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小児消化器患者の経腸栄養では, n-6系またはn-3系多価不飽和脂肪酸の含有量が高い栄養剤(n-6PUFA-EN, n-3PUFA-EN)のいずれが,蛋白・脂質代謝,腸粘膜のintegrityに関して有用かは未だ明らかでない.今回,小児消化器術後患者11例を対象に, n-6PUFA-ENからn-3PUFA-ENに変更した栄養管理を行い,血清脂肪酸分画, albumin, rapid turnover protein,血中diamine oxidase (DAO)活性を, n-3PUFA-EN投与前後に測定し検討した.その結果,栄養剤の変更によりn-6/n-3比は15.1から6.4に低下した. EPA/AA比, prealbumin, retinol binding protein濃度, DAO活性はいずれも有意に上昇し正常化した. n-3PUFA-ENの投与は,蛋白・脂質代謝のみならず,小腸粘膜のintegrityを維持するのに有用であると考えられた.

The beneficial effects of high-monounsaturated fat (high-MUFA) diets on diabetic patients have been reported, whereas studies concerning the effects on animals have been few. Although experiments on animals should be useful in elucidating underlying mechanisms, it is not clear even whether there are benefits of a high-MUFA diet in animals. This study examined the short-term effects of a high-MUFA diet on normal and genetically diabetic mice. The high-MUFA diet supplied 38% of the total calories as fat (26% from MUFA), while a regular diet was 13% fat (3% from MUFA). Normal C5 7BL/6J and diabetic C57BL/KsJ-db/db mice were fed either the regular or the high-MUFA diet for 1 wk. Serum glucose and lipid levels were then measured. In normal mice, hepatic triglyceride production was also compared between the two dietary groups using the Triton WR1339 method. An oral glucose tolerance test was conducted on the diabetic mice. After 1 wk of feeding to normal mice, the high-MUFA diet was seen to lower serum triglyceride levels and reduce hepatic triglyceride production in comparison with the regular diet; it is suggested that the lowering of triglyceride consists of mechanisms including reduced hepatic triglyceride production. When diabetic mice were fed the high-MUFA diet with a controlled caloric intake, the serum glucose levels lowered without an accompanying deterioration in lipid metabolism and the impaired glucose tolerance was ameliorated. This study demonstrates that a high-MUFA diet can lower serum triglyceride levels in normal mice and improve disorders of glucose metabolism in diabetic mice.

The purpose of this study is whether the fungal deoxyribonucleic acid (DNA) examination is useful as a sensitive parameter for pediatric surgical patients with mycosis. The eleven episodes of five cases (4 cases; progressive liver disease after biliary atresia operation, 1 case; short bowel syndrome and long term total parenteral nutrition with megacystis microcolon intestinal hypoperistalsis syndrome) with mycosis were divided into two groups according to the difference of therapeutic protocols. The sensitivity of fungal DNA examination, serum Candida antigen level, plasma beta-D glucan level, and blood culture were evaluated at the onset of infection and at the quit of antifungal medication under the protocols respectively. The duration of medication and the medication free interval in two groups were compared. The 6 episodes (3 cases) were diagnosed and treated under the protocol not including fungal DNA examination, while the 5 episodes (2 cases) under the protocol including fungal DNA examination. The occurrence rate was not significant. The sensitivity of fungal DNA examination was complete, but others were not. Using the fungal DNA examination, the duration of medication became significantly short. We conclude that the fungal DNA examination could be a sensitive parameter not only to start but to quit antifungal medication in pediatric patients with mycosis.

Nesidioblastosis is a rare disorder in pediatric surgery. It is caused by hypertrophy and hyperplasia of the islands of Langerhans, and can lead to persistent hyperinsulinemic hypoglycemia. If appropriate treatment is delayed there is a high risk of the development of cerebral palsy, impaired mental development, epilepsy or other forms of irreversible brain damage, so early detection and early treatment to stabilize serum glucose levels is essential. Initial treatment consists of nutritional management with administration of an adequate amount of calories along with drug therapy using diazoxide. In cases that are resistant to drug therapy a subtotal pancreatectomy is performed. Conventional recommended practice has been to perform a 95% pancreatectomy, however this can lead to the onset of diabetes due to abnormal pancreatic endocrine function. We report here a case of nesidioblastosis in which we performed an 85% pancreatectomy. Postoperative clinical course has been excellent, with no recurrence or impaired glucose tolerance during the four years since the operation.

褥瘡患者2症例に対して,創傷治癒促進因子である亜鉛,銅, n-3系脂肪酸高含有の経腸栄養剤を用いた栄養管理を行った. 症例1は軟菜全粥食の摂取にもかかわらず褥瘡が改善しないため,蛋白合成,創傷治癒に必要な栄養素の投与目的で,半消化態経腸栄養剤に変更した.エネルギー,蛋白,アルギニン投与量に変化はなく, n-3系脂肪酸,亜鉛,銅の投与量が増加して第6次改定の栄養所要量の摂取基準を満たし,蛋白合成能および脂質代謝の改善に伴って,治療後8週目には褥瘡は治癒した.症例2は高度の低栄養が認められ,経腸栄養剤の投与量を増加させて,摂取基準に見合うn-3系脂肪酸,亜鉛,銅の投与が行え,蛋白合成能および脂質代謝の改善に伴って治療後10週目には褥瘡は治癒した. 難治性の褥瘡患者の治療においては,エネルギーや蛋白の投与量のみでなく,蛋白合成能の改善や創傷治癒に必須となる栄養素の投与組成を考慮した栄養管理が重要といえる.

小児の腸間膜嚢腫は比較的稀な疾患である.今回私共は,間歇的腹痛を主訴とした小児の腸間膜嚢腫(リンパ管腫)の1例を経験した.症例は5歳,男児.各種画像検査にて骨盤内に腫瘍を認め,摘出術を施行した.腫瘍はTreitz靱帯より肛門120cm,回盲部より口側340cmの部位の腸間膜に存在し,大きさは13×10×8cmであった.術後病理組織学的にlymphangiomaと診断された.

We experienced a case of malignant lymphoma of the duodenum presented as obstraction of the same organ. A 23-year-old female complained of nausea and vomiting. On admission, laboratory data revealed microcytic and hypochromic anemia and a decreased number of white blood cell, but its analysis and bone marrow were normal. Occult blood was admitted. Hypotonic duodenography and gastrointestinal fiberscopy showed that the third portion of the duodenum was completely obstructed by a tumor with irregular surface. The tumor was diagnosed as Non-Hodgkins' lymphoma of medium sized cell type by histological examination of the biopsy specimen. Laparotomy was performed, and an elevated tumor with irregular surface which ran up the whole-surcumference was seen at the third portion of the duodenum. Furthermore, metastases were seen in the mesocolic lymphonodes, but the liver and spleen were intact. On the following histologic examination, the preoperative diagnosis was confirmed. No monoclonality was observed in the tumor cell immunoglobulin. Surface phenotype studies of the tumor cells were all negative. ACOP theraphy was performed ten times from the second week after the operation. She was alive and well 1 year after the operation.

A 25-year-old male who had no significant medical history presented abrupt onset of high-grade fever and chills without noticeable trigger. The patient sought for medical attention for subsequently developed dyspnea and chest pain. Radiological examinations revealed bilateral lung peripheral multiple opacities, some of which were cavitating, suggesting of septic pulmonary emboli (SPE). Isolation of Staphylococcus aureus in blood and sputum culture confirmed the diagnosis. Extensive examinations disclosed neither underlying immunocompromising conditions nor infectious foci, which are usually notable in patients with SPE. The present patient illustrates that there are patients with SPE in whom underlying conditions or infectious foci are difficult to determine, and that suspicion of the disease based on characteristic radiological findings is critical for appropriate management in those patients.

It is not unusual for patients with severe motor and intellectual disabilities to present with eating and swallowing disorders, and such patients often require long term enteral nutrition. These patients tend to receive all their nutrients in the form of a single nutrient solution that is administered over a long period, and there are concerns about the impact of the composition of these nutrient formulas on patient health. Therefore, it is very important that adequate care be taken when selecting a nutrient formula for patients of this type. In the present study we administered two types of enteral nutrient solutions and examined the effect of the differences in nutrient composition on the degree of oxidative stress experienced by human patients. Subjects were 5 patients (mean age: 27.2 years; male/female ratio: 4:1) with severe motor and intellectual disabilities who were incapable of oral feeding, and who were receiving long term enteral nutrition. The subjects were administered a standard elemental diet for 2 months, and this was followed by administration of an n-3 polyunsaturated fatty acid enriched enteral nutrient solution for three months. Results showed that the n-3 polyunsaturated fatty acid enriched diet improved serum concentrations of trace elements, protein synthesis, and the balance between n-6 polyunsaturated fatty acids and n-3 polyunsaturated fatty acids, which are essential fatty acids. At the same time oxidative stress was reduced, and serum IgE levels declined significantly. Patients with severe psychophysiological disorders often suffer from repeated bouts of pneumonia due to immune system suppression, and there are reports that such patients are subject to increased allergic diathesis. The present results indicated that the in vivo membrane damage induced by oxidative stress may be closely related to the onset of these disorders. The results also suggested that in addition to attaining an adequate understanding of the effect of each of the various nutrients in enteral nutrient formulas, it will also be important to consider not only trace elements but also fatty acid composition in the nutritional management of patients with such disorders.

Despite the numerous approaches described for the management of neonates with “long gap” esophageal atresia, controversy still exists as to the preferred method. Delayed primary anastomosis is probably the most frequently adopted practice but often the native esophagus is abandoned. We report a case of a 2.98 kg newborn with pure esophageal atresia . Although the elongation of the distal esophageal pouch by mechanical bougienage was initiated at 1 year and 8 months, a successful tension-free anastomosis with minimum dissection of the lower esophagus was performed at 2 years and 7 months. Her postoperative quality of life has been quite excellent. This report emphasizes that a tension-free anastomosis without operating on the lower esophagus and stomach is essential for the treatment of long-gap esophageal atresia.

The aims of this study were to determine the normal values of plasma diamine oxidase (pDAO) activity in children and to examine the influence of several factors (nutritional management, dietary fiber, and chemotherapy) on pDAO activity. The activity of pDAO was measured in 138 healthy children with minor surgical conditions such as inguinal hernia or undescended testis. In order to define normal values patients were subdivided into 5 groups according to age. Next, changes in pDAO activity under different nutritional conditions were studied in 14 patients with adhesive ileus. The influence of chemotherapeutic drugs on pDAO activity was also studied in 19 neuroblastoma patients. I. The normal values of pDAO activity at year1, 1or = years3, 3or = years6.6or = years12, 12or = years were 6.65 +/- 1.75, 7.70 +/- 2.29, 6.53 +/- 1.68, 5.85 +/- 1.87, 5.06 +/- 1.84 units/l, respectively. II. The pDAO activities in patients with ileus were 4.73 +/- 1.02 (total parenteral nutrition), 6.84 +/- 1.18 (enteral, nutrition), 7.62 +/- 0.67 (soluble dietary fiber added enteral nutrition) and 8.82 +/- 1.26 units/l (oral feeding). The difference in pDAO activity at enteral or oral feeding vs. total parenteral nutrition was significant (p.0001). III. The pDAO activity decreased significantly and remained low during the first 4 days after cyclophosphamide administration in neuroblastoma patients. The preadministration of dietary fiber inhibited the influence of cyclophosphamide. Plasma DAO activity was greatly influenced by nutritional management and administration of dietary fiber and/or cyclophosphamide. Plasma DAO activity may be a sensitive marker of intestinal function in children.

Multiple Organ Failure that occurred in 35 cases out of a total of 1498 cases after intestinal surgery were studied by an analysis of the clinical and statistical data from the past 5 years (1984-1988). 1. The incidence of MOF after intestinal surgery was 2.3%. 2. Twenty-eight of MOF resulted from severe infections. 3. The incidence of infection was highest after esophageal operations. 4. Hepatic failure was the most common type of primary organ failure and renal failure was the second most common. 5. The prognosis for MOF was very poor with a survival rate of 8.7%.

Changes in acid-base balance, water-electrolyte metabolism and CVP were evaluated in 315 patients with postoperative ileus during the past 21 years. Infusion therapy for postoperative ileus is described.

An adult case of congenital segmental dilatation of the jejunum with malrotation was treated by resecting the dilated tract and performing an end-to-end anastomosis. The progress of this case was reported along with a review of the literature. 1) 9 cases of congenital segmental dilatation of the intestine with malrotation, including this case (Babut et al. 1977; Komi 1974; Kusaba et al. 1983; Rossi 1973; Swenson et al. 1959) have been reported . The relative morbidity for males and females was 2 : 7. The location in the jejunum was high in 6 cases. 2) the morbidity was the highest in infants . The etiology of this disease still remains unclear. 3) Differential diagnosis of this disease from Hiruschsprung's disease in infants and from mechanical ileus in adults is important. 4) With resection of the dilated tract and end-to-end anastomosis, g results can be obtained. This method is recognized as the best treatment. 5) The etiology of this disease is unknown. Physiological and biochemical research must be continued until the etiology is clarified.

This is a case report of two cases of mesenteric cysts in a seven-monthold female and a two-year-8-month-old male, we reviewed and analysed the reported cases in Japan and applied this knowledge to the evaluation and the statistical analysis of our cases.

Segmental dilatation of the sigmoid colon in adults and the surgical treatment are reported with a review of some of the literatures. 1) There have been 10 cases of congenital segmental dilatation of the sigmoid colon, including this case. 2) Hiruschsprung's disease is an important disease for the differential diagnosis of segmental dilatation of the colon. Resection of the segmentally dilated portion of the colon and end-to-end anastomosis are the best treatments, and these procedures can produce good results. 3) The cause of segmental dilatation of the colon is unknown.

During a period from 1976 to 1982, we performed gastrointestinal operation on 2406 cases. Among the 2406 operated cases, 135 (5.3%) developed severe infections. There were 36 (26.7 %) cases which fell into the sequential system failure subsequent to these severe postoperative infection. The mortality rate was high at 51.9%. The organ failure began to appear by the second week after the development of infections in the lung, liver, and kidney. When the system failure involved four organs or more, all the patients died. The correlation of the basic cause for the multiple organ failure should not be neglected.

A rare case of eosinophilic granuloma with an ulcer in the antrum portion of the stomach belonging to the localized type due to some parasite was reported. In spite of numerous examinations before the operation, a confirmed diagnosis was not obtained.