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Volume 49, Issue 7
Displaying 1-22 of 22 articles from this issue
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2013 Volume 49 Issue 7 Pages 001-010
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
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[in Japanese]2013 Volume 49 Issue 7 Pages 1185-1186
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
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Originals
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Tatsuya Yamashita, Hiroyuki Noguchi2013 Volume 49 Issue 7 Pages 1187-1190
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
JOURNAL FREE ACCESSPurpose: For patients of acute appendicitis with abscess formation initially treated conservatively, the role of interval appendectomy is controversial in infants. We retrospectively studied the clinical course based on the operative and histopathological findings of infantile patients to evaluate the role of interval appendectomy.
Methods: A retrospective chart review was performed in 29 patients who presented with acute appendicitis with abscess formation, and were treated by initial nonoperative management followed by interval appendectomy between April 2004 and February 2012.
Results: The clinical profiles of 29 patients were as followed: the mean age was 8.2 ± 3.3 years (average + S.D.), mean duration of symptoms registered 7.1 ± 3.5 days, mean hospitalization time for initial nonoperative management was 13.2 ± 5.0 days, mean time interval between initial antibiotics therapy and operation was 114.9 ± 26.6 days, mean time of total hospitalization recorded 22.1 ± 5.6 days, and mean operation time scored 96.9 ± 55.1 minutes. Complications in the clinical course such as surgical site infection, abscess formation in abdomen after operation and ileus were not found in these cases. The narrowed inner lumen of excised appendices was found in 48.2% of the cases. Evidence of inflammation was present in 51.7% of the cases by histological examination.
Conclusions: Pathological findings, such as focal inflammations and narrowed lumen of the appendix, were found in about half of the cases in our study. These findings support the concept that interval appendectomy could be recommended in infantile acute appendicitis with a high risk of relapse.View full abstractDownload PDF (251K) -
Hiroshi Nouso, Sadashige Uemura, Yuki Muta, Hisako Kuyama, Mayumi Yama ...2013 Volume 49 Issue 7 Pages 1191-1195
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
JOURNAL FREE ACCESSPurpose: The Nuss procedure, a minimally invasive method for pectus excavatum repair, has been used worldwide. We evaluated the morphometric changes of the thorax before and after the Nuss procedure to clarify the correction effect.
Methods: Thirty-two patients who underwent Nuss procedure were included in the study. The mean age at surgery was 11.3 years, and the male to female ratio was 28 : 4. We traced the shape of the anterior chest wall in the lower end of the sternum by Orthoglass® before and after surgery, and measured the height from the dorsal line. We set 5 points for the measurement, depressed point (D), right and left top (RT·LT), and right and left midpoint between the top and the end of thorax (RM·LM). The transformation rates (postoperative/preoperative value) were calculated. In addition, the ratio of the depressed point (D) and the average of the top points ((RT + LT)/2) was calculated. The preoperative and postoperative values were named as the depression rate and elevation rate, respectively.
Results: The mean transformation rates in each point were as follows. D; 1.308 ± 0.109, RT; 1.025 ± 0.045, LT; 1.018 ± 0.055, RM; 0.936 ± 0.043, and LM; 0.937 ± 0.037. The mean depression rate was 0.861 ± 0.065, and elevation rate was 1.097 ± 0.045.
Conclusions: Elevation at the depressed point showed 10% higher than both the tops. Both the tops were only 2% higher and the both midpoints were 6% lower. Postoperative morphometric changes after the Nuss procedure were observed not only in the sternal elevation but also the whole chest remodeling according to the shape of the bar.View full abstractDownload PDF (411K) -
Yasuhiro Matsukawa2013 Volume 49 Issue 7 Pages 1196-1202
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
JOURNAL FREE ACCESSPurpose: Excision of hydrocele is reported to be essential for abdominoscrotal hydrocele (ASH). We have previously reported that the simple closure of processus vaginalis (PV) technique yields excellent outcome for childhood hydrocele. We conceived that simple closure of PV without excision of hydrocele might offer a cure for ASH. This is a report of our new approach for ASH treatment. The pathophysiology of ASH was considered based on our results.
Methods: Operations were done in 12 male childhood ASH cases. Hydrocele fluid was removed by a skin. A small inguinal groove incision was made and the spermatic cord was removed.
PV and hydrocele that extended into the abdomen were identified and dissected at the level of internal inguinal ring. PV, the common wall between PV and hydrocele, and the internal fascia were closed en bloc in 4 cases. PV, the whole of hydrocele, and internal fascia were closed in 8.
Results: All cases showed complete recovery without complications. In all cases, PVs were identified at the internal inguinal ring, where adhesions in and around the spermatic cord were severe. PVs and hydroceles were tightly adhered, forming inseparable common septa.
Conclusions: The results indicate that even if we had left hycroceles in place, blocking the supply route of ascites led to a complete cure in childhood ASH cases. This implies that ASH is a communicating hydrocele connected to the abdominal cavity through PV and possible microscopic pathways in the common septa. Operation shown here is a minimum invasive procedure, and is recommended as the first choice for childhood ASH treatment.View full abstractDownload PDF (528K) -
Calretinin Immunohistochemistry in the Diagnosis of Rectal Suction Biopsies for Hirschsprung DiseaseKengo Hattori, Yoshiaki Yuba, Masahito Sato, Yuya Miyauchi2013 Volume 49 Issue 7 Pages 1203-1208
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
JOURNAL FREE ACCESSPurpose: The pathological diagnosis of Hirschsprung disease (HD) by acetylcholinesterase histochemistry (AChEH) using rectal suction biopsies is widely established and has the highest accuracy. However, several recent reports have described the diagnostic utility of calretinin immuno histochemistry (CRI) for HD, in which the ganglion cells and intrinsic nerve fibers in the submucosal and myenteric plexus of a normal colon are tested positive. In this study, we assessed the diagnostic value of CRI for HD compared with AChEH using rectal suction biopsies.
Methods: We conducted a retrospective review of the diagnoses using CRI and AChEH sections of rectal suction biopsies for suspected HD between April 2011 and March 2012 at our institute.
Results: A total of 8 cases were collected: four surgical cases of neonates, one repeated surgical case of a three-year-old girl, and three non-surgical cases of infants. All five surgical cases were definitely diagnosed as HD based on their surgical specimens. In addition, rectal suction-biopsy sections were AChEH-positive and CRI-negative. However, in two of these five cases that showed inconsistent results compared with their first biopsies (both AChEH- and CRInegative), sequential rectal suction biopsies were subsequently conducted. In contrast, in the three non-surgical cases, the first biopsy confirmed the absence of HD with AChEH-negative and CRI-positive specimens.
Conclusions: CRI may serve as a useful adjunctive means to diagnose HD with rectal suction biopsy, particularly when there is a discrepancy between a clinical diagnosis and the AChEH-negative results.View full abstractDownload PDF (518K) -
Mayumi Hoshino, Yosuke Watanabe, Hiroshi Goto, Reina Hoshi, Akiko Soga ...2013 Volume 49 Issue 7 Pages 1209-1216
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
JOURNAL FREE ACCESSPurpose: We analyzed the data from 79 female physicians about work-life balance in this survey, and discussed about future issues in employment support of female surgeons.
Methods: We asked 79 female physicians about work-life balance in the Tokyo Metropolitan Ohtsuka Hospital using original questionnaires.
Results: The response rate was 73.4%. The proportion of married female physician was 65.5%, of whom 43.1% had children. Of the 66.7% of part-time female physicians engaged in childcare, 41.7% were part-time physicians. The proportion of those who replied that there was gender inequality between female and male physicians was higher in the married females, compared with the unmarried females. Female physicians in childcare (58.3%) replied that they could not work on an equal footing with married men (husbands). Although 91.7% of female physicians in childcare replied that they had obtained cooperation and support of childcare from their husbands, 41.7% replied that it was dissatisfactory. The 84.0% of female physicians in childcare replied that the requirements for female physicians in childcare were of their individual motivation and willingness, while 68.0% of them replied that “the improvement of childcare facilities” and “the cooperation and support from husbands” were necessary.
Conclusions: Although individual motivation and willingness are essential for career development of female surgeons in childcare, improving awareness of Japanese with a focus on males is the most important for work-life-balance of female physicians.View full abstractDownload PDF (1025K) -
Saori Nakahara, Junko Matsumoto, Mari Ichinose, Akira Hatanaka, Eriko ...2013 Volume 49 Issue 7 Pages 1217-1223
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
JOURNAL FREE ACCESSPurpose: It has been reported that umbilical cord ulceration is associated with upper intestinal obstructions, and sometimes causes massive hemorrhage in a fetus. Although the regurgitation of gastric or intestinal juice into the amniotic fluid is suspected to induce development of umbilical cord ulceration, the exact mechanism is not clear. We studied the concentration of pancreatic juice in amniotic fluid to determine the influence of pancreatic juice and ulceration on the umbilical cord.
Methods: From July 2009 to June 2011, we studied the concentrations of pancreatic enzymes (pancreatic amylase lipase, pancreatic phospholipase A2, and trypsin) and of bilirubin and bile acid in the amniotic fluid of 6 cases with upper intestinal atresia (Group A), and 6 cases with hydroamnios without intestinal atresia (Group B).
Results: In Group A, the mean concentrations of lipase, pancreatic phospholipase A2, and trypsin were extremely elevated, registering 4,055 IU/ l, 63,050 ng/dl, and 30,400 ng/ml, whereas those in Group B were 3.5 IU/ l, 99 ng/dl, and 170 ng/ml, respectively. The mean concentration of bile acid in Group A was slightly higher than Group B: i.e. 18.5 μmol/ l (Group A) versus 1.5 μmol/ l (Group B). The mean concentration of pancreatic amylase in both Groups A and B were not affected.
Conclusions: The findings revealed that the concentrations of pancreatic enzymes and pacreatic amylase in amniotic fluid were extremely elevated in the cases with upper intestinal atresia. Pancreatic enzymes regurgitated by the fetus into the amniotic fluid may cause the umbilical cord ulceration.View full abstractDownload PDF (421K) -
Keiichi Morita, Koji Fukumoto, Go Miyano, Masaya Yamoto, Hiroshi Nouso ...2013 Volume 49 Issue 7 Pages 1224-1228
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
JOURNAL FREE ACCESSPurpose: In surgical interventions of pediatric benign ovarian tumors, radical excision of the tumors and ovarian preservation are required. We evaluated the effectiveness of laparoscopic-assisted excision of benign ovarian tumor in children.
Methods: We retrospectively reviewed the medical records of pediatric patients who underwent laparoscopic-assisted excision of benign ovarian tumors between August 1994 and March 2013. An initial laparoscopic exploration was first undertaken to confirm the diagnosis and inspect the contralateral ovary. If ovarian torsion was found, detorsion would be performed. We performed aspiration of the cystic lesion and tumor excision with ovarian preservation through a short Pfannenstiel incision.
Results: Eight patients (7 mature teratomas, 1 serous cyst adenoma) underwent laparoscopic-assisted excision of ovarian tumor. Successful tumor excisions without intraoperative tumor spillage were accomplished in all cases. There were two cases with ovarian torsions. One patient underwent laparoscopic-assisted detorsion and tumor excision. In another patient, initial laparoscopic detorsion was performed with delayed laparoscopic-assisted tumor excision five days later. The median length of hospital stay was 4.1 days (range, 3–6 days). The median follow-up period was 17 months (range, 2–31 months). One patient had a mature teratoma in the contralateral ovary. All other patients showed no evidence of recurrence.
Conclusions: Laparoscopic-assisted excision of ovarian tumor is effective for benign ovarian tumors in children. This method may be able to accomplish radical excision of ovarian tumors and preservation.View full abstractDownload PDF (391K)
Case Reports
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Hirotsugu Yanai, Yoshinori Hamada, Kohei Takada, Yusuke Nakamura, A-Ho ...2013 Volume 49 Issue 7 Pages 1229-1233
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
JOURNAL FREE ACCESSIncarceration of an umbilical hernia during childhood is extremely rare. A 9-month-old boy was admitted to our hospital due to abdominal distension and coughs. His illness was diagnosed as umbilical hernia at birth, and was referred to our hospital for successional follow-up after reposition of incarcerated umbilical hernia at 8 months of age. He was discharged after one-day stay, but 11 days after discharge, an emergency surgery was needed due to failure of manual reposition for second incarceration. The diameter of the umbilical ring measured 15 mm in diameter and the incarcerated terminal ileum, cecum and appendix were repositioned after having performed a 5-mm-long excision of the fascia. The post-operative clinical course was uneventful.
We collected another thirteen pediatric cases of such incarcerated umbilical hernia in Japan and examined the pathogenesis in entity.View full abstractDownload PDF (563K) -
Junichi Suzuki, Akira Toki, Masahiro Chiba, Akihide Sugiyama, Rie Suga ...2013 Volume 49 Issue 7 Pages 1234-1239
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
JOURNAL FREE ACCESSThe patient is currently a 14-year-old female. A cloacal anomaly was suspected at an obstetrical ultrasound examination. The patient was delivered by cesarean section at 34 weeks of gestation. Complete situs inversus, spina bifida occulta, left renal agenesis, and enteric duplication had been diagnosed by various examinations. Furthermore, she had an unusual perineal canal, which manifested as hypoplasia of the left Müllerian duct and a Wolffian duct remnant. At age three, she underwent a radical surgery for cloacal anomaly as well as excision of the perineal canal. At age four, she developed congenital biliary dilatation associated with pancreaticobiliary maljunction. An extrahepatic bile duct resection and hepaticojejunostomy were performed. In addition, she was diagnosed as having left-sided conduction deafness with ossicular malformation at age 12. Multiple malformations in the present case can be classified as follows: (1) Diseases related to the Zic3 gene: situs inversus, vertebral dysplasia, and anorectal malformation; (2) MURCS association: Müllerian duct aplasia or hypoplasia, renal aplasia, cervicothoracic vertebral dysplasia, and conduction deafness; (3) Other diseases: enteric duplication and pancreaticobiliary maljunction. The present case had a very rare combination of multiple anomalies and further cases should be accumulated for genetic analysis to elucidate the pathogenesis of these combined anomalies.View full abstractDownload PDF (685K) -
Kengo Nakahata, Shuichiro Uehara, Takaharu Oue, Takehisa Ueno, Masahir ...2013 Volume 49 Issue 7 Pages 1240-1243
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
JOURNAL FREE ACCESSWe herein report a case of liver vascular anomalies indistinguishable from presurgical malignant tumors. A seven-year-old male visited our hospital for Lowe Syndrome. Abdominal ultrasonography, and examination results revealed a mass in the right hepatic lobe. Small nodes were detected around the tumor by enhanced computed tomography scanning. Although the margin of tumor was clearly enhanced, the central lesion was not. Enhanced MRI showed low intensity lesions on T1-weighted images and high intensity lesions on T2-weighted images. We therefore suspected hemangioendothelioma, although malignant tumors, such as undifferentiated sarcoma, were not ruled out. We finally decided to remove all the tumors via right hepatic lobectomy. Histopathological examinations of the resected specimen revealed congenital hemangioma or capillary malformation, which was subsequently classified as vascular malformations. In pediatric liver tumors, it is sometimes difficult to make the correct diagnosis based only on imaging or blood tests. Especially in hypervascular tumors, a biopsy may be misleading, and therefore a surgical resection should be considered in treating such cases.View full abstractDownload PDF (525K) -
Miori Ogawa, Kosaku Maeda, Shigeru Ono, Satohiko Yanagisawa, Yoshiko U ...2013 Volume 49 Issue 7 Pages 1244-1247
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
JOURNAL FREE ACCESSWe report a case of diaphragmatic eventration with gastric volvuls in a neonate. A girl of four days after birth began vomiting on day 3. A chest X-ray study showed a raised outline of the left diaphragm and elevation due to gastric gas toward the left thoracic cavity was observed. An upper gastrointestinal contrast study revealed elevation of the stomach with volvuls. After having inserted a long tube, we performed plication of the diaphragm and gastropexy on day 8. A pathohistological study showed an abnormal distribution of the diaphragmatic muscular fibers, and was diagnosed as diaphragmatic eventration. After operation, her condition improved and was discharged on the postoperative day 5.View full abstractDownload PDF (631K) -
Wataru Sumida, Yoshio Watanabe, Hidemi Takasu, Kazuo Ooshima2013 Volume 49 Issue 7 Pages 1248-1251
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
JOURNAL FREE ACCESSGastrointestinal polyps are one of the complications of tuberous sclerosis (TS). However, most cases are asymptomatic. We report a very rare case of TS with anemia caused by bleeding from colon polyposis. The patient was a 3-year-old boy, who had been suffering from TS in another hospital since he was a neonate. He was referred to our hospital because of bloody stool when he was 2 years old. Countless polyps were observed from the sigmoid colon to the rectum. They were diagnosed as hyperplastic polyps by biopsy. We decided to observe him closely therafter. After observation for six months, the extent of the polyps remained the same and his anemia did not improved. We decided to remove the bowel with polyposis by the Soave pull-through method because it was difficult to improve his anemia by iron supplementation. A histological diagnosis indicated hamartomatous polyposis. TS is defined by a combination of small and large symptoms. Hamartomatous polyps are one of the small symptoms of TS. Most of the reported cases of TS with polyps were asymptomatic, and they rarely required any treatment. However, some cases require removal of the bowel with polyposis because of bloody stool or anemia.View full abstractDownload PDF (347K) -
Mariko Hasegawa, Junko Fujino, Makoto Suzuki, Akihiro Igarashi, Masahi ...2013 Volume 49 Issue 7 Pages 1252-1257
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
JOURNAL FREE ACCESSWe report a patient who underwent repairs of esophageal atresia and congenital esophageal stenosis, and who had experienced food impactions of the esophagus frequently thereafter. The examinations revealed stenosis of the lower esophagus, and the presence of gastroesophageal reflux (GER) and reflux esophagitis were indicated. As balloon dilatation of the esophagus showed the food impactions were mainly due to reflux esophagitis, antireflux surgery was performed. After surgery, the patient experienced no food impaction and his QOL has since remarkably improved. As the patient had to move several times due to familial and other reasons, several years had passed before, he underwent antireflux surgery. Because GER frequently develops after repairs of esophageal atresia or congenital esophageal stenosis, close observation and long-term follow-up are necessary and antireflux surgery should be considered when swallowing problems or dysphagia are present.View full abstractDownload PDF (492K) -
Eiichiro Watanabe, Kiyoshi Tanaka, Hajime Takayasu, Noriko Takeda, Mas ...2013 Volume 49 Issue 7 Pages 1258-1263
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
JOURNAL FREE ACCESSA 1-month-old boy has been visiting our hospital because of his swollen right scrotum since neonatal period. He was first diagnosed as having bilateral abdominoscrotal hydrocele (ASH) at age 7 months by ultrasonography. MRI revealed bilateral giant dumbbell-like hydroceles, respectively measuring 18 cm and 10 cm at the right and left sides, which eventually developed into hydronephrosis and hydroureter at age 14 months. At 15 months old, he underwent operation through an inguinal approach. Although hydroceles were extended into the abdominal cavity, there was neither any route between the hydrocele and abdominal cavity nor patent processus vaginalis on both sides. The right testis was distorted to a spindle shape. All walls of the hydrocele, except spermatic vessels and spermatic cord area, were excised, and the procedure was completed with orchiopexy. In the case of giant ASH, operation is recommended at the early stage, because it may cause timerelated complications such as hydronephrosis, hydroureter and inflicting testicular damage by compression.View full abstractDownload PDF (646K) -
Tamaki Iwade, Shigeru Takamizawa, Tomoko Hatata, Katsumi Yoshizawa2013 Volume 49 Issue 7 Pages 1264-1268
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
JOURNAL FREE ACCESSFor repairing the abdominal wall anomaly, cosmetic outcome should be considered. We report a newborn with omphalocele and intestinal injury requiring ileostomy at the umbilicus, and an initial operation followed by umbilicoplasty was then performed. A 2,430 g male infant with omphalocele was delivered at 38-weeks and 3 days gestation. At birth, a ruptured hernia sac with multiple intestinal injuries (cecum and jejunum) and Meckel's divertitculum were encountered. We perfromed an ileostomy at the umbilicus to decrease surgical scars, and pursued a favorable cosmetic outcome. Eighteen days after the initial operation, closure of ileostomy and umbilicoplasty with three triangular skin flaps were performed. The postoperative clinical course was uneventful, and he was discharged from the hospital on day 30 after birth. He has been healthy for four months postoperatively, with a near-normal appearance of the umbilicus. Umbilicoplasty for the patient with hernia in the umbilical cord can be performed even after performing an umbilical stoma.View full abstractDownload PDF (513K) -
Kengo Hayashi, Taichi Hirotani, Nobuki Ishikawa, Takashi Shimotake2013 Volume 49 Issue 7 Pages 1269-1272
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
JOURNAL FREE ACCESSWe herein report a case of multiple endocrine neoplasia (MEN) type-2B treated by total thyroidectomy at the age six years. A girl, who had presented constipation since her infancy, was showing hypertrophic changes in her eyelids and lip, and developed multiple nodules on her tongue bas well. Although neither physical examination nor imaging tests revealed definite tumors in her neck, we diagnosed her as having MEN2B by a positive result of the calcium gluconate stimulation test, and the existence of RET gene mutation. She underwent total thyroidectomy that included cervical lymph node dissection, and bilateral medullary thyroid carcinomas without metastasis were histopathologically demonstrated. The postoperative course was non-eventful, indicating zero serum calcitonin level without recurrence so far. Although MEN2B in a child is extremely rare, early detection is possible by characteristic physical and clinical findings. When examining patients with constipation, it is important to check carefully whether they have the initial signs of MEN2B.View full abstractDownload PDF (435K)
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2013 Volume 49 Issue 7 Pages 1273-1275
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
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2013 Volume 49 Issue 7 Pages 1276-1285
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
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2013 Volume 49 Issue 7 Pages 1286-1299
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
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2013 Volume 49 Issue 7 Pages 9999
Published: December 20, 2013
Released on J-STAGE: December 20, 2013
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