BACKGROUND: Infantile Hypertrophic Pyloric Stenosis (IHPS) is one of the most common surgical problems of early infancy and one for which an eminently successful surgical treatment has been available since the work of Ramstedt in 1912. A clinical study was begun to access further the accuracy of ultrasonography in identifying hypertrophic pylorus. METHODS: This study is a retrospective clinical analysis of 31 cases of IHPS treated at the Department of Surgery of Pohang St. Mary's Hospital from Jan. 1990 to Dec. 1997. RESULTS: (1) The most prevalent age group was between 3 weeks and 8 weeks in 24 cases (77.4%), and the ratio of males to females was 5.2:1. (2) Among the 31 cases, new born babies were 21 cases (67.7%). (3) In 30 cases (96.8%), the gestational age was between 37 weeks and 42 weeks, and the birth weight was more than 3.5 kg in 21 cases (67.7%). The body weight percentile at admission was lower than the 50 percentile in 31 cases. (4) Among the 31 cases, breast-fed infants were 15 cases (48.4%), milk-fed 13 cases (41.9%), and mixed-fed 3 cases (9.7%). B type blood group was 23 cases (74.2%), and O type was 4 cases (12.9%). (5) In 4 cases (12.9%), an inguinal hernia was noted as an associated anomaly. (6) The onset of symptoms was neonatal (1 week-12 weeks) in all 31 cases, and the duration of the symptoms was between 1 week and 2 weeks in 18 cases (58.1%). (7) Non-bile stained, projectile vomiting was noted in all 31 cases (100.0%), an olive-shaped mass in right upper quadrant of the abdomen was felt in 27 cases (87.1%), and visible peristalsis on the epigastrium was noted in 25 cases (80.6%). (8) On laboratory tests, 17 patients had leukocytosis, and anemia was observed in 2 cases. Hypokalemia was observed in 9 cases (29.0%), hypochloremia in 4 cases (12.9%), and moderate to severe alkalosis (CO2 content > 25 mEq) in 7 cases. (9) Among the 25 cases, for which an the ultrasonographic evaluation was performed, the length of the stenotic canal was from 16 mm to 20 mm in 23 cases (92.0%), and the thickness of the stenotic portion was from 5 mm to 6 mm in 21 cases (84.0%). (10) All 31 cases were surgically treated by using a Fredet-Ramstedt pyloromyotomy, and the mortality was nil. The average hospitalization was 9.4 days. (11) There was 1 case of duodenal perforation and 1 case of intermittent non-projectile vomiting after the operation. CONCLUSIONS: We conclude that early accurate diagnosis, adequate preoperative preparation of the fluid & electrolyte imbalance, immediate surgical correction, and scheduled careful oral feeding are important in treatment of IHPS. Ultrasonographic determination of pyloric muscle length and thickness is the most accurate of the currently available techniques. A Fredet-Ramstedt pyloromyotomy is a safe and successful surgical procedure.
Abdomen ; Alkalosis ; Anemia ; Birth Weight ; Body Weight ; Diagnosis ; Female ; Gestational Age ; Gyeongsangbuk-do ; Hernia, Inguinal ; Hospitalization ; Humans ; Hypokalemia ; Infant ; Leukocytosis ; Male ; Mortality ; Peristalsis ; Pyloric Stenosis, Hypertrophic* ; Pylorus ; Retrospective Studies ; Ultrasonography ; Vomiting

A 67 year old male patients was anesthetized with halothane for a open reduction of the fractured right femur shaft. The patient was admitted to the emergency room after he had cerebra1 contusion and fracture of the femoral shaft by a traffic, accident. Anesthesia was continued for one and a, half hours without any problem. At around one and a half hours of anesthesia, the patient developed cardiac arrest and resuscitation was performed immediately. The patient's life was saved by resuscitation and the operation was completed without any further problem. At the time of the resuscitation, a tension pneumothorax was recognized but anesthesia was continued with immediate, proper management. Closed thoracotomy was performed at the recovery room after anesthesia and the patient recovered from anesthesia without any other problem.
Aged ; Anesthesia ; Anesthesia, General* ; Cardiopulmonary Resuscitation* ; Contusions ; Emergency Service, Hospital ; Femur ; Halothane ; Heart Arrest ; Humans ; Male ; Pneumothorax* ; Recovery Room ; Resuscitation ; Thoracotomy

Induced hypotension is a well established adjunct to anesthesia which provides improved operating conditions for a wide variety of surgical procedures without significantly increasing the risk to the patient. Since introduction of hypotensive anesthesia in 1964 by Gardner, there has been a wide choice of methods for inducing hypotension during anesthesia, most of which are based on the concept of arteriolar dilatation. Hypotensive anesthesia was attempted on ten patients for total hip replacements which were done at Gospel Hospital, from Feb. to Oct. in 1979. The patients selected did not have a liver problem, and this was determined by SGOT and SGPT, and without a limit of age or sex. The hypotension was induced with 2~3% halothane, 50% N2O and 50%, O2and the blood pressure averaged for systolic pressure 71. 22 mmHg and for diastolic pressure 50. 09 mmHg, The average duration of the induced hypotension was 57. 0 minutes and the blood loss during operation was 300 ml on average. During the hypotensive anesthesia, the urine output decreased by 27. 0% and during the recovery period from hypotension urine output increased by 20%. On our experience, we can conclude that hypotensive anesthesia provides good operative conditions and can be performed without damage to vital organs and can reduce blood loss during operation.
Alanine Transaminase ; Anesthesia* ; Arthroplasty, Replacement, Hip* ; Aspartate Aminotransferases ; Blood Pressure ; Dilatation ; Halothane ; Humans ; Hypotension ; Liver

In general, the long head of the biceps brachii originates from the superior glenoid labrum and the supraglenoid tubercle, crosses the rotator cuff interval, and extends into the bicipital groove. However, rare anatomic variations of the origins of the long head have been reported in the past. In this report, we review the clinical history, radiologic findings, and arthroscopic identifications of 3 anatomic variants of the biceps tendon long head. As the detection of long head of biceps tendon pathology during preoperative radiologic assessment can be difficult without prior knowledge, surgeons should be aware of such possible anatomic variations.
Anatomic Variation ; Head* ; Pathology ; Rotator Cuff ; Shoulder ; Tendons

Basaloid follicular hamartoma (BFH) is a benign adnexal tumor with a wide spectrum of clinical appearance and is characterized histologically by the presence of branching cords and thin strands of undifferentiated anasomosing, basaloid proliferations that are embedded in a fibrous stroma. It has been often misdiagnosed and treated as basal cell carcinoma. We report a 57-year-old woman with BFH on the face which is similar to basal cell carcinorna clinically that turned out to be a solitary BFH histologically. There has been no recurrence during one year of follow up after excisional biopsy.
Biopsy ; Carcinoma, Basal Cell ; Female ; Follow-Up Studies ; Hamartoma* ; Humans ; Middle Aged ; Recurrence

A synophthalmia, another form of cyclopia, in which the element of the two eyes are partially fused to form an apparently single eye in the middle of the forehead. The synophthalmia is a result of complex, neural plate misdevelopment syndrome involving the eye, brain, skull and face. It is well known that synophthalmia is due to heterogenous causes, most of which chromosomal imbalances. We experienced a case of synophthalmia associated with proboscis, alobar holoprosencephaly and chromosomal anomaly 46, XX, -15,t (15 q, 21 q). Diagnosis was confirmed by brain MRI and autopsy, The patient died about 20 hours of age and autopsy was done. A brief review of the literatures was also presented.
Autopsy ; Brain ; Diagnosis ; Forehead ; Holoprosencephaly ; Humans ; Magnetic Resonance Imaging ; Neural Plate ; Skull

Cutaneous horns of the penis are rare. We report a case associated with squamous cell carcinoma in a 56-year-old male. A gradually enlarging nodule had been on the glans penis for four years. He had suffered from an erythematous crusted tumor mass and horny excrescence on the glans penis which recurred and was aggravated after excision of the nodule seven months ago. Histopathologic findings of the lesions showed characteristic findings of squamous cell carcinoma and cutaneous horn. In situ DNA hybridization for human papillomavirus types 6, 11, 16, 18, 32, and 33 were all negative. The tumor mass were surgically excised and we have not found any sign of recurrence since then.
Animals ; Carcinoma, Squamous Cell* ; DNA ; Epithelial Cells* ; Horns* ; Humans ; Male ; Middle Aged ; Penis* ; Recurrence

We report a case of infantile digital fibromatosis in a 34 month-old boy, who presented with a painless subcutaneous tumor on the medial aspect of the left third toe. A histological examination showed scattered small, round eosinophilic inclusion bodies in the cytoplasm of the tumor cells, which was consistent with infantile digital fibromatosis. A'immunohistochemical study revealed that desmin, a-smooth muscle actin, and vimentin were clearly positive in the cytoplasm of the tumor cells, but the inclusions themselves showed negative staining, thus indicating a hollow-like staining pattern. Electron microscopy showed either well-defined or ill-demarcated dense bodies in the cytoplasm of the tumor cells. In some areas, small vesicles and intracellular organells were observed' in the inclusions. In the course of conservative treatment, a new lesion developed on the lateral aspect of the left third toe, seven months after the appearance of the initial lesion.
Actins ; Cytoplasm ; Desmin ; Eosinophils ; Fibroma* ; Humans ; Inclusion Bodies ; Male ; Microscopy, Electron ; Negative Staining ; Toes ; Vimentin

No abstract available.
Spondylolysis*