Eiji Nishijima - Academia.edu (original) (raw)
Papers by Eiji Nishijima
Journal of the Japanese Society of Pediatric Surgeons, Aug 20, 2001
International journal of anesthetics and anesthesiology, Dec 31, 2021
A one-month-old boy showed cyanosis and severe retraction on crying. He underwent diagnostic rigi... more A one-month-old boy showed cyanosis and severe retraction on crying. He underwent diagnostic rigid bronchoscopy under general anesthesia, maintaining spontaneous ventilation. Rigid bronchoscopy revealed laryngeal cleft type I and excessive mucosa in the interarytenoid space that protruded into the subglottic area, very unusual findings in laryngeal cleft. His clinical condition quickly deteriorated and tracheotomy was performed to prevent complete airway obstruction in the few days until surgical repair of the cleft. Tracheotomy is unnecessary in most cases of the laryngeal cleft type I, but it may be needed if the patient's airway is severely compromised.
The Journal of Pediatrics, Dec 1, 2019
10-month-old, previously healthy girl with good growth was diagnosed by her primary provider with... more 10-month-old, previously healthy girl with good growth was diagnosed by her primary provider with bacterial enteritis following a 6-day history of mild fever and diarrhea with mucous. Carbapenem was prescribed. After 1 dose, she experienced rectal prolapse with frequent defecation, which resolved spontaneously at that time. However, the following day, she was brought to our hospital because of recurrence of rectal prolapse. Physical examination showed a 3-cm prolapsed rectum with edematous mucosa. The mucosa was mostly covered with a yellowish-white pseudomembrane (Figure 1). Anaerobic culture of fresh stool for Clostridium difficile and fecal enzyme immunoassay (EIA) for toxins A/B performed on the first visit to our hospital were negative. The studies were repeated. The prolapsed rectum was reduced, and carbapenem was discontinued. After 2 days, she returned as an outpatient. The stool culture for C difficile and fecal EIA for toxins A/B were positive. Ultrasound examination revealed a 6.5-mm thickening of the rectal wall (Figure 2; available at www.jpeds.com). Based on these findings, she was diagnosed with C difficile infection and received oral metronidazole and probiotics for 10 days. The pseudomembrane on the prolapsed rectum was
Journal of the Japanese Society of Pediatric Surgeons, Jun 20, 1999
J. Jpn. Soc. Pediatr. Surg., Apr 20, 2013
PubMed, Sep 1, 1988
Despite the recent advent of total parenteral nutrition (TPN), the long-term survival of the pati... more 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.
Journal of the Japanese Society of Intensive Care Medicine
J. Jpn. Soc. Pediatr. Surg., Feb 20, 2013
PubMed, Dec 1, 1997
Advances in anesthetic management, neonatal intensive care and cardiovascular techniques for seve... more Advances in anesthetic management, neonatal intensive care and cardiovascular techniques for severe cardiac defects have permitted improved survival rate for esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) during the last two decades. In the treatment of EA-TEF, primary esophageal repair without staging or preliminary gastrostomy becomes popular among pediatric surgeons. In pure EA and long-gap EA with TEF, options for esophageal reconstruction include use of the native esophagus or replacement with colon or stomach. In considering the esophageal motility in patient's whole life, native esophageal reconstruction is the procedure of choice rather than esophageal replacement. Improved survival rates are noted irrespective of the traditional Waterson criteria, which now seem outdated. The surgical treatment of congenital tracheal stenosis have started in the early '80s. Resection of the stenotic trachea with end-to-end anastomosis has been available in the stenosis ranging less than 30% of the entire trachea. However, the treatment of long segment tracheal stenosis is still controvertial. Various surgical techniques including balloon tracheal split, slide tracheoplasty, implantation of autografts of pericardium and costal cartilage have been attempted. In this review, we described our own experience in tracheoplasty using costal cartilage.
Journal of the Japanese Society of Pediatric Surgeons, Dec 20, 2000
Journal of the Japanese Society of Pediatric Surgeons, Apr 20, 1996
J. Jpn. Soc. Pediatr. Surg., 2015
Journal of the Japanese Society of Pediatric Surgeons, Oct 20, 1997
Journal of the Japanese Society of Pediatric Surgeons, Jun 20, 1999
Journal of Pediatric Surgery, May 1, 2017
Purpose: Congenital tracheal stenosis (CTS) and a single right lung treated with slide tracheopla... more Purpose: Congenital tracheal stenosis (CTS) and a single right lung treated with slide tracheoplasty (ST) has relatively high rates of mortality and morbidity. We report a single institution's experience with adjunctive procedures at the time of ST to reduce postoperative tracheal obstruction in patients with a single right lung and CTS. Methods: With IRB approval, 8 patients with a single right lung and CTS who underwent ST in our institution between 2008 and 2016 were reviewed. Results: Seven of 8 patients (88%) survived, with a median follow-up period of 35 (3-89) months. The only mortality was because of complications unrelated to the airway. Six of 8 patients underwent ST anterior to the aortic arch (tracheal translocation, TT). This was combined with tracheopexy concomitantly in 3 patients and subsequently in one patient. Two patients had insufficient tracheal length for TT. Both underwent aortopexy. Of three patients undergoing TT with tracheopexy concomitantly, two have been successfully extubated, and a third has required tracheostomy for subglottic stenosis. All patients undergoing TT without tracheopexy have experienced severe tracheobronchomalacia. Conclusion: We conclude that adjunctive TT with tracheopexy might be associated with lower rates of tracheobronchial obstruction in patients with a single right lung undergoing ST for CTS. Level of evidence: Level IV.
Journal of Pediatric Surgery, Dec 1, 1980
During the past 12 mo, percutaneous transhepatic cholangiodrainage (PTCD) was carried out in 9 in... more 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.
The Japanese Journal of Thoracic and Cardiovascular Surgery, Apr 1, 1998
Between 1984 and 1996 five infants underwent surgical repair of pulmonary artery sling associated... more Between 1984 and 1996 five infants underwent surgical repair of pulmonary artery sling associated with severe congenital tracheal stenosis. All infants had symptoms of severe respiratory distress and three of them required ventilator support preoperatively ages ranged from 2 to 11 months (mean age 6 months). Complete tracheal rings were present in all patients as an associated lesion and right upper lobe tracheal bronchus in 3 patients. The length of tracheal stenosis ranged from 18 to 45 mm (median 40 mm). Three had associated intracardiac anomalies (Scimitar syndrome (1), VSD (1), double-outlet right ventricle with VSD (1), double-outlet right ventricle with pulmonary hypertension (1)). Surgical intervention was carried out through a right thoracotomy (1) or median sternotomy (4). Cardiopulmonary bypass (CPB) was used in 3 patients and extracorporeal membrane oxgenator (ECMO). In 1. All infants had reimplantation of the left pulmonary artery into the main pulmonary artery left anterior to the trachea. Four patients underwent simultaneous tracheoplasty using costal cartilage grafts and one had complete resection of obstructed trachea between the right upper lobe tracheal bronchus and carina. The length of resected trachea was about 30% of the entire length of the trachea. Three infants underwent simultaneous intracardiac repair. There was no hospital death. All were weaned from ventilatory support and extubated on 1 to 16 months (mean 4, 5 months) postoperatively. AS an additional procedure, aortopexy, removal of granulation tissue or balloon dilatation of the trachea were carried out in one patient each following tracheoplasty using cartilage grafts. There was one late death at 1 year postoperatively. Three of 4 survivors are doing well with no stridor. We adonostridor. We adovocate 1) early aggressive primary repair of pulmonary artery sling with tracheal stenosis, 2) concomitant repair of tracheal lesion and intracardiac anomalies whenever possible, 3) application of CPB or ECMO to avoid cumbersome intubation technique, and 4) utmost effort to perform tracheal resection and end-to-end anastomosis.
Journal of the Japanese Society of Pediatric Surgeons, Aug 20, 2001
International journal of anesthetics and anesthesiology, Dec 31, 2021
A one-month-old boy showed cyanosis and severe retraction on crying. He underwent diagnostic rigi... more A one-month-old boy showed cyanosis and severe retraction on crying. He underwent diagnostic rigid bronchoscopy under general anesthesia, maintaining spontaneous ventilation. Rigid bronchoscopy revealed laryngeal cleft type I and excessive mucosa in the interarytenoid space that protruded into the subglottic area, very unusual findings in laryngeal cleft. His clinical condition quickly deteriorated and tracheotomy was performed to prevent complete airway obstruction in the few days until surgical repair of the cleft. Tracheotomy is unnecessary in most cases of the laryngeal cleft type I, but it may be needed if the patient's airway is severely compromised.
The Journal of Pediatrics, Dec 1, 2019
10-month-old, previously healthy girl with good growth was diagnosed by her primary provider with... more 10-month-old, previously healthy girl with good growth was diagnosed by her primary provider with bacterial enteritis following a 6-day history of mild fever and diarrhea with mucous. Carbapenem was prescribed. After 1 dose, she experienced rectal prolapse with frequent defecation, which resolved spontaneously at that time. However, the following day, she was brought to our hospital because of recurrence of rectal prolapse. Physical examination showed a 3-cm prolapsed rectum with edematous mucosa. The mucosa was mostly covered with a yellowish-white pseudomembrane (Figure 1). Anaerobic culture of fresh stool for Clostridium difficile and fecal enzyme immunoassay (EIA) for toxins A/B performed on the first visit to our hospital were negative. The studies were repeated. The prolapsed rectum was reduced, and carbapenem was discontinued. After 2 days, she returned as an outpatient. The stool culture for C difficile and fecal EIA for toxins A/B were positive. Ultrasound examination revealed a 6.5-mm thickening of the rectal wall (Figure 2; available at www.jpeds.com). Based on these findings, she was diagnosed with C difficile infection and received oral metronidazole and probiotics for 10 days. The pseudomembrane on the prolapsed rectum was
Journal of the Japanese Society of Pediatric Surgeons, Jun 20, 1999
J. Jpn. Soc. Pediatr. Surg., Apr 20, 2013
PubMed, Sep 1, 1988
Despite the recent advent of total parenteral nutrition (TPN), the long-term survival of the pati... more 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.
Journal of the Japanese Society of Intensive Care Medicine
J. Jpn. Soc. Pediatr. Surg., Feb 20, 2013
PubMed, Dec 1, 1997
Advances in anesthetic management, neonatal intensive care and cardiovascular techniques for seve... more Advances in anesthetic management, neonatal intensive care and cardiovascular techniques for severe cardiac defects have permitted improved survival rate for esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) during the last two decades. In the treatment of EA-TEF, primary esophageal repair without staging or preliminary gastrostomy becomes popular among pediatric surgeons. In pure EA and long-gap EA with TEF, options for esophageal reconstruction include use of the native esophagus or replacement with colon or stomach. In considering the esophageal motility in patient's whole life, native esophageal reconstruction is the procedure of choice rather than esophageal replacement. Improved survival rates are noted irrespective of the traditional Waterson criteria, which now seem outdated. The surgical treatment of congenital tracheal stenosis have started in the early '80s. Resection of the stenotic trachea with end-to-end anastomosis has been available in the stenosis ranging less than 30% of the entire trachea. However, the treatment of long segment tracheal stenosis is still controvertial. Various surgical techniques including balloon tracheal split, slide tracheoplasty, implantation of autografts of pericardium and costal cartilage have been attempted. In this review, we described our own experience in tracheoplasty using costal cartilage.
Journal of the Japanese Society of Pediatric Surgeons, Dec 20, 2000
Journal of the Japanese Society of Pediatric Surgeons, Apr 20, 1996
J. Jpn. Soc. Pediatr. Surg., 2015
Journal of the Japanese Society of Pediatric Surgeons, Oct 20, 1997
Journal of the Japanese Society of Pediatric Surgeons, Jun 20, 1999
Journal of Pediatric Surgery, May 1, 2017
Purpose: Congenital tracheal stenosis (CTS) and a single right lung treated with slide tracheopla... more Purpose: Congenital tracheal stenosis (CTS) and a single right lung treated with slide tracheoplasty (ST) has relatively high rates of mortality and morbidity. We report a single institution's experience with adjunctive procedures at the time of ST to reduce postoperative tracheal obstruction in patients with a single right lung and CTS. Methods: With IRB approval, 8 patients with a single right lung and CTS who underwent ST in our institution between 2008 and 2016 were reviewed. Results: Seven of 8 patients (88%) survived, with a median follow-up period of 35 (3-89) months. The only mortality was because of complications unrelated to the airway. Six of 8 patients underwent ST anterior to the aortic arch (tracheal translocation, TT). This was combined with tracheopexy concomitantly in 3 patients and subsequently in one patient. Two patients had insufficient tracheal length for TT. Both underwent aortopexy. Of three patients undergoing TT with tracheopexy concomitantly, two have been successfully extubated, and a third has required tracheostomy for subglottic stenosis. All patients undergoing TT without tracheopexy have experienced severe tracheobronchomalacia. Conclusion: We conclude that adjunctive TT with tracheopexy might be associated with lower rates of tracheobronchial obstruction in patients with a single right lung undergoing ST for CTS. Level of evidence: Level IV.
Journal of Pediatric Surgery, Dec 1, 1980
During the past 12 mo, percutaneous transhepatic cholangiodrainage (PTCD) was carried out in 9 in... more 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.
The Japanese Journal of Thoracic and Cardiovascular Surgery, Apr 1, 1998
Between 1984 and 1996 five infants underwent surgical repair of pulmonary artery sling associated... more Between 1984 and 1996 five infants underwent surgical repair of pulmonary artery sling associated with severe congenital tracheal stenosis. All infants had symptoms of severe respiratory distress and three of them required ventilator support preoperatively ages ranged from 2 to 11 months (mean age 6 months). Complete tracheal rings were present in all patients as an associated lesion and right upper lobe tracheal bronchus in 3 patients. The length of tracheal stenosis ranged from 18 to 45 mm (median 40 mm). Three had associated intracardiac anomalies (Scimitar syndrome (1), VSD (1), double-outlet right ventricle with VSD (1), double-outlet right ventricle with pulmonary hypertension (1)). Surgical intervention was carried out through a right thoracotomy (1) or median sternotomy (4). Cardiopulmonary bypass (CPB) was used in 3 patients and extracorporeal membrane oxgenator (ECMO). In 1. All infants had reimplantation of the left pulmonary artery into the main pulmonary artery left anterior to the trachea. Four patients underwent simultaneous tracheoplasty using costal cartilage grafts and one had complete resection of obstructed trachea between the right upper lobe tracheal bronchus and carina. The length of resected trachea was about 30% of the entire length of the trachea. Three infants underwent simultaneous intracardiac repair. There was no hospital death. All were weaned from ventilatory support and extubated on 1 to 16 months (mean 4, 5 months) postoperatively. AS an additional procedure, aortopexy, removal of granulation tissue or balloon dilatation of the trachea were carried out in one patient each following tracheoplasty using cartilage grafts. There was one late death at 1 year postoperatively. Three of 4 survivors are doing well with no stridor. We adonostridor. We adovocate 1) early aggressive primary repair of pulmonary artery sling with tracheal stenosis, 2) concomitant repair of tracheal lesion and intracardiac anomalies whenever possible, 3) application of CPB or ECMO to avoid cumbersome intubation technique, and 4) utmost effort to perform tracheal resection and end-to-end anastomosis.