Masazumi Tsuji

Ovarian Teratoma with Gliomatosis Peritonei : Report of Two Cases

Gliomatosis peritonei, a rare condition related to ovarian teratomas, involves the peritoneal implantation of numerous nodules of predominantly mature glial tissues. We report herein the cases of two patients with immature ovarian teratoma associated with gliomatosis peritonei, in one of whom a rapid progression of teratomatous implants occurred 14 weeks after her initial surgery. Gliomatosis peritonei is considered benign in most cases; however, some reports have documented the rapid recurrence of immature peritoneal implants, as implantation is associated with teratomas of all grades. Thus, in the face of peritoneal implants suspected to be of a teratomatous nature, thorough and extensive sampling is essential to exclude the presence of immature elements which may imply a poor prognosis and require aggressive therapy.

Surgical technique of laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis

We report herein a new method of performing laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis, using refined surgical techniques. The pyloric tumor was immobilized by grasping the first portion of the duodenum and the anterior wall of the stomach, and electrocoagulation was used prior to incising the pyloric tumor to minimize bleeding during the procedure. Although this technique has been applied in only two patients so far, we present the details herein. We believe that with technical and instrumental refinements, the speed and safety of laparoscopic pyloromyotomy will improve and it will become an alternative to open surgery in pediatric patients.

Spiral computed tomography for biliary dilatation.

Spiral computed tomography (SCT), which consists of rapid volumetric data acquisition and planar image display, was performed on 12 patients with biliary dilatation after excisional procedure. The technique was evaluated for image quality and impact on clinical practice. All patients safely underwent SCT scanning after intravenous cholangiography (IVC) without any sedations. In 11 of 12 patients reliable biliary images were obtained and three-dimensional (3D) reconstruction images of the biliary system with bilioenteric anastomosis were generally of diagnostic quality even in young children. As a consequence, IVC-SCT technique appears to have the potential for improving the efficacy and safety of diagnostic CT in investigation of the biliary system. In particular, this technique may be useful for detecting bilioenteric anastomotic conditions in follow-up studies of pediatric patients with biliary dilatation.

Pancreatoblastoma managed by pancreatoduodenectomy and extended right lobectomy

We report a case in which a pancreatoblastoma with liver metastasis was successfully resected by pancreatoduodenectomy and extended right lobectomy after effective chemotherapy. The combination of surgery and chemotherapy may be a potentially useful treatment for advanced metastatic pancreatoblastoma.

Anorectal Stenosis in a Neonate: Report of a Case and Review of the Japanese Literature

We report herein the case of an infant with anorectal stenosis successfully treated by staged surgery. At 1 day of age, the anal orifice showed circumferential stenosis located 5 mm from the anal verge and extending into the anal canal for approximately 1 cm; however, no hypertrophic raphe or bucket handle appearance were observed, and no associated anomalies such as a presacral mass or sacral dysgenesis were found. At 2 days of age, the infant underwent a sigmoid colostomy under the diagnosis of low anorectal stenosis, followed by a successful anorectoplasty, performed through a sacroperineal approach when he was 8 months old. An analysis of 13 other cases of anorectal stenosis from the Japanese literature indicates that this type of malformation should be treated by staged surgery, as an initial colostomy in the neonatal period, followed by anorectoplasty through a sacroperineal approach during infancy.

Tissue insulin contents in nesidioblastosis. Report of two cases

We present two cases of nesidioblastosis, a common cause of persistent hypoglycemia in infancy that, if inadequately treated, can lead to mental retardation. Tissue insulin data obtained from both radioimmunoassay and immunohistochemistry are presented. In each case, the insulin content correlated well with the quantity of insulinpositive cells in each portion of the pancreas. However, the insulin content varied from case to case and from portion to portion of the same pancreas. Thus, discrepancies in clinical results in nesidioblastosis may be due to variability of insulin content in the resected pancreas.