It has been widely accepted that complete surgical resection of hepatoblastoma is essential for long-term survival. But unfortunately less that 50% of hepatic tumors in children can be totally removed at the time of diagnosis. This report is to present the experience of successful resection of hepatoblastoma after concurrent radiotherapy with transarterial chemoinfusion in a child. We believe this modality of treatment enables complete resection of unresectable hepatoblastoma, which is resistant to the systemic chemotherapy.
Child ; Diagnosis ; Drug Therapy ; Hepatoblastoma* ; Humans ; Radiotherapy*

The potential acuity meter(PAM) has been reported to be a useful instrument for predicting postoperative visual acuity after cataract extraction surgery. Forty nine eyes were tested with PAM before surgery, and the best postopertive visual acuity was obtained. The PAM accurately predicted the postoperative visual acuity to within three lines in 90.0% of the cases. When the test is in error, the tendency is for the PAM to underestimate the final acuity rather than to overestimate. Especially under undilated pupil, in dense cataracts (<20/200),and,in posterior subcapsular and cortical cataracts, the PAM tends to underestimate further.
Cataract Extraction ; Cataract* ; Pupil ; Visual Acuity*

PURPOSE: The megacolon after repairing an anorectal malformation is not a rare complication, and there is much controversiy on the causes, the treatment of choice and the results after a longterm follow-up. We present 5 cases of a megacolon after the repair of an anorectal malformation, which were controlled with either a surgical resection or conservative treatment. METHODS: Five patients with a megacolon after the repair of an anorectal malformation were studied. A retrospective chart review was done and fecal continence was evaluated with an individual interview. RESULTS: All five patients initially underwent conservative treatment with laxatives and/or enemas. One Patient responded well to conservative treatment and the diameter of the bowel reduced to normal size. Another patient responded to conservative treatment after correcting the location of the anus. Three patients needed a surgical resection and one of those needed a further procedure to correct the anal location. After the surgical resection of the megacolon and/or correction of the anus (one out of the three patients), they soon reported an almost normal bowel habit. CONCLUSION: The first step in treating a megacolon after repairing an anorectal malformation was conservative treatment. However patients without an adequate response to conservative treatment are best managed with a surgical resection. The cause of the megacolon is now under investigation and the lack of adequate management after repair is one of the subjects.
Anal Canal ; Enema ; Follow-Up Studies ; Humans ; Laxatives ; Megacolon* ; Retrospective Studies

PURPOSE: In order to evaluate the hypoxia-ischemia(H-I) induced neurotoxicity and the protective effect of xanthine oxidase(XO) inhibitor(allopurinol), cell number, cell viability, lactate dehydrogenase(LDH), protein synthesis(PS) and protein kinase C(PKC) activity were measured in cerebral neurons and astrocytes. METHODS: Cytotoxic effect was measured by in vitro assay at 12-72 hours after H-I on cerebral neurons and astrocytes derived from 7-day old neonatal rats which were subjected to unilateral common carotid artery occlusion and exposed to hypoxic condition for 3 hours. The protective effect of XO inhibitor was examined by the cell number, cell viability, LDH and PS on 14 days after H-I with allopurinol intraperitoneal injection 15 minutes prior to H-I. In addition, the effect of allopurinol on PKC activity in hypoxic conditions was examined in neurons. RESULTS: 72 hours from H-I, the cell numbers and viability were decreased significantly in time- dependent manner on neurons and those of astrocytes also decreased slightly, compared with control. In neonatal rats treated with H-I, the cell number, cell viability, and PS in neurons were decreased, but LDH was increased significantly compared with control. In neonatal rats pretreated with allopurinol, the cell number and viability, and PS in neurons were increased and LDH was decreased significantly compared with H-I. PKC was increased remarkably after hypoxic condition. But PKC was decreased significantly against hypoxic condition after allopurinol pretreatment. CONCLUSION: From these results, it is suggested that H-I is more toxic in neurons than astrocytes and allopurinol is very protective with increasing of PS, and decreasing of LDH and PKC in neurons from hypoxic-ischemic condition.
Allopurinol ; Animals ; Astrocytes ; Carotid Artery, Common ; Cell Count ; Cell Survival ; Hypoxia-Ischemia, Brain* ; Injections, Intraperitoneal ; Lactic Acid ; Neurons ; Protein Kinases ; Rats* ; Xanthine Oxidase* ; Xanthine*

To evaluate the differences between current and past surgical treatment of intussusception, the medical records of 48 intussusception patients who underwent surgical treatment over 4 years (1975-1978, Group A) were reviewed and compared to the medical records of 75 intussusception patients who underwent surgical treatment over 4 years (1995-1998, Group B). Sex ratio is male predominant in both group (2.7:1 vs 1.6:1) and mean age of operation is 6.7+/-5.0 month (Group A) and 8.1+/-7.0 month (Group B). Major symptoms and signs of both groups are vomiting, hematochezia and irritability. White blood cell count of peripheral blood in both groups had no significant difference (12,417+/-4,446/mm3 vs 12,297+/-4,531/mm3). In operation methods, group A had significantly higher bowel resection rate over group B (31.3% vs 14.7%, p<0.05). In group A, 2 patients were died after operation, but group B have no operative mortality. Admission period after operation is significantly short in Group B (7.5+/-2.7 day vs 5.4+/-2.1 day, p<0.01). These results suggest there were no significant difference in characters of patients between Group A and B. But surgical treatment of intussusception in 1990s was more conservative than that in 1970s. We expect that recent surgical treatment lead early recovery from operation and early discharge from hospital.
Gastrointestinal Hemorrhage ; Humans ; Intussusception* ; Leukocyte Count ; Male ; Medical Records ; Mortality ; Sex Ratio ; Vomiting

PURPOSE: The aim of this study was to evaluate the clinicopathologic characteristics and the results of surgical treatment for alveolar soft part sarcoma (ASPS). METHODS: The clinicopathologic characteristics and surgical treatment results were analyzed retrospectively by reviewing the medical records of 11 patients and interviewing them. Overall survival (OS) was calculated using the Kaplan-Meier method. RESULTS: Of the 11 patients, 5 men and 6 women, the median age at diagnosis was 27 years and the mean tumor diameter was 6.0+/-1.9 cm. Six patients without distant metastasis at the time of diagnosis were treated with radical resection, and the other 5 with distant metastasis underwent palliative surgery or biopsy only, followed by chemo-radiation therapy. The onset of distant metastasis (40.0+/-13.5 months) was similar to the onset of local recurrence (43.3+/-22.4 months) after a radical operation. The most common site of metastasis was the lung, followed by the brain and bone. The median survival was 52 months and the 5-year OS was 27.2%. The 2-year OS in stage IV disease was 27.7%. The 5-year OS and the disease free survival among the patients with localized disease were 53.3% and 0%, respectively (P=0.043). CONCLUSION: Complete resection is the primary therapeutic option for ASPS. Close, long-term follow-up is recommended in order to detect recurrence, particularly in the lung, bone and brain. Long term survival can be achieved with aggressive surgery for local recurrence and even distant metastasis.
Biopsy ; Brain ; Diagnosis ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Lung ; Male ; Medical Records ; Neoplasm Metastasis ; Palliative Care ; Recurrence ; Retrospective Studies ; Sarcoma, Alveolar Soft Part* ; Viperidae

The prognostic factors for extrahepatic biliary atresia (EHBA) after Kasai portoenterostomy include the patient's age at portoenterostomy (age), size of bile duct in theporta hepatis (size), clearance of jaundice after operation (clearance) and the surgeon's experience. The aim of this study is to examine the most significant prognostic factor of EHBA after Kasai portoenterostomy. This retrospective study was done in 51 cases of EHBA that received Kasai portoenterostomy by one pediatric surgeon. For the statistical analysis, Kaplan-Meier method, Logrank test and Cox regression test were used. A p value of less than 0.05 was considered to be significant. Fifteen patients were regarded as dead in this study, including nine cases of liver transplantation. There was no significant difference of survival to age. The age is also not a significant risk factor for survival in this study (Cox Regression test; p = 0.63). There was no significant difference in survival in relation to the size of bile duct. However, bile duct size was a significant risk factor for survival (Cox Regression test; p = 0.002). There was a significant difference in relation to survival and clearance (Kaplan-Meier method; p = 0.02). The clearing was also a significant risk factor for survival (Cox Regression test; p = 0.001). The clearance of jaundice is the most significant prognostic factor of EHBA after Kasai portoenterostomy.
Bile Ducts ; Biliary Atresia* ; Humans ; Jaundice ; Kaplan-Meier Estimate ; Liver Transplantation ; Prognosis ; Retrospective Studies ; Risk Factors

Pseudoaneurysm of splenic artery may arise from a vascular erosion by the inflammatory processes around the splenic artery, particularly in acute pancreatitis and chronic pancreatitis, which may cause rupture of pseudoaneurysm and life threatening hemorrhage. Collective experience with this massive hemorrhage is attended by a high mortality rate even with prompt therapy, and conservative management is associated with an almost 100 per cent of mortality rate. Identification of the bleeding site at laparotomy may be exceedingly difficult, which makes the preoperative detection of bleeding source desirable. Peripancreatic vascular lesions can be identified by angiography, and in selected cases the risk of urgent operation to control massive hemorrhage may be obviated by embolization. The authors have recently experienced a case of ruptured splenic artery pseudoaneurysm combined with a pancreatic pseudocyst in a 6 years old boy. A bolus enhanced CT scan and angiography were essential to confirm these complications of pancreatic pseudocyst. We managed this child successfully with an urgent procedure of transcatheter arterial embolization and another elective surgery of pancreatic pseudocyst.
Aneurysm, False* ; Angiography ; Child* ; Hemorrhage ; Humans ; Laparotomy ; Male ; Mortality ; Pancreatic Pseudocyst ; Pancreatitis ; Pancreatitis, Chronic ; Rupture ; Splenic Artery* ; Tomography, X-Ray Computed

Chin ; Discrimination (Psychology) ; Genioplasty ; Humans ; Hypesthesia ; Lip ; Mandibular Nerve ; Mandibular Osteotomy ; Nociception ; Sensation

PURPOSE: Wilms' tumor is the most common malignant tumor of the kidney during the childhood period. This is a potentially curable disease with an excellent prognosis due to the development of the multimodal treatments, including chemotherapy, radiotherapy and nephrectomy. The aim of this study was 1) to analyze our clinical experiences with of Wilms' tumor at a single tertiary medical center, including the survival rate and recurrence of disease after treatment and 2) to investigate the prognostic factors affecting the survival of patients. METHODS: We performed retrospective analysis of the clinicopathologic data of 68 patients who underwent operation for Wilms' tumor during 20 years from March 1986 to March 2005 at Yonsei Medical Center. RESULTS: 40 (58.8%) patients were male and 28 patients (41.2%) were female. The median age at diagnosis was 25 month (range: 2 month to~10 year 10 month). Preoperative neoadjuvant chemotherapy was given in 27 patients (39.7%), and initial nephrectomy followed by chemotherapy was performed in 41 patients (60.3%). Postoperative adjuvant radiotherapy was performed in 27 patients (39.7%). The median duration of follow-up period was 8 year 2 month (range: 24 day to~18 year 6 month). The overall 5-year survival rate and 5-year disease free survival rate were 87.0% and 76.9%, respectively. Univariate analysis showed that the significant prognostic factors affecting survival were age at diagnosis (P=0.016), pathologic stage (P=0.032) and, Tumor spillage or rupture during operation (P=0.005) and tumor cell anaplasia (P=0.031). Multivariate analysis showed that tumor spillage or rupture during operation was the most significant prognostic factor (Relative Risk=4.5). CONCLUSION: Early diagnosis, meticulous surgical technique and proper pre-or postoperative adjuvant chemotherapy and radiotherapy according to the tumor histology significantly increase the patient's survival rates.
Anaplasia ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Early Diagnosis ; Female ; Follow-Up Studies* ; Humans ; Kidney ; Male ; Multivariate Analysis ; Nephrectomy ; Prognosis ; Radiotherapy ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Rupture ; Survival Rate ; Wilms Tumor*