A case of intestinal tuberculosis complicated by miliary tuberculosis / 소아과

Intestinal tuberculosis presents with nonspecific and variable clinical manifestations. It is rarely seen in current clinical practice and the diagnosis may be missed or confused with many other disorders such as Crohns disease and intestinal neoplasms. The route of infection by tuberculous enteritis is variable and the treatment regimens used for treating pulmonary tuberculosis are generally effective for tuberculous enteritis as well. Uncomplicated tuberculous enteritis can be managed with a nine to 12- month course of antituberculous chemotherapy. If not treated early, the prognosis for intestinal tuberculosis is poor, with an overall mortality of between 19 percent and 38 percent. However, 90 percent of patients will respond to medical therapy alone if started early. Therefore, early detection and treatment is essential. Here we report a case of intestinal tuberculosis secondary to miliary tuberculosis.

A Case of Trichobezoar in a Child Who Visited with Intermittent Abdominal Pain, Nausea and Vomiting / 소아과

Bezoars are concretions commonly found in the stomach and small bowel, and four types of bezoars have been described based on their composition: trichobezoar, phytobezoar, lactorbezoar, and miscellaneous. Bezoars most often develop after gastric operations that alter the motility, emptying, and grinding of food in the stomach. Trichobezoars are most common in female children with normal gastrointestinal function and are usually associated with pica, mental retardation, and psychiatric disorders. Although uncommon, bezoars are a well-recognized cause of chronic abdominal complaints which, when undiagnosed, can result in serious complications including gastric ulceration, bleeding, perforation, intussusception and small bowel obstruction. Mortality rates of up to 30 percent have been reported in adults. Trichotillomania is behaviors surrounding hair-pulling, including stroking and playing with hair before pulling, or biting and swallowing the hair after it has been pulled(trichophagia). The most notorious of the medical sequelae of trichotillomania is the trichobezoar. We experienced a case of trichobezoar in an 11-year-old girl who frequently swallowed her hairs from age 4 years up to age 7 years, resulting in intermittent abdominal pain, nausea, and vomiting.

The Changes of Incidence of Nosocomial Sepsis, and Risk Factors in Extremely Low Birth Weight Infants

PURPOSE: To know whether the changes in the risk factors of nosocomial sepsis had an impact on the occurrence of nosocomial sepsis (NS) in extremely low birth weight infants (ELBW I). METHODS: ELBW I who were admitted to the NICU at Samsung Medical Center from October 1994 to December 2000 were devided into three groups according to periods (period I:1994.10-1996.9, period II:1996.10-1998.12, period III:1999.1-2000.12), and charts were reviewed retrospectively for demographic profile, incidence of NS, and changing patterns of risk factors of NS. RESULTS: Gestational age and birth weight of ELBW I decreased and the incidence of NS increased significantly during third period. However, cumulative incidence of NS corrected by hospital days was not changed irrespective of periods. Among the risk factors of NS in 3rd period, use of antibiotics in the 1st day, postnatal dexamethasone and use and duration of indwelling umbilical catheters decreased significantly and the use of nasal continuous positive airway pressure increased significantly especially, in ELBW I under 800 g of birth weight. In the ELBW I under 800 g of birth weight, cumulative incidence of NS and mortality among the infants who suffered from NS decreased significantly in 3rd period. CONCLUSION: Efforts to decrease the risk factors of NS can prevent the increase in incidence of NS in ELBW I.

The Relationship between Helicobacter pylori Infection and Iron-Deficiency: Seroprevalence Study in 937 Pubescent Children / 대한소아소화기영양학회지

PURPOSE: The purpose of this study was to investigate the relationship between Helicobacter pylori (H. pylori) infection and iron-deficiency anemia in pubescent children, susceptible to iron deficiency due to the high iron requirements for growth. METHODS: Hemoglobin, serum iron, total iron-binding capacity, serum ferritin, and serum IgG antibodies to H. pylori were measured in 937 children (475 boys and 462 girls). Their ages ranged from 10 to 18 years. The prevalences of H. pylori infection were compared between groups, based on the presence or absence of anemia, hypoferritinemia, iron deficiency, and iron-deficiency anemia. The levels of hemoglobin, serum iron, total iron-binding capacity, transferrin saturation, and serum ferritin were obtained according to the presence or absence of H. pylori infection. RESULTS: The prevalences of anemia, iron deficiency, iron-deficiency anemia, and H. pylori infection were 8.1%, 9.1%, 3.1%, and 20.8%, respectively. The H. pylori-positive rates in anemia, hypoferritinemia, and iron-deficiency group were 34.2%, 29.5%, and 35.3%, respectively, compared to 19.6% in the non-anemia group, 19.2% in the non-hypoferritinemia group, and 19.4% in the non-iron deficiency group. The H. pylori-positive rate in the iron-deficiency anemia group was 44.8% in comparison with 20.0% in the non-iron-deficiency anemia group. Hemoglobin and iron levels did not show any significant differences between the H. pylori-positive and -negative groups, whereas the serum ferritin level decreased significantly in the H. pylori-infected group. CONCLUSION: H. pylori infection is thought to be associated with iron deficiency in pubescent children.

Allogeneic Hematopoietic Stem Cell Transplantation in Children with Acute Lymphoblastic Leukemia: Experiences in a Single Center / 대한소아혈액종양학회지

PURPOSE: To improve survival of children with acute lymphoblastic leukemia (ALL), allogeneic hematopoietc stem cell transplantation (HSCT) was applied. METHODS: From June 1999 to May 2002, 27 children with ALL received allogeneic HSCT at Samsung Medical Center. Patients in complete remission (CR) who received HLA-matched HSCT before relapse when HSCT was indicated were assigned to standard-risk, otherwise were assigned to high-risk. Cyclophosphamide and total body irradiation was basic conditioning regimen. For prophylaxis of GVHD, cyclosporine alone in related HSCT and cyclosporine methotrexate methylprednisolone in unrelated HSCT were used. RESULTS: Fifteen patients in first CR including 6 induction failures, 3 MLL rearrangements and 2 Philadelphia chromosomes, and 3 patients in second CR were assigned to standard-risk. Thirteen related HLA-matched, 11 unrelated HLA-matched, 2 related HLA-mismatched and 1 unrelated HLA-mismatched HSCT were applied. Sixteen of 18 standard-risk patients are still alive with median follow-up of 12.5 (range: 2~37) months and 13 of them are disease-free without relapse. Event-free survival rate (EFS) in 18 standard-risk and 9 high-risk patients were 68.2% and 14.8%, respectively. Confined to standard-risk patients, EFS in related and unrelated HSCT were 75.0%, 60.0%, respectively. CONCLUSION: When allogeneic HSCT is indicated in childhood ALL with available HLA-matched donor, early transplantation before clinical aggravation seems to be necessary.