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1999 Volume 35 Issue 4 Pages
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Yasuyuki Higashimoto, Toshihiro Muraji, Naruaki Mouri, Masayuki Ohbata ...
Article type: Article
1999 Volume 35 Issue 4 Pages
661-665
Published: June 20, 1999
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Purpose : To evaluate the efficacy of prophylactic endoscopic sclerotherapy (ES) for esophageal varices (EV) in infants and children, the criteria of impending rupture were retrospectively determined. Methods : Seventeen patients with portal hypertension (biliary atresia 14, extrahepatic portal obstruction 2, cryptogenic cirrhosis 1) developed hemorrhages of EV and underwent urgent ES. Their ages ranged from 8 months to 9 years. Variceal bleeding recurrence was seen in 10 of them thereafter. Endoscopic findings of those varices were analyzed to confirm the criteria of risky varices in children. Results : The criteria for risky EV were determined as follows : (1) Before ES, bluish or red-color-sign positive varices with tortuosity ; and (2) after ES, bluish or tortuous varices with positive red color sign. Cumulative rebleeding rate reached 68% at 4 months after hemostatic ES for variceal rupture. Conclusions : Prophylactic ES for risky EV meeting the above criteria will contribute to a reduction in the risk of EV bleeding recurrence.
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Yoshiaki Tsuchida, Hitoshi Ikeda, Jun Miyauchi, Kentaroh Matsuoka, Tos ...
Article type: Article
1999 Volume 35 Issue 4 Pages
666-673
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Purpose : High-dose chemotherapy for advanced neuroblastoma, designated regimen A_1, had been used in the authors' institutions since 1985, and a much higher dose chemotherapy, designated regimen A_3, which utilizes cyclophosphamide at a dose of 2, 400 mg/m^2 divided on days 1 and 2, has also been used since 1991. However, the histopathological changes of neuroblastoma after such high-dose chemotherapy and their clinical implications have not yet been studied well. Methods : In the present study, all of the surgical specimens (primary tumor plus metastatic lymph nodes) from 29 patients with advanced neuroblastoma were reviewed, and the ratio of viable residual tumor tissue to total area of the tumor was determined. Histopathological effects of chemotherapy were graded as +++, ++, +, ±, and -, according to these ratios, and were assessed in relation to regimens, age of the patients, stages, and the clinical results. Results : It was clarified that the effectiveness of chemotherapy is certainly exhibited histopathologically. Namely, only a few cases of advanced neuroblastoma which received regimens A_1, new A_1 and A_3 showed the effects of ±, or -, and it was made clear that the regimens A_1, new A_1 and A_3 are more potent in histopathological effectiveness than St. Jude protocols, which were used previously in one of the authors' institutions. Conclusions : The present study emphasizes that it is truly important to review the histological change in surgical specimens after the induction of chemotherapy. This process aids in understanding the effectiveness of high-dose chemotherapy and is helpful to predict the prognosis.
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Noriaki Otagiri, Yutaro Matsumoto, Nobuyuki Sano
Article type: Article
1999 Volume 35 Issue 4 Pages
674-678
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Purpose : This study was designed to define the predictive factors for perforation in children with acute appendicitis. Method : Three-hundred-twenty-three cases of acute appendicitis in children seen at our hospital over a 10year period, from January 1988 to December 1997, were the subjects of this study. Each of age, sex, preoperative leukocyte count, preoperative C-reactive protein (CRP), and duration of symptoms before surgical intervention were reviewed in relation to varying degrees of disease. Results : The mean age of patients was 9.2 years (ranging from 2 to 15 years of age). Of the cases, 62% were male and 38% were female. There were 118 cases of acute perforated appendicitis (37%) and 205 cases of nonperforated appendicitis (64%). There were significant differences in the mean age of patients (8.1±3.0 vs. 9.8±2.9 years old), sex distribution (male : female, 1.2 : 1 vs. 2 : 1), mean preoperative leukocyte count (17, 193±6, 070 vs. 15, 076±4, 838/μl), mean preoperative CRP (10.8±6.0 vs. 4.4±4.2mg/dl) and duration of symptoms before surgical intervention (3.1±3.5 vs. 1.0±1.2 days). Conclusion : These results suggest that useful factors in predicting perforation in cases of acute appendicitis in children are age, sex, preoperative leukocyte count, preoperative CRP, and duration of symptoms before surgical intervention.
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Toshiyuki Katogi, Ryo Aeba, Ichiro Kashima, Shigeyuki Takeuchi, Shiaki ...
Article type: Article
1999 Volume 35 Issue 4 Pages
679-682
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Purpose : The long-term fate of the survivors of Fontan operation is still unclear. We analyzed 2 groups of patients who survived after modified Fontan operations in our hospital. Methods : From 1974 to 1991, patients underwent the conventional Fontan procedure by right atrium-pulmonary artery connection (Group APC ; 16 patients). Since 1989, the other patients underwent total cavo-pulmonary connection and intra-atrial partitioning (Group TCPC ; 22 patients). Actuarial survival rate and percent freedom from atrial flutter or fibrillation were analyzed using Kaplan-Meyer's method in these two groups. Results : The mean follow-up periods were 135 months for Group APC and 40 months for Group TCPC. Six late deaths occurred in Group APC between 6 and 22 years postoperatively. No late death was seen in Group TCPC. The actuarial survival at 5, 10 and 15 years were 100, 86, and 52% in the APC group, respectively. Atrial flutter was thought to be a fatal complication in all but one late mortality Although follow-up periods were shorter for the TCPC group, no patient showed atrial arrhythmia in this group of patients. The freedom rate from atrial flutter or fibrillation calculated using Kaplan-Meyer's analysis for group APC at 5, 10 and 15 years was 86, 62, and as low as 45%, respectively. Conclusions : The long-term survival of patients after conventional Fontan operation was disappointing in our series, especially complicated by the development of atrial flutter. However, a short follow-up study of the patients who underwent TCPC indicates a reduced incidence of atrial flutter and better midterm results.
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Takashi Shimotake, George Iwata, Kyoko Inoue, Katsuhiro Inoue, Jun Yan ...
Article type: Article
1999 Volume 35 Issue 4 Pages
683-688
Published: June 20, 1999
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Purpose : In this review presentation as a part of Symposium I, we analyzed the potential of water and electrolyte transports in rat proximal and distal colonic segments as a model of surgical consideration for total colonic aganglionosis and extensive aganglionosis. Methods : The proximal and distal colonic segments were perfused separately and simultaneously at a constant rate, and net movements of water and electrolyte were determined. Results : The net absorption of water and sodium were significantly dominant in the distal colonic segment. Benzamil, a specific sodium ion channel blocker, inhibited net water and sodium absorption similarly both in the proximal and distal colonic segments. Conclusions : Clinically, various postoperative complications in children with total colonic aganglionosis and extensive aganglionosis are supposed to be associated with the residual aganglionic colonic segment. The function of the residual aganglionic colon segment should be reassessed to obtain better long-term results of treatment for total colonic aganglionosis and extensive aganglionosis.
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Reisuke Imaji, Yoshiteru Takada, Masahiro Kawasaki
Article type: Article
1999 Volume 35 Issue 4 Pages
689-692
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A 4-day-old, male neonate was admitted because of tachypnea and cyanosis. A chest X-ray revealed pleural effusion. A chylothorax was demonstrated by thoracocentesis. He received conservative treatment with an intercostal catheter ; however, the pleural effusion did not improve. At times, he developed tachypnea, cyanosis and facial edema. Dosages of 0.5 and 1.0 KE of OK-432 were injected into the intrapleural space through a chest tube. After treatment on days 33 and 40, the amount of chylous drainage decreased. The chest tube was taken out 2 weeks after treatment. During the treatment, fever and transient dyspnea developed but they were not serious. We report the successful treatment of a case of congenital chylothorax by the intrapleural injection of OK-432, which produced adhesion. The modality seems to be useful for the treatment of congenital chylothorax.
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Yoshihisa Nishida, Teruaki Kishikawa, Fujio Hara, Hirokazu Tomishige, ...
Article type: Article
1999 Volume 35 Issue 4 Pages
693-697
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A case of cystic partially differentiated nephroblastoma (CPDN) is reported, and ten cases from literature are reviewed. A fifteen-month-old girl was presented with a huge mass (13×9.5×6 cm) in her left abdomen. Ultrasonography and CT scan revealed a typical multilocular cystic lesion of the left kidney. After observation for two months, the size of the tumor grew rapidly, and subsequent left nephrectomy was done. The resected mass weighed 555 g and the histological diagnosis was CPDN. Post operatively, the child has been free of disease for 38 months after nephrectomy without adjuvant chemotherapy.
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Toshitaka Hoppo, Kosaku Maeda, Takahumi Kusaka, Tetsuo Yamamoto
Article type: Article
1999 Volume 35 Issue 4 Pages
698-702
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Epignathus is a rare tumor of newborns and is associated with high mortality secondary to airway obstruction during the neonatal period. We experienced a case of a newborn with epignathus. This case was a female ; birth weight 2.2 kg, born by normal vaginal delivery at 34 weeks gestation. Her mother developed hydramnios during the 28th week of pregnancy and a pediatrician was present at the delivery because of threatened premature labor. Respiratory distress was present at birth, and the baby was intubated immediately. A large hard mass extending into her mouth was noticed at that time. Computed tomography showed a mass extending from the choanae to the pharynx. Excision was performed on day 12 of life. A pedunculated mass was found attached to the pharyngeal wall by a 5 mm diameter stalk. This mass was totally excised. The soft plate had been compressed anteriorly by the mass. Histopathological examination confirmed the mass was a mature teratoma that included all three germinal layers. Postoperative feeding disturbance gradually improved with complete resolution of respiratory distress and feeding disturbance.
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Kazuo Nishimoto, Minoru Horisawa, Noriji Niinomi, Kazuya Matsunaga, Ka ...
Article type: Article
1999 Volume 35 Issue 4 Pages
703-706
Published: June 20, 1999
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A fistulous lesion is sometimes found in the neck in the pediatric age group, but fistula to the ectopic salivary gland is very rare. The authors desctibe three cases of this rare lesion and their clinical course. A one-year-old female and two 8-month-olds, one male and one female, were treated. The orifice of the fistula was found near the sternal notch in two cases and at the middle of the inside margin of the right sternocleidomastoid muscle in one case. In all cases, mucous discharge was noted soon after birth. They all underwent successful fistulectomy. The fistulous tract terminated in the ectopic glandular tissue which revealed salivary gland tissue by histological examination.
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Toshihiro Muraji, Takayoshi Moriuchi, Yoshifumi Kato, Shiiki Sato, Eij ...
Article type: Article
1999 Volume 35 Issue 4 Pages
707-710
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A patient with Pentalogy of Cantrell, born weighing 2, 510 g at 38 weeks gestation underwent repair of a large omphalocele during the neonatal period. The diaphragmatic defect was subsequently recostructed with rectus abdominis muscle at 8 months of age. Heart activity was visible through the skin due to a short sternum. At 3 years of age, he successfully underwent reconstruction of the short sternum. Through a midline skin incision made over the sternum, bilateral costal cartilages from the 6th to 8th ribs were transected obliquely in order to approximate both edges of the costal arch without constricting the thoracic cavity. The costal arches were successfully approximated with 1-0 absorbable sutures. The pectoralis major muscles were also sutured in the midline over the reconstructed sternum. The postoperative course was uneventful.
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Shinichi Yamada, Masahiko Maie, Takao Etoh, Yasuyuki Higashimoto, Hiro ...
Article type: Article
1999 Volume 35 Issue 4 Pages
711-715
Published: June 20, 1999
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A nine-year-old girl was admitted to our hospital suffering from a prepubic abscess. A small protuberance above the pubic bone had been noticed since her birth. The patient had earlier suffered from an abscess formation at the site of the protuberance at the age of three. A fluoroscopy revealed a tract leading toward the pubic bone with dilated sinus beneath the skin. Cystourethrography showed no communication between the tract and the bladder or urethra. Excision of the fistula was carried out under the diagnosis of a congenital prepubic sinus. As the fistula extended into the pubic symphysis, a wedge resection of the symphysis was performed to complete the fistulectomy. Histopathological findings revealed that the dilated sinus was lined with squamous epithelium and that the tract was lined with transitional epithelium which was similar to the urothelium.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
1999 Volume 35 Issue 4 Pages
716-719
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[in Japanese]
Article type: Article
1999 Volume 35 Issue 4 Pages
719-722
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[in Japanese]
Article type: Article
1999 Volume 35 Issue 4 Pages
723-725
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[in Japanese]
Article type: Article
1999 Volume 35 Issue 4 Pages
726-728
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[in Japanese]
Article type: Article
1999 Volume 35 Issue 4 Pages
729-733
Published: June 20, 1999
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