Untreated cryptorchidism contributes to infertility and may play a role in increasing the risk of malignancy. The appropriate time of operation was considered before school age in 1970s, 2 years of age in 1980s, and between 1 and 2 years of age from 1990s to present time. Orchiopexy is the most common operation for congenital urological problem of children. We analyze our experience of orchiopexies to evaluate the results and to identify the role of the pediatric surgeon. We reviewed the medical records of 91 patients who underwent orchiopexy from January 1996 to December 2007. The patient age at orchiopexy were as follows: 48 cases (52.7 %) under 2 years of age, 24 cases (26.4 %) between 3 and 5 years, 16 cases (17.6 %) between 6 and 10 years, and 3 cases (3.3 %) over 11 years. Location of testes was preperitoneum in all 91 cases. There were 84 unilateral and 7 bilateral cases. Among the unilateral cases, the undescended testes were on right side in 54 cases and on the left side in 30 cases. The surgical procedure employed in all cases was trans-inguinal orchiopexies. Seventy-nine patients had excellent results. There were 12 complications; 5 cases of wound infection and 7 cases of temporary incomplete descent. Seven cases of incomplete descent have become normal from 3 to 6 months after orchiopexy. According to our results, 43 cases (47.3 %) underwent orchiopexies over 2 years of age. In conclusion, orchiopexies were successful in most cases of cryptorchidism in terms of testicular position and growth. We suggest that pediatric surgeons should educate their primary care physicians and parents concerning the potential complications of cryptorchidism and the appropriate time of operation.

Condyloma acuminata, an uncommon disease in the pediatric patients, is being reported with increasing frequency in both adults and children. During the last 10 years, we had the opportunity to treat 11 children with condyloma acuminata in anogenital area. Patient age at presentation varied from 9 months to 11 years, and boys were outnumbered girls by a ratio of 2 : 1. The lesions were found in the perianal area in 9 patients, while the remaining had lesions localized to the genitalia. No history of sexual contact or abuse could be elicited. Although the exact mode of transmission of human papillomavirus (HPV) couldn't be defined, maternal-infant transmission at birth and close nonsexual family contact were the main possible causes of HPV infection in our patients. Our experience suggest that fulguration of the warts and concomitant scissors excision for the larger ones are the satisfactory method of treatment in children. However, based on our data we feel that condyloma acuminata has a high recurrence rate despite treatment. Viral typing and careful epidemiological investigation on a larger series of patients may further clarify the causal factors and effective modalities of treatment in childhood anogenital condyloma acuminata.

Intramuscular injection(IM) into the gluteal muscles is a common route of medication, but may lead to complications. A retrospective review of 32 patients who required surgical treatment for local complications of buttock injections in children was made at the Taegu Fatima Hospital during a seven-year ninemonth period (March 1990 to December 1997). Local complications included acute inflammation, cellulitis and abscess(71.9 %), and fat necrosis(21.9 %), and injection granuloma(6.2 %). Over the half of injections were on the upper and outer quadrant of the buttock, but the other 43.7 % were in the upper and inner or lower and outer quadrant which are considered unsuitable sites for intramuscular injection. The majority of complications developed within fat tissue (90.6 %) rather than within muscle(9.4 %). Two-thirds of the patients were under 2 years of age, this suggests that it is technically difficult to accurately administer 1M injections in small children because muscle mass is smaller compared to subcutaneous. In addition subcutaneous fat is more susceptible to chemical irritation. Staph. aureus was the predominant organism, isolated in 84.6 % of the patients with abscesses. Treatment consisted of needle aspiration, incision and drainage, curettage, or surgical excision. In conclusion, the major factor that contributes to complications following 1M of the buttock appears to be the inadvertent intrafat rather than of 1M injection. Accurate injection into the muscles based on a knowledge of pelvic anatomy as well as the potential complications is necessary to prevent complications.

The anatomical variations of the external genitalia including the hymen were observed prospectively in 1,500 female infants born between March, 1992 and July, 1992 at the Taegu Fatima Hospital. Careful inspection of the external genitalia was done within 24 hours after birth, and abnormal findings photographed. Almost all hymenal tissue appeared to be redundant. The hymen was annulus in 89.1 % of patients. Ninteen point nine percent had a central orifice and the remainder a ventral orifice. External ridges, intravaginal ridges, and clefts were present in 71.5 %, 50.7 % and 40.5 %, respectively. Congenital anomalies of the external genitalia were found in 20 patients(1.4 %). There were sixteen cases of hymenal cysts, two hymenal polyps, one imperforate hymen, and one Skene's duct cyst. Seven of the 16 hymenal cysts with stalks were excised and those without stalk were aspirated. Hymenal polyps were excised. Imperforate hymen was incised and drained, and Skene's duct cyst was aspirated successfully. The surgical procedure were done without anesthesia, and the results have been good. In conclusion, routine physical examination of the female newborn infant detects frequent developmental anomalies. The significance of those anomalies will be clarified after longitudinal long-term followup studies.

A 3-year-old boy with a Wilms' tumor had unusually severe hypertension, polydipsia, polyuria and hypokalemia. Physical-examination on admission was unremarkable except for the presence of a smooth, firm mass in the right abdomen. Computerized tomography showed a tumor occupying the upper two thirds of the right kidney. Plasma renin activity and aldosterone concentration were markedly elevated, 37.7 mg/ml/hour(normal in supine position 0.15-2.33 mg/ml/hour) and 120.1 ng/dL(normal in supine position 1 to 16 ng/dL) , respectively. Hypertension varied from 150/90 mmHg to 240/180 mmHg, and was not effectively controlled by antihypertensive drugs. Right nephrectomy was performed on the sixth hospital day. At laparatomy, there was no evidence of mechenical compression of the renal artery by the tumor. The tumor, about 8 cm in diameter, was confined to the renal capsule without involvement of the renal blood vessels at the hilum. Histopathology was Wilms' tumor of favorable histology. On electron microscopy, tumor cells contained intracytoplasmic electron dense secreting graules, suggesting the possibility of renin secreting tumor cells. Shortly after nephrectomy, signs and symptoms were relieved dramatically, and plasma renin activity and aldosterone concentration were also decreased to normal.

Regional lymphadenitis is the most common complication following BCG vaccination in this country. The literature describes controversial results with medical, surgical and combined therpy. The purpose of this study is to clarify the therapeutic effect of isoniazid(INH) after surgical procedures. The early and late postoperative complications of 136 children with lymphadenitis following BCG vaccination at the Taegu Fatima Hospital between March 1985 and February 1996 were reviewed. In 90 children, INH was given for 3-4 days before operation and for 3 months after surgery. In the other 46 cases, INH was not given during the pre- or postoperative period. Surgical procedures were excision or incision and currettage according to the states of lesions. Postoperative complications were fluid accumulation, wound infection, sinus formation and others. Complication rates were 14.4 % in INH-treated group and 13.0% of INH-nontreated group. The difference was not significant. There was no recurrence or other late complication in either groups. The result suggest that surgical excision or incision and currettage are sufficient for the treatment of regional lymphadenitis following BCG vaccination and postoperative INH therapy is not neccessary.

Laparoscopic appendectomy is relatively well-established as an alternative to conventional open appendectomy by many laparoscopic surgeons. However, experience in the pediatric population remains limited. Over a period of 2 years, a total of 155 pediatric patients with acute appendicitis or complicated appendicitis were studied to compare laparoscopic and open appendectomies in childhood. Laparoscopic appendectomy was attempted in 49 patients and completed in 48 patients(98.0%). Open appendectomy was performed in 107 patients. The severity of disease, age, and male to female ratio were similar in both groups. The operation time was shorter in the laparoscopic group than open group but the difference was not significant statistically(43.7±11.3 minutes versus 49.0±21.4 minutes, p=0.066). In the laparoscopic group, the mean duration of surgery for the former half patients was significantly longer than for the latter half(49.6±9.2 minutes versus 38.1±10.3 minutes, p=O.OOl). The mean number of doses of analgesia required postoperatively was significantly less in patients undergoing laparoscopic appendectomy(2.4±1.8 versus 3.3±2.5, p=0.021). There were only 2 (4.2%) wound infections after laparoscopic appendectomy compared with 10(9.3 %) complications including 7 wound infections, 1 intestinal obstruction, and 2 pulmonary complications after open appendectomy, but the difference was not significant( p=0.614). Patients undergoing laparoscopic appendectomy had a shorter period of hospitalization(3.2±2.2 days versus 6.4±1.6 days, p=O.OOl). The present study suggests that laparoscopic appendectomy shortens operating time and hospital stay with diminished postoperative pain. Laparoscopic appendectomy in children offers advantages over open appendectomy as noted in adults. The authors consider laparoscopic appendectomy to be the reasonable alternative to open appendectomy in children.

Torsion of the wandering spleen is a rare condition especially in children. Unfortunatly, splenectomy was the advocated treatment of choice for wandering spleen in many children up to 1985 in spite of the well-known possibility of overwhelming postsplenectomy sepsis. Because of the conclusive evidence of the vital function of the spleen in infection, indication of splenectomy have been revised and more attention has been paid to preserving the spleen where possible. We are presented a girl with splenic torsion, seen as a migratory abdominal mass and intermittent vague abdominal pain. Splenopexy by fixation of the spleen to the diaphragm and posterolateral peritoneum and the use of A vitene in the splenic bed was successfully performed. Complete fixation of the spleen was confirmed by ultrasound a year after this procedure was carried out. The clinical pesentation, etiology, diagnostic procedures and management are discussed also.