No abstract available.
Twins, Conjoined*

No abstract available.
Hirschsprung Disease*

No abstract available.

Intestinal obstruction is the commonest cause for emergency surgical intervention in the newborn. An extremely rare cause of intestinal obstruction in the neonate is a congenital abnormality consisting of segmental absence of intestinal musculature with intact serosa and mucosa. This report represents not only the fourth reported case of this anomaly but also the first case associated with long segment Hirschsprung's disease in English-written literatures.
Infant, Newborn ; Humans

A case of Fetus-in-fetu is reported. The patient was a 8 month-old-boy with a tumor in the left upper retroperitoneum. The characteristic feature of the specimen consisted of vertebral column including pelvis, both upper and lower extremities, neural canal and brain tissue, and well formed large intestine.

Of 72 cases with vitelline duct and vessel remnants, 45 (62.5%) had symptomatic lesions (mean age, 27.9 months) with male preponderance (4.6: 1). Among the 45 symptomatic lesions, there were 22 cases of Meckel's diverticulum, 6 cases of Meckel's diverticulum with fibrous band attached to the umbilicus, 6 cases of patent vitelline duct, 5 cases of vitelline artery remnant as fibrous band, 2 cases of umbilical sinus, 2 cases of umbilical polyp, and 2 cases of vitelline cyst. Twenty three cases (51%) presented with intestinal obstruction, 6 (13%) with rectal bleeding, 4 (9%) with perforated Meckel's diverticulum, 5 with intestinal fluid drainage through umbilicus, 5 with umbilical lesion, and 1 with abdominal mass. Intestinal obstruction due to fibrous band developed at infancy (average age, 4.6 months). About 82% of complicated Meckel's diverticulum (n=28) presented less than 4 years of age. Seventeen Meckel's diverticulums, 8 obliterated vitelline artery remnants, and 1 vitelline vein remnant as fibrous band were found incidentally at laparotomy.
Arteries ; Drainage ; Hemorrhage ; Humans ; Intestinal Obstruction ; Laparotomy ; Male ; Meckel Diverticulum ; Polyps ; Umbilicus ; Veins ; Vitelline Duct* ; Vitellins*

Parenteral nutrition has been an essential part of postoperative care of neonates requiring major surgery soon after birth followed by prolonged period of no allowable enteral feeding. However, TPN via central venous catheters (central TPN), used in increasing trend, still presents significant morbidity. To find out whether TPN via peripheral veins (peripheral TPN) could be used as a viable alternative for postoperative parenteral nutrition in neonates, a clinical study was carried out by a retrospective analysis of 53 neonates subjected to peripheral TPN for more than 7 days after surgery for esophageal atresia with tracheoesophageal fistula, gastroschisis and omphalocele at the Division of Pediatric Surgery, Hanyang University Hospital, from 1983 to 1994. The mean total duration of TPN was 13.3 days (range: 7-58 days), the average daily total fluid intake was 117.6 ml/kg during TPN and 158.6 ml/kg during subsequent oral feeding. The average daily total calorie intake was 57.7 kcal/kg during full strength TPN and 101.3 kcal/kg during oral feeding. The mean urine output was maintained at 3.5 ml/kg/hour during TPN and at 3.6 ml/kg/hour during oral feeding. The increment of body weight observed during TPN was 132gm in TEF, 53gm in gastroschisis and 3gm in omphalocele patients, while loss of body weight was not oberved in each group. The mortality rate was 5.7% (3/53), related to underlying congenital anomalies but not to TPN. The common complications were laboratory findings suggestive of liver dysfunction in 23 cases (43.4%) with no significant clinical symptom or signs in any case, transient pulmonary edema in one case, and generalized edema in one case. The result of the study suggests that peripheral TPN could be used for adequate postoperative nutritional support in neonates requiring about 2 to 3 weeks TPN.
Body Weight ; Central Venous Catheters ; Edema ; Enteral Nutrition ; Esophageal Atresia ; Gastroschisis ; Hernia, Umbilical ; Humans ; Infant, Newborn ; Liver Diseases ; Mortality ; Nutritional Support ; Parenteral Nutrition ; Parenteral Nutrition, Total* ; Parturition ; Postoperative Care ; Pulmonary Edema ; Retrospective Studies ; Tracheoesophageal Fistula ; Veins*

A fetal rhabdomyomatous nephroblastoma is considered to be a predominantly monophasic mesenchymal variant of Wilms' tumor, which acts less aggressively than a conventional Wilms' tumor despite its much larger size. Bilaterality of this tumor in a nine month-old girl, however, may negatively affect the overall prognosis. A radical nephrectomy for bulky masses in the left kidney and a partial nephrectomy for right kidney with five small tumor masses was performed at the same time. Two small tumor masses in the upper part of right kidney were left behind because of preserving minimal renal functional capacity. Pathological study revealed a mixed type of nephroblastoma which was composed predominantly of mesenchymal components with fetal rhabdomyomatous differentiation. After post-operative chemotherapy with vincristine, actinomycin D and adriamycin, and radiotherapy(2,130 rad), residual tumor masses became a single tumor 5 cm in diameter and well demarcated, which was resected at 15 months after first operation when the size and renal function of remained right kidney was appropriate to resect out the residual tumor. The tumor resected out at second operation was entirely composed of scattered differentiated fetal skeletal muscle cells in the fibrovascular tissue. Only a few entrapped epithelial components were seen but no blastemal cornponents were present. Follow up abdominal CT and ultrasonographic examinations revealed no evidence of tumor recurrence. The girl has developed normally without disease.

Seventy neonates with congenital intestinal atresia and stenosis who were treated at pediatric surgical service, Hanyang University Hospital from September 1979 to December 1996 were analyzed retrospectively. The lesion occurred in 27 cases at the duodenum, in 26 cases at the jejunum, in 13 cases at the ileum, and in 2 cases at the pylorus and colon each. The atresia predominated over the stenosis by the ratio of 4 : 1. Male to female ratio was 1.3 : 1. The average gestational age was 38 weeks, and the average birth weight was 2,754 grams. Though 22.9% were borne prematurely and 34.3% had low birth weight, 92.3% of them had a weight appropriate for gestational age. The clinical manifestations were bile-stained vomiting (70%), abdominal distention (35.7%), jaundice (37.1%), and delayed passage of meconium (51.4%). Polyhydramnios (40%) was more frequently observed in duodenal and jejunal atresia while microcolon in ileal atresia (58.3%). Weight loss and electrolyte imbalance occurred more frequently in the duodenal stenosis cases because of delayed diagnosis. Twenty (55.6%) of 37 jejunoileal atresia cases had evidence of intrauterine vascular accident : 4 intrauterine intussusception, 3 intrauterine volvulus and 3 strangulated intestine in gastroschisis, and 10 cases of intrauterine peritonitis. There were one or more associated anomalies in 45 patients (64.3%). Preoperatively proximal loop volvulus developed in 3 cases and proximal loop perforation in 5 cases and one case each of distal loop perforation, duodenal perforation and midgut volvulus occurred in the jejunoileal atresia. There were 10 multiple atresia cases and 14 short bowel cases. Overall mortality rate was 20%.
Birth Weight ; Colon ; Constriction, Pathologic* ; Delayed Diagnosis ; Duodenum ; Female ; Gastroschisis ; Gestational Age ; Humans ; Ileum ; Infant, Low Birth Weight ; Infant, Newborn ; Intestinal Atresia* ; Intestinal Volvulus ; Intestines ; Intussusception ; Jaundice ; Jejunum ; Male ; Meconium ; Mortality ; Peritonitis ; Polyhydramnios ; Pylorus ; Retrospective Studies ; Vomiting ; Weight Loss

PURPOSE: This study was performed to be helpful in early diagnosis and treatment of the children with peptic ulcer disease. METHODS: The authors observed 36 children with peptic ulcer disease who had been admitted to Hanyang University Hospital during the 11 year 4 mont period from January 1981 to April 1992 retrospectively. The diagnosis was established in 33.3% by gastric endoscopy, in 25% by upper gastrointestinal barium study, in 11.7% by gastric endoscopy and upper gastrointestinal barium study simultaneously, and in 30% by emergency operation. RESULTS: 1) Age and sex incidence of chidlren with peptic ulcer disease(3 days to 16 years old) showed that males predominated in a proportion of 8:1 and 83.3% were 7 years of age or older. Under the age of 7, the incidence of gastric ulcer was greater than that of duodenal ulcer and above the age of 7 duodenal ulcer was 2.6 times more frequent than gastric ulcer. 2) The chief comlaints on admission were abdominal pain in 17 patients(47%), hematemesis or melena in 15 patients(25%), vomiting in 6 patients(16%). There was a tendency that abdominal pain also increased as the age increased. 3) Most common blood type among 13 patients with duodenal ulcer was Rh+O type(53.8%). 4) Of the 15 children who had gastrointestinal bleeding, 10(43.3% of duodenal ulcer) were doudenal ulcer and 4(33.3% of gastric ulcer) were gastric ulcer. Severe anemia(Hb<7g/dl) was shown in only 5 patients with duodenal ulcer. 5) According to the region of the ulcer, 20(86.9%) of 23 children with doudenal ulcer had ulcers in doudenal bulb and 8(66.7%) of 12 children with gastric ulcer had ulcers in antrum. 6) 18 children with duodenal ulcer, 7 children with gastric ulcer and 1 child with gastroduodenal ulcer had complications. Of the 26 children, bleeding occured in 10 children, perforation occured in 7 children and obstruction occured in one child. 7) 23 children were treated medically and 13 children were treated surgically. 11 patients received operation due to panperit unitis(perforation), 1 patients(71%) were treated medically, however, under 7 year of age, 5 patients(62%) received surgical treatment. Surgical methods used were primary closure(4 patients), vagotomy with pyloroplasty(1 patients), subtotal gastrectomy with gastrojejunostomy(7 patients) and antrectomy with gastroduodenostomy(1 patients). CONCLUSIONS: We conclude that it is important to diagnose early peptic ulcer disease in children, who have nonspecific symptoms and signs above mentioned, to prevent possible complications including failure to thrive.
Abdominal Pain ; Barium ; Child* ; Diagnosis ; Duodenal Ulcer ; Early Diagnosis ; Emergencies ; Endoscopy ; Failure to Thrive ; Gastrectomy ; Hematemesis ; Hemorrhage ; Humans ; Incidence ; Infant* ; Male ; Melena ; Peptic Ulcer* ; Retrospective Studies ; Stomach Ulcer ; Ulcer ; Vagotomy ; Vomiting