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1998 Volume 34 Issue 7 Pages
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Junichi Yamanaka, Stephen Lynch, Russell Strong, Tat H. Ong, Praga Pil ...
Article type: Article
1998 Volume 34 Issue 7 Pages
1145-1151
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From 1985 to 1995, 153 children received 176 liver grafts, including 109 reduced-size liver grafts (RLGs) and 67 whole liver grafts (WLGs), at the Queensland Liver Transplant Service, Brisbane, Australia. Twenty-eight children (18%) were less than one-year-old at the time of transplantation. Retransplantation was performed on 21 children (14%). The 1, 5, and 10-year patient survival rates were 88, 75, and 70%, respectively. There were no differences in patient or graft survival rates between transplants using RLGs and WLGs. Major causes of post-trans-plant mortality were sepsis (32%), hemorrhage (16%), and rejection (14%). Portal vein thrombosis, hepatic artery thrombosis, and biliary complication were experienced in 8, 7, and 16%, respectively. Post-transplant gastrointestinal perforation occurred in 15% of the cases that underwent previous laparotomy. Of the 115 children surviving more than one year postoperatively, 111 (97%) were well and leading normal active lives with normal liver function. Growth and development of the children were essentially normal after one year posttransplant, with growth at a normal rate in 92% and remarkable catch-up in 5%. Liver transplantation provides a cure and normal development for children with end-stage liver disease. The establishment of life-long follow-up for recipients is expected to warrant better long-term survival.
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Akihiro Higuchi, Kazuharu Nagao, Yukio Matsuoka
Article type: Article
1998 Volume 34 Issue 7 Pages
1152-1154
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In the operation of communicated hydrocele testis, excision or opening of the hydrocele has been performed everywhere. However, exposing hydrocele in the inguinal canal can be difficult when it is located in the scrotum. During the period of 1992 to 1996, 66 cases of hydrocele underwent operation which consisted of simple ligation of the comunicated hydrocele and needle aspiration of the hydrocele via the scrotum. No recurrence was seen in all cases. These observations suggest that neither excision nor opening of the hydrocele are necessary if aspiration is done.
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Masahiro Chiba, Yutaka Sanada, Yuuko Tsunoda, Yasuo Yosizawa, Hiroshi ...
Article type: Article
1998 Volume 34 Issue 7 Pages
1155-1161
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Hormonal factors act as major mediators of enterocyte proliferation. Among them, epidermal growth factor (EGF) and insulin-like growth factor 1 (IGF-1) show convincing evidence of enterotrophic aciton. However, the role of glicentin on enterocyte proliferation is still unclear. We have established an in vitro bioassay system for determining the growth activity of recombinant human glicentin on a human small-intestinal epithelial cell line (INT-407) under serum-free conditions. The INT-407 cell line was serum-deprived for 4 days, and then treated with a medium containing one of the following : glicentin (100 pg/ml, 1 ng/ml, 10 ng/ml, 100 ng/ml, 1 μg/ml, 10 μg/ml), EGF (1 ng/ml), 10% fetal bovine serum (FCS), or no growth factors (control). We investigated enterocyte proliferation using the MTT assay 24 and 48 h after the application of growth factors. For the determination of DNA synthesis, we measured the ELISA-BrdU assay after 24 h. The results were expressed as a growth stimulation ratio (GSR) and then compared. Glicentin demonstrated significant proliferative effects in doses ranging from 10 ng/ml to 10 μg/ml, and also showed a parallel dose-response curve in doses less than 1 μg/ml. The maximum growth activity of glicentin was approximately 120% of that in the control and approximately 60% of that in FCS, which was equivalent to the effects of EGF. There resluts suggest that glicentin seems to play the role of a growth factor which promotes enterocyte proliferation.
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Naobumi Endo, Iwao Kaneda, Toshiro Kazama
Article type: Article
1998 Volume 34 Issue 7 Pages
1162-1166
Published: December 20, 1998
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Background : Laparoscopic appendectomy (LA) has gained wide acceptance in clinical pactice in the field of general surgery, However, the precise efficacy of laparoscopic procedures is still controversial in pediatric patients, particularly in children with complicated appendicitis. This study was undertaken to compare the results of laproscopic versus conventional open appendectomy (OA). Methods : A retrospective review of children with acute appendicitis who received laparoscopic surgery or conventional surgery from January 1995 to July 1998 was performed. Results : Ninety-four cases were identified. Sixty-two children underwent LA and thirty-two underwent OA. Operating time was approximately thirty percent longer for LA, especially in the complicated cases. The length of hospital stay and recovery of bowel function tended to be short with LA, but there was no significant difference between LA and OA. The complication rate after LA, such as wound abscess and dehiscence, was significantly lower. Postoperative intraabdominal abscess as a major complication developed in one child from each group. Conclusion : The findings suggest that LA should be considered over OA for children with complicated appendicitis. LA still has advantages over OA because the frequency of postoperative complications is lower, and treatment is safe.
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Misako Hirai, Michio Kaneko, Haruo Ohkawa, Akira Nakagawara, Masanao M ...
Article type: Article
1998 Volume 34 Issue 7 Pages
1167-1174
Published: December 20, 1998
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Purpose : Comparative Genomic Hybridization (CGH) is a genome-wide study on DNA copy number abnormalities (gain and loss) which represent DNA amplification and deletion, respectively. The aim of this study was to evaluate CGH as a sensitive method for the screening of genetic imbalances in neuroblastomas in relation to other prognostic factors like MYCN amplification and 1p LOH. Methods : Forty-five neuroblastomas were examined by CGH. In addition, Southern blot and fluorescence in situ hybridization (FISH) of MYCN gene, and loss of heterozygosity (LOH) of 1p were performed. Results : DNA copy number changes detected in infant cases were significantly lower than that detected in advanced cases with bone metastasis. MYCN amplification and 1p LOH were detected as 2p gain and 1p loss in CGH, respectively. DNA copy number changes in CGH were fully consistent with the results of Southern blot, FISH and LOH analyses. The most frequent partial chromosome gain was on 17q (21 out of 45 cases), and a gain was detected in all stage 4 cases. The most frequent partial chromosome loss was on 11q (10 out of 45 cases). 14q loss was not detected by CGH. Conclusions : The present study shows that CGH enables considerably rapid detection of known prognostic factors and that it is a useful technique to elucidate previously unknown genetic changes in neuroblastoma.
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Hiroshi Nemoto, Masahiro Nagaya, Osamu Murahashi, Junji Kato, Norihiro ...
Article type: Article
1998 Volume 34 Issue 7 Pages
1175-1179
Published: December 20, 1998
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The patient, an ten-year-old boy, was first admitted to the hospital at the age of 4 because of progressive anemia and splenomegaly, and diagnosed to have extrahepatic portal hypertension. He was treated with repeated endoscopic sclerotherapies (EIS) to esophageal varices and a partial splenic embolization (PSE) to hypersplenism for a subsequent four years. It gradually became difficult to control his refractory hemorrhagic episodes with palliative interventions. At the age of eight, splenorenal shunt with splenectomy was selected as a surgical intervention to control gastrointestinal bleeding. After that, he has been apparently well without any signs of encephalopathy. We think that the surgical approach consisting of porto-systemic shunting and splenectomy is one of the definitive maneuvers for patients with refractory hemorrhagic complications after EIS and PSE, especially in children more than 6 years old.
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Tsukasa Nakama, Morito Kinjo, Tadao Kugai, Toru Sunagawa, Nobumitu Tam ...
Article type: Article
1998 Volume 34 Issue 7 Pages
1180-1185
Published: December 20, 1998
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An 11-year-old boy with bilateral pheochromocytomas was treated using predeposited autologous blood transfusion (PABT). We used the α-, β-blocking agents for the preoperative management. Before surgery, his blood was donated at weekly intervals, with the last unit withdrawn one week prior to the operation. The volume of blood withdrawn at each donation was 200ml. The total volume collected was 1, 000ml. Hypotension due to the removal of the tumor was successfully treated by PABT. The catecholamine levels of the donated plasma were elevated. PABT containing high amounts of the catecholamine might be effective in controlling hypotension after extirpation of the tumor. However, such patients should be observed carefully because they are still at a high risk for developing hypotension after surgery.
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Minoru Kuroiwa, Norio Suzuki, Atsushi Takahashi, Hitoshi Ikeda, Shiro ...
Article type: Article
1998 Volume 34 Issue 7 Pages
1186-1189
Published: December 20, 1998
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Two cases of infants with irreducible inguinal hernia of the adnexa and uterus were reported, and their specific ultrasonic (US) findings described. In both infants, irreducible inguinal masses manifested at 12 and 7 weeks of age, respectively. In the first case, US showed characteristic findings consisting of an hypoechoic mass (ovarian echo) and a homogenous echogenic mass connected to the urinary bladder through the inguinal canal. At laparotomy, the uterus and adnexae were found in the inguinal sac. The second case was diagnosed preoperatively based on specific US findings. After reduction of the hernial contents (uterus and adnexae), simple herniorraphy was performed.
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Toshitaka Hoppo, Takafumi Kusaka, Kosaku Maeda, Tetsuo Yamamoto
Article type: Article
1998 Volume 34 Issue 7 Pages
1190-1195
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Subglottic hemangioma is a rare congenital laryngeal disease. We have experienced a case of infantile subglottic hemangioma. In a 2-month-old boy, inspiratory stridor had gradually developed since the first month after birth. He was admitted to our hospital becaues of recurrent episodes of upper airway obstruction. Bronchoscopic examination demonstrated a smooth submucosal mass on the left subglottic wall, almost occluding the lumen. First, a tracheostomy was performed. However, there was no remission of the mass and excision of the subglottic mass was performed at 4 months of age. The mass was cystic and totally excised. Histopathological findings confirmed the diagnosis of capillary hemangioma. Though subglottic stenosis due to granulation occured temporarily after surgery, the tracheostomy tube was successfully removed after excision of the granulation tissue.
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Kazuhisa Shirai, Minoru Horisawa, Teiichi Sugiura, Kazuya Matsunaga, K ...
Article type: Article
1998 Volume 34 Issue 7 Pages
1196-1201
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Three-dimensional CT (3D-CT) proved very useful for evaluating complicated anatomy in a case of imperforate anus with left megaureter. The case was a 7-month-old male. On conventional invertogram, he was provisionally diagnosed as having a high-type imperforate anus with rectovesical fistula. We performed a transverse colostomy. Right hydroureter, left megaureter, and left renal atrophy were shown by ultrasound, intravenous pyelography and voiding cystogram, respectively. We performed a right nephrostomy and left ureterostomy. The patient was discharged with only a colostomy and the ureterostomy, which subsequently led to resolution of the right hydronephrosis. Next, we constructed 3D-CT images preoperatively to evaluate the relationship between the imperforate anus and the left megaureter. The 3D-CT showed that the left megaureter and left renal atrophy were due to atresia of the left ureterovesical junction and also provided useful information on the sphincter muscle and puborectal sling. At 7 months of age, we performed an abdominoperineal pull-through, left nephrectomy, and ureterectomy. A right orchiopexy was also performed for right undescended testis. The abdominoperineal pull-through operation was successfully performed using intraoperative sonography and electric stimulation. The 3D-CT information also proved helpful during this procedure. Postoperative course was uneventful.
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Yutaka Kuriyama, Kenji Kawamura, Katsunori Kouchi, Yasuhiro Ohtsuka
Article type: Article
1998 Volume 34 Issue 7 Pages
1202-1207
Published: December 20, 1998
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We report 3 cases of pyriform sinus fistula who presented symptoms in the neonatal period and were operated on, on the 77th, 33rd, and 30th days of life. In the first case, we could not reveal the fistula tract by barium meal study. The patient was suspected to have this disease using computer tomography, and we confirmed the internal fistula orifice in the left pyriform sinus by preoperative endoscopic examination. Though we traced and ligated the fistula tract at the level of the cricopharyngeal muscle with the guide of a venular catheter inserted into the fistula lumen from the operation field, the fistula recurred later. In the second and third cases, we could reveal the fistula tracts by barium meal studies, and verified the internal orifices by endoscopic examination. After exposure of the operation field, we inserted a guide wire from the internal fistula orifice using an endoscope, and held it from the operation field in order to prevent it from slipping out. Then we traced the fistula tract along the guide wire, and removed the entire tract including the internal orifice. It is essential to remove the fistula up to the internal orifice to prevent its recurrence. Even in a neonate, it is possible to insert a guide wire using a gastrointestinal fiberscope after exposure of the operation field. Endoscopic cannulation is a useful procedure for complete removal of pyriform sinus fistula.
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Mayumi Iwakawa, Fumihito Imamura, Haruo Ohkawa, Michio Kaneko, Tetsuo ...
Article type: Article
1998 Volume 34 Issue 7 Pages
1208-1212
Published: December 20, 1998
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A case of body stalk anomaly under home ventilation support was reported. The patient was diagnosed antenatally as omphalocele by ultrasonography. He was born by caesarean section at the gestational age of 35 weeks and 3 days. His birth weight was 2, 169g with an Apgar score of 4/6. He showed a giant omphalocele combined with severe scoliosis, patent ductus arterioles, atrial septal defect, tracheal stenosis, and tracheobroncho malacia. He was supported by ventilator after birth. He underwent abdominal wall closure by the Nakajo method using a synthetic fabric sheet, fundoplication, gastrostomy, ileostomy, its closure, and herniorrhaphy. He became stable when he was 2-and-a-half years old. He was discharged with a ventilator support at the age of 4 years after trials. He is now preparing for a primary school with a social support group in his neighborhood.
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[in Japanese], [in Japanese], [in Japanese]
Article type: Article
1998 Volume 34 Issue 7 Pages
1213-1222
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1998 Volume 34 Issue 7 Pages
1223-1242
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Article type: Index
1998 Volume 34 Issue 7 Pages
1243-1246
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1998 Volume 34 Issue 7 Pages
1247-1250
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Article type: Index
1998 Volume 34 Issue 7 Pages
1251-1256
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1998 Volume 34 Issue 7 Pages
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1998 Volume 34 Issue 7 Pages
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