BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) is a simple, safe and rapid method for the placement of a feeding gastrostomy tube and it is a well-established mean of providing enteral nutrition. Although it is frequently used in adults, there is limited experience for this procedure in children. METHODS: Twenty five procedures of PEG in 23 patients were performed in four institutions located in Youngnam province. We retrospectively reviewed our experiences of PEG. RESULTS: Fourteen males and nine females were included and their mean age was 5.7+/-4.1 years. The patients aged 1 to 6 years accounted for about a half the subjects. The underlying diseases of the patients were CNS disorders in all except one who was suffering with a neuromuscular disorder. The main reason for PEG was swallowing difficulty and the associated complications of the patients. Nasogastric tube feeding was the most common method of nutritional support before the procedures. The most common complication of PEG placement was wound infection. The patients' nutritional status after PEG placement was satisfactorily improved. The indwelling time of PEG tube was over 6 months in 2 of 3 patients and the tube was switched for a new one after a year. Removal of the tubes by using percutaneous traction was done in 2 of 3 patients. CONCLUSIONS: The PEG is a safe, easy to perform, and reliable technique to support enteral nutrition in children.
Adult ; Child* ; Deglutition ; Endoscopy ; Enteral Nutrition ; Female ; Gastrostomy* ; Humans ; Male ; Nutritional Status ; Nutritional Support ; Retrospective Studies ; Traction ; Wound Infection

A series of 4 patients with aneurysm of distal anterior cerebral artery(DACA), operated with microtechniques, is reviewed. Because the incidence of aneurysms in this location was only 2 to 4% of that of total aneurysm, little expericences on surgical management of this aneurysm have been reported. An aneurysm in this location is difficult to approach surgically because of their multiplicity, characteristically broad and sclerotic base, with small subarachnoid space in the interhemispheric fissure. We surgically treated DACA aneurysms of 4 cases through the interhemispheric approach via the unilateral frontal paramedian craniotomy on the nondominant side.
Aneurysm ; Anterior Cerebral Artery* ; Craniotomy ; Humans ; Incidence ; Intracranial Aneurysm* ; Subarachnoid Space

Mumps virus infections usually involve the parotid glands. It usually spreads from a human reservoir by airborne droplet of infected saliva. Therefore, early proper diagnosis and isolation of patients can help to inhibit dissemination of the disease. Diagnosis of mumps virus infection is mainly dependent on clinical inspection, palpation of the parotid and laboratory tests, because most mumps virus infections involve the parotid gland. Isolated submandibular gland involvement in mumps is rare and presents diagnostic challenge. We report unusual consecutive cases of mumps virus infections in two patients who were brothers, for whom bilateral submandibular glands were found to be involved paring parotid glands. These cases instruct us not to exclude mumps virus infection even in isolated uni/bilateral submandibular gland swelling.
Diagnosis ; Humans ; Mumps virus ; Mumps* ; Palpation ; Parotid Gland ; Saliva ; Siblings ; Submandibular Gland*

Cystic lymphangiomas are comparatively rare, benign tumors of lymphatic system and their histogenesis are uncertain. About 75% of theses lesions are in the neck, 20% are in the axillary region, and 5% are in the mediastinum, retroperitoneal region or groin. But retroperitoneal cystic lymphangiomas are very rare. Retroperitoneal cystic lymphangiomas are usually found incidentally during diagnostic procedures performed for unrelated clinical reasons or at surgery. Although retroperitoneal cystic lymphangioma is a benign lesion, it may cause significant morbidity due to its large size and its often invasive character with a strong tedency to secondary infection. They generally present as a palpable mass or abdominal pain and fever related to hemorrhage or inflammation of the cystic wall. The treatment of choice is surgical excision. We experienced a case of retroperitoneal cystic lymphangioma in a 4-year-old boy who had developed rapid abdominal distention and abdominal pain for 4 days. We have completely excised large cystic mass & histologically confirmed cystic lymphangioma. A brief review of literature was made.
Abdominal Pain ; Child, Preschool ; Coinfection ; Fever ; Groin ; Hemorrhage ; Humans ; Inflammation ; Lymphangioma, Cystic* ; Lymphatic System ; Male ; Mediastinum ; Neck

Objectives: Bisphenol A (BPA) is used in the electrical, mechanical, medical, and food industries. Previous studies have suggested that BPA is an endocrine disruptor. Regulation of BPA has led to increased use of bisphenol F (BPF) and bisphenol S (BPS). However, few studies have investigated the associations of BPF and BPS with thyroid dysfunction in children. Our study investigated the associations of prenatal BPA and early childhood BPA, BPF, and BPS exposure with thyroid function in 6-year-old children. Methods: Prenatal BPA concentrations were measured during the second trimester of pregnancy in an established prospective birth cohort. We measured urinary BPA, BPF, and BPS concentrations and thyroid hormone levels (thyroid-stimulating hormone, total T3, and free T4) in 6-year-old children (n=574). We examined the associations between urinary bisphenol concentrations and percentage change of thyroid hormone concentrations using multivariate linear regression. We also compared thyroid hormone levels by dividing the cohort according to BPA, BPF, and BPS concentrations. Results: The associations between prenatal BPA and total T3 levels were statistically significant in all models, except for girls when using a crude model. The associations between urinary BPA and BPS concentrations and levels of all thyroid hormones were not statistically significant. However, we observed that lower free T4 levels (-1.94%; 95% confidence interval, -3.82 to -0.03) were associated with higher urinary BPF concentrations in girls only. Conclusions Our findings identified significant associations between prenatal BPA exposure and total T3 levels in all children and between BPF exposure and free T4 levels in girls only.

The web of the common bile duct is an extremely rare anomaly and the cause of the obstructive jaundice. We experienced a case of the congenital web of common bile duct in a 42 years old male who complained of jaundice for 10 days prior to admission without choledocholithiasis and cholangitis. An endoscopic retrograde cholangiopancreatography revealed a common bile duct web (transverse, diaphragmatic type) and the diagnosis was confirmed by an endoscopic forcep biopsy. We reported a case of the congenita1 web of the common bile duct which was treated with a stent insertion and balloon dilatation.
Adult ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Choledocholithiasis ; Common Bile Duct* ; Diagnosis ; Dilatation* ; Humans ; Jaundice ; Jaundice, Obstructive ; Male ; Stents ; Surgical Instruments

Primary sclerosing cholangitis is a cholestatic liver disease characterized by fibroobliterative inflammation of the entire biliary tree. It is a slowly progressive disease with an undulating course, resulting in biliary cirrhosis. The gold standard for establishing the diagnosis is cholangiographic demonstration of typical diffuse biliary stricturing and beading. We exprienced a case of primary sclerosing cholangitis by Endoscopic retrograde cholangiopancreatography (ERCP) demonstration. ERCP findings revealed multiple luminal narrowing, stricture and beaded dilatation of the intrahepatic duct. We report a case of primary sclerosing cholangitis localizing at intrahepatic bile duct, which is confused with cholangiocarcinoma.
Bile Ducts, Intrahepatic* ; Biliary Tract ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis, Sclerosing* ; Constriction, Pathologic ; Diagnosis ; Dilatation ; Inflammation ; Liver Cirrhosis, Biliary ; Liver Diseases ; Phenobarbital

Pancreatic pseudocysts are a well-recognized complication of pancreatitis. Most occur in or adjacent to the pancreas. Occasionally, duodenal involvement may occur due to the nonperitonealized posterior surface of the duodenum is in direct contact with the head of the pancreas. But there is little awareness of the intramural and major extrinsic involvement of the duodenum with also occurs. A case was recently experienced involving an intramural pancreatic pseudocyst of the duodenum.
Duodenum* ; Head ; Pancreas ; Pancreatic Pseudocyst* ; Pancreatitis

BACKGROUND: Use of antispasmodic medication prior to colonoscopy is controversial but someone believes antispasmodic may improve visualization of colonic mucosa and ease colonoscope insertion. So, we designed a study to assess the effect of premedication with the antispasmodic, hyoscine-N-butyl bromide(Buscopan(R)) on the performance of colonoscopy. METHODS: This study was prospective, double blinded, randomized, controlled study, One hundred three consecutive patients were randomized to receive intravenous buscopan lml(n=52) or placebo(n=51) combined with our standard initial medication(me-peridine 50 mg and midazolam 2 mg). Insertion of colonoscopy was timed, and 100 mm visual analogue scales (VAS) were used for asscssing difficulty of procedure, colonic motility, frequency of positional change, frequency of external compression, difficulty of assistance and degree of discomfort experienced by the patients. RESULTS: There were no significant differences of intubation time between buscopan group(mean time, 7.23 min., range 2~15) and placebo group(7.07 min., range 3~25), (p=0.83) and withdrawal time between buscopan group (6.46 min., range 2-22) and placebo group(6.76 min., range 2 25), (p=0.69). Also, there was no significant differences in intubation time between males and females(buscopan; males 7.00 min., females 7.60 min., p=0.34, placebo; males 7.0~5 min., females 7.08 min., p 0.44). The VAS scores checked by endoscopist(p=0.29), assistant(p=0.32) and patient (p=0.15) were not significantly different in both groups. There were no significant differences in intubation time, VAS scores nf endoscopist, assistant, and patients. CONCLUSION: Premedication with intravenous bu.opan has no advantage on colonoscopy procedure. Use of antispasmodic medication prior to colonoscopy was not considered as recommendable agent.
Butylscopolammonium Bromide ; Colon ; Colonoscopes ; Colonoscopy* ; Female ; Humans ; Intubation ; Male ; Midazolam ; Mucous Membrane ; Premedication* ; Prospective Studies* ; Weights and Measures

We present herein the case of 31-year-old man with disseminated malignant melanoma in whom a multiple metastasis into jejunum causing multiple intussusceptian. At laparotomy, multiple variable sized metastatic melanoma were noted on proximal and distal jejunum. To our knowledge, there was no report about multiple intussusceptions by malignant melanoma in Korea.
Adult ; Humans ; Intussusception* ; Jejunum ; Korea ; Laparotomy ; Melanoma* ; Neoplasm Metastasis