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Article type: Cover
2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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Article type: Appendix
2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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Article type: Index
2008 Volume 44 Issue 4 Pages
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Hiroomi Okuyama, Akio Kubota, Hisayoshi Kawahara, Toshimichi Hasegawa, ...
Article type: Article
2008 Volume 44 Issue 4 Pages
581-584
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Purpose: Recently fetoscopic balloon tracheal occlusion has been expected to be an effective treatment for severe congenital diaphragmatic hernia. However, technical refinement is essential to apply the fetoscopic treatment to clinical cases. In this study, we evaluate the safety and technical aspect of this technique in a fetal lamb experiment. Methods: Using the single-port technique, 5 fetal lambs underwent tracheal occlusion with a detachable balloon at 110 days' gestation. Under general anesthesia, the gravid ewes underwent a laparotomy for uterine exposure. Through a 5-mm port in the uterus wall, a fetoscope was advanced into the fetal trachea. Through the instrument channel of the fetoscopy, a detachable balloon was introduced and left in the fetal trachea. One week after the operation, fetuses were sacrificed, and the effect of tracheal occlusion was evaluated. Results: Balloon tracheal occlusion was successfully performed in all of the 5 fetuses under excellent visualization. There was no intraoperative complication. Two fetuses were alive at the end of this experiment. At autopsy, the balloon was found in the trachea in one fetus with a dilated lung and ascites. Conclusion: Fetoscopic balloon tracheal occlusion using the single-port technique is thought to be feasible in the fetal treatment of severe CDH.
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Mari Suzuki, Daisuke Matsuno, Yoshiyuki Shiroyanagi, Yuichirou Yamazak ...
Article type: Article
2008 Volume 44 Issue 4 Pages
585-589
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Purpose: Augmentation cystoplasty in patients with spina bifida is widely accepted. However V-P shunt infection is a fatal complication, so we need careful attention to prevent it especially in procedures involving an open gastrointestinal and urinary tract. But perioperative management to prevent shunt infection is not standardized. We evaluate and report the rate of shunt infection and perioperative management of our experience. Methods: From 2005 January to 2007 March, we performed 6 augmentation cystoplasties in patients with spina bifida and V-P shunt. Mean age was 13 y.o. (5-17 y.o.). Surgical materials were ileum in 5, sigmoid colon in 1. Mean follow up period was 1y9m (10m-3y). We retrospectively reviewed and evaluated the rate of shunt infection, method of bowel preparation, duration of antibiotics, surgical procedures, duration of drain indwelling and results of culture. Results: We experienced no shunt infection. Preoperatively 5 had positive urine culture but after using prophylactic antibiotics, all 6 had negative urine culture on the operation day. All patients received bowel preparation using GOLYTELY. Intravenous broad-spectrum antibiotics were initiated 12 hours preoperatively and continued for 3 days at most. Afterward all patients received oral prophylactic antibiotics. Drains were removed on POD2. After operation all cultures were negative. Conclusions: The rate of shunt infection was 0%. Routine preoperative V-P shunt revision is unnecessary. A short-time use of intravenous broad-spectrum antibiotics, early drain removal and control of preoperative urinary tract infection are important to prevent shunt infection.
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Mari Suzuki, Daisuke Matsuno, Yoshiyuki Shiroyanagi, Yuichiro Yamazaki ...
Article type: Article
2008 Volume 44 Issue 4 Pages
590-594
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Purpose: Augmentation cystoplasty is a widely accepted surgical procedure in patients with spina bifida. However, many patients likely feel stress due to the long hospital stay. We modified perioperative management to shorten the hospital stay and evaluated the safety and efficacy of the management. Methods: From June 2004 to March 2007, we performed 13 augmentation cystoplasties in patients with spina bifida. Surgical materials were ileum in 12, sigmoid colon in 1. Mean follow up period was 1y11m (8m-3y5m). According to the style of discharge, patients were divided into two groups: Group 1, discharge without catheter; Group 2, early discharge with catheter and later re-admission for catheter removal. In addition, Group 2 patients were divided into two subgroups: Group 2a, with retrograde colonic enema before admission; Group 2b, without retrograde colonic enema. In each group we retrospectively reviewed clinical records and evaluated the duration of hospital stay, time to oral fluid intake, wound infection and gastrointestinal complication. Results: The total hospital stay of Group 2 (17.7 days) was shorter than that of Group 1 (27 days). Time to oral fluid intake and total hospital stay in Group 2a and Group 2b were 2.25 days, 14.8 days and 3.25 days, 20.75 days respectively. There was no wound infection. Only 1 case had postoperative acute gastric mucosal lesion. We did not experience any case of leakage with anastomosis, ileus or V-P shunt infection. Conclusion: Postoperative early discharge with catheter and retrograde colonic enema before admission were safe and effective perioperative measures to shorten the hospital stay.
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Risa Teshiba, Takeshi Yamanouchi, Shigeru Yakabe
Article type: Article
2008 Volume 44 Issue 4 Pages
595-598
Published: June 20, 2008
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A 3-month-old boy was born at 28 weeks and 6 days of gestation because of premature rupture of a membrane. He was the second of mixed twins and birth weight was 1,280 g with an Apgar score of 6/7. He grew up well and was discharged to home at the age of 70 days. He had presented an umbilical hernia in the NICU which was getting bigger. At the age of 110 days, the tense umbilical skin was red, and a little serous discharge was recognized at the top of the umbilicus. After emergency admission for intravenous antibiotics therapy, evisceration of small and large bowel contents through a ruptured umbilical hernia happened. Immediately he was taken to the operating room and put under general anesthesia. He underwent an emergency operation for primary closure of the umbilical hernia and plasty of umbilicus. Infants with umbilical hernia are usually under conservative treatment because of the extremely rare complication rate and the high possibility of spontaneous closure. According to the reported 14 cases including our case, the risk factors of spontaneous rupture were premature age (early infancy), large size of umbilical hilum, umbilical inflammation or ulceration, and the rise of intra-abdominal pressure.
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Hirofumi Shimizu, Kazuya Ise, Michitoshi Yamashita, Atsushi Kikuta, Hi ...
Article type: Article
2008 Volume 44 Issue 4 Pages
599-604
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A female infant with abdominal distension presented with respiratory failure. She was admitted to our hospital with a diagnosis of an abdominal tumor about 6 cm in diameter, identified in the midline region by computed tomography. Severe anemia and disseminated intravascular coagulation were noted, and a state of hepatic failure seriously progressed. Given a state of oncological emergency, we decided to perform emergency surgery to resect the tumor. The patient was saved without any complications. Neonatal neuroblastoma is very rare, and causes various clinical manifestations. The biological prognosis is good, but for cases presenting with oncological emergency, results are often poor. Proper, prompt treatment is required for an oncological emergency.
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Satoshi Kanada, Masayuki Hirota, Masafumi Naito
Article type: Article
2008 Volume 44 Issue 4 Pages
605-608
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An 11-year-old boy was admitted to our hospital complaining of middle upper abdominal pain. A computed tomography (CT) examination showed a fatty dense mass with the characteristic whirled sign by the animated imaging. Primary torsion of the greater omentum was definitively diagnosed due to the lack of other findings. We operated and the mass was resected. The postoperative course was uneventful. Primary torsion of the great omentum is not common and there are few reports of this in children. Although preoperative diagnosis of this disease is usually difficult, definitive diagnosis is possible when CT shows the typical examination. For this case, consecutive thin slices of CT examination were useful for the diagnosis. The standard treatment of this disease is an operation. In this case, the patient had pain when urinating, so we operated. But we think that if all symptoms disappear, conservative treatment is an option.
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Toshie Komori, Yasushi Iinuma, Shinichi Naito, Koju Nitta
Article type: Article
2008 Volume 44 Issue 4 Pages
609-613
Published: June 20, 2008
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A 14-year-old boy was transferred to the hospital after suffering from a direct compression of the upper abdomen by a seatbelt due to a traffic accident. He complained of severe abdominal pain and his vital signs were unstable. A physical examination revealed severe epigastric tenderness and muscle guarding. Computed tomography demonstrated disruption of the pancreas and a massive hemoperitoneum. He was diagnosed to have suffered a blunt pancreatic injury and intestinal perforation. The subsequent emergency laparotomy revealed a complete disruption of the pancreas, a perforation of the duodenum, and a disruption of right kidney. A simple closure of the duodenum, a pancreatico-jejunostomy (Letton & Wilson's method) and peritoneal drainage were all performed. In addition, a cholecystostomy, and a gastrostomy were also performed. Initially, the post-operative course was uneventful. However, he sometimes complained of upper abdominal pain three weeks after the operation. Postoperative cholangiography demonstrated stenosis of the lower bile duct which maintained good bile drainage to the duodenum. The diagnosis was a delayed bile duct stricture following a pancreatic injury. Conservative treatment with external bile drainage via a cholecystostomy was thus selected for this patient. The stricture disappeared and the abdominal symptoms subsided over time. Continuous bile drainage via the cholecystostomy was thus found to be an effective treatment for delayed bile duct stricture following pancreatic injury.
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Ryuta Saka, Akio Kubota, Hiroomi Okuyama, Hisayoshi Kawahara, Toshimic ...
Article type: Article
2008 Volume 44 Issue 4 Pages
614-618
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The authors reported an extremely rare case of bilateral diaphragmatic hernia associated with supraumbilical omphalocele and lower sternal cleft. A female infant with an antenatal diagnosis of right diaphragmatic hernia was born with a birth weight 1,986 g, at the gestational age of 36 weeks. The omphalocele with liver engagement was too huge to be repaired. Neither medical treatments including high-frequent oxygenation and nitric oxide inhalation nor transabdominal repair of the right diaphragmatic hernia improved cardiopulmonary function. Therefore, extracorporeal membranous oxygenation was applied to improve the respiratory insufficiency; however, the infant could not be weaned off ECMO, and she died of cardiorespiratory failure. Autopsy revealed not only right diaphragmatic hernia but also left diaphragmatic hernia, though not retro-sternal diaphragmatic defect nor cardiovascular anomaly. The bilateral lung was extremely hypoplastic, and the lung/body weight ratio was 0.003, which was thought to be responsible for the lethal respiratory failure. To the best knowledge of the authors, only two cases of bilateral diaphragmatic hernia associated with giant omphalocele have been reported in the literature.
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Kyoko Mochizuki, Youkatsu Ohhama, Masato Shinkai, Hiroshi Take, Norihi ...
Article type: Article
2008 Volume 44 Issue 4 Pages
619-622
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We report a case of severe esophageal stenosis due to corrosive esophagitis in a 12-year-old boy. He received acute medical treatment immediately after alkali ingestion and was admitted to our hospital 2 months after the injury because of progressive stenosis. Although the stenosis was severe at the upper and middle esophagus, the patient tolerated normal meals by esophageal dilatation alone. Treatment for severe stenosis due to corrosive esophagitis that requires a long period because of scar formation still remains a serious problem. Among the therapeutic strategies for esophageal stenosis including bougienage, surgery, and stenting, bougienage is the most simple and minimally invasive method, whereas surgery is invasive and sometimes causes failure to thrive. Based on our experience, bougienage should be the first choice for treatment of esophageal stenosis due to corrosive esophagitis in growing children, which may avoid invasive operative repair.
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Takuo Noda, Yasuhiro Watanabe, Atsushi Yoshida, Takanori Oyama
Article type: Article
2008 Volume 44 Issue 4 Pages
623-626
Published: June 20, 2008
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Anterior urethral polyp in a boy is a very rare abnormality. Something like a mushroom coming out of the external urethral meatus had been noticed in a 22-month-old boy. The extruded tissue was resected at the level of meatal opening in another hospital. He was brought to our clinic for evaluation of the residual lesion. He presented no urinary symptoms and a voiding cystourethrogram showed no lesion. Cystourethroscopy revealed a polyp arising from the anterior urethra 2 cm from the external meatus. The polyp was removed endoscopically. Pathological diagnosis of the polyp was fibroepithelial polyp. Urethral polyps in children are very rare and are usually seen in the posterior urethra of boys. Only 8 cases of anterior urethral polyps in boys have been previously reported in the English literature. They may present with dysuria, hematuria, or extrusion from the external meatus. A urethrogram was useful for diagnosis but cystourethroscopy was necessary in some cases. No recurrence was noted. The polyps had similar pathologic findings as fibrovascular core with transitional epithelium and/or squamous metaplasia.
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Minoru Iwasaki, Jun Tamura, Ryoh Kamimura, Hironori Shimizu, Hisato Ko ...
Article type: Article
2008 Volume 44 Issue 4 Pages
627-632
Published: June 20, 2008
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Pediatric retroperitoneal lipoma is a very rare disease with only 9 reported cases, including our case, in Japan. Retroperitoneal lipoma is apt to occur generally at perirenal tissue, but our case is retroperitoneal lipoma occurring at the retroperitoneal cavity of the dorsal portion of the pancreatic body and it is suggested that the case may be a more extremely rare case. The patient was a 6-year-old girl and came to the outpatient clinic of pediatric surgery for the purpose of further examination and medical management owing to postprandial epigastralgia. A cystic lesion closed to the right perirenal area was was pointed out by ultrasonography in the first month of life and later she had undergone tumorectomy in this hospital. The resected specimen was diagnosed as immature teratoma based on histopathological findings and longterm follow-up management was continued at the outpatient clinic in this hospital. She had frequent postprandial epigastralgia from approximately 5 years of age and it had been suggested by ultrasonography that lipoma or lipoblastoma at the retroperitoneal cavity of dorsal portion of the pancreatic body might exist. Moreover, CT and MRI examination confirmed the existence of a mass consisting of fatty tissue at the same area. Most retroperitoneal lipoma is benign, but tumor recurrence or conversion to malignancy after surgery is reported by some pediatric surgeons. We consider it important to resect the whole tumor perfectly and continue long-term follow-up examination.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
Article type: Article
2008 Volume 44 Issue 4 Pages
633-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
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2008 Volume 44 Issue 4 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
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2008 Volume 44 Issue 4 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
Article type: Article
2008 Volume 44 Issue 4 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
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2008 Volume 44 Issue 4 Pages
635-
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2008 Volume 44 Issue 4 Pages
636-
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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Article type: Article
2008 Volume 44 Issue 4 Pages
636-637
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
637-638
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
638-639
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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2008 Volume 44 Issue 4 Pages
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