Purpose: The effectiveness of laparoscopic examination of the internal ring was evaluated as a means of diagnosing contralateral inguinal hernias in children with unilateral inguinal hernia. Method: Seventy-one children with clinical unilateral inguinal hernia were studied. Contralateral inguinal hernia was diagnosed by a 30° or 45°, 5 mm laparoscopy through the inguinal hernia sac before ligation. Result: Seventy-one children were between the ages of 8 months and 8 years. Patent procesuss vaginalis was observed in 13 of 71 patients (18.1%), and the earlier two cases revealed a false negative finding. Sensitivity was 86.7% and specificity was 100%. There were no complications during the laparoscopic examination. Conclusion: This procedure is a simple, safe and accurate method for diagnosing contralateral inguinal hernia.

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Purpose: We reported long-term follow-up results on three patients with a long gap esophageal atresia repaired using circular myotomy (Livaditis method). The indication for and limitation of this method will be discussed. Materials and Methods: Between April 1980 and June 1981, three patients with long gap esophageal atresia underwent delayed primary end-to-end anastomosis using the Livaditis method. Two girls with Gross type A atresia each required one circular myotomy in the proximal esophagus to bridge the gap. A boy with Gross type B required three myotomies (one in the proximal and two in the distal esophagus) for safe anastomosis. We followed them over 20 years with regular clinical evaluation during that time. Results: All patients showed frequent episodes of respiratory infection and swallowing difficulty due mainly to anastomotic stricture during the early postoperative period. Those symptoms dramatically improved in the former two patients within three years, and have progressed smoothly thereafter. The patient with Gross type B atresia suffered from symptoms due to severe dysmotility of the repaired esophagus, necessitating resection of the poorly motile segment at the age of 19. Thus, his schooling was significantly desrupted due to repeated hospitalization over a long period. At present, one girl has graduated from college, the other girl is a university student, and the boy has his own job after graduating from junior high school. Conclusion: We conclude that the procedure achieved good long-term results in the two patients with Gross type A atresia. The procedure could even bridge an extremely long gap atresia as in our Gross type B patient. However, there does seem to be a limit to this procedure as suggested by the severe complications produced by marked dysmotility of the esophagus in the patients with three myotomies. These results, however, were seen in patients with bowel interposition.

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Purpose: Although there are many reports regarding etiology of the infantile hypertrophic pyloric stenosis (IHPS), most of those studies have been immunohistochemical or biochemical investigations of pyloric muscle. The aim of this study is to investigate contractile responses to several agents in sphincter muscle isolated from IHPS. Methods: Muscle biopsy specimens (10×2 mm), were taken at pyloromyotomy in 18 infants with IHPS. Isometric tension was recorded after 1.5-2 h equilibration under 1g loading in Krebs solution at 37℃ and pH 7.4. Following those preparations, reactions of the specimen to administration of carbachol, tetradotoxin (TTX), L-Arginine (LA), W-ω-nitro-1-arginine (NNLA), atropine, nifedipine, erythromycin (EM), and motilin were examined. Results: Spontaneous contraction appeared in all specimens, (1) This contraction was not affected by atropine and TTX, but completely blocked by nifedipine. (2) Electrical field stimulation caused on-contraction, on-relaxation and off-contraction in the specimens. The on-relaxation was inhibited by NNLA. LA caused relaxation and this response was also inhibited by NNLA. (3) Motilin and EM induced contractions and then facilitated spontaneous contractions. Conclusion: (1) We suggest that spontaneous contraction of the sphincter muscle isolated from the patient with IHPS was related to myogenic contraction. (2) Those specimens contain nitrenergic innervation. (3) Those specimens contain motilin receptor, and EM may affect the occurrence of IHPS.

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We experienced the case of a premature infant with neuroblastoma. A 34-days-old boy was admitted to our hospital with a 1.5 cm diameter mass in the left thorax which was incidentally found at the ligation of the patent ductus arteriosus. He was observed but did not undergo therapy. Yet, the mass continued to spread, so he underwent a total excision at 9 months of age (6 months of corrected age). After 2 years of treatment, he is now disease free. The routine ultrasonography during pregnancy has helped diagnose and defined the features of some congenital malformations and tumors. Additionally, we can perform the variable medical procedure to a premature infant with new advances in medicine. Neuroblastoma is incidentally found by routine prenatal ultrasonography, or in a premature infant. It appears that definite guidelines for these patients are needed.

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A portable mechanical pump for patient-controlled analgesia provides children with terminal malignancy adequate pain relief and improvement of quality of life during the final stages of the disease. In one case, a variable infusion rate, patient-controlled bolus relieved the pain suffered by a 24-year-old woman. In the other case, a portable mechanical pump provided a 5-year-old boy with a continuous infusion so he could enjoy the rest of his life outside the hospital. Previous infusion pumps were heavy, expensive and awkward to use. This new portable pump allowed a continuous infusion of narcotics and the patient could safely go outside the hospital with this PCA system.

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We report a case of mobile cecum syndrome managed successfully by laparoscopic cecopexy. A 14-year-old girl, suffering from intermittent right lower quadrant pain for several years, was admitted to Kishiwada City Hospital. She had extreme right lower quadrant tenderness without rebound tenderness but with normal bowel sounds. At laparoscopy, there was no demonstrable pathology except for the unattached and freely mobile cecum and right colon. The cecum and the ascending colon were sutured to the lateral peritoneum laparoscopically with interrupted absorbable suture. She has been symptom free for three years after the operation. Laparoscopic cecopexy is less invasive than any other operative procedures for mobile cecum syndrome.

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A newborn was referred to our hospital with a cudgel-shaped tail-like structure in the central sacrococcygeal region. The tumor, which included areas of fat, fluid and calcification, was diagnosed as teratoma. Magnetic resonance imaging showed excess coccyxes in the extended line of the normal coccyx. This was diagnosed as a human tail. There was a boundary between the excess coccyxes and the teratoma, and no continuity with the spinal canal. We removed the tumor and the excess coccyxes. A pathological diagnosis showed a mature teratoma, separated from the coccxyes by a distinct boundary. Many reports have shown major complications associated with human tails, such as spina bifida and tethered cord syndrome. It is important to check for a spinal abnormality and for any tissue in continuity with the soinal canal.

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A 1-year, 9-month-old boy swallowed a button type lithium battery. The initial trial to remove the battery at the neighboring hospital using endoscopy under general anesthesia was unsuccessful, and the patient was referred to our hospital about five hours after the ingestion. Direct esophagoscopy was performed under general anesthesia, and the ingested battery was removed six hours after ingestion using a forceps for laparoscopic surgery. Esophageal endscopy, which was done immediately after the removal showed an esophageal ulcer. The battery measured 20 mm in diameter. The patient received predonine (2 mg/kg/day) to prevent esophageal stricture. About 20 days later, however, the patient developed difficulty in swallowing. The X-ray and esophageal endscopy showed esophageal stricture. Esophageal dilatation was performed on days 23, 50, and 79 after the ingestion. About six months later, X-ray study showed only a slight esophageal stricture, and the patient had no difficulty in swallowing. Lithium batteries can cause esophageal injury during a short period, which may be followed by severe esophageal stricture. It is necessary to remove the esophageal foreign body, such a button type lithium battery, as soon as possible.

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We report two cases of total colonic aganglionosis associated with small intestinal atresia. [Case 1] A 14-day-old boy was admitted with abdominal distension and bilious vomiting. An ileostomy was performed due to the diagnosis of total colonic aganglionosis. Postoperative symptoms included bilious vomiting while an abdominal X-ray showed a dilated dudenum. An upper gastrointestinal series of test sconfirmed a duodenal atresia and dye reached the distal duodenum through the bile ducts. [Case 2] A 2-day-old boy was admitted with abdominal distension and bilious vomiting. As a barium enema was administered to the microcolon, ileal end-to-back anastomosis was performed with the diagnosis of ileal atresia. Postoperatively, anastomotic stenosis was developed and did not respond to treatment. As the ileal specimen which was resected at the first operation showed aganglionosis, an ileostomy was performed.

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An 11 year-old male was admitted to our hospital because of abdominal pain due to an abdomen blow during judo practice. The ultrasonography and the computed tomography scan revealed a cystic mass with a solid component accompanied by hemorrhage located in the pancreas tail. He was diagnosed as having a solid and cystic tumor of the pancreas, and the operation was performed. Since the tumor adhered strongly to the corpus posterior wall of the stomach and splenic hilum, a distal pancreatectomy was performed. Solid and cystic tumors are most commonly found in young women and are rarely malignant. A literature review of the young male with solid and cystic tumor was reported.

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We experienced a case of neonatal giant hepatic hemangioendothelioma. The abdominal mass was detected by fetal echogram at 35 weeks gestation in this patient. The patient was delivered by Caesarean section at 36 weeks and 3 days gestation. The patient was intubated and received mechanical ventilation just after birth because she had a respiratory disorder due to the giant abdominal mass. Blood, examinations revealed anemia, thrombocytopenia and prolonged coagulation time, which indicate disseminated intravascular coagulation (DIG). Ultrasonography, CT scan and an MRI revealed a large hepatic mass with dilatation of left hepatic vein. Under a diagnosis of hepatic hemangioma with Kasabach-Merritt syndrome, steroid and radiation therapies were performed, resulting in the improvement of DIG. But there was little change in the tumor size, so we performed a tumor resection at 60 days, after identifying the tumor as hepatic origin by angiography. The histology of the tumor was hemangioendothelioma. The patient was discharged 3 weeks after the operation. It is likely that surgical resection after steroid administration and radiation is an effective and safe treatment for neonatal giant hemangioendothelioma when complicated with a condition such as DIG.

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An 11-year-old boy was referred to our hospital for evaluation of a recurrent prandial upper abdominal pain. Abdominal ultrasonography, computed tomography, MRI and bile-scintigraphy revealed the absence of left hepatic lobe and umbilical portion with displacement of the gallbladder to the midline. After a conservative follow-up of 1 year and 10 months, he developed severe abdominal pain. An open cholecystectomy was carried out under the diagnosis of hypoplasia of the left hepatic lobe at the age of 13. A dilated gallbladder was located in the midline. Marked atrophied lateral segment with enlarged right and caudate lobes were observed. Cholangiography demonstrated the absence of branches of the bile duct of the lateral segmental bile duct. Postoperative recovery was uneventful and he has been well with no abdominal symptoms for seven months. We believed that the abdominal pain occurred due to displacement of the gallbladder neck with delayed gallbladder ejection fraction. An adult case of hypoplasia of the left hepatic lobe coexisting with gallbladder dyskinesia was reported in Japanese and this is the first report of a child case.

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