A clinical review was made on 2,191 cases of general pediatric surgery under the age of 15 years which were operated upon at the Divisionof Pediatric Surgery, Department of Surgery, Chonnam University Hospital from January 1988 to December 1997. The number of operations in pediatric age were 13,144 (13.2%) out of total 99,555 operations at Chonnam University Hospital and the most prevalent age group was under 1 year of age (14.3%). The number of operations in Divisionof General Pediatric Surgery were 2,191 (16.7%) out of total 13,144 operations in pediatric age and the incidence of patients under 1 year of age in general pediatric surgery was 42.9% (941/2,191). The prevalent diseases under 1 month of age were anorectal malformations (20.6%) and hypertrophic pyloric stenosis (20.3%) and between 1 month to 1 year of age were inguinal hernia (32.4%) and intussusception (19.6%). The total motality rate in neonatal intensive care unit was 31.3%. Gastroschisis presented highest mortality.
Gastroschisis ; Hernia, Inguinal ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Intussusception ; Jeollanam-do ; Mortality ; Pyloric Stenosis, Hypertrophic

No abstract available.
Humans ; Infant, Newborn* ; Mothers* ; Thrombocytopenia

BACKGROUND: Although enriched broth cultures have been recommended as an adjuvant to the direct plating of tissue and body fluid specimens, the cost-effectiveness of broth cultures has been questioned in regard with the clinical significance of "broth only isolates(BOI)". The purpose of this study was to investigate the usefulness of thioglycollate broth(THIO) cultures. METHODS: We reviewed retrospectively results in the culture specimens of body fluids, tissue biopsies, and puses received during the month of July 1997. All specimens were inoculated into THIO in addition to agar plates. We reviewed the medical records of culture-positive patients to determine the clinical significance and relevance of their isolates. Clinically significant isolates were defined as those for which an appropriate antimicrobial therapy was done except one judged as contaminants by clinicians and clinically relevant isolates as the clinically significant one isolated first. RESULT: Of 2,008 specimens, 512(25.4%) from 365 patients grow 561 isolates 464 plate isolates and 97 BOI. Two hundred eighty nine(62.3%) of the 464 isolates from plate cultures were clinically significant, compared to only 12(12.4%) of 97 BOI (P<0.05). Only four (4.1%) BOI were clinically relevant, including one Pseudomonas aerugiosa from ascites. one Klebsiella pneumoniae and two Staphylococcus aureus from tissue specimens. CONCLUSION: A routine use of enriched broth culture rarely recover clinically relevant isolates. Considering the laboratory and medical costs of the recovery of contaminants and clinically irrelevant isolates, the enrichment broth cultures should be used more selectively.
Agar ; Ascites ; Biopsy ; Body Fluids ; Humans ; Klebsiella pneumoniae ; Medical Records ; Pseudomonas ; Retrospective Studies ; Staphylococcus aureus

PURPOSE: This study evaluated the correlation between expression level of CD44, bcl-2 and PCNA and the extent of apoptosis in a neuroblastoma according to the Shimada histology. METHODS: Using the neuroblastoma tissue, which was kept at the Chonnam National University Hospital, this study investigated the effect of the CD44, bcl-2, proliferating cell nuclear antigen(PCNA) expression levels and apoptosis according to the Shimada histology. RESULTS: There was significant correlation between the Shimada histology and the CD44 expression level (P= 0.004). There was also a correlation between the Shimada histology and the PCNA expression level (P=0.004). The correlations between the PCNA and CD44 expression levels showed a negative correlation (P<0.01). There was also a significant correlation between the occurrence of apoptosis and the bcl-2 expression level. CONCLUSION: The CD44 and PCNA expression level and the Shimada histology were correlated. Therefore, the Shimada histology, as well as the CD44, and PCNA expression levels are prognostic factors in neuroblastoma. However, a further multicenter study is recommended in order to demonstrate the value of using the Shimada histology, along with the CD44, and PCNA level as prognostic factors in neuroblastoma.
Apoptosis* ; Jeollanam-do ; Neuroblastoma* ; Proliferating Cell Nuclear Antigen*

No abstract available.
Vasculitis*

PURPOSE: In patients with small or large aneurysms, the decision for surgical treatment is not so simple. The mortality of ruptured abdominal aortic aneurysm (AAA) is high. This study was designed to retrospectively analyse the clinical characteristics of patients with AAA. METHODS: Ninety-one cases of AAA were surgically treated between January 1991 and January 2003 at the Department of Surgery, Chonnam National University Hospital. Patients were divided into 49 elective cases and 42 emergency cases, and retrospective analysed on the basis of age, sex, chief complaints, physical examination, associated diseases, size of aneurysm, diagnostic modalities, operative mortality and causes of death. RESULTS: The initial presentations were mainly palpable masses in the elective cases. On the other hand, in the emergency cases which were ruptured, many patients complained of abdominal or back pain. There was a positive relationship between the size of AAA and the incidence of the rupture in our study, especially in the case of transverse diameters above 10 cm (P<0.001). There was no death in the elective cases, but there were 22 surgical mortalities in the 42 emergency cases (52.3%, P<0.001). Overall surgical mortality was 24.1%. The causes of death were intraoperative and postoperative bleeding (11), myocardial infarction (5), acute renal failure (4), and sepsis (2). CONCLUSION: Surgical mortality in ruptured AAA was high. Consequently, surgical intervention is recommended and the operation must be performed. In that way we can reduce the operative mortality and improve the treatment outcome.
Acute Kidney Injury ; Aneurysm ; Aortic Aneurysm, Abdominal* ; Back Pain ; Cause of Death ; Emergencies ; Hand ; Hemorrhage ; Humans ; Incidence ; Jeollanam-do ; Mortality ; Myocardial Infarction ; Physical Examination ; Retrospective Studies ; Rupture ; Sepsis ; Treatment Outcome

BACKGROUND: Recently Escherichia coli isolates with extended-spectrum beta-lactamase(ESBL) have been increased in Korea. ESBLs confer variable levels of resistance to cefotaxime, ceftazidime and other broad-spectrum cephalosporins as well as to monobactams such as aztreonam, but they have no detectable activity against cephamycins and carbapenems. The aim of this study was to characterize the ESBL produced by E. coli strains isolated from clinical specimens. METHODS: From March to July, 1998, a total of 93 clinical isolates of E. coli, which was produced ESBL, were collected from patients of the Asan Medical Center. The isolates flagged as ESBL producers by microbroth dilution antibiotic susceptibility test were confirmed by the double disk synergy test. Minimal inhibitory concentration(MIC) of beta-lactams were determined by agar dilution method. The presence of TEM, SHV or CMY-1 gene was determined by polymerase chain reaction. The types of beta-lactamase gene were determined by isoelectric focusing and nucleotide sequence analysis. RESULTS: Sixty-two strains carried plasmid-mediated TEM-52 gene, which sequence showed the substitution of 3 amino acids compared to that of TEM-1. Seventeen strains produced SHV-12, six strains produced SHV-2a, three strains produced TEM-52 and SHV-12, three strains produced TEM-52 and SHV-2a, and one strain produced SHV-2a and SHV-12. One out of twenty-seven strains of cefoxitin-resistant E. coli was confirmed to have CMY-1 beta-lactamase by PCR and nucleotide sequence analysis. CONCLUSIONS: TEM-52 was the most prevalent in E. coli isolates. The most common SHV-types of ESBL in Korea are SHV-12 and SHV-2a in E. coli isolates. In Korea, widespread use of oxyimino-cephalosporins in the hospitals has dramatically increased the prevalence of ESBL-producers in E. coli. Therefore, more prudent use of antibiotics is necessary to reduce the spread of these resistant organisms.
Agar ; Amino Acids ; Anti-Bacterial Agents ; Aztreonam ; Base Sequence ; beta-Lactamases* ; beta-Lactams ; Carbapenems ; Cefotaxime ; Ceftazidime ; Cephalosporins ; Cephamycins ; Chungcheongnam-do ; Escherichia coli* ; Escherichia* ; Humans ; Isoelectric Focusing ; Korea ; Monobactams ; Polymerase Chain Reaction ; Prevalence

PURPOSE: To investigate the trend of refractive change in hyperopic patients according to increases in age. METHODS: Eighty-eight children who had hyperopia of more than +1.50 diopters (D) and could be followed up for at least 5 years were included in this study. We divided the patients into two groups according to the level of initial hyperopia and retrospectively analyzed hyperopic refractive changes over a 5-year period according to age at initial diagnosis, presence of esotropia, amblyopia, astigmatism and anisometropia. RESULTS: We gained the following formula about the aspect of hyperopic reduction in 88 patients over a period of 5 years: Diopter (D)=7.99-2.14 Ln (age). The presence of anisometropia and amblyopia did not affect hyperopic reduction. Hyperopic reduction amounts in the group with a hyperopic eye of more than +5D at initial diagnosis were greater than in the group with a hyperopic eye less than +5D, and greater in the group with an astigmatic eye of more than 1D. The presence of esotropia and the age at initial diagnosis did not affect hyperopic reduction. CONCLUSIONS: We show that emmetropization in hyperopic children occurs according to the following formula: Diopter (D)=7.99-2.14 Ln (age). Both the initial level of hyperopia and the concurrent presence of astigmatism affected hyperopic reduction. However, the presence of anisometropia, amblyopia, esotropia and the age at initial diagnosis did not significantly affect hyperopic reduction.
Amblyopia ; Anisometropia ; Astigmatism ; Child ; Diagnosis ; Esotropia ; Follow-Up Studies* ; Humans ; Hyperopia ; Retrospective Studies

We did clinical analysis on the macular circulatory state in 34 patients(34 eyes)who were diagnosed to have branch retinal vein occlusion and followed for over 6 months. After dividing them into two groups according to their occlusion sites, we evaluated the differences of foveal capillary ring state and size of macular ischemic area between the ones who had vein occlusion in their first retinal branches and the others in their second and the rest retinal branches. We were unable to find any differences between them. However, we could find statistical correlation between their visual acuities in acute stage of the disease and macular circulatory states even though we could not find any differences between their final visual acuities or degree of their visual improvement and circulatory states during follow up period.
Capillaries ; Follow-Up Studies ; Retinal Vein Occlusion ; Retinaldehyde ; Veins ; Visual Acuity

Conjoined twins are one of the rarest and most challenging congenital anomalies in pediatric surgery. Successful surgical separation is more unusual, since the majority of conjoined twins are incapable of separating successfully. The timing of separation is variable, but separation is usually delayed until such infants are relatively mature (i.e, 9-12 months of age). Operative survival was 50% in those operated on in the neonatal period, but 90% in those of over 4 months of age. Our case was early separated beacase of one of the twins having heart problems. These twins were omphalopagus and shared only simple liver bridge without vascular and biliary communications. Surgical separation was undertaken successfully on the 11th day of life, so we describe our experience with the review of the relevant literatures.
Heart ; Humans ; Infant ; Liver ; Twins, Conjoined*