Munehisa Kogata

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.

Postoperative immunization with peanut agglutinin-binding glycoprotein from Lewis lung carcinoma in mice

The effects of postoperative immunization with purified tumor-associated antigens on the development of lung metastases following excision of the Lewis lung carcinoma (3LL) were investigated. Soluble tumor-associated antigens were isolated from 3LL cells by detergent solubilization and purified by affinity chromatography on peanut agglutinin (PNA)-agarose. The immunization with subcutaneous injections of PNA-binding glycoproteins (PNA receptors) at the early phase following excision of primary footpad tumors of 3LL resulted in a significant decrease in incidence and size of lung metastases. The delayed immunization, however, failed to suppress the development and growth of metastatic lung tumors after surgery. The suppression in postoperative development of lung metastases was found to depend on the scheduling of immunization following local tumor excision. Splenectomy performed simultaneously with amputation of the tumor-bearing leg completely abolished the decrease in the development and growth of postoperative lung metastases in immunized mice. The involvement of the lymphoid system in the control of metastatic tumor growth was also confirmed in an in vivo tumor neutralization assay utilizing the spleen cells.

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.

Effectiveness of Peanut Agglutinin-Binding Glyco-Related Antigen and Cyclophosphamide on Metastasis of Lewis Lung Carcinoma

Soluble tumor-associated antigens were isolated from Lewis lung carcinoma (3LL) cells by detergent solubilization and purified by affinity chromatography on peanut agglutinin (PNA)-agarose. Subcutaneous injection of PNA-binding glyco-related antigen into 3LL-bearing male C57BL/6 mice significantly augmented delayed-type hypersensitivity (DTH), and also inhibited the growth of the primary 3LL tumors. The effects of combined immunotherapy and chemotherapy with this antigen and cyclophosphamide (CY) were examined following excision of 3LL by determining the number of pulmonary surface nodules and wet weight of the lungs. Injection of PNA-binding glyco-related antigen and CY significantly inhibited pulmonary metastasis and prolonged the survival of the mice. The spleen cells obtained from mice with combined treatment showed higher neutralizing activity against 3LL cells than other groups. Therefore, combined immuno and chemotherapy may be useful in preventing metastasis.