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Toshihiro Muraji, Shiiki Satoh, Masayuki Obatake, Atsushi Horiuchi, Sh ...
Article type: Article
2001 Volume 37 Issue 5 Pages
795-799
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Purpose : A retrospective review of 54 patients with biliary atresia experienced from 1986 through 1998 was made to determine the effectiveness of consolidated corticosteroid therapy (CST) on bile drainage and clinical outcome after hepatic portoenterostomy. Methods : Patients were divided into two groups. Group I patients (1986-1990, n=14) received conventional CST (Prednisolone was started 7 days after surgery to enhance bile drainage during the first postoperative month. The initial dose was 4 mg/kg/day given daily, and the dose was reduced by half every two days. This regimen was repeated after each course was completed). Group II patients (1990-1998, n=40) received consolidated CST (the same regimen was repeated whenever the stools appeared pale even if the previous dose had not yet been discontinued). Results : A significant difference was seen in total bilirubin level at 1 month postoperatively and in the survival rate between the two groups for patients who received a total dose of from 141 to 420 mg. In Group II, none of the 9 patients survived with the native liver without developing portal hypertension (PT), while 8 of 18 Group II patients who received consolidated CST of this dose survived with the native liver without developing PT (p=0.02). Conclusion : Consolidated CST has a positive effect on both short and long-term outcome in selected patients with biliary atresia.
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Atsushi Horiuchi, Chikara Tsugawa, Toshihiro Muraji, Eiji Nishijima, S ...
Article type: Article
2001 Volume 37 Issue 5 Pages
800-804
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Purpose : The incidence of wound infection after stoma closure was studied in patients with and without nasopharyngeal carriage of methicillinresistant Staphylococcus aureus (MRSA). We also analyzed whether postoperative usage of MRSA sensitive antibiotics in MRSA carriers could effectively reduce the risk of wound infection. Methods : From 1993 to 2000, 86 patients who underwent closure of enteral stomas were included in this study. Among them, 21 patients (24%) were nasopharyngeal carriers of MRSA. Twelve of these 21 patients received either ABK or VCM postoperatively. The remaining 9 patients were treated with conventional antibiotics. Results : The incidence of postoperative wound infection in MRSA negative patients was 4.6%, while it was 19% in MRSA carriers (p<0.05). In the group of MRSA carriers, wound infection developed in three of 12 patients who received MRSA sensitive antibiotics. On the other hand, wound infection developed in only one of 9 patients who received conventional agents. Conclusion : MRSA carriers were at high risk for wound infections after stoma closure. Postoperative prophylactic use of ABK or VCM for MRSA carriers was not effective in reducing the risk of wound infections.
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Yoichiro Oka, Akira Hayashi, Shoichiro Kamagata, Seiichi Hirobe, Motoi ...
Article type: Article
2001 Volume 37 Issue 5 Pages
805-809
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Two cases of esophageal ulcers caused by button-shaped lithium batteries lodged in the esophagus will be discussed. In both cases, the batteries were removed using a balloon catheter immediately after the patient presented to the emergency ward, three and a half hours and one hour after accidental swallowing. In spite of such rapid removal, ulcer formation was observed using endoscopy. Button-shaped lithium batteries are large enough (2cm in diameter) to be easily lodged in the esophagus and also generate a high electric potential of 3 volts. To achieve this high potential, sodium hydrochloride is produced around the negative pole during the flow of current. This could be the cause of chemical injury to the esophageal mucosa. For this reason, it is strongly recommended that button-shaped lithium batteries lodged in the esophagus be removed as soon as possible and patients be followed-up with endoscopic examinations to check for esophageal ulceration.
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Yuuki Tsukahara, Hiromichi Ikawa, Yasunori Fukumoto, Shinya Okamoto, H ...
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2001 Volume 37 Issue 5 Pages
810-814
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A case with a giant atrial thrombosis from central venous catheter (CV catheter) is reported. The patient is a 15-years-old boy diagnosed with tetralogy of Fallot and syndrome of periodic ACTH-ADH dischage. A CV catheter had been inserted via the right cepharic vein for TPN (total parenteral nutrition) for about 3 years. During these 3 years, the CV catheter had not been replaced. For evaluation of esophageal stricture, he was scheduled for endoscopy. Preoperative echocardiogram detected a right atrial mass, which was seemed to be a thrombosis caused by the long-term CV catheter. It was removed by right atriotomy. Before removal of a long-term CV catheter, an echocardiogram should be performed.
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Shigehisa Fumino, Satoru Chujou, Taizou Furukawa, Kazuaki Tokiwa, Naom ...
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2001 Volume 37 Issue 5 Pages
815-820
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We report a case of renal abscess in an 8-month-old girl presenting with multilocular cysts of the left kidney. The initial symptom was a urinary tract infection. Multilocular cysts were found in the upper pole of the left kidney by abdominal ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). Differential diagnosis between renal abscess and other cystic renal tumors was so difficult that we repeated abdominal CT and MRI examination after two weeks. These findings showed a reduction in tumor size, and contrast ultrasonography revealed the tumor to be hypovascular. Final diagnosis of renal abscess was made by percutaneous needle biopsy guided by ultrasonography. Pathology findings revealed normal renal tissue with slight leukocytic infiltration and with no evidence of malignancy.
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Hitoshi Ikeda, Norio Suzuki, Minoru Kuroiwa, Yoshiaki Tsuchida, Tomio ...
Article type: Article
2001 Volume 37 Issue 5 Pages
821-826
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Late-presenting Bochdalek hernia is rarely accompanied by a compromising hypoplasia of the lung and treatment usually has good results. Minimally invasive surgery, therefore, should be considered because it is psychologically and cosmetically beneficial to patients. We performed endoscopic surgery, in which both laparoscopy and thoracoscopy were used, on a 1-year-old patient. Although some technical problems still remain, endoscopic surgery is safe and should be a choice of treatment in patients with late-presenting Bochdalek hernia.
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Masahiro Kawasaki, Yoshiteru Takada, Yoko Tabuchi
Article type: Article
2001 Volume 37 Issue 5 Pages
827-830
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A 11-year-old boy was admitted with painful mass in left lower abdomen. The symptom started after he played Volleyball 10 days previously. Based on the finding of ultrasonography, CTscan, MRI and the clinical history, we thought it was non-traumatic rectus sheath hematoma. Although usually conservative treatment is preferable, we performed reconstruction of the abdominal wall because a major portion of the muscle was ruptured transversely with a large hematoma. Non-traumatic rectus sheath hematoma is thought to be relative rare entity. Cases in childhood were very rare in a review of the Japanese literature. When a tender abdominal wall mass is present, we should keep this disease in mind as a probable diagnosis.
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Hideto Yoshioka, Takafumi Goto, Takashi Akiyama
Article type: Article
2001 Volume 37 Issue 5 Pages
831-836
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The term human tail often includes any mass in the lumbosacral area, particularly on the midline. We report a 12-year-old boy with human tail. Magnetic resonance imaging (MRI) revealed the absence of both spina bifida and connection with the spinal cord, resulting in simple resection being performed. Often, hunam tail is the cause of tethered cord syndrome. It is important to check for the neurological abnormality preoperatively, because most patients have additional spinal anomalies, including spina bifida, lipoma and others. Furthermore, human tail is often the cause of tethered cord syndrome.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2001 Volume 37 Issue 5 Pages
837-843
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2001 Volume 37 Issue 5 Pages
844-856
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
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2001 Volume 37 Issue 5 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2001 Volume 37 Issue 5 Pages
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Article type: Article
2001 Volume 37 Issue 5 Pages
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2001 Volume 37 Issue 5 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
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2001 Volume 37 Issue 5 Pages
857-858
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
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2001 Volume 37 Issue 5 Pages
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