it might be concluded that the radical operation for BA should be performed before the acute inflammatory process subsides.
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Masahiro Tanabe, Hideyo Takahashi, Naomi Ohnuma, Takao Etoh, Masahiko ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1237-1243
Published: October 20, 1988
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Twenty five patients with advanced neuroblastoma were shown to have bone matastasis with skeletal X-rays and/or bone scanning. The characteristic skeletal abnormalities in the metastatic neuroblastoma are a lytic-permiating lesion and periosteal reactions (single-layered or multilayered periosteal reaction or sunburst) on the radiograph. The most common bones of metastasis in neuroblastoma are the femur and skull. Sixteen patients with skeletal metastasis of neuroblastoma were examined in the distal femurs and proximal tibiae with magnetic resonance imaging (MRI). Metastatic lesions appeared of high intensity on T2 weighted (SE 1,500/60). Small lesions which had not been shown with bone scanning were found by MRI. It is likely these small lesions might be early metastasis of neuroblastoma to the distal femurs via hematogeneous spread. Bone-marrow involvement was also seen as areas of high intensity. MRI appears to be valuable for the staging and followup of children with neuroblastoma.
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Tetsuro Yasui
Article type: Article
1988 Volume 24 Issue 6 Pages
1244-1253
Published: October 20, 1988
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The effect of adoptive immunotherapy with lymphokine activated killer (LAK) cells and interleukin-2 against C-1300 murine neuroblastoma was studied. LAK cells were generated in vitro by incubation of murine splenocytes with human recombinant interleukin-2 (rIL-2) for 5 days. A 4-hr <61>^Cr microcytotoxicity test revealed that LAK cells caused significant lysis of fresh C-1300 cells. A Winn assay showed that local administration of LAK cells could not make complete suppression of the tumor growth but inhibit it. Intravenous administration of LAK cells alone couldn't affect the growth of the tumor which had been inoculated in the back of mice. Intraperitoneal injection of rIL-2 reduced the growth rates of the tumor, and produced more significant reduction when conjuncted with the intravenous administration of LAK cells. Conjunction therapy of LAK cells and rIL-2 significantly prolonged the survival of these mice. These results suggest that adotive immunotherapy with LAK cells and rIL-2 is useful in the treatment of human neuroblastoma.
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Masahito Yamazato, Eiji Nishijima, Chikara Tsugawa, Koji Aono, Chiaki ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1254-1258
Published: October 20, 1988
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During the period from 1970 to 1983, 82 patient underwent portohepatic enterostomy or portohepatic cholecystostomy for the treatment of the biliary atresia. Among which, proper transaction of portal fibrous mass was performed in 60 patients, and 46 of them demonstrated good bile excretion. In this study, 40 patients, who underwent portohepatic enterostomy and had good bile excretion, were devided into two groups. "80cm group" were the group of patients treated with a jejunal loop of 80 cm in length from porta hepatis to the Roux-en-Y anastomosis. "The other group" consists of patients before 1980, who were mainly treated by Kasai's original procedure with a jejunal loop of 40-50cm in length. Of 40 patients, early cholangitis developed in 13 patients, and 9 of them died within 2 years. Early cholangitis strongly indicates the poor prognosis of the patients. In "80 cm group", 2 of 15 patients developed early cholangitis and 2 patients died within 2 years, while in "the other group", 11 of 25 patients developed early cholangitis and 11 patients died within 2 years after operation which indicates that an 80 cm jejunal loop was successfully employed for the prevention of the early cholangitis and for the improvement of the prognosis, combined with a continuous intravenous administration of antibiotics during the first month after operation. Post-operative nutritional evaluation showed no disadvantage in an 80cm jejunal loop procedure.
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Yutaka Hayashi, Ryoji Ohi, Toshio Chiba, Tsuneo Chiba, Yutaro Matsumot ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1259-1267
Published: October 20, 1988
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Partial splenic embolization (PSE) were performed in ten children with portal hypertension accompanied by hypersplenism. Nine of these children had been treated for biliary atresia and the remaining one had portal hypertension secondary to chronic hepatitis. White blood cells and platelet counts rose and remained within normal range in nine of the ten patients. Prolonged bleeding time also recovered to normal range one week after PSE. All these patients had a high fever of more than 38℃ for 2 to 4 weeks after embolization. Splenic abscess developed in Case 3 in 2 months after embolization and it was success-fully treated by several punctures. The remaining patients had no significant complication of the treat-ment. PSE under prophylactic antibiotics appears to be safe and effective for the treatment of hypersplenism as an alternative procedure to splenectomy.
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Ryoji Ohi, Tsuneo Chiba, Yutaka Hayashi, Seiichi Yaoita, Takamichi Kam ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1268-1274
Published: October 20, 1988
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In connection with operative procedure for congenital dilatation of bile duct, we analysed the relationship between transection of the lower portion of the common bile duct and its complications. Among 83 patients who had undergone total excision of the dilated extrahepatic bile duct, one was complicated by a pancreatic juice fistula and 13 by elevation of the serum amylase level following definitive surgery. The transection maneuvers of 77 patients were categorized into four groups retrospectively. In group I the lower portion of the common bile duct was torn off spontaneously during dissection of duct in 8 cases, and in Group II it was ligated and severed in 27 cases at the narrow segment without any conformation of a pancreatic and the common bile duct junction. In Group III, 38 cases underwent almost total removal of the intrapancreatic bile duct after conformation of the junction by selective cholangiograms. In Group IV, four cases received the same procedure under direct exposure of the main pancreatic duct. Although the postoperative complications were seen in only the cases of Groups 3 and 4, the extrahepatic bile duct including the intrapancreatic bile duct should be resected to avoid late complications, such as carcinoma in the residual duct wall. Since, we think, surgeons can transect the lower portion of the com-mon bile duct just proximal to the junction by applicating the selective cholangiogram, it is unnecessary to expose the pancreatic duct in all case when total removal is performed.
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Kurao Kondo, Masahiro Nagaya, Mineyuki Tsuda, Toru Harada, Kenji * Iio
Article type: Article
1988 Volume 24 Issue 6 Pages
1275-1280
Published: October 20, 1988
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In this report, an adequate amount of bilirubin excretion for disappearance of jaundice in eleven patients with biliary atresia reconstructed by Suruga II procedure were studied. In each patient all drained bile was gathered in a urine collecting bag and daily total volume of bilirubin was calculated. More than 5mg/kg/day of bilirubin was necessary for disappearance of jaundice. This result indicates that measurement of bilirubin volume in drained bile is useful to presume the result of operation.
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Junichi Yamanaka, Chikara Tsugawa, Motoyuki Higashimoto, Shoji Yamazat ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1281-1286
Published: October 20, 1988
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An 85-day-old female infant with biliary atresia was admitted to Kobe Children's Hospital for Kasai's operation. At the time of endotracheal intubation, the tube was not able to be passed down. The tracheobronchoscopy immediately done showed a stenosis of the trachea from 1cm below the vocal cords. She underwent tracheoplasty instead of Kasai's operation, using costal cartilage graft in order to secure the patent airway for the subsequent management. She underwent Kasai's operation 3 days after the tracheoplasty. Revision of tracheoplasty was required for leakage on the 7th postoperative day. She was doing well without jaundice and without significant airway problems for the following 6 months. At the age of 9 months, restenosis of the grafted trachea was developed. Re-grafting of the costal cartilage to the stenotic trachea was done successfully by using pericardial rotational flap and pedicled omental patch to cover the grafted cartilage. She was finally discharged from the hospital without wheezing and jaundice at 13 months after the first operation. Two technical improvements were achieved through this operation; 1. Pedicied patch graft of the omentum, which is a new option for oxygen supply to the cartilage graft and for prevention of infection as well. 2. Application of hemoclip at the distal end of the graft which is very helpful as a radiopaque marker for the postoperative management.
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Yasunobu Satoh, Takatoshi Kitamura, Yasushi Suganuma, Jyunichi Hata
Article type: Article
1988 Volume 24 Issue 6 Pages
1287-1292
Published: October 20, 1988
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Two female babies were seen with the chief complaint of cystic protrusion at the vagina. In both cases ureteral ectopia was diagnosed by the vaginogram and the vaginoscopy. Both cases were type I according to Thorn's classification, with the ectopic ureteral orifice at the vagina. In case No. 1, saccular dilatation of the distal end of the ureter protruded from the vagina. In case No. 2, Gartner's duct cyst, in which ectopic ureteral orifice was found, protruded from the vagina. As the kidneys of the affected side were hypoplastic, nephrectomy and subtotal ureterectomy were performed in both cases.
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Tsuneo Chiba, Takashi Uchida, Yuhtaro Matsumoto, Yutaka Hayashi, Ryoji ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1293-1298
Published: October 20, 1988
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Bronchopulmonary foregut malformation (BFM) is a rare form of sequestration of the lungs. We have experienced 3 cases of BFM during the past 10 years. Case 1; A male newborn baby was transfered to our hospital because of esophageal atresia. He had a respiratory distress syndrome and showed cyanosis. A chest roentgenogram demonstrated complete opacification of the right hemithorax. A division of tracheoesophageal fistula and a esophagoesophagostomy had been performed on the same day. Postoperative esophagogram showed a large esophagobronchial fistula. Total lung sequestration with BFM was diagnosed at the second operation. Abnormal blood supply was not certified, and pneumonectomy was carried out. Subsequently, aortopexy was performed because of left bronchial stenosis 3 months after the second surgery. Case 2; A premature female baby was admitted to our institution because of herelip, cleft palate, and anorectal malformation. Esophageal atresia, malformation of the intestine, and annular pancreas were also seen in this patient. An esophagogram demonstrated an esophagobronchial fistula extending from the lower esophagus to the right lower opaque field of the lung. A left intralobar sequestration with a fistula was removed at the operation. Case 3; At autopsy of a 7-day-old boy with congenital jejunal atresia, total sequestration of the right lung in communication with the lower esophogus was disclosed. He had VSD in addition.
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Tadaaki Tokumaru, Masako Kubo, Koichi Suda
Article type: Article
1988 Volume 24 Issue 6 Pages
1299-1303
Published: October 20, 1988
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Portal hypertension after successful hepatic portoenterostomy is becoming a major problem in children with biliary atresia. Bleeding from the esophageal varices is common among these patients. However, bleeding from the mesenteric varices is extremely rare. In this paper, we reported a girl with postoperative bleeding from the jejunal varices. She had the hepatic porto-enterostomy at forty five days of her life with success, but started to bleed per recutum at two years and ten months of her age. The bleeding site was not esophageal varices and was difficult to detect by endoscopy or portography. Finally, red blood cell scintigraphy performed when the patient complained of another episode of abdominal pain, revealed a hot spot in the right upper abdomen. Jejunal varices was found at the site of previous enterostomy by operative endoscopy and was successfully resected.
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Kaoru Endo, Tsugumi Uchiyama, Tsuginori Yoshida, Katuhiro Niitu, Toshi ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1304-1311
Published: October 20, 1988
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Human chorionic gonadotropine (hCG) production by childhood hapatoblastoma is rare. Review of the literature reveals 34 such cases and all the patients were male. We first observed in 2 years female baby with hCG producing hepatoblastoma. She was admitted complaining of an abdominal mass and was diagnosed as hepatoblastoma. Laboratory examinations showed that the serum alphafetoprotein (AFP) was 192ng/ml, hCG 2,100IU/l, and urinary hCG 400IU/l. There was no sign of precocious puberty. Transarterial embolization (TAE) and chemotherapy were done for the unresectable tumor. Soon after the treatment, the tumor size decreased and hCG decreased to normal but serum AFP increased remarkably. Two months after TAB the tumor was removed by extended right hepatic lobectomy. The resected tumor measured 14×12×5 cm and weighed 430g. Immunohistochemically hCG was stained positive in some of the giant cells of hepatoblastoma. The tumor tissue contained hCG 20mIU/g wet weight. Postoperatively, the serum AFP decreased. But it tended to increase again 6 months after operation. The female lack of hCG producing tumor considered to simply due to the absense of FSH activity in hCG. But this hypothesis must be confirmed by other workers.
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Hajime Hosoi, Tadashi Sawada, Hidekazu Kawakatsu, Hiroshi Kuroda, Yosh ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1312-1320
Published: October 20, 1988
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We report 5 infants with Stage IV-S neuroblastoma, 3 of whom received serial observations of liver metastasis with both ultrasound (US) and CT for the last one year. Other 2 cases, who were experienced in 1977 and 1979 respectively, had unique CT patterns of liver metastasis. US is a safe, simple and very useful method to diagnose abdominal tumor and to observe the regression of the liver metastasis by repeated examinations. The liver metastasis in CT had 3 patterns; 1) diffuse, 2) large solitary, and 3) small multiple. Only one case with large solitary pattern of liver metastasis had poor prognosis. Further examination should be required whether CT patterns of liver metastasis could be one of prognostic factors in Stage IV-S neuroblastoma.
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Hideo Takamatsu, Hiroshi Akiyama, Hiroyuki Noguchi, Hiroyuki Tahara, Y ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1321-1325
Published: October 20, 1988
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Two cases of mesenteric cysts are presented. The first case was a five-yer-old boy with bile-vomitting and abdominal pain. At the emergency laparotomy, ileal mesenteric cyst was found with the torsion of the cyst and of the adjacent ileum. The second case was a 2-month-old girl with fever, vomiting and abdominal distension. Ultrasound echogram and CT scan revealed a well-defined, loculated mass. The infected cyst of the descending mesocolon and the narrowing of the descending colon were found at the laparotomy. The resection of the cyst and the adjacent intestine was performed in both cases. In Japanese literatures 171 pediatric cases of the mesenteric cyst were reported until 1987. Ultrasound echogram and CT scan have improved the accuracy of the preoperative diagnosis.
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Masaaki Watanabe, Shunichi Hoshino, Fumio Iwaya, Tsuguo Igari, Kotaro ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1326-1330
Published: October 20, 1988
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A case of a 11-month-old girl who recognized an arteriovenous fistula in the right inguinal region was reported. She was born at 28th weeks of gestation weighing 700 gm and treated in NICU. During this period, there were many times of blood sumpling from femral artery and vein for blood gas analysis and chemistries. Swelling of the right lower extremity and continuous vascular murmur were noticed around the right inguinal region at 7 months of age. Angiosgraphy revieled enlarged right external pudendal artery, right femoral arteriovenous fistula and enlarged right femoral vein. Resection of arteriovenous fistula was performed. Postoperative course was uneventful and she discharged 15th postoperative day. This case showed the possibility that the repeated femoral arterial and venous puncture for blood samplling may induce iatrogenic arteriovenous fistula.
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Takaaki Kobayashi, Noriji Niinomi, Minoru Horisawa, Masayasu Suzuki, M ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1331-1335
Published: October 20, 1988
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A case of gastroschisis with special anatomical form, which is suggestive of its embryogenesis, is reported. Abdominal defect is not found and the evisceration of the intestine occurs at the base of the umbilical cord which has a normal appearance. Our case would not come under the classification of gastroschisis denned by Moore (1953), who presented the principal features of gastroschisis: normal umbilical cord insertion, defect being extraumbilical and no covering sac nor its remnants. Our case, however, can be considered gastroschisis according to the commonly accepted concept that gastroschisis is intrauterine rupture of the umbilical cord. But the definition by Moore is still referred to even now in order to differentiate gastroschisis from ruptured omphalocele. The existence of our case suggests that gastroschisis can be divided into following three types, according to the outside appearance at birth. 1) extraumbilical location of the defect adjacent to the umbilical cord 2) existence of the skin bridge between the abdominal defect and the umbilical cord 3) ruptured orifice in the normal umbilical cord without abdominal defect like our case Although the embryogenesis of gastroschisis is not clear, it seems that review concerning to the definition of gastroschisis should be required for the purpose of seeking after the truth.
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Yukio Kanazawa, Ryouichi Motoki, Takuro Saito, Yutaka Hoshino, Michihi ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1336-1341
Published: October 20, 1988
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A female infant was born following 38 weeks gestation and normal delivery with a birth weight of 3,150g. On the second day of life, a large mass was palpated in the left quadrant. Surgery was performed on the llth day and a 6.5×4.5×4.5cm polycystic tumor in the left adrenal area was removed. Maximum thickness of the cyst wall was 15mm and the content was dark blood. Pathologic diagnosis was neurblastoma with large hemorragic cysts. The patient did well after surgery and had no evidence of recurrent tumor during 1 year follow up.
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Tatsuo Akiyama, Ikuo Okabe, Sadao Amano, Ken Morita
Article type: Article
1988 Volume 24 Issue 6 Pages
1342-1351
Published: October 20, 1988
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A girl aged 2 years 10 months with a Burkitt's lymphoma of the left temporal and mandibular area was presented and an analysis was performed in 133 reported cases with Burkitt's lymphoma in Japan. Combination chemotherapy was performed after subtotal resection of the tumor of the left mandibular area. After completion of treatment, she has been free of disease for 3 years and 8 months without any evidence of recurrence and metastasis. Burkitt's lymphoma is relatively rare in Japan. 133 cases have been reported in Japanese literature untill 1986; 78 were male, 52 were female and 3 were unknown. In 133, 82 were children with 53 boys, 28 girls and 3 unknown. Most of these cases died within a year changing to leukemia or central nerve invasion in spite of agressive treatment.
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[in Japanese]
Article type: Article
1988 Volume 24 Issue 6 Pages
1352-1354
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[in Japanese]
Article type: Article
1988 Volume 24 Issue 6 Pages
1355-1363
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1364-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1364-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
Article type: Article
1988 Volume 24 Issue 6 Pages
1364-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1364-
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[in Japanese], [in Japanese]
Article type: Article
1988 Volume 24 Issue 6 Pages
1364-
Published: October 20, 1988
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[in Japanese], [in Japanese], [in Japanese]
Article type: Article
1988 Volume 24 Issue 6 Pages
1364-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1364-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1364-1365
Published: October 20, 1988
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[in Japanese], [in Japanese]
Article type: Article
1988 Volume 24 Issue 6 Pages
1365-
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[in Japanese], [in Japanese]
Article type: Article
1988 Volume 24 Issue 6 Pages
1365-
Published: October 20, 1988
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[in Japanese], [in Japanese]
Article type: Article
1988 Volume 24 Issue 6 Pages
1365-
Published: October 20, 1988
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1365-
Published: October 20, 1988
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
Article type: Article
1988 Volume 24 Issue 6 Pages
1365-
Published: October 20, 1988
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1365-
Published: October 20, 1988
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1988 Volume 24 Issue 6 Pages
1365-1366
Published: October 20, 1988
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