Purpose: Rikkunshi-to has been widely prescribed for patients with functional dyspepsia. However, its pharmacological actions on intestinal motility are still unknown. This study was conducted to evaluate the effects of Rikkunshi-to on small intestinal motility. Methods: Male Wistar rats weighing 220-260 grams were used. All experiments were performed after 8 hours of fasting. 1) The small intestinal transit rate was measured after the administration of Rikkunshi-to. 2) Male Wistar rats were equipped with force transducers on the stomach, duodenum, and proximal jejunum. Contractile motor activity of the bowel in the interdigestive state was measured following the administration of Rikkunshi-to. 3) The serum gastrin levels and nitrite and nitrate (NOx) levels at the portal vein were also determined. Results: 1) The small intestinal transit rate was significantly inhibited after administration of Rikkunshi-to. 2) Rikkunshi-to (0.3-0.7g/kgBW) obviously reduced the motility index in the duodenum and jejunum in a dose-dependent manner. 3) Both the serum gastrin and NOx levels were significantly increased 30min after the administration of Rikkunshi-to. While the increase of NOx levels was maintained, the gastrin levels returned to the control level after 60min. Conclusion: These results indicate that Rikkunshi-to inhibits small intestinal movement. The mechanism of its inhibition seems to be related to the relaxation of intestinal smooth muscle by nitric oxide. Oral administration of Rikkunshi-to prior to feeding is likely to be useful for extending the retention time of food in the small intestine.

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There is no report which makes reference to whether the inflammation of an appendix is reversible or irreversible in acute appendicitis in children. If the inflammation is reversible, it will be thought that it may recover conservatively, and if irreversible, it can be an absolute indication of an operation. Purpose: To evaluate the irreversible appendicitis precisely before an operation, this clinical study was designed. Methods: Levovist^[○!R], contrast media for ultrasonic diagnoses (5ml of 300mg/ml solution) was given intravenously to 20 cases. The blood-flow signal was evaluated qualitatively in two steps, rich and poor. All the cases underwent appendectomy, and the picturized minute circulation of the appendix wall and the histopathological findings were weighed. Results: Among 16 examples estimated as poor signal, 14 were gangrenous appendicitis, while 3 out of 4 cases which showed rich signal were phlegmonous appendicitis. It was statistically indicated that histopathology views differed between the levels of the Levovist^[○!R] blood-flow signal by Fisher's exact test (p=0.032). It can be said that a rich signal foresees phlegmonous change and a poor signal may foresee gangrenous change. Conclusions: By the preoperative Levovist^[○!R] examination, diagnostic imaging accuracy was improved. The minute blood flow of an appendix wall is decreasing in the state of irreversible inflammation. Detecting this as a Levovist^[○!R] signal, its gangrenous change can be foreseen correctly before an operation. Conservative medical treatment can be applied more widely, and operative indication can be narrowed down by the contrast-enhanced US.

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Purpose: Accurate diagnosis of blunt abdominal trauma is often difficult in pediatric patients because initial symptoms may appear mild even in severe cases. This paper is concerned with initial approach to pediatric blunt abdominal trauma. Subjects and Methods: The subjects were six children with blunt abdominal trauma involving organ damage from 1999 to 2007. These cases were reviewed for the conditions at the initial examination and for the courses up to definite diagnosis. Results: Average age was 8.7 years, 5 males and 1 female. In the splenic/left kidney case and one of the jejunal perforation cases, definite diagnosis was obtained from CT images at the initial examination. In the remaining 4 cases, definite diagnosis was not made at the initial examination. In 2 pancreatic damage cases, although the level of serum amylase was elevated, only mild abdominal pain was observed. Definite diagnosis was made the next day. In the duodenal perforation case, only mild abdominal pain was observed and conservative treatment was performed. Definite diagnosis was obtained from the second CT scan after 5 days. In another jejunal perforation case, the initial abdominal symptom was mild and tests showed no abnormalities. Rapid exacerbation took place and definite diagnosis was made at the second examination after about 12 hours. Conclusion: In the examination of pediatric blunt abdominal trauma, it's very important that possible organ damage should always be taken into consideration, blood and urine testing and abdominal US or CT scan should be conducted, and time-course observation should be made.

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We experienced three cases of the Ewing Sarcoma Family of Tumors, including a pelvic lesion in a 15-year old male, a retroperitoneal in a 7-year old female and a subcutaneous in a 6-year old female. In addition to the surgical treatments, we adopted various chemotherapeutic regimens considering the situations in each patient, including primary site, tumor size, age and reaction to the initial chemotherapy. Two patients have been healthy in a disease-free state and the other died of a cause unrelated to the tumor. The Ewing Sarcoma Family of Tumors has a high malignant potential, and tumor size or volume, primary site (pelvic and paraspinal), age (more than 10 years old), resistance to the initial chemotherapy, distant metastasis and differentiation to neurogenic components seem to be indicators of poor prognosis. In Japan, there is no protocol which has proved to be effective so that a nationwide group study is called for.

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A 2-year-old girl presented with anemia and a positive fecal occult blood test. There was no significant family history. Abdominal CT showed a round intramural mass in the terminal ileum. Cutaneous pigmentation was not found on her lips or the fingers of either hand. Contrast study of the small intestine revealed a solitary pedunculated polyp in the ileum. With a diagnosis of small intestinal polyp, we resected 6cm of the ileum including the polyp followed by a modified functional end-to-end anastomosis. Histopathological examination showed typical features of a Peutz-Jeghers type (hamartomatous) polyp without atypia. A solitary Peutz-Jeghers type polyp occurring in the absence of Peutz-Jeghers syndrome in children is rare, and only 6 cases including our case have been reported in Japan to the best of our knowledge. We suggest that one should consider a Peutz-Jeghers type polyp as a differential diagnosis for patients with anemia and a positive fecal occult blood test, because of its potential malignancy and potential cause of extensive intestinal necrosis.

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Ileus due to spilled trichobezoar is extremely rare in Japan. We present a 6-year-old girl who had trichotillomania with ileus that represented a trichobezoar and this was removed by surgical treatment. Trichobezoars usually occur in patients who have trichotillomania, a behavioral disorder characterized by the compulsive urge to pull one's hair, pet hair, carpets or clothes, combined with trichophagia, the ingestion of that hair. Trichobezoars are most commonly seen in mentally retarded or emotionally disturbed patients. Because it is resistance to the medical management (bicarbonate of soda, dialytic enzyme etc.), surgical operation is selected. Most importantly, psychiatric follow-up is essential to prevent recurrences.

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A 19-year-old girl was admitted to our hospital with a right abdominal pain. At 52 days of age, she underwent Kasai's operation with double Roux-en-Y procedure under the diagnosis of biliary atresia. She underwent resection of enterostomy at 219 days of age. Abdominal CT scan showed a 4-cm intestinal stone and intestinal dilatation. She was diagnosed with impacted enterolithiasis, and underwent surgical treatment. The intestinal stone was impacted in jejunum near the portoenterostomy. The cause of the enterolithiasis was the resection stump of enterostomy that had stagnated the flow of bile for .a long time. Recently, a lot of patients live a long life after Kasai's operation. We should regard enterolithiasis as one of the long-term complications. Additionally, surgical treatment should be considered when an intestinal stone tends to increase.

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A 50-day-old boy presented with a sudden onset of bilious vomiting 48 days after Ladd's procedure without bowel fixation. Contrast enema and upper gastrointestinal contrast study demonstrated recurrent midgut volvulus. The second laparotomy revealed a recurrent clockwise midgut volvulus of 540 degrees without strangulation. The omentum and intestine adhered to the adequately widened base of the mesentery. The bowel was derotated and the proximal jejunum was fixed to the right retroperitoneum with three absorbable sutures. The postoperative course was uneventful and the patient has been free from recurrence for 6 years postoperatively. Recurrent midgut volvulus after Ladd's procedure is so rare that bowel fixation is not usually done. However, it should be considered at the time of recurrence to avoid a third episode.

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A 3-year-old girl with Noonan symptom-complex underwent radical surgery by median sternotomy for pulmonary stenosis at 1 year and 6 months of age. Thereafter, we performed thoracoplasty for progressive keeled pigeon chest at 3 years and 9 months of age. The surgery was performed by median sternotomy, hyperplasty of the bilateral costa from the fourth to eighth rib was removed and the sternum was broken at the seventh intercostal space level. Each right and left costal structure was fixed to the sternum using a metal-plate. The right and left divided chest was closed over the sternum. Postoperatively, she received respiratory assistance to allow thoracic rest for one week, and was discharged from hospital on the 16th postoperative day.

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A female infant with a mass screening (MS)-detected neuroblastoma originating from the right adrenal gland is presented. The tumor was 38×21mm in size and classified as stage I, which led us to adopt a wait-and-see policy without any treatment. Tumor markers, however, did not decrease to the normal levels, and the tumor size increased after the 1st year of age. Histological finding of open biopsy performed at 2 years and 10 months old was ganglioneuroma (GN), maturing, and the observation policy was continued. After biopsy, the tumor size still kept increasing, and resection of the tumor was finally performed when the patient was 3 years and 4 months old. The tumor was 70×50×50mm in size and histologically diagnosed as ganglioneuroblastoma (GNB), intermixed. After surgery, tumor marker levels were promptly normalized. Although this case was found by MS, it neither spontaneously regressed nor completely matured into GN during the observation period of 2 years and 9 months, but rather kept growing in size while maintaining malignant neuroblastic components. Such findings and natural course of the tumor in our case are likely to represent the unusual character of MS-detected neuroblastoma.

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Endoscopic ultrasound (EUS) guided endoscopic transmural drainage of a pancreatic pseudocyst was reported by Grimm et al. for the first time in 1992 and has widely spread as a highly safe procedure in adult patients. However, a complication that is frequently reported is stent occlusion or dropping into the gastric/pancreatic cyst. In order to prevent this, we performed EUS-guided transmural pancreatic cyst drainage (this operation) using a Cotton Leung biliary stent, a straight stent that is bent at the tip and has a large diameter. The patient was a 7-year-old boy who was referred to this hospital for abdominal contusion due to traffic accident trauma, on the third day after the injury. He was given a diagnosis of traumatic pancreatitis based on the abdominal CT, and conservative treatment was started. Development of a pancreatic pseudocyst was observed 7 days after the injury, and this operation was performed 42 days after the injury. Post-operative progress was satisfactory, and the patient was discharged from the hospital 35 days after the operation. The stent was removed 3 months after discharge from the hospital. Currently, there are no signs of relapse, and the progress has been satisfactory. The drainage effect of this operation is also excellent, and this method is therefore useful for improving QOL of the patient.

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