Choledochal cyst, or cystic dilatation of the common bile duct, is generally considered to be an uncommon indiopathic congenital condition that may produce symptoms in infancy but more of ten is discovered at some time during the first two decades of life. Female patients have outnumbered males 3 or 5 to1, and almost cases reported by many authors had more than two symptoms among the classic triad of abdominal mass, jaundice and upper abdominal pain. Authors would like to submit here with the brief review of the literature and report on 2 cases of idiopathic dilatation of the common bile duct that they had experiences among the Pediatric inpatient at Busan St. Benedict Hospital, and the diagnosis was established by clinical, laboratory, X-ray and surgical findings. Cases I in 14 year old girl was complained of severe abdominal distension, jaundice, pruritus and abdominal mass. On 7th admission day, exploratory laparatomy was done and choledochal cyst of 1722cm in size was confirmed and has been followed up for 1 year after Roux-en-Y choledochojejunsotomy without any complications. Cases II in 9 year old boy was complained of intermittent fever, jaundice, colicky abdominal pain and upper abdominal mass. On 6th admission day, exploratory laparatomy was done and choledochal cyst of 1015cm in size was confirmed and has been followed up for 1 year after choledochoduodenostomy with cholecystectomy without any complications.
Abdominal Pain ; Adolescent ; Busan ; Child ; Cholecystectomy ; Choledochal Cyst ; Choledochostomy ; Common Bile Duct* ; Diagnosis ; Dilatation* ; Female ; Fever ; Humans ; Inpatients ; Jaundice ; Male ; Pruritus

A case of congenital hypothyroidism in 7 month old infant was presented. This baby was admitted because of growth retardation, feeding difficulties, and constipation. We diagnosed this case by clinical features as well as thyroid scintigram, X-ray survey for bone age and skeletal maturation and biochemical studies. The patient was treated with desiccated thyroid, but was died of intercurrent infection on 20th hospital day. The review of literature was made briefly.
Congenital Hypothyroidism* ; Constipation ; Humans ; Infant ; Thyroid Gland

Hemangioma arising in soft tissue is one of the most common tumors in the head and neck region. However, intraosseous hemangiomas are rare and account for only 0.5% to 1.0% of all osseous neoplasms. Most often, intraosseous hemangiomas are found in the vertebral column or calvarium. With regard to the facial skeleton, these lesions arise primarily in the mandible, maxilla, or nasal bones. For hemangiomas of the orbit or frontal bone, several cases have been reported. We present two cases of cavernous hemangioma arising from the superolateral orbital rim and frontal bone. In one case, the preoperative diagnosis with computed tomography(CT) scan was fibrous dysplasia. The diagnosis and treatment of this rare lesion are discussed.
Diagnosis ; Frontal Bone* ; Head ; Hemangioma* ; Hemangioma, Cavernous ; Mandible ; Maxilla ; Nasal Bone ; Neck ; Orbit ; Skeleton ; Skull ; Spine

A Case of Goldenhar's Syndrome. The authors experienced a case of Goldenhar's syndrome which is characterized by epibulbar dermoid, preauricular appendage and pretragal blind fistula. The patient was a 7-month old korean boy who had epibulbar dermoid, preauricular appendages, and hemifacial microsomia. We reviewed the available literatures regarding this syndrome.
Dermoid Cyst ; Fistula ; Goldenhar Syndrome ; Humans ; Infant ; Male

The authors report a typical case of tenosynovial giant cell tumor of the right middle finger of a 31-year-old man. Histologically, this tumor is characterized by a discrete proliferation of rounded synovial-like cells accompanied by a variable number of multinucleated giant cells, inflammatory cells, and xanthoma cells. Clinicopathologically, this tumor is a benign lesion that nonetheless possesses a capacity for local recurrence. Local excision with a small cuff of normal tissue is the treatment of choice in this tumor.
Adult ; Case Report ; Fingers* ; Giant Cell Tumors/surgery ; Giant Cell Tumors/pathology* ; Histocytochemistry ; Human ; Male ; Muscle Neoplasms/surgery ; Muscle Neoplasms/pathology* ; Neoplasm Recurrence, Local ; Synovial Membrane/pathology*

To estimate the incidence of externally recognizable genitourinary anomalies and associated anomalies in the newborns in Korea, retrospective and prospective studies have been performed. Thirty eight of 48 urology training hospitals participated in this nationwide survey. In this study we have included minor defects or variations in the anomaly to evaluate the incidence of the recognizable genitourinary conditions in the newborns. The incidence of genitourinary anomaly in 1,000 newborn delivery in a year was 11.0 in the prospective study and this figure is about three times higher than the retrospective study and is considered to be close to the true incidence. The incidence of genitourinary anomaly in 1,000 male newborn was 20.4. Hydrocele, cryptorchidism and hypospadias were most commonly observed. The incidence of hydrocele in 1,000 male newborn was 9.89 and the incidence of cryptorchidism was 7.26 and the incidence of hypospadias was 2.13. The incidence of associated anomaly in 100 genitourinary anomaly was 7.9. Congenital heart diseases and anorectal anomalies were commonly associated anomalies. In the newborns with genitourinary anomalies, premature infants account larger portion than is usually reported in total delivery.
Birth Weight ; Congenital Abnormalities/epidemiology ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Korea ; Male ; *Urogenital Abnormalities

Adenoma of the ampulla of Vater is a rare disease, and there is no universal consensus on the management of this entity due to its rarity and unpredictable behavior. Because many of these tumors recur after local excision and because it is difficult to obtain a definitive diagnosis or to exclude malignancy before operation, local excision of ampullary tumors still remains controversial despite being a standard operation for nearly a century. Many surgeons resort to more radical resection, such as pancreatoduodenectomy for treatment of this troublesome disease. The author's report on the evaluation and treatment of 10 patients who underwent pancreatoduodenectomy for ampullatry tumors, diagnosed as benign adenoma on preoperative endoscopic biopsy. Endoscopic retrograde cholangiopancreaticography (ERCP) and computed tomography (CT) was performed in all cases. There were 6 men and 4 women, with a median age of 53 years (22-72 years). Postoperative histopathologic examination revealed that five of the ten patients had had cancerous change within adenoma. Four of the five ampullary adenocarninomas were confined to mucosa, but one had invaded the pancreatic parenchyma. No case was accompanied with lymphatic involvement. Reoperative pancreatoduodenectomy was perfomed in one patient with recurrent villotubular adenoma after local excision of ampulla. All patients are still alive and without any evidence of tumor recurrence after pancreatoduodenectomy (median follow up period 35 months, range 17-77 months). There was no postoperative death. Diagnosis of malignancy could not be ruled out based on a preoperative endoscopic biopsy in ampullary tumors. We conclude that pancreatoduodenectomy with regional lymph node dissection should be the standard treatment in circumstances without any contraindication to extensive surgery.
Adenoma ; Ampulla of Vater ; Biopsy* ; Consensus ; Diagnosis ; Female ; Follow-Up Studies ; Health Resorts ; Humans ; Lymph Node Excision ; Male ; Mucous Membrane ; Pancreaticoduodenectomy ; Rare Diseases ; Recurrence

Silver Spike PintElectro-Therapy(SSPET) means passing electric current through the skin surface with the triangle spike silver coated metal electrode. Transcutaneous Electrical Nerve Stimulation(TENS) for chronic pain management was first reported by Shealy in 1972. Since 1975, Vanderark and Mograth reported that TENS has had a analgesic effect for the relief of acute postoperative pain. SSPET was reported by Hyoto and Kitade at Edinburg, Scotland. 3rd World Congress on Pain in 1981; It has a number of advantages over traditional narootic medication in postoperative pain management. It does not depress the cardiovascular, respiratory of metabolic system and has no apparent effect on the sensorium. Furthermore it is noninvasive, nontoxic, simple in its application and can be used continuously or intermittently. This study was undertaken to investigate recent reports concerning the use of Silver Spike Point Electro-therapy for the relief of postoperative pain. Sisyt patients undergoing elective Cesarean section were subjected to a standard perianesthetic proctocol by the Department of Anesthesiology at Hanyang University Hospital from March, 1st to August, 31, 1984. The patients were divided into three groups of twenty, designed control, SSP and sham SSP. Postoperative analgesic requirements for each group were compared. The results are as follows; 1) The age distribution ranged from 21 years to 36 yearts. Mean age was 25 years and the body weight ranged from 45kg to 68kg. The mean body weight was 52kg. 2) The incisional area of the Cesarean section was 23 cases (38.3%) of low midline incision and 37 cases(81.7%) of Pfannenstiel incision. 3) There were no remarkable changes in the blood pressure, pulse rate or respiratory rate during before and after SSP administration. 4) The total number of intramuscular doses of Demerol given to the patients in the ward was: control group 94 doses, SSP group 31 doses and sham SSP group 89 doses. The SSP group was statistical different from the other 3 groups when compared by the Student's T-test. 5) In the subjective assessment of each group, their statements were markedly varied. Nevertherless SSP has shown that the analgesic requirement was considerably less than that of the other group. This result means that SSP can be used for the relief of acute postoperative pain. Despite a number of diffidulties encountered during this study, we were primarily concerned with the action mechanism, subjective measurement of pain and standards in the requirment of Demerol. We considered that further investigation should be done in the use of SSP for postoperative analgesia and pain. SSP for postoperative pain management is a useful method that is simple, non-invasive, non-toxic and obtains safe analgesia.
Age Distribution ; Analgesia ; Anesthesiology ; Blood Pressure ; Body Weight ; Cesarean Section ; Chronic Pain ; Electrodes ; Female ; Heart Rate ; Humans ; Meperidine ; Pain Management* ; Pain, Postoperative ; Pregnancy ; Respiratory Rate ; Scotland ; Silver* ; Skin ; Transcutaneous Electric Nerve Stimulation

This study assessed the ability of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology, Chronic Health Evaluation (APACHE) II scoring systems, as well as the Simplified Acute Physiology Score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with organophosphate. The medical records of 149 organophosphate poisoned patients admitted to the ICU from September 2006 to December 2012 were retrospectively examined. The SOFA, APACHE II, and SAPS II were calculated based on initial laboratory data in the Emergency Department, and during the first 24 hr of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II equations. The ability to predict group mortality by the SOFA score, APACHE II score, and SAPS II method was assessed using two by two decision matrices and receiver operating characteristic (ROC) curve analysis. A total of 131 patients (mean age, 61 yr) were enrolled. The sensitivities, specificities, and accuracies were 86.2%, 82.4%, and 83.2% for the SOFA score, respectively; 65.5%, 68.6%, and 67.9% for the APACHE II scoring system, respectively; and 86.2%, 77.5%, and 79.4% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.896, 0.716, and 0.852, respectively. In conclusion, the SOFA, APACHE II, and SAPS II have different capability to discriminate and estimate early in-hospital mortality of organophosphate poisoned patients. The SOFA score is more useful in predicting mortality, and easier and simpler than the APACHE II and SAPS II.
*APACHE ; Adult ; Aged ; Aged, 80 and over ; Emergency Service, Hospital ; Female ; Hospital Mortality ; Humans ; *Intensive Care Units ; Male ; Middle Aged ; Organophosphate Poisoning/*diagnosis/mortality ; ROC Curve ; Sensitivity and Specificity ; *Severity of Illness Index

PURPOSE: The high rate of road traffic crashes and rising medical costs are critical health care problems in Korea as well as in the United States. To reduce the medical cost of minor traffic accidents, we hypothesized that implementation of a 7-day critical pathway (CP) for minor car accident patients (MCP) would decrease medical costs and hospitalization time without lowering patient satisfaction level. METHODS: A pretest-posttest experimental design was used to verify the effects of CP on MCP, from June 1 to December 31, 2010. A 7-day admission schedule with daily predefined order communication system (OCS) order set was implementated for MCP. On the day of discharge, MCP completed a satisfaction survey, and the total medical cost and cost per day were calculated. Satisfaction with physician and nursing care were also surveyed using the Brief Encounter Psycho-Social Instrument-Korea tool. RESULTS: Overall rating did not differ in patients processed normally and using the CP, but length of admission was reduced in CP patients. Total medical costs were not different in either group but cost per day was higher in the CP group. Satisfaction with physicians, but not nurses, satisfaction was improved after CP implementation. CONCLUSION: A critical pathway for MCP reduces length of admission without decreasing patient satisfaction. Total medical costs are not changed after CP implementation but cost per day is significantly increased. Improved job satisfaction in physician but not for nurses was observed after CP implementation. It seems that CP is a effective tool for MCP.
Accidents, Traffic ; Appointments and Schedules ; Critical Pathways ; Delivery of Health Care ; Hospitalization ; Humans ; Job Satisfaction ; Korea ; Motor Vehicles ; Nursing Care ; Patient Satisfaction ; Research Design ; United States