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1998 Volume 34 Issue 2 Pages
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Makoto Iwafuchi
Article type: Article
1998 Volume 34 Issue 2 Pages
243-253
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Thom E. Lobe
Article type: Article
1998 Volume 34 Issue 2 Pages
254-260
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The ability to provide surgical care in association with either out-patient or short-stay appears to be cost-effective and appropriate state-of-the-art medical care. As the array of surgical instruments continues to evolve, new and innovative endoscopic procedures will continue to become increasingly available.
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Shoichiro Kamagata, Akira Hayashi, Seiichi Hirobe, Etsuji Ukiyama, Mot ...
Article type: Article
1998 Volume 34 Issue 2 Pages
261-267
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Purpose : To evaluate whether systemic pulmonary shunt (SP shunt) is specific to certain lung diseases, we analyzed the angiographic findings of children with bronchopulmonary diseases. Method : Seventy-five angiographies performed during the past 17 years were analyzed with special interest to the anomalous blood supply from the systemic artery to the lung. Results : Forty-one patients had SP shunt, in which anomalous vessels are classified into two types : 1) a large aberrant artery from the aorta, and 2) an artery from the branch of the aorta or vascular blash from the peripheralartery. The former type was seen in congenital lung diseases as pulmonary sequestration or scimitar syndrome, while the latter type was seen both in congenital and acquired lung diseases. Systemic artery-pulmonary artery shunt was detected in 22 (53.7%) of the 42 cases of SP shunt. Conclusion : SP shunt was present both in congenital and acquired lung diseases. In order to clarify the etiology, not only angiography but the pathological findings of the lung and bronchial tree are essential.
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Takashi Sasaki, Kenji Imura, Makoto Yagi, Siro Ishikawa, Takaharu Oue, ...
Article type: Article
1998 Volume 34 Issue 2 Pages
268-273
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The pathology of the placenta in newborns with surgical diseases has been rarely reviewed. In our perinatal medical center, the placenta of both in-born and out-born neonates were examined systematically and the pathological findings were all registered. In order to clarify the relation of placental abnormal findings and perinatal complications in main congenital surgical anomalies, we analyzed medical records gathered from 240 placenta and neonates, including 45 of diaphragmatic hernia, 29 of gastroschisis, 36 of omphalocele, 62 of anorectal anomaly, 50 of intestinal atresia, 10 of meconium peritonitis, and 34 of esophageal atresia. The frequency of premature rupture of membrane was high in neonates with anorectal anomaly or intestinal atresia. Meconium staining of amniotic fluid was frequently noted in neonates with gastroschisis or intestinal atresia. A single umbilical artery was also more often seen in neonates with anorectal anomaly. Macroscopic deposition of meconium and chorioamnionitis of placenta were seen remarkably in neonates with gastroschisis. Cord inflammation was frequently seen only in neonates with meconium peritonitis. It is suggested that the placental inflammation seen in neonates with gastroschisis and meconium peritonitis is related to the pathophysiology of these diseases. Further investigation of placental findings from neonates with congenital anomalies is needed in order to elucidate the pathogenesis of each congenital anomaly.
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Takashi Tsuchioka, Toshio Fujiwara, Yuusaku Kurosu, Masakatsu Sunagawa
Article type: Article
1998 Volume 34 Issue 2 Pages
274-283
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This experiment was designed to evaluate the alterations of hepatic cytoskeleton (actin and tubulin), associated proteins (α-actinin and MAP-1) and intercellular adhesion molecule (ICAM-1) caused by total parenteral nutrition (TPN). We investigated the immunohistochemical changes of hepatocyte and sinusoidal endothelial cells in rats receiving TPN. Sprague-Dawley male rats, each weighing about 200 g, were randomly divided into three groups. Group I (control group) was fed a rat chow diet for 7 days. In group II (TPN group), the rats received 20% glucose, 3.3% amino acids and 0.5% fat solution intravenously as the total parenteral nutrition for 7 days. In group III (endotoxin group), 70% hepatectomized rats received an intravenous injection of endotoxin (Escherichia coli LPS, 1 mg/kg body weight) 48 h after surgery. Six hours after the injection, the rats were sacrificed. Rat liver sections were evaluated under light microscopy and an immunohistochemical staining procedure. In normal liver, actin and α-actinin were stained around the bile canaliculi, whereas tubulin and MAP-1 were weakly stained in the cytoplasm. ICAM-1 reacted weakly with sinusoidal living cells and the portal vessel endothelium. In group II, actin and α-actinin were stained around the bile canaliculi, to a degree higher than that in group I. The degree of staining for tubulin and MAP-1 in the cytoplasm was also increased as compared to group I. The liver receiving TPN revealed a strong expression of ICAM-1 on the sinusoidal living cells. In group III, actin, α-actinin, tubulin, MAP-1 and ICAM-1 were stained identically as group II. These results suggest that the liver dysfunction caused by TPN shows the same immunohistochemical changes as found in endotoxin-induced liver injury.
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Yasuhiko Furuta, Kazuhiro Ohtsu, Yasushi Hinokida
Article type: Article
1998 Volume 34 Issue 2 Pages
284-293
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Lymphangioma in 46 infants and children was treated by intralesional bleomycin injection between April 1979 and December 1996. The evaluations after injecting 45 of 46 patients are reported. Complete clinical resolution was reported for 27 out of 45, an exellent response (>80%) for 10, a good response (>50%) for 7, and no response (<50%) for only one. Totally 44 (97.8%) out of 45 patients had effective results. There were no major complications or side effects. Bleomycin saline solution of 1 mg/ml was injected at a dose of less than 1 mg/kg. Bleomycin was administered four times in 2 weeks as a course. Pulmonary fibrosis is the most serious side effect of bleomycin therapy, and its risk is related to the dose. To prevent pulmonary fibrosis, it is important to keep the serum bleomycin concentration at a low level. In our 13 cases, the peak level of the concentration was under 1.2 μg/ml in each case.
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Takashi Kohtani, Hiroshi Takahashi, Atsushi Horiuchi, Kanji Kawachi, T ...
Article type: Article
1998 Volume 34 Issue 2 Pages
294-299
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Thirty cases of anaphylactoid purpura were analyzed of their symptoms, ultrasonographic findings, and blood biochemical tests in the acute stage. Abdominal symptoms such as pain and vomiting were reported for 60% of the patients. Abdominal symptoms preceded the onset of purpura in 16.7%, and intussuscepiton was observed in 3.3% of all cases. When abdominal pain was seen as the primary symptom, it was generally severe. A long-term followup will be necessary in such cases because abdominal pain is a possible risk factor for nephritis. In cases with late-onset abdominal pain, it was moderate. It is suggested that the ultrasonographic findings and decrease in blood factor XIII activity may be important for the diagnosis of anaphylactoid purpura in cases with abdominal pain.
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Toshihiro Yanai, Kunimasu Ando, Takeshi Miyano
Article type: Article
1998 Volume 34 Issue 2 Pages
300-305
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We report a new treatment for cavernous hemangiomas using a Nd-YAG laser. Four cavernous hemangiomas were treated by percutaneous laser photocoagulation using a fiberprobe inserted into the subcutaneous lesion. Lesions were located on the lower limb, breast, face, and neck. The age of the patients ranged from 3 months to 6 years. All were female. The sizes of the lesions ranged from 4 to 5 cm in diameter. The skin was pierced with an intravenous catheter and a fiber-probe was introduced through this catheter into the subcutaneous hemangioma. Then, the laser was activated (20 W×1-2 s) to coagulate the lesion. The fiber-probe was then passed into another part of the lesion and the process repeated in a fan-like pattern until all areas of the lesion had been treated (5, 000-10, 000 J in total). Each lesion received 2 to 4 treatments. A reduction in the size of the lesion (17-56%) and marked decrease in blood flow to the lesion was obtained for all patients. Complications such as mild burning of the skin, minor infection, disturbance of raising the upper limb, and facial palsy were noted ; however, all have healed spontaneously except for mild residual facial palsy. Percutaneous laser photocoagulation using a fiberprobe is a simple technique and provides a good cosmetic outcome. Therefore, this technique is useful as a treatment for cavernous hemangiomas that are difficult to remove surgically because of the risk of massive bleeding or remarkable scarring.
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Keisuke Nose, Akio Kubota, Takeo Yonekura, Shinji Hirooka, Shozo Ueda, ...
Article type: Article
1998 Volume 34 Issue 2 Pages
306-311
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We roport a case of gastric volvulus associated with asplenia, nonrotation and preduodenal portal vein. An 8-yea-old male with asplenia syndrome (single-atrium, single-ventricle and pulmonary atresia), for which bilateral Blalock-Taussig shut operations had been done, was referred to our hospital because of the sudden onset of epigastralgia and vomiting. An upper gastrointestinal series demonstrated mesenteroaxial volvulus of the stomach, and contrast enema showed nonrotation of the intestine. On the fifth day of admission, an exploratory laparotomy revealed nonrotation of the intestine with the portal vein running ventrally to the duodenum ; however, the gastric volvulus had been restored spontaneously. Anterior gastropexy was perfomed. His post-operative course was uneventful. We reviewed 393 cases of gastric volvulus in children reported in Japanese literature over the past 25 years, out of which 77 cases were reported to have 97 associated anomalies. There were 19 cases of splenic diseases, 15 of diaphragmatic diseases, 14 of malrotation, 9 of cardiac diseases and 8 of hypertrophic pyloric stenosis, etc. Four cases of preduodenal portal vein were reported, of which 4 cases including ours were associated with asplenia and nonrotation. Many of these anomalies can be the causes of gastric volvulus.
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Hideki Shima, Kunimasu Ando, Takao Fujimoto, Takeshi Miyano
Article type: Article
1998 Volume 34 Issue 2 Pages
312-316
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A 19-month-old boy who had had a high-grade fever for several days suffered cervical stiffness. Meningitis was excluded, but soon after, his condition deteriorated and he developed septic shock with pancytopenia and DIC. On admission to our department, a large perianal abscess was noted. Blood chemistry revealed an extremely high CPK of 1, 169 IU/l. An abdominal CT scan demonstrated a subcutaneous swelling extending from the left buttock to the left flank region with a moderate quantity of ascites. The abscess was extirpated and a large amount of pus was drained. A bacterial culture grew Methicillin-resistant Staphylococcus aureus, Candida and Ceracia. After drainage of the abscess, antibiotic and anti-DIC therapies improved his general condition gradually. Colonic fiberscopy revealed no underlying disease such as Crohn's disease. This is the case of necrotizing fasciitis in a child with perianal abscess. Some necrotizing fasciitis still cause high mortality ; therefore, early surgical debridement and antibiotic therapy should be recommended in the treatment of this condition.
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Yoshihiro Ohsawa, Nariaki Mohri, Tsutomu Sugimoto, Yohichirou Oda
Article type: Article
1998 Volume 34 Issue 2 Pages
317-322
Published: April 20, 1998
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Simultaneous gastric rupture and ileal perforation is an extremely rare condition. A premature female infant, with an extremely low birth weight (872 g), who had gastric rupture and ileal perforation associated with meconium disease is reported. She suffered from respiratory distress syndrome at birth and was managed under mechanical ventilation. On day seven, abdominal distension was noted and an abdominal X-ray film showed abdominal free air. During surgery, severe peritonitis due to the gastric rupture on great curvature and an ileal perforation at approximately 12 cm from the ileocoecal valve were found. Only the drainage procedure was performed because of her intraoperative moribund condition. Fortunately both perforations closed spontaneously. Although PDA ligation was required on the 109th day, she was discharged without any complications. The mechanism of gastrointestinal (GI) tract perforations in this patient was discussed. We suspected that both perforations were reduced to high pressure in the GI tract secondary to meconium disease.
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Masashi Kurobe, Yoji Yamazaki, Ryoji Mizuno, Tsuginori Yoshida, Joji Y ...
Article type: Article
1998 Volume 34 Issue 2 Pages
323-326
Published: April 20, 1998
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Ramstedt's pyloromyotomy is the standard curative procedure for infantile hypertrophic pyloric stenosis. The standard approach for pyloromyotomy has been a transverse, right upper-quadrant incision : however, recent reports have described a circumumbilical incision for a better cosmetic result. A 2-month-old baby underwent herniorraphy for an incisional hernia, after a circumumbilical incision which was done at another institution, at the age of one month. We assumed that there might have been some technical problem during the closure of the abdomen or some difficulties in operating in the tiny umbilical area. Circumumbilical incision brings a better cosmetic outcome, but we should take special care when performing this procedure.
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Shinsuke Hata, Makoto Yagi, Masanori Hoki, Takeo Tanaka, Yoichi Hachit ...
Article type: Article
1998 Volume 34 Issue 2 Pages
327-330
Published: April 20, 1998
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We experienced a case of neuroblastoma which showed heterogeneity in histological classification by the Shimada system and the expression of Ha-ras between the primary tumor and metastatic lymph node. The case was an 8-month-old boy with left adrenal neuroblastoma and metastatic lymph node detected by mass-screening. Histological findings of the primary site were favorable according to Shimada classification ; however, the metastatic lymph node was unfavorable. Ha-ras expression at the primary tumor was high (favorable), although low (unfavorable) at the metastatic lymph node. No case of heterogeneity in the Shimada classification and Ha-ras expression between the primary tumor and metastatic lymph node has been reported in Japan, and the cause of the heterogeneity is unclear.
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Takehito Oshio, Masao Hino, Arishige Kirino, Chosei Matsumura
Article type: Article
1998 Volume 34 Issue 2 Pages
331-334
Published: April 20, 1998
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Incarceration of an umbilical hernia during childhood is extremely rare. We recently experienced such a case. A 19-month-old boy was referred to our hospital because of pain and swelling of his umbilicus for nine hours. At three months of age, he was diagnosed as having an umbilical hernia at another hospital. As he had no symptoms except for occasional swelling, he was discharged. On admission to our hospital, he was diagnosed with an incarcerated umbilical hernia. Manual reduction was unsuccessful. One hour later, surgical reduction as well as a radical operation were performed under general anesthesia. The size of the hernia ring was 15 mm in diameter, and the contents of the hernia were a small amount of serous exudate and a strangulated short segment of small intestine with subserosal hemorrhage. The post-operative course was uneventful.
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Takashi Kohtani, Hiroshi Takahashi, Atsushi Horiuchi, Kazuhiro Katuhar ...
Article type: Article
1998 Volume 34 Issue 2 Pages
335-340
Published: April 20, 1998
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We report a case of mesentric hiatus hernia in a neonate, together with a review of the literature in Japan. Our patient was a 2-day-old male who suffered vomiting and tarry stools. Abdominal plain X-ray films of the small intestine showed fluid levels. A strangulated ileus was suspected and an emergency laparatomy was performed. A 25 cm length of small intestine was found to be necrosed due to strangulated obstruction caused by a mesenteric hiatus hernia. The defect in the ileal mesentery measured 2×3 cm, and was located 40 cm from the treminal ileum. About 25 cm of the necrotic small intestine and the defect were resected, and an end-to-end anastomosis was performed. The post-operative course was uneventful. Formerly, some neonatal cases died. This neonatal case was difficult to diagnose preoperatively. It is necessary to take this condition into consideration when treating cases of neonatal ileus, and to take prompt action.
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Keiji Matsubayashi, Yuichi Ueda, Hitoshi Ogino, Takaaki Sugita, Koichi ...
Article type: Article
1998 Volume 34 Issue 2 Pages
341-344
Published: April 20, 1998
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A 9-month-old girl with autoimmune neutropenia, whose preoperative examination revealed antineutrophil antibody and moderate neutropenia without anemia, underwent patch closure of a ventricular spetal defect. Prophylactic granulocyte-colony stimulating factor was administered both preoperatively and post-operatively. It made the neutrophil count increase effectively, and her post-opoerative course was uneventful without any infectious signs. To our knowledge, only one case undergoing open-heart surgery with neutropenia has beeen reported, and our patient is considered to be the first case in which granulocyte-colony stimulating factor was given successfully during the pre- and post-operative open-heart surgery period.
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Kazuhiro Ohtsu, Yasuhiko Furuta, Masanori Miyazaki
Article type: Article
1998 Volume 34 Issue 2 Pages
345-348
Published: April 20, 1998
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A rare ureteric anomaly of congenital ureteral diverticulum is reported. A gril weighing 2, 906 gr was born at 37 weeks' gestation. Her prenatal ultrasonograms revealed a large abdominal cystic mass at 34 weeks' gestation. At the age of 7 days, she was referred to our hospital. An ultrasonography and CT scan revealed a cystic lesion at the pelvis of the left kidney. Percutaneous cystography guided by ultrasonography showed a large cystic mass originating at the congenital ureteral diverticulum of the left upper ureter. At the age of 27 days, she underwent diverticulectomy with resection of the wall of the renal pelivis and ureter, and pyeloplasty by the Anderson-Hynes method. Her post-operative course was uneventful with normal renal function.
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The Japanese Biliary Atresia Society (Secretariat of the Society and R ...
Article type: Article
1998 Volume 34 Issue 2 Pages
349-354
Published: April 20, 1998
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