Esophageal Atresia with Tracheoesophageal Fistula: A 20 Year Experience of 51 Cases

The aim of this study is to analyze the outcomes of the esophageal atresia with tracheoesophageal fistula over the last 2 decades. The records of 51 patients born between 1987 and 2006 were reviewed. Twenty-seven patients were male. Mean values of the age, gestational age and birth weight were 2.9 days, 296 days and 2.7kg, respectively. All patients had Gross type C anomalies. Thirty-one patients (60.7 %) had one or more associated congenital anomalies and the most common anomaly was cardiac malformation. In 48 cases, primary anastomosis was done and staged operation was done in one case. Circular myotomies in the proximal esophagus were performed in 9 cases. Postoperative complication developed in 26 cases (54 %): pulmonary complication in 12 cases, anastomotic leakage in 10 and anastomotic stricture in 10, recurrent trachoesophageal fistula in one and tracheomalasia in 2 cases. Reoperation was carried out in 2 patients with anastomotic leaks, the remaining leaks were managed non operatively. Three of the strictures were reoperated upon and the others were successfully managed by balloon dilatations. Overall mortality rate was 15.6 %. Mortality rate of the second 10 years (8 %) period decreased significantly compared to that of the first 10 years (23 %) period.

Clinical Review of Idiopathic Nephrotic Syndrome in Children

PURPOSE: We reviewed the clinical manifestations, responsiveness to treatment, and prognosis in children with nephrotic syndrome. METHODS: Medical records of 159 children with idiopathic nephrotic syndrome who were admitted to the pediatric department of Chonbuk National University Hospital from January 1979 to December 2000 were retrospectively reviewed. RESULTS: There were 32 females and 127 males. The most common age group was between 3 and 5 years of age among the 159 children with nephrotic syndrome. Generalized edema (75.5%), scrotal edema (20.1%), upper respiratory infection (19.5%), and ascites (28.3%) were frequently observed. After the initial steroid therapy, diuresis occurred within the first two weeks in 138 children, and proteinuria disappeared within the first two weeks in 105 children. Among 159 patients who received initial daily steroid therapy, 110 children were in complete remission, 29 children were in partial remission and 20 children were in poor response state. Hematuria, hypertension and elevated serum creatinine were more frequently observed in the partial and the poor response groups than in the complete remission group. Among 107 children who were followed up for more than one year, 78 children were in complete remission and 55 children were relapsed within the first one year after steroid therapy. Renal biopsy was undertaken in 76 children and 53 children had minimal change nephrotic syndrome. CONCLUSION: Our study showed that most children with idiopathic nephrotic syndrome have a good responsiveness to steroid therapy and even most children show frequent relapse during 1st year after remission, long term prognosis is excellent.

A Clinical Review of Laparoscopic Cholecystectomy / 한국간담췌외과학회지

BACKGROUND/AIMS: Laparoscopic cholecystectomy (LC) was performed by Mouret in 1987 and has rapidly and radically changed the surgical treatment of gallbladder (GB) disease. The purpose of this study is to clinical and historical review of LC in the Chonbuk National University Hospital. METHODS: We reviewed 1048 patients of LC between September of 1990 to April of 2000, retrospectively by clinical record. RESULTS: The age range of the patients was from 17 to 84 years(mean: 50.3). The associated diseases were hypertension and diabetes mellitus with each 56 cases, hepatitis with 22 cases, and bronchial asthma with 10 cases in order of frequency. 98 of 1048 patients had undergone previous abdominal operation. The most frequent previous abdominal opeartions were appendectomy with 56 cases, transabdominal hysterectomy with 14 cases and Cesarean section with 13 cases in order of frequency. Urinary catheters and Nasogastric tubes have not been used as a preoperative routine preparation since May 1995. Upto 1997, we preferred 4-trocar procedure to 3-trocar procedure(628/35 cases), thereafter the proportion was reversed(48/296 cases). The mean operative time was 51.6 minutes which varied between 15 minutes to 290 minutes. Up to 1996, we preferred to use a silastic drain in the Morison's pouch (465 cases of 580 cases), thereafter postoperative drains were used in selected cases(133 cases among 468 cases). The length of hospital stay ranged from 1 day to 54 days with an average of 5.2 days. The mean time gap to first oral intake was 1.1 days. Postoperative complications were occurred in 32 patients(3.1%). 12 patients among those were explored - bile leakage: 11 cases, bleeding: 1 case, the remainders were recovered by conservative treatment. A conversion to open cholecystectomy was done in 19 patiens(1.8%) during the operation and the causes of conversion were severe fibrotic adhesion due to inflammation with 8 patients, bleeding with 4 cases and previous operation with 13 cases. Pathological findings of the specimen revealed chronic cholecystitis(786 cases), cholesterolosis(52 cases), acute cholecystitis(27 cases), GB polyp(39 cases), GB cancer(26 cases), xanthogranulomatous cholecystitis(25 cases). CONCLUSION: Operative laparoscopy has advanced surprisingly in the last 10 years. LC is increasingly used in clinical surgery because of significantly faster convalescence than occurs with open surgery. These advances have been facilitated not only by optimal use of laparoscopic instruments but also by discarding unnecessary conventional procedures such as nasogastric and urinary indwelling catheterization. One of the important task in surgical education is to teach the optimal application of instruments to facilitate the conduct of an operation. In the era of minimally invasive surgery, minimal application of instruments such as less use of trocars in appropriate sites and developing more convenient instruments and measuring the technical proficiency during laparoscopic surgery are equally important issues.

Mucinous Carcinoma of the Breast / 대한암학회지

PURPOSE: Mucinous carcinoma of the breast is relatively rare among the malignant breast lesions. It has distinctive pathological and behavioral characteristics to separate from other types of breast cancers. Accoding to the WHO definition, mucinous carcinoma of the breast is a carcinoma containing large amounts of extracellular epithelial mucus, sufficient to be visible grossly, and recognizable microscopically surrounding and within tumor cells. Mucinous carcinoma shows the characteristic features clinically and histologically because of the mucus production by the tumor. MATERIALS AND METHODS: We reviewed 29 cases of mucinous carcinoma that had been treated from 1985 to 1996 in the Department of General Surgery, Yonsei University College of Medicine. RESULTS: The results were as follows: The prevalent age group was the fifth decade (37.9%). The 27 cases were female and 2 were male. The most common sign and symptom was a palpable mass (100%). The most patients visited the hospital within 2 months of onset (55.2%). Most frequent tumor size was 2-3 cm in diameter, found in 10 cases (34.5%), and 13.8% of cases was more than 5 cm in diameter. The most frequent site of tumor was the upper outer quadrant in 16 cases (55.2%). The operations performed were as follows: Modified radical mastectomy (Auchincloss or Patey) in 24 cases (82.8%), quadrantectomy with axillary lymph node dissection in 4 cases (13.8%), simple mastectomy with lower axillar dissection in 1 cases (3.4%). Axillary lymph node metastasis was present in 3 cases (10.3%). The most common stage at diagnosis was stage IIa in 13 cases (44.8%). CONCLUSION: This study shows some characteristics of mucinous carcinoma of breast distinict from those previously proposed Further studies are needed to identify clinical parameters which characterize mucinous carcinoma of the breast.

A Clinical Review of Ulcerative Colitis / 대한내과학회지

OBJECTIVES: Ulcerative colitis is a chronic inflammatory disease of colon, which is common in western countries but rare in Korea. But the detection rate has been increasing in our hospital recently. The purpose of this study is to review the clinical features and trends of newly diagnosed cases in Korea each year. METHODS: We reviewed 126 cases, of which medical records were available and diagnosed by clinical finding, laboratory examinations, barium enema or colonoscopic examination, histologic and microbial tests at the hospitals in Pusan from Jan. 1986 to Dec. 1995. RESULTS: Recently, newly diagnosed cases tend to increase each year and the peak incidence of age groups was the fourth decade(27.4%) and the male to female ratio was 1:1.07. The common symptomes were hematochezia, diarrhea, abdominal pain, loss of weight, in the order of frequency. The laboratory findings were non-specific, including positive occult blood, increased erythrocyte sedimentation rate, anemia, hypoalbuminemia, and abnormal liver function test. According to the severity of disease, these was 50.8% in mild, 30.6% in moderate and 18.6% in severe disease. The difference of severity according to the extent of disease was not found. According to the extent of disease, these was 23.8% in proctitis, 25.4% in distal, 23.8% in left and 25.4% in extensive colitis. The incidence of proctitis was not more increased after 1991, compared with the previous records. 119 cases were treated medically and most cases showed exellent sort-term response(95.7%). According to the severity, the symptomatic remission rates of milder disease were significantly higher. Surgical treatment was performed in 4 cases(5 times); its indications were perforation in 2 cases, bleeding in 2 cases, and one case had failed to medical treatment. CONCLUSION: These results suggest that the trends of newly diagnosed cases each year have been increased recently. To evaluate the statistically significant clinical features, progress of disease and prognosis of ulcerative colitis in Korea, the nationwide collection of data is necessary.

A clinical review of pediatric burn patients in recent 10 years

During the period of 10 years from January, 1987 to December, 1996, 553 burn patients were admitted and treated at Ewha Womans University Hospital. Among them, 172 patients were under the age of fifteen. We reviewed the charts and analyzed the data retrospectively. The results revealed as follows; 1. Children under 15 years old were 31.1% of all admitted burn patients and males were frequently affected 1.46 times more than females. 2. The most prevalent age group was under 1 years old as 25.6%. 3. The most common cause of burn was scalds (84.3%), followed by flame (7.6%), contact (5.8%) and electricity (2.3%). 4. Burn accidents were frequently occurred in spring, especially March (11.6%). 5. Time interval from burn accident to arrival at hospital was 5.1 hours in direct visitors and 20.5 hours in referred patients. 6. Burn involved multiple sites of the body in 64.5% of cases. 7. In 60.2% of patients the extent of burn was under 9% of body surface. 8. Mean hospital day was 16.9 days and 17.4% of the patients were discharged against on 5.7 days. 9. The complications were developed in 38.7% of the patients. They were wound infection(61.8%), sepsis (20.0%), pulmonary complication (10.9%), urologic infection (3.6%), gastrointestinal bleeding(1.8%) and burn shock (1.8%). 10. Wound culture was positive in 66.7% of suspicious cases. The organisms cultured were Pseudomonas aeruginosa (58.9%), Staphylococcus species (26.5%), E. coli (11.8%) and Enterobacter species (2.9%). 11. Overall mortality rate was 5.6% and mean survival day was 14.7 days. The cause of death was sepsis in 50% of cases.

A clinical review of pediatric burn patients in recent 10 years

During the period of 10 years from January, 1987 to December, 1996, 553 burn patients were admitted and treated at Ewha Womans University Hospital. Among them, 172 patients were under the age of fifteen. We reviewed the charts and analyzed the data retrospectively. The results revealed as follows; 1. Children under 15 years old were 31.1% of all admitted burn patients and males were frequently affected 1.46 times more than females. 2. The most prevalent age group was under 1 years old as 25.6%. 3. The most common cause of burn was scalds (84.3%), followed by flame (7.6%), contact (5.8%) and electricity (2.3%). 4. Burn accidents were frequently occurred in spring, especially March (11.6%). 5. Time interval from burn accident to arrival at hospital was 5.1 hours in direct visitors and 20.5 hours in referred patients. 6. Burn involved multiple sites of the body in 64.5% of cases. 7. In 60.2% of patients the extent of burn was under 9% of body surface. 8. Mean hospital day was 16.9 days and 17.4% of the patients were discharged against on 5.7 days. 9. The complications were developed in 38.7% of the patients. They were wound infection(61.8%), sepsis (20.0%), pulmonary complication (10.9%), urologic infection (3.6%), gastrointestinal bleeding(1.8%) and burn shock (1.8%). 10. Wound culture was positive in 66.7% of suspicious cases. The organisms cultured were Pseudomonas aeruginosa (58.9%), Staphylococcus species (26.5%), E. coli (11.8%) and Enterobacter species (2.9%). 11. Overall mortality rate was 5.6% and mean survival day was 14.7 days. The cause of death was sepsis in 50% of cases.

Changes of Clinical Patterns of the Acute Rheumatic Fever in Korea(Compared report of 1973-1985 with that of 1986-1992)

PURPOSE: The annual incidence of acute rheumatic fever in Korea was not changing during 1980 to 1989 from Nationwide survey in 1991 in spite of talking about scanty outbreak among doctors in recent year.The proportion of patients with acute rheumatic fever among the entire pediatirc inpatients each year was approximately 0.3% and did not change significantly throughout the survey period. But rheumatic heart disease is still major heart problem in the adults in our country. Otherwise, the trend of streptococcal infection seems to be occuring virulent strains which developed fetal toxic shock like syndrome resurgence of acute rheumatic fever in North America since mid-1980. We would like to know the number of outbreak and the changing of clinical patterns of this disease between 101 cases of acute rheumatic fever during 1973 to 1985 and 41 cases during 1986 to 1992 METHODS: Subject were 41 cases of children with acute rheumatic fever and/or acute rheumatic carditis diagnosed by rivised Jones criteria who were admitted to the Department of Pediatris, Kyunghee University Hospital from Jan. 1986 to Dec. 1992 RESULTS: 1) The average incidence of rheumatic fever and rheumatic carditis for 20 years period was 0.5 per 1,000 annual pediatric inward patients. The annual changes of rheumatic fever increased between 1981 and 1986 and decreased after then. 2) The seasonal peak incidence was observed in December and the group of peak the incidence was 11-15 years. 3) The preceding infection history was observed in 43.9% 4) The incidence of major manifestation was as follows : carditis(7.0%), polyarthritis(63.4%), chorea(22.0%), erythematous marginatum(12.2%) and subcutaneous nodule(4.9%). 5) Doppler echocardiographic valvualr lesions were mitral insufficiency(65.9%), aortic insufficiency(24.4%) and mitral insuffiency combined with aaortic insuffiency(17.1%). 6) The EKG findings were PR interval prolongation(41.5%), left ventricular hypertrophy(34.1%), and prolonged P wave duration(34.1%). 7) Sites of joint involvement were knee joint(56.1%), ankle joint(26.6%), hip joint(14.6%), and elbow joint(14.6%) 8) Minor and other manifestation were fever(56.1%), arthralgia(56.1%), cough(24.4%), dyspnea(22.0), and generalized weakness(22.0%). 9) Laboratory findings were increaed ASO titer(>200 Todd units, 78.0%), posotive CRP(73.2%), and increased ESR(>30 min/hr, 65.9%). 10) The initial choice of treatment was aspirin(96.7%) and corticosteroid was used in one case because of severe congestive heart failure. CONCLUSIONS: The incidence of acute rheumatic fever in Korea was gradually decreased. On the other hand, the incidence of rheumatic carditis was increasing patterns. Especially, development of diagnositic tools in cardiology such as Doppler echocardiography contributed to make accurate diagnosis of silent carditis, valvular lesions which were passed without mentioning early study period.

Changes of Clinical Patterns of the Acute Rheumatic Fever in Korea(Compared report of 1973-1985 with that of 1986-1992)

PURPOSE: The annual incidence of acute rheumatic fever in Korea was not changing during 1980 to 1989 from Nationwide survey in 1991 in spite of talking about scanty outbreak among doctors in recent year.The proportion of patients with acute rheumatic fever among the entire pediatirc inpatients each year was approximately 0.3% and did not change significantly throughout the survey period. But rheumatic heart disease is still major heart problem in the adults in our country. Otherwise, the trend of streptococcal infection seems to be occuring virulent strains which developed fetal toxic shock like syndrome resurgence of acute rheumatic fever in North America since mid-1980. We would like to know the number of outbreak and the changing of clinical patterns of this disease between 101 cases of acute rheumatic fever during 1973 to 1985 and 41 cases during 1986 to 1992 METHODS: Subject were 41 cases of children with acute rheumatic fever and/or acute rheumatic carditis diagnosed by rivised Jones criteria who were admitted to the Department of Pediatris, Kyunghee University Hospital from Jan. 1986 to Dec. 1992 RESULTS: 1) The average incidence of rheumatic fever and rheumatic carditis for 20 years period was 0.5 per 1,000 annual pediatric inward patients. The annual changes of rheumatic fever increased between 1981 and 1986 and decreased after then. 2) The seasonal peak incidence was observed in December and the group of peak the incidence was 11-15 years. 3) The preceding infection history was observed in 43.9% 4) The incidence of major manifestation was as follows : carditis(7.0%), polyarthritis(63.4%), chorea(22.0%), erythematous marginatum(12.2%) and subcutaneous nodule(4.9%). 5) Doppler echocardiographic valvualr lesions were mitral insufficiency(65.9%), aortic insufficiency(24.4%) and mitral insuffiency combined with aaortic insuffiency(17.1%). 6) The EKG findings were PR interval prolongation(41.5%), left ventricular hypertrophy(34.1%), and prolonged P wave duration(34.1%). 7) Sites of joint involvement were knee joint(56.1%), ankle joint(26.6%), hip joint(14.6%), and elbow joint(14.6%) 8) Minor and other manifestation were fever(56.1%), arthralgia(56.1%), cough(24.4%), dyspnea(22.0), and generalized weakness(22.0%). 9) Laboratory findings were increaed ASO titer(>200 Todd units, 78.0%), posotive CRP(73.2%), and increased ESR(>30 min/hr, 65.9%). 10) The initial choice of treatment was aspirin(96.7%) and corticosteroid was used in one case because of severe congestive heart failure. CONCLUSIONS: The incidence of acute rheumatic fever in Korea was gradually decreased. On the other hand, the incidence of rheumatic carditis was increasing patterns. Especially, development of diagnositic tools in cardiology such as Doppler echocardiography contributed to make accurate diagnosis of silent carditis, valvular lesions which were passed without mentioning early study period.

A Clinical Review of Miliary Tuberculosis in Children

A Clinical study was made of 88 pediatric patients with miliary tuberculosis, who were admitted to the Pediatric Department of Kwangju Christian Hospital during the period of January, 1971 through December, 1980. 1) The incidence of miliary tuberculosis in children was 0.6%(88 cases) of the total pediatric admission cases(13969), and 12.5% (88 cases) of the total pediatric tuberculous patiens(705). 2) The highest incidence was found in those under the age of 3 years, comprising 63.7%(56 cases) of all cases. The sex ratio of male to female was 1.5:1, which is not significant. 3) The most prevalent season was Spring, with 34.1% (30 cases). 4) The source of infection was found within their family in 36.3% (32cases). 5) Only 14.8% (13 cases) had received BCG innoculation. 6) Predisposing factors were found in 24.9% (21 cases) and these were measles, chicken pox, pertussis, typhoid fever in decreasing order of frequency. 7) Chief complaints on admission in the order of frequency were:fever (72.7%), coughing (68.2%), general weakeness (37.5%), vomiting (35.2%). 8) Principal clinical features on admission were marked adnormal auscltatory findings (68.2%), emaciation (54.5%), adnormal neurologic sings (42.0%), cervical lymphaderopathy (39.8%) and hepatosplenmegaly (22.7%). 9) Tuberculin skin test was done in 55 cases and positive reaction was obtained in 21.8% (12 cases). 10) Hematologic findings revealed a mild degree of anemia in 52.3% of all patients and leukocytosis in 75.0%. 11) AFB smear was positive in only 19.3% (17 cases/88), and the highest positive rate was found in sputum (40.0%). 12) Tuberculous meningitis was the most most common disease associated with miliary tuberculosis. 40.9% (36 cases( of all miliary tuberculosis cases were complicated by tuberculous meningitis, with the highest incidence of 72.2% (56 cases) under the age of 3 years. 13) The usual treatment was the triple regimen of INH, PAS and SM, though PAS was replaced by EMB or Rifampin in recent cases, Corticosteroids were added in complicated cases. 14) In 21.6% (19 cases) of total cases, the clinical symptoms and the miliary density on X-ray disappeared after 3 months of treatment. 15) The mortality rate was 10.2% (9 cases/88).