Yukio Matsuda

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.

Electrogastrography after operative repair of esophageal atresia

Esophageal atresia (EA) is a life-threatening disorder associated with operative complications. Post-operative gastric electrical control activity detected by a non-invasive electrogastrography (EGG) technique was investigated in 13 children aged 1–17 years to clarify whether gastric motility disorders were present. EGG abnormalities were present in 5 patients; persistent dysrhythmias were found in 3. Roentgenographic examinations showed mild gastroesophageal reflux in 3 (60%) of the dysrhythmic patients; 2 others had postprandial dysrhythmias. The mean spectral frequency (MSF) of EA cases with dysrhythmia was significantly higher than that of patients without dysrhythmia in both fasting and postprandial states (P < 0.05). The variability of the peak spectral frequencies (PSFV) in patients with dysrhythmia was significantly higher than in those without dysrhythmia in both fasting and postprandial states (P < 0.05). There were no significant differences in MSF and PSFV between EA patients without dysrhythmia and controls. These results suggest that gastric motor activity may be disordered in patients following operative repair of EA, although they remain asymptomatic. EGG may be a useful screening examination for postoperative gastric functional disorders.

Intestinal motility after massive small bowel resection in conscious canines : Comparison of acute and chronic phases

To evaluate intestinal function after 80% massive distal small bowel resection (MSBR), we continuously monitored interdigestive and postprandial bowel motility using bipolar electrodes and/or contractile strain gauge force transducers in conscious beagle dogs before and at 2-4 weeks (acute postoperative phase; acute phase) and 8-13 months (chronic postoperative phase; chronic phase) after the surgery. Fasting duodenal migrating myoelectric (or motor) complexes (MMC) occurred at longer intervals in the acute phase after 80% MSBR than in control beagles. Intervals between duodenal MMC in the chronic phase were similar to those found in control beagles. MMC arising from the duodenum were often interrupted before the jejunum above the anastomosis in the acute phase, and a slight recovery of propagation frequency to the jejunum above the anastomosis was observed in the chronic phase. However, duodenal MMC did not migrate smoothly to the terminal ileum in both groups. In the acute phase, the velocity of duodenal MMC propagation was slowed in every intestinal segment, including the duodenum and the jejunum above the anastomosis, and had not recovered even long after the operation. The duration of the postprandial period without duodenal MMC was prolonged significantly in the acute phase postoperatively. Although it shortened in the chronic phase, it still remained significantly longer than in controls. These findings suggest that changes in gut motility after MSBR tend to compensate for the shorter intestine and maintain small bowel absorption early postoperatively. However, these compensatory changes decrease over the long term, and their adaptive contributions to increased intestinal absorption may decrease as well.

A huge immature cervical teratoma in a newborn: Report of a case

A neonate with a large cervical mass was transferred to our hospital at 4 days of age. A computed tomography scan showed a contrast-enhanced solid mass with multiple cystic elements and fine calcification. Ultrasonography also revealed a predominantly solid mass with calcification, containing multiple cysts. These studies suggested a teratoma, but could not rule out a hemangioma. The tumor was removed on the 12th day of life. A pathological study revealed an immature teratoma that demonstrated fetal type cartilage and an immature neural tube. The operative complete removal of a cervical teratoma in neonates is recommended as soon as possible. The management of a pediatric cervical teratoma should also be similar to that of a sacrococcygeal teratoma. The incidence of cervical teratoma in all pediatric teratomas ranges from 2.3%–9.3% in the West, and from 1.6%–8.3% in Japan.

Mediastinal yolk sac tumor in a young girl: Case report and review of the literature

The authors report a rare case of a female infant who underwent successful treatment of a mediastinal yolk sac tumor. Therapy included four cycles of preoperative PVB (cisplatinum, vinblastine, bleomycin), complete surgical resection of the tumor, and one postoperative cycle of PVB and four cycles of VAC (vincristine, actinomycine, cyclophosphamide) chemotherapy. The successful treatment of this tumor depends on preoperative chemotherapy to reduce the size, followed by complete surgical excision with subsequent postoperative chemotherapy. Recent improvements in the treatment of mediastinal yolk sac tumors are discussed.

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.

Rectal membranous atresia: sutureless endoscopic repair

Rectal atresia with a normal anus is rare, and the choice of the surgical procedure employed for its correction is controversial. A male infant with supralevator-type rectal membranous atresia who had presented with perforation of the sigmoid colon at 2 days of age and subsequently had a sigmoid colostomy for decompression underwent resection of the atretic lesion with the aid of the colonofiberscope at 1 month of age. Bougienage was employed for 6 months after the operation. No functional deficits have been observed, and the infant remains continent.

Flow-cytometric DNA analysis of neuroblastoma: the problems of Japanese mass screening

The introduction of mass screening (MS) has increased the number of patients who have been detected in the early clinical stages as well as the total number of patients who have been detected with neuroblastoma (NB). We investigated the problems of MS by DNA content analysis of NB in 89 patients treated at Niigata University Hospital. Surgical materials were available for 73 of the 89 patients. Of the 27 patients who received MS, 16 NBs were detected and 11 were not. The numbers of patients in the early clinical stages (I, II) were 7 (15.2%) before the introduction of MS an 10 (37.0%) thereafter (P <0.05). Of the 16 patients who were detected through MS, 9 (56.3%) were in the early clinical stages. The numbers of patients with DNA aneuploidy were 24 (52.2%) before the introduction of MS and 22 (81.5%) thereafter (P <0.05). All 16 patients who were detected through MS showed DNA aneuploidy. So far, DNA-ploidy of neuroblastomas has been stable. It is significt that the ratio of patients with DNA aneuploidy has increased with the introduction of MS. Considering that the total number of patients has increased since the introduction of MS, it would seem conclusive that a percentage of patients with DNA aneuploidy would not have had the opportunity to be treated had it not been for MS.

An experience of cell sorting using samples isolated from paraffin-embedded tissue of neuroblastoma

Flow cytometric DNA content analyses were performed on samples from 72 patients with neuroblastoma. Nuclear suspensions obtained from paraffin-embedded samples were prepared using the method described by Schutte et al.4 Determination of DNA ploidy was possible in 62 out of 72 patients. DNA diploidy was detected in 23 (37.1%) and DNA aneuploidy was found in 39 (62.9%) of these 62 patients. Cell sorting was performed on two peak areas of the DNA histogram of samples with aneuploidy. The sorted cells of the first peak area were composed of small round cells and were considered to be normal lymphocytes. The sorted cells of the second peak area were composed of relatively large cells with obvious nucleoli and were considered to be neuroblastoma cells. Thus, two cell components could be distinguished by cell sorting. It is concluded that cell sorting may be of benefit in giving detailed information about DNA histograms, even in samples obtained from paraffin-embedded tissue.