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Trauma is the leading cause of death in the Korean pediatric population. Initial correct assessment of injury severity is necessary to reduce preventable traumatic deaths and it can help the appropriate patient to be referred to the appropriate facility. Injury Severity Score(ISS) system widly used for categorizing the severity of injury requires many clinical datas including radiologic modalities, therefore, it does not provide a quick assessment. Five hundreds and eighty-four injury patients less than sixteen years of age were prospectively assessed for 6 month from May 1, 1990 to October 31, 1990. All patients were initially assessed for mechanism of injury, age, direct or referred admission, time from injury, anatomical site of injury, blood cell count and pediatric trauma score(PTS). After diagnostic procedure or operation, the patients were reevaluated with ISS. Motor vehicle related injuries accounted for 42.9% of all deaths and pedestrian injuries of them caused the greatest number of deaths. The patients referred from local hospitals had the prolonged time interval from injury to arrival and higher mortality rate. We have observed a significantly higher death rate among trauma patients younger than 8 year-old. Anatomically, thoracic or abdominal injury presented higher mortality rate than the other site did. All mortality cases had PTS 4 or below, and ISS above 20. A decreasing PTS was directly associated with an increasing ISS. Count of leucocyte, band-form neutrophil or lymphocyte presented linear relationship with ISS and the parients with total leucocyte count more than 20,000/mm3, lymphocyte more than 4,000/mm3, band-form neutrophil more than 500/mm3 disclosed far more death rate (p< 0.0001). We have concluded that quick assessment of injury patients with evaluation of anatomical injury site, severity scoring with PTS, and blood cell count are readily available means of identifying the high risk patients.
Hirschsprung's disease (HD) is usually diagnosed in the newborn period and early infancy. The common presentation of HD in newborns consists of a history of delayed passage of meconium within the first 48 hours of life. The differential diagnosis in newborns is one of the clinical challenges of this disorder. A number of medical conditions which cause functional obstruction of the intestines are easily excluded. Neonates with meconium ileus, meconium plug syndrome, distal ileal atresia and low imperforate anus often present in a manner similar to those with HD in the first few days of life. Abdominal radiographs may help to diagnose complete obstruction such as intestinal atresia. Microcolon on contrast enema can be shown in cases with total colonic aganglionosis, ileal atresia or meconium ileus. Suction rectal biopsy or frozen section biopsy at operation is essential for differential diagnosis in such cases. HD is also considered in any child who has a history of constipation regardless of age. Older children with functional constipation may have symptoms that resemble those of HD and contrast enema is usually diagnostic. However, children with other motility disorders generally referred to as chronic idiopathic intestinal pseudoobstruction present with very similar symptoms and radiographic findings. These disorders are classified according to their histologic characteristics.; visceral myopathy, visceral neuropathy, intestinal neuronal dysplasia (IND), hypoganglionosis, immature ganglia, internal sphincter achalasia. Therefore, the workup for motility disorders should include rectal biopsy not only to confirm the presence of ganglion cells but also evaluate the other pathologic conditions.