Shigenori Sawaguchi

Experimental analysis of the Ill effect of anomalous pancreaticobiliary ductual union

An ideal canine model of anomalous pancreaticobiliary ductal union, similar to a human anomaly, was devised. Direct anastomosis of the dorsal pancreatic duct and the choledochus was employed (dorsal pancreaticocholedochostomy). The ventral pancreatic duct was not manipulated. Cylindrical choledochal dilatation results in 13 out of 20 adult dogs and in 4 out of 6 puppies. Dilatation of the intrahepatic biliary tree and thickening of the choledochal wall in a hepatic direction were observed in high ratio among adult dogs. Puppies had less dilatation. The activation of pancreatic enzymes was studied in bile containing pancreatic juice. The proteolytic enzymes, trypsin and elastase were proven to be activated in the bile without the presence of enterokinase in the pancreaticocholedochostomy model. This would be the cause of the ill effects of refluxed pancreatic juice into bile in anomalous pancreaticobiliary ductal union.

Cholangio-venous reflux as a cause of recurrent hyperamylasemia in choledochal dilatation with anomalous pancreaticobiliary ductal union: an experimental study.

Cylindrical choledochal dilatation, associated with anomalous pancreaticobiliary ductal union, causes recurrent episodes of right hypochondrial pain, vomiting, and fever. The symptoms are very often accompanied by hyperamylasemia, which is generally considered to be due to acute pancreatitis. However, our clinical experience and experimental studies have led us to the conclusion that pancreatitis is not the sole cause of hyperamylasemia. In this paper we report our further investigations of the cause of the hyperamylasemia. In 22 mongrel adult dogs, intracholedochal infusion was performed under a continuous hydrostatic pressure of 20 cm H2O for 2 hours. Solutions of amylase from three different sources and a lipase were used in the range of concentrations found clinically in the bile within a cylindrical choledochal dilatation. In the 3 groups, hyperamylasemia was proven by quantitative estimation of serum amylase level and/or by the changes in specific amylase isozymes. Lipase was also shown to transfer into the blood stream. In an additional experiment on 5 dogs, only the extrahepatic biliary tree, including the gallbladder, was infused with a solution of amylase from Bacillus subtilis. This produced no increase in the serum amylase. Our experiments suggest that amylase passes from the hepatocholedochal system into the blood stream. This phenomenon has long been known as cholangiovenous reflux.

Clinical experience with a sucking sump catheter in the treatment of esophageal atresia

This is an introduction to the sucking sump catheter as a method of continuous salivary suction from the oral cavity for the treatment of esophageal atresia and other diseases. Upper pouch suction on many occasions is not easy. The double lumen catheter was devised by Replogle to achieve better suction efficiency, but this is not always satisfactory. Therefore, we devised an oral suction catheter that is a sucking sump catheter. A no. 8 French Argyle Salem sump catheter was transformed; we added five to six holes, and the tip was bent into a double or triple circle. This is sucked on, as a nipple would be, by the infant. From 6 years of experience, we have determined that this works very well for continuous salivary aspiration from the oral cavity, that it causes no complications; this device can also contribute to early oral feeding after esophageal anastomosis.

Computerized Analysis of Anorectal Manometry

A computer system was designed and applied to anorectal manometry that allows pressure data to be analysed in various ways. Two kinds of applications were presented. Image analysis enabled anorectal movements to be visualized as a three-dimensional image. This technique was shown to be useful in studying the pathophysiology of chronic constipation in children. Radial variation analysis demonstrated that there was no significant radial difference in the anal-canal pressure.

Sarcomatous wilms tumor associated with consumption coagulopathy

This is a case report of a sarcomatous Wilms tumor complicating disseminated intravascular coagulation with gastrointestinal bleeding, ascites, pleural effusion, and hepatitis after the second course of actinomycin D. A sarcomatous Wilms tumor is believed to have an unfavorable prognosis even if multimodal therapy is given. Arteriovenous fistulae which we created for purposes of chemotherapy and hyperalimentation by microvascular-sleeve anastomosis functioned well for three years in spite of repeated punctures.

Chondromyxoid fibroma of the chest wall in an infant.

Chondromyxoid fibroma of the chest wall in a 3-month-old boy was described. The patient was presented with respiratory distress, and a large calcified mass of the left lung field was seen on the chest roentgenogram. Treatment consisted of excision on the tumor with removal of 5th to 8th ribs. There is no evidence of recurrence during the two years folow-up.