It has been widely accepted that complete surgical resection of hepatoblastoma is essential for long-term survival. But unfortunately less that 50% of hepatic tumors in children can be totally removed at the time of diagnosis. This report is to present the experience of successful resection of hepatoblastoma after concurrent radiotherapy with transarterial chemoinfusion in a child. We believe this modality of treatment enables complete resection of unresectable hepatoblastoma, which is resistant to the systemic chemotherapy.
Child ; Diagnosis ; Drug Therapy ; Hepatoblastoma* ; Humans ; Radiotherapy*

Pseudoaneurysm of splenic artery may arise from a vascular erosion by the inflammatory processes around the splenic artery, particularly in acute pancreatitis and chronic pancreatitis, which may cause rupture of pseudoaneurysm and life threatening hemorrhage. Collective experience with this massive hemorrhage is attended by a high mortality rate even with prompt therapy, and conservative management is associated with an almost 100 per cent of mortality rate. Identification of the bleeding site at laparotomy may be exceedingly difficult, which makes the preoperative detection of bleeding source desirable. Peripancreatic vascular lesions can be identified by angiography, and in selected cases the risk of urgent operation to control massive hemorrhage may be obviated by embolization. The authors have recently experienced a case of ruptured splenic artery pseudoaneurysm combined with a pancreatic pseudocyst in a 6 years old boy. A bolus enhanced CT scan and angiography were essential to confirm these complications of pancreatic pseudocyst. We managed this child successfully with an urgent procedure of transcatheter arterial embolization and another elective surgery of pancreatic pseudocyst.
Aneurysm, False* ; Angiography ; Child* ; Hemorrhage ; Humans ; Laparotomy ; Male ; Mortality ; Pancreatic Pseudocyst ; Pancreatitis ; Pancreatitis, Chronic ; Rupture ; Splenic Artery* ; Tomography, X-Ray Computed

PURPOSE: The purpose of this study was to investigate the prognostic impact of pretreatment neutrophil to lymphocyte ratio (NLR) on breast cancer in view of disease-specific survival and the intrinsic subtype. METHODS: We retrospectively studied patients diagnosed with primary breast cancer that had completed all phases of primary treatment from 2000 to 2010. The association between pretreatment NLR and disease-specific survival was analyzed. RESULTS: A total of 442 patients were eligible for analysis. Patients with higher NLR (2.5 < or =NLR) showed significantly lower disease-specific survival rate than those with lower NLR (NLR <2.5). Higher NLR along with negative estrogen receptor status and positive nodal status were independently correlated with poor prognosis, with hazard ratio 4.08 (95% confidence interval [CI], 1.62-10.28), 9.93 (95% CI, 3.51-28.13), and 11.23 (95% CI, 3.34-37.83), respectively. Luminal A subtype was the only intrinsic subtype in which higher NLR patients showed significantly poor prognosis (87.7% vs. 96.7%, p=0.009). CONCLUSION: Patients with an elevated pretreatment NLR showed poorer disease-specific survival than patients without elevated NLR, most evident in the luminal A subtype. Further validation and a feasibility study are required before it can be considered for clinical use.
Breast ; Breast Neoplasms ; Estrogens ; Humans ; Lymphocytes ; Neutrophils ; Phenobarbital ; Prognosis ; Retrospective Studies ; Survival Rate

With Duchenne's muscular dystrophy, there are many descriptions from the view of skeletal muscle disorders. However, the functional impairment of smooth muscle can cause fatal problems. A case of a 13-year-old boy, with Duchenne's muscular dystrophy, who present with severe abdominal pain from acute gastric dilatation and acute calculous cholecystitis, is reported. The case is discussed, with a review of the literature.
Abdominal Pain ; Adolescent ; Cholecystitis* ; Gastric Dilatation* ; Humans ; Male ; Muscle, Skeletal ; Muscle, Smooth ; Muscular Dystrophies*

PURPOSE: Accurate diagnosis and optimal management of acute appendicitis, despite being the most common surgical emergency encountered in emergency departments, is often delayed in pediatric patients due to nonspecific symptoms and communication barriers, often leading to more complicated cases. The aim of this study is to investigate the diagnostic significance of common laboratory markers. METHODS: A total of 421 patients aged 15 and younger underwent surgical treatment for acute appendicitis. We conducted a retrospective analysis for white blood cell (WBC), C-reactive protein (CRP) and bilirubin. All patients were classified into simple or complicated appendicitis groups based on postoperative histology. RESULTS: The mean age of the patients in the complicated appendicitis group was younger than that in the simple group (P = 0.005). WBC, CRP and bilirubin levels were significantly higher in the complicated appendicitis group (P < 0.001, <0.001, 0.002). The relative risk for complicated appendicitis was calculated using age, WBC, CRP and bilirubin. Elevated CRP levels were associated with the highest risk for complicated appendicitis (hazard ratio [HR], 2.53; 95% confidence interval [CI], 1.38 to 4.65) followed by WBC (HR, 2.42; 95% CI, 1.07 to 5.46) and bilirubin (HR, 2.04; 95% CI, 1.09 to 3.82). The most sensitive markers for diagnosing complicated appendicitis were WBC (95.2%) and CRP (86.3%). Bilirubin levels showed the highest specificity at 74.8%. CONCLUSION: The risk of complicated appendicitis was significantly higher in patients younger than 10 years old. Preoperative WBC, CRP and bilirubin have clinical value in diagnosing complicated appendicitis with a HR of 2.0 to 2.5. Our results suggest that the utilization of WBC, CRP, and bilirubin can assist in the diagnosis of complicated appendicitis in pediatric patients, allowing prompt diagnosis and optimal management.
Aged ; Appendicitis ; Bilirubin ; Biomarkers ; C-Reactive Protein ; Child ; Communication Barriers ; Emergencies ; Humans ; Leukocytes ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND: The frequency of invasive lobular carcinomas is about 3% to 15% of all breast carcinomas. It is known that an invasive lobular carcinoma is different from other forms of breast cancer in the aspect of clinical characteristics and metastatic pattern. METHOD: To search of clinical characteristics of invasive lobular carcinomas, we restrospectively investigated 31 cases of invasive lobular carcinomas that had been treated from 1985 to 1996 at the Department of Surgery, Severance Hospital. RESULTS: The peak incidence was in the 40's (12 cases, 38.7%), and the average age was 45.8. The main clinical manifestation was a palpable mass on the breast at the time of visit to the hospital (30 cases, 96.8%), and the most frequent site was the upper outer quadrant (18 cases, 58.1%), followed by the upper inner quadrant (6 cases, 19.4%), of the breast. The most prevalent tumor size was 2-4 cm (14 cases, 45.2%), and the mean size was 3.27 cm. The negativity of the axillary nodes for invasive lobular carcinoma was 67.7%. According to the TNM system, there was 5 casess (16.1%) in stage I, 17 cases (54.8%) in stage IIa, 7 cases (22.6%) in stage IIb, and 2 cases (6.5%) in stage IIIb. The positivity of the estrogen receptor (ER) was 35.7%, and the positivity of the progesterone receptor (PR) was 54.5%. The overall 5-year survival rate was 82%, the overall 5-year disease-free survival was 70%, and the mean survival was 108 months. CONCLUSION: The clinical characteristics of an invasive lobular carcinoma seem to be similar to those of an invasive ductal carcinoma. Further studies are required to search for the clinical characteristics and for an adequate treatment.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Lobular* ; Disease-Free Survival ; Estrogens ; Incidence ; Receptors, Progesterone ; Survival Rate

In hepatoblastoma, encouraging cure rates have been achieved with recent advances in chemotherapy and surgical techniques. The aim of this study is to evaluate the role of combined therapeutic modalities and surgical resection in hepatoblastoma. Fifteen cases of hepatoblastoma were treated from January 1993 to August 2000. Six patients had resectable tumors at initial diagnosis. All underwent surgical resection and in four patients postoperative adjuvant chemotherapy was needed. Nine out of 15 patients had unresectbale tumors at initial diagnosis, and preoperative chemotherapy was applied. There was one operative mortality and 14 patients showed good prognosis after surgery. Although various treatment modalities should be combined for the unresectable hepatoblastoma, surgical resection remains the major curative procedure.
Chemotherapy, Adjuvant ; Diagnosis ; Drug Therapy ; Hepatoblastoma* ; Humans ; Mortality ; Prognosis

Femoral hernias are very uncommon in children and very easily misdiagnosed. During a period of three years, three children of femoral hernia were treated by one pediatric surgeon at Severance Hospital. Only one case was diagnosed correctly before surgery; the other two were thought to be either an indirect inguinal hernia or groin mass. Only one patient had curative hernioplasty (McVay hernioplasty) at the first operation; the other two did not have curative hernioplasty at the first operation. Femoral hernia in childhood is a challenging clinical problem because of its rarity and similar clinical presentation as indirect inguinal hernia. The frequency with which an incidental indirect inguinal hernia sac or patent processus vaginalis can be found at surgery can perpetuate a misdiagnosis. The absence of an expected indirect inguinal hernia sac or an apparent recurrence of an indirect inguinal hernia should lead to consideration of possible femoral hernia.
Child* ; Diagnostic Errors ; Groin ; Hernia, Femoral* ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Recurrence

Neuroblastoma arises from the embryonic tissue of adrenergic rest. It is commonly found in children but mostly in nonrenal tissue. We present a case of intrarenal neuroblastoma which was initially mistaken as Wilms' tumor in a 18 months-old girl treated with radical nephrectomy with postoperative adjuvant chemotherapy. The location of mass within the kidney cannot always indicate that it is Wilms' tumor. Sometimes neuroblastoma from adrenal or retroperitoneal space often compresses or invades directly the kidney and it can also origanate in the kidney. Important clinical aspects in differenctialting neuroblastoma and Wilms' tumor along with review of literatures are discussed.
Chemotherapy, Adjuvant ; Child ; Female ; Humans ; Infant ; Kidney ; Nephrectomy ; Neuroblastoma* ; Retroperitoneal Space ; Wilms Tumor

PURPOSE: Prenatal diagnosis of congenital anomalies provides the information for the perinatal treatment, which can be beneficial to the patients. Yonsei University is one of the largest tertiary referral centers in Korea and its achievement in pediatric surgery is representative figure of pediatric surgery in Korea. This achievement is used to assess the impacts of prenatal ultrasonograms on the doutcomes of prenally diagnosed anomalies in the neonates. METHODS: Between 1991 and 2000, 41,458 prenatal ultrasonograms were performed on the pregnant women and the fetal abdominal abnormalities were suspected in 165 fetuses. Of these, 87 fetuses were delivered and the abnormalities were finally confirmed. Theses 87 fetuses was the basis of this study in terms of their prenatal and final diagnosis with the outcomes. RESULTS: Among 87 fetuses, 17 cases were terminated in relation to the maternal health or multiple anomalies. Of the remaining 70 fetuses, 55 patients survived. Among the prenatal diagnoses of 87 fetuses, final diagnosis were made from 75 fetuses and the accuracy of the prenatal diagnosis was found to be 60.0% (45/75). Surgical correction was necessary in 44 cases to confirm the diagnosis and of these, 40 patients survived after the surgical correction. CONCLUSION: Prenatal diagnosis of the congenital anomalies will improve postnatal outcomes by proper surgical management. However, it can affect the rate terminations of pregnancies even though its accuracy is not so high. To advance the knowledge of the fetal pathophysiology, pediatric surgeons must play an important role in the prenatal diagnosisin relation to the postnatal treatment of the anomalies.
Diagnosis ; Female ; Fetus ; Humans ; Infant, Newborn ; Korea ; Maternal Health ; Perinatal Care ; Pregnancy ; Pregnant Women ; Prenatal Diagnosis ; Tertiary Care Centers ; Ultrasonography*