Pyogenic Pancreatic Abscess Mimicking Pancreatic Neoplasm: A Four-Case Series / 대한소화기학회지

A pyogenic pancreatic abscess mimicking pancreatic neoplasm in the absence of acute pancreatitis is rare. We report four patients who each presented with a pancreatic mass at the pancreas head or body without acute pancreatitis. The presenting symptoms were abdominal pain, fever, or weight loss. Abdominal CT scans showed low-density round masses at the pancreas head or body with/without lymphadenopathy. In each case, a PET-CT scan showed a mass with a high SUV, indicating possible malignancy. Comorbid diseases were identified in all patients: chronic pancreatitis and thrombus at the portal vein, penetrating duodenal ulcer, distal common bile duct stenosis, and diabetes mellitus. Diagnoses were performed by laparoscopic biopsy in two patients and via EUS fine needle aspiration in one patient. One patient revealed a multifocal microabscess at the pancreatic head caused by a deep-penetrating duodenal ulcer. He was treated with antibiotics and a proton-pump inhibitor. The clinical symptoms and pancreatic images of all the patients were improved using conservative management. Infective causes should be considered for a pancreatic mass mimicking malignancy.

Rhabdomyolysis-induced Acute Renal Failure in a Child

Rhabdomyolysis has been reported as a cause of acute renal failure (ARF), and it can arise from traumatic and variable non-traumatic events. Rhabdomyolysis-induced ARF is very rare in children. We experienced a case of rhabdomyolysis-induced ARF in a 14-year-old boy who presented with generalized edema and oliguria following trauma, a compressed thigh by a cultivator. Laboratory tests showed marked elevation of muscle enzymes (aspatate aminotransferase, creatine kinase and lactate dehydrogenase), increased serum and urine myoglobin, and other laboratory abnormalities showing ARF. Ten days after continuous arteriovenous hemofiltration using catheterization of the femoral artery and vein, the daily urine output gradually increased and he recoverd. We report this case with brief review of literature.

Three Cases of Symptomatic Huge Arachnoid Cysts / 대한소아신경학회지

Congenital arachnoid cysts are commonly located at sylvian cistern or middle cranial fossa which are usually asymptomatic and incidentally found. Posterior fossa cysts, however, are usually large when diagnosed, and symptomatic. Three cases of large posterior fossa cysts were recognized on the diagnostic MRI investigation for infantile spasm, developmental delay, and the precocious puberty. Surgical decompression of the cysts by craniectomy, cyst excision and fenestration were performed successfully in two patients with arachnoid cysts in the cerebellopontine cistern and the suprasellar, right cerebellopontine, and prepontine cisterns, but an additional cystoperitoneal shunt was needed in a case with the cyst in the quadrigemial cistern with obstructive hydrocephalus. Infantile spasm was treated with vigabatrin and pyridoxine, and the true precocious puberty was managed with LHRH analogue(Decapeptyl ).

Subclavian Catheterization in the Pediatric Patients

PURPOSE: Central venous catheters are used to deliver antibiotics, chemotherapeutic agents, and parenteral nutrition for a extended period of time as well as to draw samples in immunocompromised patients to minimize the discomfort with sampling and the risk of introducing infections. Hickman/Broviac catheters or implantable devices have been used in pediatric patients. This study is aimed to evaluate the safety and clinical efficacy of subclavian catheterization which has advantages of low cost without need of general anesthesia or skillful surgeon. METHODS: Between August 1994 and October 1995, subclavian venous catheters were inserted in 22 patients. The age ranged from 3 months to 17 years (median 9 years 5 months). Patients weight ranged from 5.7kg to 57.0kg (median 27.5kg). Nineteen patients had various malignancies. Arrow multi-lumen/ two-lumen central venous catheters were used. Without general anesthesia, pediatricians inserted the subclavian catheters by blind puncture at bedside after administering 0.035mg/kg of midazolam and 0.05mg/kg of morphine sulfate. Emla cream was applied at the puncture site one hour prior to the procedure. We retrospectively evaluated the patient characteristics and complications associated with catheter placement and maintenance. RESULTS: The median duration of catheter placement was 53 days, with a range of 6 to 175 days. In early series, 2 cases of pneumothorax and a case of hemothorax occured during the catheter insertion. Occlusion and infection of catheters occured in 11 and 6 patients, respectively. Twenty catheters were removed: no need to continue, 7; patient death, 4; inadvertent removal, 4; complete occlusion 3 and 2 cases of catheter-related infections. CONCLUSIONS: Subclavian catheterization is a safe, cost-effective, easy-to-perform technique of providing long-term venous access which can be done by pediatrician at bedside without the risk of general anesthesia.

A Case of Conjoined Twin / 대한주산의학회잡지

Conjoined twins occur when there is imcomplete fission of the inner cell mass later at approximately 13 to 15 days after fertilization. The earlist case in the literat.ure appears to be that of the Biddenden Maids who were born in England in 1100. since then over two hundred cases of successful separation were reported on literature. And also successful separation cases were reported by Seung et al.(1991) in Korea. Conjoined twins occur between one in 50,000 to 100,000 births but real incidence is one in 200,000 because two thirds are stillbirth or died immediately after birth. The conjoined twins are not associated with maternal age, race or family history and 70 % of them are females. We experienced a case of conjoined twins with omphalopagus and performed surgical separation. A brief review of related literatures was done.