Search

Background/purpose: The intussusception-type antireflux valve is a mechanism introduced by Nakajo, who reported the results of his initial 17 cases in 1990. This report summarizes our further experience with new patients, together with follow-up results of the cases previously reported by Nakajo., Methods: In total, 46 new patients who had biliary atresia underwent portoenterostomy at the authors' two units. The authors hoped to construct the intussuscepted antireflux valve in the Roux-en-Y loop, whenever possible, at the time of hepatic portoenterostomy., Results: Among the 46 patients, one case each was found to be too young or too old to have the valve constructed during the surgery. In another case, the Roux-en-Y loop became too short after repeated revisions of the portoenterostomy. In another patient, the valve was first constructed but later removed because of jejunal perforation near the valve. In the last patient, the valve was not constructed for unspecified reasons. The authors constructed the antireflux valve in 42 patients, but it was maintained in 41. In one case, the valve truly prevented reflux of the intestinal juice during an episode of intestinal obstruction. The valve was found to be incompetent in one patient 5 years after the initial surgery., Conclusion: The incidence of cholangitis was high in patients with postoperative cystic dilatation of the intrahepatic bile ducts, and low in those without it.

Partial liver transplantation (PLTR) was studied experimentally, using 60 monkeys (20 recipients, 20 donors, 20 blood donors). The left lobe of the donors was transplanted orthotopically, using a veno-venous bypass catheter that was inserted in the portal vein and the other side passed through the hepatic portion of the inferior vena cava. The donor survival rate at 1 week was 70%. Seven recipients survived for more than 58 hours (58, 60, 64, 68, 72, 110, and 252 hours), and 13 died within 48 hours of surgery because of postoperative complications. Clinical living related liver transplantation (LRLT) was performed between June 1990 and March 1992 on six patients with biliary atresia and on one with liver cirrhosis and hepatocellular carcinoma. In all, the father's left lobe was transplanted orthotopically. Cyclosporine, azathioprine, and methyl prednisolone were administered. In addition, FK-506 was given to two patients in whom rejection was observed; one died 37 days after surgery because of acute rejection followed by systemic cytomegalovirus infection. The other six patients have survived for 8 to 29 months since transplantation. All six have been discharged from the hospital and are enjoying normal daily life. The postoperative course of all donors was uneventful. They were discharged 2 weeks after the operation and returned to their jobs in 2 months. The authors conclude that PLTR from a living donor is a promising therapeutic alternative to liver transplantation from a cadaver.

Infants with hemangiomas of the eyelid and orbit are at risk for amblyopia and refractive errors. Several methods of treatment for these tumors have been associated with complications and limitations. Five infants with these hemangiomas were treated by intralesional corticosteroid injection combined with short-term oral prednisolone. In an attempt to eliminate complications, corticosteroid injections were administered. In the cases of orbital hemangioma, ultrasonography guidance was used to assist the injection. This treatment is safe, simple, and effective for infants. In addition, complications are minimized.

From 1977 to 1983 ileocecal resection was done in five neonates and three infants who were admitted to our pediatric surgical units. Their growth, hematology, and serum biochemistry were examined and compared with that of an ileal resection group without ileocecal resection. The body weight and height of all patients of the ileocecal resection group were within normal ranges. All patients undergoing ileocecal resection in neonates had moderate diarrhea but condition of fecal evacuation improved after age 6. None of the control ileal resection group had diarrhea since age 2. No significant differences were noted in hematology and serum biochemistry (protein metabolism, lipid metabolism, bile acid, and vitamin B12) data between the ileocecal resection groups and the control group. Our findings show that after ileocecal resection without extensive ileal resection in neonates and infants, adequate nutritional status can be maintained.