記述言語：英語  

DOI： 10.1055/a-2467-9140

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PubMed

記述言語：英語   出版者・発行元：Pediatrics International  

DOI： 10.1111/ped.70012

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記述言語：英語   出版者・発行元：Pediatrics International  

Background: Intractable vascular anomalies (VAs), including vascular tumors and venous, lymphatic, and mixed malformations, often have severe symptoms and a poor prognosis, highlighting the need for new treatments. We conducted a prospective trial of sirolimus (tablet and granule forms) for the treatment of VAs. Methods: In this open-label, single-arm, multicenter trial across four Japanese institutions, patients with VAs received oral sirolimus daily, targeting a trough concentration of 5–15 ng/mL. We evaluated response rates (radiological volume changes in lesions), skin lesions, performance status, respiratory function, visceral symptoms (bleeding, pain), laboratory data, quality of life, and safety at 12, 24, and 52 weeks. Results: Thirteen patients with VAs were treated with sirolimus. Seven patients (53.8%; 95% confidence interval: 25.1%–80.8%) showed a partial radiological response at 24 weeks, with no complete responses, and 61.5% had a partial response by 12 weeks, with little subsequent change in patients who had stable disease thereafter. Improvements in skin lesions, blood coagulation, and activities of daily living were noted. Common adverse events included stomatitis, dermatitis, diarrhea, and fever. Conclusions: Sirolimus may reduce VA tissue volume and potentially improve symptoms and activities of daily living in patients with VAs.

DOI： 10.1111/ped.70002

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記述言語：英語   出版者・発行元：Pediatrics International  

Background: Portal cavernoma cholangiopathy (PCC) has recently been recognized as an abnormality of the intrahepatic and extrahepatic bile ducts caused by external compression by the portal cavernoma or ischemia in the biliary region. Although extrahepatic portal vein obstruction (EHPVO) is common in children with portal hypertension, the association between surgical treatment for EHPVO and the incidence of PCC in children is not well known. Methods: We retrospectively reviewed the medical records of 14 cases of childhood-onset EHPVO in our department. PCC was defined by intra- and extrahepatic bile duct irregularities on imaging, both symptomatic and asymptomatic. Results: There were six cases with PCC (Group A) and eight cases without PCC (Group B). EHPVO was diagnosed at 4.8 years and 4.1 years of age in Groups A and B, respectively. PCC was asymptomatic, except in one patient with repeated cholangitis. In Group A, 4/6 patients (66.7%) showed sufficient intrahepatic portal vein inflow via cavernoma at hilum, whereas in Group B, almost all cases (7/8 cases, 87.5%) showed poor intrahepatic portal vein delineation. PCC did not develop in 4/5 patients (80%) who underwent portosystemic shunt surgery, such as mesocaval shunting. Conclusions: PCC is a serious complication of EHPVO that affects its long-term prognosis. Although there are concerns about long-term problems such as hyperammonemia and pulmonary complications after portosystemic shunt surgery, it may also be beneficial as a prophylactic surgery for PCC.

DOI： 10.1111/ped.70061

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記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

出版者・発行元：東京医学社  

DOI： 10.24479/ps.0000001039

CiNii Research

出版者・発行元：東京医学社  

DOI： 10.24479/ps.0000001030

CiNii Research

記述言語：日本語   出版者・発行元：特定非営利活動法人 日本小児外科学会  

<p>症例は17歳女性．下腹部痛を主訴に前医受診し，画像検査の結果，虫垂周囲膿瘍または虫垂腫瘤の疑いで当院紹介となった．術前検査からは確定診断に至らなかったが，虫垂悪性腫瘍の可能性を念頭におき腹腔鏡下回盲部切除術を行った．術中迅速組織検査の結果，adenocarcinomaであることが判明したため，D2リンパ節郭清術，右付属器切除術，後腹膜部分切除術を追加し，一期的に手術を完遂した．病理検査の結果，固有筋層までの浸潤に留まっておりリンパ節転移は認めなかった．頻度は非常に低いが，非典型的な経過や画像所見を認める患者においては，若年者であっても悪性腫瘍の可能性を考慮することが重要である．</p>

DOI： 10.11164/jjsps.60.7_997

CiNii Research

記述言語：英語   出版者・発行元：International Journal of Computer Assisted Radiology and Surgery  

The article Artificial intelligence facilitates the potential of simulator training: An innovative laparoscopic surgical skill validation system using artificial intelligence technology, written by Atsuhisa Fukuta, Shogo Yamashita, Junnosuke Maniwa, Akihiko Tamaki, Takuya Kondo, Naonori Kawakubo, Kouji Nagata,Toshiharu Matsuura and Tatsuro Tajiri, was originally published electronically on the publisher’s internet portal on 19 August 2024 without open access. With the author(s)’ decision to opt for Open Choice the copyright of the article changed on 19 November 2024 to © The Author(s) 2024 and this article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The original article has been corrected.

DOI： 10.1007/s11548-024-03300-1

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記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

症例は17歳女性.下腹部痛を主訴に前医受診し,画像検査の結果,虫垂周囲膿瘍または虫垂腫瘤の疑いで当院紹介となった.術前検査からは確定診断に至らなかったが,虫垂悪性腫瘍の可能性を念頭におき腹腔鏡下回盲部切除術を行った.術中迅速組織検査の結果,adenocarcinomaであることが判明したため,D2リンパ節郭清術,右付属器切除術,後腹膜部分切除術を追加し,一期的に手術を完遂した.病理検査の結果,固有筋層までの浸潤に留まっておりリンパ節転移は認めなかった.頻度は非常に低いが,非典型的な経過や画像所見を認める患者においては,若年者であっても悪性腫瘍の可能性を考慮することが重要である.(著者抄録)

記述言語：英語   出版者・発行元：(一社)日本薬物動態学会  

記述言語：英語   出版者・発行元：Drug Metabolism and Pharmacokinetics  

A population pharmacokinetic (PopPK) analysis was conducted using data from 215 Japanese administered oral sirolimus (tablet and granule) including healthy subjects and patients with intractable vascular anomalies and other diseases. The analysis included neonates, infants, and adults, and identified covariates that influence sirolimus pharmacokinetics (PK). The final model was used to predict sirolimus trough concentrations for various dosing regimens and covariates of interest. The results showed that sirolimus trough concentrations were predicted to increase with higher levels of hemoglobin, and that the granule formulation had a 1.23-fold higher exposure than the tablet formulation. Coadministration of CYP3A4 inducers was found to decrease trough concentrations by 54 %. The PK simulations showed that administration of the granule formulation at doses of 0.02, 0.04, 0.06, and 0.08 mg/kg/day in ages <3 months, 3 to <6 months, 6 to <12 months, and ≥1 year, respectively, resulted in >70 % target attainment within the therapeutic trough concentration range (5–15 ng/mL). In conclusion, incorporation of time-varying covariates (body weight and age) into the PopPK model appropriately predicted sirolimus concentrations in Japanese subjects from infants to adult sub-populations. This PopPK model would therefore be able to provide a reference for clinical individualization of sirolimus dosing.

DOI： 10.1016/j.dmpk.2024.101024

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出版者・発行元：東京医学社  

DOI： 10.24479/ps.0000000975

CiNii Research

記述言語：英語   出版者・発行元：World Journal of Gastrointestinal Oncology  

BACKGROUND Pediatric pancreatic tumors are rare and account for < 0.1% of all childhood cancers. The primary treatment for pancreatic tumors is surgical resection. However, because of the lack of knowledge regarding pediatric pancreatic tumors, no comprehensive treatment plans for pediatric pancreatic tumors have been developed. AIM To compared the clinical features, treatment methods, and prognosis of pediatric pancreatic tumors in Japan with those in other countries. METHODS Questionnaires were sent to 213 pediatric surgical units in Japan. Pancreatic tumors that were not surgically treated were excluded from the survey. The primary survey investigated the number of patients aged 0–18 years who underwent pancreatic tumor surgery and the type of tumors managed during the 22-year study period (from January 1, 2000 to December 31, 2021) by post card. The secondary survey assessed the clinical images, treatment methods, and tumor outcomes via email. RESULTS The primary survey enrolled 228 patients. In the secondary survey, 213 patients were eventually enrolled. The most common type of pancreatic tumor was solid pseudopapillary neoplasm (SPN) [n = 164 (77.0%)], followed by pancreatoblastoma [n = 16 (7.5%)], pancreatic endocrine tumor [n = 14 (6.6%)], non-epithelial tumor [n = 9 (4.2%)], pancreatic tumor [n = 7 (3.3%)], and metastatic pancreatic tumor [n = 3 (1.4%)]. Overall, 123 (57.7%) patients underwent distal pancreatectomy, of whom 49 underwent laparoscopic surgery. Forty-four (20.7%) patients underwent enucleation, of whom eight underwent laparoscopic surgery. Thirty-two (15.0%) patients underwent pancreaticoduodenectomy, of whom one underwent laparoscopic surgery. All patients with SPN, including those with distant metastases and recurrent disease, survived. CONCLUSION SPN was more common in Japan than in other countries. Regardless of the histological type, resection is the most effective treatment for pediatric pancreatic tumors.

DOI： 10.4251/wjgo.v16.i10.4166

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記述言語：英語   出版者・発行元：Surgery Today  

The purpose of our narrative review is to summarize the utilization of social media (SoMe) platforms for research communication within the field of surgery. We searched the PubMed database for articles in the last decade that discuss the utilization of SoMe in surgery and then categorized the diverse purposes of SoMe. SoMe proved to be a powerful tool for disseminating articles. Employing strategic methods like visual abstracts enhances article citation rates, the impact factor, h-index, and Altmetric score (an emerging alternative metric that comprehensively and instantly quantifies the social impact of scientific papers). SoMe also proved valuable for surgical education, with online videos shared widely for surgical training. However, it is essential to acknowledge the associated risk of inconsistency in quality. Moreover, SoMe facilitates discussion on specific topics through hashtags or closed groups and is instrumental in recruiting surgeons, with over half of general surgery residency programs in the US efficiently leveraging these platforms to attract the attention of potential candidates. Thus, there is a wealth of evidence supporting the effective use of SoMe for surgeons. In the contemporary era where SoMe is widely utilized, surgeons should be well-versed in this evidence.

DOI： 10.1007/s00595-024-02891-1

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出版者・発行元：東京医学社  

DOI： 10.24479/ps.0000000948

CiNii Research

記述言語：英語   出版者・発行元：Surgery Today  

Hirschsprung disease (HSCR) and its associated disorders (AD-HSCR) often result in severe hypoperistalsis caused by enteric neuropathy, mesenchymopathy, and myopathy. Notably, HSCR involving the small intestine, isolated hypoganglionosis, chronic idiopathic intestinal pseudo-obstruction, and megacystis-microcolon-intestinal hypoperistalsis syndrome carry a poor prognosis. Ultimately, small-bowel transplantation (SBTx) is necessary for refractory cases, but it is highly invasive and outcomes are less than optimal, despite advances in surgical techniques and management. Thus, regenerative therapy has come to light as a potential form of treatment involving regeneration of the enteric nervous system, mesenchyme, and smooth muscle in affected areas. We review the cutting-edge regenerative therapeutic approaches for managing HSCR and AD-HSCR, including the use of enteric nervous system progenitor cells, embryonic stem cells, induced pluripotent stem cells, and mesenchymal stem cells as cell sources, the recipient intestine's microenvironment, and transplantation methods. Perspectives on the future of these treatments are also discussed.

DOI： 10.1007/s00595-023-02741-6

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記述言語：英語   出版者・発行元：Pediatric Surgery International  

Purpose: The study aimed to explore and describe the lives of patients with persistent cloaca (PC) from childhood to adulthood. Methods: Semistructured interviews were conducted with nine adult patients with PC. Their experiences and thoughts regarding this disease were analyzed qualitatively and inductively. Results: After classifying the experiences and thoughts of patients with PC, 13 categories were extracted. The following five themes emerged from these categories. (1) Difficulties with excretion and vaginal management because of the disease. (2) The degree of understanding of those around them and society has a huge effect on their way of life. (3) The inferiority of a woman who is not a “normal woman.” (4) A “never-ending disease” in which problems continue even after the transition period. (5) Differences in the central point of the narrative depending on the age group. Conclusions: In this study, qualitative and inductive analyses of data from semistructured interviews with patients with PC revealed their experiences and thoughts. The results will provide a guide for young patients and the medical professionals who treat them. Accordingly, monitoring their lives until adulthood is necessary.

DOI： 10.1007/s00383-024-05807-9

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記述言語：英語   出版者・発行元：Pediatric Surgery International  

Background/purpose: Living donor liver transplantation (LDLT) is vital for pediatric end-stage liver disease due to organ shortages. The graft-to-recipient weight ratio (GRWR) preoperatively measured predicts the outcomes of LDLT. We typically target between 0.8 and 3.0–4.0%, but the ideal GRWR remains controversial. We compared the outcomes of LDLT according to the GRWR to examine whether the criteria could be expanded while ensuring safety. Methods: We retrospectively reviewed 99 patients who underwent LDLT in our department by dividing them into three groups according to their GRWR: Group S, with GRWR values lower than the normal range (GRWR < 0.8%); Group M, with GRWR values in the normal range (GRWR ≥ 0.8 to < 3.5%); and Group L, with GRWR values above the normal range (GRWR ≥ 3.5%). Results: In Groups S and L, 46.2 and 44.4% of patients underwent splenectomy and delayed abdominal wall closure, respectively. After these intraoperative adjustments, there were no significant differences between the groups in 5-year patient survival, 5-year graft survival, or the occurrence of post-transplantation thrombosis. Conclusion: When the GRWR is beyond the normal threshold, the risk of complications associated with graft size might be reduced by adjustments to provide appropriate portal blood flow and by delayed abdominal wall closure.

DOI： 10.1007/s00383-024-05814-w

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記述言語：英語   出版者・発行元：Pediatric Surgery International  

Purpose: Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is defined as a congenital visceral myopathy with genetic mutations. However, the etiology and pathophysiology are not fully understood. We aimed to generate a gene leiomodin-1a (lmod1a) modification technique to establish a zebrafish model of MMIHS. Methods: We targeted lmod1a in zebrafish using CRISPR/Cas9. After confirming the genotype, we measured the expression levels of the target gene and protein associated with MMIHS. A gut transit assay and spatiotemporal mapping were conducted to analyze the intestinal function. Results: Genetic confirmation showed a 5-base-pair deletion in exon 1 of lmod1a, which caused a premature stop codon. We observed significant mRNA downregulation of lmod1a, myh11, myod1, and acta2 and the protein expression of Lmod1 and Acta2 in the mutant group. A functional analysis of the lmod1a mutant zebrafish showed that its intestinal peristalsis was fewer, slower, and shorter in comparison to the wild type. Conclusion: This study showed that targeted deletion of lmod1a in zebrafish resulted in depletion of MMIHS-related genes and proteins, resulting in intestinal hypoperistalsis. This model may have the potential to be utilized in future therapeutic approaches, such as drug discovery screening and gene repair therapy for MMIHS.

DOI： 10.1007/s00383-024-05809-7

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記述言語：英語   出版者・発行元：Pediatric Surgery International  

Purpose: We aimed to identify factors predicting the need for future liver transplantation (LT) at 18 years of age in patients with biliary atresia (BA). Methods: BA patients with native liver survival at > 18 years of age were retrospectively reviewed. The clinical characteristics, outcomes, hepatobiliary function, and liver fibrosis markers of native liver survivors (NLS group) were compared with patients who subsequently underwent LT (LT group). Results: The study population included 48 patients (NLS, n = 34; LT, n = 14). The male-to-female ratio, age at Kasai procedure, and type of BA in the two groups did not differ to a statistically significant extent. There was no significant difference in the MELD scores between the groups at 18 years of age. The aspartate aminotransferase-to-platelet ratio index (APRI), albumin-bilirubin (ALBI), and BA liver fibrosis (BALF) scores at 18 years of age were significantly higher in the LT group. The AUCs for APRI, ALBI, and BALF were 0.91, 0.79, and 0.85, respectively. Conclusion: Adult BA patients have limited options for LT owing to the lack of donor candidates and the low prevalence of deceased donors. The elucidation of prognostic factors for LT in adulthood is important. APRI was the most useful marker in this study.

DOI： 10.1007/s00383-024-05805-x

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出版者・発行元：東京医学社  

DOI： 10.24479/ps.0000000873

CiNii Research

記述言語：英語   出版者・発行元：American Journal of Surgical Pathology  

Isolated hypoganglionosis (IHG) is histologically characterized by small numbers of myenteric ganglion cells and small myenteric ganglia; however, no numerical diagnostic criteria for IHG have been established. Therefore, this study aimed to develop quantitative pathologic criteria for IHG. We evaluated 160 resected intestinal tissue specimens from 29 pediatric autopsies and 10 IHG cases. These specimens were obtained from the jejunum, ileum, ascending colon, transverse colon, and rectum. Morphologic features of the myenteric ganglion cells and myenteric ganglia were quantified and analyzed in digitized HuC/HuD-immunostained and CD56-immunostained sections, respectively. Quantitative criteria were developed with a scoring system that used parameters with the area under the receiver operating characteristic curve (AUC) values > 0.7 and sensitivity and specificity exceeding 70%. The selected parameters were the number of myenteric ganglion cells per cm and the number of myenteric ganglia with an area > 2500 µm²per cm. The score for each parameter ranged from −1 to 2, and the total score of the scoring system ranged from −2 to 4. With a cutoff value of ≥ 2 (AUC, 0.98; 95% CI: 0.96-1.00), the scoring system had a sensitivity of 96% (95% CI: 0.82-1.00) and a specificity of 99% (95% CI: 0.95-1.00). We devised a novel pathologic criterion based on the quantification of the number of myenteric ganglion cells and ganglia. Furthermore, this criterion showed high diagnostic accuracy and could lead to a definitive diagnosis of IHG in clinical practice.

DOI： 10.1097/PAS.0000000000002243

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出版者・発行元：東京医学社  

DOI： 10.24479/ps.0000000855

CiNii Research

記述言語：日本語   出版者・発行元：特定非営利活動法人 日本小児外科学会  

<p>症例は日齢0の女児．在胎12週4日に胎児超音波検査でひょうたん型臍帯囊胞を指摘されたが，在胎24週2日には臍帯囊胞は消失していた．在胎32週5日に母体の切迫早産のため緊急帝王切開で出生した．臍帯基部尾側が裂け，膀胱粘膜が外反して露出していた．膀胱臍瘻の診断で緊急手術を施行した．膀胱切離ラインの決定の際に，術中膀胱容量測定を用いることで過度な膀胱壁の切除を回避した．病理検査では摘出標本内に明らかな尿膜管組織は含まれなかった．術後25日目の排尿時膀胱尿道造影で，膀胱尿管逆流や下部尿路狭窄のないことを確認し，術後36日目に退院した．近年の出生前診断の進歩に伴い，胎児期から臍帯囊胞を指摘され，出生後に尿膜管遺残，膀胱臍瘻と診断される症例報告が散見される．胎児期に指摘された臍帯囊胞が消失した場合，膀胱臍瘻の可能性があり，出生直後の手術介入の際には術後の泌尿器合併症を回避するための術式の工夫が必要である．</p>

DOI： 10.11164/jjsps.60.4_719

CiNii Research

記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

症例は日齢0の女児.在胎12週4日に胎児超音波検査でひょうたん型臍帯嚢胞を指摘されたが,在胎24週2日には臍帯嚢胞は消失していた.在胎32週5日に母体の切迫早産のため緊急帝王切開で出生した.臍帯基部尾側が裂け,膀胱粘膜が外反して露出していた.膀胱臍瘻の診断で緊急手術を施行した.膀胱切離ラインの決定の際に,術中膀胱容量測定を用いることで過度な膀胱壁の切除を回避した.病理検査では摘出標本内に明らかな尿膜管組織は含まれなかった.術後25日目の排尿時膀胱尿道造影で,膀胱尿管逆流や下部尿路狭窄のないことを確認し,術後36日目に退院した.近年の出生前診断の進歩に伴い,胎児期から臍帯嚢胞を指摘され,出生後に尿膜管遺残,膀胱臍瘻と診断される症例報告が散見される.胎児期に指摘された臍帯嚢胞が消失した場合,膀胱臍瘻の可能性があり,出生直後の手術介入の際には術後の泌尿器合併症を回避するための術式の工夫が必要である.(著者抄録)

記述言語：英語   出版者・発行元：Pathology Research and Practice  

Hepatoblastoma (HB) is the most common malignant liver tumor in childhood. Although pre-operative cisplatin (CDDP)-based chemotherapy is often used in cases of HB, about 20％ of HB patients exhibit resistance to CDDP. Forkhead box protein M1 (FOXM1) and chromo-domain-helicase-DNA-binding protein 4 (CHD4) have been associated with CDDP resistance in various tumors. We here analyzed the immunohistochemical expression of FOXM1 and CHD4 in HB specimens of 33 patients (mean age: 20 months) post-chemotherapy. The differentiation of specimens was assessed using the digital pathology software QuPath®, and then the relation between the FOXM1 or CHD4 expression and the differentiation and various other clinicopathological parameters was investigated. The histological type was epithelial in 19 cases (57.6%) and mixed epithelial and mesenchymal in 14 cases (42.4%). Nine cases had only a fetal component, 1 case had only an embryonal component, 22 cases had both fetal and embryonal components, and 1 case had no viable tumor. Both the FOXM1 and CHD4 immunoexpressions were found significantly more frequently in the embryonal than fetal components (p<0.0001 and p<0.0001, respectively). Regarding chemotherapy efficacy, the alpha-fetoprotein (AFP) level after chemotherapy was correlated with both the imaging shrinkage rate (R=-0.52) and histological residual rate (the percentage of the viable tumors of HB after chemotherapy)(R=0.62). High FOXM1 score was correlated with a high-postoperative AFP value (p<0.01) and a low AFP attenuation rate (p<0.05), but the FOXM1 score was not correlated with the imaging shrinkage rate (p=0.4418) or histological residual rate (p=0.4418). High CHD4 score showed a nonsignificant trend toward correlation with high postoperative AFP value (p=0.0849) and was not significantly correlated with the other parameters. Collectively, our results showed that FOXM1 expression may be useful in evaluating the response to CDDP-based chemotherapeutic regimens. Accurate measurement of FOXM1 expression by our scoring system using QuPath® is important in cases with mixed HB components of various differentiation levels.

DOI： 10.1016/j.prp.2024.155348

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   出版者・発行元：特定非営利活動法人 日本小児外科学会  

<p>症例は11歳女児，腸炎の先行感染を認め，激しい腹痛を主訴に受診となった．腹部超音波検査で下腹部正中にtarget sign，造影CTを撮像すると小腸-結腸型の腸重積を認め，腸重積症の診断となった．腹腔鏡下で手術を行ったが，整復が困難であったため開腹移行し，回腸内に隆起性の腫瘤性病変を認めたため小腸切除を行った．術後経過は良好であり，術後9日目に退院となった．最終病理結果では小腸リンパ管腫の診断となった．腸重積症の好発年齢は6か月から3歳未満であり，好発年齢外の年齢発症の多くはMeckel憩室，ポリープ，腫瘍性病変などの器質的疾患が起点となり腸重積が起こると言われており，リンパ管腫を原因とする報告は小児においては極めて少ない．今回小腸-結腸型腸重積症により発見された小腸内腔発生のリンパ管腫の症例を経験したため，過去の症例を踏まえて報告する．</p>

DOI： 10.11164/jjsps.60.2_181

CiNii Research

記述言語：日本語   出版者・発行元：特定非営利活動法人 日本小児外科学会  

<p>【目的】急性精巣上体炎は急性陰囊症と総称される疾患の一つで，比較的頻度の高い疾患である．精巣予後が良好な疾患であるが，近年発症後に精巣萎縮を来した報告があり，当施設でも同様の症例を経験した．小児急性精巣上体炎の治療方針について改めて検討すべく，当施設で経験した症例を後方視的に検討したので報告する．</p><p>【方法】2008年4月～2022年4月の期間中に急性精巣上体炎と診断され治療を行った77例を対象とし（再発例を除く），年齢，患側，発症から来院までの時間，臨床症状，身体所見，検査所見，治療内容，転帰について診療録を元に後方視的に検討した．</p><p>【結果】発症時年齢は1か月～14歳（中央値8歳），患側は右側36例，左側40例，両側1例，発症から受診までの時間は中央値8時間（IQR，5～14.5時間）であった．症状は，陰囊痛75例（97％），陰囊の腫脹44例（57％），発赤28例（36％），腹痛8例（10％），発熱5例（7％）であった．治療後の経過観察は，再診し経過観察をした症例が65例（84％）で，有事再診のみが12例（16％），観察期間の中央値は40日（IQR，7～249日）であった．精巣予後は，治療後1か月以上経過が追えた症例が33例（43％），そのうち精巣萎縮を来した症例を1例認めた．萎縮を来した症例は，経過より，精巣上体炎の波及から精巣炎を来したものと考えられた．</p><p>【結論】急性精巣上体炎は精巣予後良好な疾患だが，稀に精巣炎への波及を来し精巣萎縮の原因となる可能性があり，炎症が強い症例は長期的な観察も考慮するべきである．そのために，治療方針や経過観察期間の一定の基準が求められる．</p>

DOI： 10.11164/jjsps.60.2_147

CiNii Research

出版者・発行元：Journal of Pediatric Surgery  

Background: Tumor recurrence, anorectal and urinary dysfunction, and lower limb dysfunction after surgery are observed in infantile sacrococcygeal teratoma (SCT). In this paper, a multi-institutional retrospective observational study was conducted to clarify the long-term functional prognosis in Japan. Methods: This study was conducted using a paper-based questionnaire distributed to 192 facilities accredited by the Japanese Society of Pediatric Surgeons, covering patients who underwent radical surgery at less than 1 year old and who survived for at least 180 days after birth from 2000 to 2019. Results: A total of 355 patients were included in this analysis. Altman type was I-II in 248 and type III-IV in 107, and the median maximum tumor diameter was 6.1 (range: 0.6–36.0) cm. There were 269 mature teratomas, 69 immature teratomas, and 10 malignant tumors. Total resection was performed in 325, subtotal or partial resection in 27, and surgical complications were noted in 54. The median postoperative follow-up was 6.6 (0.5–21.7) years. Eighty-three patients (23.4 %) had functional sequelae, including 62 (17.5 %) with anorectal dysfunction, 56 (13.0 %) with urinary dysfunction, and 15 (4.2 %) with lower limb motor dysfunction. Recurrence occurred in 42 (11.8 %) at a median age of 16.8 (1.7–145.1) months old. Risk factors for dysfunction included preterm delivery, a large tumor diameter, Altman type III-IV, incomplete resection, and surgical complications. Risk factors for recurrence included immature teratoma or malignancy, incomplete resection, and surgical complications. Conclusions: Postoperative dysfunction was not low at 23.4 %, and 11.8 % of the patients experienced recurrence occurring more than 10 years after surgery, suggesting the need for periodic imaging and tumor markers evaluations in patients with risk factors. It is necessary to establish treatment guidelines for best practice monitoring of the long-term quality of life. Level of evidence: Level II Retrospective Study.

DOI： 10.1016/j.jpedsurg.2023.11.016

Scopus

記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

【目的】急性精巣上体炎は急性陰嚢症と総称される疾患の一つで,比較的頻度の高い疾患である.精巣予後が良好な疾患であるが,近年発症後に精巣萎縮を来した報告があり,当施設でも同様の症例を経験した.小児急性精巣上体炎の治療方針について改めて検討すべく,当施設で経験した症例を後方視的に検討したので報告する.【方法】2008年4月～2022年4月の期間中に急性精巣上体炎と診断され治療を行った77例を対象とし(再発例を除く),年齢,患側,発症から来院までの時間,臨床症状,身体所見,検査所見,治療内容,転帰について診療録を元に後方視的に検討した.【結果】発症時年齢は1ヵ月～14歳(中央値8歳),患側は右側36例,左側40例,両側1例,発症から受診までの時間は中央値8時間(IQR,5～14.5時間)であった.症状は,陰嚢痛75例(97%),陰嚢の腫脹44例(57%),発赤28例(36%),腹痛8例(10%),発熱5例(7%)であった.治療後の経過観察は,再診し経過観察をした症例が65例(84%)で,有事再診のみが12例(16%),観察期間の中央値は40日(IQR,7～249日)であった.精巣予後は,治療後1ヵ月以上経過が追えた症例が33例(43%),そのうち精巣萎縮を来した症例を1例認めた.萎縮を来した症例は,経過より,精巣上体炎の波及から精巣炎を来したものと考えられた.【結論】急性精巣上体炎は精巣予後良好な疾患だが,稀に精巣炎への波及を来し精巣萎縮の原因となる可能性があり,炎症が強い症例は長期的な観察も考慮するべきである.そのために,治療方針や経過観察期間の一定の基準が求められる.(著者抄録)

記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

症例は11歳女児,腸炎の先行感染を認め,激しい腹痛を主訴に受診となった.腹部超音波検査で下腹部正中にtarget sign,造影CTを撮像すると小腸-結腸型の腸重積を認め,腸重積症の診断となった.腹腔鏡下で手術を行ったが,整復が困難であったため開腹移行し,回腸内に隆起性の腫瘤性病変を認めたため小腸切除を行った.術後経過は良好であり,術後9日目に退院となった.最終病理結果では小腸リンパ管腫の診断となった.腸重積症の好発年齢は6ヵ月から3歳未満であり,好発年齢外の年齢発症の多くはMeckel憩室,ポリープ,腫瘍性病変などの器質的疾患が起点となり腸重積が起こると言われており,リンパ管腫を原因とする報告は小児においては極めて少ない.今回小腸-結腸型腸重積症により発見された小腸内腔発生のリンパ管腫の症例を経験したため,過去の症例を踏まえて報告する.(著者抄録)

記述言語：英語   出版者・発行元：Journal of Pediatric Surgery  

Purpose: To validate the effectiveness of Deflux® treatment for vesicoureteral reflux (VUR) following pediatric renal transplantation (RT), based on our single-institution experience. Method: A retrospective study was conducted using the medical records of pediatric patients who underwent Deflux® treatment for VUR after RT from April 2008 to March 2022. Results: Sixty-eight pediatric patients underwent RT. VUR was subsequently detected in 22 (32 %) of these patients. Seven of the 22 patients (32 %) underwent Deflux® treatment to avoid renal dysfunction due to urinary infection (UTI). The median age at the time of RT was 4 years (range:2–12). All 7 patients had urinary UTIs before Deflux® treatment. The median estimated glomerular filtration rate (eGFR) before Deflux® treatment was 67 ml/min/1.73 m² (range:42–138 ml/min/1.73 m²). After Deflux® treatment, VUR was downgraded in three cases (43 %). Four patients (57 %) experienced postoperative UTI, two of who underwent a second Deflux® treatment, one underwent submuscular tunnel reconstruction, and the other one experienced UTI without VUR after 1st Deflux® treatment but did not reoccur. All seven patients continued prophylactic medication after Deflux® treatment, without any history of recurrent UTIs during the observation period after treatment (median 37 months [range 7–86 months]). Furthermore, the eGFRs did not significantly decrease after Deflux® treatment (median eGFR 58 ml/min/1.73 m² [range:33–99 ml/min/1.73 m²], p > 0.1). Conclusion: Deflux® treatment for VUR after RT is technically challenging because the new ureteral orifice is ventrally anastomosed at the bladder. We believe our results indicate the possibility of reducing the frequency of UTIs and contributing to preservation of the renal function after RT. Type of study: Retrospective Study. Level of evidence: Level III.

DOI： 10.1016/j.jpedsurg.2023.12.005

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PubMed

記述言語：英語   出版者・発行元：International Journal of Molecular Sciences  

Severe obesity in young children prompts for a differential diagnosis that includes syndromic conditions. Rapid-Onset Obesity with Hypothalamic Dysfunction, Hypoventilation, and Autonomic Dysregulation (ROHHAD) syndrome is a potentially fatal disorder characterized by rapid-onset obesity associated with hypoventilation, neural crest tumors, and endocrine and behavioral abnormalities. The etiology of ROHHAD syndrome remains to be established, but recent research has been focusing on autoimmunity. We report on a 2-year-old girl with rapid-onset obesity during the first year of life who progressed to hypoventilation and encephalitis in less than four months since the start of accelerated weight gain. The patient had a high titer of anti-ZSCAN1 antibodies (348; reference range < 40), and the increased values did not decline after acute phase treatment. Other encephalitis-related antibodies, such as the anti-NDMA antibody, were not detected. The rapid progression from obesity onset to central hypoventilation with encephalitis warns about the severe consequences of early-onset ROHHAD syndrome. These data indicate that serial measurements of anti-ZSCAN1 antibodies might be useful for the diagnosis and estimation of disease severity. Further research is needed to determine whether it can predict the clinical course of ROHHAD syndrome and whether there is any difference in antibody production between patients with and without tumors.

DOI： 10.3390/ijms25052820

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203469

CiNii Research

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞過去23年間に当科および関連施設にて診断された大腸の孤立性若年性ポリープ(JP)101例,孤立性PJP(Peutz-Jeghers type polyp)29例,IMGP(inflammatory myoglandular polyp)18例を対象とし,その臨床像,内視鏡像,病理組織像を遡及的に検討した.その結果,JPは平均年齢が低かった.内視鏡所見では,JPはびらん,白苔,白斑,NBI拡大観察下の開大した腺管開口部や疎に分布した腺窩辺縁上皮,細かい血管の増生,色素拡大観察下の星芒状,疎に分布したpitの,PJPは分葉状,NBIや色素拡大観察下の樹枝状構造の,IMGPは白斑,NBI拡大観察下の開大した腺管開口部,細かい血管の増生,色素拡大観察下の星芒状pitの頻度がそれぞれ高かった.以上よりJP,IMGPとPJPは異なる内視鏡像を呈していたが,JPとIMGPの内視鏡像は比較的類似していた.しかしながら,JPはIMGPに比べ,白苔,NBIや色素拡大観察下の疎に分布する腺窩辺縁上皮やpitの頻度が高いことを加味すると鑑別できる可能性があるものと推察する.

Web of Science

記述言語：英語   出版者・発行元：Pediatrics International  

Background: Recently, reports of endoscopic approaches for neuroblastoma, ganglioneuroblastoma, and ganglioneuroma (peripheral neuroblastic tumor; PNTs) have been increasing. This study aimed to clarify the indications for endoscopic surgery for PNTs. Methods: Pediatric patients who underwent endoscopic surgery for PNTs at our institution were included in this study. Image-defined risk factors (IDRFs) were analyzed using preoperative computed tomography (CT). Results: Twenty-four patients underwent endoscopic surgery for PNTs. The diagnoses included neuroblastoma (n = 11), ganglioneuroma (n = 10), and ganglioneuroblastoma (n = 3). Regarding the tumor site, there were 18 cases of adrenal tumors, five cases of mediastinal tumors, and one case of retroperitoneal tumors. Image-defined risk factors were positive in eight cases (contacted with a renal vessel, n = 6; compression of principal bronchi, n = 2). Complete resection was accomplished in 21 cases (14 of 16 IDRF-negative cases and seven of eight IDRF-positive cases). All patients survived without recurrence during the follow-up period. Conclusions: The CT findings of contact with renal vessels and compression of principal bronchi do not seem to be indicators of incomplete resection. An endoscopic approach to PNTs in pediatric patients is feasible with a good prognosis if patients are selected strictly.

DOI： 10.1111/ped.15754

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記述言語：日本語   出版者・発行元：日本小児血液・がん学会  

<p>肝芽腫に対する肝移植は2008年4月に保険収載されてから約15年が経過した．切除不能肝芽腫が肝移植適応とされるが，「切除不能」の判断は必ずしも容易ではない．一般的には，化学療法後においても4区域へ腫瘍進展が認められる場合（POST-TEXT IV）や腫瘍が3区域に限局していても主要な脈管に浸潤が疑われる場合（POST-TEXT III P+, V+）には切除不能と判断される．しかし，術前画像診断で切除可否を判断することが難しい場合もあり，仮に切除可能と考えられるような場合においても，肝移植に対応し得る施設での最終判断と手術が推奨されている．かつては，肝切除後再発などを理由とした救済的肝移植は，移植後の成績が著しく悪いとの報告から，切除可否が疑わしい症例は肝移植を優先させることが無難であると考えられていた．しかし，近年，わが国からの報告も含め，救済的肝移植の成績が決して悪くないとする報告もあり，肝移植後の長期的な合併症発症のリスクを考え併せると，移植を回避するためのチャレンジングな肝切除という治療選択も改めて見直されつつある．本稿では，血管再建や臓器保存などの移植手術の際に用いる技術を応用した肝切除術や残肝容量不足に対する対策など，非定型的高度肝切除術の概略と可能性について概説する．</p>

DOI： 10.11412/jspho.61.144

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人 日本移植学会  

<p>【背景】 本邦での小腸移植後短期成績は改善してきているものの長期成績については未だ満足できるものではない。小腸移植後患者の長期生存を得るための課題について、当科での経験症例を通して検討する。【当科症例】 これまでに当科で小腸移植を施行した症例は5例、移植時年齢は平均24.6歳（9-36歳）で、全例が脳死小腸移植である。原疾患はHirschsprung病類縁疾患3例、短腸症1例、MYO5B遺伝子異常1例で、1例に異時性肝小腸移植（肝は生体ドナー）を施行した。患者生存は3/5例（60%）、グラフト生着は2/5例（40%）である。2例の死亡原因は拒絶治療後の感染症、COVID-19感染を契機とした腎不全であった。生存例3例のうち、1例はPTLDのコントロールが付かずグラフト摘出を余儀なくされたが生存中である。一方で、グラフト生着している2例では、移植前に比べて栄養状態や患者QOLが劇的に改善しており、グラフト生着例においては小腸移植医療の素晴らしさを感じることができている。2例ともストーマは未だ閉鎖しておらず、定期的内視鏡を継続している。【結語】 小腸移植により腸管不全患者のQOLは劇的に改善する可能性があるが、長期的生存を得るためには、将来的な腎機能やPTLD・感染制御への配慮が鍵となる。小腸移植後免疫抑制療法について、長期成績向上のためのより適切なプロトコールを再検討する必要がある。</p>

DOI： 10.11386/jst.59.supplement_s221_1

CiNii Research

記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

2007～2022年に小児神経芽腫群腫瘍(PNT:神経芽腫、神経節芽腫、神経節腫)に対して内視鏡手術が施行された24例(年齢1ヵ月齢～15歳)を対象に、PNTに対する内視鏡手術の適応について検討した。24例の内訳は神経芽腫11例、神経節腫10例、神経節芽腫3例であった。腫瘍の部位は副腎腫瘍18例、縦隔腫瘍5例、後腹膜腫瘍1例であった。術前のCT所見におけるimage-defined risk factor(IDRF)は8例が陽性であった(腎血管へのcontact 6例、主気管支の圧迫2例)。21例(IDRF陰性例14/16例[87.5%]、IDRF陽性例7/8例[87.5%])で完全切除が得られた。フォローアップ中に再発は認められなかった。これらの結果から、CT所見における腎血管へのcontactおよび主気管支の圧迫は不完全切除の指標にはならないと考えられた。小児PNTに対する内視鏡的アプローチは、厳密な患者選択を行えば実行可能かつ予後良好である。

出版者・発行元：International Journal of Surgery  

Introduction: Sacrococcygeal teratoma (SCT) is a rare congenital tumour. The risk of malignancy and recurrence is not well defined. Previous studies are small and report differing conclusions about the timing of surgery and the duration of follow-up. The authors studied the risk of malignant transformation and SCT recurrence after surgery to address these gaps. Methods: This was a global retrospective cohort study. Data of consecutive SCT patients was obtained from 145 institutes in 62 countries. Malignant transformation, defined as malignancy at initial resection, malignant recurrence or death due to malignancy, and its risk factors were analysed. Results: Of the 3612 included patients, 3407 entered analysis. The risk of malignant transformation of the initial tumour was 3.3, 5.1, 10.1, and 32.9% at age 3 months, 6 months, 1 year, and 2 years, respectively. After 6 years, the censored risk of malignancy (64%) did not further increase. Recurrent SCT was diagnosed in 349 (10.2%) children with 126 (36.1%) malignant recurrences. Risk factors for recurrence were Altman type II [odds ratio (OR): 1.6, 95% confidence interval (CI): 1.2–2.2], Altman type III (OR: 1.6, 95% CI: 1.2–2.3), initial immature histology (OR: 1.9, 95% CI: 1.4–2.6), and initial malignant histology (OR: 4.0, 95% CI: 2.9–5.4). Conclusion: The risk of malignancy at initial resection in SCT increases with age reaching a plateau at 6 years of age. Recurrence after resection occurred in 10% of patients and 36% of these were malignant at that time. Altman type II or type III, and immature or malignant histology were associated with recurrence.

DOI： 10.1097/JS9.0000000000002045

Scopus

出版者・発行元：東京医学社  

DOI： 10.24479/ps.0000000637

CiNii Research

記述言語：英語   出版者・発行元：Pediatric Surgery International  

Background/Purpose: Whether Roux-en-Y hepatic jejunectomy (HJ) or duct-to-duct biliary reconstruction (DD) is more useful in pediatric living donor liver transplantation has not yet been fully investigated. Therefore, to assess the feasibility and safety of DD, we compared the surgical outcomes of DD to HJ. Methods: We divided 45 patients, excluding those with biliary atresia, into the DD group (n = 20) and the HJ group (n = 25), according to the type of biliary reconstruction they received. Results: The 5-year survival rates (DD vs. HJ = 79.7% vs. 83.6%, p = 0.70) and the incidence of biliary complications, including bile leakage and stricture (DD vs. HJ = 1 [5.0%] vs. 1 [4.0%], p = 0.87) were not significantly different between the groups. However, intestinal complications, including bowel perforation or ileus, were significantly common in the HJ group (9/25 [36.0%]) than in the DD group (1/20 [5.0%]; p = 0.01). The three patients in the HJ group with intestinal perforation all suffered perforation at the anastomosed site in the Roux-en-Y procedure. The subgroup analysis showed the non-inferiority of DD to HJ for biliary or intestinal complications in patients weighting < 10 kg. Conclusion: With a proper selection of cases, DD should be a safe method for biliary reconstruction in pediatric recipients with little risk of biliary complications equivalent to HJ and a reduced risk of intestinal complications.

DOI： 10.1007/s00383-023-05568-x

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出版者・発行元：Journal of Pediatric Surgery Case Reports  

Introduction: Nephroblastoma is the most common type of malignant renal tumor in children, but hemorrhage in ruptured nephroblastoma is rare. Case presentation: A three-month-old boy was admitted to our hospital with a large right renal tumor and hemorrhagic shock. Laparotomy showed that the tumor had invaded the right lobe of the liver; therefore, surgeons decided to perform only hemostasis and a tumor biopsy. The following day, intratumoral bleeding persisted, necessitating continuous blood infusion, resulting in abdominal compartment syndrome. Therefore, tumor resection was performed. Intra-tumoral hemorrhage continued during the operation, resulting in bradycardia and chest compressions. Histopathological examination confirmed a diagnosis of nephroblastoma. The postoperative course was uneventful. Conclusion: This report underlines the need to choose treatment based on both extratumoral and intratumoral bleeding, keeping in mind the risks of each treatment option.

DOI： 10.1016/j.epsc.2023.102711

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出版者・発行元：東京医学社  

DOI： 10.24479/ps.0000000581

CiNii Research

記述言語：英語   出版者・発行元：Journal of Pediatric Surgery  

Purpose: The aim of this study was to clarify the appropriate management after birth for congenital biliary dilatation (CBD, choledochal cyst) patients with a prenatal diagnosis. Method: Thirteen patients with a prenatal diagnosis of CBD who underwent liver biopsy during excision surgery were divided into two groups and retrospectively analyzed: group A, with liver fibrosis above F1 and group B, without liver fibrosis. Results: Excision surgery was performed earlier in group A (F1–F2), at a median of 106 days old (p = 0.04). There were significant differences between the two groups in the presence symptoms and sludge, the cyst size, and the level of serum bilirubin and gamma glutamyl transpeptidase (GGT) before excision surgery (p < 0.05). Especially, in group A, prolonged serum GGT elevation and larger cysts were consistently observed from birth. The cut-off values of predictions for the presence of liver fibrosis in serum GGT and cyst size were 319 U/l and 45 mm. No significant differences were observed in the postoperative liver function or complications during the follow-up period. Conclusion: In patients with prenatally diagnosed CBD, the postnatal serial changes of serum GGT values and cyst size, in addition to symptoms, could help to prevent progressive liver fibrosis. Level of Evidence: Ⅲ. Type of Study: Treatment Study.

DOI： 10.1016/j.jpedsurg.2023.01.050

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記述言語：英語   出版者・発行元：Journal of Pediatric Surgery  

Background: There is no standard timing for switching to surgical management for children with adhesive small bowel obstruction (ASBO) who initially receive conservative treatment. We hypothesized that an increased gastrointestinal drainage volume may indicate the need for surgical intervention. Methods: The study population included 150 episodes in the patients less than 20 years of age who received treatment for ASBO in our department from January 2008 to August 2019. Patients were divided into two groups: the successful conservative treatment group (CT) and the eventual surgical treatment group (ST). Following the analysis of all episodes (Study 1), we limited our analysis to only first ASBO episodes (Study 2). We retrospectively reviewed their medical records. Results: There were statistically significant differences in the volume on the 2nd day in both Study 1 (9.1 ml/kg vs. 18.7 ml/kg; p < 0.01) and study 2 (8.1 ml/kg vs. 19.7 ml/kg; p < 0.01). The cut-off value was the same for both Study 1 and Study 2 (11.7 ml/kg). Conclusions: The gastrointestinal drainage volume on the 2nd day in ST was significantly larger than that in CT. Accordingly, we considered that the drainage volume may predict eventual surgical intervention for children with ASBO who initially receive conservative treatment. Level of evidence: Level IV.

DOI： 10.1016/j.jpedsurg.2023.01.052

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記述言語：英語   出版者・発行元：Den Open  

Objectives: Pyriform sinus cyst (PSC) and pyriform sinus fistula (PSF) is a rare congenital malformation that arises from the third or fourth branchial structure. In our study, we describe the safety and the utility of endoscopic electrocauterization against PSC/PSF. Methods: We retrospectively reviewed the records of patients who underwent endoscopic electrocauterization for PSC/PSF at our hospital. The internal opening of the fistula was identified under general anesthesia using a flexible endoscope (XQ-260 or H-290; Olympus, Tokyo, Japan), and the DualKnifeJ (KD-655L; Olympus) was used to ablate the internal opening. Results: We experienced three PSF and three PSC patients. The postoperative course was uneventful in all cases. The patients declared no pain in the neck, and there were no cases showing recurrent nerve paralysis. Five in six cases (83%), the closure of fistula was archived in the first cauterization. One case (16.6%) required repeated cauterization. No recurrence was found during the follow-up period (median: 1 year) in any cases. Conclusions: Owing to its rarity in neonates, the diagnosis and treatment of PSC remains complicated and not clearly described. Complete removal of the fistula and the cyst with or without affected thyroid tissue was previously the most commonly used treatment. From our experience, we believe that endoscopic electrocauterization can be the first choice not only for PSF but also for neonatal PSC. In conclusion, endoscopic electrocauterization is feasible even for neonatal PSC. Further investigations including multicenter analyses are needed.

DOI： 10.1002/deo2.128

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記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

梨状窩嚢胞(PSC)および梨状窩瘻孔(PSF)に対して、電気凝固療法を施行した症例を後方視的に検討した。内部開口部は全身麻酔下で内視鏡により同定し、DualKnifeJにより焼灼した。3例のPSCおよび3例のPSFに対して加療を行い、処置後の経過は全例良好であった。頸部痛がみられた症例はなく、反回神経麻痺を呈した症例も認めなかった。6例中5例(83%)で初回焼灼により開口部が閉鎖され、1例(16.6%)で複数回の処置が必要であった。経過観察期間(中央値1年)中に、再発は認められなかった。新生児PSCに対しても電気凝固は有効であった。大規模臨床試験が必要と考えられた。

出版者・発行元：東京医学社  

DOI： 10.24479/pm.0000000805

CiNii Research

記述言語：英語   出版者・発行元：International Journal of Surgery Case Reports  

Introduction: Food protein-induced enterocolitis syndrome (FPIES) is a T-cell-mediated allergy that can occur in newborns and infants who are introduced to milk protein. Some of the serious complications of FPIES include necrotizing enterocolitis (NEC), massive bloody stools, and disseminated intravascular coagulation. Here we report a case of NEC caused by FPIES. Presentation of case: A 28-day-old girl born at full term suddenly developed marked abdominal distention and shock a few hours after being fed highly regulated milk protein. Emergency laparotomy was performed, and extensive small-intestinal necrosis was found. The histological examination showed chronic inflammation with typical ghost crypts, hemorrhage, and extensive pneumatosis intestinalis, a presentation consistent with NEC. Discussion: In this case, the fragile intestinal mucosa associated with FPIES was stimulated by milk protein, leading to NEC. The greatest diagnostic difficulty is the lack of a definitive method for distinguishing between NEC and FPIES. The allergen-specific lymphocyte stimulation test with lactotransferrin was positive, indicating that the primary condition was FPIES. However, no eosinophilic infiltrate was found in the histological examination, but there was chronic inflammation with typical ghost crypts, hemorrhage, and extensive pneumatosis intestinalis. Consequently, the final histological diagnosis in our case was NEC rather than FPIES. Conclusion: FPIES has a variable clinical course, and severe FPIES may become exacerbated even after ingestion of highly regulated milk protein. Taking appropriate actions after correct diagnosis can prevent progression to surgical emergency and secondary NEC.

DOI： 10.1016/j.ijscr.2023.107885

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記述言語：英語   出版者・発行元：Pediatrics International  

Background: The aim of this study was to clarify the characteristics and outcomes of pediatric patients with solid pseudopapillary neoplasms (SPNs) who underwent pancreatectomy. Methods: Pediatric patients with SPNs who underwent pancreatectomy at our institution between 1995 and 2020 were included in the study. Results: During the period under review, 12 patients underwent pancreatectomy for SPNs (median age: 10 years; range: 6–15 years). The surgical procedures included pancreatoduodenectomy (n = 2; 16.6%), distal pancreatectomy (n = 3; 25%), and enucleation (n = 7; 58.3%). The most common postoperative complication was postoperative pancreatic fistula (n = 6; 50%). Patients who underwent enucleation tended to have higher postoperative complication rates compared with those who underwent other procedures. All patients were alive without recurrence at the end of the study period. Conclusions: SPN is associated with a good prognosis, regardless of the surgical procedure. If surgeons select enucleation for pediatric SPNs, they should bear in mind that it is associated with a higher complication rate.

DOI： 10.1111/ped.15666

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記述言語：日本語   出版者・発行元：一般社団法人 日本移植学会  

<p>【緒言】Hypoganglionosis(以下Hypo)に対し、当科では乳児期に鬱滞性腸炎予防のため残存腸管切除を検討する一方、Bishop-Koop型腸瘻(以下BK)やSantulli型腸瘻(以下St.)を用いて肛門側未使用腸管の活用を試みる。【方法】2022年12月までに当科の定期的な受診歴のあるHypo症例5例を後方視的に検討し、上記治療戦略の成果を検討した。【結果・考察】5例中3例がBK(症例1:2歳7ヶ月、症例2:3歳、症例3:3歳2ヶ月に施行)を、1例がSt.(2歳6ヶ月施行)を、1例がチューブ腸瘻(以下Tube;1歳3ヶ月施行)を造設された。機能性腸瘻の症例では術前後でAST、ALTの改善が見られ、特にBK症例でより改善していた(症例1:AST86.6→53.3mg/dL,ALT121.7→54.7mg/dL, 症例2:AST77.3→61.8mg/dL,ALT43.7→40.3mg/dL, 症例3:AST106.4→51.6mg/dL,ALT76.3→32.8mg/dL, St.:AST77.5→68.2mg/dL,ALT57.4→52.7mg/dL, Tube:AST57.3→56.9mg/dL,ALT81.3→78.3mg/dL)。肛門側腸管をより積極的に使用するBKで腸管蠕動が刺激され、胆汁鬱滞が改善したと考えられた。示唆に富む結果と考え、ここに報告する。</p>

DOI： 10.11386/jst.58.supplement_s162_1

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人 日本移植学会  

<p>　小腸移植は、長期にわたる重度栄養障害を背景とする症例が移植適応となる。さらに、移植後においてもグラフト臓器の状態がレシピエントの栄養状態に直結する臓器移植領域でもある。当然、小腸移植の最終的ゴールは、静脈栄養（PN）からの完全離脱と栄養状態の改善にある。わが国における小腸移植後患者のQOLについて、移植後1年以上経過したグラフト生着患者では、全員が少なくとも部分的にPNから離脱し、約9割が完全離脱可能となっている。しかしながら、ひとたび拒絶反応が生じると、小腸粘膜の脱落を反映して著明にシトルリン値が低下して吸収不全を生じ、その制御は困難な場合が多い。当科では、これまでに5例の腸管不全患者に脳死小腸移植を実施した。内訳は短腸症1例、腸管吸収不全1例、腸管運動障害3例であった。いずれも移植後経口摂取が進み、2-3か月以内でPNからの離脱が得られている。しかし、うち2例では制御困難な拒絶反応からPN管理を再導入し、最終的にはグラフト摘出に至った。残りの3例は、PN不要な状態が維持されており、大幅な栄養状態の改善からQOL向上が得られている。今後の課題として、本邦では、胃や十二指腸を含めた多臓器移植が施行できず、単独小腸移植（結腸含む場合あり）となるため、術後にも残存した自己消化管機能を考慮した管理を継続していく必要性があり、思うように経口摂取が進まない可能性が懸念される点などにある。</p>

DOI： 10.11386/jst.58.supplement_s131_1

CiNii Research

記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

1995～2020年に膵切除術が施行されたsolid-pseudopapillary neoplasm(SPN)児12例(年齢6～15歳)の特徴とアウトカムについて検討した。術式は膵頭十二指腸切除術(2例;16.6%)、膵体尾部切除術(3例;25%)、膵腫瘍核出術(7例;58.3%)であった。術後合併症としては術後膵液瘻が最も多かった(6例;50%)。膵腫瘍核出術を施行した患児では他の術式の患児に比べ、術後30日までの合併症発生率が高い傾向を示し(85% vs 20%、p=0.04)、CT画像でトレースした膵切除断端外縁長が有意に長かった(34±10mm vs 10±2mm、p<0.01)。研究期間終了時点で全例が再発をみることなく生存している。

出版者・発行元：東京医学社  

DOI： 10.24479/ps.0000000319

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本小児外科学会  

<p>症例は6歳男児．胸腹部痛と発熱を主訴に当院小児科入院．入院時血液検査所見では，CRPおよびLDHの上昇を認めた．入院後に腹痛増悪を認めたため当科紹介となった．腹部CTでは壁肥厚を伴った小腸の左側偏位および結腸の固定不良が示唆された．急激な腹痛の進行から小腸軸捻転や内ヘルニアの可能性を考え緊急手術を行った．手術所見では，空腸の静脈鬱滞所見および13×16×65 mmのLandzert窩を認め左傍十二指腸ヘルニアと診断した．腸管血流は保たれておりヘルニア解除およびヘルニア門の閉鎖を行った．左傍十二指腸ヘルニアはTreitz靭帯周囲の腹膜窩に腸管が嵌入して生じる内ヘルニアであり，診断に有用なCT所見としてのsac-like appearanceを術後の再評価で認めた．今回，我々は術前診断困難であった左傍十二指腸ヘルニアの1例を経験したので，若干の文献的考察を加えて報告する．</p>

DOI： 10.11164/jjsps.58.7_978

CiNii Research

記述言語：日本語   出版者・発行元：(一社)日本小児外科学会  

症例は6歳男児.胸腹部痛と発熱を主訴に当院小児科入院.入院時血液検査所見では,CRPおよびLDHの上昇を認めた.入院後に腹痛増悪を認めたため当科紹介となった.腹部CTでは壁肥厚を伴った小腸の左側偏位および結腸の固定不良が示唆された.急激な腹痛の進行から小腸軸捻転や内ヘルニアの可能性を考え緊急手術を行った.手術所見では,空腸の静脈鬱滞所見および13×16×65mmのLandzert窩を認め左傍十二指腸ヘルニアと診断した.腸管血流は保たれておりヘルニア解除およびヘルニア門の閉鎖を行った.左傍十二指腸ヘルニアはTreitz靱帯周囲の腹膜窩に腸管が嵌入して生じる内ヘルニアであり,診断に有用なCT所見としてのsac-like appearanceを術後の再評価で認めた.今回,我々は術前診断困難であった左傍十二指腸ヘルニアの1例を経験したので,若干の文献的考察を加えて報告する.(著者抄録)

記述言語：日本語   出版者・発行元：金原出版(株)  

＜文献概要＞76歳,女性。難治性の顔面紅斑を主訴に当科を受診した。両頬部の紫紅色紅斑,手指関節背側に中央萎縮性の角化性小丘疹,背部に浮腫性紅斑を認めた。精査にて抗TIF1-γ抗体陽性のamyopathic dermatomyositisと診断した。また全身検索にて膵管内乳頭粘液性腫瘍を指摘されたが,悪性所見を認めず,皮疹に対してシクロスポリン内服加療を行った。約2年後,皮疹再燃を契機に再精査を行い,既存の膵頭部腫瘍性病変の増大を認め膵頭部腺癌と診断した。膵癌の根治術施行後,顔面の紅斑も軽快した。抗TIF1-γ抗体陽性の皮膚筋炎は,高率に進行癌を合併する例が多く,自験例のように早期に診断し切除し得た例はまれである。

記述言語：英語   出版者・発行元：Pediatric Surgery International  

Purpose: This study aims to clarify the relationship between changes in skeletal muscle mass during treatment and prognosis of pediatric malignant solid tumors. Methods: Patients with pediatric malignant solid tumors who were treated at Kyushu University Hospital from 2007 to 2017 were divided into two groups: the progression-free survival (PFS) group and the relapse/death (R/D) group; the psoas major muscle volume (PMV) was then compared. We also measured the PMV and psoas muscle area (PMA) of pediatric patients with no complications who underwent surgery for acute appendicitis (control) and compared the values with those of patients with malignant tumors. Results: No significant differences were observed in the PMV and PMA between patients with appendicitis and those with malignant tumors. Significant differences were found in the rate of change in PMV between the PFS (1.424) and R/D groups (1.071) (P = 0.0024). When the cut-off value of the rate of change in the PMV was 1.20, patients whose rate of change in PMV was ≥ 1.20 had longer PFS (P = 0.0231) and overall survival (P = 0.0229) than those whose rate of change was < 1.20. Conclusion: Pediatric patients with malignant solid tumors and increased skeletal muscle mass during treatment have a good prognosis.

DOI： 10.1007/s00383-022-05225-9

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記述言語：英語   出版者・発行元：Pediatric Surgery International  

Purpose: The number of accessible central veins (CVs) affects the prognosis of patients with intestinal failure (IF). The loss of residual CVs should be avoided. We, therefore, evaluated the efficacy of a new CV catheter-exchange technique using a subcutaneous fibrous sheath (FS) in pediatric IF patients. Methods: We retrospectively collected the CV catheter (CVC) data of pediatric IF patients managed from January 2009 to December 2019. The data were divided into two groups; Groups 1 (CVCs placed with the FS method) and Group 2 (CVCs placed by the primary or another insertion). The main outcome was the CVC indwelling time. Results: Eighty-five CVCs were analyzed. The FS method was attempted in 47 cases and succeeded in 40 (85%). No significant difference was observed between the groups regarding characteristics. A log-rank test revealed an equivalent CVC indwelling time between the two groups (Group 1: 268 [126–588] days vs. Group 2: 229 [126–387] days, p = 0.256). Conclusions: The FS method is highly recommended for pediatric IF patients, as its attempt showed a high success rate with an indwelling time equivalent to primary insertion. The FS method leads to the prolonged use of a single CV and thereby contributes to improving the outcomes of pediatric IF patients.

DOI： 10.1007/s00383-022-05233-9

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出版者・発行元：東京医学社  

DOI： 10.24479/ps.0000000288

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記述言語：日本語   出版者・発行元：(株)東京医学社  

1歳男児。出生前より陰嚢腫大を指摘され、生後11ヵ月時のMRIにて隔壁を有する嚢胞性病変が認められ、当院へ紹介となった。初診時、左鼠径部～陰嚢は著明に腫脹し、超音波検査で精系水瘤よりリンパ管腫が疑われた。漢方治療が行われたが、病変は縮小せず、1歳4ヵ月時にMRI検査を行ったところ、陰嚢内～左鼠径管～後腹膜腔に連続する嚢胞様腫瘤が認められた。以後、診断と治療目的で腹腔鏡手術が行われ、手術所見では大網嚢腫の陰嚢内への陥入が確認され、大網嚢腫の開窓、陰嚢底を結紮した。その結果、病理組織学的に大網嚢腫はリンパ管奇形と診断された。目下、術後3年経過で再発はみられていない。

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出版者・発行元：東京医学社  

DOI： 10.24479/ps.0000000246

CiNii Research

記述言語：英語   出版者・発行元：Journal of Pediatric Hematology Oncology  

Background: Pneumothorax and tumor-bronchial fistula are rare complications of pulmonary metastasis of osteosarcoma. Observations: We herein report the cases of 3 pediatric and adolescent patients who developed pneumothorax or tumor-bronchial fistula during treatment of pulmonary metastasis of osteosarcoma with chemotherapeutics or antiangiogenic agents. Two patients developed pneumothorax, and the other patient developed tumor-bronchial fistula. All of the patients finally underwent the surgery to treat their complications. Conclusions: Although it is not a curative surgery, surgery for pneumothorax and tumor-bronchial fistula is acceptable. The operative procedure should be considered on the basis of the predicted prognosis of the patient.

DOI： 10.1097/MPH.0000000000002416

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記述言語：英語   出版者・発行元：Wiley  

Objectives: Pyriform sinus cyst (PSC) and pyriform sinus fistula (PSF) is a rare congenital malformation that arises from the third or fourth branchial structure. In our study, we describe the safety and the utility of endoscopic electrocauterization against PSC/PSF. / Methods: We retrospectively reviewed the records of patients who underwent endoscopic electrocauterization for PSC/PSF at our hospital. The internal opening of the fistula was identified under general anesthesia using a flexible endoscope (XQ-260 or H-290; Olympus, Tokyo, Japan), and the DualKnifeJ (KD-655L; Olympus) was used to ablate the internal opening. / Results: We experienced three PSF and three PSC patients. The postoperative course was uneventful in all cases. The patients declared no pain in the neck, and there were no cases showing recurrent nerve paralysis. Five in six cases (83%), the closure of fistula was archived in the first cauterization. One case (16.6%) required repeated cauterization.No recurrence was found during the follow-up period ( median: 1 year) in any cases. / Conclusions: Owing to its rarity in neonates, the diagnosis and treatment of PSC remains complicated and not clearly described. Complete removal of the fistula and the cyst with or without affected thyroid tissue was previously the most commonly used treatment. From our experience, we believe that endoscopic electrocauterization can be the first choice not only for PSF but also for neonatal PSC. In conclusion, endoscopic electrocauterization is feasible even for neonatal PSC. Further investigations including multicenter analyses are needed.

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   出版者・発行元：(一社)日本小児血液・がん学会  

背景:神経芽腫の新しい治療戦略として,NK細胞の養子免疫治療が報告されているが,高活性化かつ高用量のNK細胞製剤の報告は未だにない.共同研究施設で開発された,ヒト末梢血から増幅製造されるoff-the-shelf型のNK細胞様製剤に関して報告する.方法:高活性化NK様細胞(GAIA-102)は,CD3陽性細胞を除去した末梢血単核球を接着培養の条件下で14日間培養して作成した.3D培養を行なったIMR-32(神経芽腫細胞株)を蛍光標識GAIA-102と共培養し,GAIA-102の腫瘍塊への浸潤を観察し,その細胞傷害活性をフローサイトメトリーを用いて観察した.結果:スフェロイドを用いた3Dアッセイでは,GAIA-102は,primary NK細胞,抗GD2抗体単独,または両方の組み合わせと比較して,IMR32の腫瘍塊に対する高い細胞傷害活性を示した.ライブイメージングにより,GAIA-102はスフェロイドに対して効率的に浸潤し,スフェロイドの腫瘍細胞が死滅することを確認した.結論:GAIA-102は,3D培養を行なった神経芽腫スフェロイドに対して高い浸潤能と細胞傷害活性を示した.GAIA-102は,再発難治神経芽腫の新規治療に有望な選択肢であると考え,現在,再発性または難治性の神経芽細胞腫の臨床試験を準備している.(著者抄録)

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   出版者・発行元：Pediatrics International  

Background: Core-needle biopsy (CNB) is used less frequently for the diagnosis of tumors in pediatric patients. In this report, the utility and safety of CNB for pediatric patients are described. Methods: The medical records of patients who underwent CNB at the Department of Pediatric Surgery, Kyushu University Hospital from April 2020 to November 2021 were retrospectively reviewed. A 14 G or 16 G BARDMISSION Disposable Needle Instrument was used. For the diagnosis of neuroblastoma, a 14 G needle was selected; for the diagnosis of other tumors a 16 G needle was selected. Results: During the above period 17 CNBs were performed in 17 patients, and the median patient age was 8 years (range, 15 days–19 years). The pathological diagnoses of the tumors were as follows: neuroblastoma, n = 6; lymphoma, n = 3; hepatoblastoma, n = 2; and others, n = 6. The quantity and quality of all tumor samples obtained by CNB was sufficient to make a diagnosis. The postoperative course after CNB was uneventful in most cases, with the exception of one case of hepatoblastoma (pseudoaneurysm). Conclusions: Core-needle biopsy is useful for pediatric patients. Sufficient tumor specimens were able to be obtained in all cases, irrespective of the type of tumor, and an accurate diagnosis could be made.

DOI： 10.1111/ped.15228

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

2020年4月～2021年11月に小児外科でコアニードル生検が実施された患者の診療記録を後向きに評価し、小児におけるコアニードル生検の有用性および安全性について検討した。神経芽腫の診断には14G針が選択され、その他の腫瘍の診断には16G針が選択された。患者17例(中央値8歳)に計17回の生検が実施された。腫瘍の病理診断、神経芽細胞腫6例、リンパ腫3例、肝芽腫2例、その他6例であった。その結果、コアニードル腫瘍生検より得られたすべての腫瘍サンプルの量および質は、診断を下すのに十分であることが示された。コアニードル生検後の術後経過は、肝芽腫1例(偽動脈瘤)を除き、大部分の症例で良好であった。以上から、コアニードル生検は小児患者に有用であることが示された。

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

記述言語：日本語   出版者・発行元：(株)東京医学社  

＜文献概要＞はじめに　領域(職種)に関わらず相手に情報を提示し,理解を得るための手段つまり「プレゼンテーション能力」は非常に重要な技能である。特に医師においては,患者の治療方針・治療経過を含め,必要十分な情報を短時間でプレゼンテーションすることが求められる。その細かい方法は各施設において決められたやり方があるものと想像されるが,本稿においては,当院で行われている小児外科医間でのプレゼンテーションの「流れ」を紹介する。

記述言語：日本語   出版者・発行元：(一社)日本小児血液・がん学会  

肝芽腫に対する肝移植は2008年4月に保険収載されてから約15年が経過した.切除不能肝芽腫が肝移植適応とされるが,「切除不能」の判断は必ずしも容易ではない.一般的には,化学療法後においても4区域へ腫瘍進展が認められる場合(POST-TEXT IV)や腫瘍が3区域に限局していても主要な脈管に浸潤が疑われる場合(POST-TEXT III P+,V+)には切除不能と判断される.しかし,術前画像診断で切除可否を判断することが難しい場合もあり,仮に切除可能と考えられるような場合においても,肝移植に対応し得る施設での最終判断と手術が推奨されている.かつては,肝切除後再発などを理由とした救済的肝移植は,移植後の成績が著しく悪いとの報告から,切除可否が疑わしい症例は肝移植を優先させることが無難であると考えられていた.しかし,近年,わが国からの報告も含め,救済的肝移植の成績が決して悪くないとする報告もあり,肝移植後の長期的な合併症発症のリスクを考え併せると,移植を回避するためのチャレンジングな肝切除という治療選択も改めて見直されつつある.本稿では,血管再建や臓器保存などの移植手術の際に用いる技術を応用した肝切除術や残肝容量不足に対する対策など,非定型的高度肝切除術の概略と可能性について概説する.(著者抄録)

記述言語：日本語   出版者・発行元：(株)東京医学社  

記述言語：日本語   出版者・発行元：(株)東京医学社  

記述言語：日本語   出版者・発行元：(株)メディカ出版  

記述言語：日本語   出版者・発行元：(株)東京医学社  

記述言語：日本語   出版者・発行元：(株)東京医学社  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

小児がんは1万人に1人が発症すると言われており,年間新規診断例が2,000～2,500人と少ないものの,小児(19歳以下)の病死原因の第1位であり,現在,年間約500名が死亡している.現在,日本小児がん研究グループ(JCCG)の中で固形腫瘍分科会としては,外科として小児外科医が中心となる神経芽腫委員会,肝腫瘍委員会,腎腫瘍委員会,胚細胞腫瘍委員会の他に各臓器の外科医が必要である横紋筋肉腫委員会,ユーイング肉腫委員会(整形外科医とも連携),脳腫瘍委員会(外科は脳外科医が中心)の七つの疾患委員会で構成され,血液腫瘍分科会と連携して活動が行われており,本邦における小児がん全体の質の高い臨床研究を進める基盤が構築されている.本稿においては,小児固形がんにおける層別化治療の現状として,JCCG固形腫瘍分科会の中で脳腫瘍以外の小児腫瘍で症例数の多い三つの疾患委員会(神経芽腫委員会,肝腫瘍委員会,腎腫瘍委員会)の臨床研究を基盤とした本邦の層別化治療の現況と展開について述べる.今後,JCCGと全国の小児がん拠点病院が共同で小児がんの臨床試験を実施する地域の医療機関に対して治療相談を含む連携の強化につとめ,日本全体の小児がん治療成績向上に貢献することが期待される.(著者抄録)

記述言語：日本語  

記述言語：日本語   出版者・発行元：(株)東京医学社  

＜Key Points＞(1)小児,とくに新生児・乳児期の便秘の原因の一つとしてHirschsprung病類縁疾患は考慮すべき疾患である。(2)Hirschsprung病類縁疾患は,日本では腸管壁内神経節細胞の形態や症状などにより7つの疾患に分けられ,予後が比較的よいものと悪いものとがあるため,その鑑別は重要である。(3)とくに予後の悪いIsolated hypoganglionosis,Megacystis microcolon intestinal hypoperistalsis syndrome,Chronic idiopathic intestinal pseudo-obstructionに対する薬物治療として,漢方薬(大建中湯)やプロバイオティクスは有効とする報告があるためまず試してもよい薬剤である。(著者抄録)

記述言語：日本語   出版者・発行元：(株)東京医学社  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

記述言語：日本語   出版者・発行元：(株)東京医学社  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

記述言語：日本語   出版者・発行元：大道学館出版部  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（学術雑誌）