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Objective: To determine the appropriate initial ventilatory mode for neonatal congenital diaphragmatic hernia (CDH) by comparing patient prognosis following conventional mechanical ventilation (CMV) versus high-frequency oscillatory ventilation (HFO). Study design: This multicenter retrospective cohort study was performed at 15 participating hospitals in Japan between 2011 and 2016. The 328 eligible CDH infants were classified into CMV (n= 78) and HFO groups (n= 250) to compare mortality and incidence of bronchopulmonary dysplasia (BPD). Propensity score matching was applied to reduce confounding by indication. Result: While crude mortality was significantly higher in the HFO than the CMV group, adjusted odds ratio (OR) did not show significant difference in mortality between groups (OR of HFO group: 0.98, 95% confidence interval (CI): 0.57–1.67). Adjusted OR of BPD incidence showed no significant difference between groups (OR of HFO group: 1.66, 95%CI: 0.50–5.49). Conclusion: Initial ventilatory mode in CDH patients, whether CMV or HFO, does not affect prognosis.

Ileocecal duplication cysts are generally treated with ileocecal resection and end-to-end anastomosis. However, loss of the ileocecal valve can be a problem in childhood. Cyst enucleation is an option to preserve the ileocecal valve, but is difficult for cysts protruding into the intestinal lumen. We report a case of ileocecal duplication cyst with luminal protrusion successfully enucleated via an anti-mesenteric approach. A 4-year-old boy complaining of abdominal pain was referred to our hospital with a diagnosis of intussusception. Intussusception was reduced with a therapeutic enema, but a tumor was detected in the ascending colon. Ultrasonography showed a cystic tumor adjacent to the ileocecal valve partially sharing the muscle wall with the colon. Surgery was performed with a diagnosis of duplication cyst. The ileocecum was mobilized laparoscopically and exteriorized through the umbilicus. The cyst did not protrude outside the colon, making enucleation difficult. We incised the cecum on the anti-mesenteric side, isolated the cyst, and resected it with preservation of the ileocecal valve. The patient's postoperative course was uneventful. Nine months after surgery, he remains well, with no sign of recurrence. An anti-mesenteric approach is a good option to preserve the ileocecal valve for ileocecal duplication cysts protruding into the lumen.

Hepatoblastoma with intraatrial tumor thrombus is relatively rare. We report a case of hepatoblastoma with tumor thrombus extending into the right atrium, which responded well to chemotherapy and was resected using extracorporeal circulation. A 4-year-old girl was referred to our hospital because of abdominal distention and tenderness. A computed tomography (CT) scan showed a large tumor occupying the left 3 segments of the liver with tumor thrombus extending into the right atrium. There was also a small intrahepatic metastasis in the right lobe of the liver. She was diagnosed with hepatoblastoma on the basis of the results of open biopsy. Neoadjuvant chemotherapy with an intense CDDP-based regimen was performed. The tumor responded well to chemotherapy, and intrahepatic metastasis became undetectable on CT scan, although the tumor thrombus remained in the right atrium. After 7 courses of chemotherapy, we performed resection using extracorporeal circulation. The postoperative course was uneventful, and adjuvant chemotherapy was started 10 days after the operation. Her serum alpha-fetoprotein (AFP) level decreased to the normal range, and she was free of disease for 1 year after the operation. Tumor resection using extracorporeal circulation can be performed safely and is justified in patients with intraatrial tumor thrombus.

Granzymes are a family of serine proteases exclusively detected in the granules of cytotoxic lymphocytes, and in mice at least eight granzymes, A to G and K, have been identified. Except for granzymes A and B, which activate the apoptotic pathway, little is known about the exact functions of the other granzymes. We have found that the granzyme D transcript is selectively expressed in functional hematopoietic stromal lines as well as primary stromal cells. Stromal lines supported growth of a pre-T lymphoma clone BTK at an efficiency proportional to the expression level of granzyme D, while a stromal line lacking granzyme D failed to do so. When the defective stromal line was transfected with granzyme D cDNA, it could efficiently support the growth of BTK cells. The results indicate that granzyme D expressed in the stromal cells plays an important role in stromal cell–lymphocyte interaction.