PURPOSE: To compare the survival of corneal grafts and the changes in endothelial cell density in penetrating keratoplasty using domestic or imported corneas. METHODS: Medical records of 236 eyes of 211 patients who underwent penetrating keratoplasty from November 2004 to August 2011 in Seoul National University Hospital and were followedup at least 1 year were retrospectively reviewed. After excluding the patients who received the combined surgeries with other surgeries except cataract surgery, the eyes were divided into 2 groups depending on the origin of donor tissue resulting in a domestic cornea group (108 eyes) and an imported cornea group (128 eyes). Recipient demographics, preoperative diagnosis, donor age, death-to-preservation time, death-to-operation time and pre-and postoperative visual acuities were compared between the 2 groups. Kaplan-Meier survival and changes in endothelial cell density were analyzed at 3, 6 and 12 months and then every year. RESULTS: The most common preoperative diagnoses were regraft and corneal opacity in the domestic and imported cornea groups, respectively, without statistical difference. Death-to-preservation time was 8.9 hours and 8.0 hours in the domestic and imported cornea groups, respectively, without statistical difference. However, death-to-operation time was longer in the imported cornea group (4.98 days) than in the domestic cornea group (2.18 days). There were no differences in pre- and postoperative visual acuities, decrease in annual changes in endothelial densities and survival up to 3 years between the 2 groups. In addition, the survival and decreased annual changes in endothelial densities were not different from each other in penetrating keratoplasty combined with cataract surgery or in penetrating keratoplasty for a corneal edema. CONCLUSIONS: Our study results suggest that clinical outcomes of the penetrating keratoplasty using imported corneas are comparable in efficacy when compared with the clinical outcomes using domestic corneas.
Cataract ; Cornea* ; Corneal Edema ; Corneal Opacity ; Demography ; Diagnosis ; Endothelial Cells ; Humans ; Keratoplasty, Penetrating* ; Medical Records ; Retrospective Studies ; Seoul ; Tissue Donors ; Transplants ; Visual Acuity

No abstract available.
Child ; Choledochal Cyst ; Humans

Infantile hypertrophic pyloric stenosis (IHPS) is common surgical disease in infants having vomiting. This disease is still not fully documented despite of various hypotheses. This article reviews the literature on the etiology, clinical course, diagnosis and management of IHPS including recent opinion.
Humans ; Infant ; Pyloric Stenosis, Hypertrophic ; Vomiting

Acute appendicitis is very rare in premature neonates. Preoperative diagnosis of this condition is difficult, and then it leads to high morbidity and mortality. We report 9-day-old premature male with ruptured acute appendicitis presented with pneumoperitoneum on plain films of the abdomen. Awareness of this rare condition and possible differential diagnosis in this age group is also discussed.
Abdomen ; Appendicitis ; Diagnosis, Differential ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Male ; Pneumoperitoneum

PURPOSE: The emerging studies have suggested steadily negative appendectomy rates. The purpose of this study is to verify that short-term observation under conservative management helps surgeons avoid unnecessary surgery without poor progress in pediatric patients with presumed acute appendicitis. METHODS: We reviewed 650 medical records of pediatric patients aged 12 years and younger with presumed acute appendicitis at Ewha Womans University Medical Center between January 2005 and December 2009. We then compared 283 'appendectomy group (AG)' including 229 suppurative appendicitis (SA) and 54 normal appendix or mild appendicitis (MA), pathologically, with 96 'conservative treatment group (CG)' who were diagnosed with mesenteric lymphadenopathy associated with early appendicitis or normal appendix in radiologic study and effectively treated with conservative management. RESULTS: There was no significant difference in gender and age distribution between SA and MA groups, but the mean age of CG was younger than MA group (P=0.000). The main clinical findings between SA, MA and CG were similar but the mean duration of symptom was longest in CG. 'Delayed' and 'night-time' surgery was frequent in MA (P=0.006, P=0.027). Thirteen patients(4.6%) developed complications in AG without significant difference between SA and MA. The mean hospital stay was significantly shorter in CG than MA (P=0.000) without significant difference between SA and MA. The medical cost of CG was much cheaper than AG (P=0.000). No patient in CG needed appendectomy for the follow-up period. CONCLUSION: The authors suggested that short-term watchful waiting for presumed appendicitis in pediatric patients under conservative treatment could reduce unnecessary appendectomy, complications and cost.
Academic Medical Centers ; Age Distribution ; Appendectomy* ; Appendicitis* ; Appendix ; Child ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Lymphatic Diseases ; Medical Records ; Unnecessary Procedures ; Watchful Waiting

PURPOSE: It is controversial to treat complicated appendicitis in pediatric patients on several points, especially optimal time for appendectomy. The purpose of this study is to determine optimal time for operation in perforated appendicitis in pediatric patients. METHODS: Children with perforated appendicitis under the age of 14 underwent appendectomy between January 2006 and December 2008 at Ewha Womans University Mokdong Hospital were analyzed retrospectively according to factors which may affect the postoperative hospital course such as complications, time of beginning of diet, and length of hospital stay. RESULTS: During the study period, 357 patients with acute appendicitis underwent appendectomy and 118 patients were diagnosed with perforated appendicitis. Comparing symptom durations between more than 48 hours and less, the former induced significantly higher postoperative complication rates. Body temperature above 37.5degrees C at admission affected significantly higher complication rates and delay of beginning of diet. Children with intraabdominal abscess at appendectomy showed higher complication rates than without abscess. Children who underwent operation in the daytime started diet significantly earlier and showed less complication than those operated on at night. The frequency of preoperative antibiotics administration did not alter the postoperative hospital course. CONCLUSION: For the children diagnosed with perforated appendicitis, non-urgent appendectomy in the daytime after initial conservative management including intravenous administration of antibiotics, hydration, and correction of serum electrolyte is safer and more efficient than performing emergency operation, and moreover there is no necessity for secondary admission for interval appendectomy.
Abscess ; Administration, Intravenous ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Body Temperature ; Child ; Diet ; Emergencies ; Female ; Humans ; Postoperative Complications ; Retrospective Studies

PURPOSE: A precise and simple tool for diagnosis and the growing public interest in health caused infantile hypertrophic pyloric stenosis (IHPS) to be diagnosed in good time. The approach to pyloromyotomy as the standard treatment is undergoing changes. We compared 2000's IHPS patients with 1980's to identify the clinical features and management. METHODS: We analyzed, retrospectively, the clinical findings, diagnoses, and treatment of 68 patients with IHPS who underwent pyloromyotomy at Ewha Womans University Medical Center from January 2000 to December 2008 (2000's group), and compared the results with that of 42 patients in the 1980's (1980's group). RESULTS: There were no significant differences in age, gender, birth rank, seasonal distribution, and symptoms between both groups, but the number of patients with metabolic changes and palpable 'olive' was significantly lesser in the 2000's group. Upper gastrointestinal series (UGI) was the most common imaging tool in the 1980's (71.4%) but USG has become the standard diagnostic tool in the 2000's (88.2%). All patients received open pyloromyotomy using traditional incision in the 1980's, and supraumbilical semicircular incision in 36.8% of patients in the 2000's. The average length of hospital stay after operation was significantly shorter in the 2000's group. In the 2000's, the mean preoperative stay at hospital was 4.4+/-4.3 days. Twenty-nine (42.0%) patients did not vomit postoperatively and postoperative vomiting did not delay discharges of any patients. CONCLUSION: There were significant improvements in diagnosis and treatment in the 2000's. We suggest that the surgeon, without the need for a radiologist perform USG for IHPS in order to shorten the preoperative hospital stay.
Academic Medical Centers ; Female ; Humans ; Length of Stay ; Parturition ; Postoperative Nausea and Vomiting ; Pyloric Stenosis, Hypertrophic ; Retrospective Studies ; Seasons

PURPOSE: In pediatric solid organ injury, non-operative management is considered as a standard treatment when the patient is hemodynamically stable. However, treatment according to the injured organ and the depth of injury is controversial. The purpose of this study is to evaluate treatment results in the management of abdominal solid organ injuries in children. METHODS: This analysis was performed retrospectively with 57 consecutive children under 15 year of age who were diagnosed with abdominal solid organ injuries at Ewha Womans University Mokdong Hospital from January, 1999 to June, 2007. RESULTS: The major cause of pediatric solid organ injury was traffic accidents (59.6%) and the most frequently injured organ was the liver (66.7%). 54 patients (94.7%) were treated non-operatively and the success rate was 100%. There was no difference in type of management and success rate according to the depth of injury or the injured organs. The average ICU stay was 4.3 days, and the average hospital stay was 13.6 days and that was extended depending on the depth of injury. And according to the cause of injury, cases by traffic accident stayed significantly longer than cases by other causes. CONCLUSION: High grade of injury is not contraindication of nonoperative management in pediatric solid organ injury. Hemodynamic instability is the only absolute indication of operation. Therefore, if the patient is stable, non-operative management with intensive observation is the choice of treatment.
Accidents, Traffic ; Child ; Female ; Hemodynamics ; Humans ; Length of Stay ; Liver ; Retrospective Studies

PURPOSE: This study aims to determine the prognostic factors of pneumoperitoneum in neonates. METHODS: We reviewed 35 neonates who underwent operations for pneumoperitoneum between 1999 and 2007. The prognostic factors on survival were evaluated. RESULTS: Twenty-eight patients were male and 7 were female. Mean gestational age was 35.9+/-4.6 weeks and birth weight was 2,703.1+/-999.2 gr. Mean apgar-score were 6.0+/-2.9 at 1 min, and 6.7+/-2.6 at 5 min. The most common clinical finding was abdominal distension. Most patients were diagnosed with a simple abdominal X-ray. Perforation sites were stomach (n=8), small bowel (n=20), colon (n=5), and small bowel and colon (n=2). Operative methods were bowel resection with enterostomy (n=15), resection with anastomosis (n=9), wedge resection (n=4), primary closure (n=3), primary closure with enterostomy (n=3), and penrose-drain insertion (n=1). Postoperative complications occurred in 16 patients, and 26 patients survived and 9 expired. Mortality rate was significantly higher in lesser gestational age, lower birth weight and apgar-score, need of preoperative ventilator, and abnormalities in ABGA or platelet count. CONCLUSION: The significant prognostic factors were gestational age, birth weight, Apgar-score, need of preoperative ventilator, and abnormal laboratory findings in ABGA and platelet count. The other variables including sex, symptom duration, underlying diseases, perforation sites, and operation methods were not correlated with survival.
Birth Weight ; Colon ; Enterostomy ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Male ; Platelet Count ; Pneumoperitoneum ; Postoperative Complications ; Stomach ; Ventilators, Mechanical

PURPOSE & METHODS: Nonoperative reduction of childhood intussusception is the treatment of choice. However, few techniques of nonoperative reduction are available. When used, nonoperative reduction can be successfully completed by a radiologist. In this study, we analyzed 637 cases of childhood intussusception diagnosed and treated by ultrasound-guided saline enema reduction (UGSER) over nine years at Ewha Womans University Mokdong Hospital. We compared the results of 76 cases surgically treated after UGSER (US group) with 84 cases surgically treated after barium enema reduction in 1980s (BE group). RESULTS: The success rate of the saline reduction was 88.1%. The risk factors associated with surgery were the patient's age, symptom duration and the type of intussusception. The rate of bowel resection was 32.9%. Patients less than six months old and a pathologic lead point (PLP) on the US were risk factors for bowel resection. There were no significant differences in age, gender and the number of PLPs between the US and BE groups. The number of patients with a spontaneous reduction was greater in the BE group and bowel perforation occurred only in the US group. The bowel resection rate was significantly higher in the US group. However, the median hospital stay was significantly shorter in the US group. CONCLUSION: UGSER is reliable and safe in childhood intussusecption. Moreover, it has a high success rate and is easy to perform. The surgeon, without the need for a radiologist, performs this procedure from diagnosis to treatment. In addition, it might help avoid invasive surgery.
Barium ; Enema ; Female ; Humans ; Intussusception ; Length of Stay ; Risk Factors