Intra-abdominal desmoplastic small round cell tumor (DSRCT) is a highly malignant tumor of uncertain histogenesis. Here we report a case of DSRCT involving the stomach, initially misdiagnosed as gastric cancer. A 12-year-old boy presented with upper abdominal pain developed 1 month prior. On gastroscopy, a 7-cm mass was noted involving the esophago-gastric junction to the fundus, and positron emission tomography showed multiple hot uptakes suggesting distant metastasis. Gastroscopic biopsy showed poorly differentiated malignant cells. We diagnosed as stage IV gastric cancer and treated with 6 cycles of chemotherapy. Laparotomy revealed a huge gastric mass along with peritoneal disseminations. Palliative proximal gastrectomy was performed. Pathological examination revealed transmural involvement of DSRCT, and t(11;22)(p12;q12) was demonstrated on fluorescence in situ hybridization test. The chemotherapeutic regimen was changed and the patient underwent 8 additional cycles of post-operative chemotherapy. The patient is now alive and the residual tumor shows no significant changes after chemotherapy.
Abdominal Pain ; Biopsy ; Child ; Desmoplastic Small Round Cell Tumor ; Fluorescence ; Gastrectomy ; Gastroscopy ; Humans ; In Situ Hybridization ; Laparotomy ; Neoplasm Metastasis ; Neoplasm, Residual ; Positron-Emission Tomography ; Stomach ; Stomach Neoplasms

Failure of the urachus to regress completely results in anomalies that may be classified as patent urachus, urachal sinus, urachal cyst and bladder diverticula. The presenting symptoms of children with urachal anomalies are variable and uniform guidelines for diagnosis and treatment are lacking. The purpose of this study was to elucidate our conclusions regarding the presentation, diagnosis and treatment of urachal anomalies by reviewing our experiences. We retrospectively analyzed the records of 32 patients who were admitted for urachal anomalies from March 1995 to February 2005. The age distribution of these patients at presentation ranged from 1 day to 14 years old (median age 1 month) and they included 20 boys and 12 girls. The 32 cases comprised 13 cases of urachal sinus (40.6%), 10 urachal cyst (31.3%), and 9 patent urchus (28.1%). The presenting symptoms were umbilical discharge (14 patients), umbilical granuloma (8), abdominal pain and fever (3), fever (3), abdominal pain (2), and a low abdominal mass (2). In 30 patients ultrasonography was used for diagnosis and 2 patients with patent urachus were explored without using a diagnostic method. Twenty-three patients were confirmed by ultrasonography alone and 7 patients were examined using additional modalities, namely, computed tomography for 2 patients with an urachal cyst, magnetic resonance imaging for 1 patient with an urachal cyst, and fistulography for 3 patients with an urachal sinus. Excision was performed in 29 patients, and 3 patients were conservatively managed. Urachal anomalies in children most frequently presented in neonates, and the most common complaint was umbilical discharge with infection. Urachal anomalies can be diagnosed by a good physical examination and an appropriate radiographic test, and ultrasound was found the most useful diagnostic method. Complete surgical excision of an urachal anomaly is recommended to avoid recurrence, and even, though rare, carcinoma development.
Abdominal Pain ; Adolescent ; Age Distribution ; Child* ; Diagnosis ; Diverticulum ; Female ; Fever ; Granuloma ; Humans ; Infant, Newborn ; Magnetic Resonance Imaging ; Physical Examination ; Recurrence ; Retrospective Studies ; Ultrasonography ; Urachal Cyst ; Urachus ; Urinary Bladder

To clarify the exact role of endomyocardial biopsy in the diagnosis and monitoring of adriamycin-induced cardiotoxicity and to observe the actual relationship between pathologic changes and cardiac dysfunction, a cross-sectional clinical study was conducted. Echocardiography was used to evaluate cardiac dysfunction in 18 patients who had received chemotherapy including adriamycin(mean dose : 410mg/m2 of B.S.A.) without clinical evidence of congestive heart failure, and in 19 normal controls. Six patients receiving adriamycin underwent 7 transfemoral endomyocardial biopsy procedures, and the specimens were evaluated by light and electron microscopy for evidence of drug-related cardiotoxicity. Indexes of cardiac systolic function obtained by M-mode echocardiography(left ventricular dimension, excursion of interventricular septum and left ventricular posterior wall, shortening fraction and ejection fracton) did not show any statistically significant difference between patients who received adriamycin and normal controls. In transmitral flow-velocity curves recorded by Doppler echocardiography with a 2.25MHz probe, the patients showed less E peak velocity and decreased E/A ratio compared with normal controls, which suggests left ventricular diastolic dysfunction in the patients who received adriamycin. All the specimens of the endomyocardial biopsy showed significant pathologic changes of adriamycin indnced cardiotoxicity which was characterized by myofibrillar loss and vacuolization of the cytoplasm. In 2 specimens, pathologic grade was II, while 5 specimens showed pathologic changes of grade III and further chemotherapy with adriamycine was not done in thse 5 cases. From these results it is suggested that pathologic changes precede the clinical onset of congestive cardiomyopathy in the patients receiving adriamycin and left ventricular diastolic dysfunction occurrs before ejection fraction falls to subnormal levels. We conclude that sequential endomyocardial biopsy is absolutely indicated for exact diagnosis and monitoring of adrinamycin-induced cardiotoxicity to prevent the development of irreversible and often fatal cardiomyopathy.
Biopsy ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cytoplasm ; Diagnosis ; Doxorubicin* ; Drug Therapy ; Echocardiography ; Echocardiography, Doppler ; Heart Failure ; Humans ; Microscopy, Electron

This study was performed to evaluate the influence of clonidine pretreatment on the car- diovascular toxic effects of bupivacaine overdose induced by constant intravenous infusion. Thirty male rabbits were used for this study and they were divided into saline pretreatment group(15) and clonidine-pretreatment group(15). The changes of mean arterial pressure, heart rate and electrocardiogram by the bupivacaine-induced toxic effect during intravenous infusion of bupivacaine were observed. The results were as follows; 1. Mean arterial pressure was significantly decreased in clonidine-premedicated group compared with control group (P<0.01) before infusion of bupivacaine, but the times occuring 25% and 50% decrease of mean arterial pressure were significantly prolonged in clonidine group compared with control group (P <0.001 ). 2. Heart rate was significantly decreased in clonidine group compared with control group (P<0.01) before infusion of bupivacaine, but the times occuring 25% and 50% decrease of heart rate were significantly prolonged in clonidine group compared with control group (P< 0.001). 3. The times occuring the first QRS modification and first dysrhythmia and the final systole were significantly prolonged in clonidine group compared with control group (P < 0.001). In conclusion, clonidine given prophylactically delays the cardiotoxicity caused by bupivacaine overdose snd does not accentuate the subsequent hypotension.
Arterial Pressure ; Bupivacaine* ; Clonidine* ; Electrocardiography ; Heart Rate ; Humans ; Hypotension ; Infusions, Intravenous ; Male ; Rabbits* ; Systole

With an increase in aging population and medical expenditure worldwide, primary care has been rising as a solution to these. Japan, a representative aging society which has the most elderly population in the world, also has tried to develop a primary care system and implemented many changes recently. Based on what authors experienced and observed at the points of care in Japan, we are going to review the primary care system and training strategy of family medicine in Japan and come up with some suggestions that could apply to Korea.
Aged ; Aging ; Health Expenditures ; Humans ; Internship and Residency ; Japan ; Korea ; Primary Health Care

Objectives: ：The purpose of this study was to identify the change in the reasons for referrals before and after the COVID-19 outbreak among students who were referred to the one hospital-linked Wee center in Dalseo-gu, Daegu. Methods: ：324 students who were referred to one hospital-linked Wee center for personal counseling from January 1, 2019 to December 31 were included. In the initial session of individual counseling, 3 of the chief reasons among 27 emotional and/or behavioral problems were indicated. This reason was divided into before and after COVID-19 to determine whether there is a difference, and whether there is a difference between before and after COVID-19 depending on the school level. Results: ：The most frequent emotional and/or behavioral problem was ‘interpersonal problems’ in both pre- COVID-19 and post- COVID-19 groups. In post- COVID-19 group, ‘anxiety’ was significantly increased, whereas ‘conduct problems,’ ‘impulsivity’ and ‘inattention’ were significantly decreased. In elementary students group, only ‘conduct problems’ was significantly decreased after COVID-19 and the same result was shown in middle and high school students group. Conclusions ：The study showed that after COVID-19 pandemics in Daegu the difference of students’ problems was noted, and internalizing problems seem to increase rather than externalizing problems. This result calls upon schools to plan for students’ further mental health care measures.

BACKGROUND: It has been widely accepted that the prevalence of tinea pedis in soldiers may be higher due to their occlusive army boots and communal baths. OBJECTIVE: Our study was designed to investigate the prevalence of tinea pedis in Korean soldiers monthly throughout the year by the ranks of the soldiers and also to verify whether tinea pedis is one of the occupational diseases in Korean soldiers. METHODS: We examined the feet of soldiers in a battalion monthly throughout the year. On those with suspected skin lesions, microscopic examinations along with fungus cultures were performed in July, 1996. RESULTS: Average prevalence of tinea pedis throughout the year was 51.5% on clinical examination. The highest prevalence was 74.0% in August and the lowest in February by 36.7% . The prevalence of tinea pedis by rank was 38.3%(18/47) in the new private group, 61.7%(29/47) in the private group, 84.8%(67/79) in the private 1st class group, 72.4%(55/76) in the corporal group and 70.9%(39/55) in the sergeant group in July, 1996. Dermatophytes were demonstrated microscopically in 59.1%(123/208) of the specimens examined. Cultures were positive in 93 cases, i.e., from 44.7% of those examined. CONCLUSION: The major factor contributing to the highest prevalence of tinea pedis in August among the months of the year seems to be the hot and damp weather conditions(especially in July and August). Considering the fact that the prevalence of tinea pedis in winter season was also higher by 36.7-40.2%, Korean soldiers seem to possess higher risk of tinea pedis due to their tight-fitting army boots. The spread of infection among non-infected soldiers might have resulted from the communal bath and Korean traditional habit of taking-off their shoes in a large dormitory where they sleep together. Moreover, the fact that the prevalence of tinea pedis increases markedly with their ranks suggests that tinea pedis should be considered as an occupational disease among Korean soldiers.
Arthrodermataceae ; Baths ; Foot ; Fungi ; Humans ; Military Personnel* ; Occupational Diseases ; Prevalence* ; Seasons ; Shoes ; Skin ; Tinea Pedis* ; Tinea* ; Weather

PURPOSE: This study was undertaken to evaluate the long-term treatment of esophageal strictures in children with corrosive esophagitis and to determine the effect of self-bougienage on recurrent strictures. MATERIALS AND METHODS: We reviewed the medical records of nine children that were treated for corrosive esophageal strictures from May 2000 to May 2008. Six males and three females were included and their average age was 30 months. Six patients had ingested acids, two patents had ingested alkali, and one ingested an unknown agent. RESULTS: The interval between caustic ingestion and esophageal stricture ranged from one to eight weeks. The average length of the esophageal strictures was 3.8 cm (range, 1 to 9.2 cm). Four patients had a long segment stricture (longer than 5 cm) and one patient had multiple strictures. The most common site of involvement was the upper third followed by the mid third of the esophagus. Eight patients received repeated dilatation using a balloon catheter or bougie dilator. Among the eight patients, two patients had complete resolution of symptoms and six patients required surgery. Among five patients that developed restenosis of the esophageal anastomosis site, three patients had improved symptoms after self-bougienage and two patients had improved symptoms with repeated balloon dilatation or endoscopic bougienage. There were no complications in these patients. CONCLUSION: Although a small number of patients were studied, self-bougienage was safe, less invasive, and effective for the management of esophageal restenosis in patients who required frequent dilation after surgery.
Adult ; Aged ; Balloon Dilatation/adverse effects ; Esophageal Stenosis/*therapy ; Female ; Humans ; Male ; Middle Aged ; Self Care/*instrumentation ; Young Adult

Children who underwent reparative operations for esophageal atresia (EA) with or without tracheoesophageal fistula (TEF), are confronted with many gastrointestinal or respiratory problems, especially during the early years of life. We reviewed the medical records of 50 patients who underwent repairs of EA with or without TEF at the Division of Pediatric Surgery, Samsung Medical Center, from December 1994 to December 2005. Current status of children was accessed by telephone-interview, but only 27 of them were accessible. Of 50 patients, 3 patients (6%) were type A, 45 patients (90%) were type C, and 2 patients (4%) were type E. The mean interval between primary operation and interview was 5.5 years. The incidences of growth retardation (<10 percentile of height/weight) were 39% and 21 % during the first 5 years after repairs, respectively. The incidences of dysphagia or gastroesophageal reflux and recurrent respiratory infections were 33% and 39 %, respectively. However, these problems were likely to improve as the children grew. The incidences of growth retardations (<10 percentile of height/weight) were 11% and 11% for the children more than five years postoperative. The incidences of dysphagia or gastroesophageal reflux and recurrent respiratory infections were 22% and 22%, respectively. Children with EA with or without TEF are faced with many obstacles. Close observation and adequate treatment for delayed postoperative complications are necessary to improve the quality of life for these children.
Child ; Deglutition Disorders ; Esophageal Atresia ; Gastroesophageal Reflux ; Humans ; Incidence ; Medical Records ; Postoperative Complications ; Quality of Life ; Respiratory Tract Infections ; Tracheoesophageal Fistula

Pediatric laparoscopic appendectomy is controversial particularly in complicated appendicitis. We evaluated the outcomes of laparoscopic appendectomy (LA) and open appendectomy (OA) in simple appendicitis and complicated appendicitis respectively. Since June 2004, initial LA has been our policy in all appendicitis including complicated ones. A total of 160 patients were included in this study, consisting of 80 OA (August 2001 . August 2003) and 80 LA (June 2004 . June 2006). We compared the operating time, the length of hospital stay, the length of antibiotics use, and the postoperative complications between LA and OA. In simple appendicitis (73), there were no differences between LA and OA. However in the 87 patients with complicated appendicitis, the operating time was longer in LA (64.8 min vs. 50.2 min) but the length of hospital stay was shorter in LA than OA (8.5 days vs. 9.6 days). There was one complication in simple appendicitis group and six in complicated appendicitis group (3 cases in LA, 3 cases in OA). There was no difference in the results of LA versus OA in simple appendicitis. Therefore for simple appendicitis, LA is recommended in consideration of the cosmetic effect (fewer scar). In complicated appendicitis, early discharge was an advantage and there were no differences in complications in LA despite a longer operative time. So we conclude LA can be considered as the first choice of treatment for all pediatric appendicitis including complicated appendicitis. To confirm our impressions, more well controlled randomized prospective studied need to be done.
Anti-Bacterial Agents ; Appendectomy* ; Appendicitis ; Child* ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Postoperative Complications ; Retrospective Studies*