Yutaka Hayashida

Intestinal atresia in fetal dogs produced by localized ligation of mesenteric vessels

Experimental ileal atresia and stenosis were produced by a localized ligation of the mesenteric vessels in fetuses from 13 pregnant mongrel dogs having gestational ages of 45-55 days. The intestinal infarct in the fetus was characterized by an aseptic coagulation necrosis selectively limited to the mucosa and submucosa, and also by intense hyperemia and minimal cellular reaction in the adjacent tissue. Eleven days after the devascularization, type 2 intestinal atresia, in which there is a long cord between the blunt ends microscopically similar to that seen in humans.

Zinc deficiency during total parenteral nutrition in childhood

Changes in plasma zinc levels were studied in 11 pediatric surgical patients treated with total parenteral nutrition. Plasma copper levels were also determined in some patients. In three patients plasma zinc fell to a very low level during long-term total parenteral nutrition, and a syndrome of zinc deficiency developed characterized by dermatitis, alpecia, and enterocolitis with striking response to intravenous zinc therapy. In contrast, plasma zinc levels in the patients with short-term total parenteral nutrition remained in the normal range during the present study. This suggests that one of the mechanisms of zinc deficiency during total parenteral nutrition is insufficient amount of zinc in the nutritional solutions for long-term use, especially for older children. Symptoms of the zinc deficiency also occurred in these patients during the anabolic phase, suggesting that tissue demand for zinc may be increased at that time. Therefore, zinc should be included, on a regular basis, in all parenteral nutritional solutions in amounts sufficient to meet estimated needs for growth and tissue repair.

Immunocytochemical identification of human chorionic gonadotropin- and alpha-fetoprotein-producing cells of hepatoblastoma associated with precocious puberty

A one-year-five-month-old boy with hepatoblastoma producing both human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP) is presented. Histologically, the primary tumor was mainly composed of well differentiated hepatoblastoma cells, with minor areas of poorly differentiated cells. Immunoperoxidase staining of the tumor for hCG and AFP showed that a few well differentiated, fetal type cells and multinucleated giant cells were positive for hCG, and AFP was never stained in the same cells. In areas where cells were poorly differentiated, positive reactions for either hCG or AFP were not observed. Electron microscopic studies revealed focal aggregates of cytoplasmic cored vesicles in some tumor cells, similar to secretory granules.

Assessment of bowel control with anorectal manometry after surgery for anorectal malformation

Bowel function after surgery for anorectal malformation was assessed by Kellys score in 101 children over 3 years of age. Seventy-two were examined using anorectal manometry. In the “good” group, resting pressure of the anal canal was as high as in the normal children, and the frequency of contraction waves in the anal canal was the same as in the normal children. Recto-anal reflex was recognized in about three fourths of the “good” group. On the other hand, in the “poor” group resting pressure was low, in only one were contraction waves evident and in none was there a recto-anal reflex. The findings of the anorectal manometry placed the “fair” group between the “good” and the “poor” groups. The clear contraction waves of the anal canal or the clear recto-anal reflex related to a resting pressure in the anal canal of over 20 cmH2O. This high pressure in the anal canal is important for good anal continence, and depends on a precise pull-through of the rectum into the puborectalis muscle.

Gastric teratoma in infancy and childhood: Report of three cases and review of literature

Three cases of gastric teratoma in infants are described and a review of 26 hitherto reported cases is presented. Our three cases have been treated by excision successfully and all have survived. No recurrence following surgery has been noticed. Male preponderance, appearance in early age of life, abdominal distension and mass including calcification are helpful for diagnosis but a thorough differentiation from nephroblastoma, neuroblastoma and other malignant tumors is needed.

Radiologic diagnosis of Hirschsprung's disease utilizing rectosphincteric reflex

Artificial balloon distension of the rectum caused a reflex opening of the anal canal as seen during barium enema in 10 out of 10 normal children and in 7 of 7 children with idiopathic constipation. Reflex opening of the anal canal was not observed in any of 15 children with proven Hirschsprungs disease. This lack of response was independent of the length of aganglionosis or previous diverting colostomy and corresponded to the fact that on manometric study the intraluminal pressure of the anal canal fell in normal children but not in the children with Hirschsprungs disease. This finding greatly improves the reliability of barium enema in the diagnosis of Hirschsprungs disease.

Congenital pyloric atresia —A report of two cases

Two cases of the membranous type of pyloric atresia are described and a review of 99 cases reported in the literature is presented. Excision and incision of diaphragm with pyloroplasty was performed on both cases. The first patient was alive following the second operation of gastroduodenostomy for postoperative stenosis. The second premature patient died of sepsis on the 58th postoperative day.The treatment should be surgical and the operative procedure should be chosen depending on the type of atresia. Excision or incision of the diaphragm with pyloroplasty and gastroduodenostomy are the procedures of choice. Gastrojejunostomy should be avoided because of its high mortality rate.