Fluroscopic Removal of the Foreign Bodies from Gastroesophagus Using the Magnet

Ingested foreign bodies are common occurrences in the pediatric population. From October 2002 to April 2006, eight patients (6 male, mean age: 30.9+/-14.4 months, range: 7~45 months) who had ingested metallic foreign bodies, such as bar magnets, coin-type magnets, screws, metal beads, and disk batteries, were selected for foreign body removal using a magnetic device under floroscopic control. A 1-cm-long cylindrical magnet (6mm in diameter) was placed at the end of a 150-cm-long plastic tube from an IV set. The magnet was passed through the mouth into the stomach. Under fluoroscopic control, the magnet was maneuvered so that it attached to the metallic foreign bodies. The forgeign body was then easily removed by retracting the magnet with the metallic object attached. This procedure was successful in six patients of 8 patients. This procedure is a minimally-invasive and may avoid the use of anesthesics, endoscopy or surgery.

Trend (in 2005) of Repair of Inguinal Hernia in Children in Korea : A National Survey by the Korean Association of Pediatric Surgeons in 2005

Inguinal hernia is the most common disease treated by the pediatric surgeon. There are several controversial aspects of management 1)the optimal timing of surgical repair, especially for preterm babies, 2)contralateral groin exploration during repair of a clinically unilateral hernia, 3)use of laparoscope in contralateral groin exploration, 4)timing of surgical repair of cord hydrocele, 5)perioperative pain control, 6)perioperative management of anemia. In this survey, we attempted to determine the approach of members of KAPS to these aspects of hernia treatment. A questionnaire by e-mail or FAX was sent to all members. The content of the questionnaire were adapted from the "American Academy of Pediatrics (AAP) Section on Surgery hernia survey revisited (J Pediatr Surg 40, 1009-1014, 2005)". For full-term male baby, most surgeons (85.7 %) perform an elective operation as soon as diagnosis was made. For reducible hernia found in ex-preterm infants already discharged from the neonatal intensive care unit (NICU), 76.2 % of surgeons performed an elective repair under general anesthesia (85.8 %). 42.9 % of the surgeons performed the repair just before discharge. For same-day surgery for the ex-premature baby, the opinion was evenly divided. For an inguinal hernia with a contralateral undescended testis in a preterm baby, 61.9 % of surgeons choose to 'wait and see' until 12 month of age. The most important consideration in deciding the timing of surgery of inguinal hernia in preterm baby was the existence of bronchopulmonary dysplasia (82.4 %), episode of apnea/bradycardia on home monitoring (70.6 %). Most surgeons do not explore the contralateral groin during unilateral hernia repair. Laparoscope has not been tried. Most surgeons do not give perioperative analgesics or blood transfusion.

Application and Efficacy Evaluation of Nutritional Screening Tool

PURPOSE: Malnutrition has been frequently reported for patients on their admission to the hospital and it has been associated with an increase in morbidity, mortality and the length of the hospital stay. Although a number of screening tools have been developed to identify those patients at risk for malnutrition, there is no 'gold standard' for defining malnutrition and the malnourished patients remain largely unrecognized. The aim of this study is to evaluate the efficacy of a nutritional screening tool for use in Dankook University Hospital. METHODS: Nutritional evaluation was performed for 53 patients who were admitted to the department of surgery and internal medicine between October and December 2004. The screening tool was completed by the ward nurse and the nutritional support team nurse on the same patients within 24 hours of admission. The nutritional support team nurse performed the full assessment. The screening sheet included 4 questions regarding body mass index, recent unintentional weight loss, food intake and disease severity. Each answer was scored and a total of 5 was tested as the criterion for malnutrition. The full assessment included current body weight, recent weight loss, triceps skinfold thickness, mid- arm muscle circumference, serum albumin and total lymphocyte count. Malnutrition was defined by 3 or more values below the reference values. The reliability of the screening tool was assessed using kappa statdtatistic. Sensitivity, specificity and accuracy were calculated to evaluate the validity of the screening tool. The receiver operating characteristic (ROC) curve was drawn to choose a cutoff value that maximizes sensitivity and specificity. RESULTS: The level of agreement between the ward nurse and the NST nurse was good for BMI and food intake and moderate for weight loss and disease severity. The full assessment identified 7 patients (13.2%) as malnourished. The screening sheet had a sensitivity of 86% and a specificity of 80%. According to the ROC curve, a score of 5 points provided the best validity. CONCLUSION: The nutritional screening tool is reliable when completed by different observers and it is valid for nutritional assessment.

A Case of Spontaneous Focal Intestinal Perforation due to Defect of the Intestinal Musculature

Spontaneous intestinal perforation is characterized by isolated mucosal ulceration with acute inflammation, submucosal edema and serosal inflammation, and considered as a separate clinical entity from necrotizing enterocolitis. The causes of spontaneous intestinal perforation are administration of indomethacin, dexamethasone, umbilical artery catheterization, defect of intestinal musculature, and systemic candidasis. Intestinal perforation caused by defects of intestinal musculature is rare, and its pathogenesis remains uncertain. The authors report one case of a premature infant with defect in intestinal musculature confirmed through postoperation biopsy who was misdiagnosed as intestinal perforation due to necrotizing enterocolitis.

Long Gap Esophageal Atresia Successfully Treated by Esophageal Lengthening Using External Traction Sutures

The repair of esophageal atresia with a long gap still continues to pose difficulties for the surgeon. There is general agreement that the child's own esophagus is best, but it is also believed that a primary repair is not always possible. Foker JE et al. (1997) developed a technique of esophageal lengthening using external traction sutures. We experienced one case of esophageal atresia with a 4.5cm gap (4 vertebral spaces) which was repaired using the external traction suture technique.

Clinical Analysis of Recurrent Inguinal Hernias

PURPOSE: Recurrent inguinal hernia repairs provide a considerable technical challenge and greater risk of further recurrence. The purpose of this study was to establish a preventive method and management plan for recurrent inguinal hernia. METHODS: The medical records of adult having undergone an inguinal hernia operation at the Dankook university hospital, between June 1994 and December 2004, were analyzed. The patients' characteristics, types of hernia and operation methods were recorded. In the recurrent cases, the numbers and names of previous operation, types of recurrent hernia, and times to reoperation were analyzed. RESULTS: Of the 470 inguinal hernia cases, 35 were operated on for a recurrent hernia. With the recurrent hernias, the operation times were longer and the use of general anesthesia was more frequent. Of the recurrent hernia types, direct hernias were the most frequent. More than half the recurrent hernias were operated on 5 years after the primary hernia repairs. The recurrent hernia was treated with or without a mesh in 33 (94.3%) and 2 cases (5.7%), respectively. In the previous operations, mesh had or had not been used in 30 (85.7%) and 5 cases (14.3%), respectively. CONCLUSION: In the recurrent hernia group, the most frequent type of previous repair was an operation without a mesh. A direct hernia was the most frequent type of recurrence. The recurrent hernias were mostly repaired using a mesh.

Clinical Review of 10 Cases of Midgut Volvulus

PURPOSE: The aims of this study were to review the clinical characteristics of midgut volvulus and recognize the importance of the early diagnosis and treatment of midgut volvulus. METHODS: The medical records of 10 patients with midgut volvulus, diagnosed at the Dankook University Hospital, between May 1995 and May 2001, were retrospectively reviewed. RESULTS: There were 6 male and 4 female subjects. 80% of the patients were younger than 1 month old. The most common symptom was bilious vomiting. A simple abdominal X-ray was performed in 8 cases, with five of these 8 showing positive findings, such as a gasless abdomen or stomach dilatation. Ultrasonography was performed in all 10 cases. The sensitivity of the ultrasonography was 70%. UGI series was performed in 9 cases, and showed 100% sensitivity. Eight patients underwent surgical treatment. Seven infants in the early-diagnosis group had a Ladd operation performed, but only one patient whose diagnosis was delayed underwent a small bowel resection. The 7 patients that had undergone a Ladd operation showed good results after surgery. However, the one whose diagnosis had been delayed developed severe complications and mortality. CONCLUSION: The early diagnosis and adequate intervention for midgut volvulus can prevent life threatening complications. If the ultrasonographic findings are uncertain, especially when the midgut volvulus is untwisted after attack, UGI series or a barium enema should be performed to confirm the diagnosis.

Trichobezoar: Two Cases of Unusual Presentation

Two cases of trichobezoar with unusual presentation in female children are described. The first case is a 7-year-old female with a 3-day history of abdominal pain, obstipation, and emesis. She developed intestinal obstruction and showed double bezoars in the stomach and intestine respectively. She had been in a habit of biting or sucking hairs before sleeping from infancy until 5 years of age. The other patient is a 6-year-old girl referred for an epigastric mass, emotional disturbance and trichotillomania. In spite of the psychological treatment, 4 laparotomies were necessary due to repeated recurrences.

Associated Anomalies and Prognostic Factors

No abstract available.

Two Cases of Fetus in Fetu Diagnosed with Prenatal Ultrasonography

Fetus in fetu is a poorly understood and rare congenital malfomation. This is a rare form of monozygotic twin that asymmetric twin becomes internalized in the other twin thus acting endoparasitically. Fetus in fetu can be distinguised from teratoma, because of vertebral column, skeletal axis, and well-differentiated internal organs. We present the findings in the two cases of fetus in fetu that were diagnosed with prenatal ultrasonography. After birth, we removed fetus-like structures and confirmed by pathologic examination. Fetus-like structures were consisted of vertebral column, extremities, and other well-developed internal organs.

Clinical Evaluation of Recurrent Intussusception

To evaluate the clinical findings of the recurrent intussusception. 351 patients with 445 intussusceptions were reviewed. Recurrence rate, pattern of recurrence, reducibility, pathologic lead points (PLP), and operative findings and long term follow up of the multiple recurrences were analyzed. Of 351 patients, 303 had no recurrence, 26 had one recurrence, and 22 had multiple recurrences. Over all recurrence rate was 16.4% ; 18.5% were managed by air reduction, 16.2% by barium reduction and 5.9% by operation. Elven PLPs were proved operatively operatively and an additional 6 suspected PLPs were depicted radiologically. The most frequent PLP was ileal lymphoid hyperplasia. Intervals between reduction and recurrence were less than 2 weeks in 31 cases, between 2 weeks and 1 year in 55, and more than 1 year in 8. The longest interval was 2 years and 4 months.

Counseling for Breast Disease Using the Internet

PURPOSE: Rapid progress in the development of communication devices has enabled us to use large amounts of various kinds of medical information, regardless of time or place. Today, in Korea there are many homepages on the web which provide medical information, hospital information, and counseling on medical fields in Korea, but more detailed recent medical informations, better quality control, and a greater variety of communication skills are needed. Methods and RESULTS: We analysed the data on the web from November 1998 to October 1999 about breast cancer clinic. The frequent questions were about breast mass (44%), breast pain (29%), and counseling on breast cancer (25%). The most frequent users were in their 3rd decade (55%), 4th decade (8%), and unknown age cases (23%). The average number of visitors on web was 454 per month. CONCLUSION: In near future, we believe that use of the web as an information source will grow rapidly and the most of the people in Korea will use internet. For that purpose, we should realize that virtual space is a reality, and we should use it as an effective technique for educating the public.

A Study of the Expression of p53 and the Product of bcl-2 in Early and Advanced Gastric Cancers

PURPOSE: To evaluate of the role in carcinogenesis of p53 over-expression and bcl-2 inhibition in early gastric and advanced gastric cancers, we investigated the immunohistochemical tissue status of 31 primary early gastric-cancer patients and 31 primary advanced gastric-cancer patients. METHODS: DO7, the monoclonal antiserum to the P53 protein, and clone 124, the monoclonal antibody to the bcl-2 protein, were used for the immunohistochemical analysis of the 31 surgically resected primary early gastric cancer specimens and the 31 surgically resected advanced gastric-cancer specimens. The expressions were scored and divided into negative, positive, low expression, and overexpression. RESULTS: The clinicopathologic parameter; tumor depth of invasion, histologic type, and differentiation, were not related with the expression status of p53 or bcl-2. Of the 31 primary early gastric-cancer patients, 14 exhibited p53 overexpression and 16 showed negative the bcl-2 expression; 5 cases had both p53 overexpression and negative bcl-2 expression. Of the 31 advanced gastric cancer patients, 19 showed the p53 overexpression, and negative bcl-2 expression, 15 exhibited both p53 overexpression and negative bcl-2 expression. CONCLUSION: These results suggest that cell cycle alteration and apoptosis control by p53 and bcl-2 may play roles in the carcinogenesis of gastric cancer. However, there are many other mediators that may facilitate carcinogenesis. This study proved that bcl-2 is a valuable prognostic factor.

Bacteriologic Study and Prophylactic Antibiotics in the Acute and Complicated Appendicitis

This prospective study was performed to determine the effective antibiotics for use in treating acute appendicitis patients during the perioperative period. To identify the sensitive antibiotics, the peritoneal fluid was cultured during operation. Also, wound infection was defined as pus or serous discharge in the wound or when we opened the wound under suspicious of a wound problem. The results were obtained as follows: 1) A total of 138 cases treated during the two years from January 1995 to December 1996 were examined; 84 of them (60.87%) were found to have positive peritoneal fluid cultures, of which 29 (34.52%) were monomicrobial and 55 (65.48%) were polymicrobial. 2) The most common species were Escherichia coli (73.81%), Bacteroides (32.14%), Klebsiella (16.67%), Pseudomonas (9.52%), and Streptococcus (9.52%). 3) In the sensitivity test, the most sensitive drugs were aminoglycosides and cefotaxime. 4) Infectious complications, which developed in 27 (19.6%) patients, were wound infection and intraabdominal abscess. 5) The average length of stay for all patients 9.9 days (range: 3 to 32 days). 6) The common organisms curtured from the complication cases were E. coli and Bacteroides.

Appendicocecal Intussusception : A case report

The appendix has been reported to be a very rare leading point in intussusception. Therefore, preoperative diagnosis can rarely be made. We experienced one case of appendicocecal intussusception in a 2-year-old girl. An air contrast study done during air reduction suggested a cecal mass, and a saline filled sonogram showed a polypoid lesion in the cecum. The lesion turned out to be an intussuscepted appendix in appendicocecal intussusception.

Sacrococcygeal Abscess in Neonates

Sacrococcygeal region is the site of frequent occurrence for meningocele, congenital dermal sinus or pilonidal cyst. We have experienced 8 patients with sacrococcygeal midline abscess which developed in early neonatal period from May 1995 to July 1998. Mean age at the onset was 8.3 days with a range from 6 to 11 days. Sex ratio was 5:3 with male preponderance. They did not have any systemic symptoms except for a mild fever in one patient. Ultrasonogram revealed a slightly hypoechoic lesion in the subcutaneons tissue which became more hypoechoic with time. In pus cultures, Staphylococcus aureus grew in 7 patients. Of the 7 patients, 2 patients had a mixed infection with E. coli and other 2 were proved to be methicillin-resistance Staphylocccus aureus. Remaining one patient had a mixed infection with Klebsiella and Proteus. Histopathological examination revealed non-specific granuloma and fibrinoid necrotic debris. They were easily treated with incision, drainage and proper antibiotics.

Differences in Serum CEA Level between Colon and Rectal Cancer

We investigated whether there is differences in serum level of carcinoembryonic antigen (CEA) between patients with colon and rectal cancer. Preoperative serum levels of CEA was determined in 65 patients with colon cancer and in 88 patients with rectal cancer. Cut-off value recommended by manufacturers is 5 ng/ml for CEA. At the recommended cut-off levels for CEA, overall sensitivity of CEA was 43.1 percent for colon and 42.0 percent for rectal cancer. In colon cancer CEA was elevated in 38.4, 46.2, 60 percent of patients with Dukes Stages B, C, and D, respectively. In rectal cancer CEA was elevated in 12.5, 31.6, 44.8, 84.6 percent of patients with Dukes Stages A, B, C, and D, respectively. In Stages B, and C, sensitivity of CEA was higher in colon than in rectal cancer, but the difference was not significant. In Stages D, sensitivity of CEA was higher in rectal cancer than in colon cancer, but the difference was not significant. In overall stages sensitivity of CEA was higher in colon than in rectal cancer, but the difference was not significant. The difference was not significant either in overall or in different stages of colon and rectal cancer.

A Bacteriologic Investigation of the Acute Appendicitis

A study on the microbiology of appendiceal tissue or peritoneal fluid was carried out by the authors. A total of 40 specimens were examined, 21 of them(52.5%) were found to be positive, of which 13(61.9%) were polymicrobial and 8(38.1%) were monomicrobial. The most represented species were Escherichia coli (37.8%), Klebsiella (16.2%), Streptococcus (10.8%), and Bacteroides (8.1%). The most active drugs in vitro were found to be aminoglycosides (gentamycin, amikacin, tobramycin) and cefotaxime. The infectious complication developed in 6 patients and consisted of wound infection only. In view of relation of presence or absence of perforation of appendix with infectious complication, 4 of them arose from perforative appendicitis(36.4%) and 2 of them arose from nonperforative appendicitis(6.9%). On the other hand, in view of relation of presence or absence of organism cultured from appendiceal tissue or peritoneal fluid with infectious complication, all of them arose from positive cultures(28.6%) and none arose from negative cultures. The most represented bacterias from wound infection were Escherichia coli(40%) and Bacteroides(20%). Therefore, we suggest that an agent against anaerobes should be recommended when the appendix is perforative.

Gastrointestinal Injuries from Blunt Abdominal Trauma

Hollow visceral injuries are far less commom in blunt abdominal trauma than in penetrating abdominal trauma. From June 1994 to Sep. 1996, we treated 46 patients with blunt injuries to the gut, defined as perforation or devascularization. Thirty five patients(76.1%) were injured in motor vehicle collisions. Of these, 22 were not using constraints; 13 were wearing seat belts. Small bowel injuries were the most frequent injuries, followed by colonic injuries, duodenal injuries, rectal injury and gastric perforation. Mortality rates were the lowest in small bowel injuries(11.1%) and higher in less common colonic(22.2%) and duodenal(20.0%) injuries. Except for those patients with perforations of the small bowel, most patients had associated injuries to the head, chest or abdominal solid organs that were largely responsible for morbidity and mortality. Injuries to the abdominal hollow viscera are unusual following blunt trauma, but are the result of very high energy truncal trauma and are associated with multiple additional injuries. Most alert patients had physical findings suggestive of peritoneal irritation, but when diagnostic testing was necessary, peritoneal lavage was superior to CT scanning ( false negative=10.5% versus 88.5% respectively). A high index of suspicion is necessary to avoid diagnostic delays that can lead to severe complications and death.

Lipoma of the parotid gland

We report two cases of lipoma of the parotid gland which present as a non-tender, freely movable and intraparotid mass. Lipomas are common soft tissue neoplasms but found very rarely in the parotid gland, and so are often not considered in the initial differential diagnosis of parotid gland tumor. We believe that these tumors are cured by simple excision, and thus superficial parotidectomy is enough for treatment.