Long-term T-tube stenting as definitive treatment of severe acquired subglottic stenosis in children.

Purpose: We analyzed our results of long-term T-tube stenting for severe acquired subglottic stenosis secondary to prolonged endotracheal intubation in a neonatal period.

Materials And Methods: Twenty children treated with T-tube stenting since 1999 were retrospectively analyzed. T-tube stenting consisted of anterior cricoid split and placing silicon T-tube as a stent for expanded subglottic lumen.

The preliminary study of modified Swenson procedure in Hirschsprung disease.

Purpose: We have been using the Swenson procedure for more than 3 decades for Hirschsprung disease (HD). Recently, we modified this procedure, leaving the anterior wall below the peritoneal reflection undissected (mSwen). In 2000, we introduced mSwen with laparoscopic guidance (LapmSwen).

Congenital tracheal stenosis: the prognostic significance of associated cardiovascular anomalies and the optimal timing of surgical treatment.

Background/purpose: Cardiovascular anomalies (CA) are frequently associated with congenital tracheal stenosis (CTS), but their prognostic impact on CTS and the optimal timing of surgical treatment remain uncertain. The aim of this study was to explore the prognostic factors and the optimal timing of surgical treatment in CTS patients with CA.

Methods: After obtaining institutional review board approval, a retrospective review of 42 patients who underwent surgical repair of CTS between 1996 and 2006 was conducted.

[Multidisciplinary treatment for severe syndromic craniosynostosis].

We describe the treatment of patients having syndromic craniosynostosis with severe craniofacial abnormality. One patient had Cruzon's syndrome, one had Beare-Stevenson cutis gyrata syndrome, and four had Pfeiffers syndrome. Anterior cranial deformity in all patients was treated using fronto-orbital advancement (FOA) by gradual distraction.

Completely isolated alimentary tract duplication in a neonate.

A rare case of a completely isolated, alimentary tract duplication cyst in a 27-day-old neonate is reported. The duplication cyst was detected on antenatal fetal ultrasound and magnetic resonance (MR) imaging at 27 weeks' gestational age. At surgery, the duplication cyst was in a retroperitoneal site with no apparent communication between the cyst and any portion of the alimentary tract.

Pretransplant risk factors and optimal timing for living-related liver transplantation in biliary atresia: experience of one Japanese children's hospital and transplantation center.

Background/purpose: Although living-related liver transplantation (LRLT) is effective for patients with biliary atresia (BA) after a failed Kasai operation, the pretransplant factors affecting post-LRLT mortality and the optimal timing of the procedure remain unclear.

Method: A retrospective review of 27 patients with BA after a failed Kasai operation (median age, 22 months; range, 6-237 months) who received LRLT from 1994 to 2005 was done. The clinical characteristics at the time of the pre-LRLT assessment of those who did and did not survive were compared.

Can biliary atresia be diagnosed by ultrasonography alone?

Background/purpose: The triangular cord sign (TCS) is a specific ultrasonographic finding, reflecting a fibrotic mass at the porta hepatis in biliary atresia (BA). We evaluated whether BA can be diagnosed by ultrasonography alone using 3 findings: TCS, gallbladder length (GBL), and gallbladder contractility (GBC).

Methods: Subjects comprised 85 infants (median age, 47 days; range, 4-144 days) with cholestatic jaundice who underwent ultrasonographic examination for diagnosis between May 1996 and June 2006.

MCRA of an anastomotic stenosis after esophagoesophagostomy for long gap esophageal atresia: a case report.

A 25-month-old boy with long gap esophageal atresia developed severe esophageal stenosis refractory to balloon dilatations after definitive esophagoesophagostomy. At 33 months of age, the patient had a magnetic compression revision anastomosis, in which a pair of 2 cylindrical Samarium-cobalt rare-earth 320 mT (3200 G) magnets, 15 x 5 mm (diameter x thickness), were placed in the esophagus to compress the scar tissue of the anastomosis. The magnets were retrieved 34 days after the magnetic compression revision anastomosis procedure.

Development of acquired tracheal stenosis in premature infants due to prolonged endotracheal ventilation: etiological considerations and surgical management.

The aim of this study was to determine the etiology and appropriate surgical treatment for acquired tracheal stenosis that developed in patients who had undergone prolonged endotracheal mechanical ventilation as premature neonates. During the period 2000-2004, four patients aged 1-16 years were referred for tracheal stenosis characterized by stridor, choking, and recurrent pulmonary infection. All patients had undergone endotracheal mechanical ventilation for 2-5 months for respiratory distress related to prematurity (gestational age 25-29 weeks, birth weight 648-1,222 g).

A case report of glial choristoma of the tongue.

Glial choristoma of the tongue is extremely rare. The authors report the case of a 9-day-old infant with a congenital lingual glial choristoma. Complete surgical excision was performed without postoperative complications or recurrence.

Efficacy of urinary sulfated bile acids for diagnosis of bacterial cholangitis in biliary atresia.

This study evaluated the efficacy of measuring urinary sulfated bile acids (USBA) for diagnosis of bacterial cholangitis in patients with biliary atresia. Eight infants with biliary atresia were recruited. The USBA level was measured when they were admitted to hospital with a fever of unknown origin.

Multistaged esophageal elongation technique for long gap esophageal atresia: experience with 7 cases at a single institution.

Background/purpose: Esophageal reconstruction for long gap esophageal atresia (LGEA) is still controversial. We successfully managed 7 cases of patients with LGEA by doing staged elongation of the native esophagus and subsequent end-to-end anastomosis. The technique and efficacy of this procedure are evaluated.

Transection of the innominate artery for tracheomalacia caused by persistent opisthotonus.

Patients with cerebral palsy often develop opisthotonus. The trachea may be pinched between the innominate artery and the cervical spine. This compartmentalized thoracic inlet results in severe tracheomalacia.

Supraumbilical pyloromyotomy: comparison between intracorporeal and extracorporeal approaches.

We evaluated intracorporeal pyloromyotomy (ICP) as an alternative to extracorporeal pyloromyotomy (ECP) in infants with hypertrophic pyloric stenosis. From July 1994 to June 2002, 75 patients underwent ICP, and 29 patients underwent ECP through supraumbilical incisions. The medical charts were reviewed retrospectively with regard to operating time, time to return to full feeding, complications, and outcome.

Tracheoplasty for long segment congenital tracheal stenosis: analysis of 29 patients over two decades.

Purpose: The authors determined the long-term outcome of patients who underwent surgical repair of long-segment congenital tracheal stenosis (LCTS) and compared the quality of cartilage graft and slide tracheoplasty techniques.

Methods: Twenty-nine patients underwent surgical repair of LCTS at 29 days to 9 years of age. In 26 patients, more than 50% of the entire length of the trachea was involved.

Sonographic diagnosis of biliary atresia in pediatric patients using the "triangular cord" sign versus gallbladder length and contraction.

Objective: A retrospective review was performed to evaluate the importance of the "triangular cord" sign in comparison with gallbladder length and contraction for the diagnosis of biliary atresia in pediatric patients.

Materials And Methods: Fifty-five fasting infants with cholestatic jaundice were examined on sonography. The examinations focused on the visualization of the triangular cord sign and assessment of gallbladder length and contraction.

Laryngotracheal separation for intractable aspiration pneumonia in neurologically impaired children: experience with 11 cases.

Purpose: Laryngotracheal separation (LTS) with or without end-to-side laryngoesophagostomy was performed as an antiaspiration procedure for intractable aspiration pneumonia in 11 children. The effectiveness of LTS for preventing aspiration was investigated.

Methods: Eleven children aged from 9 months to 16 years with intractable aspiration pneumonia underwent LTS with (n = 8) or without (n = 3) laryngoesophagostomy at our institution over the last 2 years.

Successful salvage of a long-standing collapsed lung by bronchoplasty in three children.

Background: The authors report successful salvage of the ipsilateral lung by a bronchoplastic procedure in 3 patients with a long-standing, totally collapsed lung.

Methods: The 3 patients were 1, 5, and 6 years of age, and the left lung had been collapsed totally for periods of 13 months to 5 years. The origin of atelectasis was congenital in 2 patients and traumatic in one patient.

Surgical management for intractable cholangitis in biliary atresia.

Background/purpose: The efficacy of antireflux surgical procedures involving the Roux-en-Y jejunal limb for cholangitis was evaluated retrospectively in patients with biliary atresia (BA).

Methods: From July 1993 to December 2001, 41 patients with BA underwent hepatic portojejunostomy with Roux-en-Y reconstruction. Of these patients, 11 had intractable cholangitis that was treated by creation of a value with or without lengthening of the Roux-en-Y limb.

Urinary sulfated bile acids: a new simple urine test for cholestasis in infants and children.

Background/purpose: Measurement of urinary sulfated bile acid (USBA) has been reported as a simple urine test that reflects the degree of cholestasis. The authors report the diagnostic value of this new laboratory test in various cholestatic conditions affecting infants and children.

Methods: A urine sample was collected from 4 surgical neonates with parenteral nutrition-induced cholestasis and 48 patients with biliary atresia (BA).

Congenital cricopharyngeal achalasia: Diagnosis and surgical management.

Background: Congenital cricopharyngeal achalasia is a rare condition in which a newborn presents with dysphagia, choking, nasal reflux, and salivation. Awareness of this condition is important because simple myotomy of the cricopharyngeus muscle often solves the problem.

Methods: The diagnosis and the surgical management of cricopharyngeal achalasia were reviewed based on 4 cases experienced over the last 13 years.

Congenital esophageal stenosis: Therapeutic strategy based on etiology.

Background/purpose: The diagnosis and treatment of congenital esophageal stenosis (CES) can be a vexing clinical problem. This study aims at determining the ideal therapeutic strategy for the management of CES.

Methods: Medical records of patients with CES were reviewed retrospectively with regard to diagnostic method, therapy, and outcome.