Author described 57 pediatric surgical patients who were undergoing Surgery for regional complications following BCG vaccination at Ewha Womans University Hospital. The patients were randomly allocated either to surgery alone or surgery with postoperative administation of antituberculous chemother apeutics.

The result of this trial indicate the followings :

1) Among the total 57 cases, 31 cases were included into the surgery alone group(control group) and 26 cases were administration group of antituberculous chemotherapeutics following surgery(theeapy group). There was no statistically significant difference between both groups on several factors that may affect the curing process.

2) Postoperative complication rate was 1.8 percent and recurrence rate during follow-up after treatment completion is 6.5 percent. But there was no significant difference between both groups on complication rate and recurrence rate.

3) Postoperative treatment duration was less than 8 days in control group add was about 6.8 months in therapy group, and so postoperative therapy with antituberculous drugs did prolong the length of treatment period significantly(p<0.001).

This results suggest that the postoperative administration of antituberculous chemotherapeutics for regional complications following BCG vaccination would rather have economic burden and inconvenience than any benefical effect.

In spite of the many recent advances in the management of intussusception further improvements may only be possible through earlier recognition at the onset of the diease and earlier contact with pediatric surgeon.

To identify the factors leading to deliberate surgical intervention, author reviewed and analysed 84 consecutive cases of intussusception of pediatric age group surgically treated from 1980 to 1989 at Ewha Woman University Hospital.

1) Demographic data show that sex incidence was a strong male preponderance of 2.5:1, that age incidence was a peak under 1 year old(81%), that the higher incidence was associated with cow's milk-fed, and that significant number of the cases were moderately nourished to undernourished.

2) The clinical symptoms and signs were abdominal pain or irritability(83%), vomiting(82%), currant-jelly stool(61%) and palpable abdominal mass(58%), And only 40% of the cases had the clasic triad of symptoms.

3) Simple abdominal x-ray revealed diagnostic findings in 35% of cases.

4) The most common anatomic type of intussusception was ileo-colic with 45% of the cases.

5) The only 4 cases(5%) had the pathologic lead point such as duplication of cecum, lymphoma of ileum and hematoma of ileum in Henoch-Schonlein purpura.

6) The manual reduction by milking archieved success with 61 cases (73%), 13 cases(16%) needed resection of bowel and 10 cases(12%) showed spontaneous ans complete reduction of intussusception between the time of diagnosis and the time of laparotomy.

7) The average postoperative hospital stay was 8.8 days. Only 7 patients(8.3%) had significant postoperative complications.

This study points out that the duration of illness and unusual anatomic type strongly influence necessity for bowel resection, and that also hydrostatic reduction by well-trainded pediatric radiologist plays a rols in the reducing the unnecessary laparotomy.

In the pediatric age group, appendicitis is the most common condition requiring abdominal surgery that continues to be characterized by a high morbidity rate despite a significant decrease in the mortality rate.

A study was performed to identify factors associated with postoperative complications in 130 children with acute appendicitis during 4 years period from Jan. 1985 to Dec. 1988.

The results of this study indicate the following :

1) Simple appendicitis group was 80 cases(61.5%), complicated group was 50 cases(38.5%), and male to female ratio was 1.2 to 1.

2) Postappendectomy morbidity was 2.5% in simple appendicitis group and 44% in complicated appendicitis group.

3) Significant predictors of the complicated appendicitis were 1) age under 9 year-old, 2) duration of symptoms over 24 hours, 3) preoperative body temperature over 38℃, 4) leukocytosis over 15,000 WBC/mm³.

4) Duration of symptoms was the factor most closely associated with postappendectomy complications in the complicated appendicitis.

5) Preoperative antibiotics did not appreciably influence the incidence of complications in the complicated appendicitis. Results presented illustrate that postappendectomy morbidity is strongly influenced by the status itself of appendicitis.

Fifteen infants with congenital hypertrophic pyloric stenosis who underwent pyloromyotomy at Dept. of Surgery, Ewha Womans Univ. Hospital for 5 years from Sept. 1981 to Aug. 1986, have been reviewed. The results were as follows. 1) Infants with congenital hypertrophic pyloric stenosis were 1.6% of the total pediatric surgical patients. 2) Eleven cases male and 4 cases were female. A ratio of male to fermale was 2.8:1. 3) The age distribution was 11 cases(73.3%) between 4 and 6 weeks. 4) The distribution of birth rank in siblings was 7 cases of first-born infants and 8 cases of second-born infants. 5) The distribution of type of feeding was 7 cases of breast-fed infants and 6 cases of cow milk-fed infants. 6) The seasonal distribution was 6 cases in Winter, 5 cases in Spring, and each 2 cases in Summer and Autumn. 7) The number of cases associated with the other congenital anomalies was 3 cases. 8) Non bile-stained projectile vomiting was the most prominant symptom and onset time was mostly between 3 and 5 weeks. 9) The pathognomonic olive shaped mass was palpable in 11 cases and the size of mass was average 2.4x1. 4cm. 10) The results of Ramstedt pyloromyotomy or Koop's modification was excellent without operative faults.

Hirschsprung's disease is a congenital abnormality characterized by chronic constipation secondary to the absence of myenteric parasympathetic nerve ganglia in the distal large intestine.

The definitive operative treatment for Hirschsprung's disease is divided into three main classes-Swenson abdominal pull-through operation, Duhamel retrorectal pull-through operation, and Soave endo-rectal pull-through operation.

But each of these technics has one or more frequent complications or operative difficultes. Recently, the gastrointestinal stapling device is employed to cut away the common wall between the rectum and pulled-through colon of the Duhamel procedure for Hirschsprung's disease.

The authors performed three Duhamel procedures for Hirschsprungs disease using two GIA Autosutures at Ewha Womans University Hospital during recent several months, and are presenting with review of the world literatures.

It is now well established that ethanol excerts different effect on hepatic cellular metabolism, depending mainly on the duration of its intake. And induction of quantitative and qualitative alterations in the cytochrome P-450 of hepatic microso-mes after chronic ethanol feeding is a well-documented phenomenon. But the effect of ethanol ingestion on the drug metabolism appear paradoxic and the ability of chronic ethanol ingestion to potentiate the carcinogenicity of 2-acetyl-aminofluorene(2-AAF) by microsomal activation is not confirmed yet. The present study was undertaken to demonstrate the effects of 15%, 30% ethanol and a commercial liquor feeding for 16 weeks on the lipid in the rat liver, hepatic microsomal cytochrome P-450 and b5, and to elucidate whether or not ethanol-induced rat microsomes can increase the risk of cancer by increasing the rate of metabolic activation of 2-AAF in vitro. The results are followings. 1) The chronic alcohol feeding increased the contents of total cholesterol and triglyceride in the liver, but did not make a significant influence on the phospholipid contents of liver. 2) The 8 week alcohol feeding increased the hepatic microsomal cytochrome P-450 without the changeof cytochrome b5 but the 16 week feeding decreased P-450 significantly. 3) The chronic alcohol feeding elevated the AAF N-hydroxylation continuously but did not influence on AAF ring-hydroxylation. 4) The correlation of AAF N-hydroxylation and the increases of hepatic lipid contents was indicated.

We have investigated in rat liver whether different forms of cytochrome P-450 are alterated in hepatic disorders associated with impaired drug metabolism. Total hepatic cytochrome P-450 is decreased after either bile duct ligation or the administration of estradiol. In contrast, phenobarbital administrated alone increase hepatic content of cytochrome P-450, and when administrated with estradiol the reduction in cytochrome P-450 was prevented. Four forms of microsomal cytochrome P-450 apoproteins, ranging in molecular weight from 50 000 to 58,000, were tentatively identified in a sodium dodecyl sulfate(SDS)-6M urea polyaocrylamide gel electrophoresis system. Phenobrbital administration icreased primarily band IV(50,000 daltons). Bile duct ilgation was associated with a marked reduction in bands II and III while bands II and III were decreased with estradiol benzoate administration. Sumultaneous administration of phenobarbital and estradiol demonstrated a return of band I and an increase in density of bands III and IV. Simultaneous administration of cholic acid and estradiol demonstrated a return of band I and not altered in band III and IV. These studies support the hypothesis that multiple forms of cytochrome P-450 are present in liver microsomal membranes and that alterations in spenific apoproteins may be associated with an increase or a decrease in the functional properties of cytochrome P-450.

We have investigated the effect of administation of exogenous cholic acid whether total hepatic cytochrome P-450 and b5 are altered in the bile duct-ligated rats.

The effect of administration of exogenous cholic acid on the hepatic microsomal mixed-fuction oxidase system is various according to the administration route, dosage and date after administration.

In normal rats, 1ml of 0.5m mol cholic acid solution per 100g body weight administrated intravenously increases hepatic content of cytochrome P-450 and b5 on the third to fifth days after injection.

Total hepatic cytochrome P-450 and b5 are decreased after either bile duct ligation or the administration of ethinyl estradiol. In contrast when cholic acid is adminstrated simultaneously with bile duct ligation, the reduction in cytochome P-450 is relativery prevented.

These effects are similar to the potential of phenobarbital for reversing the bile duct ligation-associated decrease in all components of the mixed function oxidase system.