Gastric volvulus is a rare surgical disorder in the pediatric population. We experienced a case of gastric volvulus. A 2-year-old boy was admitted to hospital with abdominal distension. An upper gastrointestinal series showed reversal of the greater and lesser curvatures. Surgical exploration revealed an organoaxial volvulus of the stomach, and anterior gastropexy was performed.
Child, Preschool ; Gastropexy ; Humans ; Intestinal Volvulus ; Male ; Stomach ; Stomach Volvulus*

The aims of this study were to evaluate the prognostic predictabilities of the risk classifications (Waterston, Montreal, and Spitz), preoperative treatment of pneumonia and the length of esophageal gap in esophageal atresia. Twenty-five cases of esophageal atresia were reviewed retrospectively. The data was analyzed with Likelihood ratio test for trend and Fisher's exact test. Survival rates were 100.0% in group A and B, and 60.0% in group C according to Waterston classification (p=0.027). By Montreal classification, 95.7% in group I and 50.0% in group II (p=0.086). By Spitz classification, 95.5% in group I and 66.7% in group II (p=0.159). The survival rate was 85.7% in the patients with pneumonia preoperatively treated and 94.4% in the patients without pneumonia. The difference was not significant (p=0.490). Survival rate in the patients with long gap (> or = 3cm) was 50.0% and 100.0% in patients with short gap (< 3cm) with significant difference (p=0.020). The Waterston classification could be modified into two groups because the prognosis of both group A and B were the same. Preoperative pneumonia does not seem to be a risk factor. The length of the esophageal gap showed prognostic value.
Classification ; Esophageal Atresia* ; Humans ; Pneumonia ; Prognosis* ; Retrospective Studies ; Risk Factors ; Survival Rate ; Tracheoesophageal Fistula

Congenital diaphragmatic hernia (CDH) in the past was considered a surgical emergency requiring immediate operation. Several groups now advocate preoperative stabilization and delayed surgery. The treatment strategy for CDH in this institution is delayed surgery after preoperative stabilization. The aim of this study was to evaluate the results of delayed surgery. A retrospective review of 16 neonates with CDH was performed. Surfactant, conventional mechanical ventilation, high frequency oscillation, and nitric oxide were utilized for preoperative stabilization as necessary. The difference in outcome between two groups differentiated by the duration of the preoperative stabilization periods with mechanical ventilation (< or = 8 hours and >8 hours) was determined. Chi-square test was used to analyze the data. There were 7 right-sided hernias and 9 left. The average duration of stabilization was 32.4 hours. Hepatic herniation through the defect was found in 6 cases and all died. The most common postoperative complication was pneumothorax. The mortality rate of the right side hernia was higher than the left (85.7% vs. 33.3%, p=0.036). Mortality rate of the group (N=8) whose preoperative stabilization period was 8 hours or less was better than that (N=6) whose preoperative stabilization period was more than 8 hours (25.0% vs. 83.3%, p=0.031). The overall mortality rate was 56.3%. The better prognosis was noticed in left side hernia, no liver herniation, or shorter preoperative stabilization period.
Emergencies ; Hernia ; Hernia, Diaphragmatic* ; Humans ; Infant, Newborn ; Liver ; Mortality ; Nitric Oxide ; Pneumothorax ; Postoperative Complications ; Prognosis ; Respiration, Artificial ; Retrospective Studies

Nitric oxide, an endothelium-derived relaxing factor, is a selective pulmonary vasodilator. We have built and settled down the delivery system of nitirc oxide gas inhalation for the first time in Korea. Two newborn babies delvelped near fatal pulmonary hypertension after surgical repair of a congenital diaphragmatic hernia. All conventional therapeutic measures failed. So we decided to attempt to use of nitric oxide gas for treatment. Addition of ntiric oxide of 1-80 parts per million to the inspired gas allowed resolution of pulmonary hypertension. No side effect of nitric oxide therapy was observed, and ventilatory support could be substantially reduced as a result of treatment and could be stopped later. On the basis of the striking and lifesaving effects of nitric oxide therapy shown in these cases, we believe that nitric oxide inhalation can be used as a major treatment modality in the management of persistent pulmonary hypertension of the newborn.
Endothelium-Dependent Relaxing Factors ; Female ; Hernia, Diaphragmatic* ; Humans ; Hypertension, Pulmonary* ; Infant, Newborn ; Inhalation* ; Korea ; Nitric Oxide* ; Persistent Fetal Circulation Syndrome ; Strikes, Employee

Lymphangioma is a congenital malformation of the lymphatic system, commonly seen in the neck. Operation was the treatment of choice but it is difficult to resect the lymphangiomas completely. The aim of this study is to evaluate the result of intralesional injection of OK-432 as a treatment strategy of lymphangioma in children. Medical records of 51 cases of lymphangioma from March 1996 to February 2001 were reviewed retrospectively. Intralesional injection of 0.1 mg OK-432 in 10ml normal saline was performed after the aspiration of as much fluid as possible. The location of the lesion was the face and neck in 26 patients, the chest wall in 14, the extremities in 9, and the abdominal wall in 2. The cystic type was present in 45 patients and the cavernous type in 6. Four postoperative recurrent cases were included. Fluid aspiration from the lesion was impossible in 5 patients. Development of fever after injection was observed in 27 patients and local inflammatory reaction was in 5 patients. There was no scar formation at injection sites. Complete shrinkage was observed in 20 patients, remarkable shrinkage in 23, slight shrinkage in 3, and no response in 5. Cystic type or aspiration-possible cases showed better outcome than cavernous type or aspiration-impossible cases. All of four recurrent cases after surgical excision showed at least remarkable shrinkage. These results indicate that intralesional injection of OK-432 is a safe and satisfactory treatment modality of lymphangiomas in children and might be considered as a treatment of choice, even in recurrent cases.
Abdominal Wall ; Child* ; Cicatrix ; Extremities ; Fever ; Humans ; Injections, Intralesional* ; Lymphangioma* ; Lymphatic System ; Medical Records ; Neck ; Picibanil* ; Retrospective Studies ; Thoracic Wall