• Advances in pediatric surgery
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• v.14 no.2
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• pp.134-143
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• 2008

Infantile hepatic hemangioendothelioma (IHHE) is the most common benign vascular hepatic tumor in children. We analyzed the 17-year experience of IHHE. The medical records of 16 patients (M:F=8:8) treated at the Department of Pediatric Surgery and the Department of Pediatrics Seoul National University Children's Hospital between January 1991 and January 2008 were reviewed retrospectively. Mean age at presentation was 87 days (1 day - 551 days). Seventy five percent of patients were diagnosed with imaging study and 25 % with biopsy. Major symptoms were hepatomegaly (N=5), palpable abdominal mass (N=4) and congestive heart failure (N=3). Six patients had no symptoms. Kasabach-Merritt syndrome was combined in one patient. Nine patients (56.3 %) underwent operation and 2 patients (12.5 %) underwent only medical treatment. Clinical observation was tried on 5 patients (31.3 %) without any treatment. Operation was performed on the patient with clinical symptoms or on patients where the differentiation between begin and malignant could not be determined. Patients who had clinical symptoms but tumor was unreresectabile were treated medically. Among the 5 patients who had been observed for their clinical course, 2 patients showed complete regression and the tumors of the remaining 3 patients were regressing. Clinical symptoms, the age at presentation, the size of tumor and ${\alpha}$-FP, all had no significant statistical relationship with the time required for complete tumor regression. There was no relationship between the size change of the tumor and the change of ${\alpha}$-FP level. Only the size of tumor was related with clinical symptoms. One patient died of post-operatvie bleeding. Treatment plan was determined by the extent of the tumor and the presence of clinical symptoms. Observation was enough for the patients without clinical symptoms and complete resection was curative for patients with clinical symptoms. Medical treatment is an alternative for the patient whose tumor is unresectable.

• Clinical and Experimental Pediatrics
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• v.63 no.5
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• pp.184-188
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• 2020

Background: Many critically ill patients require transfer to a higher-level hospital for complex medical care. Despite the publication of the American Academy of Pediatrics guidelines for pediatric interhospital transportation services and the establishment of many pediatric transport programs, adverse events during pediatric transport still occur. Purpose: To determine the incidence of adverse events occurring during pediatric transport and explore their complications and risk factors. Methods: This prospective observational study explored the adverse events that occurred during the interhospital transport of all pediatric patients referred to the pediatric intensive care unit of Ramathibodi Hospital between March 2016 and June 2017. Results: There were 122 pediatric transports to the unit. Adverse events occurred in 25 cases (22%). Physiologic deterioration occurred in 15 patients (60%). Most issues (11 events) involved circulatory problems causing patient hypotension and poor tissue perfusion requiring fluid resuscitation or inotropic administration on arrival at the unit. Respiratory complications were the second most common cause (4 events). Equipment-related adverse events occurred in 5 patients (20%). The common causes were accidental extubation and endotracheal tube displacement. Five patients had both physiologic deterioration and equipment-related adverse events. Regarding transport personnel, the group without complications more often had a physician escort than the group with complications (92% vs. 76%; relative risk, 2.4; P=0.028). Conclusion: The incidence of adverse events occurring during the transport of critically ill pediatric patients was 22%. Most events involved physiological deterioration. Escort personnel maybe the key to preventing and appropriately monitoring complications occurring during transport.

• Advances in pediatric surgery
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• v.1 no.1
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• pp.33-39
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• 1995

The incidence of Meckel's diverticulum(MD) in general population has been assessed as 2 percent. The major complications of MD are bleeding, perforation, and intestinal obstruction. In spite that the complication rate of Meckel's diverticulum is relatively high(about 4.2% during a lifetime), the preoperative diagnostic rate of complicated MD is very low. Authors investigated the clinical characteristics of complicated MD to improve the diagnostic rate. 16 patients with complicated Meckel's diverticulum who were operated upon at the Department of Pediatric Surgery, Seoul National University Children's Hospital from June 1985 to December 1993 were reviewed. Among the 16 patients with complicated MD, 12 patients(75%) were under 2 year-old and male were predominant(88%). The most common complication was bleeding patients with bleeding MD (8 cases) were diagnosed preoperatively as MD. 8 patients with other complications(perforation : 4 cases, obstruction : 4 cases) could not be suspected as complicated MD except one patient who had previous history of melena. These patients were diagnosed after exploratory laparotomy under the various impression other than MD. Among 12 patients with ulcer related complications such as bleeding and perforation, heterotopic gastric mucosa was found in 11 patients. In conclusion, in any children with unexplained acute abdomen, especially under 2 years old, complicated MD must be included in differential diagnosis. In children with obscure lower gastrointestinal bleeding, $^{99m}Tc$-pertechnetate scintigraphy is a useful diagnostic tool to rule out bleeding MD.

• Experimental and Molecular Medicine
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• v.50 no.11
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• pp.14.1-14.14
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• 2018

The link between antibiotic treatment and IF-associated liver disease (IFALD) is unclear. Here, we study the effect of antibiotic treatment on bile acid (BA) metabolism and investigate the involved mechanisms. The results showed that pediatric IF patients with cholestasis had a significantly lower abundance of BA-biotransforming bacteria than patients without cholestasis. In addition, the BA composition was altered in the serum, feces, and liver of pediatric IF patients with cholestasis, as reflected by the increased proportion of primary BAs. In the ileum, farnesoid X receptor (FXR) expression was reduced in patients with cholestasis. Correspondingly, the serum FGF19 levels decreased significantly in patients with cholestasis. In the liver, the expression of the rate-limiting enzyme in bile salt synthesis, cytochrome P450 7a1 (CYP7A1), increased noticeably in IF patients with cholestasis. In mice, we showed that oral antibiotics (gentamicin, GM or vancomycin, VCM) reduced colonic microbial diversity, with a decrease in both Gram-negative bacteria (GM affected Eubacterium and Bacteroides) and Gram-positive bacteria (VCM affected Clostridium, Bifidobacterium and Lactobacillus). Concomitantly, treatment with GM or VCM decreased secondary BAs in the colonic contents, with a simultaneous increase in primary BAs in plasma. Moreover, the changes in the colonic BA profile especially that of tauro-beta-muricholic acid ($T{\beta}MCA$), were predominantly associated with the inhibition of the FXR and further altered BA synthesis and transport. In conclusion, the administration of antibiotics significantly decreased the intestinal microbiota diversity and subsequently altered the BA composition. The alterations in BA composition contributed to cholestasis in IF patients by regulating FXR signaling.

• Advances in pediatric surgery
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• v.7 no.1
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• pp.37-41
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• 2001

In hepatoblastoma, encouraging cure rates have been achieved with recent advances in chemotherapy and surgical techniques, The aim of this study is to evaluate the role of combined therapeutic modalities and surgical resection in hepatoblastoma. Fifteen cases of hepatoblastoma were treated from January 1993 to August 2000. Six patients had resectable tumors at initial diagnosis. All underwent surgical resection and in four patients postoperative adjuvant chemotherapy was needed. Nine out of 15 patients had unresectbale tumors at initial diagnosis, and preoperative chemotherapy was applied. There was one operative mortality and 14 patients showed good prognosis after surgery. Although various treatment modalities should be combined for the unresectable hepatoblastoma. surgical resection remains the major curative procedure.

• ETRI Journal
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• v.41 no.4
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• pp.515-527
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• 2019

This paper discusses the design, implementation, and potential use of an ontology-based mobile pediatric consultation and monitoring system, which is a smart healthcare expert system for pediatric patients. The proposed system provides remote consultation and monitoring of pediatric patients during their illness at places distant from medical service areas. The system not only shares instant medical data with a pediatrician but also examines the data as a smart medical assistant to detect any emergency situation. In addition, it uses an inference engine to infer instant suggestions for performing certain initial medical treatment steps when necessary. The applied methodologies and main technical contributions have three aspects: (a) pediatric consultation and monitoring ontology, (b) semantic Web rule knowledge base, and (c) inference engine. Two case studies with real pediatric patients are provided and discussed. The reported results of the applied case studies are promising, and they demonstrate the applicability, effectiveness, and efficiency of the proposed approach.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.24 no.6
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• pp.546-554
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• 2021

Purpose: Malnutrition is a significant issue for pediatric patients with cancer. We sought to evaluate the effectiveness and complication rate of percutaneous endoscopic gastrostomy (PEG) placement in pediatric oncology patients. Methods: A retrospective chart review was performed on 49 pediatric oncology patients undergoing PEG placement at Johns Hopkins All Children's Hospital between 2000 and 2016. Demographic and clinical characteristics, complications, absolute neutrophil count at time of PEG placement and at time of complications, length of stay, and mortality were identified. Weight-for-age Z-scores were evaluated at time of- and six months post-PEG placement. Results: The overall mean weight-for-age Z-score improved by 0.73 (p<0.0001) from pre- (-1.11) to post- (-0.38) PEG placement. Improvement in Z-score was seen in patients who were malnourished at time of PEG placement (1.14, p<0.0001), but not in those who were not malnourished (0.32, p=0.197). Site infections were seen in 12 (24%), buried bumper syndrome in five (10%), and tube dislodgement in one (2%) patient. One patient (2%) with fever was treated for possible peritonitis. There were no cases of other major complications, including gastric perforation, gastrocolic fistula, clinically significant bleeding, or PEG-related death documented. Conclusion: Consistent with previous studies, our data suggests a relationship between site complications (superficial wound infection, buried bumper syndrome) and neutropenia. Additionally, PEG placement appears to be an effective modality for improving nutritional status in malnourished pediatric oncology patients. However, larger prospective studies with appropriate controls and adjustment for potential confounders are warranted to confirm these findings.

• Journal of Korean Medicine Rehabilitation
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• v.31 no.4
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• pp.145-156
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• 2021

Objectives This study aims at using information about treatment satisfaction obtained from surveying pediatric traffic-accident patients to guide future improvement in the quality of traditional Korean medical services. Methods The survey included 95 pediatric patients treated for traffic-accident injuries at a traditional Korean medical institution. The questionnaire was developed from a similar satisfaction survey for adult traffic-accident patients and approved by a traditional Korean pediatrician. The year-long survey ran from April 2020 to April 2021. The collected data were analysed using t-tests, one-way analysis of variance, and cross-tabulation. Results Of the pediatric traffic-accident patients surveyed, the highest percentage of children were aged between 1 and 7 years (70.5%). Just over half the patients (55.8%) complained of sleeping difficulties, and 54.7% exhibited symptoms of anxiety and fear. Almost all the patients surveyed (97.9%) reported an improvement in their symptoms after undergoing traditional Korean medical treatment. The degree of satisfaction with the treatment correlated with the alleviation of symptoms. Approximately 83.2% of respondents reported 'difficult-to-administer treatment for children' and rated their satisfaction degree comparatively lower than those patients with no reported treatment difficulties. The most struggling treatment was herbal medicine (42.1%), highlighting the need for improvement in the adaptability of herbal medicine to the treatment of pediatric patients. Conclusions Treatment acceptance by pediatric traffic-accident patients affects reported treatment satisfaction. It is important to improve treatment experience and adaptability to pediatric patients to improve the perceived quality of traditional Korean medical services.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.22 no.1
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• pp.28-40
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• 2019

The incidence of pediatric-onset inflammatory bowel disease (IBD) is on the rise, accounting for up to 25% of IBD cases. Pediatric IBD often has extensive bowel involvement with aggressive and rapidly progressing behavior compared to adult IBD. Because IBD has a high morbidity rate and can have a lifelong impact, successful transition from pediatric to adult care is important to maintain the continuity of care. Furthermore, successful transition facilitates appropriate development and psychosocial well-being among patients, as well as comprehensive and harmonious healthcare delivery amongst stakeholders. However, there are various obstacles related to patients, family, providers, and organizations that interfere with successful transition. Successful transition requires a flexible and tailored plan that is made according to the patient's developmental abilities and situation. This plan should be established through periodic interviews with the patient and family and through close collaboration with other care providers. Through a stepwise approach to the transition process, patients' knowledge and self-management skills can be improved. After preparation for the transition is completed and the obstacles are overcome, patients can be gradually moved to adult care. Finally, successful transition can increase patients' adherence to therapy, maintain the appropriate health status, improve patients' self-management, and promote self-reliance among patients.

• Advances in pediatric surgery
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• v.14 no.2
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• pp.164-172
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• 2008

The survival rate for rhabdomyosarcoma (RMS) has significantly improved after the introduction of combined multimodality treatment. We report the 20-year treatment outcome of pediatric rhabdomyosarcoma in a single institution. The medical records of 16 patients treated for rhabdomyosarcoma between December 1986 and August 2007 at the Department of Pediatric Surgery, Seoul National University Children's Hospital, were retrospectively reviewed. Mean age at diagnosis was 7.1 years (range: 1.3 -14.2 years). Retroperitoneum was the most common primary site (n=7, 43.8 %), and embryonal type was predominant (n=11, 6 %). Before the treatment, most patients were in advanced TNM stage (stage III 50 %, IV; 25 %). The patient distribution according to the Intergroup Rhabdomyosarcoma Study Clinical Grouping System (IRS-CGS) was as follows; Group I 31.3 %, Group II 12.5 %, Group III 31.3 % and Group IV 25 %. Patients were classified into three groups according to the extent of resection of the primary tumor; complete resection (CR, n=5; 31.3 %), gross total resection (GTR, n=7; 43.8 %) and incomplete resection (IR, n=4; 25 %). Recurrence was observed in 9 patients (56.3 %) while there was no recurrence in CR patients. All patients with recurrence were identified as moderate or high-risk according to the IRS-V Risk Group. Pre-treatment TNM stage of RMS in our institution was advanced with aggressive clinical feature, however postsurgical conditions according to IRS-CGS were similar to the previous reports by IRS. This suggests that down-staging of IRS-CGS was achieved with multimodality treatment with CR or GTR. It also suggests that complete resection is the most important prognostic factor in the treatment of RMS in children. Patients classified as moderate or high-risk need close follow-up due to high recurrence rate. In case of localized recurrence, better outcome may be achieved with multimodality treatment including limited surgery.