PURPOSE: The application of laparoscopic surgery in children has expanded tremendously in recent years. However, the feasibility of the technique is somewhat controversial. We summarize our experience of laparoscopy in children and describe the surgical techniques used in these cases. METHODS: Between June 2001 and May 2004, 58 children (33 male, 25 female) underwent laparoscopic surgery at the Department of Surgery, Daegu Fatima hospital. All the clinical data was collected retrospectively. RESULTS: The laparoscopic procedures for each indications were a laparoscopic reduction for a barium reduction failed intussuception (n=15), laparoscopic appendectomy for acute appendicitis (n=30), laparoscopic splenectomy for symptomatic hereditary spherocytosis (n=4), laparoscopic salphin-go-ophorectomy for torsion of parovarian cyst and ovarian tumor (n=2), laparoscopic diverticulectomy for symptomatic Meckel's diverticulum (n=2), laparoscopic Hellor myotomy and Dor fundoplication for achalasia (n=1), diagnostic purpose for peritoneal tuberculosis (n=2) and the laparoscopic removal of a foreign body in the peritoneal cavity (n=2). The mean age was 7.9 years (range from 4 months to 14 years). In intussusception, the laparoscopic reduction was successful in 12 patients (80%), with a conversion to an open procedure occurring in 3 cases (20%). There were no other open con-versions. There were no postoperative wound complications except for two wound problems in patients with acute perforated appendicitis. The operative time and duration of the hospital stay was suitable. CONCLUSION: The laparoscopic procedure in various disorders of infants and children is safe and avoids the necessity of open surgery under the appropriate indication.
Appendectomy ; Appendicitis ; Barium ; Child* ; Conversion to Open Surgery ; Daegu ; Esophageal Achalasia ; Female ; Foreign Bodies ; Fundoplication ; Humans ; Infant ; Intussusception ; Laparoscopy* ; Length of Stay ; Male ; Meckel Diverticulum ; Operative Time ; Parovarian Cyst ; Peritoneal Cavity ; Peritonitis, Tuberculous ; Retrospective Studies ; Splenectomy ; Wounds and Injuries

With advancements in complex repairs in neonates with complicated congenital heart diseases, extracorporeal membrane oxygenation (ECMO) has been increasingly used as cardiac support. ECMO has also been increasingly used for low birth weight (LBW) or very low birth weight (VLBW) neonates. However, since prematurity and LBW are risk factors for ECMO, the appropriate indications for neonates with LBW, especially VLBW, are under dispute. We report a case of ECMO performed in a 1,360-g premature infant with VLBW due to cardiopulmonary bypass weaning failure after repairing infracardiac total anomalous pulmonary venous return.
Cardiopulmonary Bypass ; Dissent and Disputes ; Extracorporeal Membrane Oxygenation* ; Heart Diseases ; Humans ; Infant, Low Birth Weight ; Infant, Newborn* ; Infant, Premature ; Infant, Very Low Birth Weight ; Risk Factors ; Scimitar Syndrome* ; Weaning

BACKGROUND: A combination of salmeterol and fluticasone propionate (SFC) and tiotropium bromide (TIO) is commonly prescribed for COPD patients but there is little data on their effectiveness, particularly in COPD patients with bronchial hyperresponsiveness. This study compared the spirometric improvement based on the change in FEV1, FEV1/FVC, and IC as well as the clinical outcomes of the therapeutic strategies with SFC and TIO versus the individual components in patients with severe COPD and bronchial hyperresponsiveness. METHODS: This study examined the spirometric data and clinical outcomes of 214 patients with COPD and hyperresponsiveness, who were divided into three groups according to the therapeutic regimen (TIO only, SFC only, and a triple therapy regimen). RESULTS: All regimen groups showed early improvement in the FEV1 and IC (at 3- and 6 months after treatment). However, long-term beneficial effects were observed only in the SFC group (at 24 months after treatment). However, these beneficial effects decreased after a 36-month follow up. In all spirometric results, the 12-, 24-, and 36-months data showed a similar degree of improvement in the three groups. The triple therapy group showed higher St. George's Respiratory Questionnaire scores and lower acute exacerbations and hospitalization. CONCLUSION: SFC can be a more important component in the pharmacological treatment of severe COPD patients with hyperresponsiveness than TIO, particularly in the spirometric and clinical outcomes.
Albuterol ; Androstadienes ; Diethylpropion ; Drug Therapy, Combination ; Follow-Up Studies ; Hospitalization ; Humans ; Pulmonary Disease, Chronic Obstructive ; Surveys and Questionnaires ; Scopolamine Derivatives ; Treatment Outcome ; Fluticasone ; Tiotropium Bromide ; Salmeterol Xinafoate

PURPOSE: The aim of this study was to determine whether focused or complete parathyroidectomy was more appropriate and to compare follow-up data in primary hyperparathyroidism (PHPT). METHODS: We retrospectively analyzed 225 operations for PHPT at Yonsei University Health System between 2000 and 2012. After excluding 93 patients, the remaining 132 were divided into 2 groups: those who underwent focused parathyroidectomy (FP) and those who underwent conventional parathyroidectomy (CP). We compared clinicopathological features; preoperative calcium, parathyroid hormone (PTH), phosphorus, vitamin D, 24-hour urine calcium, and alkaline phosphatase levels; postoperative calcium and PTH levels; pathologic diagnosis; multiplicity; and results of a localization study between the 2 groups. RESULTS: There was no significant difference in the rates of development of postoperative persistent hyperparathyroidism (1/122 FP patients and 1/10 CP patients) between the 2 groups due to a technical reason (FP 0.8% vs. CP 10.0%, P = 0.146). Multiglandular disease (MGD) was uncommon in all cases (6 of 132, 4.5%). All MGD cases were diagnosed using a preoperative localization study. Sestamibi scan and ultrasonography sensitivity were 94.2% and 90.2%, respectively. CONCLUSION: We suggest that FP is appropriate in PHPT, except in cases of MGD if detected before the operation using preoperative imaging. Knowledge of hereditary PHPT and improved preoperative localization studies, such as high-resolution ultrasonography, contributed to the decision to perform FP rather than CP in all cases of unilateral results of the localizing study.
Alkaline Phosphatase ; Calcium ; Diagnosis ; Follow-Up Studies ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary* ; Parathyroid Hormone ; Parathyroidectomy* ; Phosphorus ; Retrospective Studies ; Technetium Tc 99m Sestamibi ; Ultrasonography ; Vitamin D

PURPOSE: The aim of this study was to determine whether focused or complete parathyroidectomy was more appropriate and to compare follow-up data in primary hyperparathyroidism (PHPT). METHODS: We retrospectively analyzed 225 operations for PHPT at Yonsei University Health System between 2000 and 2012. After excluding 93 patients, the remaining 132 were divided into 2 groups: those who underwent focused parathyroidectomy (FP) and those who underwent conventional parathyroidectomy (CP). We compared clinicopathological features; preoperative calcium, parathyroid hormone (PTH), phosphorus, vitamin D, 24-hour urine calcium, and alkaline phosphatase levels; postoperative calcium and PTH levels; pathologic diagnosis; multiplicity; and results of a localization study between the 2 groups. RESULTS: There was no significant difference in the rates of development of postoperative persistent hyperparathyroidism (1/122 FP patients and 1/10 CP patients) between the 2 groups due to a technical reason (FP 0.8% vs. CP 10.0%, P = 0.146). Multiglandular disease (MGD) was uncommon in all cases (6 of 132, 4.5%). All MGD cases were diagnosed using a preoperative localization study. Sestamibi scan and ultrasonography sensitivity were 94.2% and 90.2%, respectively. CONCLUSION: We suggest that FP is appropriate in PHPT, except in cases of MGD if detected before the operation using preoperative imaging. Knowledge of hereditary PHPT and improved preoperative localization studies, such as high-resolution ultrasonography, contributed to the decision to perform FP rather than CP in all cases of unilateral results of the localizing study.
Alkaline Phosphatase ; Calcium ; Diagnosis ; Follow-Up Studies ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary* ; Parathyroid Hormone ; Parathyroidectomy* ; Phosphorus ; Retrospective Studies ; Technetium Tc 99m Sestamibi ; Ultrasonography ; Vitamin D

A 50-year-old female patient with visual disturbances was referred for further evaluation of a heart murmur. Fundoscopy revealed a Roth spot in both eyes. A physical examination showed peripheral signs of infective endocarditis, including Osler nodes, Janeway lesions, and splinter hemorrhages. Our preoperative diagnosis was subacute bacterial endocarditis with severe aortic regurgitation. The patient underwent aortic valve replacement and was treated with intravenous antibiotics for 6 weeks postoperatively. The patient made a remarkable recovery and was discharged without complications. We report this case of subacute endocarditis with all 4 classic peripheral signs in a patient who presented with visual disturbance.
Anti-Bacterial Agents ; Aortic Valve ; Aortic Valve Insufficiency ; Diagnosis ; Endocarditis ; Endocarditis, Subacute Bacterial* ; Female ; Heart Murmurs ; Hemorrhage ; Humans ; Middle Aged ; Physical Examination

Paratracheal air cysts are a rare entity in which cystic formation occurs adjacent to the trachea. Most patients with paratracheal air cysts are asymptomatic, and the cysts are detected incidentally on chest radiograph or computed tomography (CT) scan. Most symptomatic patients complain of pulmonary symptoms or repeated respiratory infection. Rarely, the air cysts can lead to paralysis of the recurrent laryngeal nerve as a result of direct compression. We report a case of a 59-year-old male patient who presented with voice change, and the cause was identified as paratracheal air cysts on a chest CT scan. Surgical resection via video-assisted mediastinoscopy was performed, and the voice recovered immediately after the operation.
Diverticulum ; Humans ; Male ; Mediastinoscopy ; Middle Aged ; Paralysis ; Radiography, Thoracic ; Recurrent Laryngeal Nerve ; Tomography, X-Ray Computed ; Trachea ; Voice*

Congenital cystic adenomatoid malformation is a rare, but well-known disease. It can be managed conservatively in patients without symptoms or require surgical removal when symptomatic. The surgical option of choice is en bloc resection of the affected lesion. We report an experience of life-threatening congenital cystic adenoid malformation in a low-birth-weight (1,590 g) premature neonate who was successfully treated with a lobectomy of the lung.
Adenoids ; Cystic Adenomatoid Malformation of Lung, Congenital* ; Humans ; Infant, Low Birth Weight ; Infant, Newborn* ; Infant, Premature ; Lung

Radiofrequency neurolysis (RFN) of the genicular nerves has recently become accepted as an effective technique to alleviate knee pain particularly in patients with knee osteoarthritis (OA) or postoperative pain. However, genicular nerve RFN can produce high procedure and equipment costs, longer procedural times, procedure-related pain, and failure rate of over 25%. We are presenting two cases of alcohol neurolysis of the genicular nerve using fluoroscopy and ultrasonography in patients with knee OA or persistent postsurgical pain of the knee. Alcohol neurolysis of the genicular nerve with dual imaging modality can be a cheap, safe and effective method in patients with chronic knee pain.
Ethanol ; Fluoroscopy ; Humans ; Knee ; Methods ; Nerve Block ; Osteoarthritis ; Osteoarthritis, Knee ; Pain, Postoperative ; Ultrasonography

BACKGROUND/AIMS: Early detection of gallbladder (GB) cancer is essential for better survival rates. Most cases of GB cancer are diagnosed incidentally via pathology of the cholecystectomy specimen. Data on the clinical characteristics of early GB cancer are lacking. The aim of the current study was to investigate the clinical characteristics of early GB cancer to aid earlier diagnosis. METHODS: Sixty-four patients who were diagnosed with early GB cancer after surgical resection at the Samsung Medical Center were enrolled in this study. Clinical characteristics, preoperative diagnoses, preoperative tumor size, laboratory findings including carbohydrate antigen 19-9 (CA19-9) levels, imaging features, and survival rate were investigated. RESULTS: Clinical symptoms and serum tumor markers such as carcinoembryonic antigen and CA19-9 levels were not helpful indicators of early GB cancer. Radiologic modalities showed abnormal findings in every case of early GB cancer; a polypoid mass was the most common feature. Less common features included GB wall thickening, cholecystitis, and GB stones. The clinical outcome of early GB cancer was excellent. CONCLUSIONS: Screening with imaging modalities such as computed tomography (CT) or ultrasonography (US) is helpful in detecting early GB cancer. Even in the presence of GB wall thickening, cholecystitis, or GB stones on the CT or US, any abnormal findings should prompt careful examination and intensive follow up, considering the possibility of occult gallbladder cancer.
Carcinoembryonic Antigen ; Cholecystectomy ; Cholecystitis ; Diagnosis ; Gallbladder ; Gallbladder Neoplasms* ; Humans ; Mass Screening ; Pathology ; Survival Rate ; Biomarkers, Tumor ; Ultrasonography