Purpose : Collagen is an extracellular matrix component that plays an important role in cell growth, differentiation, and cancer invasion. The aim of this study is to evaluate the correlation between collagen composition in the neuroblastoma and its prognosis. Methods : We analyzed type I and III collagens in nine patients with neuroblastomas by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), and studied the morphologic features of collagen fibrils using transmission electron microscopy. Results : Of the nine patients, six had normal type I and type III collagens on SDS-PAGE. These patients had good prognostic factors. The other three patients had a deficient α_2 chain of type I collagen. They had poor prognostic factors and needed intensive chemotherapy. No difference was seen by the ultrastructural analysis in the collagen fibrils between the patients with normal type I and deficient α_2 chain of type I collagen. Conclusion : Tumor collagen analysis might be a useful prognostic factor in neuroblastoma, complementing other factors in determining patient selection for intesive postoperative chemotherapy.

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Purpose : To present our results for repairing unilateral vesicoureteral reflux using nondismembered extravesical detrusorrhaphy in five children. Methods : A retrospective evaluation was performed on five children who underwent repair of unilateral vesicoureteral reflux using the modified nondismembered extravesical detrusorrhaphy technique proposed by Zaontz. The key points of the technique are comlete encirclement of the ureterovesical junction and advancement of the ureteral orifice on the trigone towards the bladder neck. Results : The success rate was 100%. There was minimal postoperative morbidity and no ureteral obstruction. Postoperative discomfort related to bladder spasms was also minimal, and hematuria was not observed in any patient. All patients were discharged from the hospital by day 2 or 3 postoperatively. Conclusions : Nondismembered extravesical detrusorrhaphy is a favorable option for the treatment of unilateral vesicoureteral reflux in children. This approach also simplifies postoperative pain management.

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Two cases of umbilical polyp with ectopic pancreatic tissue are reported. A 9-month-old boy and 1-year-5-month-old girl presented moist umbilical swelling since removal of the umbilical cord. In the former case, the skin surrounding the umbilicus was eroded. Both patients underwent removal of the swelling, but the discharges and erosion did not improve postoperatively. Laparotomies were performed, and the tissue underneath the umbilicus was resected. Meckel's diverticulm was not found in either case. Histological examination of the resected tissue in both cases showed ectopic pancreatic tissue. Both patients recovered completely. Umbilical polyp with ectopic pancreatic tissue is very rare, and only 8 cases have been reported in Japan. We believe that total resection of tissue underneath the umbilicus during laparotomy is necessary for patients with this condition.

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Adrenal abscess is rare in neonates. A case of an 18-day-old girl and a review of 13 cases in literature are reported. Adrenal abscess in neonates is diagnosed correctly by a correlation of perinatal history, clinical findings, and radiographic examination. Administration of antibiotics and surgical drainage are recommended.

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We report here a case of rare splenic abscess secondary to Methicillin-resistant Staphylococcus aureus (MRSA) enterocolitis in childhood. A 1-year-3-month old boy was admitted to a nearby hospital with fever, vomiting and diarrhea. Antibiotics succeeded to improve the symptoms on the 14th hospitalized day. But two days later, he had recurrent fever and diarrhea again. Ultrasonography and computed tomography revealed splenic abscesses. Conservative treatment failed to improve the symptoms. The patient was transferred to our hospital for surgical therapy on the 19th hospitalized day. Effective antibiotics to MRSA, which were taken and cultured from the stool, succeeded in improving the symptoms and surgical therapy was unnecessary. On the 26th day after admission to our hospital, computed tomography revealed that the splenic abscesses had disappeared. In this case, it is speculated that the cause of splenic abscesses was hematogenous from MRSA enterocolitis in association with poor nutrition and lower immunity because of long-term fasting after the presence of enterocolitis.

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Congenital cartilaginous rests of the neck are rare cervical masses resulting from abnormal development of the branchial apparatus and are always present at birth. We repot two cases with cervical masses. Case 1 : A 1-year-3-month old boy was admitted with a left cervical mass. The mass was located at the lower part of the anterior border of the sternocleidomastoid muscle. Excision of the mass was performed. Histologically, the mass showed a compostion of normal hyaline cartilage in a fibrous stroma. He had no other malformations, but he had associated pathlogical conditions such as epilepsy, apnea and oronasal reflux in his neonatal period. Case 2 : A 3-year-4-month old boy was admitted with a left cervical mass. The mass was located at the lower part of the anterior border of the sternocleidomastoid muscle. Excision of the mass was performed. Histological findings were the same as that of case 1. He has no associated malformations or pathological conditions. Although congenital cartilaginous rests result from the first and second branchial arches, some of the cases have other systemic malformations and/or pathological conditions. When we manage patients with congenital cartilaginous rests, it is important to recognize the possibility of associated malformations and pathological conditions.

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A 9-year-old boy was presented to our hospital complaining of intermittent abdominal pain, constipation, and appetite loss. He had been evaluated twice before for prolapse of a polyp from the anus, but a sigmoidscopy was normal. Endoscopic examination revealed a very large lobular polyp in the upper descending colon that almost blocked the lumen completely. Colonic resection was performed because endoscopic polypectomy was considered inappropriate due to the size of the polyp. The polyp measured 80×70×40mm. A histopathology showed a hyperplastic mucosal layer without atypia, and tree-like proliferation of the muscularis mucosa. Since there was no relevant family history, mucocutaneous pigmentation or polyposis, we diagnosed a solitary Peutz-Jeghers type polyp of the descending colon. The solitary Peutz-Jeghers type polyp is very rare, and only 40 cases have been reported in Japan. Long-term prognosis is still not clear at this point, but the polyp should be removed as soon as possible because of potential malignancy.

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Our recent experience of creating a catheterizable channel in two patients with fecal incontinence is described. The appendix had been removed previously in both cases. Case 1 is a 17-year-old boy who was diagnosed with Hirschsprung's disease. He underwent a Swenson pull-through at the age of 10 months. He was found to have a periproctal abscess communicating to the rectum at 6 years of age, which was drained. The fistula ultimately healed, but he became incontinent. A cecal flap was tubularized, which was brought out to the right lower abdomen. Antegrade enemas are so effective that he is dry for 24 hr after a single 50 ml glycerin enema. Case 2 is a 3-year-old boy who was born with cloacal exstrophy and underwent a one-stage repair at the age of 10 days. Pull-through with the hind gut was employed at 3 years of age. Postoperatively, stool could not be fully evacuated from the neoanus, which was created to be slightly stenotic. The ileum was dilated. A catheter-izable channel was created with the dilated ileum and brought out to a neo-umbilicus. Regurgitation is minimal and the ileum is well evacuated with solid stools being passed through the anus.

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Dermoid cysts are congenital lesions derived from the ectodermal differentiation of multipotential cells. A full-term baby boy was observed to have a firm, nontender lingual mass, present at birth. There was a thick-walled cyst measuring 1 cm on the inferior aspect of the tongue extending from the tip posteriorly. The child was gradually having difficulty in sucking and moving his tongue. At one month of age, the mass was surgically excised. After partial decompression by aspiration, the cyst, which was about 3 cm in diameter, was completely excised. The postoperative course was unremarkable. Pathology revealed a benign cyst, lined with squamaous epithelium and columnar epithelium that was partially ciliated, containing scattered mucinous cells.

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This report describes a newborn infant with biliary atresia, in whom a cystic lesion of the porta hepatis was detected antenatally. Ultrasonography performed immediately after birth revealed that the cyst appeared to be connected to the liver by a small duct. The patient gradully became jaundiced, and the stools became completely acholic. During surgery performed on the 45th day of life, an operative cholangiogram showed marked cystic dilatation of the common bile duct with complete distal choledochal atresia. A pattern of fine infiltration of dye was also seen intrahepatically without any apparent ductal communication between the cyst and liver because of a dense connective tissue mass at the porta hepatis. The cyst and connective tissue mass were resected and hepatic portoenterostomy was performed. The patient did well for one year after surgery. Including the present case, four patients with a similar type of atresia have been reported. We thought that this type of atresia, involving atresia of the distal choledochus with obstruction by a fibrous mass at the porta hepatis, should be classified as an uncorrectable type, such as type III associated with an unusual choledochal dilatation caused by functional obstruction of the extrahepatic biliary duct.

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Gastric cancer during childhood is rare, and most cases are advanced. Case 1 in an 11-year-old girl presented with hematemesis. A gastroscopic examination was performed, and a pathological diagnosis of signet ring cell carcinoma was made. Laparotomy revealed a type 3 tumor in the body and pyloric antrum with peritoneal carcinomatosis, Stage IV. Total gastrectomy with splenectomy and resection of the tail of the pancreas was performed. Although she received chemotherpy, she died due to carcinomatosa peritonitis 2 months postoperatively. Case 2 is a 10-year-old boy, who was diagnosed with gastric cancer during investigations for anemia and nausea. Laparotomy revealed a type 3 tumor in the lesser curvature of the upper body, Stage III A. Total gastrectomy with D2 dissection was performed. A histopathology showed poorly differentiated adenocarcinoma. He is alive and well 4 months postoperatively.

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A 3-year-old boy suffered from progressive painless abdominal distension for 2 years. Clinical examination, ultrasonography, and computed tomography scan suggested massive ascites. Bloody fluid was found at the first paracentesis, the colour of fluid changed to dark brownish-green in the second and third paracentesis, and recurrent paracentesis improved his abdominal distension partially, for very short periods. The preoperative diagnosis was ascites of unknown origin and surgery revealed a giant omental cyst. The cyst contained 1, 300 ml of fluid. A histopathological examination confirmed the diagnosis of a mesothelelial cyst with chronic inflamatory cell infiltration. Resection of the omental cyst achieved complete relief of his complaints. It is suggested that apparent ascites without any disorders of the liver, kidney or heart might be an omented cyst or mesenteric cyst in children.

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