No abstract available.
Endoderm* ; Endodermal Sinus Tumor*

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

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

BACKGROUND: Despite good surgical results from right transverse hypochondrial incisions for Ramstedt's pyloromyotomies, children remain concerned by the presence of an obvious and permanent scar. The aim of this study is to compare the results of two approaches. METHODS: Forty-eight infants underwent a Ramstedt pyloromyotomy for infantile hypertrophic pyloric stenosis. To facilitate the delivery of the pyloric mass, 22 patients were operated on via a standard right transverse hypochondrial incision and 26 patients via a circumumbilical incision with or without lateral wound extension. These two group were compared retrospectively. RESULTS: The groups did not differ significantly with respect to the length of the hospital stay or the perioperative complications. The circumumbilical incision with lateral wound extension allowed easy access to the pyloric mass without conversion of incisions due to inadequate exposure. All circumumbilical incisions healed well, resulting in an apparently unscarred abdomen. The final good cosmetic result of the circumumbilical incision satisfied all parents. CONCLUSIONS: We propose the circumumbilical incision as an alternative to be used in the operative approach to the pylorus in the treatment of infantile hypertrophic pyloric stenosis.
Abdomen ; Child ; Cicatrix ; Humans ; Infant ; Length of Stay ; Parents ; Pyloric Stenosis, Hypertrophic ; Pylorus ; Retrospective Studies ; Wounds and Injuries

PURPOSE: A prospective comparison was made between imaging with Tc-99m pertechnetate (Tc-99m) and Ioine-131 (I-131) for the detection of residual and metastatic tissue after total thyroidectomy in patients with well-differentiated thyroid carcinoma. MATERALS AND METHODS: Initially our patients had imaging with Tc-99m, followed by I-131 within 3 days. The study included 21 patients who had ablation with high dose of I-131 ranging from 100 mCi to 150 mCi. Planar and pinhole images were acquired for both Tc-99m and I-131. Diagnostic images of Tc-99m and I-131 were compared with post-therapy images. Degree of uptake on Tc-99m and I-131 images was scored by four point scale and compared. RESULTS: The results of the Tc-99m study were: 16 of 19 studies (84%) were positive on simple planar images, but 19 of 20 studies (95%) were positive on pinhole images. Conventional I-131 diagnostic imaging on the other hand showed that all studies (100%) were positive on both planar and pinhole images. There was a significant difference in degree of uptake between Tc-99m and I-131 planar images (p<0.05). Only one case of Tc-99m scintigraphy was negative on both planar and pinhole studies (false negative). There was no distant metastasis on the therapeutic I-131 images. CONCLUSION: Tc-99m scan using pinhole in certain clinical situations is an alternative to the I-131 scan in detecting thyroid or lymph node metastasis prior to the first ablative treatment after thyroidectomy for well-differentiated thyroid carcinoma.
Diagnostic Imaging ; Hand ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prospective Studies ; Radionuclide Imaging* ; Sodium Pertechnetate Tc 99m* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

The ileal atresia has been commonly accepted to be caused by a vascular accident during early intrauterine period. Thanks to the development of anesthesia, surgical techniques, postoperative supportive treatment and the hyperalimentation technique, the motality rate of this disease has been decreased. In spite of these developments, premature and very low birth weight babies should be given more attention because they still have a high motality rate. The authors report a successful treatment of ileal atresia in a 1,200g premature female infant. The proximal distended and hypertrophied intestine was resected. The distal small bowel was transected using a oblique line to create a fish-mouth. An end to end anastomosis was performed. We gave postoperative care, such as incubator care, fluid therapy, gastric decomprssion and total parenteral nutrition(TPN). TPN was initiated on postoperative one day. Calories were increased from 60cal/kg to 90cal/kg. TPN was stopped on the postoperative 24 day when the patient tolerated full strength milk feeding. Eighteen months postoperatively, she is healthy and her weight is 9.0kg(9 percentile).
Anesthesia ; Female ; Fluid Therapy ; Humans ; Incubators ; Infant ; Infant, Newborn* ; Infant, Very Low Birth Weight ; Intestines ; Milk ; Postoperative Care

The history of fetal surgery features an absolute dependency upon the possibility of diagnosis before birth. Powerful new imaging methods, the techniques of sampling amniotic fluid and fetal tissue, and modern molecular genetics for the prenatal diagnosis of various congenital diseases have removed the veil of secrecy from the fetus. Even though most prenatally detected congenital malformations can be managed after maternal transport, a few simple anatomic defects require fetal surgery, albeit with predictably poor results. The understanding of intrauterine physiology and pathophysiology in several congenital malformations has been worked out in animal model study, and the natural history of congenital defects revealed by prenatal observations on human fetuses. Selection criteria for intrauterine intervention have been developed. Over the last two decades, surgical techniques for open and endoscopic fetal surgery have been defined and anesthesia and tocolysis for fetal surgery improved. As we enter the 21st century, this field of surgery will surely expand.
Animal ; Europe ; Fetus/*surgery ; History of Medicine, 16th Cent. ; History of Medicine, 19th Cent. ; History of Medicine, 20th Cent. ; History of Medicine, Ancient ; Human ; Pediatrics/*history ; Surgery/history ; United States

We underwent 3 cases of laparoscopic splenectomy in pediatric patients of hereditary spherocytosis and had excellent outcome. Average operation time was 100 minutes and it was longer than average operation time of traditional open splenectomy in pediatric patients of hereditary spherocytosis (83 minute), but average hospitalization day was 3 days and it was shorter than compared group (6.2 days). Advantages of laparoscopic surgery were appeared in this study. Excellent outcome of these cases will help further performance of laparoscopic splenectomy in children.
Child* ; Hospitalization ; Humans ; Laparoscopy ; Splenectomy*

BACKGROUND: Aging is associated with increased cardiovascular risk and firmly established as a risk factor for the development of atherosclerosis. However the exact mechanism of age-related damage to the arterial wall and its relation to the atherosclerotic process are not well known.The endothelium plays an important role for the regulation of vascular tone and the endothelial function is impaired in the presence of risk factors early in the process of atherosclerosis. Assessment of endothelial function appears to be a valuable tool for the diagnosing and therapeutic monitoring of coronary artery disease. Anti-oxidants are known to improve endothelial dysfunction in atherosclerosis patients. The aim of this study was, (1) to evaluate the endothelial function in elderly, (2) to investigate whether vitamin C administration has benefit on the endothelial function in elderly. METHODS: The endothelial function was estimated using venous occlusion plethysmography(VOP) in 7 elderly and 7 young healthy volunteers. The strain guage was connected to plethysmograph to record the forearm volume change. A rapid cuff inflator was used to inflate the arm cuff to 40 mmHg instantaneuosly thus occluding venous return from the forearm. The measurement of forearm volume change was repeated for 7 times each stage. The change of the forearm blood flow(FBF) was measured with the acetylcholine infusion through brachial artery and also with intra-arterial vitamin C. RESULTS: Endothelium-dependent vasodilatation was significantly impaired in the elderly group compared to the young group(321 +/-17% in elderly group vs 509 +/-81%, mean+/-SEM) Forearm blood flow response to acetylcholine was significantly enhanced with inraarterial infusion of vitamin C in elderly group(321+/-17% in elderly group vs 78% in vitamin C) Coinfusion of L-NMMA, an inhibitor of nitric oxide synthase, blunted forearm blood flow response to acetylcholine. CONCLUSIONS: Even though the mechanisms leading to drpressed endothelial function in elderly remains to be elucidated, our study shows that vitamin C result in demonstrable improvement by a mechanism that is probably related to antioxidant activity.
Acetylcholine ; Aged* ; Aging ; Arm ; Ascorbic Acid* ; Atherosclerosis ; Brachial Artery ; Coronary Artery Disease ; Endothelium ; Forearm ; Healthy Volunteers ; Humans ; Nitric Oxide Synthase ; omega-N-Methylarginine ; Risk Factors ; Vasodilation* ; Vitamins*