• Advances in pediatric surgery
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• v.2 no.2
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• pp.143-147
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• 1996

Spontaneous perforation of the bile duct in children is a very rare disorder. We experienced a 6 year-old girl with spontaneous perforation of the right hepatic duct. The patient was initially misdiagnosed as hepatitis because of elevation of liver enzyme and then as appendicitis because of fluid collection in the pelvic cavity demonstrated by ultrasonogram. A laparoscopic exploration was done and no abnormal findings were detected except bile-stained ascites. Peritoneal drainage was performed and the patients seemed to improve clinically. Abdominal pain, distention and high fever developed after removal of the drains. DISIDA scan showed a possible of bile leak into the peritoneal cavity. ERCP demonstrated free spill of dye from the right hepatic duct. At laparotomy, the leak was seen in the anterior wall of the right hepatic duct 2cm above the junction of the cystic duct and common hepatic duct. The perforation was linear in shape and 0.8cm in size. The patient underwent cholecystectomy, primary closure of the perforation and T-tube choedochostomy. We could not identify the cause of the perforation; however, the T-tube cholangiography taken on the 42nd postoperative day showed a little more dilatation of the proximal common bile duct compared with the cholangiography taken on the 14th day. Long-term follow-up of the patient will be necessary because of the possibility for further change of the duct.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.1
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• pp.75-78
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• 2009

A peritoneal loose body is reported to develop because of torsion and separation of the epiploic appendages. The condition is usually symptomless and may be incidentally during abdominal surgery or autopsy. It usually occurs in middle-aged and elderly adults and is very rare in children. In this paper, we report a case of a peritoneal loose body in the pelvic cavity of a 10-year old-girl who presented with urinary frequency and left lower abdominal discomfort. A second plain X-ray film of the abdomen, obtained before surgery, in a different view than the first, revealed that the calcified mass had migrated to a lower position. The mass was laparoscopically resected, and histological examination revealed it to be a fibrotic nodule with central liquefaction and calcification.

• Clinical and Experimental Reproductive Medicine
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• v.20 no.2
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• pp.177-181
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• 1993

Endometriosis involving sites outside the pelvic cavity is a relatively uncommon occurrence and its frequency is cited as being less than one percent of all occurences of endometriosis. Sites previously reported in literature have described involvement of the extraperitoneal portion of the round ligament, the rectosigmoid, the appendix, and the ileum. Other more distal sites reported to have been found to have endometriosis lesions include the inguinal ligaments, the umbilicus, abdominal incisional wounds, thoracic lesions involving the pleura or diaphragm which may result in catamenial pneumothorax, the kidneys, and vulvar episiotomy wounds. Endometriosis have even been reported to occur in males. In this presentation, three cases of endometriosis, two involving the vulvar area and one involving a Pfannenstiel incision wound, is presented with a review of the pertinent literature in order to discuss its etiology, pathology, diagnosis and treatment.

• Advances in pediatric surgery
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• v.12 no.2
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• pp.232-237
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• 2006

Abdominal cystic lymphangiomas arising from the mesentery, omentum and retroperitoneum are rare and occasionally confused with other cause of acute abdomen. Sixteen children who underwent surgery for abdominal cystic lymphangioma between 1984 and 2005 at the Division of Pediatric Surgery, Keimyung University Dongsan Medical Center were evaluated retrospectively. There were 9 boys and 7 girls. Age ranged from 12 days to 13 years (mean age: 4.7years). The cysts were located in the omentum (4 cases),mesentery (9 cases: jejunum: 3, colon: 6). retroperitoneum (2 cases) and pelvic cavity (one case). The cyst content was hemorrhagic (8 cases), serous (5 cases), and inflammatory (2 cases), and chyle (one). Prenatal diagnosis was made in 3. The clinical features were variable, but abdominal pain, mass, and abdominal distention in order. There were 3 emergency operations in patients with complicated cyst, who were suspected of having panperitonitis and volvulus preoperatively. Complete excision was accomplished in all cases. There was one mortalityin a newborn with E.coli sepsis. Intestinal obstruction developed in 2 cases in long-term follow-up. No recurrence was observed. Although intraabdominal lymphangioma arising from mesentery, omentum and retroperitoneum are rare, it should be considered as a possible cause of acute abdomen.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.6
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• pp.596-599
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• 2009

A 24 year-old female presented for a $^{99m}Tc$-methylene diphosphonatae (MDP) whole body bone scan due to chronic pain in the bilateral lower extremities that has aggravated since 2002. She was diagnosed with Camurati-Engelmann disease (CED) based on the clinical and radiological findings in 2002, and she re-visited our institute to evaluate disease status at this time. CED is a rare autosomal dominant type of bone dysplasia characterized by progressive cortical thickening of long bones, and narrowing of medullary cavity, and thus presents with typical clinical symptoms and signs such as chronic pain in the extremities, muscle weakness, and waddling gait. On the $^{99m}Tc$-MDP bone scan performed to evaluate disease status, intense increased uptake was seen in the skull, facial bones, bilateral scapulae, bilateral long bones, and bilateral pelvic bones, which clearly demonstrated the extent of CED involvement.

• Childhood Kidney Diseases
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• v.25 no.2
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• pp.117-121
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• 2021

Chronic kidney disease (CKD)-mineral and bone disorder (CKD-MBD) is a common complication of CKD, often accompanied by extra-skeletal calcification in adult patients. As increased vascular calcification is predicted to increase cardiovascular mortality and morbidity, the revised Kidney Disease: Improving Global Outcomes guidelines recommend avoiding calcium-containing phosphate chelators. However, extra-skeletal calcification is less commonly noticed in pediatric patients. Here, we report our experience of such a complication in pediatric patients receiving maintenance peritoneal dialysis. Extra-skeletal calcification was noticed at the corneas, pelvic cavity, and soft tissues of the lower leg in 4 out of 32 patients on maintenance peritoneal dialysis. These patients experienced the aggravation of extra-skeletal calcifications during peritoneal dialysis, and 2 of them underwent excisional operations. It is required to monitor extra-skeletal calcifications in children on kidney replacement therapy.

• Radiation Oncology Journal
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• v.33 no.2
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• pp.134-141
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• 2015

Purpose: This study investigates morphologic change of the rectosigmoid colon using a belly board in prone position and distended bladder in patients with rectal cancer. We evaluate the possibility of excluding the proximal margin of anastomosis from the radiation field by straightening the rectosigmoid colon. Materials and Methods: Nineteen patients who received preoperative radiotherapy between 2006 and 2009 underwent simulation in a prone position (group A). These patients were compared to 19 patients treated using a belly board in prone position and a distended bladder protocol (group B). Rectosigmoid colon in the pelvic cavity was delineated on planning computed tomography (CT) images. A total dose of 45 Gy was planned for the whole pelvic field with superior margin of the sacral promontory. The volume and redundancy of rectosigmoid colon was assessed. Results: Patients in group B had straighter rectosigmoid colons than those in group A (no redundancy; group A vs. group B, 10% vs. 42%; p = 0.03). The volume of rectosigmoid colon in the radiation field was significantly larger in group A (56.7 vs. 49.1 mL; p = 0.009). In dose volume histogram analysis, the mean irradiated volume was lower in patients in group B (V45 27.2 vs. 18.2 mL; p = 0.004). In Pearson correlation coefficient analysis, the in-field volume of rectosigmoid colon was significantly correlated with the bladder volume (R = 0.86, p = 0.003). Conclusion: Use of a belly board and distended bladder protocol could contribute to exclusion of the proximal margin of anastomosis from the radiation field.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.616-620
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• 2011

Purpose: Mayer-Rokitansky-Kuster syndrome (MRK) is second common cause of primary amenorrhea. It is a syndrome of vaginal aplasia and Mullerian duct anomaly. Vaginal aplasia varies from agenesis of whole vagina to aplasia of upper 2/3. For reconstructing vagina, various methods are introduced. Gracilis myocutaneous flap was the first attempt in that the flap is used in vaginal reconstruction. Various flap-based vaginal reconstruction methods have been introduced. Modified Singapore flap (pedicled neurovascular pudendal thigh fasciocutaneous flap) is one of those methods that used posterior labial artery as pedicle, and pudendal nerve branch as sensory root. As its donor lies on inguinal crease that is easily hidden and there are benefits on sexual intercourse by early sensory recovery, authors think that modified Singapore flap is effective for young MRK syndrome patients. Methods: Eight patients underwent surgery between 2008 and 2010. The flap was designed on both groin area with external pudendal artery branch as a pedicle. All flaps were fixated in pelvic cavity with absorbable suture, and additional compression on neovaginal wall was supplied by polyvinyl alcohol sponge ($Merocel^{(R)}$). Results: All patients were successfully reconstructed without flap related complications such as congestion or partial flap loss. The average size of the flap (each side) was 69.34 $cm^2$. Polyvinyl alcohol sponge ($Merocel^{(R)}$) was inserted into neovagina for 5 days on every patient. One case of rectal laceration was occurred while making pelvic pocket by OBGY team. Other complications such as lumen narrowing, wound contracture or vaginal prolapsed were not reported during 8 months of follow up. Conclusion: Modified Singapore flap is a sensate fasciocutaneous flap that is thinner than other myocutaneous flap such as VRAM, and more durable over skin graft. Therefore this is a good choice for vaginal reconstruction in MRK syndrome. And known complications of Modified Singapore flap could be reduced with careful procedure and mild compression techniques.

• Radiation Oncology Journal
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• v.18 no.3
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• pp.194-199
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• 2000

Purpose : Then determining the lower margin of post-operative pelvic radiation therapy field according to the traditional method (recommended by Gunderson), the organs located in the low pelvic cavity and the perineum are vulnerable to unnecessary radiation. This study evaluated the effect of individualized determination of the lower margin at 2 cm to 3 cm below the anastomotic site on the failure patterns. Materials and Methods . Authors included ぉ patients with modified Astler-Coiler (MAC) stages from B2 through C3, who received low anterior resection and post-operative pelvic radiation therapy from Sept. 1994 to May 1998 at Samsung Medical Center, Sungkyunkwan University. The numbers of male and female patients were 44 and 44, and the median age was 57 years (range: 32-81 years). Three field technique (posterior-anterior and bilateral portals) by 6, 10, 15 MV X-rays was used to deliver 4,500 cGy to the whole pelvis followed by Sn cGy's small field boost to the tumor bed over 5.5 weeks. Sixteen patients received radiation therapy by traditional field margin determination, and the lower margin was set either at the low margin of the obturator foramen or at 2 cm to 3 cm below the anastomotic site, whichever is lower. In 72 patients, the lower margin was set at 2 cm to 3 cm below the anastomotic site, irrespectively of the obturator foramen, by which the reduction of radiation volume was possible in 55 patients ($76\%$). Authors evaluated and compared survival, local control, and disease-free survival rates of these two groups. Results : The median follow-up period was 27 months (range : 7-58 months). MAC stages B2 in 32($36\%$), B3 in 2 ($2\%$), Cl in 2 ($2\%$), C2 in 50 ($57\%$), and C3 in 2 ($2\%$) Patients, respectively. The entire patients' overall survival rates at 2 and 4 years were $94\%$ and $68\%$, respectively, and disease-free survival rates at 2 and 4 years were $86\%$ and $58\%$, respectively. The first failure sites were local only in 4, distant only in 14, and combined local and distant in 1 patient, respectively. There was no significant difference with respect to local control and disease-free survival rates ( p=0.42, p=0.68) between two groups of different lower margin determination policies. Conclusion : The new concept in the individualized determination of the lower margin depending on the anastomotic site has led to the equivalent local control and disease-free survival rates, and is expected to contribute to the reduction of unnecessary radiation-related morbidity by reduction of radiation volume, compared with the traditional method of lower margin determination.

• Development and Reproduction
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• v.17 no.4
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• pp.369-377
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• 2013

The fertilized eggs of E. septemfasciatus are spherical and transparent with buoyancy at 790 to $890{\mu}m$ (average $821.8{\pm}2.0{\mu}m$) in diameter with 170 to $230{\mu}m$ oil globules (average $192.9{\pm}0.93{\mu}m$). Hatching began approximately 46 and 35 hours after fertilization at $22.0^{\circ}C$ and $25.0^{\circ}C$ water temperature, respectively. The average total length of newly hatched larvae was $1.75{\pm}0.03mm$. Most of the yolk and oil globules were absorbed within 3 to 4 days after hatching. The larvae reached 2.48 to 2.72 mm in total length, and their mouths and anuses opened at 3 to 4 days after hatching. In this time, the mouth diameters of the larvae were 0.209 to 0.238 mm. The larvae reached 3.24 to 4.15 mm in total length at 11 to 17 days after hatching, and began to metamorphose at the time the second dorsal and pelvic spines appeared and elongated. The abdominal cavity was densely lined with melanophores. The larvae reached 5.12 mm in total length at 24 days after hatching.