Journal of the Japanese Society of Pediatric Surgeons
Online ISSN : 2187-4247
Print ISSN : 0288-609X
ISSN-L : 0288-609X
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Volume 48, Issue 5
Displaying 1-25 of 25 articles from this issue
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  • [title in Japanese]
    Article type: Cover
    2012 Volume 48 Issue 5 Pages Cover1-
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_Cover1
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  • [title in Japanese]
    Article type: Cover
    2012 Volume 48 Issue 5 Pages Cover2-
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_Cover2
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  • [title in Japanese]
    Article type: Appendix
    2012 Volume 48 Issue 5 Pages A1-A3
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_A1
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  • [title in Japanese]
    Article type: Appendix
    2012 Volume 48 Issue 5 Pages A4-A11
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_A4
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  • [title in Japanese]
    Article type: Index
    2012 Volume 48 Issue 5 Pages A12-
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_A12
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  • [title in Japanese]
    [in Japanese]
    Article type: Article
    2012 Volume 48 Issue 5 Pages 819-820
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_819
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  • Treatment of Kasabach-Merritt Syndrome
    Takuro Kazama, Tomoyuki Sato, Shintaro Amae, Motoshi Wada, Hideyuki Sa ...
    Article type: Article
    2012 Volume 48 Issue 5 Pages 821-828
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_821
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    Purpose: Kasabach-Merritt syndrome (KMS) is characterized by a hemangioma with evidence of thrombocytopenia and coagulopathy. Although several modalities with a combination of steroid, interferon (IFN)-α, radiation, transcatheter arterial embolization (TAE), surgical resection, or vincristine (VCR) are adopted for KMS, there is currently no established standard therapeutic strategy for this syndrome. The efficacy and safety of these managements were examined. Methods: The records of 6 KMS patients who underwent various treatment modalities combining steroid, radiation, TAE, IFN-α, and VCR therapy or administration between 1994 and 2006 were retrospectively reviewed focusing on their clinical courses, complications, and outcomes. The modality was chosen according to the stepwise multimodal approach (SMA). However, a quick-acting modality was chosen for life-threatening cases, regardless of SMA. Results: Steroid and radiation therapy were adopted for 2 cases. Steroid and IFN-α therapy were adopted for another 2 cases. Steroid, IFN-α, and VCR therapy were adopted for 1 case. Moreover, steroid, IFN-α, TAE, and radiation therapy was adopted for 1 life-threatening case. All patients achieved remission. Complications revealed included moon face, hypertension, infection, liver dysfunction, leukocytopenia, and arthrogryposis. Conclusions: The modality effective for each KMS case was different. SMA for KMS may adopt the modality most suitable for a particular case to yield the highest efficacy with minimum side effects. The modality yielding immediate relieving effect should be chosen for life-threatening cases with precedence, regardless of SMA.
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  • Downregulation of AP-2α Gene Expression in the Cadmium-Induced Ventral Body Wall Defect in the Chick Model
    Takashi Doi, Prem Puri, John Bannigan, Jennifer Thompson, Atsuyuki Yam ...
    Article type: Article
    2012 Volume 48 Issue 5 Pages 829-833
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_829
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    Purpose: Omphalocele is one of the most common ventral body wall defects in humans. In chick embryos, administration of the heavy metal cadmium (Cd) after 60-hour incubation induces the ventral body wall defect (VBWD), a similar event that manifests in human omphaloceles. We have previously reported that the earliest detectable histological changes in the Cd-induced chick model are observed 4 hours posttreatment. However, the exact mechanism by which Cd acts in early embryogenesis still remains unclear. The transcription factor AP-2α null mice has been shown to cause VBWD. We hypothesized that Cd-induced VBWD results from downregulation of AP-2α gene expression during the critical period of embryogenesis. Methods: Chick embryos were harvested 1 hour (1 H), 4 H and 8 H after treatment with cadmium and divided into control and Cd (n=8 at each time point) groups. Total mRNA extraction and real-time RT-PCR was performed to evaluate the mRNA expression levels of AP-2α in the Cd-induced VBWD. Differences between the two groups at each time point were analyzed statistically and statistical significance was accepted for differences where p<0.05. Results: The relative mRNA expression level of AP-2α at 4 H was significantly (p<0.05) decreased in the Cd group (1.84±2.72) compared to controls (4.08±1.36). However, the gene expression levels of AP-2α at 1 H and 8 H were not significantly different between the Cd and control groups. Conclusions: Our results provide evidence for the first time that the gene expression of AP-2α is downregulated 4 hours after treatment in the Cd-induced VBWD chick model. We speculate that the downregulation of AP-2α gene expression during this narrow window of embryogenesis may have caused VBWD.
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  • Analysis of Dead Cases Who Were Antenatally Diagnosed as Sacrococcygeal Teratoma : From a Japanese Nationwide Survey
    Yutaka Kanamori, Noriaki Usui, Yoshihiro Kitano, Haruhiko Sago, Katsun ...
    Article type: Article
    2012 Volume 48 Issue 5 Pages 834-839
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_834
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    Purpose: This study was aimed to analyse the dead cases who antenatally diagnosed as suffering from sacrococcygeal teratoma in Japan. Methods: Retrospective chart review of antenatally diagnosed sacrococcygeal teratoma was planned and nationwide survey was performed in Japan in the form of interview at 46 Japanese perinatal and neonatal institutes. Results: 97 cases were collected; 11 cases were aborted, 3 cases died in utero and 83 cases were born. Eleven of 83 live neonates died. 7 cases died of massive bleeding from tumors and one case died of severe cardiac failure. Statistical analyses comparing the 72 live cases and 11 dead cases revealed that early diagnosis, early labor, emergency Cesarean section, large tumor, solid tumor, heart failure, tumor bleeding, and immature teratoma indicated poor prognosis. Conclusion: In this study, several factors indicated that poor prognosis in antenatally diagnosed sacrococcygeal teratoma was disclosed. We propose the new guidelines for treatment of the disease according to the results in this study.
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  • A Case of Type-D Esophageal Atresia Preoperatively Diagnosed as Proximal Tracheoesophageal Fistula Using CT Scan
    Kazuhiro Ohtsu, Yoshiyuki Onitake, Yuka Ueda, Sho Akamine
    Article type: Article
    2012 Volume 48 Issue 5 Pages 840-843
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_840
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    A 4-month-old girl was referred to our department. Her birth weight was 1,418 g and gestational age was 32 weeks. She had been diagnosed with type-C esophageal atresia, and underwent gastorostomy and banding of abdominal esophagus. We performed three-dimensional CT scan preoperatively, and found proximal tracheaesophageal fistula. Proximal tracheaesophageal fistula was diagnosed using contrast study of the upper esophagus. She underwent staged operation, and has been doing well. CT scan was safe and effective in diagnosis of esophageal atresia.
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  • A Case of Pediatric Pancreas Trauma Induced by Seat-belt Injury
    Seisho Sakai, Masatoshi Miyamoto, Hiroyuki Furukawa, Keishi Nakamura, ...
    Article type: Article
    2012 Volume 48 Issue 5 Pages 844-848
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_844
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    We report a case of pediatric pancreatic trauma induced by seat-belt injury. An 8-year-old girl with pancreatic injury induced in a traffic accident was transferred to our hospital. She sat behind the seat next to the driver with a 3-point system seat-belt. CT demonstrated pancreas head injury with fluid collection around the duodenum. However, MRCP did not demonstrate laceration of the main pancreatic duct. We treated by a fast-cure injection with a protease inhibitor. She was discharged from the hospital without complications 40 days after treatment. Pancreatic trauma is rare among abdominal trauma; however, we suspected that the position of seat-belt was not properly placed. As she did not sit on a junior-seat, this case was probably induced by sitting on an inappropriate position. Equipping junior seats for children is essential for children protection in automobiles.
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  • Two Older Children of Malrotation Associated With Chronic Midgut Volvulus
    Waka Yamada, Motoi Mukai, Tatsuru Kaji, Mitsuru Muto, Hiroshi Matsufuj ...
    Article type: Article
    2012 Volume 48 Issue 5 Pages 849-853
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_849
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    We report two older children with malrotation of the chronic midgut volvulus. CASE 1: A five-year-old boy had been repeatedly hospitalized due to cyclic vomiting since he was one year old. Contrast CT demonstrated a whirlpool sign. The superior mesenteric artery (SMA) was occluded distal to branch site of the middle colic artery (MCA). Distal SMA received collateral blood flow from the MCA. CASE 2: A 13-year-old boy complained of recurrent vomiting since he was 4 years old. Contrast CT revealed the whirlpool sign and SMV rotation sign. Malrotation of older children is often accompanied by chronic midgut volvulus. Clinical features of children are different from those of neonates. Chronic midgut volvulus causes obliteration of SMA just distal to MCA branching. Intact MCA supplies collateral blood flow to the small intestine.
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  • A Case of Huge Posterior Mediastinal Mature Teratoma
    Taichi Fukuzawa, Kotaro Nishi, Motoshi Wada, Hideyuki Sasaki, Takuro K ...
    Article type: Article
    2012 Volume 48 Issue 5 Pages 854-859
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_854
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    We report a case of huge posterior mediastinal mature teratoma. A 4-month-old girl who had severe dyspnea due to a giant mediastinal mass occupying the right hemithorax was referred to our hospital. At admission, she suffered from severe pneumonia and dehydration. Chest CT demonstrated a huge mass containing large calcifications in the right thorax, suggesting a mature teratoma. After improving the general condition by hydration and antibiotics treatment for 4 days, the tumor was successfully removed via right thoracotomy. The tumor size was 9×6.5×6 cm and it was histologically diagnosed as a mature teratoma. Postoperative course for 2 years has been uneventful.
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  • A Case of Right Pulmonary Agenesis, Left Horseshoe Lung, and Esophageal Atresia With Tracheoesophageal Fistula
    Tamaki Iwade, Shigeru Takamizawa, Rumi Arii, Shogo Seo, Mizuho Machida ...
    Article type: Article
    2012 Volume 48 Issue 5 Pages 860-865
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_860
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    We report a case of right pulmonary agenesis, left horseshoe lung, and esophageal atresia with tracheoesopahageal fistula (TEF). A 2,070 g male infant was born at 34 weeks of gestation by cesarean section due to non-reassuring fetal status. Esophageal atresia, right pulmonary malformation, and unilateral radial defect had been detected by fetal ultrasonography. After birth, esophageal atresia with TEF and right pulmonary malformation was suspected by X-ray. No congenital cardiac anomaly was detected by ultrasonography. Gastrostomy was performed on day 0. The right main bronchus was not detected by bronchofiberscopy and 3D computed tomography revealed a small lung in the right thoracic cavity. During esophago-esophagostomy and TEF division on day 8, neither the right lung nor right pulmonary vessels were detected. Therefore, diagnosis of right pulmonary agenesis, left horseshoe lung, and esophageal atresia with TEF was attempted. The clinical course was uneventful after the definitive operation. The endotracheal tube was extubated 14 days after the operation and the patient was discharged from the hospital on day 66 of his life. He has been well without any respiratory symptoms for 7 months after discharge.
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  • Laparoscopic Swenson Pull-through as a Redo Procedure for Complicated Hirschsprung's Disease : A Case Report
    Tomohiro Ishii, Keiichi Morita, Jiro Tsugawa, Shiiki Satoh
    Article type: Article
    2012 Volume 48 Issue 5 Pages 866-869
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_866
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    A 3-year-old boy had developed multiple episodes of enterocolitis after a modified Soave procedure which was performed at the age of 5 months for recto-sigmoid Hirschsprung's disease. On rectal digital examination, there was no anastomotic stricture, however, the rectum itself was stenosic. The result of barium enema study also revealed a 5 cm-long rectal stenosis that indicated the compression of the scarred residual muscle cuff. Secondary dilatation of the proximal colon up to the splenic flexure was also noted. A forceful dilatation of the stenotic rectal segment was performed, however, the stool impaction did not subside. Therefore, a redo Swenson procedure was performed for the purpose of a near-total resection of the scarred muscle cuff as well as a chronically dilated colon. The intra-abdominal procedure was completed laparoscopically, and undilated colon was served for pull-through. There was no intraoperative complication. Postoperative pathological examination confirmed the ganglionic rectal wall which was surrounded by scarred muscle cuff. Postoperatively, the patient temporarily required suppository support for defecation. Currently, 2.5 years after the redo pull-through, the patient has bowel movements once or twice a day without requiring medication. Patients with complicated post-operative recovery after Soave procedure may have rectal stenosis due to a scarred rectal cuff. A redo Swenson pull-through is an effective procedure to restore good bowel movements for this type of condition. It can safely be performed by laparoscopic approach even after an open pullthrough procedure.
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  • Conservative Treatment With Deep Injury of Spleen and Kidney in Children
    Takuya Kosumi, Takeo Yonekura, Keisuke Nose, Katsuji Yamauchi, Mitsugu ...
    Article type: Article
    2012 Volume 48 Issue 5 Pages 870-876
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_870
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    We report a retrospective study of the pediatric trauma patients admitted with blunt injury to the spleen and (or) kidney with Japanese Association for the Surgery of Trauma grading type III between October 1999 and March 2011. We encountered a total of 8 patients: 5 cases had type III splenic injuries and 5 cases had type III renal injuries (2 patients had type III splenic and renal injuries). The patients had a mean age of 6.7 (1-10) years. All patients showed stable vital signs and no disturbance of consciousness. We excluded one patient who was hospitalized the day after the trauma. The remaining 7 patients showed a mean duration of no oral intake of 4.2 (2-7) days, and the length of bed rest was a mean of 9.4 (4-14) days. Only two patients underwent transfusion. The period of the intravenous injection of antibiotics was a mean of 15.4 (9-24) days; until they were negative for CRP. Length of hospitalization showed a mean of 20.1 (15-28) days. All patients with injured organs on imaging studies showed almost complete resolution after some months. No complications appeared over a mean follow-up of 63.6 (6-112) months.
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  • Laparoscopic Extraction of a Wire-like Foreign Body Migrating to the Liver in a Child
    Hideaki Tanaka, Koji Yamada, Hideo Ishihama, Masataka Takahashi, Waka ...
    Article type: Article
    2012 Volume 48 Issue 5 Pages 877-881
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_877
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    We report a 2-year-old boy diagnosed with a hepatic foreign body. He had been asymptomatic until he started to have intermittent abdominal pain after dinner. He had no sign of peritoneal irritation, or no wound on his abdomen. Abdominal X ray indicated a wire-like foreign body in his upper abdomen. Computed tomography located it in his left lobe of the liver, with its end close to the umbilical portion of the portal vein. His parents recalled no episode of foreign body ingestion. Urgent laparoscopic exploration revealed a winding thin wire (about 2.5 cm in length) stuck on the surface of the left median lobe, and it was easily removed by a laparoscopic grasper. No intestinal perforation or adhesion was recognized. His postoperative course was uneventful and he was discharged 6 days after the operation. The wire in our case was thought to have been ingested accidentally and penetrated his stomach or duodenum without causing peritonitis. Because of possible complications such as hemorrhage and abscess, urgent laparoscopic exploration and removal of a foreign body that seems to have penetrated intestine was useful.
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  • [title in Japanese]
    Article type: Appendix
    2012 Volume 48 Issue 5 Pages App1-
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_App1
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  • [title in Japanese]
    Article type: Appendix
    2012 Volume 48 Issue 5 Pages App2-
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_App2
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  • [title in Japanese]
    Article type: Appendix
    2012 Volume 48 Issue 5 Pages App3-
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_App3
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  • [title in Japanese]
    Article type: Appendix
    2012 Volume 48 Issue 5 Pages App4-
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_App4
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  • [title in Japanese]
    Article type: Appendix
    2012 Volume 48 Issue 5 Pages App5-
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_App5
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  • [title in Japanese]
    Article type: Appendix
    2012 Volume 48 Issue 5 Pages App6-
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_App6
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  • [title in Japanese]
    Article type: Appendix
    2012 Volume 48 Issue 5 Pages App7-
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_App7
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  • [title in Japanese]
    Article type: Cover
    2012 Volume 48 Issue 5 Pages Cover3-
    Published: August 20, 2012
    Released on J-STAGE: January 01, 2017
    DOIhttps://doi.org/10.11164/jjsps.48.5_Cover3
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