Nineteen children found to have gallstones at Seoul National University of Children's Hospital from Jun. 1982 to Jun. 1992 were reviewed. The results were as follows: 1) The mean age was 10 years, with 9 boys and 10girls. Most of the cases(63%) were over 10 years of age. 2) Clinical manifestations were abdominal pain(14 cases), nausea and/or vomiting (5 cases), fever (2 cases), jaundice (2 cases) and fatty food intolerance (1 case). Five cases were asymptomatic. Of 14 cases with abdominal pain, only 5 cases showed typical biliary colic which suggests cholelithiasis. 3) Associated conditions in cholelithiasis were Wilson disease (5 cases), congenital hereditary spherocytosis (2 cases), choledochal cyst (2 cases), total parenteral nutrition following ileal resection (1 case). And the other conditions which had association with cholelithiasis are not certain, and they were nephrotic syndrome, histiocytic cytophathic panniculitis, meningococcal meningitis, portal vein thrombosis and cardiac cirrhosis. The remaining 4 cases showed no associated conditions or diseases. 4) Eleven of 19 patients with cholelithiasis (58%) showed cholecystitis. 5) Cholecystectomy was performed in 4 cases with frequently recurred abdominal pain or associated diseases which needed operative correction. Symptoms completely subsided after operation. In conclusion, cholelithiasis in children has a variety of associated conditions and nonspecific abdominal symptoms were nore common than classic biliary colic. Although cholelithiasis in pediatric population are uncommon problems, the possibility of gallstones should be considered in the evaluation of abdominal pain in children with associated conditions.
Abdominal Pain ; Child ; Cholecystectomy ; Cholecystitis ; Choledochal Cyst ; Cholelithiasis* ; Colic ; Fever ; Fibrosis ; Gallstones ; Hepatolenticular Degeneration ; Humans ; Jaundice ; Meningitis, Meningococcal ; Nausea ; Nephrotic Syndrome ; Panniculitis ; Parenteral Nutrition, Total ; Seoul ; Venous Thrombosis ; Vomiting

Fifty five children with endoscopically proven esophageal varices from Jul. 1987 to Dec. 1992 were analyzed for endoscopic and clinical characteristics. The results were as follows: 1) According to etiological classification of portal hypertension in 55 cases, 35 cases showed intrahepatic causes 964%) and 20 cases had extrahepatic causes (36%). The most common clinical manifestation on admission was hematemesis (42%) and abdominal mass (36%). 2) Portal vein thrombosis was the most common cause of portal hypertension. Patients with portal vein thrombosis showed more frequent bleeding than with intrahepatic portal hypertension. Most of them had the first bleeding episode before 7 years old of age. Progression of portal hypertension in portal vein thrombosis was more rapid and bleeding episode was earlier than that in most of intrahepatic causes of the portal hypertension. 3) Twenty patients showed gastritis (10 cases), duodenitis (4 cases), gastric ulcer (4 cases) and esophagitis (2 cases) besides varix on the endoscopic examination. In 4 cases, the cause of upper GI bleeding was found as duodenal ulcer (3 cases) or hemorrhagic errosive gastritis (1 case) with no variceal bleeding. 4) Among 36 cases with variceal bleeding, 20 cases had predisposing factors for bleeding such as medication for URI including Aspirin. 5) More than one episode of bleeding were noted in 36 cases (65%) of the patients with varix. Thirty-one cases were treated conservatively with success. The remaining 5 cases with severe bleeding were managed with IV pitressin, SB-tube insertion and emergency shunt operation. High mortality rate (40%) was found in these patients group. In conclusion, in patients with clinically suspected portal hypertension, regular endoscopic examination might be recommended for the earlier recognition and effective prevention of variceal bleeding. for bleeding varices, in addition to conservative management, active treatment such as pitressin, SB-tube, sclerotherapy, endoscopic variceal ligation and emergency shunt operation should be considered with the emergency endoscopy which can identify bleeding focus and predict the chance of rebleeding.
Aspirin ; Causality ; Child* ; Classification ; Duodenal Ulcer ; Duodenitis ; Emergencies ; Endoscopy ; Esophageal and Gastric Varices* ; Esophagitis ; Gastritis ; Hematemesis ; Hemorrhage ; Humans ; Hypertension, Portal ; Ligation ; Mortality ; Sclerotherapy ; Stomach Ulcer ; Varicose Veins ; Vasopressins ; Venous Thrombosis

BACKGROUND: Congenital bronchoesophageal fistula(BEF) presented in adult life is a rare disorder and has characteristic clinical findings such as paroxysmal cough after water ingestion and recurrent respiratory infections. It usually manifested recurrent pneumonia and chronic cough with purulent phlegmon which was mis-or under-diagnosed as chronic bronchitis, bronchiectesis or lung abscess so forth. METHODS: We reviewed retrospectively 13 cases of congenital BEE in adult of Paik Hospital, College of Medicine, Inje University including 22 cases of congenital BEE previously reported in literature of Korea from 1979 through 1995. RESULTS: The mean age at diagnosis was 40.2 +/- 14.3. There was no difference in sex ratio(Male: Female 18 : 17). The mast common symptom was cough(91.4%), follwed by chronic sputum(74.3), hemoptysis(25.7), and paroxysmal nocturnal cough at specific position(20%). Twenty one of 31 patients who were able to review have the most specific sign, Ono's sign presented as paroxysmal cough after liquid ingestion. By classification of Braimbridge-Keith, Fourteen(45.1%) of 31 patients were group I (associated with esophageal diverticulum), 15(48.4%) were group II (simple fistula), and group III arid IV was one case in each. The opening of fistula confined to right lower lobe in 26(76.5%), left lower lobe in 6(176%), arid left main bronchus in 2(5.9%) cases. CONCLUSION: Congenital bronchoesophageal fistula is uncommon disorder which has characteristic histories and specific symptoms such as chronic and recurrent lower respiratory infections, and paroxysmal cough after liquid ingestion. Medical attention and careful history should be done in patients who have localized recurrent lower respiratory infections in right lower lobe.
Adult* ; Bees ; Bronchi ; Bronchitis, Chronic ; Cellulitis ; Classification ; Cough ; Diagnosis ; Eating ; Female ; Fistula* ; Humans ; Korea* ; Lung Abscess ; Pneumonia ; Respiratory Tract Infections ; Retrospective Studies

No abstract available.
Choledochostomy*

No abstract available.
Nephrotic Syndrome* ; T-Lymphocyte Subsets* ; T-Lymphocytes*

To determine the types of metabolic a cidosis using anion gap in acute infantile diarrhea and to correlate it with clinical outcome, we examined 103 infants admitted with acute diarrhea. The serum electrolytes (sodium, potassium, chloride, phosphorus), creatinine, CO2 content and anion gap were measued on first admission day. They were classified group A with normal anion gap (8~16mEq/L) and group B with increased anion gap (>16mEq/L). The results were as follows. 1) The number of group A with normal anion gap (11.6+/-3.3mEq/L) was 62 and the number of group B with incresed anion gap(21.1+/-5.5mEq/L) was 38. 2) The duration of diarrhea was significantly prolonged in group B (9.0+/-2.5 days), compared with group A (5.9+/-1.1 days)(p<0.001). 3) The duration of admission was significantly prolonged in group B(5.6+/-2.2 days), compared with group A (4.+/-01.4days)(p<0.001). 4) Infants in group B, compared with group A, were significantly more severe dehydrated (p.
Acid-Base Equilibrium ; Acidosis* ; Creatinine ; Diarrhea ; Diarrhea, Infantile* ; Electrolytes ; Humans ; Infant ; Potassium

The purpose of this study was to compare the accuracy of currently used elastomeric impression materials for complete arch impression taking. Five elastomers (Impregum, Permlastic, Express, Extrude, Examix) and one Irreversible hydrocolloid (Aroma-fine) were tested. For each material, 5 impressions were made of stainless steel model to which five tapered posts were attached. Custom trays were used for polyether and polysulfide impression materials, and putty/wash two step technique was used for addition polyvinylsiloxane impression materials. Improved stone models were poured to all impressions. Accuracy of the materials was assessed by measuring ten distances on stone dies poured from impressions of the master model. All measurements for master and improved stone models were with three dimensional measuring machine. The results were as follows 1. The dimensional accuracy of polyether, extrude, and examix were significantly superior to polysulfide, exress, and alginate in reproducing full arch mode (p<0.05). 2. There were no statistical differences in dimensional accuracy for full arch impression between polyether, extrude and examix (p>0.05). 3. there were no statistical differences in dimensional accuracy between polysulfide, express, and alginate (p>0.05). 4. There were no statistical differences between addition polyvinyl siloxane materials (p>0.05). 5. There were no statistical differences between anterior-posterior and lateral dimensional changes of all impression materials (p>0.05).
Colloids ; Elastomers* ; Polyvinyls ; Siloxanes ; Stainless Steel

Lumbar hernias are rare posterolateral abdominal wall defects that may be congenital or acquired. There are two types of lumbar hernia, the superior lumbar hernia through Grynfeltt triangle, and the inferior lumbar hernia through Petit triangle. Many techniques have been described for the surgical repair of lumbar hernias including primary repair, local tissue flaps, and conventional mesh repair. But these open techniques require a large skin incision. We report a case of superior lumbar hernia, which was successfully repaired using a laparoscopic approach.
Abdominal Wall ; Hernia ; Skin

No abstract available.

communicable diseases. The purposes of the study is to estimate reporting proportion of National Notifiable Infectious Diseases(NNIDs) and investigate characteristics related to reporting using KAP(knowledge, attitude, practice) model. METHOD: We surveyed randomly selected 2,185 physicians (speciality: internal medicine, family medicine, pediatrics, dermatology, general physicians) of their knowledge, attitude, and practice of NNIDs reporting through self-administered mail questionnaires. Of them, 231 physicians responded (response proportion: 10.6%). RESULT: The reporting proportion was estimated to 27.0%. Recognition level (knowledge) of NNIDs was relatively high with proportion of 69.4%, and attitude (public health importance) of reporting was 65.8%. Multiple logistic regression analysis showed that knowledge, attitude significantly affected physicians' reporting in a positive direction (O.R. 6.2, 6.2 respectively). Whereas, senior age group, specialty (family medicine, pediatrics, dermatology) showed significantly lower reporting. General (tertiary care) hospital level of care showed significantly higher reporting practice (alpha=0.05). CONCLUSION: The NNIDs reporting proportion, 27.0% is similar with those studied recently. Continuous efforts to increase the performance level of communicable diseases surveillance system. Of those, restructuring surveillance systems considering characteristics of notifiable diseases classes must be stressed. Educational approach of physicians needs to be tailored specially to newly-designated diseases such as Group II, Designated Group NNIDs.
Communicable Diseases* ; Dermatology ; Humans ; Internal Medicine ; Logistic Models ; Pediatrics ; Postal Service ; Surveys and Questionnaires