Noritsugu Hagiwara

Pancreatitis complicated with dilated choledochal remnant after congenital choledochal cyst excision

We describe here three cases of pancreatitis after congenital choledochal cyst excision. In these three cases, the choledochal remnant in the pancreas head was markedly dilated, probably because of an incomplete resection of the cyst at the primary operation, and an increase in intraluminal pressure of the pancreatic duct caused by a dynamic obstruction by a protein plug or a pancreatic calculus. Complete cyst excision, including the choledochal wall in the pancreas, is therefore strongly recomended.

Study of 24 cases with congenital esophageal atresia: What are the risk factors?

Background: Recovery from esophageal atresia (EA) and tracheoesophageal fistula (TEF) has improved markedly over the years. But postoperative complications, however, have remained. This study evaluates recovery, preoperative, and postoperative status of patients with EA/TEF.

Spontaneous localized intestinal perforation and intestinal dilatation in very-low-birthweight infants.

Aim: To elucidate how spontaneous localized intestinal perforation (SLIP) is related to intestinal morphological features such as dilatation in very‐low‐birthweight (VLBW) infants. Methods: The medical records of 13 VLBW infants (<1500 g) undergoing laparotomy between 1983 and 2003 for presumed SLIP were retrospectively reviewed. Clinical findings including maternal, prenatal and perinatal factors were analysed, and the clinical and surgical findings upon laparotomy were compared. Results: Postnatal pathological conditions included patent ductus arteriosus (n= 7), sepsis (n= 2), respiratory distress syndrome (n= 7), intraventricular haemorrhage (n= 2), an indwelling catheter via the umbilical vein (n= 1) and pneumonia (n= 1). Indomethacin was used in seven neonates with patent ductus arteriosus, and dexamethasone preventive therapy was employed in one neonate for bronchopulmonary dysplasia. Operative findings revealed a localized small punched‐out perforation in the ileum. Five patients had intestinal dilatation: two with a perforation in the middle of the dilated intestine, and three with a perforation proximal to the region of dilatation. The muscularis propria was absent in the dilated intestine of four patients.

The effect of a novel immunosuppressant, FTY720, in mice without secondary lymphoid organs.

PurposeFTY720 is a novel immunosuppressive agent that is thought to reduce the number of peripheral blood lymphocytes (PBL) by directing them toward secondary lymphoid organs such as the lymph nodes and Peyer’s patches. We studied the effects of FTY720 on aly/aly mice that do not have either lymph nodes or Peyer’s patches, as well as on splenectomized aly/aly mice.MethodsFTY720 was orally administered by gavage (1 mg/kg) to aly/aly mice as well as to aly/+ mice with and without a splenectomy on 14 consecutive days. The number of lymphocytes was then counted using True Cell beads and flow cytometry. The number of B220-, CD3-, and CD4-positive cells was also determined. In addition, skin grafts from C3H donor mice were performed on these mice.ResultsFTY720 was effective in significantly reducing the total lymphocyte count as well as the B220-, CD3-, and CD4-positive subtypes in the peripheral blood of aly/+ mice as well as in aly/aly mice with and without a splenectomy. While we did observe allograft skin graft rejection in both the aly/+ mice as well as the aly/aly mice recipients and splenectomized aly/aly mice, the graft survival was prolonged in all groups. The skin allografts treated by FTY720 thus demonstrated fewer lymphocytic cells and less infiltration of CD4-positive cells.ConclusionsThe administration of FTY720 to mice without lymph nodes, Peyer’s patches, or spleens still results in peripheral lymphopenia. In all groups, FTY720 was found to prevent the infiltration of CD4-positive cells in skin allografts while also prolonging skin allograft survival. The fate of these lymphocytes, however, is unclear.

Intussusception in children of school age

Background: There are only a few reports discussing the characteristics of intussusception developing in school‐age children. The characteristics of these cases are discussed, with reference to previous literature.

Application of radiofrequency ablation for giant solid pseudopapillary tumor of the pancreas

Solid pseudopapillary tumors (SPT) of the pancreas are rare exocrine pancreatic tumors that are well-known for their predilection for young women. They were first described by Frantz in 1959, and have been variously designated as solid-and-cystic tumors, solid-and-papillary epithelial neoplasms, papillary cystic neoplasms, solid-and-cystic acinar-cell tumors, papillary-andsolid neoplasms, and Frantz’s tumor. In 1996, the World Health Organization renamed this tumor as SPT of the pancreas for the international histological classification of tumors of the exocrine pancreas. The tumor is more frequently localized in the pancreas (80%) and is rarely a metastatic disease (20%). Because of the malignant potential of the tumors, surgical resection has been the standard of care in the management of SPT of the pancreas to prevent recurrence, and surgical resection can result in cure. Radiofrequency ablation (RFA), a technique first described in 1990 by Rossi et al., is based on the electrical energy of a high-frequency, alternative current flowing from an electrode into the surrounding tissue. This leads to ion agitation, which is converted by friction into the head and, ultimately, induces irreparable cellular damage and coagulation necrosis. RFA is an evolving technology used to treat unresectable liver tumors, renal tumors, and lung tumors. The efficacy and safety has been reported. We report a case of a young girl for whom we carried out complete resection of unresectable SPT of the pancreas after having reduced the size of the tumor using RFA. The hospital’s institutional review board approved this study.

Traumatic intramural hematoma of duodenum with thrombasthenia in childhood

© 2007 Japan Pediatric Society Intramural hematoma of the duodenum is a relatively rare ailment. In many cases it is due to trauma and it is characterized by its frequency in children. Herein the authors report their experience of the case of a young girl who concomitantly experienced traumatic intramural hematoma of the duodenum (hereafter the current disorder) while under medical treatment for thrombasthenia, and alleviation via conservative treatment.

Pancreatitis After a Primary and Secondary Excision of Congenital Choledochal Cysts

PurposePancreatitis has been reported long after total choledochal cyst excision. The aim of this study was to determine if the disease process of postoperative pancreatitis differs between a primary and secondary cyst excision in a long-term follow-up.MethodsAmong 53 postoperative patients who underwent a total cyst excision and were followed up, 44 patients underwent a primary cyst excision (primary excision group), while 9 patients underwent a secondary cyst excision after a previous cyst-duodenostomy for internal drainage (secondary excision group). The long-term clinical course, including the pancreatographic findings after a total cyst excision, was compared.ResultsIn the primary excision group, six patients had mild pancreatitis. Endoscopic retrograde pancreatography demonstrated ductal dilatation that was limited to the common channel in two patients, concurrent with the ventral duct in three, and extended the duct of Santorini in three. Conservative treatments were carried out in three patients, and endoscopic irrigation in one patient with protein plugs in the ventral duct. A resection of the choledochal remnant in the pancreas was performed in two patients with choledochal remnant-associated pancreatitis. From the secondary excision group, 5 of the 9 patients had chronic pancreatitis. Endoscopic retrograde pancreatography showed entire pancreatic ductal dilatation. Two of these patients underwent duodenal papilloplasty at the same time as secondary surgery; however, the disease progressively worsened.ConclusionIn patients undergoing a secondary total excision after internal drainage, it is difficult to half the ongoing aggravating process in pancreatitis.

Effect of FTY720 and Ex Vivo Graft Irradiation in Rat Small Bowel Transplantation: Expression of Mucosal Addressin Cell Adhesion Molecule-1

PurposeWe performed a semiquantitative analysis of the expression of Mucosal addressin cell adhesion molecule-1 (MAdCAM-1) and gut-associated tissues (GALT) during small bowel graft rejection in the rat to confirm the effect of FTY720 and ex vivo graft irradiation.MethodsSmall bowel transplantations (SBT) were performed from BN rats to LEW rats. Four groups of SBT animals were studied on days 3, 5, and 7 after operations (untreated, FTY720, ex vivo graft irradiation, FTY720+ex vivo graft irradiation). Indirect immunoperoxidase staining was performed against CD4 and MAdCAM-1. The number of CD4-positive cells in the allografts was also analyzed by flow cytometry.ResultsThe graft survival was prolonged only in the FTY720-treated groups. The SBT allografts treated by FTY720 demonstrated less infiltration, but the ex vivo graft irradiation group did not show any effect on its expression. In the FTY720-treated groups, MAdCAM-1 expression on high endothelial venules (HEVs) in Peyers patches (PPs) was upregulated and its expression on endothelial cells of vessels in the lamina propria was downregulated in comparison with the allograft group without FTY720.ConclusionsIt is important to prevent the infiltration of CD4-positive cells, the downregulation of MAdCAM-1 expression on HEVs in PPs and the upregulation of MAdCAM-1 expression on endothelial cells of vessels in the lamina propria for the prolongation of graft survival.

Anorectal Manometric Studies in Patients with Symptomatic and Asymptomatic Rectocele.

排便障害 (残便感, 便秘, 排便困難, 会陰部重圧感など) の有無により, rectocele例 (全例女性;有症状38例, 無症状16例) の病態生理学的相違があるかどうかの解明を目的に, 直腸肛門内圧検査法を用いて, 排便異常のない女性 (16例) を対照に比較検討した. その結果, 排便障害の有無に関係なく, 内・外肛門括約筋機能 (対照に比較して, 肛門管最大静止圧と肛門管最大随意収縮圧は明らかに低値), 直腸貯留能 (対照に比較して, 直腸最大耐容量は低値, コンプライアンスは明らかに低値), 直腸感覚能 (直腸最小知覚量と直腸最小耐容量は高値) などの低下を認めた. そして, 直腸内圧は対照より明らかに高値を示した. すなわち, rectocele例では, 排便障害の有無に関係なく, 直腸壁の弾性能低下に高い直腸内圧が存在していることが判明した. これらのことは, rectoceleの成因に関与している可能性を示唆するものと思われた.