Takashi Tsuchioka

Heterotopic splenic autotransplantation in a neonate with splenic rupture, leading to normal splenic function

Loss of the spleen in infants and young children frequently results in overwhelming infection. To preserve splenic function, heterotopic splenic autotransplantation after splenectomy was performed on a newborn in whom the spleen was traumatized beyond repair because of birth trauma. Postoperatively, the percentage of pitted red blood cells that accurately reflects splenic reticuloendothelial function was normal. Splenic scintigrams obtained 3 weeks after the operation showed uptake by the reimplanted tissue. The otherwise mandatory long-term antibiotic prophylaxis could be reduced to 3 weeks in the newborn. At 7 years of age, the patient has not shown any increased susceptibility to infections.

Pelvic neuroblastoma safely excised using a combination of the abdominal and posterior sagittal routes

The authors report on a patient with pelvic neuroblastoma in whom the tumor was totally resected using a combination of the abdominal and posterior sagittal routes. In the treatment of patients with pelvic neuroblastoma, this approach can provide good exposure and improve the chance of total excision.

Base Excess and White Blood Cell Counts Predict Bowel Gangrene in Japanese Sigmoid Colon Volvulus Patients

Objective: This study aimed to investigate factors that predict bowel gangrene in sigmoid colon volvulus patients. Methods: Nine sigmoid colon volvulus cases were retrospectively analyzed for prediction of bowel necrosis. Laboratory parameters were extracted from medical records, and subsequently, a receiving operator curve for each parameter was drawn. Using these cut-off values, a comparison between the “with necrosis” and “without necrosis” groups was performed. Results: In the emergent cases, necrosis of the intestine was observed in 4 cases and not observed in 4 cases. The values of area under the curve were high in metabolic acidosis and white blood cell counts. For base excess, the cut off value was -2.4 mEq/L. A lower base excess is significantly associated with bowel gangrene (p = 0.029). For white blood cell count, the cut off value is 8400/mm3. A lower white blood cell counts is significantly associated with bowel gangrene (p = 0.029). Conclusions: In addition to physiological findings, blood gas analysis and white blood cell counts are useful to detect ischemia due to sigmoid volvulus.

Treatment outcome of obstructive colorectal cancer with bowel perforation.

Objective: We reported the analysis of long and short-term treatment outcomes of pa-tients with bowel perforation caused by obstructive colorectal cancer. Summary of Background Date: From April 2003 to March 2013, 15 patients with bowel perforation caused by obstructive colorectal cancer underwent emergent surgery in our hospital. Methods: Clinical outcomes were retrospectively analyzed by age, gender, tumor loca-tion, time to surgery from diagnosis, operative method, stage, postoperative complication, and preoperative severity score by APACHE II scoring system. We studied outcome of short-term outcomes and long-term prognosis used by overall survival. Results: The median age was 67.6 years. Male to female ratio was 10:5. The mortality rate was 20% and the median of APACHE II score was 15. The survival cases (n=11) showed significantly lower APACHE II score compared with fatal cases (n=4) (p=0.02). The median overall survival was 18.9 months in survival cases except for stage IV case. 5 patients had recur...

Modified Boerema technique for the closure of congenital abdominal wall defects to prevent incisional herniation and infection

Tension and infection often cause wound dehiscence or incisional herniation after the fascial closure of congenital abdominal wall defects in neonates. To overcome these problems, a modification of the Boerema technique (a method for repairing large incisional hernia in adults) was applied to repair abdominal wall defects in 14 neonates. The efficacy of this technique is discussed in this report.

Terminal Myelocystocele Associated with Cloacal Exstrophy: Case report

A baby boy with a terminal myelocystocele associated with cloacal exstrophy, omphalocele and imperforate anus is presented. A large cystic lumbosacral mass approximately 10×15×8 cm in size was covered with seemingly normal skin and protruded to the left at L3–4 vertebral level. It grew in size gradually after birth. In fear of the rupture of the mass, a repair surgery was performed at 7 weeks of age. It was confirmed to be a myelocystocele surgically and pathologically.