• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.5 no.2
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• pp.186-191
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• 2002

Choledochal cyst is a congenital anomaly with classic triad of abdominal pain, jaundice and right upper abdominal mass. Bile peritonitis caused by cyst rupture is relatively not rare in infancy. The mechanism of rupture must be epithelial irritation of the biliary tract by refluxed pancreatic juice caused by pancreatico-biliary malunion associated with mural immaturity in infancy, rather than an abnormal rise in ductal pressure or congenital mural weakness at a certain point. We experienced a case of bile peritonitis caused by spontanenous rupture of choledochal cyst in a 10-month-old girl presented with abdominal distension, persistent fever, diarrhea, irritability and intractable ascites. She was presumed as having bile peritonitis by bile colored ascitic fluid with elevated bilirubin level and diagnosis was made by $^{99m}Tc$ DISIDA hepatobiliary scan showing extrahepatic biliary leak. The perforated cyst was surgically removed and the biliary tree was reconstructed with a Roux-en-Y hepaticojejunostomy.

• Childhood Kidney Diseases
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• v.13 no.2
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• pp.197-206
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• 2009

Purpose : Limited information is available on experiences of intravenous iron treatment in children. In this study, iron sucrose was administered intravenously to determine its effect, the factors predicting outcome, and safety in children on chronic dialysis. Methods : Twenty-one children whose serum ferritin levels were less than 100 ng/mL or transferrin saturations (TSAT) were less than 20% were enrolled. In 12 children on peritoneal dialysis (PD), the drug was infused intravenously as 200 mg/$m^2$ ($\leq$200 mg) at week 0, 2, 4, and 6. In 9 children on hemodialysis (HD), it was given intravenously as 8 weekly doses of 3 mg/kg ($\leq$100 mg) through week 0-7. Results : After treatment, serum ferritin levels increased significantly in both groups, and TSAT rose significantly in PD group. However, hemoglobin level did not rise significantly in both groups. Children with baseline hemoglobin less than 10 g/dL or baseline TSAT less than 20% showed significantly higher rise of hemoglobin after intravenous iron treatment. To the contrary, those with higher baseline hemoglobin and TSAT levels displayed higher rise in serum ferritin after the treatment. Although no serious adverse event occurred, TSAT levels exceeding 50% were noted in 6 patients in PD group. Conclusion : This suggests that 3 mg/kg/week of intravenous iron sucrose can be used safely in children on chronic HD, but 200 mg/$m^2$ every other week may incur excessive TSAT level in some patients on chronic PD.

• Journal of Veterinary Clinics
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• v.21 no.1
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• pp.45-48
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• 2004

A five months old, female Himalayan cat was referred to the Veterinary Medical Teaching Hospital at Konkuk University, because of suspecting peritoneopericardial diaphragmatic hernia (PPDH). After consecutive examination, the patient was diagnosed as PPDH and hepatic dysfunction. In spite of medical therapy for a month, the serum chemistry profiles for liver enzymes (aspartate transferase: 469 U/L, alanine transferase: above analysis, gamma-glutamyl transferase: above analysis) did not decrease to the normal range. In operation, some of liver was necrotized and was adhesive to diaphragm, these were gently dissected from thoracic structures, and resected. After debriding, the edges of the defect of diaphragm were closed with a simple continuous suture pattern. One month after operation, the cat had normal condition, recovery was uncomplicated, and the serum chemistry profiles for liver enzymes decrease to the normal range.

• Radiation Oncology Journal
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• v.26 no.3
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• pp.135-141
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• 2008

Purpose: To evaluate the clinical outcomes and prognostic factors in retroperitoneal soft tissue sarcomas treated by postoperative radiotherapy. Materials and Methods: The records of 23 patients with retroperitoneal soft tissue sarcomas, who underwent postoperative radiotherapy between 1985 and 2003, were analyzed. The median follow-up period was 77 months (range, $8{\sim}240$ months). A total of 21 patients presented with primary disease, and two patients presented with recurrent disease. Liposarcomas and leiomyosarcomas represented 78% of the diagnosed tumor cases. Moreover, 17 cases were of high grade (grade 2 or 3). The median tumor size was 13 cm (range, $3{\sim}50\;cm$). Complete excision was achieved in 65% of patients. The median radiation dose was 50.4 Gy (range, 45.0 to 59.4 Gy), with conventional fractionation. Results: The 5-year overall, local recurrence-free, and distant metastasis-free survival rates were 68%, 58%, and 71%, respectively. Eleven patients experienced local recurrence, while 9 patients experienced distant metastasis. The most common site for distant metastasis was the liver. A univariate analysis revealed that adjacent organ invasion and age (>60 years) as the significant risk factors contributing to the prediction of poor overall survival. Moreover, multivariate analyses indicated that adjacent organ invasion remained significantly associated with a higher risk of death. In addition, patient age (>60 years) was the other identified risk factor for local recurrence by univariate and multivariate analyses. Except for one case of grade 3 diarrhea, no patient suffered grade 3 or higher complications. Conclusion: Our results were comparable to previous reports in that adjacent organ invasion and patient age (>60 years) were significant predictors of poor survival and tumor recurrence, respectively.

• Journal of Chest Surgery
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• v.43 no.5
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• pp.525-528
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• 2010

Congenital interruption of the inferior vena cava (IVC) can lead to secondary hepatic congestion, portal hypertension, and liver cirrhosis. A 49-year-old woman was admitted to the gynecology department with symptoms of menorrhalgia, known uterine myoma, and anemia. Abdominal computed tomography (CT) and venography performed at our hospital revealed congenital interruption of the IVC. The patient underwent retrohepatic cavoatrial bypass surgery with a polytetrafluoroethylene (PTFE) 16-mm ringed graft via posterolateral thoracotomy, and recovered without major complications. A retroperitoneal approach via posterolateral thoracotomy provides appropriate visualization during dorsal cavoatrial bypass in treating patients with congenital interruption of IVC.

• Childhood Kidney Diseases
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• v.12 no.1
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• pp.38-46
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• 2008

Purpose: Growth failure is a common problem in chronic renal failure(CRF). We studied the effect of growth hormone(GH) treatment and the factors influencing growth on chronic peritoneal dialysis patients. Methods: Seventeen patients who were treated with peritoneal dialysis and GH for more than one year were enrolled. Factors influencing growth such as age, height at start of GH treatment, total Kt/Vurea, residual renal Kt/Vurea, hemoglobin, albumin, BUN, creatinine, total $CO_2$, calcium, phosphate and iPTH during GH treatment were compared between the growth group (increase in height-standard deviation score(Ht-SDS) after one year of GH treatment, n=l1) and poor growth group(no increase in Ht-SDS after one year of GH treatment, n=6). Results: The mean age at the start of dialysis was 7.7${\pm}$5.2 years and the mean age at the start of GH treatment was 8.5${\pm}$4.8 years. In the growth group, Ht-SDS at start of GH treatment was smaller(-1.72${\pm}$1.00 vs. -0.77${\pm}$0.88, P=0.048) and residual renal Kt/Vurea was better (1.54${\pm}$0.51 vs. 0.15${\pm}$0.26, P=0.02) than the poor growth group. After three years of GH treatment, Ht-SDS of the growth group was better than the poor growth group. Conclusion: GH treatment in children with peritoneal dialysis was more effective on patients who had more severe growth retardation. The reservation of residual renal function was important for improvement of effect of GH treatment. And the growth response during the first year of GH treatment may be predicted as the indicator for long-term response.

• Journal of Veterinary Clinics
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• v.26 no.1
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• pp.58-61
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• 2009

A 10-year-old spayed female Shih-tzu dog with a left-sided caudal abdominal swelling of 2-month clinical duration was referred to the Konkuk University Teaching Hospital (KUVTH). We confirmed the presence of an abdominal mass by radiography and ultrasongraphy. A gossypiboma was identified between bladder and small intestines at surgery and removed. The resulting peritoneal adhesion was severe. But, the peritoneal defect did not allow easy repair of the abdominal wall. Therefore, polypropylene mesh (PPM) was used in repair. The patient was good condition after surgery with no caudal abdominal swelling. We followed the patient for the next 6 months with no complication.

• Journal of Veterinary Clinics
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• v.26 no.2
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• pp.176-180
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• 2009

Two year-old female miniature schnauzer was presented with depression, abdominal pain and inappetence. Physical examination revealed tachypnea, fever, and abdominal pain. Leukocytosis with neutrophilia was shown in complete blood count. Radiograph revealed the increase of opacity in parallel to vertebra and dislocation of descending colon. Calculi and sludge in bladder, hydronephrosis and dilation of proximal ureter in right kidney were observed in ultrasonographic examination; also, irregular shape of structure in retroperitoneal cavity was observed. Urinalysis showed protein urine and hemtauria. Many epithelial cells, spindle cells, calcium oxalate dihydrate crystals, struvite crystals, amorphous crystals and granular casts, WBC, cocci were examined in urine sediment test. ERD-kit test result was highly positive. Based on those test and excretory urogram pyelonephritis and complete unilateral obstruction of ureter were confirmed. A balloon type structure in retroperitoneal cavity was found through the exploratory laparotomy. In cytologic examination of aspirated fluid from dilated area many degenerated neutrophils and phagocytized cocci were observed. Staphylococcus intermedius was cultured from aspirated fluid. Based on these clinical results retroperitoneal abscesses caused by Staphylococcus intermedius was diagnosed with ureter obstruction and concurrent cystic calculi. Nephrectomy of right kidney with ureter was performed.

• Journal of Gastric Cancer
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• v.6 no.4
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• pp.263-269
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• 2006

Purpose: The aim of this study was to investigate the causes of under-staging in patients with advanced gastric cancer that was proven to be unresectable after a laparotomy. Materials and Methods: We retrospectively analyzed 25 gastric cancer patients who had undergone a diagnostic laparotomy between 2001 and 2005. For the preoperative evaluation, spiral CT and multidetector-row CT were performed. We analyzed the clinicopathologic features of patients and compared the image findings and the results of surgery. The causes of under-staging were divided into 3 groups; patient factor, CT factor, and interpretation factor. Results: Grossly, there were 12 cases of Borrmann type-III tumors and 13 cases of Borrmann type-IV tumors. The most frequent histologic type was poorly differentiated adenocarcinomas (8 cases) and signet ring cell carcinomas (7 cases). There were 13 cases of adjacent organ invasion, and the pancreas was the most frequently invaded organ (9 cases). There were 17 cases of peritoneal metastasis, and 3 cases of distant lymph node metastasis. For the cause of under-staging, there were four cases of patient factor, 19 cases of interpretation factor, and 9 cases of CT factor. In three cases, the cause of under-staging could not be identified. Conclusion: CT interpretation factor was the most frequent cause of under-staging in the preoperative diagnosis with gastric cancer patients. Therefore, more cautious CT interpretation is necessary to avoid unnecessary laparotomies in gastric cancer patients.

• Childhood Kidney Diseases
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• v.9 no.1
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• pp.108-111
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• 2005

Nephrotic syndrome is a common chronic disease in childhood. Patients with nephrotic syndrome are at an increased risk of bacterial Infections due to immunological changes secondary to proteinuria. Primary bacterial peritonitis is one of the most serious and common infectious complications. The rate of peritonitis is, 2-6% and overwhelming infection still carries a mortality rate of 1.5%. We experienced a rare case of nephrotic syndrome complicated with severe peritonitis and Peritoneal empyema in a 10-year old girl after 2 months of medical neglect by parents. Here we emphasize thf: importance of early detection and treatment of peritoneal infection in nephrotic syndrome.