PURPOSE: Intestinal atresia is a well-recognized cause of bowel obstruction in the newborn. The management of neonates with intestinal atresia has improved in recent decades due to refinements in neonatal intensive care, operative techniques, use of total parenteral nutrition (TPN), and neonatal anesthesia. More recently, the survival rate has risen rapidly up to 90%. METHODS: Twenty-five (25) cases of intestinal atresia were encountered at Kwangju-Christian Hospital between January 1985 and December 1998. We reviewed sex, gestational age, body weight, clinical manifestations, associated ano malies, causes, interval to operation, preoperative complications, operative methods, and postoperative complications. RESULTS: Sites involved were the duodenum (n=10; 40%), the jejunum (n=5; 20%), and the ileum (n=10; 40%). The sex distribution was male predominant (1.8:1). The overall survival rate in our hospital was 76%. CONCLUSION: Refinements in neonatal intensive care and perioperative management were important in decreasing postoperative mortality.
Anesthesia ; Body Weight ; Duodenum ; Gestational Age ; Humans ; Ileum ; Infant, Newborn ; Intensive Care, Neonatal ; Intestinal Atresia* ; Jejunum ; Male ; Mali ; Mortality ; Parenteral Nutrition, Total ; Postoperative Complications ; Sex Distribution ; Survival Rate

PURPOSE: A pancreaticoduodenectomy is the procedure of choice for patients with resectable carci nomas of the pancreatic head, duodenum, or periampullary region. Although the morbity and the mortality are decreasing now, but there are still high. Leakage of the pancreatic duct remains the major source of death and complications after a pancreaticoduodenectomy. Thus, the authors used a stented pancrea ticojejunostomy and jejunojejunostomy after a pancreaticoduodenectomy to decrease leakage of the pancreatic duct. METHODS: The authors studied retrospectively 44 consecutive patients who had a pancrea ticoduodenectomy with a stented pancreaticojejunostomy and jejunojejunostomy at Kwangju Christian Hospital between 1993 and 1998. RESULTS: Leakage of the pancreaticojejunostomy was diagnosed in one of the 44 patients (2.5%). There were two deaths after the pancreaticoduodenectomy, one from compli cation of leakage of the pancreaticojejunostomy and the other from UGI bleeding. CONCLUSION: The stented pancreaticojejunostomy and jejunojejunostomy is an effective and safe method for use with a pancreaticoduodenectomy. However, the leakage that might occur despite the stented pancreaticojeju nostomy and jejunojejunostomy can be managed less invasively.
Duodenum ; Gwangju ; Head ; Hemorrhage ; Humans ; Mortality ; Noma ; Pancreatic Ducts ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy* ; Retrospective Studies ; Stents*

BACKGROUND: Thyroid cancer is the most common tumor with a endocrine gland origin, and it has a gradually increasing incidence rate. An operative procedure is useful to obtain good results for this disease. Howevers, the selection of operation method remains controversial. Thus, we reviewed the variable prognostic factors which influence thyroid cancer recurrence in order to determine the treatment methods which reduce the recurrence rate. METHODS: We retrospectively reviewed the cases of 383 thyroid cancer patients who had received operations from January 1988 to December 1993. The review looked at age, sex, operation methods, lymph-node metastasis, histologic types, mass size and capsular invasions, and the correlations between these factors and recurrence were analyzed by using Chi-square and SAS trend tests. Complications which developed after various operation methods were also reviewed. RESULTS: Thyroid cancer recurred in 33 (8.6%) patients. Age, sex, lymph-node metastasis, histologic types and capsular invasions did not influence the cancer recurrence rate significantly. However, mass size and operation method were potential factors for recurrence. CONCLUSIONS: If thyroid cancer is diagnosed, a total thyroidectomy with lymph-node dissection is the best method for reducing the cancer recurrence rate. By careful management, complications can be prevented after a total thyroidectomy.
Endocrine Glands ; Humans ; Incidence ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Surgical Procedures, Operative ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: Thyroid disease is the most common form of endocrinologic disease. Despite recent advances in diagnosis, controversy still remains concerning the surgical management of thyroid disease. The aim of this study was to analyze the clinical distribution and the inclination of surgical treatment for thyroid disease. METHODS: The medical records from 1,743 patients who had undergone thyroid resections for thyroid diseases between January 1989 and December 1998 at Kwangju Christian Hospital were reviewed retrospectively. RESULTS: Of the 1,743 patients with thyroid diseases, 1,285 had benign diseases and 458 had carcinomas, resulting in a 26.3% prevalence of malignancy. Female patients were predominate, being 6.89 times the number of males. The peak incidence of age was the 4th decade for patients with benign diseases (29.4%) and the 5th decade for those with malignant diseases (26.0%). Both benign (39.4%) and malignant diseases (42.1%) were more prevalent on the right lobe. The incidence of carcinomas was 28.9% in solitary nodules and 29.3% in multinodular goiters. In the histopathologic study, the most common type was a papillary carcinoma (84.5%) in malignancies and an adenomatous goiter (48.8%) in benign diseases. The most commonly performed surgical procedures were a total thyroidectomy (75.4%) for malignancies and a lobectomy for benign diseases (63.3%). Postoperative complications were 3.1% in patients with benign diseases and 29.7% in those with malignancies. Regional recurrence or distant metastases appeared in 5.5% of the patients during the 10 years following treatment. CONCLUSION: The treatments of choice were a thyroid lobectomy for patients with benign diseases and a total thyroidectomy for those with malignant diseases. However, the decision to perform a surgical resection should be based on the age and the general condition of patient.
Carcinoma, Papillary ; Diagnosis ; Female ; Goiter ; Gwangju ; Hospital Distribution Systems ; Humans ; Incidence ; Male ; Medical Records ; Neoplasm Metastasis ; Postoperative Complications ; Prevalence ; Recurrence ; Retrospective Studies ; Thyroid Diseases* ; Thyroid Gland* ; Thyroidectomy

PURPOSE: To investigate the timing of colostomy closure and the associated risk factors that affect the development of complication after colostomy closure. METHODS: We have reviewed and analyzed the results of 28 patients with colostomy closure at the Kwangju Christian Hospital from January 1993 to December 1997. We investigated to associated literatures on this subject for timing of colostomy closure, preparing a patient for colostomy closure, suture technique, wound management, underlying disease process related to the incidence of complication and experience of surgeons. RESULT: Wound infection developed in 4 patients (14.4%). Anastomotic leakage occurred in one patient (3.6%). Small bowel obstruction developed in two patients (7.2%). Overall incidence of complication was 25%. The incidence of complications in patients with trauma who underwent colostomy was 44.4% and patients without trauma, 15.8%. Complication rate was 16.6% for loop colostomies and 40% for end colostomies. The morbidity was 40% for colostomies on the left side, 18.7% for transverse colostomies, and 0% for colostomies (2 ileostomies) on the right side. The morbidity rate for closures within 6 weeks for the initial operation was 50%; for those within 6 to 12 weeks, 8.3%; and for those after 12 weeks, 16.6%. CONCLUSION: The optimal timing of closure varies from patient to patient, but closure within 6 weeks of the initial operation significantly increased the morbidity. Colostomies on the left side are associated with a higher morbidity rate than transverse colostomies or colostomies on the right side.
Anastomotic Leak ; Colostomy* ; Gwangju ; Humans ; Incidence ; Risk Factors ; Suture Techniques ; Wound Infection ; Wounds and Injuries

PURPOSE: Papillary thyroid carcinoma is the most common endocrine malignancy. Despite the recent advances in diagnosis, controversy still remains concerning the surgical management. In order to select the appropriate surgical treatment, the outcome of different types of surgical procedures were reviewed. METHODS: 435 patients with papillary thyroid carcinoma who underwent surgery from January 1988 to December 1999 were retrospectively reviewed. The 12 years were divided into two periods; period 1 was from 1988 to 1993 (234 patients) and period 2 was from 1994 to 1999 (201 patients). The recurrence and complication rates according to the operation method, including a neck lymph node dissection, were analyzed. RESULTS: Twenty-six (10.7%) and 13 patients (6.5%) had a recurrence in period 1 and 2, respectively. Eighty-one (34.6%) and 51 patients (25.4%) had a postoperative complication including hypoparathyroidism and hoarseness in period 1 and 2, respectively. 271 patients (62.3%) had a lymph node metastasis, and the anterior neck was the most common site of metastasis (60.2%). CONCLUSION: A total thyroidectomy with a routine central node dissection reduces both the incidence and number of postoperative complications.
Diagnosis ; Hoarseness ; Humans ; Hypoparathyroidism ; Incidence ; Lymph Node Excision ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Postoperative Complications ; Recurrence* ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

OBJECTIVES: The purpose of this study is to compare educational effects between traditional classroom instruction and video self-instruction (VSI) for cardiopulmonary resuscitation (CPR) in boy's high school students. METHODS: This study was carried out targeting totally 96 boy students(47 people for experimental group, 49 people for control group) in the second grade of high school where is located in G city of G province from July 9-10, 2009. The experimental group and control group were arbitrarily selected two classes in the second grade. One class was assigned to the experimental group. another class was assigned to the control group. The experimental group was educated with VSI for CPR. The control group was educated with traditional classroom instructions for CPR. The analysis was performed with SPSS WIN (version 12.0) program using frequency chi-square(chi2) test, independent samples t-test, and paired t-test. RESULTS: After instructions, the knowledge, attitude, self-confidence, and skill performance accuracy scores on CPR increased statistically in both group. The increases of self-confidence (2.40 +/- 0.73) and skill performance accuracy score (2.67 +/- 0.29) in the experiment group were significantly higher than those (2.01 +/- 0.96 and 2.54 +/- 0.31) in the control group, respectively. CONCLUSION: This study suggested that VSI was more effective than traditional classroom education for self-confidence and skill-performance accuracy in CPR. To confirm it, more studies are warranted.
Cardiopulmonary Resuscitation ; Humans

PURPOSE: The aim of this prospective study was to evaluate the effect of metronidazole for wound infection by using intra-incisional infiltration before appendectomy. METHODS: From January to May 2000, 176 patients with acute appendicitis received appendectomy. All patients were randomly divided into two groups. Group I (n=50) was the treatment group and group II (n=126) was the control group. After anesthesizing the patients of group I, 7.5 mg/kg of metronidazole was injected into subcutaneous tissue and muscle. All patients of group I and II were given intravenous injection of cephalosporin and intravenous or intramuscular injection of aminoglycoside. RESULTS: In the 50 cases of group I, the rate of wound infection was 2% and the rate of wound infection in the 126 cases of group II was 4.8%. The rate of anaerobic bacteria of organisms cultured from wound of patients with infection was 0% in group I and 33% in group II. The statistical analysis using chi-square test was not significant (p=0.676) but the rate of wound infection was reduced, especially in infection caused by anaerobic bacteria. CONCLUSIONS: The rate of wound infection was not significant statistically but it was reduced after intra-incisional infiltration of metronidazole. Therefore we suggest that this method can be one of methods that reduce the rate of wound infection after appendectomy.
Appendectomy* ; Appendicitis ; Bacteria, Anaerobic ; Humans ; Injections, Intramuscular ; Injections, Intravenous ; Metronidazole* ; Prospective Studies ; Subcutaneous Tissue ; Wound Infection* ; Wounds and Injuries*

BACKGROUND: Immunoglobulin A nephropathy (IgAN) and thin glomerular basement membrane nephropathy (TBMN) are the most common causes of persistent hematuria during childhood. The objective of this study is to determine the difference in clinicl features and laboratory findings between pediatric patients with IgA deposited TBMN and IgAN alone. METHODS: Between January 2000 and March 2009, 95 children were diagnosed with IgAN by renal biopsy. Clinical features and laboratory findings of patients with isolated IgAN and with IgAN plus TBMN were compared; the children diagnosed with IgAN were compared to 127 children who had been diagnosed with TBMN alone during the same period. RESULTS: There were 71 (74.7%) of a total 95 patients that were diagnosed with isolated IgAN (Group 1); in 24 (25.3%) of the 95 patients IgAN was combined with TBMN (Group 2). There was marked difference in the gender distribution between Group 2 and isolated TBMN patients. The degree of proteinuria and pathologic severity was higher in Group 1 compared with Group 2. Gross hematuria was present in both groups. There were no distinguishing features in the other laboratory parameters. CONCLUSION: Patients with both IgAN and TBMN seem to have similar clinical features to patients with isolated IgAN; however, the latter tend to have better pathologic and laboratory findings, compared to the patients with IgAN alone.
Biopsy ; Child* ; Glomerular Basement Membrane* ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Immunoglobulin A* ; Proteinuria

PURPOSE: To compare the effectiveness of embolization of the bronchial artery embolization for the management of hemoptysis in pulmonary tuberculosis cases with the severity of lung parenchymal injury and pleural infiltration, as seen on plain chest radiographs, and with the findings of angiography of the bronchial artery. MATERIALS AND METHODS: Among 265 patients with hemoptysis due to pulmonary tuberculosis, the findings of plain chest radiography and angiography of the bronchial artery were comparatively analyzed in the 206 for whom the results of follow up were available. The chest radiographic findings were lassified as follows: Type I refers to simple pulmonary tuberculosis; Type II includes cases in which pulmonary tuberculosis is complicated by bronchiectasis, aspergillosis, or cavitation; Type III is either Types I or II accompanied by pleural infiltrates limited to the lung apex, and Type IV includes cases in which pleural infiltrates have extended beyond the apex in the whole of the lung. Bronchial angiographic findings were divided into four groups : Group I consists of cases which show abnormalities of only the bronchial artery; Group II includes those in which abnormalities are seen in the bronchial artery and either the internal mammary or an ntercostal artery; Group III comprises cases which belong to Group I or II and in which a branch of the subclavian artery is abnormal, and Group IV includes those in which abnormalities occur in at least two branches of the subclavian artery, or there is direct visualization of hypervascularity of this vessel. The initial post-embolic hemostatic effect and the results of follow up were studied over a six-month period. RESULTS: As compared with simple pulmonary tuberculosis (Type I), we found that as the severity of pleural infiltration and complications revealed by plain chest radiographs increased (Type II, III, IV), so did the severity of the manifestation of systemic collateral arteries other than the bronchial artery, as depicted by increase on bronchial angiography. Early post-embolic hemostasis occurred in 96% of Type-I cases (47/49), 82% of Type II (36/44), 70% of Type III (28/40), and 55% of Type IV (40/73). The average success rate was 74% (151/205). During the six month follow-up period, continued hemostasis was found in 80% of Type-I patients (36/45), 75% of Type II (30/40), 59% of Type III (20/34), and 48% of Type IV (20/42). The average long-term hemostasis rate was 66% (106/161). CONCLUSION: Bronchial angiography shows that in systemic collateral arteries circulation increases very substantially, and in cases in which plain chest radiographs depict extensive pleural infiltration or complications associated with pulmonary tuberculosis, it is therefore difficult to expect good hemostatic results after embolization. In such instances we thus recommend aggressive treatment such as surgical intervention.
Angiography* ; Arteries ; Aspergillosis ; Bronchial Arteries ; Bronchiectasis ; Follow-Up Studies ; Hemoptysis* ; Hemostasis ; Humans ; Lung ; Radiography ; Radiography, Thoracic* ; Subclavian Artery ; Thorax* ; Tuberculosis, Pulmonary*