Purpose and Methods: From January 1994 to December 2003, 57 patients were treated for the burn injuries at Fukuoka Children's Hospital. In order to examine the characteristics of the patients, and to assess the efficacy of using occlusive hydrocolloid dressing from the early stages of injury, their patient records were retrospectively reviewed. Results: Over 80% of the patients were less than 3 years old. Burn injury most frequently occurred in the face, neck, and chest regions (45%) due to injuries from hot liquids (75%). More than 40% of the patients demonstrated injury over 10% of their body surface. Ten patients had grade I and II (SDB) burns, 45 had grade II (DDB), and 5 had grade III. Comparison of the outcome according to the management in patients with grade II burns (DDB) wider than 10% (n=21) demonstrated that hypertrophic scar was recognized in three patients who were treated with occlusive dressings (n=9) , while in 9 treated without occlusive dressings (n=12). Three patients in the non-occlusive dressing group underwent the skin transplantation because of hypertrophic scar, finally. No patient underwent the skin transplantation within 2 weeks after injury. Conclusions: Children younger than three years old tend to suffer burn injury caused by hot liquids. To keep the wound clear, and to reduce the number of dressing changes, the use of occlusive dressing from the early stages proved to be effective, and resulted in a satisfactory cosmetic outcome.

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Purpose: The main causes of thrombocytopenia with liver disease remain unclear. The aim of this study was to clarify intervention of ADAMTS-13 for thrombocytopenia. Materials and Methods: We reviewed 14 children in which living donor liver transplantation was performed from June 2004 to August 2006 in our hospital. Perioperative platelet count ADAMTS-13 activity and von Willebrand factor (VWF) activity were measured and correlation with various factors was reviewed. Results: The platelet count on the second postoperative day (POD2) was significantly lower than preoperatively but it recovered two weeks later. Dominant factors correlating with the lower platelet count on POD2 were preoperative platelet count, recipient's age, PELD (Pediatric End-stage Liver Disease) score and GRWR (graft vs. recipient weight ratio). Postoperative recovery rate of platelet (POD7/POD2 platelet count) was 1.27 ± 0.47 but all ABO-incompatible cases were below 1. ADAMTS-13 activity was measured in 7 cases. ADAMTS-13 activity on POD7 was significantly lower than preoperatively (p=0.045) and showed positive correlation with prothrombin time on POD7. ADAMTS-13 activity on POD7 in the case of a recovery rate of platelet<1 was significantly lower than in the case that of≧1 (p=0.025). ADAMTS-13 activity showed negative correlation with vWF activity and positive correlation with platelet count in the case of a recovery rate of platelet<1. Conclusions: Preoperative ADAMTS-13 activity suggested progression of liver disease and postoperative activity reflected a graft function. The decrease of ADAMTS-13 activity may be a cause of thrombocytopenia after liver transplantation.

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Purpose: To evaluate our strategy for treating nonpalpable testis (NPT) over 10 years. Methods: Between 1993 and 2002, we treated 214 testes in 170 patients treated in our institutions. Of those, 33 NPT in 31 patients were reviewed with regard to the surgical approach, location of testis, pathological findings, and outcomes. Results: In patients with NPT, primary inguinal exploration with follow up by laparoscopy is the first choice of procedure. If neither vas nor vessel was detected, laparoscopic examination was done. Primary inguinal exploration was performed for 30 NPT testes in 28 patients. Eleven testes (36.7%) were found in the inguinal canal and orchiopexy was performed. In 17 cases (56.7%) , atrophic testis or vanishing testis was found in the inguinal canal and orchiectomy was performed. In 2 testes (6.7%) , the vessel was not found in the inguinal canal and laparoscopic examination confirmed absent testis. Conclusion: The majority of NPTs were located in the inguinal canal and more than half were atrophic or vanishing testis. In one third, orchiopexy was possible through the inguino-scrotal approach. As the number of NPT requiring laparoscopic examination is very small, primary inguinal exploration is the treatment of choice for managing NPT.

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We report a case of 9-year-old girl with intussusception which developed three times within 48 hours. We repeated the hydrostatic reduction procedure because we could not find any organic bowel diseases, but we were unable to make a decision about abdominal section. There are no guidelines for treatment of intussusception in older children although they are considered to have organic diseases. To elucidate the relationship between intussusception in older children and the presence of organic bowel diseases, we investigated 16cases of intussusception in children at or over the age of 3 years that we experienced in our hospital between September 1996 and September 2006. Only 2 patients (12.5%) had some organic bowel disease and the other cases were thought to be idiopathic even in older cmL dren. She has been well for 6 months without any symptoms since the last recurrence. Therefore, we think that we can repeat the hydrostatic reduction procedure even for recurrent intussusception in older children, continuing to look for any organic bowel disease which can become a leading indicator. Accordingly, we must carefully choose surgical procedures for recurrent intussusception in older children.

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Omental infarction (OI) is an uncommon cause of acute abdomen in children and is often misdiagnosed as acute appendicitis. We report a case of OI in a 9-year-old obese boy, who was successfully treated conservatively. He was referred to us on suspicion of acute appendicitis with a 2-day-long history of right-sided abdominal pain. He was 65.7 kg in weight and 142.2 cm in height (BMI 33). He was afebrile. Physical examinations revealed severe right flank tenderness without muscle guarding. He was diagnosed as having an OI through abdominal ultrasound and CT. He was treated with bed rest, nothing per os and infusion, and left hospital after 5 days without complaints. Patients with OI present with sudden-onset abdominal pain. Patients are usually but not invariably afebrile and without elevation of the white blood cell count. The clinical presentation may mimic appendicitis and is often nonspecific. On ultrasound, the infarcted omentum is seen as an ovoid or tubular mass immediately behind the anterior abdominal wall, usually in the right lower quadrant. The mass is slightly hyperechoic and corresponds with the patient's point of maximal tenderness. CT reveals a heterogeneous fatty mass at the same point. We should pay attention to OI, when we examine obese children with acute abdomen.

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Vascular malformation at an extremity is congenital. In particular, cystic venous malformation or arteriovenous malformation is not unusual for an infant or a younger child, but the vascular lesion sometimes swells after childhood. The appearance of varicose veins in the lower extremities is often seen particularly in women of middle age or older; however, the case of a varicose vein at the great saphenous vein in a younger child is extremely rare. In this case, a soft mass was seen at the left lower inguinal portion of the thigh in a 6-year-old girl. The reflux into the soft cystic mass from the great saphenous vein was detected by an ultrasound examination. Moreover, a cystic vascular malformation was clearly depicted by the 3D-CT at the portion where the left great saphenous vein falls into the femoral vein. But, according to the histopathological findings from a resected specimen, the soft cystic mass was finally diagnosed as an arteriovenous malformation with vascular malformation showing multilocular venous wall accompanied a fine artery. We advise that it is necessary for a patient to undergo an appropriate surgical procedure with complete resection of the arteriovenous malformation, and long term follow-up observation should be continued.

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A 1-year-old boy, an 8-month-old girl, and a 3-yearold girl with a prepubic abscess or mass were admitted to our hospital. Fistulography and magnetic resonance imaging (MRI) revealed a fistulous tract extending toward the bladder, urachus, and perineal skin, respectively. The fistula was removed in all cases. A congenital prepubic sinus (CPS) exhibits various anatomical characteristics. It was reported that a CPS can onginate from the primitive urogenital sinus, and it can be categorized into 3 subtypes: the high type extends toward the urachal remnant; the middle type, toward the bladder; and the low type, toward the urethra. Of 43 CPS cases reported in the literature, 22 cases exhibited a middle-type fistula. An MRI was useful to detect the fistulas.

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A 3-day-old male presented with dyspnea and was diagnosed as congenital diaphragmatic hernia (CDH). He was referred to our hospital and we stabilized the respiration with high frequency oscillation under the deep sedation. On the fifth day of life, he had melena. We suspected an incarcerated CDH and planned an emergency operation. At exploration he was found to have a left diaphragmatic hernia with the small bowel incarcerated. The bowel was not necrotic, and the defect was closed primarily. He had an uncomplicated recovery. Because a CDH which appears more than 24 hours after birth may have a narrow orifice, particularly with gastrointestinal symptoms, we should take account of incarceration.

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A four-year-old boy was admitted to our hospital complaining of fever and abdominal pain, which persisted for 3 days. Although abdominal pain was mild and there was no muscular guarding, laboratory findings showed severe inflammation. Computed Tomography did not show any abnormal findings in the abdomen, but detected a left mediastinal mass near the lower lobe of the left lung associated with pleural effusion. Because pleural effusion and inflammatory symptoms became worse after admission, we could not rule out inflammatory tumors or malignant tumor. After drainage of the hemorrhagic pleura! effusion and antibiotic drug administration, the inflammatory symptoms subsided. On the 14th hospital day, we performed the mass resection through left thoracotomy,which revealed torsion of extralobar pulmonary sequestration confirmed by histopathological examination. On the fifth postoperative day, acquired diaphragmatic hernia occurred, which was subsequently repaired. Otherwise, the postoperative course was uneventful. This is a rare case report of torsion of extralobar pulmonary sequestration manifested by acute abdomen in children.

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We have experienced a case of a laryngotracheal foreign body without breathing difficulty, which was diagnosed and removed by rigid bronchoscopy. A oneyear-old boy aspirated a plastic tube 1 cm in diameter and he was transferred to our hospital immediately after this episode. He was well and had no dyspnea. A slight wheeze was auscultated at bilateral lung. There was no evidence of foreign bodies in neck and chest CT or X-ray. However he was not able to speak. Under general anesthesia, rigid bronchoscopy was performed. A plastic tube was impacted in the subglottic space. The longitudinal axis of the plastic tube and the trachea were parallel. He could breathe through the inner space of the plastic tube. The plastic tube was removed by the rigid bronchoscope and then he was intubated. After he recovered from general anesthesia, he was extubated safely. He was discharged the next day. When we can't deny the presence of an airway foreign body, rigid bronchoscopy is needed.

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A 16-month-old boy with intractable emesis was transferred to our institute. He had a history of occasional vomiting since infancy. A contrast study showed duodenal stenosis at the second portion of the duodenum. Endoscopy revealed a duodenal membrane with a small opening. The papilla of Vater was not identified proximal to the stenosis. The membrane was cloven open using a high-frequency wave cutter in two radiate directions and subsequent balloon dilatation (12 mm in diameter) was added uneventfully. Although he had been free from emesis with his regular diet, after 2 months vomiting recurred. Diamond shaped duodenoduodenostomy finally cured the child. Endoscopic strategy for congenital duodenal stenosis is controversial. We discussed pros and cons of endoscopic treatments for duodenal diaphragm with a review of the literature.

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