Fumiko Yoshida

Recurrent yolk sac tumor following resection of a neonatal immature gastric teratoma.

Gastric teratomas are very rare and usually benign. Only a few cases of gastric teratomas with malignant components have been reported. This report describes recurrence of a yolk sac tumor following resection of a neonatal immature gastric teratoma. Gastric teratoma recurring as a malignant lesion has not been previously reported. Recurrence of immature gastric teratomas should be considered, and a periodic follow-up check with alpha-fetoprotein level should be mandatory.

Hepatoduodenal ligament teratoma with hepatic artery running inside

Teratoma in infants and children is not particularly rare. However, the teratoma in the hepatoduodenal ligament is extremely rare and the surgical treatment is challenging because of its anatomical complexity. We could find only six cases in the literature. In this report, we present the seventh case with special reference to the operative technique to save the hepatic artery for resection of the tumor using intraoperative ultrasonography.

Light guided procedure for congenital pyriform sinus fistula; new and simple procedure for impalpable fistula.

Pyriform sinus fistula causes acute suppurative thyroiditis, and there is a risk of recurrence if the sinus tract is not excised completely. The tract should be dissected as high as possible toward the pyriform fossa. We report our devised technique “the light guided procedure” for the impalpable fistula. A bronchoscope was inserted into the pyriform sinus fistula with the help of a gastrofiberscope positioned at the larynx. The tract of the fistula was identified with the help of the light from the bronchoscope. We were able to reach the proximal end of the fistula, directly. This procedure is easy, safe, and minimally invasive.

Morphology-based investigation of metachronous inguinal hernia after negative laparoscopic evaluation – is it acquired indirect inguinal hernia?

PURPOSE Patients who developed apparent metachronous contralateral inguinal hernia (MCIH) after negative laparoscopic diagnosis have been reported. We performed this study to investigate the morphological characteristics and etiology of this phenomenon. PATIENTS AND METHODS A consecutive series of 1,747 patients (858 boys and 889 girls) with symptomatic unilateral inguinal hernia were studied. During laparoscopic percutaneous completely extraperitoneal closure, morphological appearances at the asymptomatic groin were inspected for contralateral patent processus vaginalis (CPPV) with definitive criteria. If positive CPPV was identified, it was closed by the same technique used for the affected side. The patients were reviewed for occurrence of metachronous contralateral hernia. RESULTS A total of 755 patients (43.2%) had positive CPPV. Of the 992 patients whose CPPVs were evaluated as true negative, eight (seven boys, one girl) developed MCIH (time taken, three months to five years six months). During second-look operations, morphological appearances of the CPPV that was originally considered as true negative CPPV was found to be wide open. CONCLUSIONS Despite a true negative evaluation by laparoscopy, there was a 0.8% chance of developing a MCIH. This phenomenon was male-oriented and may be acquired indirect inguinal hernia without preceding of CPPV.

Laparoscopic Hernia Repair and Its Validation by Second-Look Inspection to Internal Inguinal Rings in Children with Patent Processus Vaginalis

We developed a unique technique for achieving the completely extraperitoneal ligation of a patent processus vaginalis (PPV) without skipping any areas (Endo et al., 2001). This technique has been used for the treatment of more than 1,600 children. A previous comparative study of this technique with the traditional cut-down repair method proved the superiority of this technique with respect to the parental perspective and choice, operative time, recurrence rate, metachronous appearance of contralateral hernia, complication of the reproductive system, and cosmetic results (Endo et al., 2009). However, some concerns have been voiced regarding the use of laparoscopic herniorrhaphy in children such as the use of a simple closure without the division of the hernial sac, evidence of a completely closed internal inguinal ring (IIR), validity with regard to future recurrence, and the high risk of adhesion (Miltenburg et al., 1998, Gorsler et al., 2003, Saranga et al., 2008). Since 1996, when we began to close PPV laparoscopically, we have conducted prospective studies involving laparoscopic inspection at previous operation sites at every opportunity so as to validate the efficacy of this procedure. The purpose of this paper was to introduce our procedure and the use of recently devised, innovative “Endoneedle kit”, comparing the outcome, including the morphological appearance of the IIRs in second-look operations, with the outcome of traditional cut-down herniorrhaphy performed during the same period.

A pediatric case of insulinoma and a novel MEN1 mutation: the efficacy of the combination therapy of diazoxide and cornstarch

Satsuki Nakano1, 2, Takeshi Sato2, Mayumi Hosokawa1, Chisato Takagi3, Fumiko Yoshida4, Tomohiro Ishii2, Seiji Sato1, and Tomonobu Hasegawa2 1 Department of Pediatrics, Saitama City Hospital, Saitama, Japan 2 Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan 3 Department of Surgery, Saitama City Hospital, Saitama, Japan 4 Department of Pediatric Surgery, Saitama City Hospital, Saitama, Japan

Venous malformation in the scrotum masquerading as a normal testis.

A 9-year-old boy visited our hospital complaining of three testes in his scrotum. His mother had noticed a dark blue spot on his left scrotum since he was born, although no abnormality had been noticed during regular checkups. When the patient was 3 years old, the primary care physician recognized the dark blue spot as a hydrocele. At the age of 9 years, the patient noticed three testes in his scrotum while bathing. The primary care physician suggested a diagnosis of inguinal hernia and referred the patient to our hospital. On physical examination, a testis-like, oval, elastic, dark blue-colored, movable, non-translucent, solid mass was palpable in the left scrotum; careful examination indicated a separate small testis in the left groin that could move between the prepubic and high scrotal area (Fig. 1a). A diagnosis of a left scrotal extratesticular mass (possibly, a venous malformation) and a left retractile testis was made. Ultrasonography and magnetic resonance imaging confirmed the diagnosis (Fig. 2). The left and right testes measured 11.8 × 4.8 × 9.1 mm and 17.0 × 5.6 × 11.1 mm, respectively. Because of mild testicular hypoplasia, excision of the left scrotal mass via a scrotal approach and left orchidopexy was planned. The scrotal mass originating from the subcutaneous tissue was separated from the testicular complex and

Development and validation of a novel fibrosis marker in biliary atresia during infancy

Objectives:Most biliary atresia (BA) patients suffer from liver fibrosis and often require liver transplantation. The aim of this study was to develop and validate a novel fibrosis marker for BA patients aged <1 year—the infant BA liver fibrosis (iBALF) score—subsequent to the previously reported fibrosis marker for BA patients aged ≥1 year.Methods:From three institutions for pediatric surgery, BA patients and their native liver histology examinations performed at the age of <1 year were retrospectively identified and assigned to a development cohort (58 patients and 73 examinations) or validation cohort (92 patients and 117 examinations) according to their institutions. Histological fibrosis stages (F0–F4), blood test results, and clinical information at the time of liver histology examination were reviewed. The iBALF score was determined using multivariate ordered logistic regression analysis and was assessed for its associations with histological fibrosis stages.Results:The iBALF score equation was composed of natural logarithms, including serum total bilirubin level, blood platelet counts, and days of age. The score revealed a strong correlation with fibrosis stage (r=0.80 and 0.73 in the development and validation cohorts, respectively; P<0.001). The areas under the receiver-operating characteristic curves for diagnosing each fibrosis stage were 0.86–0.94 in the development cohort and 0.86–0.90 in the validation cohort (P<0.001), indicating good diagnostic power. In addition, no patient with an iBALF score >6 (equivalent to F4) at the initial surgery survived with their native liver at 1 year of age (n=9).Conclusions:The iBALF score that was developed was a good noninvasive marker of native liver fibrosis for BA patients aged <1 year.

Laparoscopy-Assisted One-Stage Trans-Scrotal Orchiopexy Applicable to All Types of Maldescended Testes

So-called malposition of the testis includes congenital undescended testis (intra-abdominal, canal, and high scrotal), ectopic testis, retractile testis, vanishing testis and so on. An exact preoperative diagnosis has been mandatory for selecting an appropriate therapeutic modality for each type of malposition. Embryologically, undescended testis syndrome should be associated with a patent processus vaginalis (PPV) (Fonkalsrud, 1986). The principle of orchiopexy for undescended testis consists of the closure of the PPV high at its neck (Radmayr C. et al., 1999) and the placement of the pedunculated testis into the dartos pouch. Inguinal exploration has been a standard approach for this aim and FowlerStephens’ one-stage or two-stage operation has been recommended for intra-abdominal testes (Kogan, 1992). Laparoscopic PPV closure using an Endoneedle, which we specifically developed for PPV closure (Endo, et al., 2001) conducted us to its application to orchiopexy. And the procedures have been sophisticated to facilitate one-stage orchiopexy that is applicable to all types of malpositioned testes by combining a diagnostic/therapeutic laparoscopy and an orchiopexy through trans-scrotal incision, while rendering most of preoperative diagnostic modalities unnecessary. The purpose of this paper is to introduce our strategy for a systematic approach to cryptorchidism using laparoscopy, and to discuss the detailed operative procedures and its outcomes.