A New Convergent Route to Aldohexoses from a Common Chiral Building Block

[reaction in text] A diastereocontrolled route to the eight aldohexoses has been developed starting from a common cyclohexanoid chiral building block.

Fecal incontinence successfully managed by antegrade continence enema in children: a report of two cases

Two children with intractable fecal incontinence after correction of high anorectal malformations were successfully managed by the daily administration of a glycerin enema into the cecum via an appendicocecostomy or tubularized cecostomy, according to the method of Malone's antegrade continence enema (ACE). Fluoroscopic defecography performed during this procedure in each patient disclosed that the glycerin enema promptly evoked cecal peristalsis, which was transmitted to the distal colon and rectum, and squeezed out almost all the fecal matter, evacuating it from the anus. However, two enemas within a short interval were required to achieve a complete washout of feces. Although this report describes only two patients, our experience confirmed that the ACE was very effective and that adding the word "continence" to antegrade enema was justifiable. Moreover, fluoroscopic defecography was proven to play a significant role in determining the appropriate regimens of this technique to achieve complete washout of the feces.

An intestinal fistula in a 3-year-old child caused by the ingestion of magnets: report of a case

We describe herein the case of a 3-year-old child in whom a jejunoileal fistula was caused by the ingestion of magnets. This case report demonstrates that if more than one magnet is found as a foreign body in the intestine, they should not be left untreated even if there are no sharp edges and, it seems they could be evacuated spontaneously. This recommendation is made because the magnets will attract each other and hold the intestinal walls between them, causing necrosis and resulting in intestinal perforation or a fistula.

Surgical resection for pyriform sinus fistula

There has been no established operative procedure for pyriform sinus fistula because of its rarity. Recurrence may occur even after neck exploration. We successfully managed six pediatric cases with this disease without any complications or recurrences. Our experience indicates that exposing the inferior cornu of thyroid cartilage with its covering muscles facilitates resection of the proximal portion of this fistula.

Portal circulation and the function of hepatocytes during ex vivo perfusion of the rat liver preserved for six hours after core cooling

Portal circulation and the function of hepatocytes during isolated organ perfusion were compared between the rat liver perfused immediately after extirpation and the liver perfused after core cooling and six hours of preservation. Nine rat livers were extirpated after core cooling, preserved for six hours in University of Wisconsin (UW) solution at 4 degrees C and then were connected to a perfusion chamber (hypothermic preservation group: 6-hr HP group). Six rat livers were immediately connected to the perfusion chamber after extirpation (control group). During 60 minutes of isolated liver perfusion, both portal circulation and the function of hepatocytes were determined every 10 minutes. Portal vein resistance increased and portal blood flow decreased during the first 20 minutes of perfusion and then stabilized in both groups. Portal vein resistance was significantly higher and portal blood flow was significantly lower for the first 10 minutes of perfusion in the 6-hr HP group, compared to the control group. The function of hepatocytes, determined by the rate of elimination of ammonia, oxygen consumption, and glucose availability were depressed in the 6-hr HP group, compared to the control groups during isolated liver perfusion. However, there was no statistically significant difference of portal perfusion and the function of hepatocytes between the two groups at the end of perfusion. The results of the present study indicate that the rat liver can be preserved in a satisfactory condition for six hours by the use of hypothermic preservation, coupled with core cooling.

Hepatoblastoma in neonates: report of a case and review of the Japanese literature

A female infant who presented with abdominal distention and jaundice at the age of 2 days underwent resection of a large hepatoblastoma at the age of 8 days by a right trisegmentectomy. Although postoperative adjuvant chemotherapy was not given, the patient is now alive without disease 10 months after surgery. We were able to find only 10 other cases of hepatoblastoma occurring in the newborn period in the Japanese literature. Resection of the tumor was performed in seven of these patients, of whom there were five survivors, one operative death and one death due to tumor recurrence. However, none of the three patients treated conservatively survived. Thus, we suggest that in newborns with hepatoblastoma, resection of the tumor should be performed, if feasible, but believe that postoperative chemotherapy is not necessary for patients whose tumor has been completely resected.

Metachronous bilateral adrenal neuroblastoma

A boy with bilateral adrenal neuroblastoma was presented. The left adrenal neuroblastoma was found when he was at 5 years of age and was curatively excised. The right adrenal neuroblastoma was found when he was at 13 years of age and also was totally excised. The authors consider that the case presented is an extremely rare, metachronous primary bilateral adrenal neuroblastoma, reflecting the multicentric origin of neuroblastoma.

[Pathophysiology and treatment of idiopathic chronic constipation with megarectum in children]

Anorectal manometry was carried out in 65 children with idiopathic chronic constipation. Forty-five had no megarectum, and 20 had megarectum. Patients without megarectum showed normal anorectal pressures, recto-anal reflex, rectal sensation and rectal compliance, but motility of the colon was disturbed in these patients. Patients with megarectum also had normal anorectal pressures, recto-anal reflex and rectal sensation, but they showed remarkably high rectal compliance, or excessive rectal reservoir. Patients without megarectum were treated with laxatives and all of them were cured within 6 months after institution of therapy. Patients with megarectum were treated with rectal washout and suppository and 14 out of 20 were cured within 10 months. Six out of 20 patients with megarectum, however, were resistant to conservative therapy and necessity of surgical treatment to reduce the excessive rectal reservoir was proposed for these patients.

Rectoanal pressures and rectal compliance in children with rectal prolapse

The results of anorectal manometry in 11 children with complete rectal prolapse were evaluated. Abnormalities of sphincter control or bowel movements occurred in 8 out of these 11 patients. Anal canal pressure of the patients was lower than in the controls, but there was no significant difference of resting pressure profiles of the anorectum between the patients and the controls. Rectoanal reflex was present in all the patients and in the controls. Rectal compliance was significantly lower in the patients, but there was no correlation between rectal compliance and sphincter control of the patients.

Clear-cell sarcoma of the kidney seen in a 3-day-old newborn

A case of clear-cell sarcoma of the kidney seen in a 3-day-old baby is reported. Resection of the right kidney with tumour and dissection of enlarged lymph nodes were followed by chemotherapy with Vincristine. No radiotherapy was employed. The patient has been living to date without recurrence or metastasis one year after surgery. Favourable outlook of renal neoplasms in the newborn was discussed.

[Manometric studies on asymmetry of lower esophageal sphincter in dogs (author's transl)]

Manometric pressure profile of the lower esophageal sphincter (LES) was measured with perfused 3-lumen tube (Sherwood Type I, Fr. 10) at 3 different directions at the same level in dogs. 1. Measurement in 8 mongrel dogs disclosed that LES pressure was significantly high at right anterior (2 o'clock) and left anterior (10 o'clock) directions compared with pressure at dorsal direction (6 o'clock). There was no statistically significant difference of LES length 3 different directions. 2. LES pressures and lengths were significantly increased and difference of LES pressures among 3 different directions was amplified by intravenous administration of 4 micrograms/kg/hr of Tetragastrin. 3. LES pressures and lengths were not affected by intravenous administration of 0.5 mg/kg/hr of Atropine sulfate. 4. LES pressures were preserved, but LES lengths were shortened by division of the phrenico-esophageal ligament. Difference of LES pressures among 3 different directions disappeared after this procedure. Division of the phrenico-esophageal ligament produced the "second" high pressure zone at directions of 2 and 10 o'clock. The present studies suggest that difference of LES pressures, or lengths in different directions is a product of anatomical structures of the hiatal muscle, and not of LES itself.

Anorectal pressure and rectal compliance after low anterior resection

Measurements of the resting pressure profile of the anorectum, recto-anal reflex and of rectal compliance (reservoir function of the rectum) were made in 24 normal subjects and 16 patients who had undergone low anterior resection for cancer of the sigmoid colon or upper half of the rectum. In the early postoperative period (< 6 month) frequent bowel movements and occasional soiling were experienced by most patients. Fifteen of 16 such patients had regular bowel movements and no soiling after six months. The present studies disclosed that there was a close correlation between control of bowel movements and rectal compliance, but not between the resting pressure profile of the anorectum or the recto-anal reflex and control of bowel movements after low anterior resection.

Rectoanal pressures and rectal compliance in constipated infants and children

Anorectal manometry with perfused side opening catheter was carried out in 86 normal infants and children, 9 infants with Hirschsprung's disease, and 10 children with idiopathic chronic constipation. Studies on pressure volume curve of the rectum and rectal compliance were carried out in 37 normal infants and children, 4 infants with Hirschsprung's disease, and 10 children with idiopathic chronic constipation. Decreased basal rhythmic contraction of the anal canal, absent recto-anal reflex, steep elevation of pressure volume curve of the rectum, and low rectal compliance were characteristic of infants with Hirschsprung's disease. Resting pressure profile of the anorectum, recto-anal reflex, pressure volume curve of the rectum, and rectal compliance were normal in chronically constipated children without megarectum, whereas remarkably high rectal compliance was characteristic of those with megarectum.