The pathologic lead points in childhood intussusception

Most childhood intussusceptions are occured by unknown cause, but a few of them have pathologic lead points. We have collected and analyzed cases with pathologic lead points, and compared them with cases without pathological lead points. A retrospective review was performed on 227 patients who were operated on for intussusception in Yeungnam University Hospital from Jan. 1986 to Apr. 1999. We divided them into 2 groups; idiopathic group (209 cases, 92.1%) and pathologic lead points group (18 cases, 7.9%), and compared the characteristics of each group. Intussusceptions were most commonly occurred in patients between 2 to 6 months of age in both groups. Enteroenteric type of intussusception was relatively more frequent in pathologic lead points group than in idiopathic group (p<0.05). The pathologic lead points were veil (10 cases, 52.6%), Meckel's diverticulum (3 cases, 15.8%), lymphoma (3 cases, 15.8%), ectopic pancreas (2 cases, 10.5%), and Henoch-Schonlein purpura (1 case, 5.3%). The rate of bowel resection was 44.4% in pathologic lead points group and 8.6% in idiopathic group (p<0.05). The present study suggests that the sex, age, type, and operation of intussusception behaved somewhat differently between idiopathic group and pathologic lead points group.

The Effects of Pudendal Block in Voiding Complication after Anal Surgery

Urinary retention in common benign anal surgery is a burden to ambulatory surgery. PURPOSE: To reduce voiding complication pudendal nerve block (PB) was applied in hemorrhoids surgery. METHODS: We compared PB with spinal anesthesia (SA) for anal surgery. In this prospective study, 163 patients undergoing elective hemorrhoids surgery by single surgeon were randomized to receive either PB with 0.5% bupivacaine (n=81) with 1: 20,000 epinephrine or SA with 0.5% bupivacaine (n=83). RESULTS: There were no statistically significant differences in patient demographics, total amount of administered fluid, time to onset of block, or intraoperative pain. All patients had a successful block for surgery however, puborectalis muscle relaxation with PB was not complete. The time from injection of the anesthetics to first development of pain was longer in the patients who received PB (9.1 vs 3.1h; P<0.001). Urinary catheterization needed in only 6 patients in PB group compared with 57 cases in SA group (p<0.001). Degree of pain was significantly low in PB (2.7 vs 5.2 with VAS; p<0.001) Injected analgesics was significantly reduced in PB (16/81 vs 45/82; p<0.001) CONCLUSIONS: Our results suggest that PB with bupivacaine results in fewer postoperative voiding complications and less pain compared with traditional SA in hemorrhoidectomy.

Two Cases of Pancreatoblastoma

Pancreatoblastoma is uncommon in children and is exceedingly rare in adults. Prognosis is known to be good if the tumor is discovered prior to metastasis. Complete tumor resection is the most important factor for long survival. We report two cases of pancreatoblastoma in a 4 year and 7 year- old females. Palpable abdominal mass was accidentally discovered by their parents. Abdominal CT scan showed huge retroperitoneal mass of unknown origin in one case and of the pancres in the other case. At laparotomy, well encapsulated tumor mass (10x10 cm in diameter) was noted in the body of pancreas in one case, and well encapsulated tumor mass ( 8x7 cm in diameter) in the tail of pancreas in the other case. We resected the tumor and saved spleen in both ases. Histologic examination revealed that the tumors were pancreatoblastoma. Patients received postoperative chemotherapy with 6 cycles of cisplatinum, adriamycin, ifosfamide and etoposide and are alive in good condition 19 months and 17 months after operation.