Streptococcus dysgalactiae subsp.equisimillis (SDSE) is classified as a group G streptococcus (GGS).In systemic SDSE infection, septic shock is easily induced and has a high mortality of 44%.The case was a 78-year-old man presented with fever and chills of 20 hours duration.He was in shock at the presentation and developed melena on day nine.CT images showed bowel wall thickening with emphysema and bedside colonoscopy showed active bleeding in the descending colon and rectum.Blood cultures were positive for Streptococcus dysgalactiae and a diagnosis of streptococcal toxic shock syndrome (STSS) due to SDSE was made.Urgent Hartmann procedure with laparotomy for removal of descending and rectal colon was performed to relieve his shock status.His shock status was reversed after surgery.Surgical specimens confirmed the presence of SDSE on the intestinal mucosa.This is the first case of STSS due to SDSE infection of the intestinal wall.Resection of infected tissue in the setting of multiple organ dysfunction syndrome and necrotizing enterocolitis is indicated in such cases.

We present a new, scarless, circular incisional approach around the umbilical cord for neonates with intestinal atresia. This novel approach achieves truly woundless surgery. It is simple, safe, and can be used for an intestinal surgical treatment in neonates.

A 57-year-old man was admitted for careful examination of lower limb edema. Abdominal computed tomography(CT) showed hepatocellular carcinoma(HCC), 2 cm in diameter, arising in liver segment S6. Posterior segmentectomy was performed, and histological examination of the specimen revealed poorly differentiated HCC. Nine months after surgery, a metastatic tumor was detected in the left scapula, and the patient gradually began to show a high blood concentration of hemoglobin and erythropoietin(Epo). Sorafenib was started but was discontinued because of intractable diarrhea. The patient died of the metastatictumor 15 months after surgery. This is the first case report of a patient with metastaticHCC developing erythrocytosis associated with a high concentration of Epo.

Our patient was a 58-year-old man who was diagnosed with a large bowel obstruction caused by ascending colon cancer, together with multiple liver metastases for which a right hemicolectomy was performed. After the operation, he developed disseminated intravascular coagulation(DIC)and severe anemia. Bone marrow biopsy findings led to a diagnosis of disseminated carcinomatosis of the bone marrow caused by colon cancer. We administered S-1+oxaliplatin(SOX) and bevacizumab( BV)chemotherapy, which improved the DIC. The patient was discharged from the hospital. After a total of six courses of chemotherapy, the carcinoma became resistant. We changed the drug regimen and his clinical condition improved. He survived for 292 days from the onset of disease.

Although familial occurrence of congenital pyloric atresia (CPA) has been frequently reported in the past, many of these cases were associated with epidermolysis bullosa (EB), and familial isolated CPA was a relatively rare condition. We prenatally diagnosed and successfully treated a sibling of a subject with isolated CPA, who was diagnosed prenatally by fetal ultrasonography based on the findings of a distended stomach combined with polyhydramnios. The first case was a 2398-g female infant born at 36 weeks of gestation, who had been prenatally diagnosed as CPA. The second case, a younger sister of the first case, was a female infant weighing 2434 g, who had been also diagnosed as CPA by fetal ultrasonography at the check-up for the polyhydramnios of the same mother. Neither of the infants showed dermal lesions such as EB, and both underwent pyloroplasty with an excision of the pyloric membrane successfully after birth.

Pediatrics InternationalVolume 53, Issue 2 p. 247-248 Living-donor liver transplantation using hyper-reduced graft for a neonatal fulminant hepatic failure Kazunari Sasaki, Corresponding Author Kazunari Sasaki Departments of Transplantation SurgeryKazunari Sasaki, MD, Department of Transplantation Surgery, National Center for Child Health and Development, 2-10-1 Okura, Setagaya City, Tokyo 157-8535, Japan. Email: sasaki-kz@ncchd.go.jpSearch for more papers by this authorMureo Kasahara, Mureo Kasahara Departments of Transplantation SurgerySearch for more papers by this authorAkinari Fukuda, Akinari Fukuda Departments of Transplantation SurgerySearch for more papers by this authorTakuya Kimura, Takuya Kimura Departments of Transplantation SurgerySearch for more papers by this authorTakanobu Shigeta, Takanobu Shigeta Departments of Transplantation SurgerySearch for more papers by this authorHideaki Tanaka, Hideaki Tanaka Pediatric SurgerySearch for more papers by this authorSatoshi Nakagawa, Satoshi Nakagawa Intensive CareSearch for more papers by this authorSyuichi Ito, Syuichi Ito NephrologySearch for more papers by this authorAtsuko Nakagawa, Atsuko Nakagawa Pathology, National Center for Child Health and Development, Tokyo, JapanSearch for more papers by this author Kazunari Sasaki, Corresponding Author Kazunari Sasaki Departments of Transplantation SurgeryKazunari Sasaki, MD, Department of Transplantation Surgery, National Center for Child Health and Development, 2-10-1 Okura, Setagaya City, Tokyo 157-8535, Japan. Email: sasaki-kz@ncchd.go.jpSearch for more papers by this authorMureo Kasahara, Mureo Kasahara Departments of Transplantation SurgerySearch for more papers by this authorAkinari Fukuda, Akinari Fukuda Departments of Transplantation SurgerySearch for more papers by this authorTakuya Kimura, Takuya Kimura Departments of Transplantation SurgerySearch for more papers by this authorTakanobu Shigeta, Takanobu Shigeta Departments of Transplantation SurgerySearch for more papers by this authorHideaki Tanaka, Hideaki Tanaka Pediatric SurgerySearch for more papers by this authorSatoshi Nakagawa, Satoshi Nakagawa Intensive CareSearch for more papers by this authorSyuichi Ito, Syuichi Ito NephrologySearch for more papers by this authorAtsuko Nakagawa, Atsuko Nakagawa Pathology, National Center for Child Health and Development, Tokyo, JapanSearch for more papers by this author First published: 19 April 2011 https://doi.org/10.1111/j.1442-200X.2010.03218.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume53, Issue2April 2011Pages 247-248 RelatedInformation

We describe our new technique for laparoscopic herniorrhaphy with subumbilical single-site access to treat inguinal hernias in children. First, we inserted a transparent 3-mm trocar and a 2-mm minitrocar at the umbilicus. We then inserted a 3-mm 45° camera through the 3-mm trocar and needle-grasping forceps through the 2-mm trocar. We closed the hernia defect by using a 19-gauge hooked injection needle with a nonabsorbable suture. We treated 11 consecutive female children with inguinal hernia using this operation. The mean operating time was 26.7 min (range 21–36 min) and the procedure was technically successful, without the need for additional trocars, in all 11 patients. There were no intraoperative complications and all the patients were discharged on the same day after the surgery. Single-site laparoscopic herniorrhaphy using needle instruments is feasible and seems to be safe. Further studies are required to determine whether this approach would benefit patient compared with standard laparoscopic herniorrhaphy.

Purpose This study analyzed the inside appearance of the trachea and the main bronchus at the time of performing the Nuss procedure to test the hypothesis that the trachea and the main bronchus might be deformed by compression from great vessels due to sternal depression.Methods A retrospective cohort study included 36 patients with pectus excavatum, who were treated using the Nuss procedure between July 2001 and December 2009. The primary outcome measures were the oblateness of the trachea and bilateral main bronchus. The oblateness in patients with pectus excavatum was compared with that of the control group. Their postoperative changes and the relationship between the Haller CT index were also analyzed.Results The oblateness of the trachea and the left main bronchus in patients with pectus excavatum was significantly greater than that of the control group. A negative correlation was recognized between the percent vital capacity and the oblateness of the left main bronchus. The oblateness of the bilateral main bronchus significantly improved during the 2 years of bar placement.Conclusion A significant deformation of the airways was demonstrated in patients with pectus excavatum, which improved after correcting it by means of the Nuss procedure.

Background Duct-to-duct biliary reconstruction (DD) is currently a standard procedure in adult live donor liver transplantation (LDLT). Its pediatric feasibility, however, has rarely been reported. The goal of this study is to assess the incidence and treatment of biliary complication after pediatric LDLT with DD or Roux-en-Y hepaticojejunostomy (RY). Method Sixty children received LDLT between November 2005 and June 2008, and their database was reviewed. Results Biliary reconstruction was achieved with DD in 14 patients and with RY in 46 patients with mean follow-up period of 26.0 and 22.3 months, respectively. The incidence of biliary leakage in the DD and RY groups was 7.1% and 8.7%, respectively, and that of stricture was 28.6% and 10.9%, respectively; but the differences were not statistically significant. Biliary stricture in the DD group tended to require revision surgery with RY and longer treatment with percutaneous transhepatic cholangiodrainage compared with that in the RY group. Conclusion Theoretical advantages of DD over RY were not confirmed in this study. Duct-to-duct biliary reconstruction tended to encounter more biliary complications, especially stricture, with more difficulty in treating it than RY. Roux-en-Y hepaticojejunostomy seems preferable to DD in the setting of pediatric LDLT, but DD must be considered when making new Roux-en-Y limb seems impossible or troublesome owing to abdominal dense adhesion or short bowel syndrome.

NICCD is an autosomal recessive genetic disorder, characterized by cholestasis, coagulopathy, hypoglycemia, fatty liver and multiple amino acidemia. NICCD develops in the neonatal/infantile period and has been reported as a "naturally curable" disease within one yr of life. Recently, we experienced an infantile NICCD who developed progressive liver failure, and required subsequent LT using a heterozygote living donor at eight months of age. Diagnosis of NICCD was established before transplantation, and donor evaluation included mutation in the SLC25A13 gene for exclusion of individuals with citrin deficiency citrullinemia. LDLT, from blood type identical mother using a left lateral segment graft, was performed without serious complication. Plasma amino acid concentration was normalized rapidly, and the patient was discharged 30 days after transplant. During one yr follow up, the recipient has been doing well without additional medication for NICCD. NICCD should be considered in the differential diagnosis as a cause of neonatal/infantile cholestatic disease. LT using a heterozygote living donor is an effective alternative in countries where a deceased donor is not available.

INTRODUCTION:Induction therapy with daclizumab or alemtuzumab has been recently introduced for intestinal transplantation; however, the impact of such induction therapy on bacterial infections remains to be clarified. The purpose of this study was to evaluate the impact of induction therapy on the incidence of bacterial infections and long-term patient survival.PATIENTS AND METHODS:Over the past seven yr, we performed 39 intestinal (ITx) and multivisceral (MTVx) transplants in 38 adult patients. In the early period, daclizumab was used for induction, and tacrolimus and steroids were administered for maintenance [daclizumab and tacrolimus (DT) group; n = 11]. From 2002, we used alemtuzumab for induction, with low-dose tacrolimus maintenance [alemtuzumab and tacrolimus (AT) group; n = 23]. The incidence of bacterial infections and patient outcome were compared between the two groups.RESULTS:There were no significant differences in recipient and donor demographics, procedure (ITx vs. MTVx), and cold and warm ischemic time between the two groups. Within 30 d after ITx, bacterial infections were observed in seven patients (64%) in the DT and in 14 patients (64%) in the AT group. Between 30 and 180 d after ITx, a total of 17 episodes of bacterial infections were observed in the DT and 26 episodes in the AT group. Three patients in the DT and eight in the AT group died, and all of the deaths were related to infectious complications except one each in DT and AT.CONCLUSION:There was no difference in incidence of bacterial infections and long-term patient survival between the two groups.

はじめに: イタリアのボローニア大学S'Orsola-Malpighi附属病院で過去7年間に脳死ドナーから成人の小腸単独移植を28例 (29移植) に行ったので報告する. 方法: 原疾患は短腸症候群と小腸機能不全が29移植中27移植 (93%) で, 移植の適応としては中心静脈アクセスの確保不能, 中心静脈栄養に関連した合併症 (繰り返す感染症, 肝機能障害) が20例 (69%) を占めた. 免疫抑制剤はdaclizumab, alemtuzumab, antithymocyte globulinのいずれかをinductionに用い, tacrolimusを維持に用いた. Daclizumab投与例ではプレドニゾロンも併用した. 結果: 患者/グラフトの5年生存率は74%/71% であった. 拒絶反応は13例に認め, 全例にステロイドパルス療法を, 2例にはOKT3を追加投与したが, 1例は回復せず, graftの摘出を要した. 6例死亡したが (中央値: 400日) 敗血症3例, アスペルギルス肺炎2例, CMV腸炎による多発穿孔1例とすべて感染症関連であった. 生存例22例中19例は中心静脈栄養を必要とせず, 経口摂取で生活し, 生活の質が保たれていた. 考察: 成人の小腸単独移植は, induction therapyの導入や適応の選択などで他の臓器移植とほぼ同じ生存率を得ることが可能となってきた. 小腸移植は小腸機能不全や短腸症候群患者における有用な選択枝となりえるが, 拒絶反応, 感染症で失う症例も多く, さらなる工夫が必要である.

Background/Aims: Patients with hepatocellular carcinoma on the waiting list for liver transplantation are excluded due to causes related to liver failure and tumor progression. We analyze the various factors to Suggest a new liver transplant priority.Methodology: We evaluated the outcome on the list of 309 patients with hepatocellular carcinoma and causes of drop-out from the list were divided as death, "too sick" and tumor progression. The impact of model for end stage liver disease score, tumor stage and waiting time on the causes of drop-outs was evaluated.Results: During the Study period, 197 patients had a liver transplantation, 50 were still on the list and the remaining 62 were removed from the list (28 deaths, 30 tumor progressions, and 4 "too sick"). The receiver operating characteristic curves analysis showed that the model for end stage liver disease score predicted the rate of deaths on the list at 1-year (p < 0.001). The waiting time and the tumor stage predicted the rate of drop-outs for tumor progression at 1-year on the list (p < 0.05).Conclusions: Patients with hepatocellular carcinoma on the waiting list should have priority based on their model for end stage liver disease score, waiting time with tumor and tumor stage.

Volvulus of the gallbladder has been reported mostly in elderly women and is rarely reported in children. In this paper, we report a recent case of successful detorsion and removal of the gallbladder via minimal access surgery, which was diagnosed as gallbladder volvulus preoperatively by means of magnetic resonance imaging (MRI). An 11-year-old boy presented with an acute abdomen, and acute cholecystitis was suspected, based on the findings of ultrasound and computed tomography. However, a diagnosis of gallbladder volvulus was established through MRI, and emergency laparoscopic surgery was subsequently performed. Laparoscopy revealed a hemorrhagic, gangrenous gallbladder that floated anteriorly. The gallbladder was rotated twice around its pedicle in a counterclockwise direction. It was untwisted through laparoscopy, and a cholecystectomy was performed without difficulty. To achieve an early, prompt preoperative diagnosis, MRI could be an effective alternative to conventional imaging modalities. The advent of laparoscopic detorsion and cholecystectomy as a treatment for gallbladder volvulus allows less invasive treatment, a shorter hospital stay, and better cosmesis, which are highly desirable in children.