The application of laparoscopic techniques for the surgical management of Hirschsprung's disease is the recent trend. We described the surgical technique and postoperative long-term outcomes of the one-stage, laparoscopic-assiseted endorectal pull-through operation for Hirschsprung's disease. The technique uses three to four small abdominal ports. Laparoscopic mobilization of the sigmoid colon and rectum is performed and marginal artery-preserving colon pedicle is prepared. The rectal mobilization is performed using a transanal endorectal sleeve technique. The anastomosis is performed 0.5~1 cm above the dentate line. The age at surgery ranged from 6 days to 4 years. The average operative time was 144 minutes. Almost all of the patients passed stool and flatus within 36 hours of surgery. The average hospital stay after surgery was 6.5 days. Among 42 patients, 32 patients older than 3 years old were evaluated for function on defecation. All 32 patients have been continent, of those who needed laxatives were 11 (34.3%) due to constipation and overflow incontinence. Four children (12.5%) have remained dependent on laxatives. Laparoscopic-assisted endorectal pull-through operation for Hirschsprung's disease appears to be safe, provides the less pain, shorter time to full feeding, shorter hospital stay, and excellent cosmetic outcomes. Helping patients and parents ensure the quality of life, they should be provided with counseling, education, and longer-term follow-up care.
Child ; Colon ; Colon, Sigmoid ; Constipation ; Counseling ; Defecation ; Education ; Flatulence ; Follow-Up Studies ; Hirschsprung Disease* ; Humans ; Laxatives ; Length of Stay ; Operative Time ; Parents ; Quality of Life ; Rectum

Clear cell sarcoma of the kidney(CCSK) is one of the rare malignant renal tumors in childhood and is different from Wilms tumor by its pathologic features, clinical manifestations and propensity to metastasize to the skeletal system and brain. We report a case of CCSK on the right kidney in a 14-month-old girl presented with abdominal distention and palpable huge abdominal mass on physical examination, followed by metastasis to the rib on the left upper thorax. After right nephrectomy, chemotherapy with National Wilms Tumor Study DD regimen(vincristine+dactinomycin+adriamycin) was continued without any evidence of relapse until the last follow-up, 1 year after beginning chemotherapy. A brief review of related literatures was made.
Brain ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Infant ; Kidney* ; Neoplasm Metastasis ; Nephrectomy ; Physical Examination ; Recurrence ; Ribs ; Sarcoma, Clear Cell* ; Thorax ; Wilms Tumor

Among chemical agents in herbicides, dioxin(2,3,7,8-tetrachloro dibenzo-rho-dioxin: a chemical contaminant in herbicides sprayed during the vietnam war has been known to be the major agent causing toxic effects. Approximately 320,000 korean soldiers participated the vietnam war from 1964 to 1974. Although the potential hazards of the herbicides among Korean veterans exposed were implicated, the problem had not been a public issue until 1991 when Korean veterans were informed U. S. companies, the herbicides manufacturer payed fund, from which a trust fund for New Zealand and Australian Class members were established in 1985. After a series of appeals and demonstration by the korean veterans demanding medical care and compensation for their serious health damages, a bill of medical care and compensation for herbicides victims was promulgated in March 1993 and become effective from May 1993. This study was carried out with two major objectives: the first to understand the health problems caused from the herbicides by reviewing literatures published, and the second to examine the nature and extent of health impacts among Korean veterans exposed and to develop valid study methods for the major study by interviewing and reviewing records on a part of veterans (638 persons) registered and completed medical examination in Seoul Veterans Administration Hospital from June to october 1993. The results obtained are as follows: 1. The literature review of 107 papers revealed that: l) Dioxin is teratogenic, carcinogenic and affects almost all organs including nertous, endocrine, and reproductive systems in animal experiments. 2) The diseases showing evidence of causal association were Hodgkin's disease, non-Hodgkin's disease, lung cancer, lymphoma, soft tissue sarcoma, chloroacne and polyneuropathy when judged on the basis of consistency in study results and biological plausibility. 2. Interview and medical record review study on 638 veterans, though limited validity owing to lack of control group, crude estimates of dioxin exposure levels (no biomarkers measurable), and uncertainty of diagnosis, showed that: 1) Most of the study subject's were in their 40's of age and had been dispatched to vietnam during the period from 1965-1970 around one year. 2) Most frequently complained symptoms in medical examination were motor weakness(32%), sensory abnormalities in extremities(23%), skin diseases(22%), and pain in extremities(20%) whereas in interview they were more frequent in order of skin problem(44%), motor weakness (38%), sensory abnormalities and pain in extremities(l7% and 19% each). Kappa indices on the same category of complaints between two sources of information were variable and relatively low. 3) On medical examination, only a part of the 638 subjects had initial impression (442 pts) and final diagnosis (218 pts) suggesting decision making on diagnosis appeared to be difficult even with all available modern medical technologies; in initial impression disorders from peripheral and central neuropathy were predominant whereas in final diagnosis various types of skin disorder were most frequent. 4) when dose-response relationship between several conditions (from questionnaire) and arbitrary exposure scores were examined by CMH linear trend test, spontaneous abortion, sexual problems and health problem of offsprings showed statistically significant linear trends. However, pregnancy, accident and suicidal attempts did not show any relationship in this study capacity. 5) Among complaints, psychosis and neurosis(anxiety, phobia) in interview study, and memory disorder and psychosis in medical record study revealed linear trend. 6) Skin disorder was the only condition showing linear trend in initial impression and none in final diagnosis on medical examination. Even though objective to select out dioxin-related disease or group of diseases from this study was not achieved the research experiences provided firm basis for developing various methodological approaches. 3. From this preliminary study we concluded that a larger scale major epidemiologic study on health impacts of herbicides among Korean veterans exposed is not only indispensible but also well designed study with more valid exposure information and diagnosis may be able to establish causal relationship between certain groups of diseases and exposure to the herbicides among Korean veterans.
Abortion, Spontaneous ; Animal Experimentation ; Biomarkers ; Compensation and Redress ; Decision Making ; Diagnosis ; Epidemiologic Studies* ; Female ; Financial Management ; Herbicides* ; Hodgkin Disease ; Humans ; Lung Diseases ; Lymphoma ; Medical Records ; Memory Disorders ; Military Personnel ; New Zealand ; Polyneuropathies ; Pregnancy ; Psychotic Disorders ; Sarcoma ; Seoul ; Skin ; Uncertainty ; United States Department of Veterans Affairs ; Veterans* ; Vietnam*

No abstract available.
Acne Keloid* ; Acne Vulgaris* ; Humans

BACKGROUND AND OBJECTIVES: Arterial grafts have a better long-term patency rate than saphenous vein (SV) when used in off-pump coronary artery bypass surgery (OPCAB). However, arterial grafts in elderly patients are often diseased. We sought to compare the early outcomes achieved by using the two different types of composite grafts. SUBJECTS AND METHODS: We conducted a randomized trial to compare radial artery (RA) and SV composite grafts based on the in situ left internal mammary artery in 60 elderly (>70 years old) patients, who were scheduled to undergo OPCAB. Clinical outcomes and 1-year postoperative CT angiography results were compared. The quality of the conduit was evaluated by employing vascular ultrasonography, optical coherence tomography (OCT), and histologic examination. RESULTS: No differences in immediate postoperative morbidity and mortality were observed between the two groups. Early postoperative CT angiography revealed a SV patency rate of 100%, which was not different from that of RA composite grafts (99.1%). CT angiography after a year showed an overall patency rate of 96.3%. The overall patency rate of the SV group at 1 year was 94.7%, which was similar to that of the RA group (97.4%). Also, there was no difference in overall survival rate between the two groups. Vascular ultrasonographic images showed strong correlations between OCT and histopathology. CONCLUSION: Our analysis of early outcomes revealed that the SV could be used as an alternative composite graft to the RA in elderly patients. Vascular ultrasonography is an accurate, real-time, and reproducible method for assessing the quality of the RA conduit.
Aged ; Angiography ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Humans ; Mammary Arteries ; Radial Artery ; Saphenous Vein ; Survival Rate ; Tomography, Optical Coherence ; Transplants

BACKGROUND: As the population of immunocompromised patients continues to grow, the incidence of infections caused by opportunistic filamentous fungi will continue to increase. Inhalation of fungal spores which are found in the environmental air precedes infection with molds. We investigated the relative frequency of various molds recovered from hospital air as compared to isolates from clinical specimens. METHODS: Air samples were taken from 83 sites in Chonnam University Hospital during December 1997. Air sampler (Biotest, Germany) with Rose Bengal agar strip (Biotest, Germany) was calibrated to take 40 liters of air. The strips were incubated at 37degrees C for 2-14 days. The results of air cultures were compared with those from the clinical specimens during a year (1997). RESULTS: Of 83 air samples cultured, 61 (73.5%) were positive for molds: 43 (51.8%) samples with 1-2 CFU, 15 (18.1 %) samples with 3-5 CFU, and 3 (3.6%) samples with > 5 CFU. A total of 184 molds were isolated and the most frequently recovered molds were Cladosporium (26.0%), followed by Penicillium (25.5%), Aspergillus (18.5%) and Alternaria (9.8%). The most frequently isolated molds from clinical specimens were Aspergillus (62.8%) and Fusarium (20.2%). For Aspergillus species, A. flavus (28,8%) and A. fumigates (25.4%) were predominant among the clinical isolates, whereas A sydowii (44.1%) and A. niger (38.2%) were common in the hospital air. CONCLUSION: This result shows that Cladosporium and Penicillium are the predominant molds in the hospital air and the relative frequency of molds recovered from hospital air is quite different from those of clinical isolates.
Agar ; Alternaria ; Aspergillus ; Cladosporium ; Fungi* ; Fusarium ; Immunocompromised Host ; Incidence ; Inhalation ; Jeollanam-do ; Niger ; Penicillium ; Rose Bengal ; Spores, Fungal

Eight patients in the state of ASA classification l, ll were investigate. Blood samples were collected before, just after, 30 minutes after and 60 minutes after induction of anesthesia. Glucose and electrolyte changes in relation to maintenance fluids in balanced and halothane anesthesia were as follows. 1) In both anesthetic techniques blood sugar level showed increasing tendency according to duration of anesthesia. 2) There were no specific changes in serum electrolytes related to type of anesthesia. 3) The administration of D/S and H/D showed a little increase in Na+ and Cl- level compared to the administration of just DsW. 4) The administration of H/d showed less increase in K+ level than the administration of DsW or D/S. 5) Just after induction of anesthesia the K+ level increased a little and decreased gradually thereafter.
Anesthesia ; Anesthesia, General* ; Blood Glucose* ; Classification ; Electrolytes* ; Glucose ; Halothane ; Humans

OBJECTIVES: This study aims to find differences that reflect the magnitude of health disparities in wage workers in Korea according to income index(personal income, household income, equivalized income) by gender. METHODS: Data was obtained from the 11th wave of Korean Labor and Income Panel Survey in 2008. This study analyzed 4,205 subjects(2,570 males and 1,635 females) aged 19-65 years. To compare the health effects of each income index by gender, unconditional multiple logistic regression, health-related behaviors, and working conditions were used. The unconditional multiple logistic regression was adjusted by socio-demographic characteristics. All statistics were estimated using SAS survey procedures. RESULTS: According to unconditional multiple logistic regression, significant differences in ORs between men and women were observed in this study for those wage workers who self-rated their health status to be poor. This was consistent between each income index. Men had an OR of 1.76 (95% CI, 1.28~2.43) by personal income, 1.70 (95%CI, 1.25~2.32) by household income and 1.69 (95% CI, 1.23~2.31) by equivalized income. Women had an 2.09 (95% CI, 1.47~2.97) by household income and OR of 1.95 (95% CI, 1.36~2.79) by equivalized income, but personal income did not have a significant effect on OR for women. CONCLUSIONS: The study of occupational and environmental medicine should consider that each income index has different effects on the self-rated health status according to gender. Household income index and equivalized income index would represent a health status for women.
Aged ; Electrolytes ; Environmental Medicine ; Family Characteristics ; Female ; Humans ; Korea ; Logistic Models ; Male ; Phenothiazines ; Salaries and Fringe Benefits ; Socioeconomic Factors

No abstract available.
Humans ; Multiple Myeloma ; Xanthomatosis

OBJECTIVES: To propose a screening dose based on the probability of causation (PC) to simplify the evaluation procedure for the work-relatedness of the cancers occurring among Korean radiation workers. METHODS: Under the PC uncertainty distribution, the screening dose was defined in which the maximum PC is equivalent to 50% for single exposure to radiation, after which the values were calculated according to three significance levels: 90%, 95%, and 99%. By using the screening doses for each cancer, we also predicted the number of compensations for the occupational cancers among the current Korean radiation workers to determine a reasonable criterion for the significance level. RESULTS: If the cumulative dose received by a radiation worker with cancer is less than the screening dose, then PC can not be greater than 50%, i.e., the case can not be awarded as an occupational disease. The numbers of compensation cases for a future decade were predicted to be 3-5, 4-6, and 6-10 at the significance levels of 90%, 95%, and 99%, respectively. CONCLUSIONS: The procedure to evaluate the occupational disease was greatly simplified by using the screening dose for evaluation. A criterion of 95% was recommended as the PC upper limit following consideration for the results of the predicted cases for compensation and the economic circumstances in Korea.
Awards and Prizes ; Compensation and Redress ; Korea ; Mass Screening* ; Occupational Diseases ; Uncertainty ; Workers' Compensation