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Tetsuro Kodaka, Yutaka Kanamori, Yujiro Tanaka, Mitsuhiro Ito, Masahik ...
Article type: Article
2003 Volume 39 Issue 2 Pages
163-167
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Purpose & Methods: Protractor, a self-retaining atraumatic abdominal wall retractor, has a wound protection function, and is very effective in the meaning of wound protection and development of the operation field. We used Protractor in 18 cases (biliary atresia, 6; appendicitis, 2; vesico-ureteral reflux, 7; intussusception, 1; duodenal atresia, 1; and ureteropelvic junction stenosis, 1) from October 2000 through October 31, 2001. We examined the patients' age, presence of complications, size of skin incision, etc. of the 18 cases. Results: It seemed that there was no age limitation for the use of Protractor, being applicable to use for children from the age of 14 days to 11 years old. No complication that seemed to originate as the result of Protractor, such as wound infection, was found in the 18 cases. It was able to secure an effective large operation field in skin incisions from 3 to 10 cm. Moreover, it was able to ensure collection of the washing water, and it seemed to be useful in respect to temperature maintenance. In addition, utility was shown regarding operations on the urinary system. Conclusion: Protractor, which has a wound protection function, seems to be especially useful for pediatric surgery operations thus necessitating its expansion to new applications in the future.
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Masayuki Obatake, Eiji Nishijima, Shigeru Takamizawa, Atsushi Horiuchi ...
Article type: Article
2003 Volume 39 Issue 2 Pages
168-173
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Purpose: Omphalitis in children frequently causes granulation and secretion at the umblicus. However prolonged infection at the umblicus may result from remnants of the vitelline duct or urachus. The aim of this report is to review cases of vitelline duct and urachal remnants associated with omphalitis. Methods: From 1990 to April 2001, 30 children with vitelline duct or urachal remnants were operated on in our department. Results: Of these 30 children, five had mucosal tissue and granulation at the umbilicum, two had fistula, seven revealed omphalitis, and 16 required draining of umbilical lesion. Nine of 30 children had vitelline duct remnants (three patent vitelline duct, two umbilical sinus, one vitelline duct cyst and three umbilical polyp). Twenty-one of 30 children had urachal remnants (three patent urachus, 16 urachal sinus and two urachal cyst). The remnant tissues of all cases was resected by laparotomy. Histopathological examination revealed two aberrant pancreas and two aberrant gastric gland in the vitelline duct remnants, and transitional epithelium or glands in the urachal remnants. Conclusion: We sometimes have difficulty in diagnosing simple omphalitis or omphalitis with vitelline duct and urachal remnants. Omphalitis patients with vitelline duct or urachal remnants need surgical therapy.
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Yoshimitsu Fukuzato, Youkatsu Ohhama, Masato Shinkai, Hiroshi Take, To ...
Article type: Article
2003 Volume 39 Issue 2 Pages
174-180
Published: April 20, 2003
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Background/Purpose: Surgical management for congenital hyperinsulinism (HI) is still contraversial in terms of surgical indications and extent of pancreatic resection. To evaluate the therapeutic significance of pancreatic resection and the extent of resection for HI, the authors analyzed 11 of their patients with HI. Materials and Methods: A retrospective chart review was conducted for the 11 HI patients operated on at the authors' institution in the past 30 years (1970-2001). Results: The extent of pancreatectomy was as follows. 97% resection (3 cases), 95% resection (3 cases),90% resection (1 case, ended up 98% secondary resection due to persistant hypoglycemia after the initial resection), and 85% resection (2 cases). The remaining one patient had a nodular lesion in the pancreas head that was enucleated. Histopathologically, nine patients had diffuse lesions and two patients had focal lesions. Postoperatively, in the diffuse lesion group, three patients having less than 95% resection had persistent hypoglycemia, four patients having 97% or more resection had diabetes mellitus or glucose intolerance, and three patients having 95% resection had restored euglycemia. Both patients with focal lesions had euglycemia after the enucleation procedure and 75% resection. Conclusion: In the diffuse HI group, 95% pancreatectomy is the procedure of choice for initial surgical management. In the focal HI group, when preor intraoperative localization of the lesion is possible, minimal resection may be sufficient to prevent hypoglycemic attack. However, if such localization is unclear, 95% pancreatectomy is the better choice.
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Masaki Nio, Nobuyuki Sano, Tomohiro Ishii, Hideyuki Sasaki, Dai Kimura ...
Article type: Article
2003 Volume 39 Issue 2 Pages
181-186
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Purpose: To elucidate the role of partial splenic embolization procedures (PSEs), long-term outcome was assessed in terms of the recurrence of thrombocytopenia. Methods: A retrospective chart review was performed for 41 PSEs conducted on 36 patients for hypersplenism due to portal hypertension. Results: The underlying disease was biliary atresia in 32, extrahepatic portal obstruction in three, and idiopathic cirrhosis in one. The patients were followed from 20 d to 182 mo (average, 70.8 mo). Five patients subsequently died, and six underwent liver transplantation. The causes of death or the reasons for liver transplantation were not related to hypersplenism. Eleven patients developed recurrence of thrombocytopenia (<100,000/mm^3). There was no significant difference in embolized volume % or platelet count before PSE between the patients with and without the recurrence of thrombocytopenia. The peak value of platelet count after PSE was significantly lower in the patients with recurrence of thrombocytopenia (p=0.0091). In seven of 24 survivors without liver transplantation, platelet counts remained normal throughout the follow-up period. Conclusion: PSE is a safe and effective procedure. Hematologic indices for all of the 36 patients improved after PSE, and its long-term efficacy was demonstrated in 70% of the survivors.
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Ryoichi Ikegami, Akio Kubota, Hiroomi Okuyama, Takaharu Oue, Seika Kur ...
Article type: Article
2003 Volume 39 Issue 2 Pages
187-192
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Purpose and Methods: The authors reviewed 11 cases, five boys and six girls, of congenital hiatal hernia that occurred in the first year of life, including four cases found during the neonatal period Results: Four cases had congenital cardiac diseases, including three cases of asplenia syndrome. Nine cases had manifestations of clinical symptoms, all of them included symptoms associated with upper gastrointestinal tract (ie vomiting in six, dysphagia in four, and failure to thrive in four). Four cases had respiratory symptoms, intractable cough in three and repeated pneumonia in one, respectively. The duration between onset and diagnosis ranged from 2 to 865 d, with an average of 254 d. Contrast meal demonstrated hiatal hernia m all the cases and sliding and short-esophageal type in eight and three, respectively. In four cases, the whole stomach hermated into the mediatinum. Surgical repair was performed four nine cases; with open surgery for six and under laparoscopy for three cases. Laparoscopy offered a better view for trans-hiatal procedure than the conventional laparotomic approach. Conclusions: In conclusion, four of 11 cases of congenital hiatal hernia were presented in the first month of life. The duration between onset and diagnosis ranged from 2 to 865 d. The delay in diagnosis may be caused by the variety of clinical features, from hematemesis to failure to thrive, although diagnosis could be made easily using contrast meal.
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Yukio Ogura, Minoru Horisawa, Noriji Niinomi, Shunji Tsuboi, Norihisa ...
Article type: Article
2003 Volume 39 Issue 2 Pages
193-197
Published: April 20, 2003
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Purpose: Today, subclavian vein puncture is the most popular means of central venous access, but some complications, such as pneumothorax, hemothorax and fracture of the catheter due to pinch-off syndrome, may occur. Recently, an ultrasonically guided puncture method has been developed for diagnostic and therapeutic aspects. For prevention of complications, especially fracture of the catheter, we tried to approach the subclavian vein at the distalpoint to the clavicula under the dynamic image of two-dimensional echography in children. Methods: A small transducer (T739) enables us to puncture the vein of small children. The present report describes our safer technique of ultrasonically guided subclavian vein catheterization. Results: We performed ultrasonically guided subclavian vein catheterization in 21 cases of children. Without 2 cases of neonate, we were able to puncture the subclavian vein with no complications. Conclusions: We improved ultrasonically guided subclavian vein catheterization in children. By this procedure, we experienced no complications.
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Sumi Kudou, Tadashi Iwanaka, Mari Arai, Hiroshi Kawashima, Jun Fujishi ...
Article type: Article
2003 Volume 39 Issue 2 Pages
198-203
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Purpose: The aim of this study is to ascertain the incidence of adhesive small bowel obstruction (ASBO) after pediatric surgery and evaluate the risk factors of the previous operation. Methods: The medical records of all patients admitted to Saitama Children's Medical Center between 1983 and 2000 with the diagnosis of ASBO were reviewed retrospectively. Data included 114 patients, accounting for 143 admissions. Results: The initial diseases associated with the highest incidence of ASBO were malrotation (11.1%), post-operative ileus (10.9%), congenital diaphragmatic hernia (10.7%), and liver tumor (10.3%). Lower risk diseases were appendicitis (1.9%), esophageal hiatus hernia (1.6%), and hypertrophic pyrolic stenosis (0.2%). Fifty percent of the first obstructions developed within six months of prior operations and 75% within three years. Immediate operation was performed for 23 episodes. The remaining 120 episodes initially underwent conservative treatment. Although 94 episodes were cured with conservative treatment, 26 subsequently necessitated surgical intervention. All strangulated episodes occurred on the first admission for ASBO. The cumulative risk of ASBO after laparotomy was roughly 4.7% as compared to 0.7% after laparoscopic surgery. Conclusions: The risk factors for developing ASBO following initial operation were long incision, wide lack of or damage to the serosa, and surgical manipulation of a large area of the small bowel. Prophylaxis of ASBO is considered to reduce these factors by the following means: laparoscopic approach and minimum incision, serosal repair and using a bioresorbable membrane, and less invasive surgical procedures.
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Yuichiro Yamazaki, Rie Yago, Mari Suzuki, Hiroshi Toma
Article type: Article
2003 Volume 39 Issue 2 Pages
204-209
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Purpose: To evaluate our results of anti-reflux surgery in children from the point of success rate, feasibility of post-operative management, and parental preferences in particular. Methods: We report on 35 consecutive patients (mean age 3.5 yr) who underwent open anti-reflux surgery between January 1997 and March 2002. Unilateral and bilateral reimplantations were done in 15 and 30 children, respectively, and we used the extravesical procedure in 14, Cohen procedure in 15 and Politano-Leadbetter procedure in six. A retrospective evaluation was performed for surgical outcomes, length of hospitalstay, catheter requirements, performance of post-operative epidural anesthesia and parental preferences using a questionnaire. Results: The success rate was 100%. There was no post-operative complication except contra-lateral reflux in two unilateral procedures. The mean hospital stay for all children was 4.5 d (2.3 in latest 14 patients), and mean length of indwelling catheter was 1.9 d. Ureteral stent was not used for any patient. No patient needed post-operative epidural anesthesia after the extravesical procedure. Sixty-three percent of the parents preferred surgery on admission day and 92% approved the concept of perioperative management with short hospital stay. Conclusions: In our experience, open anti-reflux surgery can be done safely with a short hospital stay (less than 3 d) with parental satisfaction. While the surgical outcome is not different, the extravesical procedure is less morbid compared to the intravesical procedure. The necessity of catheter placement was thought to be very limited.
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Yasuaki Yoshino, Yukio Kanazawa, Kazuya Ise, Tsuyoshi Nemoto, Yoshinor ...
Article type: Article
2003 Volume 39 Issue 2 Pages
210-214
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A six-year-old girl was diagnosed as having nephrotic syndrome at the age of two years old, and steroids had been administered since then. She developed a huge pancreatic pseudocyst 6 month after acute pancreatitis, requiring as external drainage tube to be inserted into the cyst. After a month, the drainage tube came out naturally. The condition developed into diffuse peritonitis, and cyst-gastrostomy was soon performed. Post-operative hemorrhaging into the cyst continued. Two months later, she experienced a hemorrhagic shock and hemostasis was performed. A week later, she experienced hemorrhagic shock again, so the cyst was resected. She failed to recover from the shock and died. Attempted arteriographic occlusion or intentional resection of the cyst may have saved her life.
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Akihide Tanano, Yoshinori Hamada, Kohei Takada, Masahito Sato
Article type: Article
2003 Volume 39 Issue 2 Pages
215-221
Published: April 20, 2003
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Currarino syndrome is a very rare disorder of which rectal and anal malformation, presacral tumor, and sacral malformation are characteristic. We report four patients with this syndrome in a review of related literature. The patients consisted of one boy and three girls. Rectal and anal malformation was rectal stenosis, intermediate anal atresia, cloaca, and cloacal extrophy in one patient each. Presacral tumor was mature teratoma in one patient, lipoma in one patient, and myelocystocele in two patients. Sacral malformation was crescent deficiency in one patient, deficiency on the right side in one patient, and aplasia in two patients. In the patients with rectal stenosis and cloacal extrophy, a permanent artificial anus was formed, and they are under follow-up observation. In the patients with cloaca and intermediate anal atresia, radical surgery was performed. To determine the method for the treatment of rectal and anal lesions in patients in whom Currarino syndrome is suspected, it is important to determine whether there are complications such as presacral tumor, diagnose the type and severity of rectal and anal malformation, and make a qualitative diagnosis of presacral tumor by imaging.
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Article type: Article
2003 Volume 39 Issue 2 Pages
222-227
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Article type: Article
2003 Volume 39 Issue 2 Pages
228-230
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2003 Volume 39 Issue 2 Pages
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2003 Volume 39 Issue 2 Pages
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Article type: Article
2003 Volume 39 Issue 2 Pages
231-232
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Article type: Article
2003 Volume 39 Issue 2 Pages
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Article type: Article
2003 Volume 39 Issue 2 Pages
232-
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2003 Volume 39 Issue 2 Pages
232-
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Article type: Article
2003 Volume 39 Issue 2 Pages
232-233
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2003 Volume 39 Issue 2 Pages
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[in Japanese], [in Japanese]
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2003 Volume 39 Issue 2 Pages
233-
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Article type: Article
2003 Volume 39 Issue 2 Pages
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2003 Volume 39 Issue 2 Pages
233-234
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