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Makoto Suzuki, Masahito Kawatani, Tsuyoshi Ozaki, Takao Okamatsu
Article type: Article
1996 Volume 32 Issue 4 Pages
669-674
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Nitric oxide (NO) has been identified as a very important relaxation transmitter for mammalian intestinal smooth muscle, NADPH has been used as a maker for neuronal nitric oxide synthase. In the present study, NADPH histochemical staining was used to identify the distributions and origins of nitric oxide in the intestine and rectum of the aganglionosis rats. Seventeen rats, aged 17-22 days old, were obtained and perfused with 4% paraformaldehyde following pentobarbital anesthesia. The enlarged and trasitional intestine which were from the small intestine, the constricted intestine, and the rectum were processed independently. The parasympathetic ganglia, pelvic ganglia were also isolated from the animals and processed for NADPH. In control animals, mesh network like NADPH was identified in the small intestine, large intestine, and rectum. NADPH was present at soma and axons in the myenteric ganglia. NADPH was present at 70〜90% of the ganglion cells. The cell size measured between 17 and 25 μm. Proximal dendlides were positive. It was present at axons and the most neurons in the ganglia and at axons in the circular muscles. In contrast, NADPH was not identified at the constricted part of intestine of the aganglionosis rats (AGR). Mesh networks of the NADPH at myenteric plexus at the proximal bowel segment from the constricted intestine, which is not different from the control animals. Large bundle of NADPH positive fibers were identified at extrinsic part of the distal end of the colon and rectum of the AGR. In both AGR and control animals. NADPH positive neurons were identified from the pelvic ganglia which innervate urinary bladder and colon. These results suggested that the constriction of the intestine at the AGR might be due to lack of NO activities.
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Yoshinobu Matsuo
Article type: Article
1996 Volume 32 Issue 4 Pages
675-685
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To evaluate the effect of dietary fiber "pectin" on mucosal hyperplasia following massive small intestinal resection, the following models were designed in rats, 1) Proximal intestinal resection by 90% and end to end duodenoileostomy (group I) 2) Distal intestinal resection by 90% and end to end jejunocecostomy (group II). In each group rats were subdivided into two subgroups according to the enteral formula administered, one subgroup with an elemental diet (a subgroup) and another subgroup with an elemental diet supplemented with 1% (w/v) pectin (b subgroup). Specimens were obtained from the duodenum and residual intestine two weeks after operation. The mucosal hyperplasia was evaluated by measuring the variables including villous height, crypt depth, total mucosal thickness, DNA contents, protein contents as well as wet weight per segment. In Group I, all parameters in the duodenum were significantly higher in b subgroup compared with a subgroup. However, they didn't differ significantly beween two subgroups in Group II. These results indicate that supplementation of dietary fiber to an elemental diet has a favorable effect on the adaptive hyperplasia of duodenum following massive small intestinal resection and that ileum might play an important role for the effect.
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Masahiro Tanji, Fumio Iwaya, Tsuguo Igari, Takashi Ono, Tomohiro Ogawa ...
Article type: Article
1996 Volume 32 Issue 4 Pages
686-691
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During a 10 year period, 11 infants including 6 neonates underwent surgical repair of coarctation of the aorta. A ventricular septal defect was present in all but one patient with dextrocardia. 10 patients underwent two-stage repair and one patient underwent one-stage repair. Of the 10 patients with two-stage repair, 4 had pulmonary artery banding. Of the 6 patients without pulmonary artery banding, 3 were less than 0.5 of Pp/Ps and their VSDs became smaller or closed spontaneously. The other 3 patients with greater than 0.8 of Pp/Ps required intracardiac repair before extubation of the tracheal tube. There was one hospital death with left ventricular outflow tract obstruction and hypoplastic aortic arch. All patients with pulmonary artery banding were able to undergo elective intracardiac repair after extubation of the tracheal tube. One patient with one-stage repair was low risk preoperativley and did well postoperatively. We suggest that two-stage repair with pulmonary artery banding be performed in high risk patients.
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Toshiki Ohya, Susumu Tsunoda, Keijiro Sruga, [in Japanese], Takeshi Mi ...
Article type: Article
1996 Volume 32 Issue 4 Pages
692-696
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Needle liver biopsy was carried out on 10 patients with biliary atrtesia after portoenterostomy. Their age at needle liver biopsy was 0.8-16 years of age, and all these patients have either persistent janudice or severe portal hypertension. Two specimens were taken in each patient from one site to two different direction under ultrasound guide. When we compared the specimen with that taken at first portoenterostomy. all patients showed progressive liver fibrosis and all but one presented decreased number of interlobular bile ducts. Paucity of the bile duct was seen in three patients, even though one of them has no jaundice. One patient showed very different picture in the two specimens, one showed mild liver fibrosis with paucity of bile duct, and another showed severe liver fibrosis with almost normal number of interlobular bile duct. This indicates that changes of the liver is not homogenoeous, and needle liver biopsy does not always reflect real liver condition, accordingly, special attention is required at the interpretation.
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Toshihiro Yanai, Hiroshi Shimomura, Takeshi Miyano
Article type: Article
1996 Volume 32 Issue 4 Pages
697-701
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A case of urethral duplication at the dorsal side of the penis is reported. Definition, pathology, classification, clinical features, diagnosis, complicated anomaly (especially, imperforate anus), management of the urethral duplication are discussed. A 4-year-old boy was hospitalised because of persistent pus adhesiveness on the glans penis. Local examination revealed normal shaped phallus with two openings, and the abnormal opening located dorsal to the normal urethral orifice. Voiding cystourethrography and fisterography demonstrated a blind channel, which ran paralle1 and had no communication to the normal urethra. The accessory urethra, 3 cm long, was surgically removed. The superficial part of the sinus was lined with squamous epitherium, and the deeper part with transitional epitherium, surrounded by smooth muscle.
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Hiroyoshi Kawate, Shimpachi Ishizone, Mitsuhisa Okura, Yoshitaka Momos ...
Article type: Article
1996 Volume 32 Issue 4 Pages
702-707
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Heterotopic gastric mucosa in the small bowel, exclusive of Meckel's diverticulum or duplication of gastrointestinal tract, is exceedingly rare. A case of thirteen months old boy, who had heterotopic gastric mucosa in the ileum, which caused ileo-ileal intussusception was reported. At lapalotomy nodular tumor (1.5 × 1.5cm) was found on the antimesenteric border of the ileum, about 80cm oral from the ileocecal valve. A 10cm segment of ileum was resected and end-to-end anastomosis was performed. The lesion. 1.5 × 1.5cm, was nodular in shape with sharp circumscription. Histologically, the tumor consisted of gastric prepyloric glands. Review of the literature revealed only 31 other patients with heterotopic gastric mucosa without an associated anatomic anomaly in the small bowel of the distal portion from the ligament of Treitz. Eighteen of these patients had intussusception. Among 19 cases including the present case, 9 cases were located in the jejunum and 10 cases were in the ileum. The lesions in the intestinal wall of 6 cases were found in the mesenteric border, and 7 in the antimesenteric border. The sex incidence was even. The ages of the patients ranged from 3mo to 32yr, although 16 patients (84%) were 16yr old or less, and the average age was 11.1 years.
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Hideki Tomiyama, Takashi Shimotake, Jun Yanagihara, Naomi Iwai, Eiji Y ...
Article type: Article
1996 Volume 32 Issue 4 Pages
708-711
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A case of left congenital diaphragmatic hernia (CDH) associated with myeloschisis was reported in this paper. A female baby, birth weight 2199g, was delivered by a cesarean section in 37th week of gestation. The baby whose prenatal ultrasonography had shown severe hydrocephalus was further diagnosed as having two myeloschisis (Th5, Th10-L5) at birth. She showed respiratory insufficiency 26 hours after birth, and chest X-ray showed intestinal gases in the left thoracic cavity. At two days of age, left diaphragmaic hernia (Bochdalek) was repaired by trans-abdominal approach under general anesthesia. Additionally, the baby underwent repairs of myeloschisis using skin flap method at 7 days, and a ventricular-peritoneal (VP) shunt operation at 11 days of age, respectively. The postoperative course was uneventful. In the case reported here, (1) the proneposition management of patient to prevent poor circulation or infection to the back wounds, and (2) the limitation of skin incision for CDH repair within the anterior abdominal wall to deliver wide-ranged skin flap were needed in the perioperative course.
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Yutaka Kuriyama, Kenji Kawamura, Tadashi Matsunaga, Hiroshi Horie
Article type: Article
1996 Volume 32 Issue 4 Pages
712-716
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We report a 3-year-old boy who presented with dysphagia since he was 7 months old. Barium swallow examination revealed the presence of a stenosis at the lower end of a dilated esophagus. Manometric study showed findings closely mimicking esophageal achalasia, such as intra-esophageal pressure higher than that of the gastric fundus, no relaxation of the lower esophageal sphincter upon stimulation with cold water, and positive methacholine test. Esophageal achalasia was suspected preoperatively. During operation, we found small nodules in the lower esophageal wall, and intraoperative pathological examination revealed tracheobronchial remnants in them. Resection of the lower esophageal stricture, end-to-end anastomosis, and anti-reflux operation were performed. Postoperative pathological examination revealed not only bronchial cartilage and bronchial glands in the esophageal wall, but also degeneration of ganglion cells of myenteric nerve plexus. Because dysphagia disappeared, and esophageal motility improved postoperatively, the esophageal achalasia-like motility disorders were thought to be secondary to the congenital esophageal stenosis due to trancheobronchial remnants. Prior Japanese literatures report some cases of congenital esophageal stenosis due to tracheobronchial remnants accompanied with esophageal achalasia-like motility disorders. If preoperative diagnosis is uncertain, it is important to feel out nodules in the lower esophageal wall during operation.
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Syuichi Ashizuka, Morihiro Saeki, Toshirou Honna, Miwako Nakano, Tatsu ...
Article type: Article
1996 Volume 32 Issue 4 Pages
717-721
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From 1966 to 1994. Meckel's diverticula were confirmed at laparotomy in 84 children in our hospital. Of the 47 symptomatic patients, 28 had bleeding episodes. ^<99m>Tc-pertechnetate scintigraphy revealed positive results in 17 (74%) out of the 23 patients examined. Ectopic gastric mucosa was present in the wall of the diverticulum in all these 17 positive cases. More than 2 examinations were required to get the proper postive scans in 8 of the 17 positive cases. In the other 4 (17%) cases, scintigraphy was completely negative (false negative). In order to decrease these false negative scintigraphy, we recommend that a repeat ^<99m>Tc-pertechnetate scintigraphy. if there is a storng clinical suspicion of Meckel's diverticulum. Furthermore, previous literature says that the use of pentagastrin, cimetidine and glucagon may increase the concentration of the radioisotope in the diverticulum.
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Naruaki Mouri, Yasuyuki Higashimoto, Shigeteru Oka, Masayuki Ohbatake, ...
Article type: Article
1996 Volume 32 Issue 4 Pages
722-726
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Case 1 was a 6-year-old male, who was referred for several anemia due to continuous bleeding from a giant gastric polyp. During hospitalization, the polyp caused gastric outlet obstruction, which necessitated laparotomy for resection of the polyp. Case 2 : A 13-year-old female, who had undergone an endoscopic polypectomy for the gastric and descending colon polyps at 12 years of age. She was admitted for intermittent abdominal pains. She underwent partial resection of the inlussuscepted segment of jejunum and excision of polyps grossly recognized in the rest of the small intestine. One year and 3 months after the surgery. UGI series performed for recurrent abdominal pains revealed polyps in the jejunum. Based on our experience, regular endoscopic examination and endoscopic polypectomy are important to minimize open surgery before the polyps of stomach and colon become too big for endoscopic procedures. When surgical intervention is necessary, we recommend total investigations of all intestinal tracts for polyps, using intraoperative endoscopic extirpation, in order to avoid multiple laparotomies in patients with Peutz-Jeghers syndrome.
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Motoi Mukai, Akira Hayashi, Shoichiro Kamagata, Haruo Ishida
Article type: Article
1996 Volume 32 Issue 4 Pages
727-731
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A case of congenital dumb-bell neuroblastoma was reported. She had completely flaccid and areslexic legs at birth. MRI and CT revealed a huge mass in the right retroperitoneal region, which extended into the spinal canal and compressed the spinal cord from the level of Th 11 to L5. The diagnosis of neuroblastoma was made by biopsy taken from her right back tumor. The spontaneous tumor regression was recognized before treatment on the 30th day after birth. The chemotherapy (vincristine 0.75mg/m^2 and cyclo-phosphamide 150mg/m^2 given alternately every one week) was started on the 33rd day after birth and the tumor disappeared four months later. Although her neurological problems were improved with the tumor regression, significant deficits of motor nerves below the level of Th 12 and of sensory nerves below that of L3 have remained. Neurogenic bladder was also her major problem. Her neurogenic outcome would not be improved despite the emergency laminectomy, because irreversible damage had already occurred before birth. Furthermore, the deformity and instablity of spinal column following laminectomy have been reported. From these findings, we concluded that laminectomy should not be indicated in the patients of congenital dumb-bell neuroblastoma with flaccid paralysis.
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Atsushi Takahashi, Shiro Matsuyama, Norio Suzuki, Minoru Kuroiwa, Hito ...
Article type: Article
1996 Volume 32 Issue 4 Pages
732-736
Published: June 20, 1996
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We treated an infant with a peculiar form of battered child syndrome. A boy weighing 2,504g was born at 34 weeks of gestation. The baby's APGAR score was 2 (1 min) and 4 (5 min). The baby was followed in our hospital due to hypoxic-ischemic encephalopathy occurred at birth. At the age of five months, the baby began to have a fever, vomiting and abdominal distension, and was then admitted to our institution. Three days after the onset, the baby's mother confessed to have abused her baby. The kind of abuse was a peculiar form: the infusion of a cleaning agent containing strong acids into the distal colon from the anus. The colon, contacted with the agent, exhibited a cicatricial stenosis. The stenotic colon was resected and colon anastomosis was done 2 months after the abuse. The abuse may have been caused by the mother's nursing neurosis, her mental depression and the baby's encephalopathy. To prevent a recurrence of abuse, we performed a psychiatrical treatment of the mother's mental depression and stress, and provided a guidance for her family to lessen her stress. Although the mother is nursing the baby at home now, there has been no recurrence of abuse over 1.5 years follow-up period.
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Mikito Yasudo, Toshiyuki Katogi, Ryo Aeba, Tsukasa Nakamichi, Shiaki K ...
Article type: Article
1996 Volume 32 Issue 4 Pages
737-740
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A 10 year-old girl, who had underwent transaortic patch closure of aorto-pulmonary window 10 years before, was admitted with hypertension of right upper extremity. This phenomenon known as Coanda effect, is one of the characteristic symptoms of supravalvular aortic stenosis. She underwent single sinus patch aortoplasty. The postoperative course was uneventful and hypertension observed in right upper extremity disappeared perfectly after operation. Transverse aortotomy to repair aorto-pulmonary window with patch closure might cause a severe stenosis to make a jet stream of Coanda effect.
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[in Japanese]
Article type: Article
1996 Volume 32 Issue 4 Pages
741-745
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 4 Pages
746-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 4 Pages
746-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 4 Pages
746-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 4 Pages
746-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 4 Pages
746-747
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 4 Pages
747-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 4 Pages
747-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 4 Pages
747-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 4 Pages
747-748
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
Article type: Article
1996 Volume 32 Issue 4 Pages
748-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 4 Pages
748-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
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1996 Volume 32 Issue 4 Pages
748-
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