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2007 Volume 43 Issue 7 Pages
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2007 Volume 43 Issue 7 Pages
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2007 Volume 43 Issue 7 Pages
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[in Japanese]
Article type: Article
2007 Volume 43 Issue 7 Pages
911-912
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Hiromitsu Matsuda, Hiroyuki Noguchi, Hiroyuki Tahara, Tatsuru Kaji, Ta ...
Article type: Article
2007 Volume 43 Issue 7 Pages
913-918
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Purpose: Laparoscopic surgery is a minimally invasive procedure even in infants. We reviewed our experiences of laparoscopic resection in retroperitoneal neuroblastoma detected by a mass screening test (NBMS). Materials and Methods: Five patients with retroperitoneal NBMS underwent laparoscopic resection (LR group). Their ages ranged from 7 to 9 months; four were male and one female. Three tumors were found in the left retroperitoneum and two in the right. There were no symptoms, and all were in INSS 1. We compared surgery time, amount of blood loss, post operative fast period, length of hospital stay (LHS), and complications between the LR group and the 6 cases which underwent open laparotomic resection (OR group). Results: In the LR group, the surgery time of the two most recent cases was shorter than that of the first two cases. There were no complications other than a temporary circulatory disturbance to the upper pole of the kidney. Although operation time in the laparoscopic group was significantly longer than in the open group, the amount of blood loss was significantly smaller. There were no significant differences in the postoperative fast period or LHS. Conclusions: Due to the small number of cases, it is difficult to conclude the usefulness of laparoscopic resection in retroperitoneal tumors. However, laparoscopic resection has the potential to be an effective treatment for retroperitoneal tumors in infants.
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Hiroaki Fukuzawa, Naoto Urushihara, Takanori Matsuoka, Morimichi Tani, ...
Article type: Article
2007 Volume 43 Issue 7 Pages
919-922
Published: December 20, 2007
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Purpose: In pancreaticobiliary maljunction, we had considered that a diameter of the bile duct less than 6mm was normal regardless of age. But, it is supposed that the diameter of the bile duct in children increases in size with increases in age, weight and height. In this study, we measured the diameter of the bile duct in normal children, and our 8 cases of pancreaticobiliary maljunction without biliary dilatation were compared with normal children in the width of bile duct. Methods: One hundred twenty-eight children who had no hepatobiliary disease underwent ultrasonography. The diameter of the common bile duct was measured, and the standard diameter was established. Our 8 cases of pancreaticobiliary maljunction without biliary dilatation were compared with normal children in bile duct size. Results: In normal children, the diameter of bile duct had close correlations with age (month), weight (kg), and height (cm). Statistically this study showed that standard diameter of bile duct was 1.53+0.0124×age (month), -0.34+0.0256×height (cm) and 1.36+0.054×weight (kg). In our 8 cases of pancreaticobiliary maljunction without biliary dilatation, the bile duct was larger than the standard diameter. Conclusions@@ This study showed that the diameter of the bile duct in normal children had close correlations with age (month), weight (kg), and height (cm). In pancreaticobiliary maljunction without biliary dilatation, the bile duct had minimal dilatation compared with the standard child bile duct.
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Kazunori Masahata, Tetsuro Nakamura, Takashi Azuma, Kouichi Ohno, Tats ...
Article type: Article
2007 Volume 43 Issue 7 Pages
923-927
Published: December 20, 2007
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A 28-day-old infant was referred to our institution due to right pleural effusion. She was admitted because her right chest cavity revealed chylothorax. We managed conservatively for 15 days with chylous effusion drainage, medium-chain triglycerides (MCT) milk and total parenteral nutrition (TPN). The drained volume showed no change during the period of conservative management. Pleurodesis was performed through the intrathoracic injection of 8 mg of minocycline hydrochloride dissolved in 5ml of normal saline, and the drain tube was clamped for 1.5h. After the pleurodesis with minocycline hydrochloride, the volume drained from the tube decreased markedly. After 10 days, there was no drainage. There were no complications in this case. After the discharge, she showed no recurrence. We conclude that pleurodesis with minocycline hydrochloride is a safe and effective treatment for chylothorax in neonates and children.
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Kouji Nagata, Takeshi Yamanouchi, Shigeru Yakabe, Hideki Saitsu, Ryouz ...
Article type: Article
2007 Volume 43 Issue 7 Pages
928-932
Published: December 20, 2007
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We experienced three cases of blunt hepatic trauma in children who were treated non-operatively. The first case was a 9-year-old girl, with vena caval thrombosis after traumatic liver injury due to a "handle bar" bicycle accident. Anti-coagulant therapy using warfarin was effective for the thrombus and the thrombus had almost disappeared when she was discharged from the hospital within 97 days after the injury. The second case was a 12-year-old boy, with a large hepatic hematoma due to a traffic accident. The large hematoma was recognized in the center of the right lobe, but the hematoma gradually decreased and he was discharged from the hospital within 19 days after the injury. The third case was an 8-year-old boy, with blunt hepatic trauma due to a fall from a ladder. He experienced delayed hemorrhage from the pseudoaneurism within 10 days after the injury. Transcatheter arterial embolization (TAE) was performed and he was discharged from the hospital within 32 days after the injury without complication.
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Yoshikiyo Nakagawa, Sadashige Uemura, Tsunehiro Yano, Tatsuo Nakaoka, ...
Article type: Article
2007 Volume 43 Issue 7 Pages
933-937
Published: December 20, 2007
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Abdominal distension and a mass in a 12-month-old boy were noticed by a local doctor. The tumor was about 15cm in diameter in the left abdomen with a smooth and hard surface on palpation. In the diagnostic imaging, a large mass originated from the left kidney. Another mass, 4cm in diameter with same properties as the left tumor, was also pointed out in the lower pole of the right kidney. An abdominal open biopsy on both sides was performed. The diagnosis was nephroblastoma on the right and fetal rhabdomyomatous nephroblastoma (FRN) on the left side. We started chemotherapy with ActD and VCR to reduce the right tumor. One month later, the tumor on the right was reduced in size but the left became almost double in a diagnostic imaging. Then, he underwent left nephrectomy and enucleation of the right tumor. Most of the right kidney was able to be preserved. Pathological diagnosis was FRN on both sides. He recovered well after the operation and following chemotherapy. He has been disease free for 1 year after the treatment. FRN is a rare type of nephroblastoma with abundant striated muscle components. Chemotherapy and radiation therapy are not effective and in bilateral and large cases, their prognosis is poor. This case might provide some suggestions regarding the treatment strategy for FRN.
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Masanori Uchiyama, Hiroki Murata, Masahiro Ohtaki
Article type: Article
2007 Volume 43 Issue 7 Pages
938-944
Published: December 20, 2007
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An 8-year-old girl showed symptoms of acute abdomen by the inflammatory infiltration of the retroperitoneal lymphangioma to the seromuscular layer of the 4th portion of the duodenum. A retroperitoneal multilocular tumor was resected together with resection of the seromuscular layer of the duodenum. The literature on 71 cases of abdominal lymphangioma in children during 6 recent years were reviewed. In 33 cases, the origin was small intestinal mesenterium. In 4 particular cases among them, the origin was the intestinal wall or the tumor was invaded the intestinal wall (intestinal type). Mesocolon, greater or lesser omentum, retroperitoneum, and spleen were the site of origin in 5, 9, 1, 21, and 2 cases, respectively. In 23 (70%) of 33 cases with mesenteric tumor of the small intestine including 4 cases of the intestinal type, combined resection of the adjacent intestine was done. In another 10 cases, the tumor was removed without damaging the surrounding organ. For the lesions originating from the mesocolon, greater or lesser omentum, complete removal of the tumor was done in 3 cases and in 7 cases, and partial resection with fenestration was observed in 2 cases and 3 cases, respectively. Among 21 cases of retroperitoneal lymphangioma, 19 cases underwent operation, while tumors in 2 cases disappeared during the follow-up. Complete removal was done in 13 cases and partial resection was performed in another 6 cases. Consequently, re-operation or persistent chylorrhea was reported in approximately 30% of the cases. Regarding the pathological features of these 71 cases, most of the lesions were multicystic, while cavernous lymphangioma was demonstrated in 4 cases (small intestinal mesenterium origin in 3 and spleen in 1).
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Yuichi Kondo, Yasuhiko Iiboshi, Toshio Sawai, Yasuji Seki, Jiro Fujimo ...
Article type: Article
2007 Volume 43 Issue 7 Pages
945-947
Published: December 20, 2007
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Ileus due to spilled trichobezoar is extremely rare in Japan. But, in children almost all ileus due to bezoar are those due to trichobezoar. We show a child case of ileus due to trichobezoar which was resolved by gastrografin enema. An 11-year-old girl admitted for vomiting and lower abdominal pain was found in plain abdominal radiography to have multiple air-fluid levels. A long intestinal tube inserted on hospital day 4 did not improve symptoms. Gastrografin enema showed an oval shadow in the ileum. One day after gastrografin enema, intestinal obstruction was resolved and three masses of trichobezoar were defecated from the anus. Although surgical management had been the main therapy for ileus due to trichobezoar, gastrografin enema was useful for diagnosis of the cause of ileus and therapy to resolve the obstruction of the intestine.
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Yasuhiko Iiboshi, Yuko Tazuke, Yasuji Seki, Kazuhiro Suzumura, Jiro Fu ...
Article type: Article
2007 Volume 43 Issue 7 Pages
948-952
Published: December 20, 2007
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Pyriform sinus cyst and fistula most commonly present as recurrent deep neck infections. We describe a neonate who presented with air in the cyst and without infection, and whose fistula and cyst were resected easily by endoscopic air insufflation. A 2-day-old girl was admitted with an enlarging left-sided neck mass. She had had a full-term gestation and normal delivery, and was 2,648g in weight. On admission, there was a soft mass measuring 5×5cm on the left side of the neck. A neck magnetic resonance imaging revealed that the mass contained an air-fluid level, suggesting communication with the airway or oral cavity. A gastrografin with milk swallow (cine-esophagram) disclosed a tract extending inferiorly from the left pyriform sinus to the cyst and air in the cyst. At 19 days of age, the baby underwent surgical excision of pyriform sinus fistula and cyst after endoscopic examination detected an opening in the apex of the left pyriform sinus and an air flow through the opening into the cyst was felt palpably. The fistula tract entering into the inferior pharyngeal constrictor muscle was easily detected, and complete excision was possible at the point of the left pyriform sinus. No recurrence was noted for the next 6 months. Neonatal pyriform sinus fistulae must be differentiated from other cervical masses, and we should try to discover the fistulae as soon as possible and resect them before infection sets in. Air insufflation is useful for the diagnosis and therapy of a pyriform sinus cyst and fistula in neonate.
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Wataru Fukunaga, Yasuhiko Iiboshi, Toshio Sawai, Yasuji Seki, Akihiro ...
Article type: Article
2007 Volume 43 Issue 7 Pages
953-956
Published: December 20, 2007
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A 3-year-old boy was admitted to our hospital with an abdominal mass. Abdominal CT and MRI showed that the abdominal mass was a 6.5×6.5×6.5-cm tumor with calcification in the tumor. At operation, the tumor was located in the hepatoduodenal ligament and had adhesion to the common bile duct. The tumor was excised with the common bile duct ; a cholecystectomy was performed and the bile duct was reconstructed using a Roux-Y choledochojejunostomy. The tumor, which was surrounded by a capsule, contained upper and lower limbs, hair, fingers, and nail as a fetiform mass. There was intestine in the tumor, too. Histological diagnosis was mature teratoma. There was liver fibrosis that was thought to be induced by cholestasis with stenosis of the common bile duct. The postoperative course was uneventful and no recurrence was recognized for 6 years. To our knowledge, there are 6 previous reports of teratoma in the hepatoduodenal ligament and only 4 reports in children. The diagnosis and resection of teratoma in the hepatoduodenal ligament should be performed as soon as possible to prevent adhesion to and stenosis of the common bile duct.
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Hiroaki Fukuzawa, Naoto Urushihara, Takanori Matsuoka, Morimichi Tani, ...
Article type: Article
2007 Volume 43 Issue 7 Pages
957-960
Published: December 20, 2007
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Meckel's diverticulum is a major disease of intestinal hemorrhage in children. In most cases, Meckel's diverticulum with bleeding has ectopic gastric mucosa and is detected in ^<99m>Tc-pertechnetate scintigraphy. But, some cases are not detected in scintigraphy and diagnosis is considered difficult. We tried ultrasonographic examination in 3 cases of suspected bleeding Meckel's diverticulum. Meckel's diverticulum was detected in all cases. Ultrasonography showed that Meckel's diverticulum was a blind-ending thick walled cylindrical intestine with no peristalsis in all cases. Two cases had resection of the Meckel's diverticulum under laparoscopy. The specimen had hypertrophic ectopic gastric mucosa like ultrasonographic findings. We think that bleeding Meckel's diverticulum was clearly different from normal small intestine in ultrasonography. In ultrasonography, the characteristics of bleeding Meckel's diverticulum were (1) the thick walled cylindrical intestine, (2) the blind-ending intestine, (3) the intestine having no peristalsis and no passage. We suggest that ultrasonography is an available test for Meckel's diverticulum undetectable in scintigraphy.
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Article type: Appendix
2007 Volume 43 Issue 7 Pages
961-962
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Article type: Article
2007 Volume 43 Issue 7 Pages
963-
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Article type: Article
2007 Volume 43 Issue 7 Pages
963-964
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
Article type: Article
2007 Volume 43 Issue 7 Pages
964-
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[in Japanese], [in Japanese]
Article type: Article
2007 Volume 43 Issue 7 Pages
964-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2007 Volume 43 Issue 7 Pages
964-965
Published: December 20, 2007
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2007 Volume 43 Issue 7 Pages
965-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2007 Volume 43 Issue 7 Pages
965-
Published: December 20, 2007
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2007 Volume 43 Issue 7 Pages
965-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2007 Volume 43 Issue 7 Pages
965-
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[in Japanese], [in Japanese]
Article type: Article
2007 Volume 43 Issue 7 Pages
965-966
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2007 Volume 43 Issue 7 Pages
966-
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[in Japanese], [in Japanese]
Article type: Article
2007 Volume 43 Issue 7 Pages
966-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2007 Volume 43 Issue 7 Pages
966-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2007 Volume 43 Issue 7 Pages
966-967
Published: December 20, 2007
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2007 Volume 43 Issue 7 Pages
967-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2007 Volume 43 Issue 7 Pages
967-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
Article type: Article
2007 Volume 43 Issue 7 Pages
967-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2007 Volume 43 Issue 7 Pages
967-968
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Article type: Article
2007 Volume 43 Issue 7 Pages
968-
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[in Japanese]
Article type: Article
2007 Volume 43 Issue 7 Pages
968-
Published: December 20, 2007
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
Article type: Article
2007 Volume 43 Issue 7 Pages
968-
Published: December 20, 2007
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