• Korean Journal of Head & Neck Oncology
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• v.10 no.2
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• pp.122-127
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• 1994

One hundred fifty four cases of branchial anomaly treated from January 1987 to July 1993 were analysed to determine clinical features, embryologic and anatomic types of the branchial cleft anomaly, to investigate the differences between adults and pediatrics, and to establish the appropriate treatment plan. The male to female ratio was not signifiacntly different in pediatric and adult patients. The mean symptom duration was 0.5 years(range 0.08-14 years) in pediatric patients and 1.67 years (0.7-7 years) in adult patients. The clinical presentations of these anomalies were lateral neck mass in 112(72.7%), infected discharge in 22(14.3%), non-infected discharge in 6(3.9%), and abscess in 14 cases(9.l%). Sites of the lesions were upper third of the neck in 93(60.3%), infraauricular in 35(22.7%), middle third of the neck in 17(11.0%) and inferior third of the neck in 9 cases(5.8%). The anatomic types were cystic form in 117(75.9%), sinus in 24(15.5%), and fistula in 13 cases(8.4%). Embryologic classification were 124 second branchial cleft anomalies(80.5%), 29 first branchial cleft anomalies(18.8%), and 1 third branchial cleft anomaly(0.6%). Immediate surgery under the uncontrolled infection in 17 cases result in 82.4% recurrent rate(14 cases), and 17.6% cure rate(3 cases). Delayed surgery under the controlled infection in 8 cases recurrent rate(1 case), and 87.5% cure rate(7 cases). In summary, the most common branchial cleft anomaly is second type cyst both in pediatric and adult group, delayed surgical exterpation after infection control with I & D or antibiotics may give a good chance for care and may reduce the recurrence.

• Clinical and Experimental Reproductive Medicine
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• v.13 no.2
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• pp.137-144
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• 1986

A reveiw of 85 patients with uterine anomalies was made in respect to the incidence, chief complaints, the reason of infertility, fetal wastage rate, pregnancy complications, fetal presentations and obstetric outcome after metroplasty from 1980 to 1985. The results were summarized as follows: 1. Incidence of uterine anomaly was 0.18% among all outpatients (85/48,240). 2. Of the 85 patients, there were 36 with bicornuate deformities (42.3%), 21 septate (24.7%), 18 uterus didelphys (21.2%), 8 arcuate (9.4%) and 2 patients with unicornuate anomalies (2.4%). 3. Uterine anomalies were diagnosed by hysterosalpingogram (54.1%), pelvic examination (14.2%) and other operative procedures. 4. Chief complaints were primary infertility (41.2%), secondary infertility (15.3%), repeated pregnancy loss (12.9%), antenatal care (11.8%) and menstural disturbance (10.6%), etc. 5. Twenty-nine patients with uterine anomalies had primary infertility. The cause of infertility was proved nonuterine in 26 cases and remained unknown in 3 cases. 6. The obstetric outcome of 104 pregnancies was spontaneous abortion in 51.0%, premature delivery in 11.50/0 and fetal loss in 57.7%. 7. Complications of 41 present pregnancies were threatened abortion (22%), premature rupture of membrane (12%) and premature labor (10%), etc. The frequency of abnormal presentation was 35.3% and 64.7% of deliveries was made by Cesarian section. 8. Metroplasty was performed in 13 patients who didn't have a baby because of repeated miscarriage and unknown cause of infertility. Subsequently 8 patients had 9 successful pregnancies: 6 patients had 7 healthy babies and 2 patients are now in pregnancy without any complications.

• Journal of Chest Surgery
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• v.5 no.2
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• pp.107-112
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• 1972

Recently we experienced a case of the portal hypertension, extrahepatlc origin in the National Medical Center, Seoul. The case was a male aged 19 who was undergone the elective splenorenal shunt with splenectomy 9 years ago and emergency ligation of the coronary vein because of recurred variceal rupture 6 years later and had recurring esophageal varices with bleeding this time.At the age of 10 he had been occasionally suffering from nasal bleeding and visited to our Pediatric department, when there was encountered for the first time the splenomegaly, esophageal varices in the lower third esophagus on the esophagogram, and stenosis and kinking of the portal vein with rich collateral circulation on the splenoportography without hepatic functional impairment.The elective splenorenal shunt with splenectomy was undergone under the diagnosis of portal hypertension due to congenital anomaly of the portal vein and postoperatlvely no troubles had been obtained until postoperative 1st attack of massive hematemesis due to esophagenl variceal rupture recurred about 6 years later which was confirmed by control esophagogram and it was resulted by stenosis of previous anastomotic site of the splenorenal shunt.Then emergency ligation of the coronary vein was only made for bleeding control and no episodes of hematemesis had been encountered thereafter until April 1972 about 3 years after the 2nd operation, when hematemesis recurred again. In this time, recurring esophageal varices were noted in the lower third esophagus on the control esophagogram and he was employed side to end mesocaval shunt as the final step of portal decompression,and following results were obtained. 1] No postoperatlve troubles as leg edema or pain: Postoperatively leg elevation and elastic bandage on the both legs were employed until discharge. 2] During operation the portal pressure was 300 mm $H_2O$ and immediately lowered to 170 mm $H_2O$ after shunt.

• Journal of Chest Surgery
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• v.29 no.8
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• pp.844-849
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• 1996

During the 2 years period, we hav performed acute peritoneal dialysis in twenty two children after cardiopulmonary bypass among 198 patients who underwent surgery due to complicated congenital heart diseAses . were fluid over- load (10 cases), oliguria (9 cases) and hyperkalemia (3 cases). Bypass time greAter than 90 minutes was a predictor of the need for dialysis(p< 0.05). Five neonates (38 %) operated on instituted peritoneal dialysis but it was insignificant determinant factor (p 08). Sixteen patients recovered their renal suction, but 4 patients died due to respirAtory fAilure or sepsis. All the patients which could not recover their renal function, expired although the renal failure was not re- sponsible for the mortality. We think that early peritoneal dialysis is helpful in cases of oliguia, fluid overload or hyperkalemia after cradiopulmonary bypass.

• Journal of Veterinary Clinics
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• v.31 no.1
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• pp.51-53
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• 2014

An 10-day-old, male Jindo puppy was presented with anuria. This puppy was diagnosed as agenesis of prepuce and preputial orifice. To treat anuria exploratory operation was performed and the penis was found in situ under the skin. The penis was protruded outside of the skin. Because of strangulation and dryness of the penis by growing up, the artificial prepuce was made by making the subcutaneous tunnel. After that this puppy showed normal urination and had no complication. In case of the agenesis of the prepuce with the penis in situ, artificial prepuce by subcutaneous tunnel would be an alternative choice for saving the puppy.

• Neonatal Medicine
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• v.16 no.2
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• pp.154-162
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• 2009

Purpose: Death is an important problem for physicians and parents in neonatal intensive care unit. This study was intended to evaluate the mortality rate, causes of death, and the change of mortality rate by year for infants admitted to the neonatal intensive care unit. Methods: We retrospectively surveyed the medical records of the infants who were admitted to the neonatal intensive care unit at Asan Medical Center and who died before discharge between 1998 and 2007. Gestational age, birth weight, gender, time to death and the underlying diseases related to the causes of infant deaths and obtained from the medical records and analyzed according to year. Results: A total of 6,289 infants were admitted and 264 infants died during the study period. The overall mortality rate was 4.2%. For very low and extremely low birth weight infants, the mortality rate was 10.6% and 21.4%, respectively. There was no significant change in the mortality rate during the study period. Prematurity related complications and congenital anomalies were the conditions most frequently associated with death in the neonatal intensive care unit. of the infant deaths 37.1% occurred within the first week of life. Conclusion: Even though a remarkable improvement in neonatal intensive care has been achieved in recent years, the overall mortality rate has not changed. To reduce the mortality rate, it is important to control sepsis and prevent premature births. The first postnatal week is a critical period for deaths in the neonatal intensive care unit.

• Journal of Chest Surgery
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• v.38 no.10 s.255
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• pp.699-704
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• 2005

Background: Coronary artery fistula is rare congenital anomaly, which account for $0.27\~0.40\%$ of all congenital heart diseases. We report the clinical observations of 45 patients with coronary artery fistula. Material and Method: We reviewed all patients presented with or without symptoms of coronary artery fistula between 1987 and 2004. Age ranged from 1 to 83 years. Twenty-six patients were female. The patients were divided into 2 groups according to the presenting symptoms. Twelve patients were in group A (asymptomatic) and 33 patients in group B (symptomatic). The most common clinical presentation in group B was angina (18) followed by dyspnea (7), atypical chest pain (5), syncope (1), fatigue (1), and palpitation (1). Twenty-five patients were associated with other cardiac diseases, which were atrial septal defect (4), coronary artery occlusive disease (6), hypertension (12), and valvular heart disease (2). Result: Patients were followed-up for a mean period of $64.8\pm62.7$ months. There was no complication related to coronary artery fistula during the follow-up period in both group. There was no mortality related to coronary artery fistula. Conclusion: In symptomatic patients, early surgical treatment is recommended considering the low perioperative morbidity. In asymptomatic patients receiving medical treatment, close follow up may be necessary.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.292-298
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• 2009

Background: Surgery for mitral valve disease in children carries both technical and clinical difficulties that are due to both the wide spectrum of morphologic abnormalities and the high incidence of associated cardiac anomalies. The purpose of this study is to assess the outcome of mitral valve surgery for treating congenital mitral regurgitation in children. Material and Method: From 1997 to 2007, 22 children (mean age: 5.4 years) who had congenital mitral regurgitation underwent mitral valve repair. The median age of the patients was 5.4 years old and four patients (18%) were under 12 months of age. 15 patients (68%) had cardiac anomalies. There were 13 cases of ventricular septal defect, 1 case of atrial septal defect and 1 case of supravalvar aortic stenosis. The grade of the preoperative mitral valve regurgitation was II in 4 patients, III in 15 patients and IV in 3. The regurgitation was due to leaflet prolapse in 12 patients, annular dilatation in 4 patients and restrictive leaflet motion in 5 patients. The preoperative MV Z-value and the regurgitation grade were compared with those obtained at follow-up. Result: MV repair was possible in all the patients. 19 patients required reduction annuloplasty and 18 patients required valvuloplasty that included shortening of the chordae, papillary muscle splitting, artificial chordae insertion and cleft closure. There were no early or late deaths. The mitral valve regurgitation after surgery was improved in all patients (absent=10, grade I=5, II=5, III=2). MV repair resulted in reduction of the mitral valve Z-value ($2.2{\pm}2.1$ vs. $0.7{\pm}2.3$, respectively, p<0.01). During the mid-term follow-up period of 3.68 years, reoperation was done in three patients (one with repair and two with replacement) and three patients showed mild progression of their mitral reguration. Conclusion: our experience indicates that mitral valve repair in children with congenital mitral valve regurgitation is an effective and reliable surgical method with a low reoperation rate. A good postoperative outcome can be obtained by preoperatively recognizing the intrinsic mitral valve pathophysiology detected on echocardiography and with the well-designed, aggressive application of the various reconstruction techniques.

• Clinical and Experimental Pediatrics
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• v.50 no.3
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• pp.241-247
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• 2007

Purpose : Congenital muscular torticollis (CMT) is a common and benign congenital disorder of the musculoskeletal system in neonates and infants. The pathophysiology is that the sternocleidomastoid muscle (SCM) is shortened on the involved side by fibrosis, leading to ipsilateral tilt and contralateral rotation of the face and chin. In this study, we investigated the clinical features of CMT, the role of ultrasonography (USG) in prediction of prognoses and the clinical significance of early detection and treatment. Methods : Forty seven patients (M:F=31:16) were diagnosed as a CMT between March 2003 and May 2006. We reviewed age at diagnosis, physical findings, USG findings, treatment and therapeutic outcome from their medical records. Results : The median age at diagnosis was 90 days (18 days-9 years, 7 months) and the right side of neck was affected in more patients (right : left=26:21). Of 24 patients with a palpable neck mass, 21 had USG; 19 cases showed sternocleidomastoid tumor (SMT). In cases with no neck mass, USG was performed in 11 patients; seven had postural torticollis (POST), three had SMT and one had muscular torticollis (MT). Among 40 patients with follow-up, 36 had total resolution. There was negative correlation between the age at diagnosis and the recovery time, whereas the final outcome was not correlated with USG findings. However, the patients without positive findings in USG had earlier resolution (1 month vs 2.6 months, P=0.0008). The patients with SMT had earlier diagnosis and excellent outcomes. The patients with MT were delayed to diagnosis and had the longest time to resolve. Lastly, the patients with POST had delayed diagnoses, but they had excellent outcomes. Conclusion : Since the patients with delayed diagnoses, in despite of benign courses, may take a long time to resolve and rarely need surgical treatment, it is important to diagnose and treat early. This study showed that USG findings of the SCM may be used as predictive factors.

• Journal of Chest Surgery
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• v.30 no.9
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• pp.927-931
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• 1997

Tricuspid regurgitation due to rupture of a chorda is a rare disease in newborns. Recently, we experienced one day old male with tricuspid regurgitation due to rupture of a chorda of anterior papillary muscle, and who had suffered from severe hypoxemia, acidosis, cyanosis, and bradycardia. Preoperative diagnosis was pulmonary atresia with intact ventricular s ptum, massive tricuspid regurgitation, and patent ductus arteriosus by echocardiogram, which demonstrated no flow through the pulmonic valve. At operation, the pulmonic valve was intact and a chorda of anterior papillary muscle was ruptured. Tricuspid regurgitation was corrected successfully with reconstruction of the chords. Postoperative course was complicated by pneumonia and sepsis, but the infant recovered and discharged at postoperative 20 days.