• Clinical and Experimental Pediatrics
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• v.46 no.2
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• pp.203-206
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• 2003

Castleman's disease is an atypical lymphoproliferative disorder of unknown origin. It has three histologic variants(hyaline vascular, plasma-cell, and mixed) and two clinical types(localized and multicentric). Some sufferers have constitutional symptoms and laboratory abnormalities such as anemia, hypoalbuminemia, hypergammaglobulinemia, and elevated erythrocyte sedimentation rate. The localized form is cured by complete surgical excision whereas the multicentric form is managed by prednisone and other immunosuppressor drugs. The prognosis of the multicentric form is worse than the localized form since malignancies and severe infections may lead to a rapidly fatal outcome. Castleman's disease has been rarely reported at pediatric age in Korea. We experienced two cases of Castleman's disease detected at 3 and 5 years of age. They were presented with painless enlargement of submandibulars and axillary lymph nodes but had no associated symptoms. The lesions were excised and diagnosed as Castleman's disease, and no recurrence was noted during follow-up periods.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.19 no.4
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• pp.281-285
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• 2016

Laparoscopic cholecystectomy, though an uncommon surgical procedure in paediatric age group is still associated with a higher risk of post-operative bile duct injuries when compared with the open procedure. Small leaks from extra hepatic biliary apparatus usually lead to the formation of a localized sub-hepatic bile collection, also known as biloma. Such leaks are rare complication after laparoscopic cholecystectomy, especially in paediatric age group. Minor bile leaks can usually be managed non-surgically by percutaneous drainage combined with endoscopic retrograde cholangio-pancreatography (ERCP). However, surgical exploration is required in cases not responding to non-operative management. If not managed on time, such injuries can lead to severe hepatic damage. We describe a case of an eight-year-old girl who presented with biloma formation after laparoscopic cholecystectomy who was managed by ERCP.

• The Korean Journal of Pain
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• v.25 no.4
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• pp.267-271
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• 2012

The Nuss procedure for the correction of Pectus Excavatum (PE) is associated with intense postoperative pain. Our strategy to control early postoperative pain is to combine epidural with intravenous analgesia. Our aim was to analyse our pain control strategy by reviewing all the PE cases treated at our institution. Sixty consecutive patients, aged between 12 and 26 years old, received the PE operation at our institution from January, 2007 to September, 2010. The median age was 16 (12-27) with a male/female ratio of about 7/1. An epidural catheter was employed in all the cases, with 38 patients (63%) requiring additional drugs to control pain, which remained in place for 74 hours (72-96). The pain score was higher in male patients, but lower in those younger than 16 years old. Moreover, patients that consumed benzodiazepines had a significant decrease in cumulative opioid intake (P = 0.0408). Both gender and age had an impact on pain control, while we noticed a synergistic effect between opiates and tranquillizers.

• Journal of Korean Neurosurgical Society
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• v.59 no.3
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• pp.233-241
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• 2016

In this review, we discuss in detail our current procedure for treating craniosynostosis using multidirectional cranial distraction osteogenesis (MCDO). The MCDO method allows all phenotypes of skull deformity to be reshaped by distraction osteogenesis, except in patients who are 5 months of age or younger and patients with posterior cranial vault problems. We report the results of clinical data of 36 children with craniosynostosis who underwent MCDO between 2005 and 2014 in our institute. This method has the following benefits, such as a high flexibility of reshaping, shorter treatment period and less invasive secondary intervention. We also discuss the other distraction osteogenesis techniques that are used to treat craniosynostosis and compare them with MCDO. The preferred procedure for correction of craniosynostosis may depend on the patient's age, the extent of deformity, and the extent of correction achievable by surgery. We can arrange the combinations of various methods according to the advantage and disadvantage of each technique.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.6 no.2
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• pp.215-220
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• 2003

A 14-month-old child visited emergency room with stuporous mental state. He had been suffering from failure to thrive (FTT) and emaciation since three months of age, but he had good appetite and had been euphoric. A large mass was found in the third ventricle by brain CT and MRI. His parents refused operative removal of the mass and he expired 14 days after admission. It is necessary to include diencephalic syndrome in the differential diagnosis of failure to thrive when infants show FTT despite of good appetite and euphoric status.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.18 no.4
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• pp.224-229
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• 2015

Cyclic vomiting syndrome (CVS) is a functional disorder characterized by stereotypical episodes of intense vomiting separated by weeks to months. Although it can occur at any age, the most common age at presentation is 3-7 years. There is no gender predominance. The precise pathophysiology of CVS is not known but a strong association with migraine headaches, in the patient as well as the mother indicates that it may represent a mitochondriopathy. Studies have also suggested the role of an underlying autonomic neuropathy involving the sympathetic nervous system in its pathogenesis. CVS has known triggers in many individuals and avoiding these triggers can help prevent the onset of the episodes. It typically presents in four phases: a prodrome, vomiting phase, recovery phase and an asymptomatic phase until the next episode. Complications such as dehydration and hematemesis from Mallory Wise tear of the esophageal mucosa may occur in more severe cases. Blood and urine tests and abdominal imaging may be indicated depending upon the severity of symptoms. Brain magnetic resonance imaging and upper gastrointestinal endoscopy may also be indicated in certain circumstances. Management of an episode after it has started ('abortive treatment') includes keeping the patient in a dark and quiet room, intravenous hydration, ondansetron, sumatriptan, clonidine, and benzodiazepines. Prophylactic treatment includes cyproheptadine, propranolol and amitriptyline. No mortality has been reported as a direct result of CVS and many children outgrow it over time. A subset may develop other functional disorders like irritable bowel syndrome and migraine headaches.

• Journal of Chest Surgery
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• v.28 no.1
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• pp.18-22
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• 1995

From January 1989 to December 1993, cardiac catheterization and open heart surgery for ventricular septal defect closure were performed in 115 pediatric patients who were selected as meeting the criteria for elective closure of restrictive ventricular septal defect. These criteria included age greater than 1 year and less than 15 years, no evidence of congestive heart failure, Qp/Qs 2.0, pulmonary artery systolic pressure 35mmHg, and no associated cardiac anomalies. Mean age of patients was 5.25$\pm$ 3.53, and 72 patients were male, 43 patients were female[male:female=1.9:1 . Mean systolic pulmonary artery pressure was 19.66$\pm$4.79mmHg, and mean pulmonary to systemic flow ratio was 1.27$\pm$ 0.28. Aortic cusp prolapse was present in 30 patients [26% , aortic insufficiency was present in 1 paient, and 1 patient had prior bacterial endocarditis. There were no instances of complete atrioventricular dissociation, reoperations for bleeding, or reoperations for recurrent ventricular septal defect, but wound infection was present in 1 patient, and there were 7 patients who had the hemodynamically insignificant remnant shunt. There were no early or late deaths or major morbidity.

• Advances in pediatric surgery
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• v.14 no.2
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• pp.125-133
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• 2008

To evaluate the long-term prognosis of biliary atresia after Kasai operation, a total of 14 patients (of the 41 patients operated upon from 1982 to 1997), who had been followed up for more than 10 years, were included in this retrospective study. Eleven out of 14 patients survived with their native livers, and their data analyzed for age at operation, clearing time of jaundice, histological outcome, postoperative complications, effectiveness after the application of an intussusception anti-reflex valve, and quality of life. Average age at surgery was 62.8 days. Serum bilirubin was normalized within three months in all patients. Six among the eleven long-term survivors had ascending cholangitis as one of the postoperative complications. The application of an intussusception anti-reflux valve did not show any statistical significance in long-term survival. Most of long-term survivors appeared to enjoy good quality of life. Kasai operation might not be the definitive treatment for biliary atresia; however, Kasai operation made it possible to achieve long-term survival for patients with biliary atresia when the patients were detected and treated as early as possible.

• Advances in pediatric surgery
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• v.8 no.2
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• pp.133-137
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• 2002

To evaluate the clinical characteristics and results of treatment of fistula-in-ano and perianal abscess in childhood, we analyzed 95 cases of fistula-in-ano and/or perianal abscess seen in childhood, between January 1995 and June 2001 at the Department of General Surgery of Ewha Womans University Mokdong Hospital. Perianal abscess was in 25 patients, anal fistula in 62 and combined disease (perianal fistula and abscess) in 8. Male predominance was noted (95%). Median age was 8 months and 78% of cases were presented under the age of 1 year. Median duration of symptoms was 60 days. Twenty four abscesses (77%) and 18 lesions (72%) of combined disease (n=25) were located on both lateral sides of the anus, and fistulas located on both lateral sides were 33 (53%). Multiplicity of the lesion was noted in 25% of cases. Sixteen percent of abscess, 81% of fistula and 88% of combination group have had previous perianal abscesses. The perianal abscesses were treated with incision and currettage and fistulas were treated with fistulotomy or fistulectomy. There were no recurrent diseases and no complications after surgical treatment. Although the progresses of the perianal abscess and fistula in ano in childhood may be self-limitied, surgical management was safe and curable.

• Advances in pediatric surgery
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• v.9 no.1
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• pp.41-44
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• 2003

Appendicitis is the most common surgical emergency in childhood. Open appendectomy has been the standard treatment. The minimally invasive techniques have been adopted in children after experiences in various surgical conditions in adults has accumulated. It is debatable whether laparoscopic appendectomy (LA) is superior to open appendectomy (OA) in children. The goal of this study is to review the results of laparoscopy and laparotomy in the nonperforated appendicitis. The records of 22 patients under 15 years of age who were operated upon for nonperforated appendicitis at Asan Medical Center were analyzed between December 2002 and April 2003. Age, type and length of intervention, frequency of analgesic use, complication, length of hospitalization, and cost for each treatment groups (N=11) were compared. Laparoscopy patients were older (13.0 vs. 10.1 years; p > 0.05), and operative time was longer (55.0 vs. 35.0 minutes; p < 0.05). There was no conversion (OA to LA). The median length of hospital stay was significantly shorter in laparoscopy (3.0 vs. 2.0 days; p < 0.05). The median cost for LA was more expensive (W833, 836 vs. W751,398; p < 0.05). Even though there were higher costs and longer operative times with laparoscopic procedures, the shorter hospital stay was an advantage.