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전시열,Jun, Si-Youl 대한소아외과학회 1997 소아외과 Vol.3 No.2
Reduction of intussusception using air or oxygen has wide acceptance as an alternative to conventional hydrostatic reduction. This study was undertaken to evaluate the results and complications of air pressure enema in 948 pediatric intussusception. One hundred and twenty nine cases were operated on at the Department of Surgery, Masan Samsung Hospital from 1985 to 1996 because of air reduction failure. The success rate was 86.4 %. Twenty-one patients(2.2 %) showed perforation during air reduction. Risk prone factors of perforation were; age less than 3 months(42.9 % vs 11.1 %), duration of symptoms greater than 48 hours (66.7 % vs 33.3 %), and presence of pathologic leading point(28.6 % vs 3.7 %). Vomitting and spontaneous rectal bleeding revealed higher prediction to the complication. In nineteen cases, bowel infarction, coagulated necrosis and hemorrhage suggested that the cause of perforation was due to the preexisting strangulation. In conclusion, when doing an air pressure enema reduction, care must be taken if the patient is of a young age or the symptoms are of long duration.
전시열,Jun, Si-Youl 대한소아외과학회 2013 소아외과 Vol.19 No.2
The entity of negative appendectomies still poses a dilemma in chlidren. Focused computed tomography (CT) scanning has become the diagnostic test of choice in many hospitals. However, the impact of CT scans on the diagnosis in children is unknown exactly. The purpose of this study was to critically evaluate CT scans for the evaluation of acute appendicitis in children, to review utilization of this diagnostic test in our appendicitis population and to determine if diagnostic accuracy has improved. A retrospective analysis of efficacy of CT scan for diagnosis of appendicitis in children was conducted. Children undergoing appendectomy for acute appendicitis were reviewed from 2007 to 2012. Perforation and negative appendectomy (removal of a normal appendix) rates were determined by the final pathologic report. Statistical comparison were made using the $x^2$ test and significance was assigned at p < 0.05. Five hundred four appendectomies were performed. Mean age was $10.1{\pm}3.21$ years, and 62.7% were boys. Overall, 308 children (61.1%) underwent CT scanning, 100 (19.8%) had US performed, and 97 (19.2%) had no radiographic study. A pathologically normal appendix was removed in 8.7% (27 of 308) of CT patients, 9.0% (9 of 100) of US patients, and 11.3% (11 of 97) of patients without a study. The frequency of CT scanning increased from 29.7% (27 of 91) of all children in 2007 to 75.6% (59 of 78) in 2012, whereas utilization of US decreased from 30.8% (28 of 91) to 11.5% (9 of 78). During this time period the difference in the negative appendectomy rate did change significantly from 14% to 6%. Liberal use of CT scans in diagnosing appendicitis in children has resulted in a decreased negative appendectomy rate.
전시열,Jun, Si-Youl 대한소아외과학회 2010 소아외과 Vol.16 No.2
The clinical characteristics of fistula-in-ano in infants are different from those of older children, and its treatment remains controversial. We suggest that fistula-in-ano in infants has a congenital etiology. To verify this hypothesis and to settle the controversies regarding fistula-in ano in infants, a retrospective analysis of 29 patients less than 2 years of age with anal fistulae treated between 1994 and 2009 at Samsung Changwon Hospital were reviewed retrospectively. Twenty two patients were male and mean age at diagnosis was $7.2{\pm}5.2$ months. Eleven out of 22 cases had previous surgical drainage for perianal abscess. 18 patients had fistulotomy (81.8 %) and four had fistulectomy (18.2 %). Cryptotomies with fistulectomy were performed in 10 patients (45.5 %) who had involved crypt. There was one recurrence. These results suggest that fistula-in-ano in young children less than two years of age is different from those in older children or adults. Fistulotomy is suggested to be the recommended treatment of choice. A future study involving non-operative management would be required to explore all treatment options.