To evaluate the profitable central venous catheters (CVCs) in children, 320 CVCs placed in 255 neonate and children over a 10-year period were analyzed retrospectively. CVC was provided by one pediatric surgeon for a total of 6,116 patients days. The number of perioperative group including immediate TPN or chemo was 223, CVC just for TPN was 57 and chemotherapy 40. Local anesthesia was applied in 71 cases, and the others were under the general anesthesia. Subclavian vein catheterizations (SCVs) were 202 cases (82 infants and neonates), tunneled external jugular venotomy(EJV) 38, tunneled internal jugular venotomy(IJV) 2, facial venotomy (FV) 3, and umbilical venous catheterization (UVC) with vein transposition 74. In neonates, 72 UVCs were applied during laparotomy. SCV was increased with ages, 3 kg of minimal body weight. The average catheter-periods over-all were 19.1 days, of SCV 17 days, EJV 40, IJV 60 and UVC 14. Technical complications were; arterial puncture (6), puncture failure (5) and abnormal location(12) in SCV; insertion failure (3) in EJV; abnormal location in the portal vein (4) and the liver parenchyma (2) making cystic fluid accumulations in UVC. Twelve migrations (3.8%) out of position occurred; SCV(2), EJV (1) and UVC (9). For 4 cases (1.2 %) of catheter obstruction and 11 (3.4 %) of catheter infection (3 SCV, 2 EJV and 6 UVC), rescue procedures were applied with some achievements. There was one mortality (0.3 %) due to deep sedation in 1.06 kg baby for EJV. Cumulated surgeon's experience of the crafts, proper catheter selection and keeping the safety rouls would be the important factors for successful CVCs.

Parenteral nutntlon 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 132g in TEF, 53g in gastroschisis and 3g 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.

Of 72 patients with vitelline duct and vessel remnants, 45 (62.5 %) had symptomatic lesions. The mean age of the patients was 27.9 months. Males predominated (4.6 : 1). There were 22 cases of Meckel's diverticulum, 6 of Meckel's diverticulum attatched to the umbilicus with a fibrous band, 6 cases of patent vitelline duct, 5 cases of vitelline artery remnants as a fibrous band and 2 cases each of umbilical sinus and polyp, and vitelline cyst. Twenty-three patients (51 %) presented with intestinal obstruction, 6(13 %) with rectal bleeding, 4(9 %) with perforated Meckel's diverticulum, 5 with intestinal juice drainage through umbilicus, 5 with umbilical lesions, 1 with abdominal mass, and 1 with sepsis. Intestinal obstruction due to fibrous band developed during infancy(average age; 4.6 months). Seventeen asymptomatic Meckel's diverticulum, 8 obliterated vitelline artery remnants and 1 vitelline vein remnant as fibrous band, and 1 vitelline cyst were found incidentally at laparotomy. About 82 % of the complicated Meckel's diverticulum presented in infants and children less than 4 years of age.

Infantile hypertrophic pyloric stenosis(IHPS) is common in full-term babies, and relatively rare in prematures. The diagnosis of IHPS in premature infants may be obscured because of the lack of classic symptoms and signs and the absence of the standard criteria for ultrasonic diagnosis. The purpose of this study is to discover the clinical differences between premature and full-term infants with pyloric stenosis, and determine the appropriate diagnostic methods for early diagnosis in premature infants. The clinical records of 52 IHPS patients who had been operated upon from October, 1994 to April, 1997 were reviewed. The incidence of IHPS in premature infants was 25 %. The onset of symptom was 4.7 weeks of age in premature, and 2.9 weeks in full-term babies. Diagnosis was established by typical symptoms. signs. and diagnostic imaging studies. In two premature infants, diagnosis was confirmed by upper gastrointestinal(GI) series, because ultrasonography did not meet the diagnostic criteria. Two premature infants initially diagnosed as gastroesophageal reflux by esophagography. were found to have IHPS by upper GI series. For the diagnosis of IHPS, a new set of criteria for premature babies has to be developed.

Infantile hypertrophic pyloric stensosis(IHPS) occurs in three of 1000 live births, and is a major cause of nonbilious vomiting of early infancy. It's etiology and pathogenesis however are still obscure. The operation of pyloromyotomy described by Ramstedt in 1912 remains the standard treatment. From January 1990 to July 1997, 64 infants with IHPS were treated at the Department of Pediatric Sursery, Yeungnam University Hospital. The ratio of male to female was 7:1, and the most prevalent age ranged from 2 weeks to 8 weeks(81.2%) of age. Fifty-seven infants were first born (57.8percent). The body weight of all patients at admission was below the 50 percentile. Age of onset of symptoms was between 2 and 4weeks of age in 23 cases(35.9 %). All infants had a history of nonbilious vomting, generally projectile in nature. Hypokalemia was noted in 14 cases(21.9%) and hypochloremia in 26 cases(40.6%). In the preoperative ultrasonography, the average muscle thickness, diameter, and length of the pylorus were 6.3 mm, 12.3 mm, and 17.8 mm. A total of 13 associated anomalies were noted in 12 patients. All cases were treated with Fredet-Ramstedt pyloromyotomy. Postoperative wound infection occured in 3 cases. Thirteen cases(20.3%) presented intermittent nonprojectile vomiting after operation. With control of oral intake vomiting subsided within one week in 63 patients, and in thirteen days in another.

A total of 335 pediatric inguinal hernias were analyzed at the Department of General Surgery, St. Benedict Hospital, for last 10 years (1986 to 1995). Male patients were predominant(2.25 : 1), and 78.2 % were under 2 years of age. Right side was 1.63 times more frequent than the left. Among the 19 cases of incarcerated hernias, 84 % could be safely reduced preoperatively. Twelve cases(3.6 %) were repaired by the Bassini procedure and 21 cases(6.3 %) by internal ring repair. The majority (90.1 %) however did not require a posterior wall reconstruction. Bilaterality was found in 25 cases(7.5 %), and in 8 cases(2.4 %) subsequent contralateral hernia developed after primary ipsilateral repair. Postoperative complication occurred in 15 cases(4.5 %); scrotal seroma and/ or hematoma(3%), wound infection(0.6 %), and pneumonia(0.9 %). In order to reduce the incidents of complications, children with inguinal hernias should be treated by a pediatric surgeon.

Six children with solid and papillary epithelial neoplasm of the pancreas were studied retrospectively. There were 2 boys and 4 girls. The mean age at operation was 11 years(range; 8-13years). Three patients had incidental abdominal mass, in two patients the mass was non-tender, in one patient the mass was tender. The minimum size of tumor was 6.5 × 6.0 cm and the maximum was 10.5 × 8.0 cm. Five tumors were located in the head of the pancreas, and the other one in the tail. Local invasion or metastasis was not noticed. Tumors were removed completely by performing the following operations: 3 pylorous preserving pancreaticoduodenectomy, 2 Whipple's operation and 1 distal pancreatectomy. There was no mortality. The histologic findings were characteristic. There were no recurrences during a follow-up of 0.5 to 12 years (mean; 5.0 years).

Mesenteric and omental cysts are rare lesions in childhood. These cysts are morphologically and pathologically similar to lymphangiomas that occur in other parts of the body. From 1980 to 1997, 8 children were diagnosed and treated for mesenteric or omental cysts. Their ages ranged from 18 days to 6 years. There were 5 boys and 3 girls. The main presenting symptom was abdominal pain. Operative procedures were complete cysts excision, complete excision with intestinal resection, or complete excision with intestinal resection and colostomy. Accurate preoperative diagnosis was possible with the current ultrasonographic imaging techniques. Complete excision of the lesion was possible in all patients and results were excellent.

Although diaphragmatic eventration in newborn infants is generally regarded as a rare condition, the need for accurate diagnosis and appropriate intervention according to the etiological factors is well known. Recently the authors experienced five consecutive cases of diaphragmatic eventration below the age of two months(one to 55 days) requiring surgery. All were in males, and were left sided. Respiratory symptoms were present in 4 patients, and one patient showed inability to gain weight. Diaphragms were elevated to the level of the third to fifth intercostal spaces. Diaphragmatic plication through the abdomen gave excellent results. There was no postoperative mortality.

Early recognition and surgical treatment of Hirschsprung's disease prevents serious mortality and morbidity from enterocolitis and obstruction. Usually this disease is characterized by a single aganglionic segment of the colon extending distally to the anal margin. In surgical treatment, the surgeon performs a frozen section biopsy to confirm whether there are ganglion cells. If there are intervening ganglionic sites in aganglionic bowel, there may be confusion in diagnosis and treatment. The authors experienced one case of total colonic aganglionosis with skip area. A transverse loop colostomy was performed on a 7 day-old male baby with colon perforation due to Hirschsprung's disease. But intestinal obstruction persisted and required two more operations to find the true nature of the disease. There were aganglionic segments from the anal margin to the terminal ileum 3.7cm proximal to the ileocecal valve. The entire transverse colon and appendix were normally ganglionated.

We have treated a case of pseudocyst of transverse mesocolon in 3-year-old male child. Operative findings demonstrated that the pseudocyst originated in the transverse mesocolon, and was not connected to the pancreas. A colonic duplication was found incidentally near the pseudocyst. On microscopic examination, ectopic pancreatic tissue was noted in the transverse mesocolon. This pseudocyst was thought to have originated from the ectopic pancreas of the transverse mesocolon. This is the first reported case of pseudocyst originated from ectopic pancreas of the transverse mesocolon, combined with a colonic duplication. The pathogenesis is discussed.