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1995 Volume 31 Issue 2 Pages
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Toshiki Ohya, Takeshi Miyano, Takao Fujimoto, Kunimasu Ando, Osamu Seg ...
Article type: Article
1995 Volume 31 Issue 2 Pages
169-174
Published: April 20, 1995
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In these days, we have two options for the patients with failed Kasai operation; one is re-portoenterostomy, and the other is liver transplantation. According to our experience of re-portoenterostomy, good prognosis can be expected in the patients who had mild liver fibrosis at the first portoenterostomy, and their jaundice once had disappeared after surgery, We think that correct estimation of viability of the liver in each patietents is the most important prior to decision of re-portenterostomy. We evaluate the prognositic factors, such as age at the first portoenterostomy, degree of liver fibrosis, size of ductuli at portahepatis, actin deposition at bile canaliculi, and preoperative urine D-glucaric acid. These prognositic factors closely related to viability of the liver. They are quite useful when we have to decide who needs re-portoenterostomy and who needs liver transplantation. In addition, we can evaluate thesse prognositc factors at the time of first portoenterostomy, that means, the outocome of biliary atresia seems already predicable at that time to a certain extent.
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Yoshihiro Ohsawa, Makoto Iwafuchi, Masafumi Naito, Kimio Kondo
Article type: Article
1995 Volume 31 Issue 2 Pages
175-179
Published: April 20, 1995
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The purpose of this paper was to describe the effects of mass screening test (MST) on survival rates of neuroblastoma and to clarify the differences of the primary site of the tumor before and after MST started. Since 1985, we have started MST for early diagnosis of neuroblastoma. We recently encountered four interesting cases which were found as a small tumor of adrenal gland origin (OS) at operation, however these were all diagnosed as the retroperitoneal paraganglion origin (OR) microscopically. We analyzed 74 cases of the neuroblastoma (OS and OR) to define the primary site of the tumor after and before MST to clarify the relationship between prognosis and the primary site of the tumor. Results : The survival rate and the occupied rate of the OR tumor in the cases after MST were 100% and 57% respectively, on the other hand, the survival rate and the occupied rate of the OR tumor before MST were 18% and 24%, respectively. We concluded that the better prognosis after MST was influenced by the increasing number of the OR tumor partially.
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Mitsumasa Iwata, Ikuo Okabe, Moritaka Oohara, Takesi Matsuda, Akinori ...
Article type: Article
1995 Volume 31 Issue 2 Pages
180-185
Published: April 20, 1995
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Though the spontaneous regression of neuroblastoma has been well known, its mechanism are unclear yet. To understand the pathogenesis, we studied the apoptotic change and the proliferating rate of the tumor cells using surgically extirpated samples. Materials : Nineteen cases, detected by mass screening for neuroblastoma, were investigated (Stage I : 6, II : 3, III : 3, IVb : 2, IVs : 5). Methods : 1. apoptosis : The DNA, extracted from the samples, were electrophoresed in 1.8% agarose gel stained with ethidium bormide. Further electrophoretical study was performed using the DNA treated with Frank's method. 2. proliferating rate : The proliferating index (PI score) was measured by flow cytometry using the paraffin thin sections treated with Hedley's method. As a control, the PI scores of 5 advanced neuroblastomas were used. 3. Ploidy pattern, Histology (Simada's histological classification), N-myc amplification and serum NSE level were also measured. Results : 1. The ladder structures were demonstrated only in 4 cases by usual electrophoresis, but in all cases when treated with Frank's method. 2. The PI scores of neuroblastomas, detected by mass screening, were significantly lower than those of advanced cases (p<0.05). 3. No corelatinship was found between the existence of ladder structure demonstrated by ethidium bormide staining and other prognositic factors. Conclusion : The presence of apoptosis and the low proliferating rate were demonstrated in all nuroblastomas detected by mass screening. We speculate that these characteristics may play important roles in inducing spontaneous regression in neuroblastoma.
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Kiyoshi Takeda, Yasuhiko Furuta, Yoshihiro Sakashita, Takashi Sakano, ...
Article type: Article
1995 Volume 31 Issue 2 Pages
186-190
Published: April 20, 1995
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Gastric duplication is a rare anomaly of the gastrointestinal tract. We recently encountered a 28-day-old girl with association of MDK and malratation. Some examinations indicated gastric duplication, MDK, and malrotation. Gastric duplication, which is shared a common seromuscular wall with the middle greater curvature wall of the stomach, was treated by partial gastrectomy. The right MDK, with no visible parencyma, was resected with its ureter. A classical Ladd procudure was performed for malrotation. She has been healthy for about 2 years after the operation.
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Yukio Kanazawa, Yasuaki Yoshino, Shiiki Sato, Atai Sato, Hitoshi Inoue ...
Article type: Article
1995 Volume 31 Issue 2 Pages
191-197
Published: April 20, 1995
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We report a case of left congenital diaphragmatic hernia that was treated with extracorporeal membrane oxygenation (ECMO) using nafamostat mesilate (FUT) as an anticoagulant. A 3020g female infant with a prenatal diagnosis was born by cesarean section 2 weeks prior to term. Repair of the hernia was performed at 4 hours after birth. ECMO was started at 26 hours after birth because of continuous high values of alveolar-arterial oxygen gradients. Serial laparotomies were done for intra-abdomonal bleeding at 30 and 33 hours after the start of ECMO. Furthermore thoracotomy was was done for intrathoracic bleding at 72 hours after the start of ECMO. Before this operation, anticoagulant drung was changed from heparin to FUT for the prevention of bleeding. Thereafter FUT was infused at the rate of 2.0-3.4mg/kg/h., and we maintained activated coagulation time about 200 seconds. Hyperkalemia occured as a side effect with the admninistration of FUT, but serum potassium values returned to normal range after reducing the infusion of potassium. We continued ECMO using FUT for 4 days without bleeding, and pulmonary function improved. The patient weaned from ECMO at 8 days after birth. These results show that FUT is a useful anticoagulant to prevent hemorrhagic complications in ECMO.
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Yasuhiko Furuta, Yoshihiro Sakashita, Osamu Ishii
Article type: Article
1995 Volume 31 Issue 2 Pages
198-201
Published: April 20, 1995
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A 4-year old boy was seen for evaluation of a recurrent right inguinal hernia. On physical examination, the bulge was lateral and inferior to the external inguinal ring, and was easily reducible. The diagnosis of femoral hernia was made. He underwent a right groin exploration and revealed a right femoral hernia. The hernia sac was ligated by transfixing sutrue at the neck of the sac, and was resected. The hernia porta was repaired with inguinal ligament sutured to Cooper's ligament. He made an uneventful postoperative recovery, with no recurrence in 12 months. Femoral hernia in children is rare. Twenty-eight children of this disease have been reported in Japan. The etiology of femoral hernia is still debated. Preoperative diagnosis is difficult. The methods of repair for femoral hernias are varied, but there is no uniform procedure.
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Masami Ishikawa, Jun-ichi Suzuki, Masahiro Nakada, Yuu Watarai, Yoshih ...
Article type: Article
1995 Volume 31 Issue 2 Pages
202-206
Published: April 20, 1995
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A 9-month-old girl was admitted to our hospital with the complaint of abdominal mass. Rectal examination and barium enema demonstrated normal anus and anal canal stenosis from the dentate line to the I point. Sigmoid colostomy was performed and then the Z-shaped colo-rectal anastomosis using the GIA autosuture was done at 1 year and 4 months of age. Postoperative course was uneventful. She is now free from constipation with no need of enema and doing well for 18 months after operation. The stenotic anal canal was covered with the transitional epithelium, and had normal anal glands and no ganglion cells. We speculate the etiology of the anal canal stenosis is a dysplasia of the dorsal cloaca.
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Hiroki Ishibashi, Takehito Oshio, Chosei Matsumura, Arishige Kirino, M ...
Article type: Article
1995 Volume 31 Issue 2 Pages
207-212
Published: April 20, 1995
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Pleomorphic adenoma of the submandibular gland is rare in children, Only 11 cases were reported in Japanese literature. The authors treated two such cases as described below : Case 1 : A 16-year-old boy was transferred to the authors' hospital because of a mass located in the right submandibular region. The mass was noted from 15 years of age. At the time of the operation, the mass was 3.5×2.0×2.0cm in size and was attached to the submandibular gland, so that the tumor along with the submandibular gland was resected. Case 2 : A 12-year-old girl visited the authors' hospital because of having a mass in the right submandibular region since 11 years of age. At the time of operation, the mass was 2.0×1.8×1.5cm in size and well capsulated from the submandibular gland, so that the tumor alone was resected. Histologically, both tumors were diagnosed as a typical benign, salivary, pleomorphic adenoma. The postoperative course was uneventful in both cases.
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Atsushi Takahashi, Shiro Matsuyama, Yuichi Shoda, Norio Suzuki, Minoru ...
Article type: Article
1995 Volume 31 Issue 2 Pages
213-218
Published: April 20, 1995
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A 7-month-old male infant was admitted to our hospital with vomiting and swelling in the right inguinal portion. Considering it to be incarcerated hernia, an emergency operation was performed. At the operation, comunicating hydrocele and a bloody ascites without incarcerated hernia were found. Echogram and CT scan were performed after the operation, and these examinations showed enlargement of the pancreatic body with cyst formation. The symtoms of pancreatitis were aggravated, and medical treatments were given. After recovery from the pancreatitis, endoscopic retrograde cholangio pancreatography and MRI were done, and these showed that the enlargement of pancreatic body was due to chronic pancreatitis, and that the main pancreatic duct was the duct of Santorini, which was connected to the duct of Wirsung. Stenosis in two places and irregularity of the duct were also noted in the pancreatic body, but the duct was not greatly dilated. These findings indicate that his symptoms are related to incomplete pancreas divisum. The patient may be the youngest infant so far seen with symptoms of pancreas divisum. His symptoms would be due to chronic pancreatitis with stenosis of the pancreatic duct rather than accessory papilla failure.
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Shigeki Takahashi, Hirokazu Kawase, Katuyuki Tanaka, Mariko Nagashima, ...
Article type: Article
1995 Volume 31 Issue 2 Pages
219-224
Published: April 20, 1995
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Congenital sternal cleft without another major anomalies is a very rare deformity. Until now, only about 10 cases of this anomaly have been reported in Japan. We experienced a girl case of congenital upper sternal cleft, and have folluwed her for a long time after the operation (about 9 years). She was admitted to our hospital on 34 days of age. When she was 48 days old, we performed the operation of Sabiston's method on her. She had a good post-operative course, and was dicharged 2 weeks after operation. But the ossification center of her sternum hasn't been observed until now, and her sternal ossification has delayed remarkably. We were almost satisfied with this operative result. But she showes slight depression of the upper anterior chest wall. Therefore, we can suggest that Salley's method might bring more satisfactory result. It is conceivable that a embryological cause of this anomaly is fusional hindrance of sternal bar, since ossification center of her sternum hasn't appeared and sternal ossification is delayed remarkably. In future, it is necessary for us to observe on her sternal ossification and her chest depression for a long term.
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Hitoshi Hara, Kunio Okajima, Hiroshi Isozaki, Shinshou Morita, Takashi ...
Article type: Article
1995 Volume 31 Issue 2 Pages
225-230
Published: April 20, 1995
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Cholecystolithiasis is a relatively uncommon disease in children. We treated 2 cases of this disease and evaluated symptoms, diagnostic methods, complicating diseases, and other physical conditions in 104 operated cases reported in Japan including ours. Case 1 was a 4-month-old male with vomiting as a primary manifestation. Calcification in the right upper abdomen showed plain abdominal raidiography, and a diagnosis of cholecystolithiasis was made by ultrasound examination. Open cholecystectomy was performed. Case 2 was a 7-year-old male with an initial symptom of vomiting. Gallstones Were diagnosed by abdominal ultrasound examination during the course of acute lympocytic leukemia. After endoscopic retrograde cholangiography, laparoscopic cholecystectomy was performed. Common symptoms of cholecystolithiasis in children were abdominal pain, jaundice, nausea, and vomiting, and abdominal ultrasound examination was the best diagnostic method. The condition was often complicated by hereditary spherocytosis and congenital choledochal cyst, but cases without complication and of unknown causes have been increasing recently.
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Takao Etoh, Masahiko Maie, Yutaka Kuriyama, Hiroaki Kuroda, Tadashi Fu ...
Article type: Article
1995 Volume 31 Issue 2 Pages
231-236
Published: April 20, 1995
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2-year old girl with a Wilms' tumor of the right kidney extending through the inferior vena cava to the right atrium was reported. The MRI confirmed the presence of a large right renal mass and a massive tumor thrombus extending into the right atrium. The tumor and thrombus were removed completely under cardiopulmonary bypass and the patient is alive and well 30 months postoperatively without recurrence. The knowledge of the exact tumor extension into the vena cava and atrium is essential for planning and performing a successful operation.
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Yoh Masuko, Yoshiro Yamashita, Hideyuki Uotani, Shinichiro Hirokawa, T ...
Article type: Article
1995 Volume 31 Issue 2 Pages
237-241
Published: April 20, 1995
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Gastric teratoma is a very rare tumor. Only 46 cases have been reported in the Japanese liturature. We reported a case of 1 day-old male infant with gasric teratoma and the incarcerated left inguinal hernia. The prenatal diagnosis was intestinal atresia with ultrasonography. At operation the tumor was arising from the posterior gastric wall. Tumor was removed with the muscular layer of the stomach. Histological diagnosis was benign teratoma including immature neural tissue cells. A year after surgery, he was healthy and asymptomatic. We performed prenatal ultrasonography, but could not diagnose gastric teratoma. We discussed clinical presentation, surgical treatment and significance of prenatal diagnosis of the gastric teratoma with relevant liteatures.
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Shigeki TAKAHASI, Akira SATOMI, Kiyoshi ISIDA, Syuzi TOKIMATU, Yuima O ...
Article type: Article
1995 Volume 31 Issue 2 Pages
242-247
Published: April 20, 1995
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We reported 2 cases of atresia of the small bowel on the postoperative course and discussed about the etiology. First case was 1-year-old female. She was made a diagnosis of incarcerated para-duodenal hernia and operated. The involve intestine seemed viable, so we did not resect it. After the operation, she repeated the intestinal obstruction. She was made an operation again on 43rd days after the first operation. We found an atresia of the jejunum (type I). Second case was 15-year-old female. She had mental retardation and admitted to our institution. Severe deformities were found on her spinal and pervic bone. The small bowel was incarcerated in the stenotic minor pelvic space. She was made an operatin. When we released her intestine, it seemed viable and was not resecte. On 30th post operative days, she showed the intestinal obstruction again. Surgical treatment was necessary for her condition, but we could not because she had severe pneumonia. It was a cause of her death on 102nd days after the operation. We found ileal atresia (typeIII a) and torsion of the mesentery at autopsy. Recent concept holds that atresia of the small bowel may result from a impaired vascularity. We think these 2 cases suggested this concept.
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Yoshiaki Mochida, Takeji Uno, Yukio Harada, Takashi Matsushita, Teruak ...
Article type: Article
1995 Volume 31 Issue 2 Pages
248-256
Published: April 20, 1995
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Most patients with retroperitoneal teratoma are generally first seen with complaints of nonspecific symptoms attributable to a mass, such as an increase in abodminal girth, a recognition of the mass, and pain. This is a report of retroperitoneal teratoma associated with polydipsia, polyuria, severe hypertension, proteinuria, and hypokaremia in a 4-year-old boy. Laboratory and radiographic examinations revealed causes of various signs and symptoms. Compression of the left kidney laterally and stretching of the left renal artery by the retroperitoneal teratoma gave rise to increase a renin release, secondarily causing of high serum levels of angiotenisn II and aldosterone. Consequently, he had renovascular hypertension and secondary hyperaldosteronism. At operation a 9 cm cystic mass was found between the aorta and the left kidney. The mass also extended the left renal artery anteriorly in the cephalic direction, and the left renal vein caudally. The tumor was removed totally without any injury to renal vessels, aorta, kidney, and adrenal gland. Histologically, the diagnosis was mature cystic teratoma. Elements of all three embryonic layers were present, but the tissue resemble to juxtaglomerular apparatus was not found. After the removal of the tumor, all of the signs and symptoms except hypertension were relieved. The blood pressure came down to be about 120/80 mmHg.
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Hiroyuki Ishida, Tohru Sugimoto, Hajime Hosoi, Hiroshi Mine, Miyuki Mu ...
Article type: Article
1995 Volume 31 Issue 2 Pages
257-263
Published: April 20, 1995
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This paper documented a two-month-old girl with malignant rhabdoid tumor of the left kindney (MRTK) After total tumor excision, she was treated with radiotherapy and various kinds of anti-cancer drugs. Although mitomycin C and vincristine were partially effective, she died of the tumor growth eleven months after the onset of the disease. The surgical specimens and the cell line, established from the relapsed tumor, were analyzed using a panel of monoclonal antibodies bound with cytoskeletal proteins. The primary tumor was positive for neurofilament of neurogenic marker and vimentin of mesenchymal marker. The cell line was positive for neurofilament, vimentin and α-somooth muscle actin of myogenic marker. That suggests these results indicates this tumor has multiphenotypical divrsity or heterogeneity. Furthermore, fourteen cases of MRTK reported in Japanese literatures were reviewed. Most of cases involved infants under six months old. The prognosis was extremely poor, deu to the rapid tumor growth and multiple metastases.
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[in Japanese]
Article type: Article
1995 Volume 31 Issue 2 Pages
264-269
Published: April 20, 1995
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1995 Volume 31 Issue 2 Pages
270-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1995 Volume 31 Issue 2 Pages
270-
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[in Japanese], [in Japanese]
Article type: Article
1995 Volume 31 Issue 2 Pages
270-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1995 Volume 31 Issue 2 Pages
270-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
Article type: Article
1995 Volume 31 Issue 2 Pages
270-271
Published: April 20, 1995
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[in Japanese], [in Japanese], [in Japanese]
Article type: Article
1995 Volume 31 Issue 2 Pages
271-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1995 Volume 31 Issue 2 Pages
271-
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