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1999 Volume 35 Issue 2 Pages
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Naomi Iwai, [in Japanese]
Article type: Article
1999 Volume 35 Issue 2 Pages
191-192
Published: April 20, 1999
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Sumio Kohno, [in Japanese]
Article type: Article
1999 Volume 35 Issue 2 Pages
193-194
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Takao Okamatsu
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1999 Volume 35 Issue 2 Pages
195-197
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Takatoshi Kitamura
Article type: Article
1999 Volume 35 Issue 2 Pages
198-199
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Hideo Takamatsu
Article type: Article
1999 Volume 35 Issue 2 Pages
200-201
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Satoshi Takeuchi, Masashi Nakahira, Teturo Nakamura, Takashi Azuma, Ke ...
Article type: Article
1999 Volume 35 Issue 2 Pages
202-205
Published: April 20, 1999
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Objects : Pediatric surgical medical services were investigated from the aspects of medical insurance expense and medical service economics. Methods : The 511 cases hospitalized in 1996 were classified into the following three attributes : specialty (S), multi-disciplinarity (M), and emergency (E), and the medical service charges of each attribute were determined and compared with medical practice costs for investigation. Results : The average medical service charges were 74±5 thousand yen/day for a disease group (S-1 group) represented by indirect inguinal hernia, 32±7 thousand yen/day for diseases including imperforate anus, congenital megacolon (Hirschsprung's disease), biliary atresia, etc. in a special disease group (S-2 group), 33±6 thousand/day for diseases with a strong propensity to multi-disciplinarity (M group), 48±3 thousand yen/day for the emergency disease group (E group), 40±9 thousand yen/day for a group that possesses both attributes of specialty and multi-disciplinarity (S+M group), 35±5 thousand yen/day for a group that possesses both attributes of specialty and emergency (S+E group), 34±8 thousand yen/day for a group that possesses both attributes of multi-disciplinarity and emergency (M+E group), and 100±53 thousand yen/day for a group which possesses all the attributes (S+M+E group). Conclusions : It is only the S+M+E group that enabled the average medical service charges to meet the mean medical practice cost of the present institution, and the business goes into the red to the extent of 30, 000 yen/bed/day as a whole. In order for pediatric surgical medical services to support itself, the backing of technical fees that can meet the medical practice costs provided is essential. For technical fees, it was proposed to incorporate the life-support emergency medical hospitalization fee, ICU administration fee, NICU administration fee, bioclean room administration fee, the addition of one-to-one nursing care, etc. Furthermore, in order to indicate the social role of pediatric surgical medical services and acquire social recognition and support for pediatric surgery, promotion of pediatric surgical life-support services by pediatric surgeons as well as the need of pediatric surgeons to participate in the perinatal section were emphasized.
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Akira Nagasaki
Article type: Article
1999 Volume 35 Issue 2 Pages
206-207
Published: April 20, 1999
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Satoshi Takeuchi, Masashi Nakahira, Teturo Nakamura, Takashi Azuma, Ke ...
Article type: Article
1999 Volume 35 Issue 2 Pages
208-214
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Purpose : The aim of this study was to evaluate peritoneal drainage as a primary therapeutic strategy in extremely-low-birth-weight infants with intestinal perforation. Methods : Twelve infants were examined by arterial pH and BE, platelet count and their systemic conditions before and after peritoneal drainage. Results : Six infants survived and 6 died. An enterostomy was created in 4 cases subsequent to the initial drainage. Among them, the arterial pH and platelet count were improved in three survival cases, one who developed deterioration of these measurements after the drainage ceased. In three cases, the perforation closed spontaneously with improvement of arterial pH and BE after drainage, and enteral feeding was resumed after 21, 17 and 28 days, respectively. Mean body weight and gestational age are both high in the survivors (745±166g vs 532±160g, 178±9 days vs 170±12 days). Conclusions : Primary peritoneal drainage seems to be effective for infants with peritonitis when over 700 g at birth and 25 weeks of gestation. Other strategies such as blood purification, particularly plasma exchange, blood adsorption and blood filtration or dialysis are necessary in addition to drainage. Further refinement of the circuits and developement of a low-volume model that meets the requirements for low-birth-weight infants are needed.
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Hirokazu Tomishige, Teruaki Kishikawa, Fujio Hara, Osamu Nishikawa, Yo ...
Article type: Article
1999 Volume 35 Issue 2 Pages
215-220
Published: April 20, 1999
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Purpose : Congenital biliary dilatation (CBD) with a pancreaticobiliary maljunction was thought to be an important risk factor for biliary tract carcinoma in Japan. However, the mechanism of carcinogenesis is unknown. Forty-five cases of congenital biliary dilatation were analyzed for the presence of K-ras gene point mutations. Pancreaticobiliary maljunction was confirmed in 27 of these patients. Methods : K-ras mutations were examined using genomic DNA extracted from histologic specimens resected at the time of surgery. DNA was analyzed using polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) and direct sequencing. Results : 22 of the 45 cases (44%) showed point mutations of K-ras codons 12 and 13. A direct sequence analysis of the K-ras gene revealed that mutation of codon 12 substituted GGT (glycine) for GAT (aspartic acid) in 13 cases and mutation of codon 13 substituted GGC (glycine) for AGC (serine) in 9 cases. Conclusions : Mutation of the K-ras gene may represent an early event in the pathogenesis of biliary tract carcinoma.
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Kenji Imura, Masahiro Nakayama, Takashi Sasaki, Seika Kuroda, Hisayosh ...
Article type: Article
1999 Volume 35 Issue 2 Pages
221-225
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Purpose : The pathology of the placenta in congenital abdominal wall defects has seldom been reported. At our perinatal center, placental pathological findings are registered for near neonates, even if they were not born at our center. In order to clarify the prenatal characteristics of congenital abdominal wall anomalies, perinatal complications and placental abnormalities were compared between gastroschisis and omphalocele. Subjects & Methods : During the past 14 years, 30 placentae from 37 cases of gastroschisis, and 37 placentae from 48 cases of omphalocele were available for study. Perinatal complications and registered placental findings were analyzed retrospectively. Results : The incidence of intra-uterine growth retardation (IUGR), meconium staining of amniotic fluids and positive C-reactive protein (CRP) of cord blood were significantly higher in gastroschisis than in omphalocele. Single umbilical artery was found more frequently in omphalocele. There was no significant difference in the incidence of hydramnios, preeclamp-sia, or premature rupture of membrane between the two conditions. Macroscopic deposition of meconium and placental chorioamnionitis were noted in gastroschisis. There was no difference in placental weight, cord length, or frequency of cord inflammation bet-ween the two conditions. Conclusions : It was summarized that the characteristic perinatal complications and placental findings in cases of gastroschisis would appear to be IUGR, meconium staining of amniotic fluid, positive CRP of cord blood and chorioamnionitis. These changes may be related to the fibrous coating seen in gastroschisis.
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Ryo Sumita, Hisashi Matsumoto, Yasuhiro Otomo, Akio Kimura, Kunihiro M ...
Article type: Article
1999 Volume 35 Issue 2 Pages
226-230
Published: April 20, 1999
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We report here a case of jejunal injury as the consequence of blunt abdominal trauma, which was diagnosed as diagnostic peritoneal lavage (DPL). A 9-year-old girl was referred to our hospital with a suspected case of abdominal organ injury. We did not confirm or exclude the presence of bowel injury by physical examination, abdominal X-ray films, ultrasonography and computed tomography. Therefore, DPL was performed and the result indicated intestinal injury. She underwent laparotomy and jejunal perforation was confirmed. Physical examination and radiologic diagnostic procedures may not always provide definitive diagnosis of bowel injury with blunt abdominal trauma. DPL is a useful procedure to detect intestinal injury due to blunt abdominal trauma in children, especially cases complicated with head, pelvis or chest injury.
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Seisuke Sakamoto, Morihiro Saeki, Miwako Nakano, Tatsuo Kuroda, Tsukas ...
Article type: Article
1999 Volume 35 Issue 2 Pages
231-236
Published: April 20, 1999
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Congenital (infantile) hemangiopericytoma is a rare vascular tumor of infants. It has been recognized as having a benign clinical course, in contrast to the more malignant behavior of many hemangiopericytomas that occur in older children and adults. Twenty-four cases of congenital hemangiopericytoma have been reported in literature in Japan. Histopathologically, it often shows increased cellularity, prominent mitotic activity, and a foci of necrosis or hemorrhage. These histopathological findings are similar to malignant hemangiopericytoma in adults. Thus, congenital hemangiopericytoma is a problematic tumor because of the dissociation between the malignant histopathological findings and benign clinical courses. Herein, we reported a case of congenital hemangio-pericytoma in a neonate which showed malignant findings histopathologically and invaded to the surrounding tissues macro-grossly. However, only excision of tumor without any further treatment was performed. Follow-up examinations have shown no recurrence and no metastasis for 16 months since the excision.
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Hiroshi Nakamura, Keihachiro Hirano, Haruhiro Nakazaki, Kiyoshi Watana ...
Article type: Article
1999 Volume 35 Issue 2 Pages
237-245
Published: April 20, 1999
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A 5-year-old boy was admitted to our hospital because of abdominal distention for a month. Ultrasonography and magnetic response imaging (MRI) revealed a large cystic tumor which occupied the entire right lobe of the liver. Slight elevation of plasma CA125, NSE, IAP and CA72-4 were found though the AFP level stayed in the normal range. Complete resection of the tumor was achived by right hepatic lobectomy. The tumor was 19×19×19 cm in size and weighed 2, 400 gm. The tumor was composed of solid and cystic mass containing clear yellowish fluid, and histological examination revealed immature tumor cells with the diagnosis of undifferentiated embryonal sarcoma of the liver. The postoperative course was uneventful without recurrence for 24 months after the operation. Undifferentiated embryonal sarcoma of the liver is a rare tumor in children, and the present case was reviewed toghether with other 48 reported cases in children in Japan. Ultrasonography and CT scan showed a cystic mass in liver. It is important to attempt to diagnose this disease. It should be stressed that cystic lesions of the liver may account for this rare condition of the liver.
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Motoi Mukai, Hideo Takamatsu, Hiroyuki Noguchi, Hiroyuki Tahara, Tatsu ...
Article type: Article
1999 Volume 35 Issue 2 Pages
246-248
Published: April 20, 1999
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We report a case of a girl with Hirschsprung's disease, and associated with Down's syndrome and congenital hypothyroidism. The patient showed cyanosis shortly after birth and was diagnosed with Down's syndrome, congenital heart disease (VSD, ASD) and rt. acheilia. She also showed abdominal distension after birth, which did not respond to the usual treatment. Neonatal screening disclosed congenital hypothyroidism. However, thyroid hormone replacement did not resolve her condition either. At the age of two months, the diagnosis of Hirschsprung's disease was confirmed by barium enema, manometry, and histochemical study. At that point, she underwent sigmoid colostomy. She died of heart failure at the age of seven months. Past research literature describes that an association of congenital hypothyroidism might co-exist in patients having gastrointestinal anomalies in combination with Down's syndrome. The present report calls one's attention to the awareness of the hypothyroid when Hirschsprung's disease is detected with Down's syndrome.
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