• Advances in pediatric surgery
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• v.9 no.1
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• pp.19-23
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• 2003

Necrotizing Enterocolitis (NEC) is usually a disease of premature infants, but occasionally it affects the term neonate. Twenty-five infants with NEC were treated at Asan Medical Center between January 2000 and December 2002, and 13 of them were term infants. In each case, the diagnosis of NEC was established by a clinical illness fulfilling the Bell's stage II or III NEC as modified by Walsh or by surgical findings. There were six males and seven females. The birth weight was from 1,960 to 3,700 g. The age at diagnosis was from 1 to 40 days. Four patients had congenital heart disease: one of who had hypothyroidism and cleft palate. Abdominal distension was present in all, and bloody stools in four. One patient had history of hypoglycemia, three had Rota viral infection. Eight patients had leucopoenia (<$5.0{\times}10^9/L$), seven had thrombocytopenia (<$100{\times}10^9/L$), and three severe thrombocytopenia (<$50{\times}10^9/L$). Laparotomy was required in 10 of the 13 patients. Indications for operation in the acute phase were failure to respond to aggressive medical therapy in five, and perforation in three patients. There were two late phase operations for intestinal stricture and fistula. There were no operative complications. Ten of thirteen patients survived (76.9%). Two patients died of septic complication. There was a delayed death due to heart failure. There was a significant difference in survival according to platelet count ($50{\times}10^9/L$) (p<0.05). Congenital heart disease and Rota viral infection are associated with NEC in term infants and thrombocytopenia and leucopoenia may be surgical indications.

• Archives of Plastic Surgery
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• v.37 no.4
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• pp.481-484
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• 2010

Purpose: Congenital dermoid cysts develop during the fusion of the embryo when the ectodermal tissue gets trapped in the line of fusion. Dermoid cysts of the head are rare lesions comprised of epidermal and mesodermal elements. Furthermore, dermoid cysts in the occipital area are extremely rare. Only a few cases of dermoid cysts in the posterior scalp have been reported. Especially, A bilateral, synchronous presentation in this location has not been reported previously in the literature. Methods: All 5 cases had a gradually enlarging mass of the posterior aspect of the scalp. The cysts were mobile, noncompressible, and non-tender, without evidence of an associated sinus tract, skin dimpling, discoloration, or communication with adjacent structures. The CT scan displayed a hypodense cystic lesions about -87 to +24 HU (Housefield units, average +3.2 HU) with hypodense capsule and no postcontrast enhancement. All tumors were found just under the skin, and were well encapsulated, so they were completely removed the mass with adjacent periosteum. Results: On gross findings, all tumors were oval-or round-shaped, and when the cystic tumor was cut open it presented a greasy and caseous substance. Histologically, all specimens contain desquamated squamous epithelium and keratin in the lumen and are encapsulated and lined by keratinized stratified squamous epithelium. And, all cases of posterior mass are the presence of adnexal structures. Conclusion: Appropriate diagnosis requires not only an index of suspicion for this rare tumor a very careful history and search for skin changes. Especially, CT can reveal the exact location of the cyst, its relationship with the adjacent structures. We think that occipital dermoids divide into superficial and deep type. In our cases, because they did not have intra-cranial involvement or fistula formation, they are superficial type. This report describes the clinical and operative aspects of the superficial dermoid cysts and provides a review of the literatures.

• Advances in pediatric surgery
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• v.17 no.2
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• pp.162-169
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• 2011

Branchial cleft anomalies are the second most common head and neck congenital lesions seen in children. Amongst the branchial cleft malformations, second cleft lesions account for 95 % of the branchial anomalies. This article analyzes all the cases of second branchial cleft anomalies operated on at Seoul National University Hospital from September 1995 to February 2011. We analyzed sex, age, symptom and sign, accompanied anomaly, diagnosis, treatment, pathologic report and outcome via retrospective review of medical records. In this series, we had 61 patients (27 female and 34 male). The mean age at the time of operation was 38 months. 31 lesions were on the right, 20 were on the left and 10 were bilateral. The most frequent chief complaints at presentation were non-tender mass and cervical opening without any discharge. According to anatomic type, 29 patients had branchial cleft sinuses, 14 had cysts, 14 had fistulas and 4 had skin tags. Complete excision was attempted if possible and antibiotics challenged when infection was suspected. Complete excision was achieved in 96.7 % of cases. Incision and drainage was done in 2 cases due to severe inflammation, and both recurred. Postoperative complications included wound infection in 2 cases. Microscopic examonation revealed squamous epithelium in 90.2 % and squamous metaplasia in one case in the branchial cleft cyst wall. In summary, second branchial anomaly is found more frequently on right side of neck. Fistulas are diagnosed earlier than cystic forms. Most cases could be diagnosed by physical examination. The definitive treatment is complete excision and sufficient antibiotics coverage for cases with inflammation. After drainage of infected lesions, follow up excision after 1 year might be beneficial for preventing recurrence.

• Journal of Periodontal and Implant Science
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• v.33 no.3
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• pp.383-393
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• 2003

The aim of this retrospective study was to compare the amount of marginal bone loss between upper anterior area and upper posterior area with 71 upper single-tooth restorations on 2 stage machined $Br{{\aa}}nemark$ implants since Jan 1995. The second aim was to compare the bone defect group which had dehiscence and fenetration and the others in the upper anterior region. The results were as follows. 1. The most frequent reason of missing tooth in the upper anterior region was trauma by 61%. While upper posterior region showed various reasons such as congenital missing, advanced periodontitis, trauma. 2. Peri-implantitis with fistula occurred 1 of 41 implants in the upper anterior group in 1 year after loading and 2 of 32 implants in the upper posterior group failed before loading. The 1 year success rate of upper anterior group was 97.56 %, and 93.75 % for upper posterior group. 3. The mean marginal bone loss in the upper anterior group was 0.44${\pm}$0.25 mm, while 0.57${\pm}$0.32 mm in the upper posterior group. There was statistically significant difference in the amount of mean marginal bone loss (P${\pm}$0.10 mm at one year, and 0.48${\pm}$0.26 mm for the control group. No statistically significant difference of mean marginal bone loss was showen between bone defect group and the others at implantation. According to the results, the upper anterior region showed less marginal bone loss than the upper posterior region. In case of missing single upper tooth, careful consideration on recipient residual ridge to determine proper implant diameter and length, sufficient healing time, proper loading would lead to implant success. Single tooth implants in the maxilla seemed to be an alternative to fixed partial dentures without damage to adjacent teeth.

• Archives of Plastic Surgery
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• v.37 no.3
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• pp.297-300
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• 2010

Purpose: Failure of proper migration, fusion, or maturation of the branchial apparatus components results in a variety of congenital defects. Of these, cartilaginous rests are infrequent, while branchial cysts and sinuses are more common, relatively. The purpose of this study is to examine the clinical and pathological features of rare cervical branchial remnants in order to provide basis for its correct diagnosis and treatment. Methods: We report three cases of cervical branchial remnants which were treated in our hospital from December 2004 to December 2009. These cases were examined their clinical features, histologic findings and treatments. The patients had been operated with simple excision, excision of the combined components and preoperative antiboitics. Results: A retrospective review produced 2 cases of the cervical branchial remnants and 1 case of the cervical chondrocutaneous branchial remnant. All cases were on the left side of the neck, and anterior to the sternocleidomastoid muscle. Histopathological examination showed that fistula & sinus were lined with stratified squamous epithelium, additionally, they were consisted of a cutaneous envelope containing sebaceous glands, hair follicles, various amounts of adipose tissue, and elastic fibers. And, One case revealed containing hyaline cartilage. No patient developed complications or reccurences. Conclusion: The authors recommend simple surgical excision of the remnants when discharge, infection, or cosmetic problem occur. Finally, these lesions do not have fistulous tracts or connections with important, deeper organs, and so can be safely transected at the level of the superficial musculature.

• Journal of Chest Surgery
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• v.41 no.5
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• pp.671-674
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• 2008

Jejunum and fasciocutaneous and myocutaneous flaps are theoretically recommended as esophageal substitutes in reconstruction of the esophagus after several occurrences of failed reconstruction. However, other esophageal substitutes should also be considered. Secondary esophageal reconstruction was successfully performed on a 24-year-old woman who had a history of cervical, thoracic, and abdominal operations and esophageal stricture secondary to several failed reconstructions for esophageal atresia and tracheo-esophageal fistula 21 years prior. The esophageal reconstruction was done subcutaneously by end-to-side anastomosis at the left cervical area using a deformed stomach graft. The patient was discharged with the ability to consume a regular diet after the operation.

• Advances in pediatric surgery
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• v.4 no.1
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• pp.16-26
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• 1998

Parenteral nutrition has been an essential part of postoperative care of neonates requiring major surgery who are unable to tolerate enteral feeding for long periods during the postoperative period. However, TPN via central venous catheters(central TPN), used in increasing trend, still presents significant morbidity. To find out whether TPN via peripheral veins(peripheral TPN) could be used as a viable alternative for postoperative parenteral nutrition in neonates, a clinical study was carried out by a retrospective analysis of 53 neonates subjected to peripheral TPN for more than 7 days after surgery. Operations consisted of procedures for esophageal atresia with tracheoesophageal fistula, gastroschisis and omphalocele. Surgery was performed at the Division of Pediatric Surgery, Department of Surgery, Hanyang University Hospitall, from 1983 to 1994. The mean total duration of TPN was 13.3 days (range; 7-58 days), the average daily total fluid intake was 117.6 ml/kg during TPN and 158.6 ml/kg during subsequent oral feeding. The average daily total calorie intake was 57.7 kcal/kg during full strength TPN and 101.3 kcal/kg during subsequent oral feeding. The mean urine output was maintained at 3.5 ml/kg/ hour during TPN and at 3.6 ml/kg/hour during subsequent oral feeding. The increment of body weight observed during TPN was 132 g in TEF, 53 g in gastroschisis and 3 g in omphalocele patients, while loss of body weight was not observed. The mortality rate was 5.7 %(3/53) and was related to the underlying congenital anomalies, not the TPN. The most common complication of peripheral TPN observed was laboratory findings suggestive of liver dysfunction in 23 cases(43.4 %) with no significant clinical symptom or signs in any case, transient pulmonary edema in one case, and generalized edema in one case. None of the major complications usually expected associated with central TPN were observed. The result of this study suggest that peripheral TPN can be used for adeguate postoperative nutritional support in neonates requiring 2 to 3 weeks of TPN.

• Archives of Plastic Surgery
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• v.41 no.1
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• pp.45-49
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• 2014

Background Preauricular sinuses are congenital abnormalities caused by a failure of fusion of the primitive tubercles from which the pinna is formed. When persistent or recurring inflammation occurs, surgical excision of the infected tissue should be considered. Preauricular defects inevitably occur as a result of excisions and are often difficult to resolve with a simple suture; a more effective reconstruction technique is required for treating these defects. Methods After total excision of a preauricular sinus, the defect was closed by a plastic surgeon. Based on the depth of the defect and the degree of tension when apposing the wound margins, the surgeon determined whether to use primary closure or a posterior auricular flap. Results A total of 28 cases were examined. In 5 cases, including 2 reoperations for dehiscence after primary repair, reconstruction was performed using posterior auricular transposition flaps. In 16 cases of primary closure, the defects were closed using simple sutures, and in 7 cases, closure was performed after wide undermining. Conclusions If a preauricular defect is limited to the subcutaneous layer and the margins can be easily approximated, primary closure by only simple suturing may be used to perform the repair. If the defect is deep enough to expose the perichondrium or if there is tension when apposing the wound margins, wide undermining should be performed before primary closure. If the extent of the excision exposes cartilage, the procedure follows dehiscence of the primary repair, or the tissue is not sufficiently healthy, the surgeon should use a posterior auricular flap.

• Korean Journal of Bronchoesophagology
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• v.13 no.1
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• pp.23-28
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• 2007

Background and Objectives: Since intractable aspiration in patients with impaired protective function of the larynx often results in multiple episode of aspiration pneumonia, repeated hospitalizations and expensive nursing care. The authors reported the preliminary results of laryngotracheal separation(LTS) in patient with chronic intractable aspiration. The purpose of this study was to report the follow up results of patient outcome with the LTS. Materials and Methods: A retrospective review of 15 patients who underwent LTS between 1996 and 2006 was conducted. Ages ranged from 3 to 72 years. Results: Eight patients had morbid aspiration as a consequence of acquired neurologic injuries and seven patients with congenital neurologic injuries. Two patients had a postoperative fistula, which was well controlled with local wound care. Following LTS, aspiration was effectively controlled in all patients and eight were able to tolerate a regular diet. Conclusion: LTS is a low-risk, successful, definitive procedure which decreases the potential for aspiration, pulmonary complications, duration of hospitalizations and increases quality of life, especially in patent with irreversible upper airway dysfunction and poor speech potential.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.25 no.6
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• pp.453-460
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• 2022

Purpose: Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is a congenital anomaly that can cause frequent digestive and nutritional problems, even after repair. The most common complication is anastomotic stricture, for which reoperation or balloon dilatation is performed. This study aimed to evaluate the postoperative complications of EA and the role of endoscopic balloon dilatation (EBD) in cases of anastomotic stricture. Methods: We retrospectively analyzed patients diagnosed with EA with or without TEF between January 2000 and February 2021. Patients' baseline characteristics, associated anomalies, and postoperative complications were reviewed. Results: Among 26 patients, 14 (53.8%) were male, 12 (46.2%) had coexisting anomalies, and the median follow-up was 6.1 years (range, 1.2-15.7 years). In univariate analysis, prematurity, low birth weight, and long-gap EA were associated with postoperative complications in 12 (46.2%) patients. Among the 10 (38.5%) patients with anastomotic stricture, nine (90.0%) required EBD. Regarding the first EBD, it was performed at a median of 3.3 months (range, 1.2-7.6 months) post-repair, while the average patient weight was 4.6 kg. The mean diameter ranged from 3.3 to 9.1 mm without major complications. In univariate analysis, long-gap EA alone was significantly associated with EBD. Conclusion: Approximately half of the patients experienced complications after EA repair. In particular, patients with a long-gap EA had a significantly increased risk of complications, such as anastomotic strictures. EBD can be safely used, even in infants.