• Advances in pediatric surgery
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• 제17권2호
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• pp.133-138
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• 2011

Extracorporeal membrane oxygenation (ECMO) has been utilized in congenital diaphragmatic hernia (CDH) patients with severe respiratory failure unresponsive to conventional medical treatment. We retrospectively reviewed 12 CDH patients who were treated using ECMO in our center between April 2008 and February 2011. The pre ECMO and on ECMO variables analyzed included gestational age, sex, birth weight, age at the time of ECMO cannulation, arterial blood gas analysis results, CDH location, timing of CDH repair operation, complications and survival. There were 9 boys and 3 girls. All patients were prenatally diagnosed. Mean gestational age was $38.8{\pm}1.7$ weeks and mean birth weight was $3031{\pm}499$ gram. Mean age at the time of ECMO cannulation was $29.9{\pm}28.9$ hours. There were 4 patients who survived. Survivors showed higher 5 min Apgar scores ($8.25{\pm}0.96$ vs. $7.00{\pm}1.20$, p=0.109), higher pre ECMO mean pH ($7.258 {\pm}0.830$ vs. $7.159{\pm}0.986$, p=0.073) and lower pre ECMO $PaCO_2$ ($48.2{\pm}7.9$ vs. $64.8{\pm}16.1$, p=0.109) without statistical significance. The hernia was located on the left side in 10 patients and the right side in 2 patients. The time interval from ECMO placement to operative repair was about 3~4 days in 5 early cases and around 24 in the remaining cases. There were 3 cases of post operative bleeding requiring re operation and 2 cases of abdominal compartment syndrome requiring abdominal fascia reopening. ECMO catheter reposition was required in 4 cases. Three cases of arterial or venous thrombosis were detected and improved with follow up. Our data suggests that ECMO therapy could save the lives of some neonates with CDH who can not be maintained on other treatment modalities. Protocolized management and accumulation of case experience might be valuable in improving outcomes for neonates with CDH treated with ECMO.

• 대한소아치과학회지
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• 제50권2호
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• pp.155-167
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• 2023

이 연구의 목적은 상악 확장 속도에 따른 치아치조성, 골격성 효과 및 상기도에 대한 효과를 CBCT를 통해 3차원적으로 분석하여 저속 상악 확장의 효과를 확인하는 것이다. 전북대학교 소아치과에서 Banded hyrax를 이용하여 상악 확장을 시행한 23명(평균 8.93 ± 1.61세)의 환자가 포함되었다. 확장 속도에 따라 저속 상악 확장군과 급속 상악 확장군으로 분류되었다. 치료 전후의 치아치조성, 골격성, 기도 부피 변화를 평가하기 위해 치료전(T0)과 치료 종료 및 유지 후(T1)에 촬영한 CBCT를 사용하였다. 상악 확장 결과 두 군 모두에서 치아치조성, 골격성 측정 값 및 상기도 부피의 유의한 증가가 관찰되었다. 또한 모든 측정 값에서 저속 상악 확장과 급속 상악 확장 간의 유의한 차이를 보이지 않았다. 이 연구는 혼합치열기 어린이에서 저속 상악 확장의 효과에 대해 확인하였다. 저속 상악 확장은 치아치조성, 골격성 측정 값 뿐만 아니라 기도 부피, 상악동 기체 부피에서도 유의한 효과를 보였다. 또한, 급속 상악 확장의 효과와 비교하였을 때 유의한 차이를 보이지 않았다. 따라서 소아치과의사는 성장기 어린이의 치주 조직의 생리적 측면, 불편감에 따른 협조도 등을 고려하여 급속 상악 확장과 저속 상악 확장 중 적절한 방법을 선택할 수 있을 것이다.

• Advances in pediatric surgery
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• 제2권2호
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• pp.81-87
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• 1996

Although nonoperative reduction plays a major role in the management of uncomplicated intussusception in the pediatric age group, surgical treatment is still a necessary alternative when nonoperative reduction is unsuccessful. The author analyzed the clinical features of 68 patients requiring operation in order to identify factors which might influence the type of operative management. A nine-year experience at Ewha Womans University Hospital was reviewed, and the findings compared to previous reports. Barium was used for the initial reduction attempt in 33 cases, saline in 35. Manual reduction by milking at operation achieved success in 41 cases(60.3%). Fifteen cases(22.1%) required resection of bowel, and 12 patients(17.6%) were found to have spontaneous and complete reduction of the intussusception at operation. Two cases had pathologic leading points. There were no perforations due to nonoperative reduction. There were no significant differences in demographic data, clinical findings, laboratory data, and anatomic type of intussusception between barium and saline reduction groups. However, a significant number of cases with spontaneous reduction were in saline reduction group(p<0.05). There was a slight chance of spontaneous reduction in infants under 6 month of age(p<0.001). Age under 6 month. body temperature over $38^{\circ}C$, symptom over 24 hours, and ileo-colic and ileo-ileo-colic intussusception contributed significantly to the necessity for bowel resection(p<0.05-0.001). The author believes that the age, body temperature, duration of illness, and anatomic type of intussusception strongly influence operative management.

• Advances in pediatric surgery
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• 제2권1호
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• pp.1-7
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• 1996

Clinical experiences of 833 hydrocele children presented at Hanyang University Hospital, of whom 456 children were operated by one pediatric surgeon from September 1979 to December 1993, were analyzed. Eight hundred and twenty three children were boys(right 476, left 279, bilateral 49, and unknown 19), and 10 were girls(8 right and 2 left). Operation was performed on 446 boys and all girls. Of boys diagnosed before the age of 6 months, 15.6% was operated and 68.7% of those after 6 months of age was operated. Among the boys operated after 2 years old, 16.5% had had hydrocele before 6 months of age, 20.4% before 1 year old and 34.6% before 2 years old. On the other hand, 28.8% of boys diagnosed after 2 years of age did not undergo hydrocelectomy. Sixteen children with hydroceles had contralateral hernias at the same time. After repair of unilateral hydroceles, contralateral hydroceles developed in 7 and hernias in 3 children. After disappearance of unilateral hydroceles, it reappeared at the same site in 4 and contralateral hydroceles or hernias developed in 2 children each. Hydroceles converted to hernias in 6 children before treatment. Hydroceles developed after ventriculo-peritoneal shunt in 5 children. The pathophysiology of hydrocele and inguinal hernia seems to be the same because of the similar distribution of onset age between them but hydrocele has various clinical courses. The results that 34.6% of boys operated after 2 years old had had hydrocele before 2 years of age and 28.8% of boys diagnosed after 2 years old did not undergo hydrocelectomy could not imply the proper age when hydrocelectomy could be performed. But operative repair of hydroceles after the age of 6 months seems to be recommendagle.

• Advances in pediatric surgery
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• 제5권1호
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• pp.58-63
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• 1999

Neuroblastoma is a solid tumor derived from neural crest cells of the sympathetic nervous system. It is the most common extracranial solid tumor in children. Although it has the highest rate of spontaneous regression, it has a bad prognosis. Recent reports indicate a much improved outcomes utilizing the multitreatment approaches and early diagnosis as a result of patient screening. We have studied 42 patients managed in the last decade at the Severance and Yongdong Severance Hospitals. The patients were followed until January 1998 and analyzed in terms of age, sex, admission period, stage, diagnostic studies, clinical symptoms, physical findings, operative time, treatment modalities, and survival rate. Twenty eight patients underwent operative procedures, 16 patients had postoperative chemotherapy, and 19 patients had preoperative chemotherapy. Sexual difference was 1.33:1 in favor of males, and 43 % of patients were under one year of age. The patients were initially diagnosed as a result of symptoms and signs. An abdominal mass was the most common clinical finding. Eighty six percent of the patients were in advanced stages (>Stage III of INSS). The 2 year survival rate was 59.2 % and the 5 year survival rate was 29.6 %.

• Advances in pediatric surgery
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• 제5권2호
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• pp.121-125
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• 1999

To study the role of anomalous pancreatico-biliary ductal union (APBDU) in the development of choledochal cyst, we reviewed 23 cases. APBDU is defined as a long common channel(>0.4 mm). The patients ages ranged from 1 week to 112 months and the mean age was 22.5 months. Right upper quadrant pain was the most prevalent symptom. The diagnosis was made by ultrasonography and operative cholangiography in most patient. The preoperative diagnosis was made in 100 % of the cases. Gallstones were found in 5 cases. Todani type I and type IV were prevalent. A long common channel was found in all cases. The operative treatment consisted of cyst excision and Reux-en-Y hepaticojejunostomy or choledochojejunosotmy. One patient had postoperative pancreatitis. There was no mortality. We conclude that detection of choledochal cyst is occurring at a younger age and APBDU seems to play an important role in the pathogenesis of type I and IV cysts. Cyst excision is the treatment of choice to eliminate repeated cholangitis and malignant transformation.

• 대한소아치과학회지
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• 제42권2호
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• pp.136-143
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• 2015

과거에 비해 교정치료에 대한 일반인의 관심이 증가하고 소아청소년기에 교정치료를 시작하는 경우가 증가하고 있으며 소아치과에서 교정치료가 차지하는 비율 또한 증가하는 추세이다. 이러한 변화에 맞추어 소아치과에 내원하는 교정환자의 분포양상을 파악하고 치료의 경향을 알아보기 위하여 본 연구를 시행하였다. 2004년 1월 1일부터 2013년 12월 31일까지 10년간 전남대학교 치과병원 소아치과에 내원하여 교정 진단을 받은 670명의 환자(남자 349명, 여자 321명)를 대상으로 조사를 진행하였으며 다음과 같은 결과를 얻었다. 연도별 교정환자 수가 불규칙한 증감추세를 보였으며, 월별 분포에서 방학인 1, 2, 7, 8월에 많았다. 연령별 교정환자 수는 8세가 19.6%로 가장 많았고 7세, 9세, 10세, 11세, 6세 순서로 나타났다. 수평적 골격형태에 따른 분포는 골격성 1급 형태가 48.1%로 가장 많았고 2급(28.7%), 3급(23.2%) 순서로 나타났다. 수직적 골격형태는 mesofacial type이 65%로 가장 많았고 dolichofacial type(19.3%), brachyfacial type(15.8%) 순서로 나타났다. 1차 교정치료 기간이 2004년(30.4개월)부터 2013년(11.5개월)까지 지속적으로 감소하였다.

• 대한소아치과학회지
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• 제41권2호
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• pp.145-151
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• 2014

본 연구의 목적은 전신질환으로 입원한 환자의 소아치과 협진 의뢰 현황에 대한 통계분석을 실시하여 소아치과로 의뢰되는 전신질환 환자 실태를 파악하는 것이다. 2012년 한 해 동안 연세대학교 세브란스 병원에 전신질환으로 입원한 소아환자 중 소아치과에 의뢰되어 실제 진료를 받았으며 그 기록이 온전한 391건을 대상으로 하였다. 환자의 나이, 성별, 전신질환명, 협진의뢰과, 협진주소, 치과적 진단명, 치과적 치료 내용, 사망여부로 분류하여 통계 분석하였으며 환자 정보의 수집은 연세의료원의 Clinical Data Retrieval System을 이용하였다. 총 288명의 환자(M:F=166:122)가 소아치과로 의뢰되었으며 평균 연령은 5.9세였다. 재활의학과에서 129건(33.1%), 소아혈액종양내과에서 80건(20.5%), 소아심장과에서 51건(13.0%), 소아신경과에서 44건(11.3%)이 의뢰되었다. 협진주소는 기본 구강검진(156cases, 39.7%), 치아우식증(55cases, 14.0%), 수술 전 검진(50cases, 12.8%)순으로 많았으며 이 외에도 구강통증, 외상, 치아동요도, 교정치료, 자해로 인한 외상, obturator 제작 등 다양한 주소로 의뢰되었음이 확인되었다. 협진 의뢰된 환자의 절반 가량은 특별한 치료 없이 구강검사만을 시행하였으며(193건, 49%), 보존치료 및 예방치료는 각각 63건, 60건으로 비슷한 것으로 나타났다. 전신질환으로 입원한 환자의 소아치과 의뢰 현황을 분석한 결과 구강검진을 포함한 다양한 주소로 의뢰됨이 확인되었으며 재활의학과 및 소아혈액종양내과에서 가장 많은 의뢰가 이루어졌다. 의뢰된 환자의 치과적 진단명은 치아우식증이 가장 많았고 이에 대한 비침습적이고 예방적 치과치료가 주로 이루어졌다. 입원환자의 전신건강관리와도 밀접한 구강질환 예방 및 처치를 위하여 치과협진이 독려되어야 할 것이며 이를 위한 의사 및 보호자의 인식 개선이 요구된다.

• Advances in pediatric surgery
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• 제15권2호
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• pp.149-156
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• 2009

Contralateral groin exploration (CGE) in children with unilateral inguinal hernia remains controversial. Between January 2002 and December 2007, 1967 pediatric patients with inguinal hernia were treated by two surgeons with different criteria of CGE (group A; boys younger than 2 years, older boys prematurely delivered, and all girls, B; birth weight lower than 2 kg with inguinal hernia presentation within 6 months after birth, and suspicious physical findings) at Samsung medical center. Patient's age, sex, body weight, diagnosis, and metachronous contralateral inguinal hernia (MIH) incidence were analyzed retrospectively. Among 895 patients in group A, CGE was performed in 460 patients (66.4 %) and MIH incidence was 1.7 %. In group B, 31 patients (3.5 %) had CGE among 1072 patients, and MIH incidence was 4.2 %. The average hospital costs of group A and B were 763,956 won and 500,708 won, respectively. The CGE criteria of group B had advantage in total hospital cost. The primary site and the age at presentation had a signiticant effect on the incidence of MIH. But MIH incidence was low and the more contralateral explorations lead to increase of total costs. Therefore, routine contralateral groin exploration and surgery for a patent processus vaginalis could not be justified.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권5호
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• pp.423-429
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• 2020

Purpose: Alimentary tract duplication (ATD) is a rare congenital condition that may occur throughout the intestinal tract. Clinical symptoms are generally related to the involved site, size of duplication, or associated ectopic mucosa. This study aimed to identify clinical implications by anatomical locations and age group and then suggest a relevant management according to its distinct features. Methods: We retrospectively reviewed the clinical data of pediatric patients who received a surgical management due to ATD. Furthermore, data including patients' demographics, anatomical distribution of the duplication, clinical features according to anatomical variants, and outcomes were compared. Results: A total of 25 patients were included in this study. ATD developed most commonly in the midgut, especially at the ileocecal region. The most common clinical presentation was abdominal pain, a sign resulting from intestinal obstruction, gastrointestinal bleeding, and intussusception. The non-communicating cystic type was the most common pathological feature in all age groups. Clinically, prenatal detection was relatively low; however, it usually manifested before the infantile period. A laparoscopic procedure was performed in most cases (18/25, 72.0%), significantly in the midgut lesion (p=0.012). Conclusion: ATD occurs most commonly at the ileocecal region, and a symptomatic one may usually be detected before the early childhood period. Surgical management should be considered whether symptom or not regarding its symptomatic progression, and a minimal invasive procedure is the preferred method, especially for the midgut lesion.