ABSTRACT
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.
Subject(s)
Child , Humans , Infant , Infant, Newborn , Male , Analgesics , Anemia , Anesthesia, General , Blood Transfusion , Bronchopulmonary Dysplasia , Cryptorchidism , Diagnosis , Electronic Mail , Groin , Hernia , Hernia, Inguinal , Herniorrhaphy , Intensive Care, Neonatal , Korea , Laparoscopes , Pediatrics , Surveys and QuestionnairesABSTRACT
Pyloric duplication is a rare anomaly usually manifested as an abdominal mass or gastric outlet obstruction mimicking infantile hypertrophic pyloric stenosis. We experienced a rare case of pyloric duplication without any evidence of a communication to neighboring organs including extrahepatic biliary tree or pancreatic duct in in a newborn male patient. We performed a complete excision of that lesion without bowel resection and encountered an uneventful postoperative recovery.
Subject(s)
Humans , Infant, Newborn , Male , Biliary Tract , Gastric Outlet Obstruction , Pancreatic Ducts , Pyloric Stenosis, HypertrophicABSTRACT
PURPOSE: The aim of this study is to evaluate the effectiveness and surgical morbidity of preoperative chemoradiotherapy for locally advanced rectal cancer. METHODS: Between December 1997 and March 2000, 36 patients with locally advanced rectal cancer (clinical stage II or III) were treated with preoperative chemoradiation: bolus i.v. leucovorin, 20 mg/m2, plus 24-h continuous infusion i.v. 5-Fluorouracil, 425 mg/m2, Days 1-5, 29-33 and concurrent radiotherapy 4,500 cGy over 5 weeks. Surgery was performed 4-8 weeks after completion of the chemoradiotherapy. RESULTS: Grade 3-4 toxicity during chemoradiotherapy was low: hematological toxicities 2.8%, gastro-intestinal toxicities 5.5% and skin toxicities 8.3%. Complete response rate was 16.7% and partial response rate was 47.2%, the rate of downstaging for tumor was 65.5%. The overall rate of resectability was 94.1%. In 13 of 22 (59.1%) patients planned APR, the sphincter was preserved. The overall rate of surgical morbidity was 23.5%, but there was no postoperative mortality. One patient needed a reoperation because a complication may be associated with preoperative chemoradiotherapy. CONCLUSIONS: Preoperative chemoradiotherapy for locally advanced rectal cancer seems to afford some potential advantages: patients are able to tolerate higher chemotherapy doses with low toxicities; tumor downstaging and resectability rates are high; sphincter preservation is feasible; But perioperative morbidity has generally tolerable complications. And so we recommend the preoperative chemoradiotherapy may be one of the best treatments for locally advanced rectal cancer.
Subject(s)
Humans , Chemoradiotherapy , Drug Therapy , Fluorouracil , Leucovorin , Mortality , Radiotherapy , Rectal Neoplasms , Reoperation , SkinABSTRACT
PURPOSE: Adult intussusception is relatively rare and it's course is subacute or chronic course. It usually occurs secondary to tumors or other underlying cause. Especially the incidence of associated malignancy is increasing compare to the past. Purpose of this study was review of adult intussusception, our comprehension of the disease improved by and helped to plan treatments METHODS: During the past 11 yeasrs, from January, 1987 to December, 1997, 27 cases of adult intussusception at Department of Surgery, Presbyterian Medical Center were analyzed retrospectively. RESULTS: The age incidence was variable. But it occurred more frequently at 4th decades. Useful radiologic diagnostic tools were CT, U/S as well as barium enema. Nineteen instances of intussusception originating in the small bowel and 8 instances originating in the colon. The etiologic factors were found in 22 cases (74%). Of the 19 small bowel intussusception, 5 cases were associated with malignancy and 3 out of 8 colon intussusception were result from the malignancy. The common malignancy in small bowel was lymphoma and that in colon was adenocarcinoma. Surgical intervention was carried out in all of these 27 cases: 20 cases underwent surgical resection and 7 cases were reduced manually after surgical exploration; Only manually reduction was performed in 4 cases, manually reduction and cecopexy in 2 cases and manually reduction and adhesiolysis in 1 case. CONCLUSION: The malignancy was the major cause of adult intussusception. Especially in colonic intussusception, occupational percentage of malignancy was higher. The common malignancy in small bowel was lymphoma and that in colon was adenocarcinoma. So, we cosidered plans of treatments according to location, etiology and bowel state.
Subject(s)
Adult , Humans , Adenocarcinoma , Barium , Colon , Comprehension , Enema , Incidence , Intussusception , Lymphoma , Protestantism , Retrospective StudiesABSTRACT
BACKGROUND: Since its introduction in 1987, the laparoscopic cholecystectomy has become the treatment of choice for most patients with symptomatic cholelithiasis. However, about 20% of the patients requiring a cholecystectomy present with acute cholecystitis, and the safety of a laparoscopic cholecystectomy in these patients has been questioned. With increasing experience, many studies have reported that a laparoscopic cholecystectomy in patients with acute cholecystitis is safe and cost effective. This study was to review retrospectively the results of laparoscopic cholecystectomies in patients with acute inflamed gallbladders. METHODS: From July 1993 through Fabruary 1997, laparoscopic cholecystectomies were attempted in 250 patients with or without symptomatic gallbladder disease. Acute cholecystitis, confirmed by clinical, laboratory, operative, and histological findings, was present in 61 patients. The preoperative factors that may be useful in predicting conversion to an open operation were analyzed. RESULTS: The frequency of conversion to an open operation was 19.7% for acute inflammation and 3.2% for chronic inflammation. Patients who had a laparoscopic cholecystectomy done within 72 hours of the onset of symptoms had a lower rate of conversion to open procedures. Patients who had a laparoscopic cholecystectomy done and who had a white blood cell count over 15 10(9)/L, persistant high fever (>38.0degrees C) over 3 days, and managed diabetes mellitus for over 3 years had a high rate of conversion to open procedures. There were no bile-duct injuries and no mortalites. CONCLUSIONS: Laparoscopic intervention appears to be a safe and beneficial option in the management of patients with acute cholecystitis. Surgeons should have extensive experience with both routine laparoscopic cholecystectomy and conventional open biliary tract surgery. A greater number of patients with inflammation require conversion to an open operation compared with the number of patients with no obvious inflammation who require conversion. Conversion to an open operation was frequent for patients with empyema, with symptoms that had lasted for longer than 72 hours prior to the operation, with white blood cell counts over 15 10(9)/L, with persistant high fever (>38.0degrees C) over 3 days and with managed diabetes mellitus for over 3 years, suggesting that once this diagnosis of acute cholecystitis is made, excessive time should not be spent in a laparoscopic trial dissection before conversion to an open operation.
Subject(s)
Humans , Biliary Tract , Cholecystectomy , Cholecystectomy, Laparoscopic , Cholecystitis, Acute , Cholelithiasis , Diabetes Mellitus , Diagnosis , Empyema , Fever , Gallbladder , Gallbladder Diseases , Inflammation , Leukocyte Count , Retrospective StudiesABSTRACT
BACKGROUND: All standard methods of hernia repair involve suturing together tissues which are not normally in apposition. This violates the basic surgical principle that tissue must never be approximated under tension and account for an unacceptable number of failures. Total reinforcement of the inguinal floor with a sheet of suitable biomaterial of a 'tension-free' technique is a more effective approach. METHODS: We have treated inguinal hernias by Bassini method in eighty-nine patients and by Lichtenstein tension free method in sixty-one patients from September, 1993 through December, 1995 and compared these two groups on age, sex, site, type anesthesia, operation time, admission date, postoperative complication, postoperative pain-killer injection period, recurrence. RESULTS: The result are as follows 1) There was no significantly difference compared Bassini method with Lichtenstein tension free method on age, sex, site, type, anesthesia, postoperative complications. 2) The average time of operation was 61.8 minutes on Bassini method and 53.6 minutes on Lichtenstein tension free method. 3) The postoperative complications were hematoma 2 cases, wound seroma 1 case on Bassini method, and wound seroma 1 case on Lichtenstein tension free method. 4) The average duration in the hospital stay after operation was 6.01 days on Bassini method and 4.75 days on Lichtenstein tension free method (p<0.01). 5) The average period for injection of pain-killer after operation was 3.61 days on Bassini method and 2.21 days on Lichtenstein tension free method (p<0.01). 6) The recurrence rate was 6 cases(6.7%) on Bassini method and no recurrence case on Lichtenstein tension free method (p<0.05). CONCLUSIONS: We conclude that Lichtenstein tension free method is less painful and shorter postoperative hospital stay than Bassini method.
Subject(s)
Humans , Anesthesia , Hematoma , Hernia, Inguinal , Herniorrhaphy , Length of Stay , Polypropylenes , Postoperative Complications , Recurrence , Seroma , Wounds and InjuriesABSTRACT
Lymphocytic infiltration within and around a tumor and distinctive types of regional lymph node reaction such as sinus histiocytosis, paracortical lymphoid cellular hyperplasia, and follicular hyperplasia at the cortical area are morphological changes often found in solid tumors. These histological features indicate the immunologically mediated tumor-retarding responses of the host. The aim of the present study was to assess the real prognostic value of both lymphocytic infiltration and the various types of lymph node reactions in patients with stage IA gastric carcinoma and their role compared with the value of other prognostic factors. We reviewed 119 patients with stage IA gastric carcinoma who were admitted to and operated on at the Department of Surgery, Presbyterian Medical Center, from January 1989 to December 1991. The 5-year survival rate was 93.23%, and the mean survival time was 91.18 months. Univariate analysis showed that the degree of lymphocytic infiltration was significantly related to survival(p<0.05). The 5-year survival rates according to the degree of lymphocytic infiltration were 66.67% in grade 0, 92.31% in grade 1, 95.83% in grade 2, and 100% in grade 3. The correlation between survival and age, tumor size, tumor site, or nuclear grade was not statistically significant. Our data indicated that the longer survival in cases of stage IA gastric carcinomas was associated with the presence of certain types of lymph node reactions such as sinus histiocytosis, paracortical lymphoid cellular hyperplasia, and follicular hyperplasia at the cortical area, but these correlations were also not stastistically significant. Although arguments may exist for using the presence or absence of sinus histiocytosis to stratify patients in prospective studies of adjuvant treatment, we suggest that adjuvant treatment after curative resection for gastric cancer is needed ever in the group without lymphocytic infiltration and regional lymph node reactivities. Also, we will study advanced gastric cancer, as well as early stomach cancer in future research.
Subject(s)
Humans , Histiocytosis, Sinus , Hyperplasia , Lymph Nodes , Prospective Studies , Protestantism , Stomach Neoplasms , Survival RateABSTRACT
A case of Agenesis of gallbladder in 73-year old female patient who had an emergent operation due to obstructive jaundice with impacted CBD stones is reported. The patient suffered from icteric sclera and abdominal pain which waxed and waned for three days. Impacted CBD stones and an agenesis of the gallbladder was suggested by a computed tomogram of the abdomen. In the operating field, multiple adhesions around the biliary tree was noticed, but we could not find the gallbladder and cystic duct. She underwent choledocholithotomy, T-tube choledochostomy, operative cholangiography, and drainage. Operative cholangiogaphy showed no remained stones, and there was no structures suggesting gallbladder and cystic duct. The authors described the case with a recent review from the literature.
Subject(s)
Aged , Female , Humans , Abdomen , Abdominal Pain , Biliary Tract , Cholangiography , Choledochostomy , Cystic Duct , Drainage , Gallbladder , Jaundice, Obstructive , ScleraABSTRACT
A 17 month-old girl presented in the pediatric clinic on November 27th, 1990 with a neck mass. The mass was 2 cm in diameter, firm in consistency and movable on the upper pole of the thyroid cartilage in the midline. The technetium thyroid scan showed a hot reactivity at the compatible site of the mass, but no other radioactivity in either site of the normal thyroid positions. At her second visit on January 23th, 1996, the mass had enlarged up to 3.5cm in diameter in the same location of the neck. The follow up thyroid scan revealed a walnut sized, snowman-like radioactivity. One of the snowman-like double images seemed to be a lingual ectopic thyroid and the other a midline ectopic thyroid remnant in the infrahyoid level. This interpretation was supported by the computed tomography of the neck, which showed a ligual mass in the foramen cecum area and an another mass in the anterior comis-sure of the larynx in the mildline. Thyroid function test was normal except a slightly increased TSH. As a result of this changing pattern of thyroid radioactive images, a case of a lingual thyroid as well as another midline ectopic thyroid tissue at the infra hyoid level is reported.
Subject(s)
Female , Humans , Cecum , Follow-Up Studies , Juglans , Larynx , Lingual Thyroid , Neck , Radioactivity , Technetium , Thyroid Cartilage , Thyroid Dysgenesis , Thyroid Function Tests , Thyroid GlandABSTRACT
Annular pancreas is a rare congenital anomaly with the descending duodenum encircled by a ring of pancreatic tissue, which may cause partial or complete obstruction of the duodenum. In newborn, the symptoms can be those of duodenal stasis resulting from partial intestinal obstruction secondary to some degree of duodenal stenosis. A male newborn weighing 2.0 Kg was born by C-section delivery at 37 weeks' gestation to a 27-year-old mother who had a hydramnios. He was in relatively good condition at birth except regurgitation of saliva and intermittent apnea. A plain film of the abdomen showed the double-bubble of gas filled stomach and proximal duodenum, and upper gastrointestinal series showed a dilated proximal duodenum, with a complete obstruction of the descending duodenum. Intraoperative finding revealed encirclement of the duodenal second portion by pancreatic tissue. Duodenojejunostomy was performed. After the operation, he had developed two serious complications, neonatal septicemia by Enterobacter cloacae on postoperative day 12 and systemic candidiasis on postoperative day 19, and been managed with ventilatory support, antibiotics, and antifungal agents with recovery.
Subject(s)
Adult , Humans , Infant, Newborn , Male , Pregnancy , Abdomen , Anti-Bacterial Agents , Antifungal Agents , Apnea , Candidiasis , Constriction, Pathologic , Duodenum , Enterobacter cloacae , Intestinal Obstruction , Mothers , Pancreas , Parturition , Polyhydramnios , Saliva , Sepsis , StomachABSTRACT
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