Yoshihide Tanabe

Primary omental-mesenteric myxoid hamartoma of the mesoappendix incidentally detected after abdominal trauma in a child: report of a case.

A 14-year-old boy was brought to our hospital with abdominal pain and nausea after suffering a blow to the abdomen. A mass was felt in the right hypogastrium, and the patient was hospitalized for possible hematoma resulting from the abdominal trauma. Initially, we treated him conservatively and observed his course, but on the 20th day after trauma, enhanced computed tomography showed that the area of strong enhancement in the tumor was unchanged. Superior mesenteric angiography showed findings indicative of a pseudoaneurysm caused by the trauma, and surgery was performed 26 days after the injury. Laparotomy revealed a tumor with a clear boundary, thought to originate in the mesoappendix, without any sign of pseudoaneurysm. Histopathological examination confirmed that the tumor was an omental-mesenteric myxoid hamartoma. The patient had an uneventful postoperative course and was discharged from hospital on the 12th day after surgery. More than 5 years have elapsed since the operation and no sign of recurrence or metastasis has been recognized.

Laparoscopic gastric pull-up and thoracoscopic esophago-esophagostomy combined with intrathoracic fundoplication for long-gap pure esophageal atresia.

The management of long-gap pure esophageal atresia (LGEA) remains controversial. An 8-month-old girl with LGEA underwent a laparoscopic and thoracoscopic gastric pull-up and esophago-esophagostomy in the right thorax combined with intrathoracic fundoplication. She was positioned supine, and three 5-mm ports were placed in the standard locations for laparoscopic Nissen fundoplication. The gastrostomy was taken down and an additional 5-mm port was inserted at the gastrostomy site. Laparoscopic gastric mobilization was performed; the short gastric and left gastric vessels were divided using harmonic shears, and the whole stomach and distal esophageal stump maintained their vascular supply via the right gastric and gastroepiploic arteries. The hiatus was enlarged by radial incisions at both cruras, and the mobilized whole stomach and distal esophageal stump were pushed up into the right thorax through the hiatus. The patient was placed in a modified prone position and three 5-mm ports were inserted into the right thorax. Via thoracoscopy, the upper esophageal pouch was dissected bluntly, and an esophago-esophagostomy was performed using interrupted 4-0 absorbable sutures and was wrapped by a 360-degree gastric fundoplication. The patient was positioned supine again, and a Heinecke-Mikulicz pyloroplasty and gastropexy were also performed laparoscopically. The patient has mild respiratory distress that requires bronchodilators; however, she is eating baby food well without vomiting. Postoperative intrathoracic gastrofiberscopy showed a well-functioning antireflux valve, and her parents are also satisfied with the cosmetic appearance of the seven small wounds. Our new procedure is feasible and is an excellent option in selected patients with LGEA.

Liposome Drug Delivery System for Murine Neuroblastoma

PURPOSE The effects of liposome-infused doxorubicin on C-1300 murine neuroblastoma were studied. The liposome surface was covered with polyethylene glycol to avoid migration toward the reticuloendothelial system and to prolong its presence in the bloodstream. Liposome-infused doxorubicin hydrochloride (DXR), an anthracycline was used as an anticancer antibiotic substance. METHODS Each A/J mouse was transplanted with 1 x 10(5) C-1300 murine neuroblastoma cells subcutaneously in the thigh. The experiment was conducted when the maximum tumor dimension was 1 cm. The control group was given only physiological saline solutions, the second group was given DXR alone, and the third group received liposome-infused DXR (Lip-DXR). The survival and doubling times were measured. One, 12, and 24 hours after the injection, the DXR concentration in the cardiac tissues was measured for statistical comparison. RESULTS The survival time of the mice was found to be 27+/-5.10 days in the control group, 31.40+/-3.15 days in the DXR group, and 43.86+/-2.13 days in the Lip-DXR group. The Lip-DXR group showed the longest survival time. The tumor-doubling time was found to be 9.07+/-2.30, 10.75+/-3.49, and 19.80+/-3.26 days, for each group, respectively. When comparing the DXR concentration in the heart tissues, the Lip-DXR-administered mice showed significantly lower DXR accumulation in the cardiac tissues after 1 and 12 hours than the DXR-administered mice. CONCLUSION This study proved that liposome-infused DXR could be used effectively on murine neuroblastoma (C-1300 tumor cell model) and may reduce the incidence of cardiac toxicity as compared with DXR alone.

Biliary atresia with cartilage formation

Extrahepatic biliary atresia (EHBA) is an infl ammatory obliteration of the extrahepatic biliary system and usually an isolated anomaly that is an acquired and progressive disease. There are a number of theories about the pathogenesis of BA, which include occult viral infections, morphological defect and vascular insults. 2 Reovirus type 3 is one of the candidates of the pathogenesis of BA because of serological reactivation and localization of particles in the porta hepatis. Cytomegalovirus (CMV) has been also associated with EHBA in previous case reports. 3 We report a rare case of EHBA associated with cartilage formation and CMV infection.