Hirotoshi Yamamoto

Laparoscopic surgery for neuroblastoma identified by mass screening

Most neuroblastoma identified by mass screening are clearly different from the clinically diagnosed tumors with respect to biology, epidemiology, and outcome. Because the neuroblastomas detected by mass screening have favorable biological features (97% survival rate at 5 years), aggressive surgery may not be appropriate for such tumors. Laparoscopic adrenalectomy was performed on a 9-month-old boy and two 8-month-old girls who had suitable lesions. The tumors were small (< 20 mm in diameter). With the patients under general anesthesia, five trocars were placed in the abdomen. The abdominal wall traction method was used in addition to pneumoperitoneum. Intraabdominal pressure was maintained at below 4 mm Hg. The adrenal tumors were well encapsulated and completely excised, placed into a plastic bag, and removed through one of the 10-mm trocar sites. No lymphadenopathy was observed. The postoperative course was uneventful. The tumors were of favorable Shimada histology and had no N-myc gene amplification. The patients have survived, with no evidence of recurrence or metastasis, through the follow-up period of 17 to 22 months.

Malposition of a Totally Implantable Venous Access Catheter in the Azygous Vein : Report of a Case

We report herein the case of a 2-year-old girl with short bowel syndrome who developed chest pain 2 weeks after a totally implantable central venous access catheter had been surgically placed to facilitate total parenteral nutrition. A lateral chest X-ray and contrast flow study subsequently revealed that the catheter tip had been inserted into the azygous vein. Although this complication is very rare, it may be encountered more commonly with the increasing use of this type of venous access. Thus, we believe that a lateral chest X-ray should be routinely performed on all patients following catheter insertion to check for possible malposition of the tip in the azygous vein.

Resolution of cirrhosis-related pulmonary shunting in two children with a transplanted liver

We treated two children with hypoxemia caused by intrapulmonary shunting associated with cirrhosis secondary to extrahepatic biliary atresia. Following orthotopic liver transplantation, digital clubbing and intrapulmonary shunting were resolved, as demonstrated by normalization of room air arterial blood gases, reduction in shunt fraction, and perfusion lung scanning with 99mTc-labeled macroaggregates of albumin. We recommend that early liver transplantation be considered for young subjects with a severe hepatopulmonary syndrome.

Reduced bone marrow toxicity of neocarzinostatin by conjugation with divinyl ether-maleic acid copolymer

Neocarzinostatin (NCS) was conjugated with divinyl ether-maleic acid anhydride copolymer (pyran copolymer), and its therapeutic effect was compared with that of NCS. The conjugated NCS (pyran-NCS) with a molecular weight of about 23,000, exhibited in vitro cytotoxic activity against eight cell lines and bone marrow cells that was similar to the cytotoxic activity of NCS on a molar basis. Furthermore, both drugs had similar effects against a multidrug-resistant Chinese hamster ovary cell line (CHR C5) and its parent cell line (AUXB1) in vitro. However, pharmacological analysis showed that pyran-NCS had reduced accumulation in the spleen, and most important was three times less hematotoxic in vivo compared with NCS. Also, pyran-NCS had a 1.7-fold higher 50% lethal dose (LD50). Antitumor activity of pyran-NCS and NCS was tested against two different forms of Meth A tumor. In a solid tumor model, pyran-NCS and NCS suppressed tumor growth at three-fourths of the LD50 to 12.8 and 19.0% of the control tumor as evaluated on day 28, respectively (P less than 0.025). In an ascitic tumor model, the percentage increase in the median life span caused by pyran-NCS and NCS was more than 400 and 150% on day 60, respectively. Pyran-NCS is more effective than NCS because the reduced acute toxicity permits an increased drug dosage.

Laparoscopic cholecystcholangiography in a patient with biliary atresia.

A 24-day-old female newborn with persistent jaundice and acholic stool was diagnosed by laparoscopic cholecystcholangiogram. A catheter was inserted through a small incision at the fundus of the gallbladder. With definitive diagnosis of biliary atresia, laparotomy was performed, and Kasais operation was carried out successfully.

Effect of phenobarbital on serial ultrasonic examination in the evaluation of neonatal jaundice

The diagnosis of some cases of neonatal jaundice is complicated because of inability to identify the gallbladder, which makes it very difficult to differentiate biliary atresia from neonatal hepatitis even by serial ultrasonic (US) examination. Serial (US) examination after the administration of phenobarbital as a cholagogue at a dosage of 5 mg/kg/day for 5 days was performed to evaluate nine patients with neonatal jaundice. In five of the nine patients, the gallbladder was identified by a change in size following oral feeding. These patients were diagnosed as having neonatal hepatitis. The gallbladders of the other four patients were not identified before, during, or after feeding. They were diagnosed as having biliary atresia and the diagnoses were confirmed by surgery. Administration of phenobarbital for 5 days before serial US examination is very useful in the diagnosis of neonatal hepatitis when differentiation between neonatal hepatitis and biliary atresia is impossible because of inability to identify the gallbladder by US alone.

Giant liver cyst in a fetus with prune belly syndrome

A male fetus with a congenital giant liver cyst was diagnosed by ultrasonography at 27 weeks of gestation. The prune belly syndrome was present at birth, but computed tomography and a technetium99mTc DTPA scan revealed a normal urinary tract. We conclude that the abdominal disorder in our patient was due to splitting of the abdominal wall secondary to the massive abdominal distension produced by the congenital giant liver cyst.

Drainage of subcutaneous lymphatic fluid for the management of respiratory distress in a case of generalized lymphangiectasia in an infant

A 10-month-old girl was referred to our hospital because of congenital and persistent bilateral chylothorax and generalized lymphedema as well as long-standing respiratory disturbance. Radiological studies showed a diffuse network of superficial lymphatic vessels without major trunks throughout her entire body as well as the lung. She was diagnosed with systemic lymphangiomatosis complicated with pulmonary lymphangiectasia. Percutaneous puncture in the lower leg was performed to discharge the lymphatic fluid and proved to be effective for the respiratory disturbance. This procedure is safe and easy and effectively improves the quality of life of the patient and the family in case of such a persistent disease.

Laparoscopic cholecystectomy with abdominal wall traction in pediatric patients

Laparoscopic cholecystectomy using abdominal wall traction with a winch retractor instead of a pneumoperitoneum in pediatric patients is reported. Lifting the abdominal wall by the falciform ligament is useful for laparoscopic procedures, especially in small children. Because of the elasticity of the abdominal wall in children, traction on the right upper quadrant alone allows sufficient access to perform a cholecystectomy without maintenance of a pneumoperitoneum.

Differential neutralizing effect of tiopronin on the toxicity of neocarzinostatin and SMANCS: a new rescue cancer chemotherapy.

The toxic effect and antitumor activity of neocarzinostatin (NCS) and SMANCS [copoly(styrenemaleic acid)‐conjugated NCS] were greatly affected by N‐(2‐mercaptopropionyl)‐glycine [tiopronm] both in vitro and in vivo, in cultured HeLa cells and RL♂1 tumor‐bearing mice. The cytotoxicity of NCS and SMANCS against HeLa cells was remarkably reduced by the addition of tiopronin during drug treatment. Interestingly, the neutralizing effect of tiopronin on the toxicity of SMANCS was greater than that in the case of NCS. In the continuous presence of 10 mM tiopronin during a 1 h drug treatment, the 50% cell‐killing doses of NCS and SMANCS were increased 72 and 208 times as compared to those without tiopronin, respectively, whereas tiopronin itself has no cytotoxicity to HeLa cells up to 100 mM. Furthermore, more effective reduction of the lethal toxicity of SMANCS was observed by the intraperitoneal (ip) administration of tiopronin after ip injection of a lethal dose of SMANCS as compared to the same protocol in the case of NCS in mice. Therapeutic studies on RL♂1 tumor‐bearing mice revealed that delayed (time lag) ip administration of tiopronin after high‐dose SMANCS administration ip was much superior to the combination of NCS with tiopronin, or SMANCS alone. In this time‐lag combination chemotherapy of SMANCS with tiopronin, 60% of treated mice survived more than 60 days after tumor inoculation, while all the untreated control mice died within 20 days.