No abstract available.
Humans ; Infant, Newborn* ; Neurologic Examination*

PURPOSE: This study aimed to assess the long-term clinical outcome of laparoscopic Nissen fundoplication (LNF) in children according to their neurologic status. METHODS: The study retrospectively analyzed the data of 82 children (62 neurologically impaired and 20 neurologically normal children with primary gastroesophageal reflux disease) who had undergone LNF between 2003 and 2012. The main outcome measures were the occurrence of recurrence that required reoperation and post-procedure complications such as infections, pneumonia, and gastrointestinal complications including ileus, dysphagia, and delayed gastric emptying. RESULTS: The median age at the time of the LNF was 25 months (range, 1-192 months), and the median of body weight was 10.0 kg (range, 2.8-37.0 kg). The average weight gain was 1.55±1.68 kg at 6 months, 3.32±2.30 kg at 1 year, and 5.63±4.22 kg at 2 years after surgery. Six (9.7%) of the 62 neurologically impaired patients and two (10.0%) of neurologically normal lost their body weight or had no weight changes. Eight (12.9%) of the 62 neurologically impaired children had required redo surgery because of gastroesophageal reflux disease recurrences, while 2 (10.0%) of the 20 neurologically normal children had experienced recurrences. In the neurologically impaired children, the postoperative complications included pneumonia (n=1), wound infection (n=1), urinary tract infection (n=1), dysphagia (n=1), delayed gastric emptying (n=1), and ileus (n=2). All of these complications were not found in the neurologically normal group, except for only one case of infectious colitis. However, there was no statistically significant difference between the two groups in postoperative complications. CONCLUSION: The outcomes of laparoscopic fundoplication were similar in the neurologically impaired children and in the neurologically normal children.
Body Weight ; Child* ; Colitis ; Deglutition Disorders ; Fundoplication* ; Gastric Emptying ; Gastroesophageal Reflux ; Humans ; Ileus ; Laparoscopy ; Neurologic Manifestations ; Outcome Assessment (Health Care) ; Pneumonia ; Postoperative Complications ; Recurrence ; Reoperation ; Retrospective Studies ; Urinary Tract Infections ; Weight Gain ; Wound Infection

PURPOSE: The single stage transanal pull-through (SSPT) for Hirschsprung’s disease is becoming the most popular procedure. This single center study compared the result of single stage operation with two-stage operation for Hirschsprung’s disease in neonates. METHODS: We retrospectively reviewed medical records of all patients who were diagnosed as Hirschsprung’s disease and underwent SSPT or two-stage operation operation in Asan Medical Center between January 2003 and July 2014. RESULTS: There were 17 SSPT and 28 two-stage operation. The mean age of SSPT group was 14.2±7.1 days, and the mean age of two-stage operation group was 15.4±8.6 days for stomy formation, and 188.6±36.3 days for Duhamel operation. The operation time of SSPT was shorter than Duhamel operation (145.0±37.0 minutes vs. 193.0±36.0 minutes, p<0.001). The mean follow-up period of SSPT and two-stage operation was 35.5±34.9 months (range, 2-132 months) and 56.6±35.5 months (range, 1-121 months), respectively. Defecation problem rate such as fecal soiling or fecal impaction showed no significant difference between the two groups (p=0.719). Two SSPT patients required botulinum toxin injection due to rectal stenosis. Three patients of SSPT group underwent re-do endorectal pull-through due to remnant aganglionic or hypoganglionic bowel. CONCLUSION: The SSPT showed shorter hospital days. However, few patients experienced rectal stenosis, but were manageable with botulinum toxin injection. The SSPT requires experienced-pathologist, as well as surgeon, because intra-operation pathology reading is critical for appropriate SSPT. SSPT is a feasible and reasonable option to treat Hirschsprung’s disease.
Botulinum Toxins ; Chungcheongnam-do ; Constriction, Pathologic ; Defecation ; Fecal Impaction ; Follow-Up Studies ; Hirschsprung Disease ; Humans ; Infant, Newborn* ; Medical Records ; Pathology ; Retrospective Studies ; Soil

PURPOSE: Enteral nutrition is recommended in critically ill patients. On the other hand, the recommendation of nutritional support is limited and often controversial in critically ill patients in the prone position. Therefore, this study evaluated the clinical outcomes of nutritional support in critically ill patients in the prone position. METHODS: A retrospective evaluation of the electronic medical records was conducted, including adult patients who were in the medical intensive care unit (ICU) in the prone position in Seoul National University Bundang Hospital from May 1, 2015 to June 30, 2017. The patients' characteristics, nutritional support status while they were in the prone position, mortality in ICU and during hospitalization, ICU length of stay, mechanical ventilation days, and complications, such as ventilator associated pneumonia (VAP) and vomiting were collected. RESULTS: In total, 100 patients were included. Of these, 12 received enteral nutrition and parenteral nutrition and 88 received only parenteral nutrition. The groups were similar in terms of age, sex, number of comorbidity, weight, PaO₂/FiO₂, hours of prone position, Simplified Acute Physiology Score II (SAPS II), Acute Physiologic and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score. No differences were observed in ICU mortality (75.0% vs. 46.6%; P=0.065), hospital mortality (83.3% vs. 58.0%; P=0.081), ICU length of stay (22.2±14.6 vs. 18.2±21.2; P=0.128) and mechanical ventilation days (19.3±14.8 vs. 14.5±19.1; P=0.098). In addition, there were no differences in the possible complications of the prone position, such as VAP (8.3% vs. 4.5%; P=0.480) and vomiting (8.3% vs. 1.1%; P=0.227). CONCLUSION: No significant differences in the clinical outcomes were observed. Further studies will be needed to confirm the way of nutrition support while in the prone position.
Adult ; Comorbidity ; Critical Illness* ; Electronic Health Records ; Enteral Nutrition ; Hand ; Hospital Mortality ; Hospitalization ; Humans ; Intensive Care Units ; Length of Stay ; Mortality ; Nutritional Support ; Parenteral Nutrition ; Physiology ; Pneumonia, Ventilator-Associated ; Prone Position* ; Respiration, Artificial ; Retrospective Studies ; Seoul ; Vomiting

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) patients need parenteral nutrition because of nausea, vomiting, and mucositis caused by conditioning regimens. The demand for glutamine increases during the HSCT period. We evaluated the effects of glutamine-containing parenteral nutrition on the clinical outcomes of HSCT patients. METHODS: In this retrospective analysis, we reviewed HSCT patients from Seoul National University from August 2013 to July 2017. Depending on their glutamine supplementation status, 91 patients were divided into 2 groups: glutamine group (N=44) and non-glutamine group (N=47). We analyzed the rate of weight change, infection (clinically/microbiologically documented), complications (duration of mucositis and neutropenia, acute graft versus host disease), and 100-days mortality in each group. RESULTS: Regarding the clinical characteristics of the patients, there were no significant differences between the 2 groups except that there was a larger proportion of myeloablative conditioning regimen in the glutamine group (P=0.005). In the glutamine group, the average number of days of glutamine use, parenteral nutrition, and mucositis was 7.6±1.4, 14.6±9.9, and 13.3±9.5, respectively. Furthermore, multivariate analysis revealed odds ratios of 0.37 (95% CI, 0.14–0.96; P=0.042) and 0.08 (95% CI, 0.01–0.98; P=0.048) for clinically documented infection and 100-days mortality, respectively, in the glutamine group. CONCLUSION: Results showed that the glutamine group had less clinically documented infection and 100-days mortality than the non-glutamine group, but the other outcomes did not show significant differences. The extended duration of glutamine supplementation according to the period of total parenteral nutrition and mucositis should be considered.
Adult ; Glutamine ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Mortality ; Mucositis ; Multivariate Analysis ; Nausea ; Neutropenia ; Odds Ratio ; Parenteral Nutrition ; Parenteral Nutrition, Total ; Retrospective Studies ; Seoul ; Transplants ; Vomiting

No abstract available.
Cellulitis

PURPOSE: Spontaneous neonatal gastric perforation is a rare but fatal disease with unclear etiology. In this study, we reviewed its clinical manifestations, outcomes, and discussed the etiology and prognostic factors. METHODS: There were 12 neonates with gastric perforation in our hospital from 1989 to 2015. Their medical records were reviewed retrospectively including birth record, associated disease, site and size of perforation, type of surgical management, clinical outcome. Also, the prognostic factors were analyzed. RESULTS: The median gestational age and birth weight was 32 weeks (range, 26-43 weeks; preterm birth rate, 66.7%) and 1,883 g (range, 470-4,400 g), respectively. Five patients had associated gastrointestinal anomalies including esophageal atresia and tracheoesophageal fistula (two patients), midgut volvulus, non-rotation and microcolon, and meconium plug syndrome. The median age at surgery was six days after birth (range, 2-13 days), and the median weight at surgery was 1,620 g (range, 510-3,240 g). Upper third part of stomach was the most frequently involved location of perforation. The size of perforation varied from pin point to involving the whole greater curvature. Primary repairs were done in seven cases, and in five cases, resections of necrotic portion were needed. Mortality rate was 33.3% (n=4), morbidity (re-operation) rate was 16.7% (n=2). The causes of death were sepsis (n=3), and heart failure from Ebstein anomaly (n=1). The median hospital stay was 92.5 days (range, 1-176 days). The factors mentioned as prognostic factors in previous studies showed no significant relations to the mortality and morbidity in our study. CONCLUSION: There were improvements of outcomes in patients with large size perforation. As previous studies, we assume these improvements were possible due to the improvements of critical care medicine. Given that rare incidence, a multi-center study can help us get a better understanding of this disease, and a better outcome.
Birth Certificates ; Birth Weight ; Cause of Death ; Critical Care ; Ebstein Anomaly ; Esophageal Atresia ; Gestational Age ; Heart Failure ; Humans ; Incidence ; Infant, Newborn ; Intestinal Volvulus ; Length of Stay ; Meconium ; Medical Records ; Mortality ; Parturition ; Premature Birth ; Retrospective Studies ; Sepsis ; Stomach ; Tracheoesophageal Fistula

An anomalous origin of the right coronary artery (RCA) from the left coronary cusp is a rare congenital anomaly. Because of the unusual location and the noncircular luminal orifice of this anomaly, cannulation of this artery during coronary angiography and percutaneous coronary intervention (PCI) poses significant technical difficulties when using the currently available guiding catheters. Primary PCI should be performed as quickly as possible when a patient displays this condition. When we face the situation of an anomalous artery during primary PCI, it takes a much longer time to open the occluded artery. We report here on two cases of successful primary PCI with using manually manipulated catheters and Ikari type guiding catheters in 2 patients who both had an anomalous RCA arising from the left coronary cusp.
Angioplasty, Balloon, Coronary ; Arteries ; Catheterization ; Catheters ; Coronary Angiography ; Coronary Vessel Anomalies ; Coronary Vessels ; Humans ; Percutaneous Coronary Intervention ; Phenobarbital ; Tomography, X-Ray Computed

PURPOSE: Preterm formula used in Korea, theoretically does not supply the recommended mineral intake for optimal bone metabolism in very low birth weight infants(Formula 500-700 mg Ca/L, 300~370mg P/L, and 440IU of vitamin D/L). The purpose of this study is to identify th e possible etiologic factors and clinical course of rickets in these infants. METHODS: We recently identified radiographic rickets or osteopenia in 16 VLBW infants over a 30-month period from January 1990, to July 1992. We performed a retrospective case analysis to evaluate the clinical features, nutritional status, biochemical and radiological findings o f metabolic disease in preterm infants. RESULTS: Mean gestational age and birth weight were 29+/-2.1wks, and 1172+/-245gm. All infants received parenteral nutrition and 11 infants needed assisted ventilation. Enteral feeding w as started at a mean age of 9.4+/-11.0d and mean total calorie intakes were 62+/-16.2kcal/kg /d in the first 2wks and 111+/-26.9kcal/kg/d at 2-4 wks of age. Oral Ca/P intakes were severely restricted during the first month of life, and they were about 20% of recommended intakes of Ca /P for VLBW infants. At diagnosis of active rickets, serum Ca was high in 19% and serum P wa s low in 69% of infants. Serum alkaline phosphatase was increased in 56% and serum 25-hydroxyvitamin D was low in 67%. Active rickets was diagnosed at mean age of 38+/-14.7 d; 12 infants had overt rickets(grade 2), including 3 infants with fractures(grade 3). Healing rickets was diagnosed on follow-up at mean age of 67.3+/-22.0 days. Thus, metabolic bone disease of VLB W infants was associated with low mineral intakes compared to recommended intakes, and signs of P deficiency occurred at about 2 wks of age and persisted to 8 wks of age; hypercalcemia occurred initially, and these biochemical abnormalities precede the radiological abnormalities about 2 or 3 weeks. CONCLUSIONS: Many factors are related to the development of metabolic hone disease of prematurity; one of the most important factor in our study was nutritional deficiency, especially m ineral(phosphorus) and vitamin D. In preterm VLBW infants whose adequate enteral feeding is restricted, mineral(calcium and phosphorus) and vitamin D supplementation would be needed t o reduce the development of metabolic bone disease in preterm infants.
Alkaline Phosphatase ; Birth Weight ; Bone Diseases, Metabolic* ; Diagnosis ; Enteral Nutrition ; Follow-Up Studies ; Gestational Age ; Humans ; Hypercalcemia ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Korea ; Malnutrition ; Metabolic Diseases ; Metabolism ; Nutritional Status ; Parenteral Nutrition ; Retrospective Studies ; Rickets ; Ventilation ; Vitamin D ; Vitamins

The affiliation of the 8th author was misprinted.