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1994 Volume 30 Issue 1 Pages
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1994 Volume 30 Issue 1 Pages
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[in Japanese]
Article type: Article
1994 Volume 30 Issue 1 Pages
1-4
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[in Japanese]
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1994 Volume 30 Issue 1 Pages
5-12
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[in Japanese]
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1994 Volume 30 Issue 1 Pages
13-16
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[in Japanese]
Article type: Article
1994 Volume 30 Issue 1 Pages
17-22
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Ryoji Ohi, Shigehiko Yoshida, Masaki Nio, Naobumi Endo, Makoto Goto, M ...
Article type: Article
1994 Volume 30 Issue 1 Pages
23-28
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For the purpose of prevention of cholangitis in the surgical treatment of biliary atresia, we employed double-valved (spur-valve and intussuscepted valve) hepatic portojejunostomy for 20 patients with biliary atresia in the last 2 years. Bile flow after their corrective operation were active in 15 cases and fair in 4 cases respectively. Among these 19 cases, 6 cases (32%) developed cholangitis during their postoperative courses. No patients died of cholangitis. Although these results are not fully satisfactory, double-valved hepatic portojejunostomy, for the time being, is thought to be the choice of a modified procedure for prevention of cholangitis in the treatment of biliary atresia.
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Yoji Yamazaki, Jyoji Yoshizawa, Shigehiro Yasukawa, Kazuhiko Yoshida, ...
Article type: Article
1994 Volume 30 Issue 1 Pages
29-34
Published: February 20, 1994
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A hepatic metastasis model was established by intrasplenic implantation of mouse neuroblastoma C-1300 in A/J mice. The following experiments were carried out in 4 groups using this hepatic metastasis model of neuroblastoma. Group 1 : Saline solution (0.1ml) was given intraperitoneally for 7 days consecutively, and the animal was killed on the 10th day. Group 2 : Etoposide (2mg/kg/day) was given for 7 days consecutively, and the animal was killed on the 10th day. Group 3 : Etoposide (2mg/kg/day) was given for 7 days consecutively and then saline solution (0.1ml) was subcutaneously given with micro-osmotic pump, and the animal was killed on the 18th day. Group 4 : recombinant human granulocyte colony-stimulating factor (rhG-CSF) (60μg/kg) was given instead of saline solution which was given in Group 3. As a result, histological findings clearly showed that hepatic metastasis was suppressed in Group 2, and no increase of hepatic metastasis was recognized in rhG-CSF-given Group 4. Hepatic weight in each group was as follows : Group 1 ; 3.3±1.04g, Group 2 ; 1.2±0.23g, Group 3 ; 5.9±0.64g, and Group 4 ; 5.6±0.75g. There was a significant difference between Group 1 and Group 2 (p=0.0017). No significant difference was found between Group 3 and Group 4 (p=0.334). These results suggest that rhG-CSF does not have any increase action of hepatic metastasis after chemotherapy as far as it is seen in mouse neuroblastoma hepatic metastasis model. Therefore, rhG-CSF can be safely used as a drug to decrease suppression of bone marrow caused as side effect of anticancer drug.
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Akira Okada, Shinkichi Kamata, Masahiro Fukuzawa, Yuichi Fukui, Takesh ...
Article type: Article
1994 Volume 30 Issue 1 Pages
35-42
Published: February 20, 1994
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Clinical analysis was made on 45 cases of hepatic tumor in childhood encountered in our institution during these 35 years. Thirty six cases were of malignant group, and all of 9 cases who didn't receive hepatic resection died while 15 of 27 (55.6%) cases who received hepatic resection survived. Among 22 cases with hepatoblastoma and hepatocellular carcinoma, 13 cases (59.1%) survived while 3 of them developed local recurrence and 8 exhibited pulmonary metastasis during the clinical course. The longest survival was obtained in an 8 month old boy who received right trisegmentectomy followed by resection of pulmonary metastasis twice, and is, now, disease-free at the age of 20 years. The improved prognosis of hepatic tumors in childhood is mainly due to (1) the introduction of modern image diagnotic procedures i. e., angiography, echography, CT and MRI. (2) improved technique of hepatic resection, i. e., CUSA, Pringle's method and Argon beam coagulator, and (3) the introduction of chemothetapy for combined use of Adriamycin and Cisplatin.
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Hideki Kitatani, W. Ross, J. Geoffrey, K. MarK, Yasunobu Shimizu, M. J ...
Article type: Article
1994 Volume 30 Issue 1 Pages
43-49
Published: February 20, 1994
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A randomized cross over study was conducted to determine the efficacy of ursodeoxycholic aced (UDCA) in the treatment of possible candidates for liver transplantation in children with cholestatic disease. Fourteen patients (Biliary atresia 6, Alagille syndrome 6, alphal-antitrypsin deficiency 2, hypoplastic bile duct syndrome 1) were submitted to this study. The median age was 4.2 years with a range of 0.6-14 years. UDCA was administered orally (median dose 19.5mg/kg/day, range 12.5-24.4mg/kg/day). Assessments, which consisted of pruritus score, physical measurement, total body potassium (TBK), standard liver function tests, and monoethylglycinexylidide (MEGX) formation test, were carried out just before UDCA or placebo was commenced and 8 weeks after that. Each group was crossed over. Ten children completed the whole study. UDCA resulted in no significant improvement either in standard liver function tests nor in nutritional status. Only MEGX at 30 minutes showed significant improvement by UDCA (UDCA vs. Placedo ; +17.1±25.3 vs. -5.3±13.4, P < 0.05). It could be worthwhile to use this drug for longer period in the management of cholestatic children.
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Moriyuki Matsuki
Article type: Article
1994 Volume 30 Issue 1 Pages
50-58
Published: February 20, 1994
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For the purpose of finding a cause of the neonatal gastric rupture, we performed an experiment. An ischemic gastric re-perfusion method was prepared using rabbit. We assessed 1) a correlation between the effects of ischemic re-perfusion and the gastric mucosal disorder, 2) an influence of milk and buffer solution as gastric contents consists of group I--14% milk, groupII--pH8.0 McIlvain buffer solution and group III--pH2.5 McIlvain buffer solution. Results were as follows : 1. After ischemic re-perfusion technique, an increase of substances related to active oxygen and elevated intensity of ESR (electron spin resonance) signal were observed. We considered that the free radical had casused the histological disorder on the stomach. 2. Epithelial cells and mucous-producing cells were disappeared during the experiment. These are the protective factors for the gastric mucosa. The parietal cells and chief cells were remained. These cells are well known to produce gastric acid and secrete digestive enzyme. 3. When McIlvain buffer solution (pH 2.5) was administered after ischemic re-perfusion, no increase of gastrin, mucosal blood flow or substances related to active oxygen was observed. 4. When McIlvain buffer solution (pH 8.0) or 14% milk was administered after ischemic re-perfusion, increases of gastrin and secretion of gastric acid were noted. It caused an exacerbation of mucosal lesions. 5. A sharp increase of gastric mucosal blood flow was observed in the milk-administered group. It was presumed that severer disorder was brought about by newly developed active oxygen. A hypoxic state are often seen in neonates at the perinatal period. This seems to be a mimicing of ischemic re-perfusion state of this experiment. Therefore, from the above, the possibility was suggested that the ischemic re-perfusion disorder presumedly occur at the recovery of hypoxic state. A suckling constitute parts of the causes for neonatal gastric rupture.
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Yasuaki Yoshino, Yukio Kanazawa, Shiiki Satoh, Tomoyuki Kanno, Takeo O ...
Article type: Article
1994 Volume 30 Issue 1 Pages
59-67
Published: February 20, 1994
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The aim of this study is to estimate the effect of nafamostat mesilate (FUT) without using heparin for the purpose of preventing hemorrhagic tendency during ECMO. We used puppies whose weights ranged from 3.0 to 5.0 kg. General anesthesia was maintained with hypoventilation and V-A ECMO was started. Each two puppies with 8, 4, 2mg/kg/h. of FUT underwent ECMO for 7 hours. ECMO flow was 50ml/kg/min. Activated coagulation time (ACT), concentration of FUT and blood gas data in the ECMO circuit and arterial blood were respectively measured to know adequate dose of FUT, that was considered 3 mg/kg/h. And five puppies underwent ECMO with 3 mg/kg/h. of FUT (group F), another five with heparin (group H), for 7 hours to examine the effect on platelets, red cells, liver, and kidneys. There were no significant differences between group F and H. But no hemorrhagic tendency occurred in group F even enough ACT in the arterial blood was more than 300 sec. ACT and concentration of FUT were higher in the ECMO circuit than those in the arterial blood. It was considered that FUT was a useful anticoagulant to prevent hemorrhagic tendency during ECMO. Clinical application of the ECMO with FUT may be warranted.
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Gen Hatakeyama, Noboru Nagahara, Takahsi Azuma, Testuro Nakamura, Haru ...
Article type: Article
1994 Volume 30 Issue 1 Pages
68-75
Published: February 20, 1994
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We have experienced five cases of meconium disease (meconium ileus without mucoviscidosis) These five cases manifested remarkable abdominal distension soon after birth. Abdominal roentogenographic findings were 1) paucity of air-fluid level in plain upright X-ray film, 2) microcolon on contrast enema film and 3) filling defects formed by meconium in colon. Loop ileostomy were performed on four patients and tube ileostomy on one. Mucoviscidosis was ruled out in all five cases by trypsin activity test of duodenal juice or sweat test. Four patients suffered from postoperative complications such as persistent ileus, necrotizing enterocolitis, adhesive ileus, and immpassability of the distal ileum. Four patients were cured. One patient still requirs IVH and tube ileostomy due to oligoganglionosis of the distal ileum. In pathological examination of biopsied specimens of the ileum, the nuclei of intermuscular ganglion cells were smaller than those of control group and became large at the closure of ileostomy. Furthermore intermuscular ganglion cells were few in one patient (case 5) and this patient was considered oligoganglionois. We suspect that immaturity of ganglia or oligoganglionosis is related to the etiology of meconium disease.
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Yasushi Iinuma
Article type: Article
1994 Volume 30 Issue 1 Pages
76-84
Published: February 20, 1994
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In order to clarify the disturbance of bile acid metabolism and indication for administration of UDCA as choleretic agents to post-operative patients with CBA, UDCA tolerance tests were performed in 12 non-jaundiced (Group 1), 7 jaundiced (Group 2) patients and 5 healthy controls. The serum bile acids were measured continuously before and at the timing of 30, 60, 120, and 180 min after oral administration of UDCA. The results were as follows ; 1) In group 1, the change in the ratio of sum of cholic acid (CA) and chenodeoxycholic acid (CDCA) at 180 min and sum of those before administration of UDCA [namely ; the ratio change of the sum of CA and CDCA] was significantly correlated to the postoperative period (r=0.64, p < 0.05). 2) In group 1, the ratio change of serum total bile acid was significantly correlated to that of the sum of CA and CDCA (r=0.77, p < 0.01). 3) Σ⊿ UDCA (parameter for absorption disturbance of bile acid) showed no significant difference between the two patients-groups. Σ⊿ GUDCA (parameter for excretion disturbance of bile acid) was significantly higher in group 2 than that in group 1 (p < 0.05). In Conclusion ; 1) UDCA administration to Group 1 become overload on liver fynction with the longer post-operative period, therefore it should not be over 80 months (about 6 years) after radical operation. 2) It is proposed that the ratio change of serum total bile acid was useful index to reveal latent bile acid metabolism disturbance. 3) The liver capacity to handle the loaded UDCA in Group 2 patients was well preserved as well as in group 1 patients. The liver capacity to excrete the loaded UDCA in Group 2 patients was inferior to that in group 1 patients.
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Tomohisa Kawahito, Yoshiyasu Egawa, Takehito Ohshio, Kazuya Horike, Ty ...
Article type: Article
1994 Volume 30 Issue 1 Pages
85-89
Published: February 20, 1994
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We report an infant with congestive heart failure secondary to an arteriovenous fistula of the abdmoinal wall. The patient was refered to our hospital on the 4th day of life because of tachypnea and poor feeding. After further examinations including abdominal aortography, we diagnosed the disorder as an arteriovenous fistula of the abdominal wall, located between the bilateral hypogastric arteries and the umbilical vein. We ligated the feeding arteries and the drainage vein. After the operation, distension of the abdominal wall developed progressively. Serum transaminase level rose to over a hundred times greater than normal, and the infant's blood was concentrated. We believed that these symptoms represented plasma transudation caused by hemostasia in the arteriovenous fistula. We untied of the umbilical vein. The infant's postoperative course was satisfactory and he was discharged from our hospital on the 42nd day after the reoperation. Three months after the reoperation, blood flow in the umbilical vein was normal according to noninvasive examinations. Arteriovenous fistula of the abdominal wall is very rare. To our knowledge, previous reported cases number only three, and we believe this is the first report in Japan. Congenital arteriovenous fistula is rare, but may cause severe congestive heart failure in infants. The objective of surgical treatment is reduction of the heart failure. We ligated the feeding arteries, but did not resect the arteriovenous fistula. This method was less stressful and appeared to be appropriate for the control of heart failure caused by arteriovenous fistula.
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Yasuhiro Ohtsuka, Hideyo Takahashi, Naomi Ohnuma, Masahiro Tanabe, Hid ...
Article type: Article
1994 Volume 30 Issue 1 Pages
90-94
Published: February 20, 1994
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A 0-day-old male infant was admitted to our hospital because of an abdominal mass and respiratory distress since birth. On physical examination, a large mass was palpated in the right upper abdomen, and the evidence of heart failure was present. Laboratory data revealed the presence of anemia, disseminated intravascular coagulation (DIC), and respiratory acidosis. Both ultrasonography and CT scan revealed tumors in both lobes of the liver. Color doppler ultrasonography (CDUS) revealed enlargement of proper hepatic artery, arterial blood flows in the tumor, arterio-portal shuntings, and arterio-venous shuntings. The clinical diagnosis was an infantile hemangioendothelioma of the liver. Although conservative treatment with steroid was tried, heart failure and DIC were not improved. Right hepatic artery ligation was performed on the 5th day of birth, which provided good control of the clinical symptoms. Postoperative course was followed up using CDUS. On the 3rd day after the operation, clinical symptoms recurred together with increase of the arterial blood flows in the residual tumor in the left lobe. So proper hepatic artery ligation was performed. Although complicated with inspissated bile syndrome, his post-operative course was good. The residual tumor is diminishing in size 7 months after the operation.
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Toshinori Muramatsu, Hideyo Takahashi, Naomi Ohnuma, Masahiro Tanabe, ...
Article type: Article
1994 Volume 30 Issue 1 Pages
95-100
Published: February 20, 1994
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Absence of the common hepatic duct is one of the rarest congenital malformation of the bile duct system. A 7-year-old girl came our hospital because of right upper quadrate pain and acholic stool. There was not found Pancreatico-billiary Maljunction by ERCP. Echogram and PTC suggested some congenital anomalies of bile duct system, but were useless for diagnosis. Cine- cholangiography from PTC tube showed gall-bladder were directry described lead to intrahepatic bile duct, and connected to common bile duct via cystic duct. Common hepatic duct was not found in this case. Under general anethtesia, gall-bladder and common bile duct were resected and hepatojejunostomy (Roux-Y) was performed. Post operative diagnosis was the absence of the common hepatic duct. She has no symptom for two years scince the surgery.
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Yoshiaki Tanaka, Hiroyoshi Mizote, Hiromichi Yano, Jun-ichi Komura, To ...
Article type: Article
1994 Volume 30 Issue 1 Pages
101-107
Published: February 20, 1994
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We report a 9-year-old boy with severance of pancreas by the quad swing. He was treated conservatively with only drainage of pseudocyst in spite of pancreatic duct injured. Pediatric traumatic severance of pancreas have been reported only 6 cases in Japan. All of these cases underwent operative repair such as Poux-Y anastomosis, Whipple's operation, or distal resection. It is generally believed that the severance of head and neck of pancreas with duct injured is an indication for surgery. However, especially in children, conservative therapy should be an alternative in selected cases such as this, when the late complication of surgery is taken into account.
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Koonosuke Nakada, Hiroaki Kitagawa, Munechika Wakisaka, Noboru Yamate, ...
Article type: Article
1994 Volume 30 Issue 1 Pages
108-113
Published: February 20, 1994
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Because of long-standing hypersplenism and mechanical problemes resulting from massive splenomegaly, approximately 90% partial splenectomy was performed in a 16-year-old boy with Gaucher's disease. After resection of the massive spleen, a small remnatnt of the upper pole of the spleen remained, and this was vascularized by only the short gastric verssels. Two pieces of a thumb-sized accessory spleen were also saved. Bleeding from the cut surface was controlled with an argon laser coagulator and by placement of hemostatic materials. The cut edge was approximated with stitches using interrupted absorbable sutures. The sutured area was widely covered with omentum and the area was fixed to the gastric wall with several stitiches to prevent torsion. The postoperative liver-spleen scan confirmed an adequate blood flow to the residual splenic fragment and the accessory spleens. Accelerated skeletal deterioration after splenectomy has not been observed and the patient's quality of life has been considerably improved. When the upper pole of the spleen is retained, as in the present case, transection and hemostasis is thought to be technically easier to achieve than when resection is performed closer to the center of the spleen.
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Takehito Oshio, Chosei Matsumura, Arishige Kirino, Hiroki Ishibashi, M ...
Article type: Article
1994 Volume 30 Issue 1 Pages
114-119
Published: February 20, 1994
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Reports of dental foreign bodies in the bronchial tree are rare in children. To our knowledge, only 9 cases have been reported in Japnaese literature. The authors experienced three such cases. Case 1. A six-year-old boy was transferred to us with stridor and chest X-ray film revealed the shadow of a tooth. Twelve days before, his mandibular incisor had come out spontaneously. He had not coughed, so the tooth was thought to have entered his sotmach. He was diagnosed as having a foreign body in the air way. The tooth was removed from the right bronchus using a balloon catheter. Case 2. A three-year-old girl was transferred to us on account of a severe cough and an abnormal shadow on chest X-ray film. During the treatment of her maxillar molar at dentist, she had accidentally aspirated a dental filling. She was diagnosed as having a foreign body in the air way. The dental filling was removed from the right bronchus using a basket foreseps five hours after the incident. Case 3. A two-year-old girl visited the authors' hospital suffering from severe cough. She swallowed her maxillar incisor after it came out spontaneously at breakfast. A foreign body in the air way was suspected. But the tooth shadow was unclear on chest X-ray film. Diagnosis was confirmed by chest CT-scan. The tooth was removed from the right bronchus using a balloon catheter seven hours after aspirating the tooth.
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Mitsuo Nagao, Hiromichi Kanehiro, Masato Horikawa, Yoshiyuki Nakajima, ...
Article type: Article
1994 Volume 30 Issue 1 Pages
120-125
Published: February 20, 1994
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A case, two month-old male, is reported who complained of the massive hemorrage from duodenal ulcer on day 6 after the operation for the biliary atresia (BA). The patient underwent the hemostatic simple suture of the ulcer portion, and the postoperative course was not eventful. It is conceivable that the disorder of mucosal protective factor and the augmentation of aggressive factor due to obstructive jaundice, biliary diversion and surgical stress might participate in occurrence of gastroduodenal ulcer after corrective surgery for BA. Peptic ulcer in infant occurs rarely, since function of gastric secretion in infancy might be still immature. Therefore, it would seem that disorder of mucosal protective factor may account for gastroduodenal ulcer in the early period after corrective surgery for BA like this patient. On the other hand, the augmentation of aggressive factor due to biliary diversion has possibly some influence upon occurrence of the ulcer formation in the late period after the operation. It is important to consider not only the esophageal varix but also the peptic ulcer as a complication of the corrective surgery for BA. And we must strive to prevent its occurrence.
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kokichi Otsuka, Eiji Ikeda, Yoshiki Umemori, Hisasi Tuji
Article type: Article
1994 Volume 30 Issue 1 Pages
126-131
Published: February 20, 1994
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A case of thyroid cancer in a 2-year-old boy is reported, together with a review of 191 cases in Japanese literature. The patient was admitted to the hospital because of a tumor in the fore neck. Subtotal thyroidectomy with regional lymphnodes dissection was carried out under a presumpitve diagnosis of thyroid cancer with hypothyroidism. Histologically it was diagnosed as follicular carcionma of thyroid gland. No tumor has recurred for six years after the operation. In 191 patients of 15 year old or under, there were 125 female and 56 male patients. In 20 patients of 6 year old or under, there were 11 female and 9 male patients. Histologically, there were about 70% papillary and 20% follicular carcinoma. There seemed to be no distinct difference in frequency between childhood and adult thyroid cancer. Metastases to the lung occured in 20% of papillary carcinoma. Thyroid cancer in childhood is characterized by frequent metastases to the lung and lymphnode, low mortality, and the prolonged clinical course.
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Haruyasu Honda, Kimio Shimizu, Shinpati Ishizone
Article type: Article
1994 Volume 30 Issue 1 Pages
132-138
Published: February 20, 1994
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The patient was a 37-month-old male. He had vomitted at table with increasing frequency for about two years. He was admitted to a local hospital for treatment of dehydration, and was pointed out esophageal stenosis due to the mediastinal mass. The mass was located in, the mediastinum between left main bronchus and aortic arch, possessed abscess cavity and calcified body arround the esophageal wall. We carried out right 4th intercostal thoracotomy and longitudinal esophagotomy, and removed the foreign body (a plastic sucking disk) buried in granulation tissue. Postoperative course was uneventful. Probably the episode "misintaking the foreign body" occured two years ago. The ingested foreign body developed perforation of the esophageal wall and inflammatory mass was formed in the mediastinal region arround the esophageal wall. The esophageal stenosis was gradually progressed.
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Tomotake Enami, Koonosuke Nakada, Yoshitaka Kim, [in Japanese], [in Ja ...
Article type: Article
1994 Volume 30 Issue 1 Pages
139-143
Published: February 20, 1994
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A case of complete duplication of the extrahepatic bile duct in a 13-year-old boy is reported. The patient suffered severe epigastric pain with hyperamylasemia, which was thought to be due to a possibly abnormal arrangement of the pancreatico-biliary ductal junction. Preoperative diagnosis of the lesion was made successfully by endoscopic retrograde cholangio-pancrea-ticography, revealing two ducts separated throughout their length, but draining together through a papilla. Resection of the duplicated choledochus and hepaticojejunostomy relieved the symptoms. Fifty-seven patients, including 12 children, with such duplication of the biliary system were reviewed, and the clinical characteristics, diagnoses, and surgical treatments for this condition are discussed.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1994 Volume 30 Issue 1 Pages
144-166
Published: February 20, 1994
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1994 Volume 30 Issue 1 Pages
167-
Published: February 20, 1994
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