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Background: Pathogenesis of pediatric acute appendicitis (AA) is yet to be elucidated. Therefore, we performed a comprehensive microbial analysis of saliva, feces, and appendiceal lumen of AA patients using 16S ribosomal RNA (rRNA) gene amplicon sequencing to elucidate the pathogenesis of pediatric AA. Methods: This study included 33 AA patients and 17 healthy controls (HCs) aged 5% (16.0%, 9.1%, 7.9%, and 6.0%, respectively). Conclusions: The relative abundance of Fusobacterium was high in the appendiceal lumen of pediatric AA patients. Moreover, the relative abundance of Fusobacterium was significantly higher in the saliva and feces of pediatric AA patients than in those of healthy children. These results suggest that ectopic colonization of oral Fusobacterium in the appendix might play an important role in the pathogenesis of pediatric AA.

Introduction: The long-term management of central venous catheters (CVCs) is extremely important in various pediatric treatments. However, in addition to catheter infections, catheter lumen obstruction (CLO) often causes treatment to be interrupted.Thrombosis is a well-known cause of CLO. However, we experienced a case of occlusion not caused by a thrombus but by an atheroma-like sclerotic substance. Case presentation: The patient was an 18-month-old girl born with extremely low weight (23 weeks’ gestation, birth weight 497 g). She had multiple surgeries for ileal perforation and postoperative adhesive bowel obstruction, resulting in short bowel syndrome. Owing to that condition, she was managed with parenteral nutrition administered via a central venous catheter. The content of the parenteral nutrition included amino acid preparations, sugar, heparin, and fat emulsion. During the catheter replacement procedure when she was aged 18 months, yellow embolic material was recognized with blood film in the lumen of the catheter. The embolic material was thought to be the atheroma-like sclerotic substance shown on the pathologic findings.After the replacement of the catheter, the patient is still under central venous nutritional management and is being monitored to see if a similar obstruction occurs. Conclusion: In the case of CLO, we cannot detect the cause by any kind of examination. Therefore, we must pay special attention to the method of recanalization to prevent not only spillage of microbes and blood clotting, but also severe embolism due to a sclerotic substance.

Introduction: Alagille syndrome (ALGS) is a cholestasis disorder with multiple organ dysfunction, including heart and kidney. The causative genes of ALGS are JAG1 and NOTCH2. Dysregulation of Notch signaling leads to defects in the developmental mechanisms of the bile ducts. Sometimes extrahepatic bile duct hypoplasia makes it difficult to differentiate ALGS from biliary atresia. The Kasai procedure for ALGS is associated with poor liver and patient outcomes. Therefore, it is important to differentiate ALGS from biliary atresia correctly. Case presentation: A 2-day-old female neonate was admitted to the neonatal intensive care unit due to poor feeding; blood tests on day 7 showed elevated direct bilirubin and total bile acids. Right hydronephrosis, peripheral pulmonary artery stenosis, butterfly vertebra, and posterior embryotoxon were observed, and ALGS was suspected from these findings. Duodenal fluid tests and biliary scintigraphy showed no bile excretion from the liver into the intestinal tract. These findings suggested biliary atresia, and to distinguish ALGS from biliary atresia, rapid JAG1 and NOTCH2 sequencing was performed preoperatively. We found a heterozygous de novo single nucleotide insertion mutation c.192dupC p.(Lys65GlnfsX8). Operative cholangiography showed that the common bile duct was patent, but the common hepatic duct was barely open, a finding consistent with type III-a-o biliary atresia. Because of the preoperative diagnosis of ALGS, Kasai procedure was omitted. Conclusion: Neonates and early infants with cholestasis with extrahepatic symptoms should be carefully examined, with genetic syndromes and biliary atresia considered differential diagnoses. Advances in genetic analysis methods are expected to facilitate early diagnosis of ALGS.

Background: Stenosis of the permanent tracheostoma causes the patient reduced quality of life. We herein report a treatment of permanent tracheostomal stenosis with local steroid injection after laryngotracheal separation in a patient with severe motor and intellectual disabilities. Case presentation: The patient was a 22-year-old woman with congenital myopathy who underwent laryngotracheal separation at the age of 21 years. Tracheostomal enlargement was performed at the age of 22 years. Two months after the operation, permanent tracheostomal stenosis developed owing to a hard cicatricial constriction. Although the size of the tracheostoma decreased, yet the patient did not have any respiratory distress. Therefore, we started local steroid injection therapy using triamcinolone acetonide instead of revision surgery. After those 3 injections, the tracheostomal stenosis was apparently dilated. The patient received this treatment 19 times in 3 years and 4months. She has not needed this treatment in the past 1 year and 8 months. No adverse effect of the corticosteroid was seen during the 5-year period. Conclusions: On the basis of our experience, if patients have no symptoms related to stenotic airway obstruction, triamcinolone acetonide injection therapy, instead of revision surgery, is a simple, safe, and highly effective procedure for permanent tracheostomal stenosis.

Hepatolithiasis is well known to be a late complication after biliary reconstruction. However, there were few reports regarding hepatolithiasis in late complications of long-term, native liver survivors in postoperative patients of biliary atresia. Here, we present a 52-year-old woman who underwent Kasai portoenterostomy for biliary atresia type Ⅲ at the age of 110 days. She was asymptomatic for over 30 years, and birthed three normal babies. Then she suffered from repeated cholangitis due to multiple hepatolithiasis since age 50. A lithotripsy via Roux-en-Y limb was performed but failed due to hepatic hilum strictures. Finally, she underwent living donor liver transplantation. Endoscopic lithotripsy and hepatectomy for hepatolithiasis often fail in biliary atresia patients due to unresolvable intrahepatic or hilar bile duct stenosis and liver dysfunction. Therefore, we consider that liver transplantation is curative and strongly recommended for symptomatic hepatolithiasis as a late complication after biliary atresia surgery.

The prognosis for duodenal atresia (DA) is generally good if radical surgery is performed. However, some cases of DA may be complicated by morphological abnormalities in the pancreaticobiliary system, which may cause problems in the distant period. Here, we report a case of gallbladder cancer (GC) that developed more than 20 years after the initial DA operation. A female infant was admitted to our institution with an anorectal malformation after birth. She had Down syndrome, a ventricular septal defect, and DA. She underwent duodenoduodenostomy for DA, during which a Y-shaped biliary duct was found. The patient grew up well postoperatively, and she was followed up at our institution until the age of 12 years. At the age of 24, she was reintroduced to our institution for multiple hepatic tumors and was diagnosed with GC and multiple liver metastases. Simultaneously, a pancreaticobiliary maljunction (PBM) without a choledochal cyst was also identified. She received palliative care and died two months later. Although reports of combined DA and PBM are rare, the combination should not be overlooked, given the carcinogenic risk of PBM. DA with pancreaticobiliary anomalies requires attention to the possibility of PBM during the postoperative follow-up.

Congenital herniation of the liver through the chest wall associated with chest wall deformity is an extremely rare clinical observation. There are only a few reports of intercostal liver herniation associated with Poland syndrome, which is characterized by hypoplastic unilateral chest wall structures. We present a case of a neonate with a mass drooping through a defect in the left side of the chest wall with diaphragmatic eventration. The patient demonstrated a left-sided hypoplastic pectoralis musculature defect and an ipsilateral costal cartilage defect in the left side of the sternum at the level of the fifth to sixth ribs. The radiological investigation revealed that the mass was a result of herniation of the left lobe of the liver. On the day after birth, resection of the mass was performed by laparotomy because the color of the mass gradually changed to a dark red appearance, and incarceration and necrosis were suspected. There were no intraoperative or postoperative complications. Postoperatively, the diaphragm was concluded to have normal movement on radioscopic examination.

The patient was an 11-month-old boy. He has been followed up at an outpatient clinic for inguinal hernia. He visited at our emergency room because of multiple episodes of vomiting. After receiving a diagnosis of incarcerated hernia, he underwent emergency surgery under general anesthesia. Intraoperative findings showed that not only the appendix but also the cecum, ascending colon, and end of the ileum had herniated, so we diagnosed him with expansive Amyand's hernia. None of the intestine was necrotic, and intestinal resection was not necessary, but there was significant ileocecal dilatation. Therefore, we resected the appendix and inserted a flexible catheter through the root of appendix to decompress the ileocecal lumen. If the ultrasound sonography at outpatient clinic had shown an appendix-like intestine with proper attention, we may have been able to diagnose him with expansive Amyand's hernia. It is crucial to check the diagnosis of hernia but also detailed contents of the hernia sac carefully by ultrasound sonography. If the appendix is confirmed with the intestine in the hernia sac, we should consider early elective surgery to avoid an emergency operation.

Foreign body ingestion in trachea is a common occurrence in children. However, pharyngeal foreign bodies are rare. Unlike the trachea, the lumen of the pharynx is not kept patent by tracheal cartilage. Therefore, it is difficult to distinguish the lumen of the pharynx from the surrounding tissues. In addition, tracheal foreign bodies are photographed in the lung window, so radiolucent objects may be seen, but the pharynx in the mediastinal window may sometimes appear to be invisible. If a pharyngeal foreign body is suspected, then it is important to obtain a CT scan of the neck and to also obtain a lung window image. However, the most important thing is not to rely on CT alone, but to also use endoscopy when necessary.

Background: To assess the actual experiences of long-term follow-up and discuss ways to improve care during the period from childhood to adulthood in newborns who have undergone surgery. Methods: A total of 306 patients with congenital anomalies requiring newborn surgery who survived to discharge from 1994 to 2013 were eligible for inclusion. Survivors with severe chromosomal and cardiac anomalies were excluded. Patients with myelomenigocele, urogenital anomalies and miscellaneous diagnoses were also excluded. Patients with Hirschsprung’s disease were excluded since many of them underwent surgery after the neonatal period. Patients with hypertrophic pyloric stenosis were also excluded since their duration of follow-up was too short for this study. Results: According to the follow-up status, survivors were categorized into 4 groups: under follow-up as an outpatient (UF, n = 67), moved (MV, n = 60), follow-up suspended by doctor (Sus, n = 87), and lost to follow-up (LF, n = 92). The incidence of active medical problems was high, and the duration of follow-up was significantly longer in the survivors with esophageal atresia, congenital diaphragmatic hernia and high-type anorectal malformations than in those with other anomalies. Survivors followed by pediatric surgeons alone, free from active medical problems or free from adverse events during the initial hospitalization were at risk of being LF. Conclusions: More than 30% of the surgical newborn cases were LF. Disease-specific and standardized multidisciplinary follow-up programs that increase both children’s and parents’ satisfaction and compliance are needed. (230/250 words).

Crohn's disease is a rare cause of appendicitis. In this report, we describe a case of Crohn's disease that was diagnosed 4 months after surgery for acute appendicitis in a 15-year-old boy. He was followed carefully after surgery, because the pathological findings showed the presence of a granuloma, which may imply Crohn's disease. At four months after surgery, he visited our hospital with a chief complaint of diarrhea. Lower gastrointestinal endoscopy revealed longitudinal ulcerative lesions in the entire colon. Taken together with the pathological findings of the appendix, the patient was diagnosed with Crohn's disease. The patient is currently on a continuous infliximab regimen.In the present case, although there were no symptoms at the time of surgery, we informed the patient and his parents of the pathology results in advance, and told them to return to our clinic as soon as symptoms appeared. The pathological diagnosis led to an early diagnosis of CD. Although rare, Crohn's disease should be kept in mind as a cause of appendicitis.

We report a case of a 12-year-old boy with an accessory spleen torsion. He presented with left-sided abdominal pain after trauma. A 4 cm oval mass without contrast enhancement was detected on contrast-enhanced computed tomography (CT), and ultrasound (US) showed a 4 cm oval mass below the spleen. The mass mainly consisted of high echoes similar to the spleen; the central part showed irregularly low echoes. Subsequent follow-up daily US examinations showed gradual expansion of the central low echoes with conspicuous hyperechoic dots. Discontinuation of the branch from the splenic artery to the mass was observed, both, on US and CT. These findings led to the diagnosis of a hemorrhagic infarct caused by torsion of the accessory spleen. Laparoscopy showed adherence of the accessory spleen to the omentum and colon by twisting four times around its axis. It was resected and confirmed the diagnosis of a torsioned accessory spleen.

Background: Treatment modalities for neonates with congenital diaphragmatic hernia (CDH) have greatly improved in recent years, with a concomitant increase in survival. However, long-term outcomes restrict the identification of optimal care pathways for CDH survivors in adolescence and adulthood. Therefore, we evaluated the long-term outcomes within the Japanese CDH Study Group (JCDHSG). Methods: Participants were born with CDH between 2006 and 2018 according to the JCDHSG. Participants were enrolled in the database at 1.5, 3, 6, and 12 years old. Follow-up items included long-term complications, operations for long-term complication, and home medical care. Results: A total of 747 patients were included in this study, with 626 survivors (83.8%) and 121 non-survivors (16.2%). At 1.5, 3, 6, and 12 years old, 45.4%, 36.5%, 34.8%, and 43.6% developed complications, and 20.1%, 14.7%, 11.5%, and 5.1% of participants required home care, respectively. Recurrence, pneumonia, pneumothorax, gastroesophageal reflux disease, and intestinal obstruction decreased with age, and thoracic deformity increased with age. Conclusions: As CDH survival rates improve, there is a need for continued research and fine-tuning of long-term care to optimize appropriate surveillance and long-term follow-up.

Adenomyoma of the gastrointestinal tract is a rare tumor-like lesion, which occasionally leads to intussusception if it occurs in the small bowel. We report a case of ileal adenomyoma causing intussusception in a 16-month-old boy. The patient was treated by enema reduction; however, he immediately experienced recurrence of intussusception. An intestinal mass with multiple small cysts was detected by ultrasonography, suggesting the presence of a lead point. Partial enterectomy was performed to resect the mass and Meckel's diverticulum, which was incidentally found 10 cm distal to the mass. The histopathological diagnosis was adenomyoma of the small intestine and Meckel's diverticulum with gastric heterotopia. This is a rare case of adenomyoma and Meckel's diverticulum occurring at separate locations. While adenomyoma of the small intestine has a good prognosis, our case also followed an uneventful postoperative course.

Spermatic cord torsion in children is a urological emergency that requires operation and fixation within 6 h. Ultrasound sonography allows for the diagnosis of torsion in the early stages; however, some cases are sometimes overlooked and necrotize. While two peaks of onset have been reported (in the neonatal period and adolescence), attention must be paid to prepubertal children as well. Torsion manifests in two ways: as extravaginal torsion (EVT) and intravaginal torsion (IVT). EVT is common in newborns, and IVT is common in adolescents. Bell clapper deformity is thought to be a major cause of IVT. The bell clapper theory describes an anatomical anomaly wherein the testis is freely suspended, leading to its rotation. In EVT, spermatic cord twisting occurs outside of the tunica vaginalis because of a loose connection of the testis to the scrotum in newborns. However, we highlight the fact that IVT can also occur in prepubertal children. A one-year-old and three-year-old boy were admitted to our hospital with testicular pain as the chief complaint. Ultrasonography did not reveal any whirlpool sign. A physical examination showed apparent symptoms of testicular torsion; we therefore performed an emergency operation. We found both boys to be suffering from IVT-type torsion. We corrected the rotation and attempted an ultimately unsuccessful reperfusion. Both testes had bell clapper deformity and were torn in a narrow space. This small space can induce a steep and narrow pitch of torsion far beyond the detectability of ultrasonography. In prepubertal cases, we must pay attention to cases of torsion with no signs of whirlpools after ultrasonography.

Abstract Background Currently, there is no consensus regarding the optimal therapeutic strategy for the management of an ectopic lingual thyroid. A surgical approach is suggested when airway obstructive symptoms cannot be tolerated at all, or when bleeding or malignancy occurs. However, for patients in whom ectopic thyroid is the only functioning thyroid tissue, complete surgical excision needs to be followed by lifelong hormone replacement therapy. We report the case of an infant with ectopic lingual thyroid obstructing the airway that was treated using our novel surgical procedure. Case presentation A 10-day-old male infant presented with symptoms of airway obstruction and subclinical hypothyroidism. Imaging tests revealed an ectopic lingual thyroid and the absence of a normal pretracheal thyroid gland. We administered oral levothyroxine to lower his thyroid stimulating hormone (TSH) level and reduce the volume of the lingual mass; however, his airway symptoms did not improve. Subsequently, we performed a surgical intervention when he was 2 months old. We split the hyoid bone, and then suspended the lingual thyroid by suturing it to the hyoid bone to elevate the epiglottis. We confirmed the degree of suspension using intraoperative laryngo fiberscopy. After the surgery, the symptoms of airway obstruction were resolved and the patient was clinically euthyroid on low-dose oral levothyroxine. Conclusions Our laryngo fiberscopy-guided suspension procedure can be an effective surgical procedure for the treatment of ectopic thyroid. This relatively simple surgical procedure could completely preserve the patient’s thyroid tissue and resolve airway obstruction.

Abstract Background Nonoperative management (NOM) has been established as the standard treatment for isolated blunt organ injury in hemodynamically stable pediatric patients. Although delayed splenic rupture or bleeding is a rare complication in NOM, it is an issue that many pediatric surgeons are greatly concerned about. We herein report a rare pediatric case concerning the mechanisms involved in delayed splenic rupture after NOM. Case presentation A 9-year-old boy with severe abdominal pain was transferred to our hospital. Twenty-one hours before the admission, he had been kicked in the region of his left lateral abdomen. Contrast-enhanced abdominal computed tomography revealed a severe intra-parenchymal hematoma and multiple lacerations of the spleen with a large amount of hemoperitoneum without active bleeding. His condition was diagnosed as a grade III injury on the AAST splenic injury scale. After fluid resuscitation, his vital signs became stable. The patient was treated with NOM in our intensive care unit. However, suddenly after defecation (72 h after the injury), he started complaining of severe abdominal pain and left shoulder pain. His blood pressure dropped to 70/35 mmHg, and he started to lose consciousness. Abdominal ultrasonography (US) revealed increased ascites. Fluid resuscitation and blood transfusion were performed. His symptoms and abdominal US findings suggested that splenic re-bleeding had caused delayed splenic rupture to occur. Emergency splenectomy was performed. The resected spleen was enlarged with a large parenchymal hematoma. The posterior-lateral side of the splenic capsule was ruptured. Conclusions The mechanism of delayed splenic rupture in our case was considered to be the result of a tear in the subcapsular hematoma caused by stretching the splenocolic ligament related to a bowel movement during defecation. Although delayed splenic rupture or bleeding is unpredictable, it is very important to understand the mechanisms and to educate the family of the children with splenic injuries of the warning signs of delayed rupture or bleeding.

A 30-day-old female infant presented with a cystic lesion at the porta hepatis. The cyst was first detected on a prenatal ultrasound at 16 weeks of gestation and diagnosed as congenital biliary dilatation. The size of the cyst did not change over the course of gestation and the infant's liver function was stable after birth, although she had a persisting yellowish stool. Surgical cholangiography was performed at 30 days, and a complete obstruction of the hepatic hilum was identified as a type IIId cyst. However, cholangitis recurred at 10 months post-surgery, with marked dilation of the right and left hepatic ducts. Right cyst-intestinal anastomosis and left cyst-gastric anastomosis were performed. Cyst recurrence is sometimes a complication in patients with type III biliary atresia who undergo the Kasai procedure. The mechanisms of cyst formation are still unknown, and there is no consensus regarding the treatment. Our case suggests that cysto-enterstomy is a feasible treatment for recurrent cysts.

Abstract Background Current treatment options for lymphatic malformations (LMs) are multimodal. Recently, the effectiveness of treating LMs with Eppikajyutsuto (TJ-28) has been reported. TJ-28 is a kind of oral herbal medicine classified as the traditional Japanese Kampo medicine. Case presentation A 12-year-old girl was admitted to our hospital for intermittent upper abdominal pain. Radiological examinations revealed a large (9.5 × 5.8 × 10.0 cm) retroperitoneal LM, which was suspected to adhering and stretching both pancreas head and duodenum. The large retroperitoneal tumor resection might induce involving complications because of the size and the location. Therefore, we used TJ-28 in order to diminish the tumor size before surgery. The patient received oral doses of 7.5 g/day (2.5 g × 3 times/day) of TJ-28. Six months after the medication, the tumor decreased markedly to 3.5 × 1.5 × 1.2 cm in size. Thereafter, the mass was sub-totally resected (95%) via a 3 cm trans-umbilical incision without any surgical complications. Conclusions We reported a case of successfully treated retroperitoneal LM with the combination treatment of TJ-28 and surgery. Based on our experience, this TJ-28 treatment option may be very useful in treating cases of LMs having surgical difficulties because of size and/or location.

Objective: To establish better management practices to reduce morbidities in survivors with congenital diaphragmatic hernia (CDH). Methods: Of 60 patients treated for CDH at our institution between 1991 and 2011, 49 patients without severe anomalies were retrospectively reviewed. Results: Since 2004, gentle ventilation (GV) has been the main treatment for CDH. Patients were divided into the following two groups: the non-GV group (n = 29) who were treated before GV treatment was implemented, and the GV group (n = 20). The overall survival rate was 62.1% (18/29) and 95% (19/20) in the non-GV and GV groups, respectively (p = 0.016). Despite the high survival rate, the incidence of long-term complications in survivors was still high (14/19, 73.7%) in the GV group. In the GV group, liver-up (p = 0.106) and the need for patch repair (p = 0.257) tended to be associated with the development of long-term complications, but did not reach statistical significance. The presence of perioperative complications was associated with the development of long-term complications (p = 0.045) in the GV group. Conclusion: Patients who developed short-term complications seemed to be at risk of long-term complications. Therefore, to minimize long-term morbidities in CDH survivors, the prevention of short-term complications might be important.

We herein report a neonate who presented with non-bilious vomiting at one day of age caused by a prepyloric ectopic pancreas. Ultrasonography clearly detected the presence of a submucosal mass preoperatively, which was treated with local gastric resection. Only 9 neonates with a symptomatic pyloric or prepyloric ectopic pancreas have been previously reported in the literature. Therefore, we reviewed and discussed the clinical features of neonates with this type of ectopic pancreas.

We herein report the case of a 21-day-old boy in which the detection of an intramedullary spinal cord abscess led to the diagnosis of Currarino syndrome (CS). He had a complete phenotype of CS, including sacral agenesis, an anorectal malformation, a presacral mass, and spinal cord malformations. In addition, he had an intramedullary spinal cord abscess. Intramedullary spinal cord abscess is rare in CS and is thought to require immediate intervention. Therefore, we additionally reviewed the available literature and discussed the therapeutic approach for CS with an intramedullary cord abscess.

Colonic volvulus is a rare disease in children. Delayed diagnosis of the condition can often be fatal, especially in pediatric patients with mental retardation. We herein present the case of a female pediatric patient with colonic volvulus, prune belly syndrome, and mental retardation. Preoperative CT scans showed the characteristic signs of this disease. The volvulus occurred in the proximal colon of the colostomy. The release of the colonic volvulus and reconstruction of the colostomy were performed without the resection of the ischemic colon. The postoperative clinical course was uneventful.

The familial clustering of multinodular goitres (MNGs) with a dominant mode of inheritance has been repeatedly reported. Linkage studies have revealed several genetic loci responsible for familial MNG; however, most of the causative variants remain unknown.Through linkage analysis using single-nucleotide polymorphism markers, we identified a new MNG locus on 19p13.2-q12 in a five-generation Japanese MNG family. Subsequent mutation searches focusing on the candidate 25-Mb region of chromosome 19 identified a heterozygous mutation, c.879_880delinsA, p.Asp294Thr, fs*23, in exon 3 of the KEAP1, which plays a central role in the cytoprotection pathway against oxidative stress. Reverse transcriptase-PCR analysis showed low expression of wild type KEAP1 accompanied by no transcription product of mutant allele in the normal and goitre region of thyroid tissues obtained from the proband. In agreement with previous studies showing that KEAP1 negatively regulates NFE2L2, the NFE2L2 target genes GSTA4 and GCLC were up-regulated in the thyroid tissues of the patient.This study identified the first KEAP1 mutation in MNG. The results provide insights into the pathogenesis of goitre which develops in the organ continuously exposed to oxidative stress during hormone synthesis.

Cow's milk allergic enterocolitis is a common paediatric gastrointestinal disease. However, radiological findings from contrast studies have rarely been reported. We report two Japanese neonate patients with cow's milk allergic enterocolitis with vomiting, bloody stool and unique findings on upper gastrointestinal contrast study. Upper gastrointestinal contrast study showed folds of the small intestine to be thickened, such as in spasm, or ribbonlike cords in both cases. There was also poor passage from the duodenum to the jejunum in one case. In addition, there were spastic findings on lower gastrointestinal contrast study in part of the large colon in one case. Clinicians, including paediatric surgeons, treating neonates with bloody stool and/or vomiting should thus be aware that unique findings on upper and lower gastrointestinal contrast studies may be useful in suspecting cases with cow's milk allergic enterocolitis.

We report our experience with two cases of adrenal cytomegaly, both of which were detected as cystic adrenal masses during prenatal ultrasonographic examinations. In Case 1, a left suprarenal cystic mass was detected in the fetus at 25 weeks of gestation. The mass, measuring 7 cm in diameter, did not show any change in size and was resected 26 days after birth. In Case 2, a right suprarenal lesion was found at 30 weeks of gestation. The cystic lesion, measuring 2 cm × 1.5 cm, did not change in size and was resected 3 months after birth. Adrenal cytomegaly is still not well known. It is characterized by the presence of large polyhedral cells with eosinophilic granular cytoplasm and enlarged nuclei in the adrenal cortex. This condition is thought to be a degenerative process but not a malignancy. Adrenal cytomegaly rarely forms cysts. It seemed to be impossible to diagnose preoperatively in our cases. Because of the difficulty of differentiating between cystic adrenal cytomegaly and other cystic diseases such as neuroblastoma, operative intervention is required in cases where the cysts do not decrease in size. Further study of a larger number of cases is needed to establish an optimal treatment protocol for these tumours.

A sensor chip that can detect enzyme electrode reactions with a sample volume as small as 20 μL has been developed using screen-printing technology with porous silica spheres (PSSs). PSSs are spherical particles of silica with mesoporous pores, a material with a large specific surface area. Other material properties of PSSs include good dispersibility, high mechanical strength, and the ability to be synthesized with precisely controlled mesopore sizes. These advantages support the increased adsorption of enzymes to create highly sensitive sensors. The electrode was designed as follows: carbon paste (CP) with PSSs was used as the working electrode, glucose dehydrogenase (GDH) was used as the enzyme, and quinoline-5,8-dione (QD) was used as the mediator of electron transfer to induce a glucose dehydrogenation reaction. The sensitivity of the sensor was demonstrated through the detection of glucose. The glucose sensor showed reliable sensitivity between 1 and 60 mM glucose, which is comparable to the detection range of a traditional working electrode such as platinum. Furthermore, the GDH had a minimal reduction in activity over repeated usage. This device demonstrates the ability to create an equally sensitive but less expensive and reusable sensor that has the potential to better suit general applications. [ABSTRACT FROM AUTHOR]