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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
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Article type: Index
2007 Volume 43 Issue 1 Pages
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Kwang-Jong Lee, Shoichiro Kamagata, Seiichi Hirobe, Miki Toma, Fumiko ...
Article type: Article
2007 Volume 43 Issue 1 Pages
1-6
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Purpose: Lobar overinflation (LO) is characterized by overexpansion of the affected lobe due to a checkvalve mechanism. Full investigations may reveal the causes of LO. From the aspect of etiology, we have reviewed our experience of cases that had the diagnosis of LO. Methods: Recordings of children who had respiratory symptoms with overexpansion of the involved lobe on chest X-rays at our hospital between 1973 and 2004 were reviewed. We investigated the cause of LO by chest computed tomography, bronchoscopy and/or bronchography. Results: There were 20 children who had the diagnosis of LO in the study period. The age at onset of symptoms was less than 6 months in 14, 6 months to 6 years in 4 and over 6 years in 2. The affected sites and their frequency were left upper lobe (n=6), left lower lobe (n=4), right middle lobe (n=2) and right lower lobe (n=3), respectively. The whole right lobes were involved in 3 and 2 patients had bilobar lesions. Intrinsic causes were seen in 15 (6 bronchial stenosis, 2 diffuse bronchiolar narrowing, 6 bronchial atresia and 1 bronchial ectasia) and extrinsic causes were seen in 3 (compression with bronchogenic cyst in 1 and with cardiovascular cases in 2): the remaining 2 cases proved to be other diseases (1 pulmonary sequestration and 1 congenital cystic adenomatoid malformation) postoperatively. Conclusions: We found some causes of LO in all cases. Since LO is found to consist of several disorders that result in overinflation of a pulmonary lobe, the term lobar "emphysema is not appropriate and should be avoided from a pathological point of view. To investigate the etiology and pathology of overinflation is important for the diagnosis and treatment of LO.
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Takuro Kazama, Masaki Nio, Nobuyuki Sano, Ryoji Ohi
Article type: Article
2007 Volume 43 Issue 1 Pages
7-12
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Purpose: The tracheal separation procedure has recently been employed to prevent recurrent aspiration pneumonia, which can be life-threatening especially in neurologically impaired children. The effectiveness and safety of this procedure were examined. Methods: The records of 11 neurologically impaired patients with intractable aspiration who underwent the tracheal separation procedure with (8 patients) or without (3 patients) tracheoesophageal anastomosis between March 2004 and August 2005 were retrospectively reviewed, focusing on their clinical courses, complications, and outcomes. In patients with gastroesophageal reflux (GER) associated with aspiration symptoms, we carried out fundoplication first unless the breathing problem was serious. The patients who subsequently developed symptoms for severe aspiration underwent the tracheal separation procedure. Results: Frequency of oral and tracheal management for aspirated saliva decreased after the operation (preoperative frequency: 5.4±2.0/day, postoperative frequency: 4.4±1.4/day, p=0.066). Degree of oxygen saturation improved (preoperative level: 93.8±3.3%, postoperative level: 98.0±1.6%, p=0.002). Incidence of aspiration pneumonia decreased postoperatively. Four patients who developed respiratory symptoms associated with GER underwent tracheal separation following fundoplication. Postoperative complications were one tracheoesophageal anastomotic leakage and one subcutaneous hematoma. Both were successfully treated by drainage. At the time of writing, 5-22 months after the operations, all patients were alive. Conclusions: The tracheal separation procedure was safe and effective. This procedure not only prevented aspiration pneumonia but also improved the QOL of both patients and caregivers. Carrying out fundoplication for GER first benefited patients' families providing enough time to realize the necessity of the tracheal separation procedure.
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Etsuji Ukiyama, Yasuo Ito, Yuuji Nirasawa, Yoshiko Watanabe, Hiroko Ta ...
Article type: Article
2007 Volume 43 Issue 1 Pages
13-17
Published: February 20, 2007
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Purpose: To determine the feasibility of functional end-to-end anastomosis of small bowels with different calibers in infants. Materials and Methods: Four infants were treated by functional end-to-end anastomosis with staplers when calibers of the small bowels were greatly different (more than two times). The following parameters were compared retrospectively: operation time, blood loss, days until oral intake, days until discharge from the hospital, body weights before and after the operations, and complications. Results: The most recent patient had a shorter operation time and smaller amount of bleeding. Two cases of functional end-to-end anastomosis needed twice as many days until oral intake and more days until discharge from the hospital. Increase of body weight after the operations was good except in one case with chronic lung disease. Conclusions: Functional end-to-end anastomosis with staplers in infants was a safe, steady, and useful procedure. But some cases showed disturbance of bowel movement after the operations. Careful start of oral intake was necessary.
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Yasuhiko Iiboshi, Toshio Sawai, Yasuji Seki, Yuko Tazuke, Kazuhiro Suz ...
Article type: Article
2007 Volume 43 Issue 1 Pages
18-22
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Purpose: In spite of the importance of central venous routes for many therapies, cutdown and catheterization are sometimes difficult. We present child cases inserted with 3.6 Fr Silascon O type catheters or 7 Fr Hickman dual lumen catheters, reporting the patient's background, the rate of success and the cause of failure. Methods: We made 133 central venous routes in patient from neonates to 15-year-old children for 4 years. We utilized anesthesia for cutdown, and x-ray to confirm the placement of the catheter tip in the operation room. Results: We managed 57 malignant cases, 41 gastrointestinal cases and 37 intensive care cases. 3.6 Fr Silascon venous catheters were used in 39 cases, and 7 Fr Hickman dual lumen catheters in 98 cases. Of 133 first catheterizations for central venous routes, 129 cases were successful. Of 4 second catheterizations, all 4 cases were successful. The causes of failure in the first catheterization were misleading of the Hickman catheter's tips in the right external jugular vein of an 8-year-old patient and in the left external jugular vein of a 10-year-old patient. In addition, the Hickman catheter was too large to ingent into the left cephalic vein of a 6-year-old patient. Moreover, The Silascon catheter was not inserted through the right external jugular vein of an 8-year-old child because of occlusion. Conclusions: All catheters could be inserted in neonates and infants because it was easy to distend their veins and change their direction. The reasons why the central venous accesses were difficult were intravenous thrombus, direction of vein of bifurcation for large catheters, and the thickness of veins except the external jugular vein.
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Mayumi Hoshino, You Asai, Mikiya Inoue, Kiminobu Sugito, Taro Ikeda, N ...
Article type: Article
2007 Volume 43 Issue 1 Pages
23-31
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Purpose: To clarify clinical characteristics of intussusception in infancy and childhood with special attention to underlying organic bowel lesions causing the disease. Methods: One hundred and thirty-nine patients with intussusception treated in our institution between 1995 and 2006 were reviewed. Japanese literature reported since 1958 was also reviewed. Results: The average age of our patients was 1 year and 11 months. Boys were more frequently affected than girls; the sex ratio was 1.54. Prodromal symptoms were recognized in 43.4% of the patients, and 73.6% of them were treated by non-surgical procedures. The ileoileocolic type was the most likely type for surgical indication. In 6 cases (4.3%), intussusception was induced secondarilly by the organic lesions. The average age and recurrence rate of these 6 cases were higher than those without organic lesions, and ileoileo and coliccolic types were most commonly observed. In the literature review, out of 6,681 cases of intussusception, 183 cases (2.7%) were found to have organic lesions. Conclusions: In most of our patients intussusception was found to occur idiopathically, and male infants were most commonly affected. Six patients in our series were associated with underlying organic bowel lesions. Age and recurrence rate in these patients were higher than those observed in the idiopathic patients.
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Shigeru Yakabe, Takeshi Yamanouchi
Article type: Article
2007 Volume 43 Issue 1 Pages
32-36
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Purpose: Recent treatment policy for inguinal hernia and the frequency of contralateral appearance was assessed with a questionnaire survey. Patients and Methods: A questionnaire survey about inguinal hernia was carried out at 24 facilities performing pediatric surgery in the Kyushu area. The contents included the sex, the age of operation from 2001 to 2003, the individual part numbers of the examples, operative method, number of contralateral examinations with positive appearance. Details about examples of contralateral appearance up to June, 2005 from 2001 were asked for. Results: From 24 facilities during 3 years, 5,686 examples were collected. There were mostly in the 1-to-3 age bracket for the operation, had a sex ratio of 1.3:1 (boy:girl), showed many lateralities in the right side to be few for boys and represented examples of bilateral simultaneous in about 10% of cases for both sexes. As for the technique, 95% was Potts' method. There was a total of 333 examples of contralateral appearance, which is a rate of 5.6%. The mean time from the initial operation was 18.5±20.3 months (from 4 hours to 10 years after operation) and 90% of the cases was within 3 years. There was a difference between age, sex and initial operation site. The most frequent rate was 13.6% in the case of a girl in the 1-to-3 age bracket whose initial operation site was left. Next was 10% in the case of infant boy whose initial operation site was left. At 20 facilities, contralateral examination was not carried out and laparoscopy was used at 4 facilities. The positive rate of contralateral examination was 34.1% in total.
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Makoto Hayashida, Makoto Nakao, Tohru Arima
Article type: Article
2007 Volume 43 Issue 1 Pages
37-41
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Midgut volvulus can occur during intrauterine life and often presents findings which mimic jejunal atresia and meconium peritonitis. Midgut volvulus is rarely diagnosed prenatally and it has been described as showing non-specific sonographic findings. Recently, however, several reports have described prenatal midgut volvulus in which the fetal sonogram showed a whirlpool sign. We herein report a case of prenatal midgut volvulus suspected to be jejunal atresia by ultrasonography. A 23-year-old woman was referred at 36 weeks of gestation because of fetal intestinal dilatation and polyhydramnios found on routine ultrasonography. Our ultrasound examination revealed polyhydramnios and a dilatation of the duodenum and proximal jejunum. At 36 weeks and 2 days, a male infant weighting 2,968g was delivered transvaginally. His abdomen was slightly distended. A contrast enema suggested intestinal malrotation. A laparotomy revealed midgut volvulus and intestinal malrotation. The small bowel and cecum were twisted around the SMA 1,080 degrees in a counterclockwise direction, but the involved bowel showed no ischemic changes. Ladd's operation and an appendectomy were thus performed. The postoperative course was uneventful and he was discharged on the 19th postoperative day. Midgut volvulus can occur prenatally. Whenever the fetus shows signs of intestinal obstruction, it is therefore considered to be useful to look for the presence of a whirlpool sign which has been shown to be pathognomonic of midgut volvulus.
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Masayuki Obatake, Masahito Nomura, Yukio Inamura, Kenji Tanaka, Yasuak ...
Article type: Article
2007 Volume 43 Issue 1 Pages
42-47
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Vitamin K deficiency bleeding in late neonates and infants is roughly classified into two groups whether in association with being human milk-fed or not, and results in intracranial hemorrhage with considerable frequency. Intracranial hemorrhage in biliary atresia resulting from vitamin K malabsorption and liver dysfunction has been reported by many authors. A 2-month-old boy presenting with congenital biliary dilatation developed bradypnea and unconsciousness. Brain CT scan showed high density areas in the right lateral lobe. He was diagnosed with acute intracranial hemorrhage due to vitamin K deficiency by a coagulation study and operated on for intracranial hemorrhage because of a deteriorating general condition. We performed a definitive operation on him for congenital biliary dilatation because of persisting liver dysfunction. Congenital biliary dilatation in late neonates and infants should be considered with risk of vitamin K deficiency bleeding.
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Yasuhiko Iiboshi, Toshihiro Okada, Yuko Tazuke, Jiro Fujimoto
Article type: Article
2007 Volume 43 Issue 1 Pages
48-52
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Antenatal diagnosis by ultrasonography and laparoscopic treatment in the newborn has become widespread. We show a case of successful observation and resection of a neonatal right ovarian cyst through the wound of laparoscopy. An antenatal ultrasound scan done at 32 weeks showed a cystic lesion in the abdomen. Following an uneventful pregnancy, a 37-week female child was born with a birth weight of 3,198g. An ultrasound of the abdomen showed a 5.9×5.1cm cystic lesion in the right ovary. The cyst moved into the left abdomen on day 2 of life, and again moved into the right abdomen on day 3. The cyst seemed to become torsed, and an emergent operation was performed. A single-port technique was utilized on day 4 of life. Under general anesthesia, a 12-mm trocar was introduced infraumbilically by the open method. Videolaparoscopy was performed with a 10-mm fibreoptic laparoscope. The intraabdominal pressure was maintained at 6mmHg. A large simple ovarian cyst on a stretched and untorted right fallopian tube and normal left ovary was clearly visualized. The cyst wall was delivered through an infraumbilical port site to the outside. The cyst was aspirated, placed outside and decapsulated. Postoperative course was uneventful and a fine cosmetic result was obtained.
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Yuki Ishimaru, Masahiro Hatanaka, Yushi Otani, Kazunori Tahara, Hajime ...
Article type: Article
2007 Volume 43 Issue 1 Pages
53-57
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A 4-day-old female baby, who was born at 35 weeks' gestation and weighed 1,918g at birth, was admitted to our hospital complaining of tachypnea and abdominal distention. A video esophagogram showed an H-type tracheoesophageal fistula (Gross E esophageal atresia) at the level of Th2. The patient had thrombocytopenia, and a diagnosis of Wiscott-Aldrich syndrome also was made based on the patient's family history. Through a right cervical incision, division of the fistula was performed at the age of 9 days. Postoperative esophagograms showed a distortion of the upper esophagus with swallowing, but there were no other complications. Based on the experience of the presented patient, we conclude that division and closure of the fistula should be secured under a full exposure of the cervical region. Minimal dissection of the trachea and esophagus and postoperative ventilatory support with low pressure also are essential to avoid complications. This is a rare case report of H-type tracheoesophageal fistula complicated with Wiscott-Aldrich syndrome.
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Miho Watanabe, Hiroaki Komuro, Michio Kaneko, Tetsuo Hori, Misako Hira ...
Article type: Article
2007 Volume 43 Issue 1 Pages
58-61
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We report a case of an extremely low-birth-weight infant with ileal obstruction caused by usage of an umbilical ligation ring. A female baby was born after a gestation of 25 weeks, weighing 798g. The umbilicus was ligated using a ring. The baby developed gradual abdominal distension, followed by bile vomiting at the age of 18 days, and she was referred to our hospital. Emergent laparotomy was performed for bowel obstruction. Volvulus cased by adhesion of the terminal ileum to umbilicus was observed. Ileal resection and primary anastomosis was performed. However, the second laparotomy for anastomotic leakage on the 3rd postoperative day disclosed a deeply buried ligation ring in the umbilicus. By examination of intraoperative pictures at the initial operation, it was confirmed that the terminal ileum was pinched in the ligation ring at the umbilicus. This complication is extremely rare, but should be borne in mind in the case of using an umbilical ligation ring.
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2007 Volume 43 Issue 1 Pages
62-91
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
92-93
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
93-94
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
94-95
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
95-96
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
97-98
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
98-99
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2007 Volume 43 Issue 1 Pages
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2007 Volume 43 Issue 1 Pages
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