Purpose : A variety of organic bowel diseases are reported to induce intussusception as the leading indicator in the infancy and childhood. Methods : The authors retrospectively reviewed medical charts and surgical records for 106 pediatric patients who were treated for intussusception between 1978 and 2004. Of the 106 children, obvious organic bowel diseases were confirmed at surgery in 10 patients. Results : Leading indicators for intussusception were identified as Meckel's diverticulum in 5 cases, jejunoileal polyp in 2, ileal hamartoma in 1. Henoch-Schonlein syndrome in 1, and malignant lymphoma in 1, respectively. In this series of patients, small bowel polyp and hamartoma were identified at younger ages (4 months to 17 months), while Henoch-Schonlein syndrome and malignant lymphoma were diagnosed at later ages, after 4 and 5 years. Meckel's diverticulum was intraoperatively found in 5 patients between 2 months and 4 years of age, in which no massive bloody stool had been noticed. Conclusion : Patient's characteristics of pediatric intussusception including age at onset and clinical manifestations were thought to be of value for routine pediatric surgical clinics.

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Purpose : Hybrid liposomes composed of vesicular and micellar molecules have been used as drug delivery systems. But it has become clear that hybrid liposomes alone have an inhibitory effect against the growth of some kinds of tumor cells. The present study was designed to determine whether a drug-free hybrid liposome composed of dimyristoylphosphatidylcholine (DMPC) and polyoxyethylenealkyl ether (EO) (90mol% DMPC/10% C_<12>(EO)_<21>(HL21), 90mol% DMPC/10% C_<12>(EO)_<23>(HL23), or 90mol% DMPC/10% C_<12>(EO)_<25>(HL25), inhibits metastasis of mice neuroblastoma cells to the liver and thus increases survival. Methods : A mice neuroblastoma cell, C1300N18, and A/J mice were used in this study. First, we determined the inhibitory effect of the hybrid liposomes on C1300N18 cells in vitro. Next, to determine the inhibitory effect of the hybrid liposomes on the metastasis of neuroblastoma cells to the liver, we compared weights and histological findings of the livers 30 days after the beginning of a 7-day intraperitoneal injection of a hybrid liposome. We also compared survival rates using the Kaplan-Meier method. Results : In mice implanted with C1300N18 cells and treated with HL21 or HL25, no histological evidence of metastasis was found, the weight of the liver was normal, and survival was longer than for mice treated with HL23 and control mice respectively. Conclusions : Two kinds of hybrid liposomes. HL21 and HL25, inhibit metastasis of mice neuroblastoma cells to the liver, and thus increase survival.

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Purpose : The aim of this study is to evaluate recent operative cases of hydronephrosis due to PUJ stenosis at our department. Methods : Thirty-four operative cases of hydronephrosis presenting between 1996 and 2004 were reviewed in regard to clinical parameters, US, renogram and operative complication. Results : Of 34 cases, 26 were males and 8 females. Six cases were right hydronephrosis, 22 were left, and 6 were bilateral. Twenty-two cases (64.7%) were operated in infancy. Fourteen cases (41.2%) were diagnosed prenatally, 10 cases (29.4%) were diagnosed by physical examination, 9 cases (26.5%) showed clinical symptoms. The mean pressure of postoperative renal pelvis in 14 cases was 15.7 cmH_2O. Follow up appearances of the kidneys after pyeloplasty were improved in 97.1% (33 cases). Two cases had postoperative complications, and re-operation was done. Initial differential renal function was calculated in 29 cases. The preoperative renal function was less than 45% in 6 cases (20.7%), and 55% or more in 10 cases (34.5%). Conclusion : The appearance of the pelvis after pyeloplasty was improved in 97.1% (33 cases). However postoperative follow up is necessary to evaluate the functional prognosis.

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Although we performed fetal surgery for a complex urinary tract anomaly, we are worried about reconstruction of the patient's urinary tract. We report a case of this rare condition. When a 32-year-old primigravida underwent ultrasonography at 19 weeks' gestation, a dilatated fetal bladder was prenatally detected. After follow-up by the previous doctor, the patient was admitted to our hospital from the previous maternity hospital at 21 weeks' gestation because of a gradual increase of fetal bladder size. Oligohydramnios was present; the fetus was male and had megacystis, bilateral hydronephrosis and dilatation of intestine detected by fetal ultrasonography after admission. By diagnostic aspiration of urine from the fetal bladder at 22 weeks' gestation, the fetal renal function was thought to be good from the urinalysis. After discussing the treatment of the fetus, percutaneous placement of a catheter shunt was performed from the fetal bladder to the amniotic fluid at 26 weeks' gestation. Although oligohydramnios was temporarily improved by the fetal surgery, the tip of the shunt catheter prolapsed from the amniotic fluid space into the intraperitoneal cavity of the fetus at 32 weeks' gestation and fetal urinary ascites was present. So cesarean section was performed emergently. The 2,196-g boy at 32 weeks' gestation had a high imperforate anus and urethral occlusion. On day 1, colostomy and cystocutaneostomy was performed. During the postoperative course, turbid urine, pyelonephritis, and increase of serum creatinine were present. By further examination, a left non-functioning kidney, obstruction of right ureterovesical junction, and a rectovesical fistula were diagnosed. According to the urinary tract, a right ureterocutaneostomy (ring type) was performed. Subsequently, recurrent urinary tract infection has not been seen and renal function has been stable within normal limits. Concerning the digestive tract, terminal colostomy remains. Since we are worried about the procedure and the time of the reconstruction of his urinary tract for acquiring continence, we described the clinical course of the patient in anticipation of useful suggestions.

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We describe a case of familial occurrence of Hirschsprung's disease. The father had the radical operation at the age of 1 year. The daughter had right transverse colostomy at 2 days after birth. After 6 months, she had the radical operation. Hirschsprung's disease is characterized by the relatively high incidence of familial occurrence, but few cases of father (mother) and daughter (son) have been reported. We collected 11 cases among 5 families in Japan and 51 cases among 23 families in other countries. The incidence was 43% (12 cases) among affected fathers and 57% (16 cases) among mothers. The incidence in the affected mother was higher than that in sporadic cases. The risk of recurrence of this disease in a family increases with the length of the aganglionic segment. Our patient had the mutation of exon2 and exon11, but her father didn't have the same mutation.

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We experienced continuous duplication of the intestine from the lower portion of the esophagus to the stomach. The case was a 1-year-7-month-old girl. The principal complaint was an abdominal mass palpated as a fist-sized mass in the left upper quadrant of the abdomen, so the girl was admitted for further testing. Duplication of the stomach was suspected because of an upper GI series and abdominal CT and MRI, and an operation was performed. The cyst presented in the intestinal tract, continuing from the lower portion of the esophagus to the wall of the greater curvature of the pylorus, and the cyst was removed. Histopathologically, it consisted of stomach tissue, although glandular epithelium, cartilage, and lymphocytic infiltrate were noted in the portion starting in the esophagus. Theories about the occurrence of duplication of the intestine include origins in diverticulum during the fetal period, a partial twin, impaired intestinal recanalization, and impaired notochord development. In this case, tissue of both the stomach and trachea was noted. The mechanism for the development of the condition in this case is thought to be a developmental disorder during the period of the foregut. This case might be explained when considering the mechanism for development of duplication of the stomach.

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Eleven examples of inverteral Y ureteral duplication have been reported in our country, including the example of the effect by a very rare ureter deformity. A 5-year-1-month-old girl was taken to another hospital with urinary tract infection. VCG and CT showed right vesicoureteral reflux and a right duplicated ureter. Afterwards she passed without causing urinary tract infection, but the vesicoureteral reflux did not respond to treatment. She had undergone antivesicoureteral reflux plasty and passage was excellent after the operation.

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An 11-month-old boy presented with a left neck mass. It was removed after a preoperative diagnosis of neurological tumor, but aberrant cervical thymus was confirmed by pathological study. Twenty-one cases of aberrant cervical thymuses in childhood reported in the Japanese literature are reviewed.

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Eosinophilic gastroenteritis is a rare disease characterised by tissue eosinophilia of the bowel wall. We describe a variant of eosinophilic gastroenteritis. This case differed from classical submucosal eosinophilic gastroenteropathy as the functional intestinal obstruction was closely associated with eosinophilic myenteric ganglionitis, rather than wall thickening. A 3-year-old girl was admitted our hospital due to acute intestinal obstruction. CT scans and contrast enema showed caliber change and suggested partial stricture at the colon and splenic flexure; hence surgery was contemplated. The caliber changed segment was resected and end-to-end anastomosis was performed. Pathological investigation of the resected colon revealed an inflammatory process affecting the Auerbach's plexus, in which eosinophils were predominant. The postoperative course of this case was uneventful.

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Retroperitoneal xanthogranuloma is a very rare entity, especially in childhood. This tumor is histologically benign, but reported to have local recurrence or distant metastasis in some patients. We report a patient with retroperitoneal xanthogranuloma associated with hypoplastic kidney and hydroureter. The patient was a 6-year-old girl, complaining of high-grade fever and abdominal pain. She was referred to our hospital because of right lower abdominal mass. Laboratory data showed urinary tract infection and high serum level of CA19-9 and CA125. CT examination and MRI examination revealed right hydronephrosis, hypoplastic kidney, and hydroureter. Garium scintigraphy showed the accumulation on the right upper abdomen. From the surgical findings, a solid yellowish mass, which connected to the kidney, was noticed and it directly invaded the ascending colon. Therefore, the tumor was removed with the right kidney, hydroureter, and the ascending colon. Histologically, the tumor was diagnosed as retroperitoneal xanthogranuloma. The postoperative course was uneventful. Follow-up studies for 18 months have shown no evidence of local recurrence or distant metastasis.

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