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Segmental intestinal dilatation is rare, which causes symptom of bowel obstruction and requires resection. The resection is not only diagnostic but also curative procedure. Recently, author experienced 2 cases of segmental dilatation of the ileum due to focal agenesis of the intestinal muscularis in 7 day & 4 day-old female neonates. The post operative recovery was excellant in the first case after resection of dilated ileum(15cm in length) and end to end anastomosis, and discharged at 20th day. But in the second case, the passage disturbance was not relieved after resection of dilated ileum (30cm in length), and author re-resected 80cm more of dilated proximal ileum at 2 weeks after the first operation. This baby discharged after diarrhea control with Loperin on 1 month after the second operation. Final histologic examination showed 1) normal population of ganglion cells in both narrowed & dilated ileum in both cases. 2) focal abscence of muscularis propria in both cases. 3) relative hypertrophy of inner circular muscle layer and thinned, multiple fragmented outer longitudinal muscle layer in case 2.
Precocious puberty is difficult to define because of the marked variation in the age at which puberty begins normally, onset of puberty before 8 years of age in girls and 9 years in boys may be considered precocious. The etiology of precocious puberty in boys is usually idiopathic, but can result from adrenal and testicular tumors. The hepatoblastoma that produces hCG is a very rare functioning tumor known to cause precocious puberty in boys. Recently, author experienced one case of virilizing adrenal cortical adenoma in 22 month-old boy, one case of adrenal cortical carcinoma in 28 month-old boy, and one case of virilizing hCG-producing hepatoblastoma in 7 year-old boy and reviewed literatures.
Jejunal and ileal atresias are the most common cause of congenital intestinal obstruction and accounts for about 1/3 of all cases of intestinal obstruction in newborns. Despite the relative frequency of this anomaly, its survival rate was less than 10% up to 1950, more recently the survival rate has risen rapidly to 90% with the introduction of modern surgical techniques and the use of total parenteral nutrition. In 1969 Thomas described a tapering jejunoplasty to manage the discrepancy in the size of the proximal dilated lumen & contracted distal lumen, and to preserve absorptive surface when the dilated jejunum involved a long length, and Grosfeld et al.(1979) facilitated this method by using GIA staplers. Author have also used GIA stapler to resect the antimesenteric portion of the dilated proximal bowel in 8 cases of jejunoileal atresias with good results. The following results were obtained ; 1. There we 3 jejunal atresias & 5 ileal atresias, and male to female sex ratio was 5 : 3. 2. The type of atresia was as follows ; type IIIa was 3 cases, type IIIb was 4 cases, type IIIb+IV was 1 case. 3. In non-complication cases(5 cases), the mean hospital day was 16 days, and oral feeding was feasible from 6.2 days after operation. 4. The complications(anastomotic leakage, pneumonia) were frequently occurred in type IIIb cases and in low birth weight cases(75%). 5. Mortality rate was 25% including DAMA(discharge against medical advice) discharge case.