• Neonatal Medicine
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• v.25 no.1
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• pp.23-28
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• 2018

Purpose: Abdominoperineal solid tumors presenting in neonates often require surgical intervention during the neonatal period. Although we report our single-center experience, this study would be meaningful to understand the clinical implications of these neoplasms. Methods: We retrospectively reviewed and analyzed the clinical data and characteristics of 22 patients (${\leq}28$ days old) diagnosed with histopathologically confirmed abdominoperineal solid neoplasms (benign or malignant) after surgical resection. Results: The mean gestational age and postnatal age at the time of operation were $38.3{\pm}1.8weeks$ and $13.5{\pm}8.3days$, respectively. Most patients (18/22, 81.8%) were diagnosed during antenatal care visits; however, 4 (18.2%) were identified after birth. The mean tumor size was $6.4{\times}5.3cm$ (3.5-17.0 cm), and tumors occurred most frequently within the sacrococcygeal region (8/22, 36.4%). Histopathologically, 14 patients (63.6%) demonstrated benign tumors and 8 (36.4%) demonstrated malignant tumors. Germ cell tumors and hepatoblastomas were the most commonly observed tumors. Fortunately, all patients showed a localized pattern of tumor involvement without distant metastasis. No recurrence or mortality was observed during the follow-up period (mean $66.4{\pm}44.2months$). Conclusion: Abdominoperineal solid tumors occurring in neonates show variable clinical patterns during the antenatal and postnatal monitoring/screening periods. We conclude that aggressive and multidisciplinary approaches could achieve good clinical results in these patients.

• Journal of Trauma and Injury
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• v.28 no.3
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• pp.149-157
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• 2015

Purpose: Traumatic brain injury (TBI) is the most common cause of pediatric trauma patients came to the emergency department. Without guidelines, many of these children underwent repeat brain computed tomography (CT). The purpose of this study was to evaluate the value of repeat brain CT in children with TBI. Methods: We conducted a retrospective study of TBI in children younger than 19 years of age who visited the emergency department (ED) from January 2011 to December 2012. According to the Glasgow Coma Scale (GCS) and Pediatric Glasgow Coma Scale score of the patients, study population divided in three groups. Clinical data collected included age, mechanism of injury, type of TBI, and outcome. Results: A Total 83 children with TBI received repeat brain CT. There were no need for neurosurgical intervention in mild TBI (GCS score 13-15) group who underwent routine repeat CT. 4 patients of mild TBI group, received repeat brain CT due to neurological deterioration, and one patient underwent neurosurgical intervention. Routine repeat CT identified 12 patients with radiographic progression. One patient underwent neurosurgical intervention based on the second brain CT finding, who belonged to the moderate TBI (GCS score 9-12) group. Conclusion: Our study showed that children with mild TBI can be observed without repeat brain CT when there is no evidence of neurologic deterioration. Further study is needed for establish indication for repetition of CT scan in order to avoid unnecessary radiation exposure of children.

• Journal of Korean Neurosurgical Society
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• v.37 no.3
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• pp.207-212
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• 2005

Objective: Classically, single photon emission tomography is known to be the reference standard for evaluating the hemodynamic status of patients with moyamoya disease. Recently, T2-weighted perfusion magnetic resonance(MR) imaging has been found to be effective in estimating cerebral hemodynamics in moyamoya disease. We aim to assess the utility of perfusion-weighted MR imaging for evaluating hemodynamic status of moyamoya disease. Methods: The subjects were fourteen moyamoya patients(mean age: 7.21 yrs) who were admitted at our hospital between Sep. 2001 to Sep 2003. Four normal children were used for control group. Perfusion MR imaging was performed before any treatment by using a T2-weighted contrast material-enhanced technique. Relative cerebral blood volume(rCBV) and time to peak enhancement(TTP) maps were calculated. Relative ratios of rCBV and TTP in the anterior cerebral artery(ACA), middle cerebral artery(MCA) and basal ganglia were measured and compared with those of the posterior cerebral artery(PCA) in each cerebral hemispheres. Using this data, we analysed the hemodynamic aspect of pediatric moyamoya disease patients in regarding to the age, Suzuki stage, signal change in FLAIR MR imaging, and hemispheres inducing symptoms. Results: The mean rCBV ratio of ACA, MCA did not differ between normal children and moyamoya patients. However the significant TTP delay was observed at ACA, MCA territories (mean = 2.3071 sec, 1.2089 see, respectively, p < 0.0001). As the Suzuki stage of patients is advanced, rCBV ratio is decreased and TTP differences increased. Conclusion: Perfusion MR can be applied for evaluating preoperative cerebral hemodynamic status of moyamoya patients. Furthermore, perfusion MR imaging can be used for determine which hemisphere should be treated, first.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.17 no.1
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• pp.41-46
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• 2014

Purpose: The spontaneous seroconversion rate of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) virus infection in children is lower than that in adults. However, few studies have investigated the rate of transition from the immune-tolerant to the early immune-clearance phase in children. Methods: From February 2000 to August 2011, we enrolled 133 children aged <18 years who had visited the Department of Pediatrics, Kyungpook National University Hospital. All subjects were in the immune-tolerant phase of HBeAg-positive CHB virus infection. The estimated transition rate into the early immune-clearance phase was calculated using the Kaplan-Meier method. Results: Among the 133 enrolled pediatric CHB virus infection patients in the HBeAg-positive immune-tolerant phase, only 21 children (15.8%) had converted to the early immune-clearance phase. The average age at entry into active hepatitis was $10.6{\pm}4.8$ years. The incidence of transition from the immune-tolerant to the early immune-clearance phase in these children was 1.7 episodes/100 patient-years. When analyzed by age, the estimated transition rate was 4.6%, 7.1%, and 28.0% for patients aged <6, 6-12, >12 years, respectively. Conclusion: In children with CHB virus infection, the estimated rate of entry into the early immune-clearance phase was 28.0% for patients aged 12-18 years, which was significantly higher than that observed for children aged <12 years (11.7%; p=0.001).

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.21 no.1
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• pp.59-67
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• 2018

Purpose: to compare cut off points corrected for age and gender (COOP) with fixed cut off points (FCOP) for fasting plasma insulin and Homeostatic model assessment-insulin resistance (HOMA-IR) for the diagnosis of IR in obese children and adolescents and their correlation with dyslipidemia. Methods: A multicenter, cross-sectional study including 383 subjects aged 7 to 18 years, evaluating fasting blood glucose, plasma insulin, and lipid profile. Subjects with high insulin levels and/or HOMA-IR were considered as having IR, based on two defining criteria: FCOP or CCOP. The frequency of metabolic abnormalities, the presence of IR, and the presence of dyslipidemia in relation to FCOP or CCOP were analyzed using Fisher and Mann-Whitney exact tests. Results: Using HOMA-IR, IR was diagnosed in 155 (40.5%) and 215 (56.1%) patients and, using fasting insulin, 150 (39.2%) and 221 (57.7%), respectively applying FCOP and CCOP. The use of CCOP resulted in lower insulin and HOMA-IR values than FCOP. Dyslipidemia was not related to FCOP or CCOP. Blood glucose remained within normal limits in all patients with IR. There was no difference in the frequency of IR identified by plasma insulin or HOMA-IR, both for FCOP and CCOP. Conclusion: The CCOP of plasma insulin or of HOMA-IR detected more cases of IR as compared to the FCOP, but were not associated with the frequency of dyslipidemia. As blood glucose has almost no fluctuation in this age group, even in the presence of IR, fasting plasma insulin detected the same cases of IR that would be detected by HOMA-IR.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.5
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• pp.430-438
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• 2020

Purpose: We investigated the clinical features and factors affecting the choice of treatment modality and the course of pediatric gallstone (GS) disease. Methods: We retrospectively analyzed the medical records of 65 patients diagnosed with GS using imaging studies between January 2009 and December 2017 were included. Results: This study included 65 patients (33 boys and 32 girls; mean age, 8.5±5.3 years; range, 0.2-18 years) who primarily presented with abdominal pain (34%), jaundice (18%), and vomiting (8%). Idiopathic GS occurred in 36 patients (55.4%). The risk factors for GS included antibiotic use, obesity, hemolytic disease, and chemotherapy in 8 (12.3%), 7 (10.8%), 6 (9.2%), and 4 patients (6.2%), respectively. We observed multiple stones (including sandy stones) in 31 patients (47.7%), a single stone in 17 (26.2%), and several stones in 17 (26.2%). GS with a diameter of <5 mm occurred in 45 patients (69.2%). Comorbidities included hepatitis, choledocholithiasis, cholecystitis, and acute pancreatitis in 20 (30.8%), 11 (16.9%), 11 (16.9%), and 4 patients (6.2%), respectively. Ursodeoxycholic acid (UDCA) was administered to 54 patients (83.1%), leading to stone dissolution in 22 patients (33.8%) within 6 months. Cholecystectomy was performed in 18 patients (27.7%) (mean age, 11.9±5.1 years). Most patients treated surgically had multiple stones (83%) and stones measuring <5 mm in size (89%), and 66.7% of patients had cholesterol stones. Conclusion: Cholecystectomy is feasible in patients with small-sized or large numbers of GS and those with persistent abdominal pain and/or jaundice. UDCA administration with close follow-up is recommended in patients with uncomplicated GS.

• Advances in pediatric surgery
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• v.3 no.2
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• pp.117-125
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• 1997

Seventy neonates with congenital intestinal atresia and stenosis who were treated at pediatric surgical service. Hanyang University Hospital from September 1979 to December 1996 were analyzed retrospectively. The lesion occurred in 27 cases at the duodenum, in 26 cases at the jeiunum, in 13 cases at the ileum and in 2 cases at the pylorus and colon each. There were 10 multiple atresias and 7 apple-peel anomaly cases. The atresia predominated over the stenosis by the ratio of 4 : 1. Male to female ratio was 1.3 : 1. The average gestational age was 38 weeks, and the average birth weight was 2,754 grams. Though 22.9 % were borne prematurely and 34.3 % had low birth weight, 92.3 % of them had a weight appropriate for gestational age. Polyhydramnios(40 %) was more frequently observed in duodenal and jeiunal atresia while microcolon in ileal atresia(58.3 %). Weight loss and electrolyte imbalance occurred more frequently in the duodenal stenosis cases because of delayed diagnosis. Twenty(55.6 %) of 37 jeiunoileal atresia cases had evidence of intrauterine vascular accident : 4 intrauterine intussusception, 3 intrauterine volvulus and 3 strangulated intestine in gastroschisis, and 10 cases of intrauterine peritonitis. There were one or more associated anomalies in 45 patients (64.3 %). Preoperatively proximal loop volvulus developed in 3 cases and proximal loop perforation in 5 cases and one case each of distal loop perforation, duodenal perforation and midgut volvulus occurred in the jeiunoileal atresia. Overall mortality rate was 20 %.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.1
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• pp.79-88
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• 2020

Purpose: Management of eosinophilic esophagitis (EoE) varies from center to center. In this study, we evaluated the effectiveness of a dairy-free diet (DFD) and the 6-Food Elimination Diet (SFED) as initial therapies for the treatment of EoE in our practice. Methods: This was a retrospective study of children who had been treated for EoE at Connecticut Children's Medical Center, Hartford, CT, USA. Pre- and post-treatment endoscopy findings and histology results of patients treated with DFD or SFED were examined. Results: One hundred fifty-two patients (age 9.2±5.2 years, 76.3% male, 69.7% caucasian) met the inclusion criteria for initial treatment with DFD (n=102) or SFED (n=50). Response for DFD was 56.9% and for SFED was 52.0%. Response based on treatment duration (<10, 10-12, and >12 weeks) were 81.8%, 50.0%, and 55.1% for DFD, and 68.8%, 50.0%, and 40.0% for SFED. Response based on age (<6, 6-12, and >12 years) were 59.3%, 42.9%, and 67.5% for DFD, and 36.4%, 58.8%, and 72.7% for SFED. In patients treated with DFD, concomitant proton pump inhibitor (PPI) administration resulted in improved outcomes (p=0.0177). Bivariate regression analysis showed that PPI with diet is the only predictor of response (p=0.0491), however, there were no significant predictors on multiple regression analysis. Conclusion: DFD and SFED are effective first line therapies for EoE. DFD should be tried first before extensive elimination diets. Concomitant therapy with PPI's may be helpful.

• Journal of the korean academy of Pediatric Dentistry
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• v.28 no.3
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• pp.391-402
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• 2001

The reports concerning dental disease in handicapped children are contentious, and there are many differences of opinion as to what extent handicapped children differ in oral health and disease from healthy children. The present study was done by conducting a comprehensive study and evaluation of the oral health between the 267 handicapped and the 128 normal persons with regard to caries rate, occlusion and the condition of the periodontium. The result showed that the dft, the dfs and DMFT indices of handicapped persons according to age were significantly lower than those of normal persons(p<0.05). The prevalence of gingivitis in handicapped persons increased with age and was significantly higher than those reported for normal persons(p<0.001). It was found that the handicapped group had a significant difference in the class distribution of occlusion, with a higher percentage of Class II and Class III occlusion from that observed in the control group(p<0.05).

• Advances in pediatric surgery
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• v.12 no.2
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• pp.175-182
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• 2006

VATER association is defined as a combination of 3 or more anomalies- vertebra (V), imperforate anus (A), esophageal atresia with or without tracheoesophageal fistula (TE), renal and radial anomaly(R). We reviewed our experiences in one center to determine etiology, prevalence, clinical manifestation, other associated anomaly and prognosis. Two hundred and twenty-three cases that underwent operations for imperforate anus or esophageal atresia were analyzed retrospectively through medical records at Department of Pediatric Surgery, Asan Medical Center from June, 1989 to July, 2005. The total number of neonates who had been admitted during period of study were 46,773 and VATER association was 9 (0.019 %, 1.92 persons per 10,000 neonates). Median gestational age and birth weight were $37^{+4}wk$ ($35^{+1}$ - $41^{+4}$) and 2,594 g (1,671-3,660), respectively and median age of mother was 32 years (23-38). There was no family history. Three patients were twins but their counterparts had no anomalies. Patients who have 3 anomalies were 6, 4 anomalies in two and 5 anomalies in one patient. Vertebra anomalies were detected in 7(77.7 %), imperforate anus in 8(88.9 %), esophageal atresia in 5 patients (55.6 %), renal anomaly in 6(66.7 %), and radial anomaly in 5(55.6 %), respectively. Four patients are alive, 2 patients were lost during follow up period. Three patients died due to neonatal sepsis, respiratory dysfunction and cardiac failure. VATER association did not appear to be a definite risk factor, but merely a randomized combination of 5 anomalies. The prognosis was dependent on the other associated anomalies, appropriateness of management and operation. Careful follow-up and aggressive treatmentare required for improving survival and quality of life.