Elimination of Metastatic Neuroblastoma from Bone Marrow Using Magnetic Immunobeads with Newly Produced Antibodies to Neuroblastoma Cells

Removal of metastatic neuroblastoma cells using magnetic immunobeads with newly produced antibodies were investigated. Magnetic immunobeads were M-450 (DYNAL) coated with purified sheep polyclonal IgG against all mouse IgG subclass. Two newly produced antibodies (5E9 and 3C1) and other two antibodies were used. Four antibodies were added to a mixture of the neuroblastoma cells stained with Hoechst 33342 with the human bone marrow cells. The magnetic immunobeads were added to the cell mixture. After incubation for 30 min at 4 °C , the magnetic beads reacted to the neuroblastoma cells were removed by using cobalt samarium magnets. The residual neuroblastoma cells were assayed under the fluorescence microscopy, and the clonogenic capacity of the bone marrow progenitor cells were measured by culturing in the soft agar assay. A ratio of neuroblastoma cells to normal bone marrow cells was 1:10 and a ratio of magnetic immunobeads to neuroblastoma cells was 100:1. A tumor cells depletion rate of 1.9-3.8 logs was achieved using the cocktail antibodies with 5E9, 3C1, NCC-LU-243 and NCC-LU-246 and second cycle treatment. In a clinical cell separation unit 2.81 log removal rate of tumor cells was obtained. Residual rate of human normal bone marrow cells after second cycle purging was 17.1%. Reduction in the clonogenic bone marrow progenitor cells was about 10%. This purging method in use the procedure with the magnetic immunobeads and neuroblastoma cell antibodies seems to offer advantage with respect to speed and simplicity. By use of suitable antibodies, the immunomagnetic tumor cell depletion method is useful in autologous bone marrow transplantion of advanced neuroblastoma children with poor prognosis. Newly produced antibodies 5E9 and 3C1 are of great use in the immunomagnetic tumor cell depletion procedure

Prophylactic Ligation of the Innominate Artery and Creation of Tracheostomy in a Neurologically Impaired Girl: A Case Report

Tracheoinnominate artery fistula is known as a potentially fatal complication for patients who depend on tracheostomy or tracheoesophageal diversion. Since the bleeding from a TIF is often difficult to control, preventative procedures are recommended to avoid this complication. An 11-year-old girl with hypoxic-ischemic encephalopathy and scoliosis developed tracheal stenosis caused by compression from the innominate artery. Respiratory control with intubation through the tracheal stenosis was needed, and the patient was at high risk for developing a TIF. She underwent ligation of the innominate artery at tracheostomy. Subsequent tracheostomy revealed a widened tracheal lumen and no further complications. Prophylactic ligation of the innominate artery and creation of tracheostomy might be considered as a valid option for patients at high risk of developing TIF

Surgery for Congenital Duodenal Atresia

Congenital duodenal atresia consists of extrinsic duodenal obstruction of annular pancreas and intrinsic obstruction of intestinal atresia. The aim of this study is to clarify clinical patterns of congenital duodenal atresia on the basis of surgical experiece and discuss major problems with respect to surgical treatment

Surgical Strategy for Low Imperforate Anus in Girls -Cutback Anoplasty , Anal Transplantation or Limited Posterior Sagittal Anorectoplasty?-

From 1991 to 2001, we performed 5 re-operations with limited posterior sagittal anorectoplasty (PSARP) for low imperforate anus in girls who had anteriorly located anus after primary surgery. Four girls were diagnosed with anocutaneous fistula and one girl with anovestivular fistula. Primary operations were one cutback anoplasty and four anal transplantation. None of them underwent colostomies before re-operation with the limited PSARP. The sphincter muscle was cut through a median perineal skin incision and then the rectum was placed at the center of the complex muscles. This limited PSARP could give good anal function and satisfactory cosmetic appearanc

Arthralgia and Osteolytic Lesions Associated with Traumatic Pancreatitis in a 10-Year-Old Girl

A case of traumatic pancreatitis with subsequent joint pain and osteolytic lesions is presented. A 10-year-old girl was admitted to our hospital with abdominal pain caused by blunt epigastric injury. She was diagnosed with traumatic pancreatitis, and multiple pancreatic pseudocysts subsequently developed. Two weeks after admission, she complained of joint pain, and MR revealed osteolytic lesions of both knee joints. On the 58th day, endoscopic transgastric pseudocyst drainage was performed. Joint pain and osteolytic lesions resolved rapidly, in parallel with the decrease in serum amylase level and pseudocyst size

Thoracoscopic repair of neonatal congenital diaphragmatic hernia

Purpose: To describe the surgical technique and criteria for neonatal congenital diaphragmatic hernia (CDH) repair. Methods:CDH repairs were carried out by a thoracoscopic approach between February 2013 and April 2014. Preoperatively, the neonateswere stabilized with high-frequency oscillatory ventilation and nitric oxide inhalation. They had no associated cardiac anomalies. Confirmation of the appropriateness of thoracoscopic repair was determined based on the patient’s stability in the decubitus position and no clinical signs of pulmonary hypertension. The operation was carried out with one optical and two operating trocars. The hernia defect was closed by interrupted nonabsorbable sutures. The more lateral portion of the defect was repaired with a U-shaped stitch using a laparoscopic percutaneous extraperitoneal closure needle. Results: Three neonates underwent repair via thoracoscopy. Two patients underwent primary CDH repair, and conversion to laparotomy was required in the other because of a large diaphragmatic defect. There was no intraoperative cardiorespiratory instability or postoperative complications. Conclusions: Thoracoscopic repair of neonatal CDH is a feasible and safe procedure for the patients who have respiratory stability in the decubitus position, no pulmonary hypertension and no intra-thoracic liver herniation

Percutaneous transhepatic electrohydraulic lithotripsy for intrahepatic bile duct stones after choledochal cyst excision

Excision and hepaticojejunostomy are well-established treatments for choledochal cysts. However, the formation of intrahepatic bile duct stones has been reported as one of the most serious long-term complications on follow-up of choledochal cyst excision. The reported incidence of this complication varies from a small percentage of patients to 10% or more. Various procedures have been reported as treatments for postoperative bile duct stone formation. We report a case in which percutaneous transhepatic electrohydraulic lithotripsy (EHL) was used in the treatment of bile duct stones that developed after choledochal cyst excision. A 17-year-old boy, who had undergone choledochal cyst excision and hepaticojejunostomy when he was 27 days old, presented with colic abdominal pain in the right hypochondriac region and liver dysfunction. CT performed in our emergency department revealed intrahepatic bile duct stones in minimally dilated intrahepatic bile ducts in both lobes. Percutaneous transhepatic cholangiography showed packed stones distal to the right hepatic duct and stenosis of the right hepatic duct; there was no evidence of stenosis at the hepaticojejunostomy anastomosis. He underwent extracorporeal shockwave lithotripsy under general anesthesia. Although the large stone was fragmented into smaller stones, they were not small enough to be eliminated due to stenosis of the hepatic duct. After balloon dilatation of the stenosis, the patient underwent percutaneous transhepatic EHL. The fragmented stones were then thoroughly washed out from the intrahepatic bile duct. EHL is an effective and less invasive treatment for intrahepatic bile duct stones after choledochal cyst excision

Gastric Cancer in younger patients of less than age 30

Twenty-five gastric cancer of less than 30 years of age were clinically evaluated in comparison with those of manhood. 1) Gastric cancers in younger patients were predominant in female, four times as frequent as in male and the most favorable location in the younger was the cardia of the stomach. 2) In terms of histologic findings, undifferentiated carcinoma of Borrmann IV type was common in younger patients. 3) Peritoneal dissemination and serosal invasion as an extension type of carcinoma were most common in younger patients although hepatic metastasis was very few. 4) Surgical outcome of curative operation was very favorable although that of noncurative one was very pessimistic

Surgery for complications by diverticular disease of the colon

Surgical experience with fifteen complications of diverticular disease of the colon has been reported. These had a considerably long period from onset to operation except for perforation episode. Conservative treatment prior to surgery is of great benefit to avoid postoperative complications. The surgical outcome, thereafter is satisfactory and recurrence has not been experienced

Surgery for Traumatic Injury of the Trachea and Bronchus

Surgery for traumatic disruption of the trachea and the bronchus was evaluated with respect to the surgical outcome in three with tracheal injury and four with bronchial injury. In this series, the results were satisfied except for one who underwent delayed operation. Experience seems to indicate that the primary care to ensure security of air way is of great value in life-saving and guarantee of the outcome including pulmonary function following surgery. In conclusion, it is emphasized that the fortuitous result and preservation of pulmonary function are mandatory for pertinent treatment with expediously precise diagnosis