Mineyuki Tsuda

Preservation of the umbilical cord at the primary fascial closure in infants with gastroschisis

Recently, the survival of patients with gastroschisis has been dramatically improved and it has reached more than 90%. Over the last 10 years, 20 of 21 cases (95%) survived in our hospital. We have been using the primary fascial closure of the abdominal wall as a standard operative procedure. The umbilical cord was usually excised at the operation in order to secure the suture line and prevent wound infection. The survivors sometimes complained of the absence of the umbilicus. However, it was somewhat difficult to create a new umbilicus later by use of the surrounding skin. In the last five cases, we tried to carry out the primary fascial closure with preservation of the umbilical cord. All patients could obtain good cosmetic results with near-normal appearance. Omphalitis or cellulitis was never observed, but a small umbilical hernia occurred in one case.

Leiomyosarcoma of the transverse colon in a neonate: a rare cause of meconium peritonitis.

A rare case of a newborn infant with leiomyosarcoma of the transverse colon is reported. The condition was associated with meconium peritonitis due to a perforation proximal to a portion of the transverse colon that was completely surrounded by the tumor. The 12 previously published cases of leiomyosarcoma of the colorectum in childhood are reviewed, and the pathogenesis of meconium peritonitis is discussed.

Specific quantitation of secretory immunoglobulin a with enzyme immunoassay using activated thiol-Sepharose for separation method

A specific and sensitive enzyme immunoassay system for human secretory IgA was developed using anti-alpha-chain antibodies coupled to activated thiol-Sepharose, and anti-secretory component antibodies labeled with beta-D-galactosidase from Escherichia coli. The dose response of the enzyme activity in eluate was observed between 3 and 1000 ng of secretory IgA with little cross-reactions with IgA, IgG, IgM and secretory component. The assay method could be employed for the measurement of secretory IgA in saliva, urine, feces, intestine and serum without interferences by the abundant IgA in the same samples.

Extracorporeal membrane oxygenation (ECMO): applications and results in patients with congenital diaphragmatic hernia

Congenital diaphragmatic hernia (CDH) that causes symptoms within the first 24 h after birth often leads to fatal hypoxia due to refractory persistent pulmonary hypertension of the newborn (PPHN) and/or hypoplastic lungs despite aggressive ventilator care and pharmacological treatment. Since 1985, extracorporeal membrane oxygenation (ECMO) has been used in our hospital as “last resort” therapy for these patients. Of the 33 patients treated up to March 1992, 15(45.5%) were selected for ECMO. In 13 cases ECMO was used after repair of a CDH and in 2 patients with fatal cardiorespiratory disease it was started shortly after admission and the operation was carried out after stabilization on ECMO. Average birth weights were 2.96 kg and average gestational ages 39 weeks 1 day. The average age at the start of ECMO was 31.9 h, the average ECMO time was 99.1 h and the longest was 422 h. Eleven of the 15 patients who required ECMO survived, and the overall survival in the 33 CDH patients who presented with symptoms in the first 24 h was 78.8%, which was a significant improvement compared with the 57% survival in the 21 previous patients.

Extracorporeal membrane oxygenation — succesful treatment after repair of congenital diaphragmatic hernia

A case of congenital diaphragmatic hernia successfully treated by extracorporeal membrane oxygenation (ECMO) is reported. A female baby weighing 3.4 kg was admitted 3 h after birth because of respiratory distress. Her left diaphragmatic hernia was repaired 5 h after birth by laparotomy. The AaDO2 levels were higher than 500 mmHg before and after the operation. She was managed by high-frequency ventilation and administration of tolazoine for the first 58 h. These effects were temporary, however, and she reverted into persistent fetal circulation three times. Therefore, ECMO was started at 59 h after birth. When the flow rate of ECMO reached 320 ml/min, the newborn entered a state of complete lung rest. Her general condition improved slowly, and ECMO was successfully terminated after 60 h of bypass. This was the first successful case in Japan.

New surgical procedure for sliding inguinal hernia repair in female infants and girls.

The basic principle of inguinal hernia repair in infancy and childhood has been universally accepted to be high ligation of the sac. No standard procedure exists to correct sliding hernias containing the ovary or the fallopian tube, although as many as 20% of hernias in girls are of this type. Reported procedures have been variously deemed complicated, difficult, or contrary to the principle of high ligation. Based on the precise local anatomy of female inguinal hernia, we have developed a simple new technique that can return the prolapsed adnexa safely to the correct anatomic position and achieve high ligation.

The efficacy of extracorporeal membrane oxygenation (ECMO) in newborns with septic shock

The efficacy of extracorporeal membrane oxygenation (ECMO) for patients with septic shock has not yet been documented with certainty. Seven septic newborns who were resistant to conventional therapy were managed by ECMO in our hospital, and five (71.4%) survived. Veno-arterial ECMO thus was very beneficial in supporting cardiorespiratory insufficiency due to septic shock. Ultrafiltration or hemodialysis carried out on a bypass route in the ECMO circuit was also beneficial in controlling the fluid and electrolytic imbalance often encountered in septic newborns. On the other hand, despite activated clotting times being maintained at relatively low levels compared to non-septic cases, major hemorrhagic complications occurred in more than one-half of the cases and became the main cause of death in two. Some modifications will therefore be necessary in ECMO practice for septic newborns.