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1996 Volume 32 Issue 7 Pages
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1996 Volume 32 Issue 7 Pages
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1996 Volume 32 Issue 7 Pages
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1996 Volume 32 Issue 7 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 7 Pages
1048-1065
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1996 Volume 32 Issue 7 Pages
1066-1072
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Yasuharu Ohno, Yoshio Zaizen, Sachiyo Suita
Article type: Article
1996 Volume 32 Issue 7 Pages
1073-1077
Published: December 20, 1996
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In order to analyze the levels of the myclosuppression induced by the recently developed intensive chemotherapy and the standard chemotherapy, we compared the hematologic data before and after each chemotherapy and the contents of the supportive therapy employed. Since 1990, 38 children with malignant solid tumors newly received 196 courses of chemotherapeutic regimens. The regimens were divided into three groups according to the intensity as follows, non-intensive, moderate and intensive groups. In each group, the hematologic data were significantly decreased after chemotherapy. The level of inclination was remarkably more prominent in the intensive group than in others. The average leulocyte count was 436/micro L and the platelet count 3.4×10^4/micro L after chemotherapy. The average interval to full recovery from the myelosuppression was significantly shortened using human granulocyte stimulating factor. We emphasize the importance of the application of the recently advanced hematologic supportive therapy, including recombinant human granulocyte colony-stimulating factor and peripheral blood stem cell autotransplantation.
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Masayuki Ohbatake, Yasuyuki Higashimoto, Naruaki Mouri, Shigeteru Oka, ...
Article type: Article
1996 Volume 32 Issue 7 Pages
1078-1083
Published: December 20, 1996
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From July in 1994 to February in 1996. 11 children underwent 31 times of balloon dilatation, using the polyethylene terephthalate (PET) balloon dilator which is of low compliance and of high pressure tolerance. Eleven patients include 5 with esophageal anastomolic stricture after tracheoesophageal fistula operation, one with anastomotic stricture of the esophagus after diverticulectomy of the esophagus. 2 with the congenital esophageal stenosis, one with esophageal stricture due to endoscopic injection sclerotherapy, one with the hypertrophic pyloric stenosis after operation of omphalocele and one with pyloric stricture due to duodenal Crohn's disease. The symptoms completely relived in 9 patients, but not in 2 patients. No significant complications were noted. Based on our experiences, the PET balloon dilator applied through an endoscope was found preferable because of the safe dilatation made under direct vision. But for small children with short gastrointestinal tract, a 8cm PET is too long to be detected the lesion by an endoscope. A 4cm PET balloon dilator is recommended for small children.
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Yoh Horimoto, Hitoshi Yoshioka, Akira Suzuki, Shinji Fujino, Akiko Kur ...
Article type: Article
1996 Volume 32 Issue 7 Pages
1084-1087
Published: December 20, 1996
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We compared the frequency of using laryngeal mask airways (LMAs) during general anesthesia for these 3 years in order to reevaluate the clinical usefulness of LMAs, The frequency was decreased from 19% in 1992 to 8% in 1995. We had experienced some definite disadvantages such as hypercardia due to insufficient ventilation, high risk of aspiration due to inflated stomach, and the necessity of skillful removal of LMAs after awaking from anesthesia to prevent vomiting. Furthermore tracheal intubations without muscle relaxants were possible relatively easily in sevoflurane anesthesia. From these viewpoints LMAs were considered to be used less and in more older children (from 70 months to 77 months) and longer time surgery (from 43 min. to 28 min.) during the latter period in Shizuoka Children's Hospital. We concluded LMAs should be applied in more selected cases to prevent complications.
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Koji Aoyama, Koji Kumori, Takahumi Goto, Takasi Akiyama, Yoshinobu Iwa ...
Article type: Article
1996 Volume 32 Issue 7 Pages
1088-1091
Published: December 20, 1996
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A newly invented intraumbilical skin incision was successfully applied for pyloromyolomy in three patients with hypertrophic pyloric stenosis. The incision was placed on the upper 3/4 circumference 1mm inside along the umbilical margin. Pyloromyotomy was performed in the abdominal cavity in all patients. The operation left almost undetecteble scar and cosmetic result was satisfactory. No patients experienced undesirable events postoperatively.
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Masanori Uchiyama, Makoto Iwafuchi, Yukio Matsuda, Masafumi Naito, Min ...
Article type: Article
1996 Volume 32 Issue 7 Pages
1092-1096
Published: December 20, 1996
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Anal transplantation, so called Potts' procedure, was performed in 40 cases of anovestibular fistula as one of low types of female anorectal malformations. This paper describes results of the operation, management of bowel movement. Regarding age at operation, before 1980. Potts' operation was performed in various ages, 6 cases from neonate to 2 months, 11 cases from 3 to 12 months, and 6 cases over 1 year of age. In addition, in 8 of these patients, colostomy was constructed because of misdiagnosis of the type. In these 23 patients, postoperative complications were observed in 6 cases (recurrent anoveslibular fistula, 4 cases ; mucosal prolapse. 1 ; and anal stenosis, 1) . For the 4 patients with recurrent fistula, under colostomy, fitulectomy was done in 3 at the age of 7 months, 2 and 3 years respectively, and in 1 patient Soave procedure was done at 22 years of age. Anoplasty for stenosis and sliding skin graft operation for prolapse were done at 4 years and 17 months of age, respectively. From 1981, technique of diagnosis, management, care of bowel movement were established, and in all the 17 patients, Potts' procedure was performed in a relatively limited range age from 5 to 10 months (mean ; 7.6 months old) under the colonic preparation and intravenous alimintation without colostomy. There were 2 recurrent fistulas and 1 anal stenosis. Fistulectomy (vestibulo-anal pull-through method) was performed for recurrent fistula at the age of 3 and 6 years of age under IVH without colostomy, after these patients obtained sense of defecation. Anoplasty was done for stenosis at 4 years of age. Regarding bowel habit, in recent 20 postoperative patients who underwent Potts' procedure in infantile period and whose age was more than 5 years, 12 cases (60%) acquired a good bowel control by postoperative cares like bougie, laxatives and enema until they were 3 years old, and 90% of patients did until they were 5 years old.
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Shigeru Ueno, Seishichi Yokoyama, Jinichi Soeda, Hitoshi Hirakawa, Tom ...
Article type: Article
1996 Volume 32 Issue 7 Pages
1097-1103
Published: December 20, 1996
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On reconstructing infrapelvic structure in patients with imperforate anus, it is essential to pull the anorectum through correctly. To apprehend the ideal pull-through route stereoscopically, three-dimensional images of the pelvic structure were obtained after processing MR images from 10 patients with the anomaly and 7 controls. In controls, the infrapelvic muscle structure, which is composed of bilateral superficial perineal muscles, levator muscle complex and sphincter muscle complex, was demonstrated to converge at the center. The rectum was shown stereoscopically to descend through this central portion of the muscle, making an anoreclal angle to reach the anal orifice. In those with a low-type anomaly, the rectum was shown to descend in front of the levator muscle complex and the fistula ran through the anterior portion of the sphincter complex without making an anorectal angle. The purpose of the anoplasty for those patients was considered to make a correct anorectal angle. In those with a high-type anomaly, three-dimensional position of the rectal pouch was visualized within the normally-positioned muscle complex but the sphincter muscle was thinner than control patients. For the ideal anoplasty in those patients, the rectum should be conducted into the center of the muscle complex and pulled through in the midst of the thin sphincter mass after making an anorectal angle. Anoplasty procedures should be reevaluated whether they are good for making an ideal pull-through route by three-dimensional images of the infrapelvic organs.
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Yoshihiro Kabasawa, Masami Ishikawa, Takao Okamatsu
Article type: Article
1996 Volume 32 Issue 7 Pages
1104-1109
Published: December 20, 1996
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Diagnosis of midgut volvulus in intestinal malrotation is critical for decision making in treatment strategy. In this paper, we stress that ultrasonography is very useful for a diagnosis of midgut volvulus in urgent setting. "Whirlpool sign" of the superior mesentric vein, intestine and mesentry sorrounding the superior mesentric artery is showed in the present cases. Urgent laparotomy shoud be done when this finding was detected by ultrasonography.
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Shun-ichi Makino, Shigeru Matuzaki, Hiroo Uchida, Mituhiro Ito, Kazuki ...
Article type: Article
1996 Volume 32 Issue 7 Pages
1110-1114
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It is very important to improve the fecal and urinary incontinence in patients with the meningomyelocele. We tried to recover the normal sensitibity of peri-anal region using a sensory flap application. We present an operative technique and a result in 5 years old male patient. An inferior gluteal thigh flap from right lower extremity was used. Two third of peri-anal skin was excised, and replaced by this flap. This flap is supplied by the descending branch of the inferior gluteal artery and innervated by the posterior femoral cutaneous nerve. The sensation of the flap was maintained postoperatively, so two third of peri-anal region was functioned as a skin with sensation. Patient could obtain a skin sensation for stools after bowel movements. He is expected to have a better management of his problem about bowel habits by an improved peri-anal skin sensation.
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Tamotsu Tanaka, Hiroyoshi Mizote, Kimio Asagiri, Tomomitsu Tsuru, Yosh ...
Article type: Article
1996 Volume 32 Issue 7 Pages
1115-1120
Published: December 20, 1996
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Congenital cystic adenomatoid malformation (CCAM) of the lung is a relatively rare congenital pulmonary cystic disease. We have experienced a case of CCAM of the lung complicated by an isolated extralobar pulmonary sequestration in a 0-day-old girl. Fetal ultrasonography showed a multiple cystic lesion of the right lung at the 25th gestational week. She developed no symptom after birth. A multiple cystic lesion In the lower portion and a solid mass like lesion in the posterior middle portion of the right lung were Identified on chest X-rays, CT, and MRI. The right lower lobectomy and the extirpation of the mass like lesion were performed at 27th day of age. The mass like lesion had an inherent artery, a drainage vein and pleura, but not communicated with normal bronchus. Clinical diagnosis was extralobar pulmonary sequestration and pathologically diagnosed as a CCAM Stocker type I. Multiple cystic lesion was base of the right lower lobe and pathologically diagnosed as a CCAM Stocker type II.
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Minoru Kuroiwa, Shiro Matsuyama, Norio Suzuki, Atsushi Takahashi, Hito ...
Article type: Article
1996 Volume 32 Issue 7 Pages
1121-1125
Published: December 20, 1996
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A fragmented catheter was accidentally migrated to the right heart in a 5-year-old girl with Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS) . Breakage of the catheter occurred by the attempted flushing to restore catheter function. Eight hours later, this fragmented catheter was uneventfully extracted with a stone basket via right internal jugular vein. Our experience suggests that forced irrigation of occluded catheter may result in catheter rupture and/or catheter embolism.
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Katsutoshi Miyauchi, Hiroshi Takahashi, Shigeharu Ueda, Kanji Kawachi
Article type: Article
1996 Volume 32 Issue 7 Pages
1126-1130
Published: December 20, 1996
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We described a case of familial occurrence (father and son) of Hirschsprung's disease. The father, born in 1971, had the radical operation (Swenson procedure) at the age of 8 months in another institution. The level of aganglionosis reached up to the sigmoid colon. The son, born in 1995, had right transverse colostomy at 6 days after birth. At 3 months, he was operated on with the modified Duhamel-Ikeda procedure. The level of aganglionosis extended up to the middle of the transverse colon. Hirschsprung's disease is characterized by the relatively high incidence of familial occurrence, but a few cases of father (mother) and son (daughter) have been reported. We collected 7 cases among 3 families in Japan and 51 cases among 23 families in other countries. The incidence was 42% (11 cases) in the affected fathers and 58% (15 cases) in the mothers. The incidence in the affected mother was higher than that in sporadic cases. Regarding to the length of aganglionosis, the involved length was likely longer in the children than the one in their affected parents.
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Kanae Tawarava, Ushio Yazaki, Kazunori Ohama, Hiroshi Shimizu, Kazuhik ...
Article type: Article
1996 Volume 32 Issue 7 Pages
1131-1135
Published: December 20, 1996
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A Child with traumatic intramural hematoma of the duodenum is presented. The hematoma regressed spontaneously without surgical intervention, even though it was a huge one. A 8-year-old girl fell down on the saddle of a bicycle and had a blunt trauma to her upper abdomen. Two days after the trauma, she was referrd to our hospital because of abdominal pain and bile-stained vomit. Abdominal sonography and CT demonstrated a huge mass, 10×8×4cm in size, in upper abdomen and complete obstruction was noted in the second portion of the duodenum on the upper GI series. After diagnosing a traumatic intramural hematoma of the duodenum, we started a conservative therapy including continuous nasogastric suction, and total parenteral nutrition and strict bed rest. The symptoms improved in a couple of days, but massive gastric juice was suctioned until the 17th hospital day. The size of the hematoma did not change for two weeks, then it shrank rapidly and disappeared on the 26th day. We started per oral feeding on the 17th day and she left the hospital one month after admission. We recommend a conservative therapy as the first choice of treatment even for a huge traumatic intramural hematoma of duodenum in childhood.
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Tatsurou Tajiri, Sachiyo Suita, Masayuki Kubota, Tomoaki Taguchi
Article type: Article
1996 Volume 32 Issue 7 Pages
1136-1142
Published: December 20, 1996
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We experienced three typical cases of Beckwith-Wiedemann sundrome (EMG syndrome) . In common to three cases, omphalocele was antenatally found. At birth, the large statue for gastational age, the macroglossia and hypoglycemia were recognized. Type of omphalocele was a hernia into the umbilical cords and primary repair was performed on the first post-natal day in all three cases. Degree of hypoglycemia varied considerably among patients and a proper intravenous glucose infusion was necessary in each case. Three cases are alive without development of malignancies and now became 11-year-old, 7-year-old, 8-month-old, respectively. In antenatally diagnosed cases with omphalocele, association of Beckwith-Wiedemann syndrome should be carefully investigated to prevent irreversible hypoglycemia and to follow up the organ carcinogenesis.
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Morihiro Saeki
Article type: Article
1996 Volume 32 Issue 7 Pages
1143-1149
Published: December 20, 1996
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A quetionnaire was sent to and collected from 18 pediatric surgical services for the purpose of analyzing the present status of pediatric surgical education at children's hospitals in Japan. The undergraduate education has not been widely accepted at pediatric surgical institutions because of inactive demands from the source of students, i. e. university, and insufficient educational environment of the hospital. On the other hand, postgraduate education is genarally taken place at the children's hospital. The postgraduate training seems to be of benefit to both the trainee and the hospital. The hospital gives the trainee quite an efficient pediatric surgical training and the trainee serves as the hospital man power.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 7 Pages
1150-
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Article type: Article
1996 Volume 32 Issue 7 Pages
1150-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 7 Pages
1150-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 7 Pages
1150-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 7 Pages
1150-1151
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Article type: Article
1996 Volume 32 Issue 7 Pages
1151-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 7 Pages
1151-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 7 Pages
1151-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1996 Volume 32 Issue 7 Pages
1151-1152
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