| Kum-Ja Choi | 11 Articles |
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[English]
Infantile hypertrophic pyloric stenosis (IHPS) is common surgical disease in infants having vomiting. This disease is still not fully documented despite of various hypotheses. This article reviews the literature on the etiology, clinical course, diagnosis and management of IHPS including recent opinion. Citations Citations to this article as recorded by
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The purpose of study is to assess the clinical characteristics of complicated Meckel's diverticulum in children. A retrospective review of pediatric cases of complicated Meckel's diverticulae that were surgically treated at Ewha Womans University Hospital from 1985 was performed. The charts were reviewed for the age and sex of the patients, operation finding, treatment, and outcome. A total 13 patients with a complicated Meckel's diverticulum were identified. There were 8 boys(61.5%) and 5 girls (38.5%) with a mean age of 5.3 years (range, 1month to 14years). Presenting signs and symptoms included digestive hemorrhage (6), intestinal obstruction(4), perforation (1), intussusception due to inverted Meckel's diverticulum (1) and diverticulitis (1). A99m technetium pertechnetate scintiscan was positive in 3 of 4 patients. Barium contrast studies and colonoscopys were not diagnostic. The mean distance from the ileocecal valve to the diverticulum was 47.0±15.7cm. Average length of the diverticulum was approximately 4.7±3.0cm. Segmental small bowel resection including Meckel's diverticulum (84.6%) or wedge excision(15.4%) was done for treatment. In the bleeding group, ectopic gastric mucosa was present in 5 of 6 patients. Postoperative morbidity and mortality was each 0%. The results of this study draw attention to the fact that the complicated Meckel's diverticulum must be suspected in children with acute abdomen or gastrointestinal bleeding.
[English]
No abstract available in English. Citations Citations to this article as recorded by
[English]
Recently, the improvement of the economic conditions and the increasing application of abdominal sonography as a diagnostic tool makes the early diagnosis of infants with infantile hypertrophic pyloric stenosis(IHPS) easy and precise. And the cases with the classical pathophysiologic derangement of IHPS have a declining tendency. In this study the author analyzed and reported the trend at Ewha Womans University Hospital. The author analysed the clinical features and management of 91 young infants who were undergoing pyloromyotomy by author for IHPS from January 1981 through December 1997 at Ewha Womans University Hospital. The findings were compared between the former(1981-1990) and the latter period(1991-1997). Among the total 91 cases, 42 cases were included into the former and 49 cases were the latter period. There has been no difference in sex ratio, birth rank, and age at time of admission between the former and the latter period. The percentage of patients breastfed decreased from 23.8% to 0. And the percentage of patients with alkalosis decreased from 54.8% to 30.6%, hypochloremia from 57.1% to 39.6%, and hypokalemia from 45.2% to 29.2% under the influence of increasing the incidence of early diagnosis. The number of patients with palpable pyloric mass by palpation of the abdomen decreased from 83.3% to 71.4%. And the use of upper gastrointestinal series only as diagnostic test decreased from 71.4% to 18.4%, ultrasonography increased from 11.9% to 46.9%, and both increased from 11.9% to 34.7%. There was no specific postoperative complication during the latter period, and the postoperative hospital stay decreased from 7.1±1.5 days to 4.5±0.7 days. In conclusion, the increasing use of ultrasonography as diagnositic tool enabled the early diagnosis of infantile hypertrophic pyloric stenosis before appearing the disturbed fluidelectrolyte balance of the body. Although the signification decrease of the postoperative hospital stay and complications in the latter period, there has been less change in areas controlled by other specilaties.
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The postoperative peritoneal adhesions are associated with numerous complications, including small bowel obstruction, difficult and dangerous reoperations, and infertility. However the adhesion formation is inevitable phenomenon after abdominal surgery. In this study, a reproducible, quantitative rat model was developed that used uniform ischemic injury on the parietal peritoneum of the area over the right lateral thoracoepigastric vessles. The resulting adhesions and the inflammatory reaction of the insulted area were subsequently scored. And then two potential antiadhesive agents, allopurinol and verapamil, were tested and compared. The result suggest that verapamil appeared to be very effective in reducing adhesion formation but not with allopurinol. However, there was not significant relation to the severity of peritoneal adhesion and inflammatory reaction.
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The mortality of surgical neonates at Ewha Womans University Hospital was analysed and classified during 1976 through 1993 in order to assess e change of mortality rate and provide an opportunity for developing strategies to take off our neonatal surgery. The study period was devided three groups-'76 to'81 as period I,'82 to '87 as period II, and'88 to'93 as period III. Author evaluated retrospectively and compared the mortality rates and causes of death in three periods one another. The clinical classification system(CCS) and morality pattern were used to assess the severity of illness in each death. Surgical neonates were 35 cases during period I, 61 cases in period II, and 115 cases in period III. And during the period III, there was threefold increase in comparision with period I. The number of death and mortality rate were 12 and 34.3% In period I,8 and 13.1%in period II, and 5 and 4.6% in period III. And the mortality rate in period III was significantly decreased. The most marked improvement of survival in neonatal surgery was in esophageal atresia and gastroschisis/omphalocele . And congenital diaphragmatic hernia was the most challenging problem in neonatal surgery with 40% of the overall mortality rate. The CCS of death cases in period I were 5 Class II, 4 Class III, and 3 Class IV, and 1 nonpreventable, 2 permissible, and 9 preventable deaths. There were 2 Class II, 1 Class III, and 5 Class IV in period II. And in period III, there were 3 Class III, and 2 Class IV. Although'preventable death' hold the first place as mortality pattern, it dropped from 9 of 12 cases in period I to 3 of 5 cases in period III. The most common causes of death were respiratory failure and sepsis. Although our hospital had very limited the trained intensive care unit physician and nurses and well-equipped NICUs, the treatment results were very significantly improving progressively. However we should keep up advance the survival of the neonates with multiple anomalies and severely malformed premature giving the adequate attention and active management.
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Hypoxia is one of the most common major stress to which a neonate exposed, and subclinical ischemic/hypoxic insults to the intestine has been implicated as playing a major role in the development of NEC. The exact mechanism leading to mucosal injury due to mesenteric ischemia-reperfusion have not been fully elucidated, yet there is an increasing body of evidence to suggest a role for xanthine oxidase(XO)- derived reactive oxygen metabolites. Allopurinol has repeatedly been demonstrated to be effctive in decreasing reperfusion injury. This study was designed to evaluate the protective effects of allopurinol via breast-feeding to suckling rats, in the setting of ischemia and reperfusion. One-hundred forty Sprague-Dawley rat pups(one-week-old) received breast-feeding whose lactating mothers were bred on standard chow with allopurinol(2mg/100g) suspension water(expermental group) or tap water(control group) for 1 week. Eight rats(each 4 of experimentals and controls) were used to identify histologic finding of small bowel mucosa. Twelve rats(each 6 of experimentals and controls) were used to measure serum uric acid levels. Ninety-six rats (each 48 of experimentals and controls) were subjected to superior mesenteric vessels occlusion for 5, 10 or 20 min. to produce ischemic injury to the intestine. Segmental small bowel resections were performed in each 24 rats of control group and experimental group before and after reperfusiort to histopathologic evidence of reperfusion injury. And the remaining 72 rats(each 36 of experimentals and controls) were observed for mortality after IRI for 1 month. Serum uric acid 1.93±0.64mg/dl of experimentals was significantly lower than 7.32±1.18mg/dl of controls(p<0.005). Bowel injury severity was more severe on longer period of mesenteric vascular occlusion in experimentals and controls. Mucosal injury severity was not different significantly between experimentals and controls with same period of mesenteric vascular occlusion, but after 30 min of reperfusion, severity of mucosal injury in experimentals was attenuated than in controls, especially in the 5 min and 10 min occlusion of mesenteric vessels. All of death occurred in 3 days after IRI, and mortality was decreased from 69.4% in controls to 52.8% in experimental groups. Mortality was increased in case of longer period occlusion of mesenteric vessels but not significant statistically. These results indicate that it is ability to transfer the effect of allopurinol to suckling rats via breast-feeding routes and the protective effects of allopurinol increases the survival rate after IRI.
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Two hundred thirteen patients who underwent inguinal herniorrhaphy before 5 years old at Ewha Womans University Hospital during July 1986 to June 1991 were analyzed. The paients were classified into two groups. unilateral herniorrhaphy group and bilateral herniorrhaphy group. The results of this study indicate the followings. 1) Among total 213 cases. unilateral herniorrhaphy was done in 160 patients and bilateral herniorrhaphy in 53 patients. ; The incidence of bilateral inguinal hernia was 25%. 2) The male to female sex ratio was 86% : 14%. and the incidence was highest in age group less than 1 year old(44.1%). 3) Among 53 cases with bilateral hernias. 19 cases had the simultaneous bilateral hernia and 34 cases had potential bilateral hernias. The incidence of potential contralateral hernia was 17.5% of total eases. 4) The incidence of bilateral hernia in each age group was 20~30%. with 25.6% and 20.0% in male and female, respectively. The difference was not statistically significant(p<0.1). Right side hernia showed potential contralateral hernia in 17.7% of cases and left side hernia showed in 17.3%, which was not significantly different(p>0.l). 5) Incidence of prematurity was not significantly different between two groups. According to this study, since the incidence of contralateral hernia is low and there is no significant parameter for high potentiality of contralateral hernia, it is undesirable to explore the contralateral groin in all unilateral hernia patients.
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The sequelae of ischemic injury to the intestine are potentially devastating to the patient. And it has also been implicated as playing a major role in the development of necrotizing enterocolitis, a major cause of morbidity and mortality in the newborn. Many studies have demonstrated that allopurinol can reduce reperfusion injury after ischemia. But they have limited clinical significance because the data in those studies were produced using parenteral allopurinol unavailable for use in patients or enteral allopurinol at high-doses that is not tolerated and has prohibitive side effects. This study evaluated the protective effects of clinically used doses of enteral allopurinol in rats with intestinal ischemia. One-hundred sixteen Sprague-Dawley rats(180~250g) received allopurinol(1mg/100g) suspensin water(experimental group) or tap water(controls) for 1 week. Four rats(2 treated with allopurinol and 2 controls) were used to identify histologic finding of small bowel mucosa. Sixteen rats(each 8 of allopurinol-treated and control) were used to measure serum uric acid levels to document systemic effects of allopurinol. Ninty-six rats were subjected to superior mesenteric vessels occlusion for 20, 30 or 40 min to produce ischemic injury to the intestine. Segmental small bowel resections were performed in 12 control rats and 12 allopurinol-treated rats before and after reperfusion to identify histopathologic evidence of reperfusion injury. And the remaining seventy-two rats(each 36 of allopurinol-treated and control) were observed for mortality(death within 7 days) after reperfusion. Serum uric acid was decreased from 3.70±1.62mg/dl in controls to 2.41±0.75mg/dl in allopurinol-treated group. Mucosal injury severity was not different significantly among the periods of mesenteric vascular occlusion. But after 30 min of reperfusion, severity of mucosal injury in controls was significantly aggrevated and in allopurinol-treated groups was not different from injury severity of ischemic period. The lethal time 50% (LT5O) in controls was between 30 and 40 min of ischemia. There was reduction in mortality after allopurinol pretreatment in the presently available form and dose with 20, 30 or 40 min of ischemia. And the reduction of mortality in allopurinol-treated groups was distinguishable with LT5O of ischemic period. This study has demonstrated that protective effects of allopurinol to mucosal injury caused by mesenteric ischemia can be achieved with enteral doses that are not likely to cause intolerable side effects and agonizing stress with daily gastric lavage chronically.
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A clinical analysis of the surgically managed neonatal surgical diseases was made with 92 patients under 4 weeks old who were admitted during 12 years period from Jan. 1976 to Dec. 1987. And the outcome of the first half period was compaired with that of the second half period. The results were as follows. 1) Pediatric surgical patients were 17.6% of total patients admitted in the department of the general surgery, and 4.6% of these (92 cases) were neonatal surgical patients. The number of neonatal surgical patients were increased significantly during the second half period. 2) 69 cases were male and 23 cases were female. A ratio of male to female was 3:1. 3) About 60% of the cases were admitted during their first week of life and there were 30% of the cases who admitted during the last week of their neonatal period. 4) Except three cases, 89 cases (96.7%) were admitted with congenital surgical anomalies. 5) More frequent diseases were as follows: congenital hypertrophic pyloric stenosis ; 24 cases (26.1%), jejuno-ileal atresia or stenosis ; 13 cases(14.1%), imperforate anus; 13 cases (14.1%) and congenital duodenal obstruction; 11 cases(11.1%). 6) Vomiting was the main symptom to three quarters of the cases. 7) The number of cases associated with the other congenital anomalies were 14 cases(15.7%). 8) The postoperative complication rate was equally 26% during the first half (9/35) and the second half period (15/57), and the frequent complications were the respiratory problems, sepsis, and wound complications. 9) The mortalities were 28.6% (10/35) during the first half and 8.8% (5/57) during the second half period. Better understanding of neonatal physiology, adequate attention, and active management of pre- and postoperative neonates have certainly contributed to the increased survival during the second half period.
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