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T Muraji

Publications and source records attributed to T Muraji.

54 records · Page 3Linked to original sources
PubMed1988

Extensive aganglionosis: further experience with the colonic patch graft procedure and long-term results.

During the period from 1979 to 1986, seven patients have been treated for extensive aganglionosis involving the colon and distal ileum (5 to 40 cm) employing the colonic patch graft (CPG) procedure. This consists of (1) ileostomy; (2) creation of a longitudinal side-to-side ileocolostomy between normal ileum and aganglionic ascending colon, forming a CPG; and (3) the definitive pull-through procedure. In all patients, the initial course after ileostomy was complicated by severe diarrhea, which was significantly improved by creation of the CPG. At the definitive operation several months later, the mesocolon attached to the CPG was severed to mobilize the ileocolostomy segment to the distal pelvis. Four patients in this series have been followed for 5 to 8 years. No patient has developed enterocolitis requiring hospitalization. Body weight became normal for age in all patients within 4 years of the definitive operation.

Colon↗
PubMed1988

[Surgical managements of massive involvement of small bowel and of short gut syndrome].

Despite the recent advent of total parenteral nutrition (TPN), the long-term survival of the patients with short gut syndrome is not satisfactory with complications of catheter-related sepsis and cholestasis. The causes of short gut syndrome in pediatric surgery are multiple intestinal atresias, necrotizing enterocolitis (NEC), and midgut volvulus. For the multiple atresias, multiple anastomosis without resection has been successfully undertaken to avoid developing short gut syndrome for the last 17 years. For the massive involvement of the intestines due to NEC or volvulus, high jejunostomy and peritoneal drainage with TPN support have been tried for the last two patients and successfully weaned from the TPN within two months after closure of jejunostomy. However, in case 2 malabsorption has been persistent presumably due to a severe degree of mucosal damage occurring in the remaining intestines. Whether this eventually gets back to the normal or not is unknown. For the patients with short gut syndrome, small bowel reversal procedure was successfully done and now doing well 10 years after surgery. This paper reports details of these 3 cases.

Enterocolitis, Pseudomembranous↗
PubMed1986

Low antithrombin III in neonatal shock: DIC or non-specific protein depletion?

Low antithrombin III (AT III) levels in shock are usually ascribed to disseminated intravascular coagulation (DIC). However, decreased activities of clotting factors and their inhibitors could reflect a generalised fall in plasma proteins rather than DIC. AT III and albumin were compared in 48 asphyxiated and non-asphyxiated newborn rabbits (pH 6.70-7.30). Both AT III and albumin were markedly decreased in the sickest animals and there was a direct linear relationship between the two proteins (P less than 0.001). Similar results were obtained in ten newborn infants suffering from shock and haemorrhagic diathesis. In all cases AT III and albumin were decreased below the normal range and significantly correlated (P less than 0.01). Our findings suggest that AT III is not a useful diagnostic marker of DIC. Further, a similar fall of clottable and non-clottable proteins in shock questions the general assumption that the ensuing coagulopathy is due to intravascular coagulation.

Animals↗
PubMed1986

Plasma exchange therapy for endotoxin shock in puppies.

The efficacy of plasma exchange (PE) therapy for endotoxin (ET) shock has not been evaluated. The following experimental study was designed to evaluate the feasibility of PE in infants and children and determine the efficacy as a therapeutic modality for ET shock. A compact circuit for PE designed for this experiment consists of two pumps and a membrane plasma separator for a venovenous extracorporeal circulation with the limited prime volume of 100 mL. The capacity of this device for PE was tested. When a membrane separator of 0.3 m2 in surface area was used, a plasma flux of 5 to 13 mL/min was satisfactorily obtained with the blood flow rate of 25 to 40 mL/min, which was taken through centrally placed catheters of 18 gauge or larger. Transmembrane pressure was maintained in a safe range (0 to 50 mm Hg) in the first 90 minutes, during which time a PE of 100 mL/kg was completed with a sieving coefficient greater than 0.8. In 14 puppies (1.8 to 3.5 kg), a shock state was produced by infusion of ET (Escherichia coli, 055:B5). Eight puppies were resuscitated simply with lactated Ringer's solution and bicarbonate. Six puppies were treated with PE using 100 mL/kg of fresh-frozen plasma prepared from adult dogs. A significant decrease in the mean blood pressure, platelet and leukocyte counts, total protein, and CH50 was documented in all animals after ET administration. Seven of eight control animals died within 24 hours of post-ET infusion. All of the six PE-treated animals survived for 48 hours or longer.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

The prognostic implication of hypercholesterolemia in infants and children with hepatoblastoma.

This paper reports the relationship between serum cholesterol level and hepatoblastoma in nine patients. Four of the nine patients had a high (417-544 mg%) serum cholesterol. All of these patients were less than one year of age and had tumors of the epithelial type. Three of the infants died soon after being diagnosed. Three patients had a moderately elevated serum cholesterol (206-249mg%). One underwent primary hepatic resection. Two had nonresectable tumors that became resectable after chemotherapy. One died secondary to pulmonary metastases. The remaining two patients had a normal serum cholesterol level prior to treatment. Both patients had hepatic resection after chemotherapy and had no evidence of increased cholesterol postoperatively and are alive six years after diagnosis. From these data, it is suggested that the pretreatment level of serum cholesterol may be of prognostic significance in infants and children with hepatoblastoma.

Adolescent↗
PubMed1984

Surgical problems in patients with VATER-associated anomalies.

From 1960 through 1980, 14 patients with esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) with two or more other associated anomalies of VATER have been seen. Seventy percent of patients were preterm or low in birth weight. In addition to the esophageal abnormality, vertebral anomalies were found in 7 patients, anorectal anomalies in 11, limb anomalies in 9 and renal anomalies in 9 patients. Three patients had associated duodenal atresia and 4 had cardiac anomaly. Eight patients are dead, 5 are living, and 1 is lost to follow-up. Six of the eight deaths occurred during 1960 to 1970. Preliminary gastrostomy was done in all patients. Primary esophageal repair was carried out in 9 patients--5 died and 4 survived. Three patients had delayed esophageal repair and two of these patients survived. Cervical esophagostomy was done in one patient with EA without TEF after unsuccessful repeated bouginage for elongation of the upper esophageal pouch. Three of the survivors showed growth retardation--below 5th percentile. Aggressive nutritional support and management of chronic problems related to the anomalies are important.

Abnormalities, Multiple↗
PubMed1984

The effect of intrauterine esophageal ligation on growth of fetal rabbits.

Babies with pure esophageal or duodenal atresia weight less than normal babies at birth. Whether this is due to the obstruction to fetal swallowing or some other cause is not known. To determine how intrauterine interruption of swallowing affects fetal growth, we developed a model of esophageal atresia in the fetal rabbit. Twenty-five time-mated rabbits at 24 days gestation were anesthetized with halothane and ketamine. The uterus was exposed through a midline abdominal incision. The head and neck of the fetus in the distal end of one horn were isolated through a 2-cm hysterotomy. Biparietal diameter (BPD) was measured and the esophagus was isolated and ligated through a midline cervical incision. The fetus in the distal end of the opposite horn underwent sham operation. Four days later, cesarean section was done. The newborn rabbits were weighed, and crown/rump length and BPD were measured. Ligation of the esophagus was confirmed by re-exploration of the neck. Three does died under anesthesia and two aborted. From the remaining 20, 156 fetuses were recovered, of which 135 were alive. One set of operated fetuses was dead, leaving 19 pairs for analysis. There was a statistically significant reduction in weight gain (31.7 +/- 1.3 g to 29.1 +/- 0.9 g, P less than 0.05) following interruption of the esophagus but linear growth was unchanged. Obstruction to normal fetal swallowing may account for the low birth weight with normal head circumference reported in babies with esophageal and duodenal atresia.

Animal Nutritional Physiological Phenomena↗
PubMed1983

Effect of prosthetic airway splint on the growing trachea.

Airway splints are now used clinically to treat tracheomalacia and may also have a place in the management of tracheal stenosis. These studies in 5 to 7 Kg piglets were designed to assess the effects of prosthetic airway splints on airway growth and to establish their usefulness in the reconstruction of tracheal defects. Three experimental groups were studied: group I (n = 8). Silastic reinforced Marlex mesh or Vicryl mesh prostheses were placed around 75% of the circumference of a 3 cm segment of trachea. Pigs were sacrificed at 4 months (average weight = 78.9 +/- 9.0 Kg) and the cross-sectional area of trachea was measured. Group II (n = 5). The same prostheses were used to replace the tracheal defect created by excising three rings (50% of tracheal circumference). Tracheas were examined grossly and histologically at sacrifice. Group III (n = 5). Same as Group II except tracheal defect covered by strap muscles. Prostheses placed external to them to prevent airway collapse. Group I had 4% to 14% (mean 8%) decrease from normal cross-sectional area of trachea at site of splint. No airway obstruction and no infection was encountered. Group II, severe airway obstruction, granulation tissue, and infection at site of defect was noted. Group III showed no signs of airway obstruction, no infection, and minimal airway narrowing. Re-epithelialization of the muscle surface in contact with airway occurred in all these animals. Silastic reinforced Marlex or Vicryl splints placed around the intact rapidly growing trachea do not significantly limit its growth. In addition, these synthetic materials appear to be well-tolerated when used to reconstruct tracheal defects if placed over well-vascularized tissue such as muscle.

Animals↗
PubMed1982

Evaluation of the surgical aspects of staging laparotomy for Hodgkin's disease in children.

Experience with 72 children in which the type of staging laparotomy recommended by the Intergroup Hodgkin's Disease in Childhood Study (IHDCS) was employed (1967-1981) is reviewed. Laparotomy altered the stage in 35% of these patients including advance in stage (I-II to III-IV) in 24 patients, and reduction in stage (III to II) in one patient. In adults, Stage III disease is divided into III1 and III2 on the basis of the presence or absence of lower abdominal node involvement; and prognosis is significantly better in III1. Nine patients from two additional institutions were included in a special study of Stage III disease. This included 22 children in III1 and 11 children in III2. Although the children with Stage B (systemic symptoms) disease were concentrated in III2, none of the measured difference between these two groups were significant. No fatal postsplenectomy sepsis has been noted since the use of pneumococcal vaccine and prophylactic penicillin became standard.

Abdomen↗
PubMed1981

Traumatic hepatic artery/hepatic vein fistula.

Traumatic hepatic artery/hepatic vein fistula was experienced in a 3 year-old boy. This hepatic arteriovenous fistula was diagnosed by a selective angiography of the hepatic artery. To prevent heart failure and pulmonary embolism developing, hepatic artery ligation was carried out. The postoperative course was uneventful and the patient was discharged without any sequelae. This paper summarizes our experience of a case with traumatic hepatic arteriovenous fistula and the treatment of hepatic artery ligation is discussed.

Arteriovenous Fistula↗
PubMed1980

Percutaneous transhepatic cholangiodrainage after hepatic portoenterostomy for biliary atresia.

During the past 12 mo, percutaneous transhepatic cholangiodrainage (PTCD) was carried out in 9 infants (12 procedures) who had undergone hepatic portoenterostomy (8) and hepatic portocholecystostomy (1) for biliary atresia. Bile excretion following surgery was observed in all infants. In all patients, cholangiogram at the initiation of PTCD was successful in visualizing the intrahepatic biliary system. PTCD was achieved in 5 infants (9 procedures). In infants with cholangitis, cultures of the intrahepatic bile were positive for enteric flora. Direct administration of antibiotics via the PTCD catheter into the bile ducts was transiently effective in the management of cholangitis. In one patient, it was observed that continuous PTCD over three weeks was effective in reducing serum bilirubin by relief of cholestasis. This technique is useful for: (1) demonstration of the reconstructed biliary system, (2) collection of bile from the intrahepatic biliary system for biochemical and bacteriologic studies, (3) direct administration of antibiotics to the bile ducts for cholangitis and (4) decompression of the intrahepatic system and relief of biliary stasis.

Bile Ducts↗
PubMed1979

[The effects of sphincteroplasty on manometric profile of common bile duct and the duodenum (author's transl)].

A simultaneous manometric monitoring of the common bile duct (CBD) and the duodenum were performed 2 weeks after choledocholithotomy on 15 patients whose common bile ducts were explored without sphincteroplasty and 30 patients with sphincteroplasty. These manometric studies were carried out by open-tip catheters intubated into the CBD and duodenum through the T-tube at the operation. In patients without sphincteroplasty, no effects of the duodenal pressure on a CBD pressure profile were recognized, while a synchronized pressure profile of the CBD and the duodenum was obtained in patients with sphincteroplasty. By stimulation with morphine (Morphine sulfate; 0.17 mg/Kg iv bolus), waxing and waning of the pressured in the CBD without sphincteroplasty were observed with 20 cmH2O in maximum at about 13 minutes after injection. However, in the CBD with sphincteroplasty, scale-over increase of the pressure curve was seen immediately after duodenal contraction caused by morphine stimulation. A direct infusion of 5 ml of 0.1 N hydrochloride to the duodenum causes hyperperistalsis of the duodenum, which made a synchronized pressure profile in the CBD with sphincteroplasty but made no remarkable change in a pressure profile of the CBD without sphincteroplasty. These findings conclude that the sphincter of Oddi plays an important role as a "pressure barrier" between the CBD and the duodenum, and that with the destruction of this sphincter by sphincteroplasty, a pressure profile of the CBD becomes close to that of the duodenum. This simultaneous manometric study of the CBD and the duodenum might be one of most valuable methods for evaluation of completeness of the sphincteroplasty.

Ampulla of Vater↗