Liver abscess is a rare disease but shows a high mortality rate. The standard treatment is complete drainage of the abscess through surgery or insertion of a percutaneous catheter and proper antibiotic treatment. However, successful percutaneous drainage in a multiseptated abscess has several drawbacks, such as the necessity for inserting more than one catheter for proper drainage, a necessity for repetitive cathterization and moreover, the ultimate failure of effective drainage causing surgery to become inevitable. The authors used 80,000 IU urokinase three times per day over 5 days to lyse the fibrous septum in a 9-year-old child with multiseptated liver abscess. Catheter drainage with urokinase under radiologic intervention yielded successful a outcome in the treatment of a multiseptated liver abscess.
Abscess ; Catheters ; Child ; Drainage* ; Humans ; Liver Abscess* ; Liver* ; Mortality ; Rare Diseases ; Urokinase-Type Plasminogen Activator*

A quantitative assessment of the density of the protein gene product 9.5 (PGP9.5), the neural cell adhesion molecule (NCAM), and the low-affinity nerve growth factor receptor (NGFR) expressing nerve fibers in the circular muscle layer in the colon was carried out by morphometric analyses from 13 patients with Hirschsprung's disease (HD). The difference in the nerve fiber density between the ganglionic and aganglionic segments was compared by calculating the ratio of the sum of the areas occupied by positively stained nerve fibers per unit area of the muscle after immunohistochemical staining on paraffin embedded tissue sections using computer software. There was an obvious difference in the density of the PGP9.5 stained nerve fibers between the ganglionic (0.0380 +/- 0.0171) and aganglionic segments (0.0143 +/- 0.01661). The NCAM-positive nerve fibers were fewer in number than those of both the PGP9.5-positive fibers and NCAM-positive fibers, which were also markedly lower in number in the aganglionic segment (0.0066 +/- 0.0076) than in the ganglionic segment (0.0230 +/- 0.0195). Immunostaining for low-affinity NGFR revealed much fainter staining in the ganglionic and aganglionic segment without a statistically significant difference in their density. Considering the fact that PGP9.5 is a very sensitive marker for nerve fibers, the results of this study reaffirm the innervation failure of the proper muscle in HD. The decreased NCAM expression level in the aganglionic segment appears to be caused not by the selective down-regulation of NCAM expression among the nerve fibers but by a markedly reduced number of nerve fibers.
Colon/*innervation ; Hirschsprung Disease/*pathology ; Human ; Muscle, Smooth/*innervation ; Nerve Fibers/*chemistry/pathology ; Neural Cell Adhesion Molecules/*analysis ; Receptor, Nerve Growth Factor/analysis ; Thiolester Hydrolases/*analysis

PURPOSE: The purpose of this study was to construct a fetal animal model of congenital diaphragmatic hernia in a lamb under domestic environments. METHODS: Left-sided diaphragmatic hernias were created in seven fetal lambs at about 85 days' gestation (experimental group). Three other fetal lambs did not receive any surgical procedure and served as control group. Four of these lambs (3 in the experimental group and 1 in the control group) were delivered after a sufficient intrauterine period. The morphological changes of lung development were compared between the two groups. RESULTS: Creation of diaphragmatic hernia resulted in marked hypoplasia in fetal lung development. In this experiment, the maternal mortality was 33.3%, and the fetal mortality was 60% which are relatively high as compared with previous reports. CONCLUSION: From this data, the authors concluded that experimental fetal diaphragmatic hernia can be established although the technique for the measurement of gestational age, anesthesia and postoperative care should be improved to overcome domestic inexperience in using the lamb as an experimental animal.
Anesthesia ; Animals ; Fetal Mortality ; Gestational Age ; Hernia, Diaphragmatic* ; Lung ; Maternal Mortality ; Models, Animal ; Postoperative Care ; Pregnancy

PURPOSE: The megacolon after repairing an anorectal malformation is not a rare complication, and there is much controversiy on the causes, the treatment of choice and the results after a longterm follow-up. We present 5 cases of a megacolon after the repair of an anorectal malformation, which were controlled with either a surgical resection or conservative treatment. METHODS: Five patients with a megacolon after the repair of an anorectal malformation were studied. A retrospective chart review was done and fecal continence was evaluated with an individual interview. RESULTS: All five patients initially underwent conservative treatment with laxatives and/or enemas. One Patient responded well to conservative treatment and the diameter of the bowel reduced to normal size. Another patient responded to conservative treatment after correcting the location of the anus. Three patients needed a surgical resection and one of those needed a further procedure to correct the anal location. After the surgical resection of the megacolon and/or correction of the anus (one out of the three patients), they soon reported an almost normal bowel habit. CONCLUSION: The first step in treating a megacolon after repairing an anorectal malformation was conservative treatment. However patients without an adequate response to conservative treatment are best managed with a surgical resection. The cause of the megacolon is now under investigation and the lack of adequate management after repair is one of the subjects.
Anal Canal ; Enema ; Follow-Up Studies ; Humans ; Laxatives ; Megacolon* ; Retrospective Studies

PURPOSE: The results of surgical treatment for acute suppurative cervical lymphadenitis in children were evaluated with literature reviews. METHODS: Children under 15-year old who required operative management for acute suppurative cervical lymphadenitis between January 1996 and December 2000 were evaluated with retrospective manner. The clinical characteristics, pathologic results and microbiologic studies were reviewed. RESULTS: 37 patients were treated with surgical methods. 36 patients recovered fully after surgical intervention without any recurrence and one patient expired of sepsis. CONCLUSION: The classical treatment, incision and drainage, is one of the treatment of choice for the recovery from suppurative cervical lymphadenitis in children.
Adolescent ; Child* ; Drainage ; Humans ; Lymphadenitis* ; Recurrence ; Retrospective Studies ; Sepsis

PURPOSE: Since 2002, Department of Surgery, Yonsei University Wonju College of Medicine attempted to revise the evaluation method of surgical clerkship program. The purpose of this study was to analyze the effect after change of evaluation method. METHODS: Major changes in current revisions were summarized as follows; (1) multiple evaluator, (2) student's attitude evaluated by rating scale method, (3) attendance and procedure evaluation were measured in numbers according to the fixed criteria, (4) addition of clinic-based items such as problem-solving items in the final written examination. We compared the measurement of revised evaluation at 2002 with those at 1999. And the correlation or simple linear regression analysis between score of clerkship and student academic grade score were taken. RESULTS: The clerkship score of students at 2002 showed more powerful discrimination between high performance group and poor group than that of 1999's. Even though the subject score of clerkship was significantly correlated with grade score regardless of evaluation method of clerkship, the subject score of clerkship at 2002 was more closely correlated with a grade score than 1999's. The score of knowledge-based items from final written examination is not correlated with clerkship score, but on the other hands, there was significant correlation between score of clinic-based items and clerkship score. CONCLUSION: In conclusion, variable measurements under the exact guideline and principle are more reliable method in evaluation of surgical clerkship.
Discrimination (Psychology) ; Gangwon-do ; Hand ; Humans ; Linear Models

Objective To understand the pathogen-carrying status of hand-foot-mouth disease (HFMD) among healthy people in Guangdong province.Methods Stool specimens were collected randomly on 7 age groups from 7 cities in Guangdong province.Real-time RT-PCR was used to detect enterovirus (EV),enterovirus 71 (EV71) and coxsackie virus A16 (CA16).Results Altogether,1285 stool specimens were collected.The positive rates of EV71,CA16 and other enterovirus were 0.39％ (5/1285),0.23％ (3/1285) and 7.00％ (90/1285),respectively.The highest EV71 positive rate (1.79％) was among the 4-6-year-old group,followed by the age group 0-3 with positive rate as 0.67％.EV71 was not found among the rest age groups.The highest CA16 positive rate (1.35％) was among the 4-6 year-olds group,but the CA16 was not found among the rest age groups.EV71 was only found among native population,with the positive-rate as 0.47％.CA16-positive rate was 0.19％ among the native population and 0.85％ among floating population,with no significant difference found (P＞0.05).The EV71 positive rate was 0.36％ among rural residents and 0.54％ among urban residents,but with no significant difference (P＞0.05).All CA16 was found among the urban residents.Conclusion Recessive infection of EV71 and CA16 were only found among 0-6 year-old group but not found among other groups,which suggested that the approaches on prevention and control should be targeted to all children especially on pre-school children.

Objective To study the efficacy of bronchoalveolar lavage(BAL)combined with prone positioning in children with Mycoplasma pneumoniae pneumonia(MPP)and atelectasis and its effect on pulmonary function.Methods A prospective study was conducted on 94 children with MPP and atelectasis who were hospitalized in Ordos Central Hospital of Inner Mongolia from November 2020 to May 2023.The children were randomly divided into a treatment group and a control group,with 47 children in each group.The children in the treatment group were given conventional treatment,BAL,and prone positioning,and those in the control group were given conventional treatment and BAL.The two groups were compared in terms of fever,pulmonary signs,length of hospital stay,lung recruitment,and improvement in pulmonary function.Results Compared with the control group,the treatment group had significantly shorter time to improvement in pulmonary signs and length of hospital stay and a significantly higher rate of lung recruitment on day 7 of hospitalization,on the day of discharge,and at 1 week after discharge(P<0.05).Compared with the control group,the treatment group had significantly higher levels of forced vital capacity(FVC)as a percentage of the predicted value,forced expiratory volume(FEV)in 1 second as a percentage of the predicted value,ratio of FEV in 1 second to FVC,forced expiratory flow at 50%of FVC as a percentage of the predicted value,forced expiratory flow at 75%of FVC as a percentage of the predicted value,and maximal mid-expiratory flow as a percentage of the predicted value on the day of discharge and at 1 week after discharge(P<0.05).There was no significant difference in the time for body temperature to return to normal between the two groups(P>0.05).Conclusions In the treatment of children with MPP and atelectasis,BAL combined with prone positioning can help to shorten the time to improvement in pulmonary signs and the length of hospital stay and promote lung recruitment and improvement in pulmonary function.

Background:Chronic kidney disease (CKD) with moderate-to-severe renal dysfunction usually exhibits an irreversible course,and available treatments for delaying the progression to end-stage renal disease are limited.This study aimed to assess the efficacy and safety of the traditional Chinese medicine,Niaoduqing particles,for delaying renal dysfunction in patients with stage 3b-4 CKD.Methods:The present study was a prospective,randomized,double-blind,placebo-controlled,multicenter clinical trial.From May 2013 to December 2013,300 CKD patients with an estimated glomerular filtration rate (eGFR) between 20 and 45 ml,min-1· 1.73 m-2,aged 18-70 years were recruited from 22 hospitals in 11 Chinese provinces.Patients were randomized in a 1∶1 ratio to either a test group,which was administered Niaoduqing particles 5 g thrice daily and 10 g before bedtime for 24 weeks,or a control group,which was administered a placebo using the same methods.The primary endpoints were changes in baseline serum creatinine (Scr) and eGFR after completion of treatment.The primary endpoints were analyzed using Student's t-test or Wilcoxon's rank-sum test.The present study reported results based on an intention-to-treat (ITT) analysis.Results:A total of 292 participants underwent the ITT analysis.At 24 weeks,the median (interquartile range) change in Scr was 1.1 (-13.0-24.1) and 11.7 (-2.6-42.9) μmol/L for the test and control groups,respectively (Z =2.642,P =0.008),and the median change in eGFR was-0.2 (-4.3-2.7) and-2.2 (-5.7-0.8) ml·min-1.1.73 m-2,respectively (Z =-2.408,P =0.016).There were no significant differences in adverse events between the groups.Conclusions:Niaoduqing particles safely and effectively delayed CKD progression in patients with stage 3b-4 CKD.This traditional Chinese medicine may be a promising alternative medication for patients with moderate-to-severe renal dysfunction.

OBJECTIVETo analyze retrospectively the therapeutic efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for chronic myelomonocytic leukemia (CMML).

METHODSThe engraftment, graft versus host disease (GVHD), infection, relapse, and survival of 13 CMML patients received allo-HSCT were observed. The clinical outcome of allo-HSCT for CMML was analyzed.

RESULTSThirteen (10 males and 3 females) CMML patients with a median age of 38 years old received allo-HSCT including 4 from HLA-matched unrelated donors, 6 from HLA-matched sibling donors and 3 from haploidentical related donors. All 13 patients achieved engraftment, and the median time of neutrophil engraftment and platelet engraftment were 12 (11-18) days and 15 (10-55) days respectively, acute GVHD occurred in 8 patients. After the median follow-up of 13 (6-29) months, the overall survival, disease free survival and relapse were 53.8%, 53.8%, 7.7%, respectively.

CONCLUSIONAllo-HSCT can improve the survival of patients with CMML, and is a effective method for treatment of CMML.

Adult ; Disease-Free Survival ; Female ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Humans ; Leukemia, Myelomonocytic, Chronic ; Male ; Retrospective Studies ; Siblings ; Tissue Donors ; Transplantation, Homologous