Journal of the Japanese Society of Pediatric Surgeons
Online ISSN : 2187-4247
Print ISSN : 0288-609X
ISSN-L : 0288-609X
Volume 46, Issue 5
Displaying 1-24 of 24 articles from this issue
  • Article type: Cover
    2010 Volume 46 Issue 5 Pages Cover1-
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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  • Article type: Cover
    2010 Volume 46 Issue 5 Pages Cover2-
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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  • Article type: Appendix
    2010 Volume 46 Issue 5 Pages App1-
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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  • Article type: Appendix
    2010 Volume 46 Issue 5 Pages App2-
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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  • Article type: Appendix
    2010 Volume 46 Issue 5 Pages App3-
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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  • Article type: Index
    2010 Volume 46 Issue 5 Pages Toc1-
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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  • [in Japanese]
    Article type: Article
    2010 Volume 46 Issue 5 Pages 829-830
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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  • Ryuichi Shimono, Hideo Takamatsu, Hiroyuki Tahara, Tatsuru Kaji, Yoshi ...
    Article type: Article
    2010 Volume 46 Issue 5 Pages 831-836
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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    Purpose: In this paper, we review complications with the Nuss procedure. Materials and Methods: In the last six years 24 cases with a mean age of 8.9 years, 18 males and 6 females, underwent the Nuss procedure for pectus excavatum from March 2001 to March 2007. Twenty-three cases had one bar inserted and only one case had two bars. The pectus bar was fixed to the rib in 8 cases using only stainless-steel wires, with a unilateral stabilizer in 4 cases, and with bilateral stabilizers in the remaining 12 cases. The bar was removed in 15 cases three years after the initial surgery. Results: Early complications: Eight cases showed atelectasis and 4 cases showed subcutaneous emphysema, one case showed pleural effusion, and one case showed pneumothorax with spontaneous resolution. In one case the pectus bar was removed after surgery, because of a bar infection. Bar displacement was seen in one patient, who underwent a subsequent surgery. Late complications: Bar displacement was seen in one case. Three cases showed asymmetrical elevation of the sternum with spontaneous recovery. Retraction of the sternum was seen in one. The displacement of the pectus bar was not seen in any of the recent 12 cases with bilateral stabilizations. Discussion and Conclusions: The displacement of the pectus bar is one of the major complications of the Nuss procedure. Bilateral stabilizers may prevent bar displacement. Infection caused by the bar is another major complication. If conservative therapy is unsuccessful, bar removal should be considered.
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  • Keigo Nara, Shinsuke Hata, Ryota Saka
    Article type: Article
    2010 Volume 46 Issue 5 Pages 837-841
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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    Purpose: We have performed a standard appendectomy using a "woundless" technique in cases of childhood appendicitis. We report the technique and its effectiveness for laparoscopic appendectomy in children with appendicitis. Methods: We used an extracorporeal appendectomy technique, which involved inserting a laparoscope and forceps together through the umbilicus, grasping the appendix and pulling it to the level of the umbilicus, and excising the appendix outside the abdominal cavity. Eighty-six cases diagnosed with appendicitis between August 2005 and March 2009 were studied. We defined the woundless group as the cases in which the "woundless" technique was used. Cases of appendicitis with abscess around the appendix or with panperitonitis were defined as serious cases, while the others were defined as mild cases. Results: Sixty-eight cases (79.1%) underwent the "woundless" technique. The procedure was converted to a pneumoperitoneal laparoscopic method in 17 cases (19.8%). Due to a huge abscess mass, one case (1.2%) underwent an open procedure from the beginning. The woundless group consisted of 66 mild and 2 serious cases. The operative time was 34.7±12.5min. The length of the postoperative stay was 2.2±0.9 days. Only one patient in the woundless group had wound infection because of an intra-abdominal abscess. Conclusions: The "woundless" technique for children has a cosmetic advantage and is practicable in most mild cases of appendicitis. This technique can be easily converted to a pneumoperitoneal laparoscopic method. Therefore, we recommend the "woundless" technique as a standard appendectomy procedure in children.
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  • Shigeru Takamizawa, Toshie Yamazaki, Katsumi Yoshizawa, Mizuho Machida ...
    Article type: Article
    2010 Volume 46 Issue 5 Pages 842-846
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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    Background and Purpose: Diarrhea, dumping syndrome or abdominal pain are some of the problems associated with liquid nutrients for patients with gastrostomy. To solve these problems, we introduced a home rapid-injection method of semi-solid food for pediatric patients with gastrostomy. Materials and Methods: The rapid-injection method of semi-solid food was introduced to five gastrostomy patients who suffered from liquid nutrient originated symptoms such as diarrhea or nausea. The semi-solid food was made from ordinary foodstuffs at home. A 50ml dose of semi-solid food was injected through the gastrostomy at a speed of 50ml in 2 to 3 minutes for the initial dose. The family was allowed to increase the dose to the same dose as liquid nutrients if the 50ml of semi-solid food was accepted by the patient. Results: Semi-solid food could be injected 2 to 4 times a day in all five patients. Total time for injection decreased from the median time of 8 hours to 1.8 hours a day. The shape of stools was improved from watery or loosely formed stools to well formed or hard stools in all patients. Conclusion: The rapid injection method of semi-solid food is a good alternative method for gastrostomy nutrition in terms of improving patients' quality of life.
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  • Norihiko Kitagawa, Youkatsu Ohhama, Masato Shinkai, Hiroshi Take, Shoh ...
    Article type: Article
    2010 Volume 46 Issue 5 Pages 847-851
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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    Purpose: Half-solid nutrients have been used widely in adult patients with gastrostomy. But in pediatric patients, special problems seem to exist such as narrow catheters, and small stomachs. Here we report our experience of feeding half-solid nutrients to pediatric patients. Methods: Nine patients were fed with half-solid nutrients through their gastrostomy. Half-solid nutrients were made by adding pectin, dextrin or agar to liquid nutrients. All patients used balloon gastrostomy buttons whose outside diameter was in the range of 14 Fr to 20 Fr. Results: Eight patients achieved shortening of feeding time, improvement of dumping syndrome, maintenance of blood sugar level (in patients with glycogenosis) and improvement of leakage of gastrostomy, by using half-solid nutrients. Two infants failed to be fed with half-solid nutrients because of nausea, but one of them succeeded after growing up. Conclusions: Half-solid nutrients could be used safely even in pediatric patients. It improved the quality of life of the patients and their parents.
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  • Hiroaki Hayashi, Koichi Ohno, Tetsuro Nakamura, Takashi Azuma, Hiroto ...
    Article type: Article
    2010 Volume 46 Issue 5 Pages 852-856
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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    Purpose: A surveillance culture at hospitalization was performed to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) carriers in order to prevent postoperative and nosocomial infections caused by MRSA. Methods: Bacterial investigations were performed within 48 hours after admission in 762 patients who were hospitalized for more than 4 days. The frequency of MRSA in the samples (carrier rate) and the correlation between the carrier rate and a history of previous hospitalization (HPH) were analyzed. The prophylactic administration of antibiotics in carriers who underwent surgery and the development of postoperative and nosocomial MRSA infections were also assessed. Results: A total of 1,601 samples consisting of 761 throat swabs, 732 stool samples, and 108 other samples were examined. The carrier rate of MRSA was 8.5%. This rate increased to 11.8% in the 493 patients with HPH and to 15.2% in the 341 patients with HPH within 1 year. Of the 37 carriers who underwent surgery, 15 were administered antibiotics that were effective against MRSA, and no postoperative MRSA infection was observed. Nosocomial MRSA infection was observed in only 1 non-carrier. Conclusions: HPH, especially within 1 year, is a high-risk factor for MRSA carriage. Strict observation of standard precautions can prevent outbreaks of nosocomial MRSA infection. Selective administration of effective antibiotics not only prevents postoperative MRSA infections but also reduces the development of new strains of resistant bacteria.
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  • Minoru Kuroiwa, Akira Nishi, Hideki Yamamoto, Sayaka Ohtake, Masahiro ...
    Article type: Article
    2010 Volume 46 Issue 5 Pages 857-861
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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    A 7-year-old boy with short bowel syndrome was admitted because of severe anemia. He had a history of undergoing massive bowel resection in the neonatal period. Only 70cm of the jejunum without an ileocaecal valve remained. He showed breathlessness and general fatigue 4 years (at the age of 7 years) after weaning off parenteral nutrition. His Hb was 6g/dl, and MCV was 111 fl. His serum vitamin B_<12> (VB_<12>) level was 71pg/ml. Diagnosis of megaloblastic anemia (MA) was made, and VB_<12> was intravenously administered. In the English and Japanese literature, 12 patients including our case who had developed MA after a surgery were found. Mean time between the surgery and presentation was 9 years. The causes of MA were malabsorption in 8 patients, bacterial overgrowth in 3, and discard of gastric juice (loss of intrinsic factor) in 1. It should be kept in mind that MA needs many years to develop clinical symptoms after surgery, and that various possible causes for MA were observed even after surgery.
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  • Yoshiro Itatani, Kaoru Sano, Masakatsu Kaneshiro, Satsuki Ogata, Keizo ...
    Article type: Article
    2010 Volume 46 Issue 5 Pages 862-866
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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    A 1-year-old boy was referred to our hospital because of frequent vomiting. After two days, he had a fever and diarrhea. After his admission, his diarrhea stopped, but his abdomen was gradually distended and his abdominal radiography showed marked dilatation of the small intestine. After five days, his abdominal CT scan showed a spherical foreign body in his ileum and intestinal dilatation. We diagnosed intestinal obstruction due to the foreign body, and he underwent emergent surgery. A foreign body was found in his ileum and removed. It was a soft spherical toy 25mm in diameter made of TPE (thermoplastic elastomer). After the operation, his fever fell immediately. We often experience infant foreign body ingestion in the emergency room, but few cases are operated on because of bowel obstruction with a foreign body. Moreover, it takes us time to diagnose bowel obstruction because infants can't describe their symptoms in cases where no one sees their ingestion.
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  • Risa Teshiba, Kouji Masumoto, Genshiro Esumi, Kouji Nagata, Yoshiaki K ...
    Article type: Article
    2010 Volume 46 Issue 5 Pages 867-872
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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    The prognosis of congenital diaphragmatic hernia (CDH) is improving due to perinatal management such as gentle ventilation and operation after stabilization. However, we often experience difficult cases in long-term management. We report a case of a 1,222g very low weight infant boy with left congenital diaphragmatic hernia, born at 38 weeks' gestation. Sonographic examination of the fetus at 35 weeks' gestation had revealed a lung-to-head ratio of 0.66, a lung-to-thorax ratio of 0.04, and liver intrusion to the thorax. After birth, the general examination revealed bilateral cloudy corneas, a cleft palate, and hypospadias. Left diaphragmatic repair was performed at 6 days of age. Due to perforation of the intestine, drainage was performed at 7 days and jejunostomy was placed at 16 days. After 2 months of respirator support, the baby was extubated and oxygen was supplied by a nasal canula. However his pulmonary hypertension got worse from around 12 months of age. After several reintubataion for respiratory deficiency, he died at 18 months due to severe pulmonary hypertension and circulatory failure.
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  • Takuya Kosumi, Takeo Yonekura, Seika Kuroda, Katsuji Yamauchi, Yoshiyu ...
    Article type: Article
    2010 Volume 46 Issue 5 Pages 873-879
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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    We experienced 2 cases of intestinal duplication which needed an operation neonatally. Case 1 was a girl at four days of age. She showed vomiting after birth. An intraperitoneal cystic lesion of 3×4×5cm was detected by echography and she was referred to us. An operation was performed at 8 days of age. We used laparoscopic surgery for evaluation. However, we were not able to detect the cystic lesion. Therefore we performed a laparotomy with a right upper quadrant horizontal incision. We diagnosed an intestinal duplication of the ileum, and resected the small intestine with the duplication. Case 2 was a boy of 30 days of age. He had showed bloody stool for one week. In addition, he showed sudden pyrexia and abdominal distention, and arrived by emergency transportation at a clinic. He showed cyanosis, tachypnea, tachycardia, and he was transported to our hospital in a pre-shock state. Contrast CT examination showed a cystic lesion 4cm in diameter. He was diagnosed with intestinal obstruction by intestinal duplication compressing ileocecum; therefore he underwent an emergency operation. We performed ileocecal resection.
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  • Tomoya Takao, Masahiro Kawasaki
    Article type: Article
    2010 Volume 46 Issue 5 Pages 880-883
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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    A 23-month-old girl with a chief complaint of urinary tract infection was referred to our hospital. Abdominal CT revealed bilateral hydronephrosis with a radiolucent urinary stone. Emergency nephrostomy and transurethral ureterolithotripsy was successfully performed. The spectrophotometric analysis of the stone indicated a 2,8-dihydroxyadenine stone. The patient was found by a PCR method to have adenine phosphoribosyltransferase deficiency. The bilateral hydronephrosis improved ESWL for both pyelolithiases, but the stone remains. A small-dose oral allopurinol regimen was employed as a follow up.
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  • Mitsugu Owari, Takuya Kosumi, Masaharu Oue, Takeo Yonekura, Masahiro F ...
    Article type: Article
    2010 Volume 46 Issue 5 Pages 884-888
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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    A rare case of congenital duodenal atresia (DA) associated with a choledochal cyst (CC) is reported. After birth, the patient was admitted to another hospital where she received the diagnosis of duodenal atresia. She underwent duodenoduodenostomy for correction of type III duodenal atresia associated with an annular pancreas. She recovered uneventfully after the operation and did well for 8 years. Eight years after the initial operation, she underwent a thorough health examination. Abdominal ultrasonography demonstrated a CC and dilated intrahepatic bile ducts. Magnetic resonance cholangiopancreatography showed an anomalous arrangement of the choledochus and the main pancreatic duct. A diffusely dilated extrahepatic bile duct was resected, and a hepaticoduodenostomy was performed after a cholecystectomy. The patient was discharged without complications.
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  • Article type: Appendix
    2010 Volume 46 Issue 5 Pages App4-
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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  • Article type: Appendix
    2010 Volume 46 Issue 5 Pages App5-
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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  • Article type: Appendix
    2010 Volume 46 Issue 5 Pages App6-
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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  • Article type: Appendix
    2010 Volume 46 Issue 5 Pages App7-
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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  • Article type: Appendix
    2010 Volume 46 Issue 5 Pages App8-
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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  • Article type: Cover
    2010 Volume 46 Issue 5 Pages Cover3-
    Published: August 20, 2010
    Released on J-STAGE: January 01, 2017
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