Yoshihiro Ohsawa

Flow cytometric DNA analysis of neuroblastoma: Prognostic significance of DNA ploidy in unfavorable group

Flow cytometric DNA content analyses were performed on samples of 54 patients with neuroblastoma. DNA aneuploidy was detected in 55.6% of the 54 patients. A high incidence of DNA aneuploidy was observed in patients with prognostically favorable variables such as age (less than 1 year), clinical stage (I, II, or IVs), and primary site (extraadrenal sites). DNA aneuploidy was predominant in surviving patients, even in those with unfavorable variables. In patients 1 year old or more, the survival rate among those with DNA aneuploidy was 58.8% compared with 28.6% in patients with diploidy. Likewise, in patients with advanced stage (III or IV) neuroblastoma, the survival rate among those with DNA aneuploidy was 63.2% compared with 30.4% in patients with DNA diploidy. It is concluded that DNA content analysis is of value in predicting the prognosis of patients with neuroblastoma.

Long-Term Results After Nonshunt Operations for Esophageal Varices in Children

The clinical results of nonshunt operations for esophageal varices in 15 children were evaluated. The varices were caused by congenital extrahepatic portal obstruction (EHPO) in 10, liver cirrhosis or fibrosis (C/F) in 3, and idiopathic portal hypertension (IPH) in 2. The operative procedures were transthoracic esophageal transection with paraesophageal devascularization (TR) for 2 EHPO patients under 5 years of age, TR combined with splenectomy and paragastric devascularization (Sugiura procedure) for 11 (8 EHPO, 3 C/F), and splenectomy with devascularization (SP) or splenectomy for the 2 IPH patients. In the EHPO patient under 5 years of age, TR is associated with a likelihood of gastric or esophageal hemorrhage resulting from hypersplenism, gastric congestion, or persistent distal esophageal varices, which can be treated with partial splenic arterial embolization (PSE), endosclerotherapy, or an additional abdominal procedure. The Sugiura procedure has provided satisfactory long-term results, without rebleeding from esophageal varices, in patients with EHPO and C/F for 1 to 20 years. But EHPO patients who undergo the Sugiura procedure before age 6 can have gastric hemorrhage, because of mucosal congestion, for more than 10 years after the procedure, and selective gastric arterial embolization (GAE) might be necessary. In some EHPO patients, especially young ones who have variceal bleeding, a significant increase in hepatopetal portal flow may not develop, but hepatofugal natural shunts may progress. Therefore we recommend direct operative procedures, ie, TR for patients < or = 6 years of age and a one- or two-stage Sugiura procedure for those over 7 years old.(ABSTRACT TRUNCATED AT 250 WORDS)

Intestinal myoelectric activity and contractile motility in dogs with a reversed jejunal segment after extensive small bowel resection

To evaluate the functioning and effectiveness of a reversed jejunal segment after extensive small bowel resection, we continuously measured the postoperative bowel motility (using bipolar electrodes and/or contractile strain gage force transducers) in interdigestive and postprandial conscious dogs at 2 to 5 weeks after surgery. The fasting duodenal migrating myoelectric (or motor) complex (MMC) occurred at markedly longer intervals in dogs with a 20-cm reversed jejunal segment created after 75% to 80% extensive small bowel resection (group 3) than in dogs that received extensive resection alone (group 2) or dogs that underwent construction of a reversed jejunal segment without bowel resection (group 1). The MMC arising from the duodenum was often interrupted at the jejunum above the proximal anastomosis and did not migrate smoothly to the reversed segment or terminal ileum in group 3. In addition, brief small discordant contractions were frequent in the reversed segment and the jejunum above the proximal anastomosis in group 3. The duration of the postprandial period without duodenal MMC activity was significantly prolonged in groups 2 and 3. These results suggest that the transit time and passage of intestinal contents were delayed and that the periodical MMC was disturbed in group 3. The delay of transit time was due to prolongation of the interval between duodenal MMCs, the interruption of MMC propagation at the jejunum above the proximal anastomosis, the dominance of MMCs that followed the inherent anatomical continuity of the bowel, and discordant movements across the proximal anastomosis. Functional obstruction could be a potential problem in a 20-cm reversed jejunal segment inserted after extensive small bowel resection.

Familial occurrence of congenital bile duct dilatation

The occurrence of congenital bile duct dilatation (CBD) in both a mother and her daughter was recently experienced at Niigata University Hospital and Niigata Shimin Hospital. Bile duct dilatation with anomalous pancreaticobiliary ductal junction (AP-BDJ) was disclosed in both. Intrahepatic bile duct dilatation was only in the mother. Removal of dilated bile duct, cholecystectomy, and hepaticojejunostomy were performed in both. Fourteen cases of CBD from seven families were collected from literature and discussed.

A case of congenital colonic atresia associated with atresia ani

The association of atresia ani with congenital colonic atresia is extremely rare, with only one such case having been reported up to date. We have recently treated a female infant with atresia ani (covered anus complete) accompanied by atresia of the sigmoid colon, who was managed by three stage surgery.

Electrogastrography in patients after operative repair of gastric rupture

Electrogastrography (EGG) measures the myoelectric and motor activity of the stomach as detected by cutaneous electrodes attached to the epigastrium. The specific frequency of gastric activity is thought to be 3 cycles per minute (cpm) as determined by spectral analysis. EGG was performed to evaluate gastric motor function in 13 patients (mean age 11.6 ± 2.90 years) who had undergone operative repair of a gastric rupture. The EGG results were compared with those of 8 normal, age-matched controls (mean age 9.25 ± 2.14 years). The mean frequency (MSF) (2.84 ± 0.067 cpm) of the postprandial EGG spectra of 5 patients with ruptures at or along the greater curvature was significantly lower (P <0.05) than that of the control subjects (3.18 ± 0.0186 cpm). Similarly, the MSF for 3 patients whose areas of rupture were greater than 20 cm2 was 2.75 ± 0.202 cpm in the fasting state (F) and 2.53 ± 0.0385 cpm in the postprandial state (P). These values were significantly lower than those of normal controls (3.29 ± 0.0313 cpm, n = 7 [F]; 3.18 ± 0.0186 cpm, n = 8 [P], respectively). The ratio of fasting to postprandial power was similar between the gastric rupture group and the controls. There was significantly greater variability in the postprandial spectral frequency of the gastric component in the gastric rupture group than in the controls. The results of EGG analysis suggest that the gastric pacemaker and/or gastric motor activity may be disrupted in patients following operative repair of a gastric rupture, although these patients remain asymptomatic.

Renal artery thrombosis — an unusual complication following removal of a neuroblastoma

A 2-month-old female infant with a retroperitoneal neuroblastoma on the left side was admitted to Niigata University Hospital. Her systolic blood pressure, as high as 220 mmHg, was attributed to renovascular hypertension because the plasma renin activity was increased up to 208 ng/ml per hour. Excision of the tumor, including the left kidney, and periaortic lymphnode dissection were performed. For safety during the lymphadenectomy, Nelaton catheters were placed around the inferior vena cava, aorta, superior mesenteric artery, and right renal artery. On the 2nd postoperative day anuria was noted, and aortography was performed revealing obstruction of the right renal artery, inferior mesenteric artery, and left common iliac artery. Thrombectomy via aortic incision was performed immediately to restore the blood flow. The patient developed chronic renal failure, however, and still requires hemodialysis or peritoneal dialysis. Pediatric surgeons should bear in mind that extensive periaortic lymphadenectomy may cause postoperative arterial thrombosis.

Resulting long-term intestinal motility in dogs following construction of a reversed jejunal segment after extensive small bowel resection

To evaluate the long-term function and effective motility of a reversed jejunal segment after extensive small bowel resection, the authors continuously measured postoperative bowel motility during interdigestive and postprandial periods in conscious dogs 6 to 10 months after surgery. The long-term findings were compared with previously reported short-term results measured 2 to 4 weeks after the operation. In the long-term follow-up dogs with a 20-cm reversed jejunal segment constructed after extensive (75% to 80%) small bowel resection, the fasting duodenal migrating myoelectric (or motor) complex (MMC) was often interrupted in the jejunum above the reversed segment, and did not migrate smoothly to the reversed segment or terminal ileum. The MMCs arising from the duodenum predominantly propagated to the ileum through the inherent anatomic continuity of the bowel. In addition, brief small discordant contractions were frequent in the reversed segment and the jejunum, above the proximal anastomosis. These findings are similar to those of the MMC propagation pattern noted 2 to 4 weeks after surgery. However, the postprandial duration without duodenal MMC activity was significantly shorter in the dogs with long-term follow-up than in those with short-term follow-up (both were longer than in control dogs). Marked dilatation of the jejunum and reversed jejunal segment was noted across the proximal anastomosis. These results suggest that the transit time and passage of intestinal contents can be delayed and stagnated for at least 10 months after extensive small bowel resection with a 20-cm reversed jejunal segment.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatoma in children — A clinical analysis on 15 cases

In ten boys and five girls with hepatoma, evaluations were made as to the sex, age, pathologic findings, operation and prognoses. Ages at the time of operation ranged from 1 month to 12 years. In twelve, the tumors were successfully removed; 4 underwent left lateral segmentectomy, 4 right hepatic lobectomy and 4 trisegmentectomy. At least at the time of completion of this paper, eight of these 12 patients (66%) were alive including one patient with pulmonary metastases. Thirteen patients had hepatomas of massive type and 2 had nodular type. Histologic type of these hepatomas was hepatoblastoma in 14 cases and hepatocarcinoma (liver cell carcinoma) in one. These hepatoblastomas included 10 of the fetal type and 4 of the embryonal type. In five of 12 patients pulmonary metastases were detected after the hepatectomy. Four of these 5 patients underwent pulmonary surgery; one girl is alive with no sign of recurrence for over 8 years after surgery on both lungs. Histological examination of pulmonary lesions disclosed hepatoblastomas of an embryonal type, and such were not related to the histological types of hepatic lesions.

Successful multimodal therapy with chemotherapy and surgery for bilateral pulmonary metastases secondary to hepatoblastoma

Two children with hepatoblastoma and bilateral pulmonary metastases were effectively treated with an aggressive combination of chemotherapy and surgery. Chemotherapeutic agents included cyclophosphamide, vincristine, THP-adriamycin, and cis-platinum. The pulmonary metastases were temporarily responsive to a regimen of these agents, recurred, and were subsequently resected without further recurrence. Such multimodal therapy is advocated for the treatment of pulmonary metastases secondary to hepatoblastoma.