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Article type: Cover
1995 Volume 31 Issue 5 Pages
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Article type: Cover
1995 Volume 31 Issue 5 Pages
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Article type: Appendix
1995 Volume 31 Issue 5 Pages
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Article type: Appendix
1995 Volume 31 Issue 5 Pages
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1995 Volume 31 Issue 5 Pages
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Article type: Appendix
1995 Volume 31 Issue 5 Pages
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Article type: Index
1995 Volume 31 Issue 5 Pages
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[in Japanese]
Article type: Article
1995 Volume 31 Issue 5 Pages
691-
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[in Japanese]
Article type: Article
1995 Volume 31 Issue 5 Pages
692-693
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[in Japanese]
Article type: Article
1995 Volume 31 Issue 5 Pages
694-695
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[in Japanese]
Article type: Article
1995 Volume 31 Issue 5 Pages
696-698
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[in Japanese]
Article type: Article
1995 Volume 31 Issue 5 Pages
699-700
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Yoshiaki Tsuchida
Article type: Article
1995 Volume 31 Issue 5 Pages
701-705
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Hisashi Nikaidoh
Article type: Article
1995 Volume 31 Issue 5 Pages
706-709
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Gerald M. Haase
Article type: Article
1995 Volume 31 Issue 5 Pages
710-717
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Alberto Pena
Article type: Article
1995 Volume 31 Issue 5 Pages
718-731
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Toru Ichikawa, Takasi Yokoyama, Eizo Hiyama, Yuichiro Matuura
Article type: Article
1995 Volume 31 Issue 5 Pages
732-738
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We analyzed 24 cases with congenital bile duct dilatation operated in childhood and followed up over 3 years after surgery. Among these cases, we performed primary diversion in 14 patients, secondary diversion after initial external drainage for bile duct perforation in 3 and for severe pancreatitis or chorangitis in 3. In 4 patients internal drainage procedure without diversion was performed from 1964 to 1971 at our and at other hospitals. Patients who had primary diversion were sometimes suffered form cholangitis or pancreatitis, but most of them became free of symptoms and well so far. All of patients who had temporary external drainage have been well too. Whereas all patients who underwent internal drainage were suffered from severe cholangitis and required reoperation within 2 to 19 years after the surgery. We recommend cyst excision for who had internal drainage procedure even when asymptomatic. In cases with stasis of pancreatic juice, additional drainage procedure may be indicated.
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Takeshi Ohsawa, Kazunori Ohama
Article type: Article
1995 Volume 31 Issue 5 Pages
739-743
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During the period from January 1989 through May 1994, 50 children underwent appendectomy for perforated appendicitis in our pediatric surgical section. In 7. of them (14.0%), complications such as wound infection or abdominal abscess required prolonged hospitalization. We studied factors that involved in abscess formation by using the X^2 test. The factors included 1) age. 2) period from the onset of illness to surgery, 3) preoperative WBC count, 4) preoperative CRP level, 5) bacteria in ascites and abscess, and 6) antibiotics. The period from the onset of illness to surgery, preoperative CRP level and B. fragilis in ascites were associated with abscess formation. The extraction rate of B. fragilis In ascites was high in patients who were ill in excess of 6 days before surgery. The choice of appropriate antibiotics is most important for the prevention of abscess formation. Removal of bacteria from the abdomen and wound by washing is also important.
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Yuichiro Yamazaki, Rie Yago, Mari Suzuki, Hiroshi Toma
Article type: Article
1995 Volume 31 Issue 5 Pages
744-747
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Testicular biopsies were performed in 25 prepubertal cryptorchid patients. In each biopsy, all tubules and germ cells were counted and germ cell per tubule (GC/T) were calculated. The mean germ cell counts were reduced in all age groups. Compared with previous studies of European and North American institutions, germ cell counts were markedly reduced even in children aged one year old. In relation to the position of the testes. there were less germ cell counts in the testes located above external inguinal ring than in the suprascrotal testes. Although this histological study clearly showed germ cell reduction in all specimens, there was no treatment option after orchiopexy. As a result, histological finding was not practically useful for each patient and his family at present.
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Kazumitsu Terashima, Noboru Nakaigawa, Katsuyuki Sano, Tomoyuki Asakur ...
Article type: Article
1995 Volume 31 Issue 5 Pages
748-753
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Seventeen children with unilateral mild hydronephrosis (ureteropelivic junction obstruction) were followed nonoperatively for a long period. Patients age at diagnosis ranged from 3 months to 4 years, and a follow-up period from 10 to 21 years. The grade of hydronephrosis was low (grade I and II) in 14 kidneys and medium (grade III) in 3 kidneys. No children demonstrated alteration of hydronephrosis grade or thinning of renal parenchyma during the follow-up period. We conclude that surgical intervention is not indicated in most of low grade and some of medium grade hydronephrosis. However, a close follow-up of these patients is mandatory because of potential worsening of hydronephrosis.
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Akira Tohda, Shozo Hosokawa, Kenji Shimada
Article type: Article
1995 Volume 31 Issue 5 Pages
754-759
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From October 1981 to September 1992, seven patients with Beckwith-Wiedemann syndrome (BWS) were treated in our hospital. Among the seven patients, five (71%) had urological abnormalities; urethral stenosis with bilateral vesicoureteral reflux (VUR), bilateral ectopic ureter, cystinuria with bladder stone, bilateral hydronephrosis and unilateral abdominal testis. The co-existances of cystinuria and ectopic ureter with BWS has not been reported in literature. Four patients recieved urological interventions. The patient with urethral stenosis was treated with optic internal urethrotomy, and bilateral VUR disappeared. The patient with bilateral ectopic ureter was tredted by left percutaneous nephrostomy followed by bilateral uretero-cysto neostomy. Now she is continent, but suffering from chronic renal failure. The patient with cystinuria was treated by transurethral cystolithotripsy and urinary alkalization. No recurrence of urolithiasis is observed. Long-loop vas orchiopexy was performed for abdominal testis. High incidence of urological abnormalities in cases of BWS was documented.
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Toshiki Ohya, Takeshi Miyano, Takao Fujimoto, Kunimasu Ando, Shunichi ...
Article type: Article
1995 Volume 31 Issue 5 Pages
760-764
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We investigate apoptosis in the liver with biliary atresia using iramunological staining technique. Liver specimens were obtained from 12 patients with biliary atresia at primary portoenterostomy. Also liver specimens from 6 patients with choledochal cyst, and 6 patients with pyloric stenosis are examined as control. All liver specimens with biliary atresia demonstrate apoptosis either on hepatocytes or intrahepatic biliary epithelial cells. Apoptosis seems to be prominent around portal area, and this distribution is different from physiological apoptosis in normal liver. Mild reverse correlation is seen between severity of apopiosis and age at primary portoenterostomy, however, severity of apoptosis has no relation to degree of liver fibrosis and prognosis. On the other hand, only 1 of 6 patients with choledochal cyst and 2 of 6 with pyloric stenosis show apoptosis. Apoptosis is considered to be physiological cell death, accordingly, presentation of apoptosis does not always indicate morbid condition. However, our results suggest that apoptosis may contribute liver damage in biliary atresia in some degree.
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Masahiro NAKADA
Article type: Article
1995 Volume 31 Issue 5 Pages
765-771
Published: August 20, 1995
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Changes in plasma fibronectin levels were evaluated in two types of malnourished growing rats (kwashiorkor, marasmus) and in replete rats following 7 day's of total parenteral nutrition (TPN). The levels of plasma total protein, albumin, retinol binding protein and plasma fibronectin in the malnourished rats were lower than those in normal feeding rats. The total protein and albumin concentrations were significantly increased after TPN in kwashiorkor rats. The plasma levels of retinol binding protein were shown to be increased after TPN in both kwashiorkor and marasmus rats. The plasma fibronectin levels in both kwashiorkor and marasmus rats were significantly increased 3 days after the start of TPN, These results suggest that the level of plasma fibronectin is a useful parameter of the early phase reaction during the nutritional replenishment with TPN.
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Akira Tohda, Shozo Hosokawa, Kenji Shimada
Article type: Article
1995 Volume 31 Issue 5 Pages
772-775
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We reported 2 cases of incomplete hypospadiac duplication of the urethra in patients with VATER association. Case 1: A 4-year-old boy visited with the chief complaint of double urinary stream. A voiding cystogram(VCG) showed incomplete liypospadiac duplication of the urethra. He also presented TEF(Gross C), radial dysplasia, vertebral anomaly. He is followed up with no treatments. Case 2: A male neonate with imperforate anus(recto-bulbar fistula), TEF(Gross C), VSD presented 2 urethral meatus. A VCG at 11 months of age showed incomplete hypospadiac duplication of the urethra. Recently, urethral anomalies are reported to be common in patients with VATER association, and some cases of hypospadiac duplication of the urethra associated with anorectal malformations are reported. These cases suggest that the etiology of hypospadiac duplication of the urethra is related with some developpemental anomalies of cloacal membrane.
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Muneyasu Kawasaki, Yoshinori Takanashi, Hiroki Yokomuro, Sumio Kano, K ...
Article type: Article
1995 Volume 31 Issue 5 Pages
776-780
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A 3-year-old girl was admitted to our institute with complaint of heart murmur and a diagnosis of anomalous origin of left coronary artery from pulmonary trunk (Bland-White-Garland syndrome) associated with severe mitral regurigitation was made. With the aid of cardiopulmonary bypass, she underwent establishment of Two coronary sysytems by reimplantation of anomalous left coronary artery into aorta and concomitant mitral cuspal-plasty and annuloplasty. She made uneventful postoperative recovery and was discharged on 26th postoperative day. Postoperative echocardiogram and planar <201>^T1 perfusion scan (or bull's eye view) disclosed amelioration of both mitral regurgitation and myocardial blood perfusion.
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Kei Kanto, Tetsuo Kato
Article type: Article
1995 Volume 31 Issue 5 Pages
781-785
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An 11-year-old girl encountered traffic accident and had an abdominal contusiton. Routine examination revealed normal findings except many leukocytes in urine. Intravenous pyelography showed right triplicate ureter which represented three ureters extending from the kidney. and joining into a single ureter entering the bladder. As there were blunt calices and prlonged abnormal urianalysis in spite of no evident history of repeated urinary tract infection, operation was performed. On operation, uppermost ureter which joined the common ureter near the urinary bladder was resected and end-to-side anastomosis of the ureter was performed at a higher level. Post operative course was uneventful.
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Yosuke Komoto, Takeshi Kusafuka, Takaharu Oue, Hiroomi Okuyama, Noriak ...
Article type: Article
1995 Volume 31 Issue 5 Pages
786-791
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A 13-month-old boy was referred to Osaka University Hospital becuse of enlarging hard abdominal masses. Image diagnostic findings and an incisional biopsy confirmed a diagnosis of bilateral Wilms' tumor. After the chemotherapy with etoposide, pirarubicin, carboplatin, vincristine and cyclophosphamide, a CT scan revealed a decrease in the size of the left mass with no significant changes of right mass. Then right partial nephrectomy was performed followed by left partial nephrectomy. After all, half of the right kindey and one-theird of the left remained. The histopathological study revealed the definitive diagnosis of bilateral fetal rhabdomyomatous nephroblastoma and the hyperplastic intralobar nephrogenic rest in left kidney. The renal function is well preserved. Eleven months later, he is well and is checked up on regular basis.
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Yukio Kanazawa, Yasuaki Yoshino, Siiki Sato, Shinichi Matuyama, Hitosh ...
Article type: Article
1995 Volume 31 Issue 5 Pages
792-798
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A 3150g female infant with a prenatally diagnosed cervical teratoma was born by cesarean section at 34 weeks gestation. Endotracheal intubation and mechanical ventilation were required immediately after birth because of airway obstruction and respiratory distress syndrome requiring surfactant therapy. The tumor was excised on the fifteenth day of birth. The tumor originated from the right lobe of the thyroid gland. The tumor was 12×7×6cm in size and 280g in weight respectively. Pathological diagnosis was immature teratoma. She is doing well currently one year after surgery. Thirty nine cases of cervical teratomas have been reported in the Japanese literatures since 1959. Twenty seven cases (69%) were neonates and 9 cases (23%) were children under fifteen years old. Main signs and symptoms were cervical mass, respiratory distress, and dysphagia. Respiratory distress was more common in neonates requiring appropriate preoperative airway and respiratory management. Seven of 9 cases reported since 1989 were prenatally diagnosed by ultrasonographic examination. None of the 39 reported cases were diagnosed as malignant by pathological examination. Six cases were dead. Three cases were stillborn. 2 cases were dead immediately after birth and 1 case was dead of congestive heart failure due to ventricular septal defect. The prognosis was good in the cases whose tumors were resected.
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Takashi Sasaki, Toshimichi Hasegawa, Nagato Katsura, Yasuhiko Yoshioka ...
Article type: Article
1995 Volume 31 Issue 5 Pages
799-803
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We present a case of twisted ovarian cyst who underwent cystectomy through a small abdominal incision. An 8-year-old girl developed right lower abdominal pain, nausea and a large mass in the lower abdomen. Ultrasonography and computerized tomography revealed a 10cm cystic mass including calcification. Under general anesthesia, the mass moved freely, leading to diagnosis of a twisted ovarian cyst. Through a 4cm transverse incision, she underwent cystectomy to preserve the ovary, following aspiration of 300cc bloody content from the cyst. Another ovary appeared normal. Histology showed mature teratoma. Postoperative course was uneventful with minimum incisional pain. Small incisional approach may be useful for postoperative recovery and cosmetic benefit in extirpation of the ovarian cyst.
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Shigeki TAKAHASHI, Hiroshi TAKAHASHI, Hirokazu KAWASE, Katuyuki TANAKA ...
Article type: Article
1995 Volume 31 Issue 5 Pages
804-808
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Meckel's diverticulum is the most frequent congenital anomaly of the digestive tract, and the incidence is estimated between 0.3 and 3.0 per cent. The common complications are intestinal obstraction, diverticulitis, bleeding, and perforation. Intestinal obstruction is occured by intussusception, omphalomesenteric duct, mesodiverticural band and adhesion caused by diverticulitis etcetera. We experienced a case whose small bowel was knoted by long Meckel's diverticulum without adhesion, bands and ducts. And it had been widely necrotic. Only 6 cases with this kind of complication were reported by Walsh et al (1950). He pointed out the causes as follows; (1) The diverticulum is unusually long, (2) it must be quite mobile and unattached, save for its origin from the ileum. (3) it should possess an ampulla at its distal end. Our case had also the same conditions. But a case with so wide small bowel necrosis had not been reported yet. We think that the patient had shortening of the mesenterium.
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Shigeru Matsuzaki, Shun-Ichi Makino, Mitsuhiro Itoh, Hiroo Uchida, Mit ...
Article type: Article
1995 Volume 31 Issue 5 Pages
809-813
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A 46, XY individual with incomplete testicular feminization syndrome was investigated. The patient's chief complaints were clitoromegaly and inguinal nodules. The hormonal studies showed high serum testosterone(T) and FSH. The dihydrotestosterone(DHT) level was relatively low. The ratio of T:DHT was slightly high, 22. After stimulation with hCG. both T and DHT responded well, and the ratio decreased to 17. The radiological and surgical examinations revealed that inguinal nodules were testicles and there were epididymis and vas deferens. Mullerian derivatives and ovaries did not exist. The gonads were resected, and subtunical total reduction clitoroplasty was carried out. Pathological examinations of testicles showed that atrophic seminiferous tubles were populated by Sertoli cells without spermatocytes. Leydig cells were rich in number. "She" received estrogen for further feminization.
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Mayumi Iwakawa, Kiichi Inagawa, Haruo Ohkawa, Michio Kaneko, Tetsuo Ho ...
Article type: Article
1995 Volume 31 Issue 5 Pages
814-819
Published: August 20, 1995
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Prenatal detection of serial sonographic study makes it possible to diagnose a baby with congenital cystic adenomatoid malformation (CCAM) before manifesting respiratory distress. A full term infant was admitted to our hospital maternal transport and planned delivery. The sonographic study had prenatally revealed a macrocystic tumor in the left pleural cavity with polyhydroamnios. Prompt management including CT scanning and surgical treatment was successfully done. CT scanning revealed a large mass containing innumerable small cysts, mainly involving S_6. A right lower lobectomy was performed at 3 hours after delivery. The infant was discharged on the 11th postoperative day. The pathological findings confirmed the diagnosis of CCAM. Fetuses with CCAM have a good clinical prognosis with maternal transport, planned delivery, and immediatal surdery.
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Kazunori Ohama, Takeshi Ohsawa, Ushio Yazaki, Tadashi Kamesui, Kazunor ...
Article type: Article
1995 Volume 31 Issue 5 Pages
820-826
Published: August 20, 1995
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Recently, the number of patients with gastroesophageal reflux(GER) after repair of congenital diaphragmatic hernia has been increasing. We experienced a case of GER after two-staged repairs of neonatal gastric rupture and left sac-containing diaphragmatic hernia in a 6-year-old girl. Upper gastrointestinal series before diaphragmatic hernia repair showed that the stomach was located deeply beneath the left elevated diaphragma with a sharp His angle of 12 degrees. She was referred to Ishikawa Prefectural Central Hospital with a chief complaint of hematemesis during the asthma attack. Upper gastrointestinal series showed severe GER with a dull His angle of 108 degrees. After esophagea) manometry. 24-hour esophageal pH monitoring, gastroesophageal scintigraphy and esophgoscopy with biopsy comfirmed the diagnosis of GER and indication for surgical intervention, she underwent a Nissen fundoplication with success. We speculate that a delicate change of His angle after congenital diaphragmatic hernia repair might be a key factor which caused GER in this case.
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Kohei Takada, Eiji Nishijima, Masayuki Ohbatake, Yuka Ogawa, Masahito ...
Article type: Article
1995 Volume 31 Issue 5 Pages
827-830
Published: August 20, 1995
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A neonate with a left cervical mass was presented with airway obstruction at birth, requiring immediate endotracheal intubalion. CT-scan of the neck showed a large cyst which occupied the extralaryngeal region, pushing the trachea to the right side. Laryngoscopy revealed that the cyst was a lateral saccular cyst, which was covering up the laryngeal ventricle and extending through the crico-thyroideus muscle. The patient underwent the removal of the saccular cyst via the external approach with intraoperative laryngoscopic support. Histological examination of the resected specimen demonstrated that the cyst was lined with respiratory epithelium. The patient has been free from airway obstruction after surgery and doing well. Laryngeal cyst is an uncommon disease as a cause of infant airway obstruction. Our experience suggested that Laryngoscopy is a useful adjunct for the recognition, diagnosfs, and treatment of laryngeal cyst.
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Yuji Yamamoto, Koichi Hirata, Yoshihumi Shinohara, Toshinori Hirama, T ...
Article type: Article
1995 Volume 31 Issue 5 Pages
831-835
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A case of Hirschsprung's disease associated with imperforated anus was reported. A male newborn baby was transfered to the NICU of our hospital because of anorectal malformation. The next day a sigmoid colostomy was performed under a diagnosis of high imperforated anus. At about 6 months of age, he developed mild constipation and symptoms of enterocolitis. A barium enema revealed a caliber change on the transverse colon. Biopsy from the portion of the colostomy showed aganglionsis. He has been had a conservative treatment another 8 months. At age of 18 months, ileostomy was placed on 15 cm oral portion from the cecum. Aganglionosis started at the hepatic flexure of the transverse colon. A age of 23 months, anoplasty and modified Soave operation was perforemed by an abdomino-perineal approach.
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[in Japanese]
Article type: Article
1995 Volume 31 Issue 5 Pages
836-842
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[in Japanese]
Article type: Article
1995 Volume 31 Issue 5 Pages
843-844
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[in Japanese]
Article type: Article
1995 Volume 31 Issue 5 Pages
845-847
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Article type: Appendix
1995 Volume 31 Issue 5 Pages
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Article type: Appendix
1995 Volume 31 Issue 5 Pages
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Article type: Cover
1995 Volume 31 Issue 5 Pages
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