Tohru Arima

Motility function of the esophagus before primary anastomosis in esophageal atresia

Two patients with a long gap esophageal atresia without tracheoesophageal fistula underwent an esophageal manometric study before primary anastomosis and one of them underwent an identical study after operation. Before operation both patients showed peristaltic contraction in the proximal esophagus when swallowing which was always followed by a coordinated contraction of the distal esophagus the same as in that of the normal esophagus. These peristaltic contractions induced a reflex relaxation of the lower esophageal sphincter (LES). After operation the manometric studies of the repaired esophagus demonstrated an abnormal esophageal motility, with simultaneous contractions occurring when swallowing in the proximal to the distal esophagus. In addition, the reflex relaxation of LES was incomplete. These data suggest that even if the intraluminal continuity is defective, the esophageal motility function is not disturbed in the proximal to distal esophagus in preoperative esophageal atresia, and that intraoperative mobilization and denervation may be suggested to be an important factor in esophageal dysmotility even when esophageal atresia is successfully repaired.

Regular structures on the microvillar surface membrane of ileal epithelial cells in suckling rat intestine

Freeze-fracture deep-etch studies were done to examine regular patterns of surface membrane particles in the suckling rat ileal epithelium by using quick-freezing method. In addition to the presence on the luminal surfaces of well-developed endocytic complexes, latticed particles were consistently observed on almost the entire apical membrane between microvilli and frequently on the microvilli. These particles seemed to be partly integrated in the outer half layer of membranes. After rinsing with phosphate-buffered saline, patterns on the microvilli appeared to be parallel circle lines rather than latticed particles found in fresh preparations. Filipin treatment showed the presence of filipin-sterol complexes on most of the particle-covered membrane areas except small tubules and vesicles. Possibilities were suggested that these latticed particles were transferred to the apical surface along the outer half layer of membranes, and released or secreted into the intestinal lumen.

Fate of infants with neonatal hepatitis : pediatric surgeons' dilemma

Thirty-five cases of neonatal hepatitis (20 males and 15 females) were reviewed, 3 of whom were lost during the follow-up, leaving 32 patients for review. There were 10 late deaths and 22 patients survived, 18 of whom with a normal bilirubin level and 4 with a bilirubin level of greater than 1.0 mg/dL. In the 18, jaundice disappeared between the ages of 4 and 7 months. The current lifestyles of the patients include 4 adults aged 19 to 21 who are either working or at university, while the other 18 children are all making good progress at school. Except for moderate growth retardation in 3 children, all are growing well. In all 10 patients who died, liver failure persisted until the time of death. Three died of other causes and 7 died of neonatal hepatitis itself between 4 months and 7 years of age. Four patients ran a fulminating course resulting in death between the ages of 4 and 12 months. All 7 had growth and developmental retardation. A histological examination showed that in those who died, there was significantly more periportal fibrosis, inflammation in the periportal area, and diffuse giant cell transformation. These results indicate that some infants with neonatal hepatitis have a poor prognosis and, therefore, the identification of such a condition requires a careful, long-term follow-up.

Verapamil attenuates postischemic oxidative injury in the rat liver

SummaryWe assessed the effects of the calcium channel blocker verapamil on postischemic oxidative injury in the rat liver. In the untreated rats, the values of tissue lipid peroxidation products (thiobarbituric acid-reactive substances) remained unchanged during 90 min of warm ischemia. However, the values increased significantly after the next 60 min of reperfusion compared with those in the sham-operated rats (P<0.01). Intravenous infusion of verapamil (5 μg·kg−1 ·min−1) significantly reduced the extent of lipid peroxidation during reperfusion compared with that in the untreated rats (P<0.02). The percentages of tissue water content and the serum lactate dehydrogenase activities after 60 min of reperfusion were significantly lower in the treated rats than in the untreated rats (P<0.02 andP<0.01, repsectively). We also investigated the influence of verapamil on superoxide-generating activity determined by the superoxide-dependent cytochromec reduction of peritoneal polymorphonuclear leukocytes (PMNs) harvested from normal, non-ischemic, and non-treated rats in vitro. This demonstrated that there was no apparent effect with the highest verapamil concentration level (8μM) observed in the rat plasma during our experiment. These findings suggest that verapamil might reduce the postischemic oxidative injury in the rat liver by mechanisms perhaps not related to the suppression of rat PMNs superoxide-generating activity.

UNDIFFERENTIATED (EMBRYONAL) SARCOMA OF THE LIVER

A 10‐year‐old girl with undifferentiated (embryonal) sarcoma of the liver reported here had abdominal pain, nausea, vomiting and weakness when she was 8 years old. Chemical analyses of the blood and urine were normal. Serum alpha‐fetoprotein was within normal limits. She died of cachexia 1 year and 8 months after the onset of symptoms. Autopsy showed a huge tumor mass in the liver and a few metastatic nodules in the lungs, which were consistent histologically with undifferenitated sarcoma of the liver. To our knowledge, this is the second case report of hepatic undifferentiated sarcoma of children in Japan, the feature being compatible with the description of Stocker and Ishaka.

Radiological Findings in Two Patients with Cow's Milk Allergic Enterocolitis

Cows milk allergic enterocolitis is a common paediatric gastrointestinal disease. However, radiological findings from contrast studies have rarely been reported. We report two Japanese neonate patients with cows milk allergic enterocolitis with vomiting, bloody stool and unique findings on upper gastrointestinal contrast study. Upper gastrointestinal contrast study showed folds of the small intestine to be thickened, such as in spasm, or ribbon-like cords in both cases. There was also poor passage from the duodenum to the jejunum in one case. In addition, there were spastic findings on lower gastrointestinal contrast study in part of the large colon in one case. Clinicians, including paediatric surgeons, treating neonates with bloody stool and/or vomiting should thus be aware that unique findings on upper and lower gastrointestinal contrast studies may be useful in suspecting cases with cows milk allergic enterocolitis.

Significance of antenatal diagnosis of omphalocele

A comparison has been made between 16 infants with omphalocele treated between 1962 and 1975 (group A) and 22 treated between 1976 and 1989. In the latter group 11 antenatally detected cases (group C) were considered separately from the 11 cases diagnosed at birth (group B). Recent advances have reduced the mortality for neonates with omphalocele from 37.5% in group A to 18.2% in group B. However, despite antenatal diagnosis, maternal transport, and early perinatal care, a surprising increase in mortality (45%) was observed among neonates with omphalocele detected antenatally (group C). Seven cases in group C (60%) also had other lethal or potentially lethal multiple anomalies including trisomy 13 or 18, and it is probable that the high mortality in this group was a result to these associated anomalies. Before the introduction of antenatal diagnosis, most of these infants would have died before referral to a pediatric surgeon for treatment. In general, if omphalocele is an isolated lesion the prognosis for survival following postnatal surgical correction exceeds 90%; in such cases, antenatal diagnosis may potentially contribute to improved survival. However, the presence of other multiple and/or untreatable malformations in the group diagnosed antenatally is associated with a poor overall prognosis.

A freeze-fracture study of perinatal changes of intramembranous particles in microvilli of absorptive cells in mouse small intestine

SummaryPerinatal changes in the appearance of intramembranous particles (IMPs) of microvilli of enterocytes were analyzed quantitatively. In both the jejunum and the ileum, the IMP density on the P-face showed no significant changes from day 17 of gestation to day 5 of postnatal life. It increased between day 5 and day 12, reached a maximum at day 21, and thereafter decreased slightly. The IMP density on the E-face remained almost constant during the perinatal period in both intestinal parts. Measurements of particle diameters proved that neither the P-face nor the E-face membrane showed significant differences in either mean value or size distribution among different age groups.This study has revealed that the perinatal change in the IMP density on the P-face of microvilli correlates well with changes in the activity of certain enzymes found in the membranes of microvilli, e.g. disaccharidase and aminopeptidase.

Endoscopic treatment of intrahepatic gallstones after surgery for choledochal cyst

Three patients with intrahepatic gallstones after surgery for a choledochal cyst were successfully treated with lithotomy under percutaneous transhepatic cholangioscopy. We conclude that this technique should be considered as one of the potential treatment modalities for intrahepatic gallstones in such a situation.

New Technique of Experimental Partial Liver Transplantation: Hemodynamic Study During Surgery

Orthotopic liver transplantation of children is often limited by the scarcity of an appropriately size-matched donor organ. The transplantation of a reduced liver was thus conceived to solve this problem. A new technique of partial liver transplantation in mongrel dogs is reported, which partially retains the recipients liver and uses an Ameroid constrictor to occlude the recipients portal branch gradually. The donors right and median lobectomy was performed in situ. The donors left lobe was perfused in situ and removed as a graft. It was then transplanted orthotopically in the space after a left and median lobectomy of the recipient. An Ameroid constrictor was applied around the recipients right portal branch for a gradual occlusion of the host hepatic blood supply (the Ameroid group). To compare the hemodynamic stability during surgery with this technique, two other methods were also performed. The mean systemic blood pressure of orthotopic liver transplantation with a passive venovenous bypass during the anhepatic period (the Bypass group, n = 5) was lower than that of the Ameroid group (n = 16). Instead of fitting an Ameroid constrictor, an orthotopic partial liver transplantation with ligation of the right portal branch (the Ligation group) was performed. The mean systemic blood pressure of the Ligation group (n = 10) was lower than that of the Ameroid group (n = 11) after either fitting a constrictor or performing a ligation.(ABSTRACT TRUNCATED AT 250 WORDS)