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*

Transhiatal gastric transpositions were performed in two case of long gap esophageal atresia without tracheoesophageal fistula. The patients were a 12 months old female and an 18 months old male. Stamm type gastrostomies were performed at other hospitals in both cases. The stomach was mobilized preserving the right gastric artery, the right gastroepiploic artery and spleen. The proximal and distal esophageal pouches were excised by transcervical and transhiatal route, respectively. The mobilized stomach was pulled up to the neck through esophageal hiatus and posterior mediastinal route. The esophagogastrostomy, the only one anastomosis of this procedure, was performed in the neck. There was no clinical evidence of anastomotic leakage, stricture, regurgitation, difficulty of gastric emptying, hoarseness or respiratory problem. Transhiatal gastric transposition seems to be a safe and easy alternative surgical procedure for esophageal replacement in long gap esophageal atresia.
Anastomotic Leak ; Arteries ; Constriction, Pathologic ; Esophageal Atresia* ; Female ; Gastric Emptying ; Gastroepiploic Artery ; Gastrostomy ; Hoarseness ; Humans ; Infant ; Male ; Neck ; Spleen ; Stomach ; Tracheoesophageal Fistula

No abstract available.
Endoderm* ; Endodermal Sinus Tumor*

PURPOSE: To elucidate a proper method of intraocular lens (IOL) power calculation in highly myopic eyes with previous radial keratotomy (RK). METHODS: Five post-RK-surgery eyes with pre-RK-surgery myopia over -10.0 diopters (D) were studied retrospectively. The keratometric values obtained via the clinical history method, the contact lens over-refraction method, conventional keratometry, and Orbscan II were compared to the true keratometric value calculated retrospectively using the SRK/T formula. RESULTS: The mean pre-RK-surgery refractive power was -19.35+/-5.86D (-14.50 ~ -29.50D) and cataract surgery was performed on average 16.6 years after RK. The true keratometric value was closest to that estimated by the contact lens over-refraction method in 1 eye and to the flatter keratometric value between Sim K and the 3mm zone mean Pwr obtained with axial keratometric power map of Orbscan II in 4. CONCLUSIONS: The flatter keratometric value between Sim K and the 3mm zone mean Pwr from Orbscan II was closest to the true post-RK-surgery keratometric value of the central cornea.
Cataract ; Cornea ; Keratotomy, Radial* ; Lenses, Intraocular* ; Myopia ; Retrospective Studies

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

BACKGROUND: The etiology of choledochal cysts is unknown, but the theory of pancreatobiliary reflux through an anomalous pancreatobiliary ductal union (APBDU) is widely accepted. The aim of this study was to evaluate the correlation between choledochal cysts and APBDUs in children. METHODS: We retrospectively analyzed 33 pediatric patients with choledochal cyst who had undergone excision of the whole extrahepatic bile duct along with hepaticoenterostomy at the Division of Pediatric Surgery, Department of Surgery, Yonsei University College of Medicine, from 1993 to 1998. RESULTS: The mean age of the patients was 51 months, and the ratio of males to females was 1:2.3. Anatomical types were Ia (n=17, 52%), Ic (n=11, 33%), III (n=1, 3%), and IVa (n=4, 12%) in the Todani classification of biliary cysts. We performed endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, or intraoperative cholangiopancreatography in all cases. An APBDU was identified in 24 patients (73%): right angle union (n=11, 33%), acute angle union (n=11, 33%), or a complex union (n=2, 6%) in the Todani classification of APBDUs. Type Ia cystic lesions correlated with right angle unions whereas Type Ic cylindrical lesions correlated with acute angle unions. The mean age of patients with a Type Ic, acute angle union was older than that of patients with a Type Ia, right angle union. In Type Ic, the amylase levels in serum and bile were elevated, but in Type Ia, they were not. CONCLUSIONS: APBDUs correlated highly with the shape of the extrahepatic dilatation, the age at onset, and the reflux of pancreatic juice. We think the excision of the entire extrahepatic duct along with a hepaticoenterostomy and appropriate evaluation of the APBDU are essential for the treatment of choledochal cysts in children.
Amylases ; Bile ; Bile Ducts, Extrahepatic ; Child* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance ; Choledochal Cyst* ; Classification ; Dilatation ; Female ; Humans ; Male ; Pancreatic Juice ; Retrospective Studies

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*

It is generally believed that the anomalous pancreaticobiliary duct union (APBDU) might be involved in the formation of choledochal cyst and malignancies of hepatopancreaticobiliary system. The purpose of this study is to make an animal model of APBDU similar to that of human. One to two-month-old Mongrel dogs (n=12) were divided into two groups; the control group (n=2) in which sham operation was performed, and the experimental group (n=10) in which the end of distal common bile duct (CBD) was anastomosed to the side of dorsal pancreatic duct to produce APBDU. Serum was obtained for chemical analysis at the 10th postoperative day. The dogs were sacrificed at the 5th week (n=3), the 6th week (n=3), the 7th week (n=2), the 8th week (n=2) and the 6th month (n=2) after the operative intervention. At the day when the experimental animals were sacrificed, operative cholangiogram was taken, and bile juice was obtained for chemical analysis and bacterial culture. The en-bloc specimens of hepatopancreaticobiliary system were obtained for microscopic examination. Serum and bile juice amylase levels were elevated in the experimental group (n=10), but not in the control group (n=2). On operative cholangiogram, there was no evidence of bile duct dilatation in control group (n=2). On the other hand, bile duct in the experimental group was markedly dilated without any evidence of stenosis in all (n=10). Histologic examination of the hepatopancreaticobiliary system in the experimental group resembled the findings of choledochal cyst in human. The APBDU of this animal model can produce bile duct dilatation by pancreaticobiliary reflux. We think that this animal model can be potentially promising for the research about the APBDU associated hepatopancreaticobiliary diseases.
Amylases ; Animals ; Bile ; Bile Ducts ; Choledochal Cyst ; Common Bile Duct ; Constriction, Pathologic ; Dilatation ; Dogs ; Hand ; Humans ; Models, Animal* ; Pancreatic Ducts

A choledochal cyst is a relatively common lesion of the biliary tract in pediatric patients and usually presents abdominal pain, jaundice, and abdominal mass. Its etiology is unknown, but the theory of pancreatobiliary reflux through anomalous pancreatobiliary duct union is widely accepted. A mucinous cystadenoma of the pancreas is very rare in children. To our knowledge, there is no literature reporting a case of a choledochal cyst with a mucinous cystadenoma of the pancreas. We report a case of a choledochal cyst combined with a mucinous cystadenoma of borderline malignancy at the head of the pancreas in a 5-year-old girl and review the literature.
Abdominal Pain ; Biliary Tract ; Child ; Child, Preschool ; Choledochal Cyst* ; Cystadenocarcinoma ; Cystadenoma, Mucinous* ; Female ; Head ; Humans ; Jaundice ; Mucins* ; Pancreas*

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is an inflammatory disease of the retina characterized by rapid loss of central vision, secondary to multiple flat yellow-whitish placoid lesions at the level of the pigment epithelium on the posterior pole. The fluorescein angiography demonstrates initial hypofluorescence in the lesion, where shows hyperfluorescence later. Usually, the central vision is recovered spontaneousely despite of permanent alterations in the pigment epithelium. The authors describe the clinical analysis of 19 cases of APMPPE treated at Department of Ophthalmology, Pusan Paik Hospital, Inje Medical college from January 1986 to July 1990. The results were as follows: 1) Ten cases(54%)occurred in the third decade. 2) Bilateral involvement occurred in 17 cases(90%) and 4 cases of those showed a different onset of symptoms in both eyes. 3) Nine cases(48%) occurred in the summer. 4) The symptoms of upper respiratory tract infection(URI) preceded by an average six days. 5) The symptoms of URI was indicated by 13 of the patients(68%). 6) Seventeen eyes(47%) showed uveitis as the combined ocular sign. 7) The lymphocytosis of cerebrospinal fluid was shown in four of eight cases(50%). In the complete blood count, leukocytosis was shown with 78% of all. 8) The visual acuity was below 0.4 in 83% of all at the time of presentation, and the final visual acuity was above 0.5 in 89% of all. 9) The visual acuity improved an average of eight weeks after the onset of symptoms.
Blood Cell Count ; Busan ; Cerebrospinal Fluid ; Epithelium ; Fluorescein Angiography ; Leukocytosis ; Lymphocytosis ; Ophthalmology ; Respiratory System ; Retina ; Uveitis ; Visual Acuity