No abstract available.
Choledochal Cyst* ; Cholestasis*

This study is based on 155 patients of congenital me colon. For the diagnosis, 93 cases were histologically proven and the remaining 63 cases were diagnosed on clinical basis including barium enema or surgical gross findings. On histologic examination, 80 cases(86%) showed typical features of absence of ganglion cell in the myenteric plexus and the 13 cases(14%) had atypical features which were segmental absence Of ganglion cell in one case. There we 127 males(82%) and 28 females(18%). The age at diagnosis was younger than 30 days in 87 cases(56%), I month to 1 year in 39 cases(25%) and older than I year in 29 cases(18%). The levels of aganglionosis were variable: short segment (rectosigmoid) in 134 cases(86%), intermediate segment (more proximal colon) in 14 cases(100%). and 6 cases(4%) had total aganglionosis. Common clinical presentations were abdominal distention, delayed meconium passage or bilious vomiting in neonate, and chronic constipation in infancy or childhood. Following initial colostomy or ileostomy, a definitive procedure was performed in 151 cases(Duhamel type in 150 cases; Soave type in 2 cases; Swenson type in 3 cases). Frequently associated problems after definitive procedure were persistent constipation(ll%) due to septum formation, fecaloma, remnant aganglionic segment and rectal stenosis. Overall mortality rate was 4%, and increased mortality was associated with enterocolitis(14%) which was the most frequent cause of death. The follow-up study longer than 3 months was available in 138 patients who underwent a definitive procedure(mean 2 year 11 months). Seventy-three cases(53%) had normal bowel function, 38cases(27.5%) had occasionally used enema or stool softners, and 27 cases(19.5%) had severe constipation or soiling. The bowel habit improved with time, and were considered normal in 60% of patients after follow-up more than 3 years. The results of definitive procedures for congenital megacolon including Duhamel operation was satisfactory, and long-term follow-up appeared an important and critical component of patients'care.
Child ; Male ; Female ; Infant, Newborn ; Humans ; Mortality ; Follow-Up Studies

No abstract available.
Caroli Disease*

Intractable ulcerating enterocolitis of infancy is uncommon, inhereditary disease characterized by ulcerating stomatitis, severe perianal disease, affecting the whole gastrointestinal tract, mainly colon with flask shaped large ulcer. It was first described by Sanderson et al in 5 cases of infant with intractable diarrhea having above clinical manifestation. It should be differentiated with Crohn's disease and Behcet's disease. We experienced a case of intractable ulcerating enterocolitis in an infant. A 17 month old patient was admitted because of intractable diarrhea since 2 months of age. Radilogical and endoscopic examination revealed chronic ulcerative inflammation with pseudopolyps involving ileum and entire colon. Ileocolectomy was performed because of its unresponsiveness to medical theraphy. The histology of resected specimen showed large flask shaped ulcer with underlying edge in the colon, terminal ileum. No evidence of granuloma suggesting Crohn's disease or vasculitis suggesting Behcet's colitis were noted. We report this case as an example of Intractable ulcerating enterocolitis (Sanderson et al).
Colitis ; Colon ; Crohn Disease ; Diarrhea ; Enterocolitis ; Gastrointestinal Tract ; Granuloma ; Humans ; Ileum ; Infant* ; Inflammation ; Stomatitis ; Ulcer* ; Vasculitis

No abstract available.
Tracheoesophageal Fistula*

Ischemic enteritis is caused by embolism or thrombosis of superior mesenteric artery and nonocclusive ischemia. Mesenteric venous thrombosis, drugs, and vasculitis are less frequent etiologic factors. In children, occlusion of microcirculation by fibrin thrombi initiated by endotoxemia may be an etiology. Severe abdominal pain, vomiting, and diarrhea with evidence of gross or microscopic bleeding are common presenting symptoms. Angiography may be diagnositic and permit therapeutic intervention. Revascularization with resection of necrotic bowel is the treatment of choice. We experienced a case of ischemic enteritis that was presented with projectile vomiting and diarrhea. Diagnosis was confirmed histologically. Radiological findings suggested multiple adhesive ileus. Laparatomy was followed by resection of the necrotic bowel.
Abdominal Pain ; Adhesives ; Angiography ; Child ; Diagnosis ; Diarrhea ; Embolism ; Endotoxemia ; Enteritis* ; Fibrin ; Hemorrhage ; Humans ; Ileus ; Ischemia ; Mesenteric Artery, Superior ; Microcirculation ; Thrombosis ; Vasculitis ; Venous Thrombosis ; Vomiting

Productivity analysis of physician is one of essential factors for the optimal health manpower planning. Among 690 physicians operating clinic and registered on the Kyeongsangnamdo Medical Association, 623 physicians were studied with a structural questionnaire from April 1 to May 31, 1990. This study covers the general characteristics and productivity of physicians and attempts to find relevant determinants of their productivity through stepwise multiple regression analysis based on collected data. The major results were as follows. First, physicians were more prevalent 35~44 group (38.2%) in age, male (95.8%) in sex, specialist (76.5%) in specialization, city (78.0%) in geographical location. Age group of 35-54 and specialist were more prevalent in cities than in counties, while age group of 25-44 and 55 over and general practitioner in counties (p<0.001). Second, daily outpatient load of all physician were 77.1 persons on average. Age group of 35~44 had the most outpatient load (90.3 persons) among all age group, 6~10 years group (94.2 persons) in years of duration of practice, 11 hours per day group (83.4 persons) in working hours per day. Specialists had more outpatient load (82.6 persons) than general practitioners (61.1 persons) and physicians in cities had more (80.2 persons) than physicians in counties (66.3 persons). Daily average outpatient load of physicians were significantly different by their age, speciality, number of assistants and years of practice (p<0.001) and working location (p<0.05), but not significantly different by working hours per day of physician (p>0.1). Third, the productivity of physicians operating clinic were significantly affected by the three factorsnumber of assistants of physician, age of physician and duration of practice at the current clinic. Age of physician had negative regression coefficient.
Efficiency* ; General Practitioners ; Health Manpower ; Humans ; Male ; Outpatients ; Surveys and Questionnaires ; Specialization

No abstract available.
Child* ; Humans

No abstract available.
Meconium* ; Peritonitis*

BACKGROUND/AIMS: The aim of this study was to characterize the spectrum of esophageal motor dysfunction after repair of an esophageal atresia with a tracheoesophageal fistula (EATEF). METHODS: This study included 16 patients, aged 0.8 to 13.3 years, who were diagnosed with Gross Type C esophageal atresia and underwent a fistula repair and end to end anastomosis. Esophageal function was evaluated with manometry, 24 hour esophageal pH monitoring, a barium esophagogram, and an endoscopy. RESULTS: Symptoms were present in 8 patients (dysphagia for solid food in 2; frequent vomiting in 6; and poor weight gain in 4). Anastomotic stricture was present in 6 patients. An esophageal manometric study showed that the reflex relaxation of the lower esophageal sphincter (LES) was incomplete or absent in 9 patients (56%). The upper esophageal sphincter (UES) was completely relaxed in all 16 patients. In 14 patients (88%), a normal peristaltic wave was present in the proximal esophagus, but absent below the anastomotic site. Simultaneous contractions were observed in 2 patients (12%). Seven (64%) of 11 patients who underwent 24 hour esophageal pH monitoring presented gastroesophageal reflux. CONCLUSION: Most of the patients after the repair of an EATEF developed motor dysfunction of the esophagus. Poor transmission of the peristaltic waves beyond the anastomotic site and abnormal reflex relaxation of the LES were present.
Barium ; Constriction, Pathologic ; Endoscopy ; Esophageal Atresia* ; Esophageal pH Monitoring ; Esophageal Sphincter, Lower ; Esophageal Sphincter, Upper ; Esophagus* ; Fistula ; Gastroesophageal Reflux ; Humans ; Manometry ; Reflex ; Reflex, Abnormal ; Relaxation ; Tracheoesophageal Fistula* ; Vomiting ; Weight Gain