No abstract available.
Esophageal pH Monitoring* ; Gastroesophageal Reflux*

PURPOSE & METHODS: Nonoperative reduction of childhood intussusception is the treatment of choice. However, few techniques of nonoperative reduction are available. When used, nonoperative reduction can be successfully completed by a radiologist. In this study, we analyzed 637 cases of childhood intussusception diagnosed and treated by ultrasound-guided saline enema reduction (UGSER) over nine years at Ewha Womans University Mokdong Hospital. We compared the results of 76 cases surgically treated after UGSER (US group) with 84 cases surgically treated after barium enema reduction in 1980s (BE group). RESULTS: The success rate of the saline reduction was 88.1%. The risk factors associated with surgery were the patient's age, symptom duration and the type of intussusception. The rate of bowel resection was 32.9%. Patients less than six months old and a pathologic lead point (PLP) on the US were risk factors for bowel resection. There were no significant differences in age, gender and the number of PLPs between the US and BE groups. The number of patients with a spontaneous reduction was greater in the BE group and bowel perforation occurred only in the US group. The bowel resection rate was significantly higher in the US group. However, the median hospital stay was significantly shorter in the US group. CONCLUSION: UGSER is reliable and safe in childhood intussusecption. Moreover, it has a high success rate and is easy to perform. The surgeon, without the need for a radiologist, performs this procedure from diagnosis to treatment. In addition, it might help avoid invasive surgery.
Barium ; Enema ; Female ; Humans ; Intussusception ; Length of Stay ; Risk Factors

PURPOSE: In pediatric solid organ injury, non-operative management is considered as a standard treatment when the patient is hemodynamically stable. However, treatment according to the injured organ and the depth of injury is controversial. The purpose of this study is to evaluate treatment results in the management of abdominal solid organ injuries in children. METHODS: This analysis was performed retrospectively with 57 consecutive children under 15 year of age who were diagnosed with abdominal solid organ injuries at Ewha Womans University Mokdong Hospital from January, 1999 to June, 2007. RESULTS: The major cause of pediatric solid organ injury was traffic accidents (59.6%) and the most frequently injured organ was the liver (66.7%). 54 patients (94.7%) were treated non-operatively and the success rate was 100%. There was no difference in type of management and success rate according to the depth of injury or the injured organs. The average ICU stay was 4.3 days, and the average hospital stay was 13.6 days and that was extended depending on the depth of injury. And according to the cause of injury, cases by traffic accident stayed significantly longer than cases by other causes. CONCLUSION: High grade of injury is not contraindication of nonoperative management in pediatric solid organ injury. Hemodynamic instability is the only absolute indication of operation. Therefore, if the patient is stable, non-operative management with intensive observation is the choice of treatment.
Accidents, Traffic ; Child ; Female ; Hemodynamics ; Humans ; Length of Stay ; Liver ; Retrospective Studies

OBJECTIVE: Falls from a height are the leading cause of injury and death among urban children. In this study, objective was to describe the incidence, clinical characteristics, and treatment results of the children who fell from a certain height and admitted over abdominal injury. METHODS: The medical records of patients under 15 years old admitted over abdominal injury by a fall from one meter or more height between January 1997 and December 2003 at Ewha Womans University Mokdong Hospital were analyzed retrospectively. RESULTS: Of 585 consecutive patients who admitted to our hospital after a fall from a height of 1 to 31.2 meters, 28 patients (4.8%) suffered from blunt abdominal trauma. The male to female ratio was 2.1: 1. The children between 12 months and 13 years old were the patients with 5.5 years old of the median age, and the median height fallen was 3 meters. Fifteen patients (53.6%) were during the summer and seventy-nine percent of the falls occurred between noon and 9 pm. Eighteen (64.3%) of falls occurred in residential place and 19 (67.8%) of patients arrived at the emergency department in 30 minutes after the accidents. Only 16 patients (57.1%) complained of abdominal pain. Liver injuries were found in 12 (42.9%), spleen injuries in 5 (17.9%), kidney injuries 3 (10.7%), pancreatic injuries in 1 (3.6%) and nonspecific abdominal injuries in 9 (32.1%) of cases. The increased SGOT and SGPT were found in each 23 (82.2%) and 18 (64.3%) of cases. Eleven patients (39.3%) had been associated with head injuries and limb injuries in each 17.9% and thoracic injuries in 7.1%. Twenty-five patients (89.3%) were recovered under the conservative treatments and the median length of hospital stay was 6 days (range, 2 -20 days). CONCLUSIONS: Despite the absence of abdominal symptoms or shock, falls from a height in children may carry a significant intra-abdominal organ injuries. Moreover the height of free fall cannot reliably predict the degree of the abdominal injury. Accordingly after a fall from height, the abdomen should be evaluated by CT scan for potential injury.
Abdomen ; Abdominal Injuries* ; Abdominal Pain ; Adolescent ; Alanine Transaminase ; Aspartate Aminotransferases ; Child* ; Craniocerebral Trauma ; Emergency Service, Hospital ; Extremities ; Female ; Humans ; Incidence ; Kidney ; Length of Stay ; Liver ; Male ; Medical Records ; Retrospective Studies ; Shock ; Spleen ; Thoracic Injuries ; Tomography, X-Ray Computed

No abstract available.
Cerebrospinal Fluid* ; Immunoglobulin G* ; Meningitis, Aseptic*

Infantile hypertrophic pyloric stenosis (IHPS) is common surgical disease in infants having vomiting. This disease is still not fully documented despite of various hypotheses. This article reviews the literature on the etiology, clinical course, diagnosis and management of IHPS including recent opinion.
Humans ; Infant ; Pyloric Stenosis, Hypertrophic ; Vomiting

Inguinal hernia is the most frequent problem requiring surgery in children. Moreover, subsequent contralateral occurrence after repair of the symptomatic unilateral inguinal hernia(UIH) is not rare. This study is to evaluate the diagnostic value of inguinal ultrasonography (IUS) for potential bilateral inguinal hernia(BIH). A prospective study was performed for preschool children less than 6 years of age who were diagnosed as UIH from July 1999 to December 2000. We selected 58 cases with potential BIH, based on the past history, such as prematurity, ventriculo-peritoneal shunt, family history of BIH, hernia on the left side (LIH), age below 2, female, and contralateral positive silk glove sign on the physical examination. Screening with IUS and bilateral surgical exploration were applied on these cases. Forty-seven cases were males (81.0%) and 11 cases were females(19.0%). Thirty-four were infants. Symptomatic right inguinal hernia (RIH) were 28 (48.3%), and LIH were 30 cases (51.7%). Six cases had no evidence of contralateral patent process vaginalis (PPV) by IUS but showed contralateral PPV by operation, Two cases were suspicious to contralateral PPV under IUS, but operative findings were negative. Fifty cases showed contralateral PPV by IUS as well as operation. The detection rate of contralateral PPV under IUS was 86.2%. The preoperative IUS may reduce contralateral exploration.
Child* ; Child, Preschool ; Female ; Hernia ; Hernia, Inguinal* ; Humans ; Infant ; Male ; Mass Screening ; Physical Examination ; Prospective Studies ; Silk ; Ultrasonography* ; Ventriculoperitoneal Shunt

Although bleeding was reported before as the first symptom in a few cases of biliary atresia, this association is not generally known. We treated 115-day-old female with extrahepatic biliary atresia presented with subdural hemorrhage rather than with prolonged jaundice. Four years after craniectomy and Kasai's hepatic portojejunostomy, she looks happy without jaundice nor brain damage sequela even though she had recent episode of esophageal variceal bleeding.
Biliary Atresia ; Brain ; Esophageal and Gastric Varices ; Female ; Hematoma, Subdural ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Jaundice

In this paper, we examined the depression of stroke patient's caregivers and analyzed influencing factors of the depression. The subjects were 215 caregivers who have takencare of stroke survivors in their home. The conceptual model of this study consisted of the caregiver's depression, perceived burden, illness intrusiveness, and patient's ADL. Modified Korean CES-D, modified subjective and objective Burden Scale, Illness intrusiveness(II), and Instrumental Activity of Daily Living(IADL) were used to measure concepts. Path analysis was used to test the model of this study. The results were as follows: 1. The mean depression score was 11.6 which was below the cut-off score of the CES-D. This score indicates that the subjects were higher than normal adults' mean score but not depressive. Eighty-six out of 215 caregivers(40%) were above the cut-off score. This finding was different from previous research results, and the reason might be the patients' capability of ADL. In a group of low capability patient's activities of daily living, caregiver's depression score was 15.5. 2. Caregiver's depression was positively related to caregiver's burden and illness intrusiveness, but negatively related to patient's activities of daily living. 3. The caregiver's perceived burden and illness intrusiveness directly influenced on their depression. Furthermore, the and caregiver's illness intrusiveness led to depression indirectly through their burden. A patient's activities of daily living didn't influence directly on depression but indirectly through caregiver's illness intrusiveness and burden.
Activities of Daily Living ; Caregivers* ; Depression* ; Humans ; Stroke* ; Survivors

Predicting factors of post-stroke depression were investigated. The subjects were 254 stroke patients who had been discharged and visited regularly the outpatient clinic for follow up care. The influencing factors were classified into five categories: demographic, disease-related, current state, social support, and illness intrusiveness. Sex, age, job, and educational level were defined as the demographic factor. The disease-related factors included stroke type, illness duration, attack frequency, and NIH score. ADL, cognitive function, and social activity were considered as the current state factors. The social support was measured as the perceived amount of social support. Illness intrusiveness means the perceived illness induced life style disruptions. Demographic, disease-related, current state, and social support were hypothesized to directly and indirectly affect post-stroke depression through illness intrusiveness. The illness intrusiveness was hypothesized to directly affect post-stroke depression. The hierarchial multiple regression was used to identify significant factors. The result showed that this model explained 43.3% of variance of post-stroke depression. And the prevalence of post-stroke depression was 38.8%. Among the demographic factors, job was identified as a main contributor to indirectly increase the post-stroke depression. Among the disease-related factors, stroke type, attack frequency, and NIH score were found to indirectly affect the post-stroke depression. Among the current state factors, ADL and social activity indirectly affected the post-stroke depression through illness intrusiveness. Social support and illness intrusiveness were identified to directly affect the post-stroke depression. This study has proved the factors likely to be implicated in the development of post-stroke depression. Based upon these results, it is recommended that the nurses who take care of post-stroke patients consider the risk factors such as social support, illness intrusiveness et al. Also programs which decrease the illness intrusiveness and increase the social support to reduce post-stoke depression recommended to be developed.
Activities of Daily Living ; Ambulatory Care Facilities ; Demography ; Depression* ; Follow-Up Studies ; Humans ; Life Style ; Prevalence ; Risk Factors ; Stroke