Journal of the Japanese Society of Pediatric Surgeons

From January 1986 through June 2001, 16 patients under 15 years of age with spontaneous pneumothorax were admitted to our hospital and underwent operations. We performed mid-axillary thoracotomy in 6, and thoracoscopic surgery in the remaining 10 patients. There was no significant difference in the age between the two groups. However, the operating time, the duration of drainage and the postoperative hospital stay were significantly shorter in the thoracoscopic surgery group than in the thoracotomy group. From the cosmetic standpoint, the former was superior to the latter. Therefore, the thoracoscopic surgery is very useful for pediatric patients with spontaneous pneumothorax.

View full abstract

Show abstractHide abstract

Although respiratory management with highfrequency oscillatory ventilation (HFOV) and inhalated nitric oxide (NO) has generally been used for neonates with congenital diaphragmatic hernia (CDH), the entry criteria for extracorporeal membrane oxygenation (ECMO) based on data from patients who underwent HFOV and NO have not yet been reported. Purpose : The aim of this study is to determine the entry criteria for ECMO in neonates with CDH treated with HFOV and NO. Methods : To establish the entry criteria for ECMO, we retrospectively studied 30 neonates with CDH treated by HFOV between 1986 and 1993, and 43 neonates with CDH treated by NO between 1994 and 2000 in our institutions. From the admission records, preductal and postductal arterial blood gas data, and ventilation conditions for 72 hours after admission were extracted. An oxygenation index (OI) and an alveolar-arterial oxygen gradient (A-aDO_2) time interval combination were calculated. Patients were divided into two groups according to requirement for ECMO : (1) candidates for ECMO, who underwent ECMO or who died without ECMO, and (2) noncandidates, who survived without ECMO. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated, and the entry criteria were determined, when all of these values reached over 80%. Results : The preductal and postductal OI for 4 hours (mean value for 4 hours) >25 were determined useful as entry criteria in CDH patients treated with HFOV. The preductal OI for 4 hours (mean value for 4 hours) >20 and the postductal OI for 4 hours (mean value for 4 hours) >35 were determined reasonable as the entry criteria in CDH patients treated with HFOV and NO in combination.

View full abstract

Download PDF (681K)

Purpose and Methods : The choice of treatment for small intestinal bleeding (SIB) associated with portal hypertension after surgery for biliary atresia (BA) is still controversial. Nine patients with BA developing SIB were treated in our institution. To assess the management for SIB, we reviewed clinical courses, methods of treatment and outcomes. Results : The ages at bleeding were between 2 years and 14.9 years old (average, 9.2 years old). Two patients had jaundice and 2 other patients had thrombocytopenia due to hypersplenism at SIB. Two patients eventually died. One died of liver failure and the other died of a complication after liver transplantation. SIB was not the cause of death in either patient. Of 7 survivors, no treatment except blood transfusion was performed in 2 patients who recently developed SIB. SIB recurred in 2 patients who underwent dissection of collateral vessels. Partial splenic embolization (PSE), which was employed in 2 patients with hypersplenism, and ligation of collateral vessels in one were effective to control bleeding. Two patients developed pulmonary vascular abnormalities : hepatopulmonary syndrome and portopulmonary hypertension, respectively. Conclusion : Although the liver transplantation should be considered in progressive liver cirrhosis, patients with good liver function and controllable bleeding could be expected to have a favorable prognosis.

View full abstract

Today, we experience a lot of patients who need a central venous catheter (CVC) for the purpose of chemotherapy, total parenteral nutrition and so on. But when we implant CVC or care for a patient with an implanted CVC in the long term, we must be careful of many kinds of complications. One of the most severe complications which often threatens a patient's life is a fracture and a division of the CVC. We experienced two cases of CVC division in children who had a CVC implanted through the subclavian vein. We thought the cause of the division was pinch-off syndrome. We described the two cases and the way in which we can prevent and cope with the pinch-off syndrome.

View full abstract

Register with J-STAGE for free!