Hiroki Kai

Successful treatment of an infected wound in infants by a combination of negative pressure wound therapy and arginine supplementation.

OBJECTIVE Wound dehiscence caused by surgical site infection (SSI) presents a complicated problem. Negative pressure wound therapy (NPWT) was developed to treat wound dehiscence. Nutritional treatment using arginine has also been recently shown to be effective for the treatment of pressure ulcers. Therefore, wound complications due to SSI were treated using NPWT combined with nutritional therapy with an arginine-rich supplement (ARS). METHODS Six pediatric patients with wound dehiscence due to SSI received this combined therapy. RESULTS The average age of the patients was 12.2 mo. The operations that these patients underwent included laryngotracheal separation, radical operation for spinal bifida, gastrostomy, colostomy, anorectoplasty, and tumor extirpation. A local wound infection induced wound dehiscence in all patients. Therefore, NPWT was introduced with an enteral administration of ARS. All wounds completely healed within 1 mo after the introduction of this combined therapy without any other complications from the NPWT or ARS. A follow-up study at 6 mo after this therapy was completed showed no complications associated with the wounds. CONCLUSION This combination therapy using NPWT and ARS administration was effective in inducing early healing of infected wound complications after surgery.

Iatrogenic ileal perforation: an accidental clamping of a hernia into the umbilical cord and a review of the published work.

This report describes the case of an ileal perforation secondary to clamping of the exomphalos minor in 3‐day‐old girl. Eighteen accidental clamping or cutting cases were found in the published work. It is thought that this defect resulted from either the clamping, ligation or cutting of the bowel in a small unrecognized omphalocele. These complications are extremely rare, but should be held in mind when performing an umbilical ligation.

Thoracoscopic surgery in children in the Kyushu area of Japan

Background:  Recently, minimally invasive thoracoscopic surgery has offered several options for both the diagnosis and surgical treatment in the field of pediatric surgery. This report reviews the surgical experience in order to assess the problems including the complications, encountered during thoracoscopic surgery in children under 15 years of age in the Kyushu area, Japan.

Long‐term outcome of peroral endoscopic myotomy for achalasia treatment in a 9‐year‐old female patient

Achalasia is a primary motility disorder with incomplete lower esophageal sphincter relaxation; it has an annual incidence of 0.11 cases per 100 000 children. Peroral endoscopic myotomy (POEM) is a new endoscopic treatment method for achalasia. Reports about POEM in pediatric patients are rare. We herein report the case of a 9‐year‐old female patient with achalasia who underwent POEM. The patient underwent endoscopic balloon dilatation because medication was not effective at a previous hospital; however, endoscopic balloon dilatation was not effective either. She then underwent successful POEM upon admission at our hospital. The patient was symptom‐free at 2 years postoperatively with no signs of esophagitis in the absence of proton‐pump inhibitor therapy.

Ultrastructural evaluation of type II pneumocytes in the hypoplastic lung of rabbit fetuses induced by oligohydramnios

Aim:  The present study was carried out using electron microscopy to evaluate the expression of lamellar bodies in type II pneumocytes of fetal rabbit lungs with hypoplasia induced by oligohydramnios.