Congenital segmental dilatation of the colon is a very rare entity of unknown etiology, characterized by a localized dilatation of a bowel segment of the colon of variable length and an abrupt transition between the normal and dilated intestine. It can affect any part of the colon, with the rectosigmoid colon being the most commonly affected site. The clinical and radiological features may resemble that of Hirschsprung disease, but differ in that the normal ganglion cells are found in the dilated and normal segment of the colon. We performed laparoscopic-assisted transanal endorectal pull-through for segmental dilatation of rectosigmoid colon in an 8-year-old boy with chronic constipation since the age of 5 months.
Child* ; Colon* ; Constipation ; Dilatation* ; Ganglion Cysts ; Hirschsprung Disease ; Humans ; Intestines ; Male

PURPOSE: To compare the efficacy of a 20-gauge and an 18-gauge needle in sono-guided percutaneous automated gun biopsy for establishing the specific diagnosis of renal parenchymal disease in pediatric kidneys. MATERIALS AND METHODS: In 60 pediatric patients with renal parenchymal diseases, percutaneous sono-guided gun biopsy was performed by an experienced radiologist. In two groups of 30 patients, regardless of their age, two needle passes were performed, using alternately an 18-gauge or a 20-gauge biopsy needle. The core of renal tissue thus obtained was examined with light, immunofluorescent or electron microscopy by the renal pathologist. The mean number of intact glomeruli of whole tissue core per biopsy, as seen on the light microscopy, and post-bioptic complications were compared between the two different needle size groups. RESULTS: The number (mean+/-1 standard deviation) ofglomeruli obtained per biopsy was 17+/-8 in the 18-gauge needle group, and 14+/-5 in the 20-gauge group. Between two groups, there was no major post-bioptic complication requiring specific treatment, nor a statistically significant difference in the frequency of minor complications. CONCLUSION: Even though more glomeruli were obtained with an 18-gauge needle, the number obtained with a 20-gauge needle also permitted adequate pathologic examination. Both an 18-gauge and a 20-gauge needle may thus be suitable for renal biopsy in pediatric patients.
Biopsy* ; Diagnosis ; Humans ; Kidney ; Microscopy ; Microscopy, Electron ; Needles*

Median raphe cyst (MRC) of the perineum is rare congenital midline cyst of the male genitalia. MRC is thought to be caused by congenital alterations in the embryologic development of the male genitalia during fetal life. MRC can be found on the midline position between the urethral meatus and the anus. The lesion can be cystic, but sometimes it looks like an elongated configuration called a raphe canal. Diagnosis in childhood is particularly rare because they are usually asymptomatic, but some cases have reportedly been identified after infection. Although conservative treatment can be possible in small asymptomatic lesions, the treatment of choice is simple excision followed by primary closure in symptomatic cases. We describe here the case of 2-year-old boy presented at our institution with a 10-month history of anomaly of the perineal median raphe, which was treated by surgical excision.
Anal Canal ; Child, Preschool* ; Diagnosis ; Genitalia, Male ; Humans ; Male* ; Perineum

No abstract available.
Endodermal Sinus Tumor ; Follow-Up Studies ; Germ Cells ; Liver ; Neoplasms, Germ Cell and Embryonal

We report a case of nonfunctioning neuroendocrine tumor of the pancreas in a 15-year-old girl who presented with back pain. On physical examination, there was mild tenderness in the left upper quadrant of the abdomen. The patient had no pancreatic hormone-associated symptoms. An abdominal ultrasonography showed a well-demarcated hypervascular solid mass with calcification in the tail of the pancreas. An abdominal computed tomography scan showed a 6x5cm sized well-encapsulated enhancing solid mass with cystic component in the tail of the pancreas. Distal pancreatectomy was performed. Pathology revealed awell- differentiated nonfunctioning low grade malignant neuroendocrine tumor of the pancreas. The postoperative course was uneventful.
Abdomen ; Adolescent ; Back Pain ; Humans ; Neuroendocrine Tumors ; Pancreas ; Pancreatectomy ; Physical Examination

Gastric trichobezoars are commonly observed in young women with trichotillomania and trichophagia. We encountered an 8-year-old girl who had trichotillomania and trichophagia with abdominal pain and a mass, which was diagnosed as a large gastric trichobezoar. On physical examination, a huge, firm nontender mobile mass was palpated in her epigastrium. An upper gastrointestinal series and abdominal computed tomography (CT) scan showed a large mass in the stomach. Endoscopic removal was tried but failed. Laparoscopic removal was therefore performed. The trichobezoar was successfully retrieved through a gastrotomy and removed through an extended umbilical trocar incision. This case demonstrates that laparoscopic removal of large gastric trichobezoars is feasible and safe without a large abdominal incision.
Abdominal Pain ; Bezoars ; Child ; Female ; Humans ; Physical Examination ; Stomach ; Surgical Instruments ; Trichotillomania

A 67-year-old-man, who had a medical history of hypertension and angina pectoris, was referred to our hospital due to dysuria and a palpable lower abdominal mass. He was a farmer until at the age of 50 and then had been working at a textile factory. The physical examination revealed a fixed, firm and round mass in the lower abdomen. The laboratory data were within the normal ranges, except for elevation of CA-125 (128 U/ml). Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) showed a 6 x 5 cm round hypodense mass in the pelvic cavity. Preoperative ultrasound-guided needle biopsy resulted in a suspicious rhabdomyosarcoma. Exploratory laparotomy revealed a 10 x 8 cm size firm, round mass that was located between the superior aspect of the urinary bladder and lower anterior abdominal wall. En bloc excision of the mass with partial cystectomy was performed. The pathologic diagnosis was primary malignant peritoneal mesothelioma. The postoperative course was uneventful.
Abdomen ; Abdominal Wall ; Angina Pectoris ; Biopsy, Needle ; Cystectomy ; Diagnosis ; Dysuria ; Hypertension ; Laparotomy ; Magnetic Resonance Imaging ; Mesothelioma* ; Physical Examination ; Reference Values ; Rhabdomyosarcoma ; Textiles ; Urinary Bladder

Thyroglossal duct cysts (TGDC) are the most common type of congenital developmental anomaly encountered in the anterior midline of the neck in childhood. The aim of the study was to evaluate the clinical characteristics of TGDC and identify any factors that could be related to recurrence after surgery. This study consisted of a retrospective chart review of 45 patients treated at Kyungpook National University Hospital for TGDC between 1990 and 2008. All records were reviewed for age and sex, length of history, presentation, diagnostic methods, sizes and locations of cyst, surgical management, histopathology of the lesion and recurrences. The statistical analysis of risk factors for recurrence was made using the Fisher's exact test with a significance level of p < 0.05. The male to female ratio was 2.2:1 with a male preponderance. The mean age at operation was 5 years and 2 months (4 months - 17 years). The most common presenting symptom was a nontender cervical mass (78%). Most TGDC were found in the midline position. Twenty four were infrahyoid, 17 were hyoid, and 4 were suprahyoid level. Forty one (91%) patients received the Sistrunk operation, and 4(9%) patients received cyst excision. Postoperative a seroma developed in six patients in the early postoperative days. There were a total of 3(6.6%) recurrences, 2 in patients who had excision only and in one patient who had the Sistrunk operation. Univariate analysis for risk factors with recurrence showed that there was no statistical relationship between the presence of preoperative infection and the development of recurrence. The removal of hyoid bone along with TGDC was a statistically significant risk factor for recurrent disease. This study suggests that the Sistrunk operation is the treatment of choice for TGDC in order to reduce recurrence.
Child ; Female ; Humans ; Hyoid Bone ; Male ; Neck ; Recurrence ; Retrospective Studies ; Risk Factors ; Seroma ; Thyroglossal Cyst

There have been a few reports of familial anorectal malformations extending over more than one generation. We experienced a case of a family with 3 members spanning 2 generations affected with isolated low type anorectal malformations. They had same low type of anorectal malformations. In all 3 patients, a perianal anoplasty was performed.
Family Characteristics ; Humans

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation that is usually progressive. It is a major cause of morbidity and mortality worldwide, leading to substantial and increasing economic and social burden. Palliative care for COPD patients aims to reduce symptoms and exacerbations and improve exercise tolerance and quality of life. It is difficult to make a prognosis for COPD patients due to the variable illness trajectory and advanced care of patients. However, severity of breathlessness, assessment of lung function impairment, and frequency of exacerbations can help to identify palliative care needs and determine effective methods to mitigate symptoms, which is discussed in this paper. In these patients, it is recommended to provide individualized palliative care along with curative/restorative care at the onset of COPD symptoms. Before launching a palliative care system in Korea, it is necessary to prepare pulmonary rehabilitation resources, patient-centered communication, timely palliative responsiveness, and a program for effective advanced care planning. A multidisciplinary approach involving collaboration with not only the respiratory and palliative care teams but also primary care offers a new model of care for these patients and should be considered with a priority.
Cooperative Behavior ; Dyspnea ; Exercise Tolerance ; Hospice Care ; Hospices* ; Humans ; Korea ; Lung ; Mortality ; Palliative Care* ; Primary Health Care ; Prognosis ; Pulmonary Disease, Chronic Obstructive* ; Quality of Life ; Rehabilitation ; Respiratory Therapy