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

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*

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*

PURPOSE: We tried to determine whether six-hour fasting before abdominal computed tomography (CT) scan is necessary to prevent aspiration of gastric contents in patients with acute abdominal pain. METHODS: Adult patients with acute abdominal pain who were checked abdominal CT were enrolled. Exclusion criteria were age <15 years, pregnancy, traumatic cause of symptoms, chronic pain(>7 days), renal impairment and hypersensitivity to contrast media. We compared Group-I (<6-hour fasting) with Group-II(> or =6-hour fasting). We collected the demographic and clinical data on the causes of abdominal pain, pain duration, presence of nausea and vomiting, and use of medications before and after abdominal CT. In order to estimate the volume of gastric contents, we measured the area on the CT image which showed the largest volume of gastric contents. RESULTS: Among the 122 patients, Group-I consisted of 38 patients(31.1%) and Group-II included 84(68.9%). The demographic makeups of the two groups were similar, except for gender proportion (more males in Group-I). Group-I showed significantly greater gastric contents compared than Group-II(46.8+/-32.1 vs. 33.7+/-28.3, p=0.024). A slightly negative correlation (r=-0.2313; 95% CI=-0.3929 to -0.0559) was observed between the fasting time and the volume of gastric contents. However, the frequencies of the nausea [13/38 (34.2%) vs. 26/84 (31%), p=0.721] and vomiting [6/38 (15.8%) vs. 18/84 (21.4%), p=0.468] showed no difference between two groups. There were no aspiration events in either groups. CONCLUSION: Six hours of fasting before abdominal CT may not be required to prevent aspiration of gastric contents in patients with acute abdominal pain.
Abdomen, Acute ; Abdominal Pain ; Adult ; Contrast Media ; Fasting ; Humans ; Hypersensitivity ; Male ; Nausea ; Pregnancy ; Tomography, Spiral Computed ; Vomiting

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: To investigate the relationship between intraocular pressure (IOP) and visual field defect progression (VFP) in normaltension glaucoma (NTG). METHODS: We reviewed the records of patients who were enrolled according to the following inclusion criteria: at least one IOPmeasurement at every section, which was divided into four sections (90 minutes) by IOP measurement time and a follow-up for 2 years or more. Patients were divided into VFP (n=9) and non-visual field defect progression (NVFP, n=28) groups. The baseline IOP was defined as an average IOP measured five times with 90-minute intervals before treatment. The maximal, minimal and mean IOPs were defined as the highest, lowest and average IOPs among all checked IOPs during follow-up. IOP fluctuation was defined as the difference between the maximal and minimal IOPs. The section IOP was defined as an average IOP among all checked IOPs in each section, and section IOP fluctuation was the difference between the highest and lowest section IOPs. We reviewed and compared the IOP indices of the two groups and the risk factors, including hypertension, diabetes, migraine, familial history of glaucoma, disc hemorrhage, and number of eyedrops. RESULTS: Thirty-seven eyes with an average follow-up of 50.4+/-18.9 months were included. The baseline and the maximal IOPs were higher than those of the NVFP group (p=0.001 and 0.032, respectively), but the mean, minimal and IOP fluctuations were not different (all, p>0.05). All section IOPs, section IOP fluctuations and other risk factors were not different (all, p>0.05). CONCLUSIONS: The baseline and the highest IOPs were a risk factor of VFP in NTG.
Eye ; Follow-Up Studies ; Glaucoma ; Hemorrhage ; Humans ; Hypertension ; Intraocular Pressure ; Migraine Disorders ; Risk Factors ; Visual Fields

In Korea, studies of splenectomies are mainly performed in adult groups, but a review of splenectomies in children is significant because the indications of a splenectomy and the importance of the spleen in children are different from those in adults. The authors reviewed 51 cases of splenectomies performed between January 1986 and April 1996 on children under 15 years of age. The indications of the splenectomy were divided based on hematologic diseases (37) and non-hematologic diseases (14). For the hematologic diseases, hereditary spherocytosis (24) was the most common indication of a splenectomy and idiopathic thrombocytopenic purpura (11) was the next most common. For the non-hematologic diseases, trauma (10) was the most common indication of a splenectomy. After the splenectomy, abnormal hematologic findings were improved in all hereditary spherocytosis patients and in nine of the idiopathic thrombocytopenic purpura patients (82%). To prevent postsplenectomy sepsis, 27 patients received antibiotic medication, but no one received a pneumococcal vaccination. One case of postsplenectomy sepsis occurred in a patient who had not received antibiotic medication. This study suggests that a splenectomy provides efficacious treatment for a number of pediatric disorders, but it is associated with a risk of postsplenectomy sepsis.
Adult ; Child* ; Hematologic Diseases ; Humans ; Korea ; Purpura, Thrombocytopenic, Idiopathic ; Sepsis ; Spleen ; Splenectomy* ; Vaccination

Background: Clear cell acanthoma is a rare benign epidermal tumor that is considered a nonspecific reactive dermatosis. To date, no reports have described systematic analyses of clear cell acanthoma in Koreans. Objective: We investigated the clinical, histopathological, and dermoscopic features of clear cell acanthoma. Methods: In this study, we evaluated 14 lesions of clear cell acanthoma. Results: We observed female predominance (male:female ratio 1:1.3), and the mean patient age was 55.8±18.0 years (range 15∼76 years), with the peak incidence observed in patients in their 60s. Notably, 57.1% of lesions developed on the lower extremities. The lesion was most commonly misdiagnosed as seborrheic keratosis. Histopathological examination revealed a well-demarcated area of keratinocytes with pale-staining cytoplasm and psoriasiform epidermal hyperplasia and mild spongiosis, exocytosis of neutrophils, and thinned suprapapillary plates. Dermoscopic examination showed a clear cell acanthoma with characteristic vascular findings, including pinpoint red dots, globular red dots, and glomeruloid structures with linear or reticular patterns. Conclusion Clear cell acanthoma commonly presents as a small solitary lesion measuring <1 cm in diameter that occurs on the lower extremities in women in their 60s. Histopathological characteristics of this lesion include Periodic acid Schiff-positive with pale cytoplasm, and dotted, globular, and glomeruloid vessels with a linear or reticular pattern on dermoscopy. This was a single-center, small-sized retrospective study; however, in our view, the results of this study would contribute to the literature by providing a better understanding of clear cell acanthoma in Koreans.

No abstract available.
Foot ; Hand

This study was to analyze the changes of levels of alkaline phosphatase before and after enucleation of jaw cysts combined with bone grafting, and to evaluate biochemically the effectiveness of the early detection of bone healing and infection as a prognostic marker. Eighteen patients (13 males, 5 females) with cystic lesions of the jaws were divided into two groups. The bone graft group underwent enucleation and bone graft. The control group underwent only enucleation. Both groups were measured levels of ALP before surgery, and plus-minus 4 weeks postoperatively. The more discriminating results were obtained in the bone graft group. The results were as follows : 1. Levels of ALP after enucleation of jaw cysts were decreased in all patients with and without bone graft. 2. The bone graft group showed more marked decrease in variation of levels of ALP than the control group.(p=0.008) This should be considered as a result of increased osteoblastic activity and new bone formation. 3. Such variation could be used as a prognostic marker for bone healing after cyst operation. In the cost/benefit ratio, measurement of ALP activity could be useful as a convenient procedure in routine clinical practice.
Alkaline Phosphatase* ; Bone Transplantation ; Humans ; Jaw Cysts ; Jaw* ; Male ; Odontogenic Cysts ; Osteoblasts ; Osteogenesis ; Transplants