Hepatitis associated with Mycoplasma pneumoniae infection in Korean children: a prospective study / 소아과

PURPOSE: Mycoplasma pneumoniae (MP) infection is a major cause of respiratory infection in school-aged children. Extrapulmonary manifestations of MP infection are common, but liver involvement has been rarely reported. The aim of this study was to determine the clinical characteristics of MP-associated hepatitis. METHODS: This prospective study included 1,044 pediatric patients with MP infection diagnosed serologically with MP IgM at one medical center from January 2006 to December 2012. Eighty of these patients had elevated levels of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT), each greater than 50 IU/L, without any other specific liver disorder and were compared with the 964 children without liver disorders. RESULTS: In total, 7.7% of patients with MP infection had a diagnosis of hepatitis, especially in fall and winter. The ratio of male to female patients was 1.7:1, and the mean age of the patients was 5 years and 5 months. The most common symptoms were cough, fever, and sputum. Anorexia was the most common gastrointestinal symptom, followed by nausea/vomiting, diarrhea, and abdominal pain. Mean levels of AST and ALT were 100.65 IU/L and 118.73 IU/L, respectively. Serum AST/ALT level was normalized within 7.5 days on average without complications. The mean duration of hospitalization (11.3 days) was longer for children with hepatitis than for those without hepatitis (P=0.034). CONCLUSION: MP-associated hepatitis is not uncommon and has a relatively good prognosis. Therefore, clinicians should be concerned about liver involvement in MP infection but avoid further unnecessary evaluation of hepatitis associated with MP.

Clinical Features of Symptomatic Meckel's Diverticulum in Children: Comparison of Scintigraphic and Non-scintigraphic Diagnosis / 대한소아소화기영양학회지

PURPOSE: Meckel's diverticulum (MD) has various clinical manifestations, and diagnosis or selectection of proper diagnostic tools is not easy. This study was conducted in order to assess the clinical differences of MD diagnosed by scintigraphic and non-scintigraphic methods and to find the proper diagnostic tools. METHODS: We conducted a retrospective review ofthe clinical, surgical, radiologic, and pathologic findings of 34 children with symptomatic MD, who were admitted to Gachon University Gil Medical Center, Inha University Hospital, and The Catholic University of Korea, Incheon St. Mary's Hospital between January 2000 and December 2012. The patients were evaluated according to scintigraphic (12 cases; group 1) and non-scintigraphic (22 cases; group 2) diagnosis. RESULTS: The male to female ratio was 7.5 : 1. The most frequent chief complaint was lower gastrointestinal (GI) bleeding in group 1 and nonspecific abdominal pain in group 2, respectively. The most frequent pre-operative diagnosis was MD in both groups. Red blood cell (RBC) index was significantly lower in group 1. MD was located at 7 cm to 85 cm from the ileocecal valve. Four patients in group 1 had ectopic gastric tissues causing lower GI bleeding. The most frequent treatment modality was diverticulectomy in group 1 and ileal resection in group 2, respectively. CONCLUSION: To diagnose MD might be delayed unless proper diagnostic tools are considered. It is important to understand indications of scintigraphic and non-scintigraphic methods according to clinical and hematologic features of MD. Scintigraphy would be weighed in patients with anemia as well as GI symptoms.

Correction: Clinical Features of Symptomatic Meckel's Diverticulum in Children: Comparison of Scintigraphic and Non-scintigraphic Diagnosis / 대한소아소화기영양학회지

The name "Sung Min Kim" should be "Seong Min Kim" and "Yoon Mi Kim" should be "Yun Mi Kim".

The Comparison of Clinical Characteristics and Courses of Pediatric Patients Hospitalized with Pandemic Influenza A (H1N1) and Seasonal Influenza from 2009 to 2011 / 소아알레르기및호흡기학회지

PURPOSE: Pandemic influenza viruses have caused significant morbidity and mortality. Pandemic influenza A (H1N1) was detected in April 2009 and caused worldwide outbreak. We investigated the differences in clinical characteristics and courses between pandemic and seasonal influenzas. METHODS: We reviewed the medical records of pediatric patients, (< or =18 years) with influenza hospitalized to Gachon University Gil Medical Center from the 1 April 2009 to the 31 August 2011. RESULTS: Two hundred twenty-six patients with pandemic influenza and 118 patients with seasonal influenza were included. Age, sex, and proportion of underlying diseases were similar between the two groups. Hypoxemia, shortness of breath, and tachypnea were more common in pandemic influenza.(P<0.05) Oxygen supplementation and radiologically confirmed pneumonia were more common in pandemic influenza.(P<0.005) However, there were no significant differences in the mean duration of hospitalization, proportion of patients admitted to the intensive care unit, need for mechanical ventilation, and death. CONCLUSION: Pandemic influenza caused more frequently lower respiratory tract infection and pneumonia. However, the courses of pandemic influenza were not different from those of seasonal influenza; probably, due to the effects of several factors, including antiviral therapy.

Initiation of Therapeutic Hypothermia with a Cooling Fan for an Asphyxiated Newborn

Induced hypothermia for newborns with hypoxic-ischemic encephalopathy results in a significant decrease in mortality and neurodevelopmental disability. For optimal neuroprotection following perinatal hypoxia-ischemia (HI), therapy should begin within 6 hrs of the insult and continue for > or =72 hrs. We report on a baby with HI who underwent therapeutic hypothermia that was initiated with a cooling fan, as the whole-body cooling machine was in use for another patient. Although overcooling occurred, the method was successful. For effective and safe brain hypothermic therapy (BHT), a purpose-built cooling machine is recommended. The adherence to standard protocol is required for every BHT, as clearly defined by protocols similar to those used in published trials.

Antibiotic-Associated Diarrhea in 3 to 6 Month Old Infants with Febrile Urinary Tract Infections / 소아감염

PURPOSE: This study attempted to investigate the frequency, duration, and risk factors of antibiotic-associated diarrhea (AAD) in infants hospitalized due to febrile urinary tract infection (UTI). This is a basic research on the probiotics used in the prevention and treatment of AAD in infants. METHODS: Medical records of the infants aged 3-6 months hospitalized in Gachon University Gil Hospital from January 2008 to September 2010 due to the febrile UTI were retrospectively reviewed. The episodes of loose or watery stool were investigated for frequency, onset, and duration. Those who had AAD and those who did not (non-AAD) were compared. The antibiotic regimens and the episodes of diarrhea were investigated in AAD group. RESULTS: Total 147 infants were included. Fifty-four (36.7%) showed AAD. Intravenous third-generation cephalosporin (3rd CS) single therapy was used for 102 patients (69.4%), the 3rd CS and non-3rd CS combination therapy for 24 (16.3%), and non-3rd CS combination therapy for 21 (14.3%). There was no significant difference in the dose of cefotaxime between AAD and non-AAD group (P=0.601). According to the antibiotic therapies above, in AAD group, there was no significant difference in the onset and duration of diarrhea respectively (P=0.717, P=0.830). Although the frequency of diarrhea was higher for the 3rd CS and non-3rd CS combination therapy subgroup with 9.25+/-5.30 times/day than the other two subgroups (7.58+/-2.97 times/day in 3rd CS single therapy subgroup, 6.75+/-4.40 times/day in non-3rd CS combination therapy subgroup), there was no statistical significance (P=0.078). CONCLUSION: AAD seems common to the infants aged 3-6 months with febrile UTI, regardless of regimen and amount of antibiotics in usual dosage. Further research on the effects of probiotics used in the prevention and treatment of AAD in infants is warranted.

Diabetic Ketoacidosis and Cerebral Infarction Leading to a Diagnosis of Moyamoya Disease

There have been few reports of concomitant moyamoya disease (MMD) with type 1 diabetes mellitus. We report a case of MMD associated with type 1 diabetes mellitus in a 9-year-old boy who presented with altered mentality and left side motor weakness. Laboratory test results indicated diabetic ketoacidosis (DKA), but his stuporous mental state and hemiparesis persisted despite DKA management. Brain magnetic resonance imaging revealed multiple cerebral infarcts and stenosis of cerebral arteries with basal collateral vessels, suggesting MMD. After management of DKA and successive surgery for MMD, his hemiparesis improved without further ischemic attacks. Although rare, the possibility of comcomitant MMD should be considered in a type 1 diabetes mellitus patient with neurologic symptoms and cerebral infarction.

Pattern of Hospital-Associated Infections in Children Admitted in the Intensive Care Unit of a University Hospital / 소아감염

PURPOSE: Hospital associated infection (HAI) caused by multidrug-resistant (MDR) microorganisms has been recognized as an important issue in the world, especially in critically ill patients such as the patients admitted in the intensive care unit. There are fewer papers about MDR-HAI in pediatric patients compared to adult patients. In this study, we investigated the incidence and associated factors of MDR-HAI in children admitted to the intensive care unit (ICU) of a university hospital. METHODS: We retrospectively evaluated 135 children who were admitted in ICU for at least 3 days between January 2009 and December 2010. HAI cases were divided into MDR-HAI group and non-MDR-HAI group. Clinical characteristics and various associated factors were compared between those groups. RESULTS: In 39 patients, 45 cases of ICU-related HAI were developed. ICU-related HAI incidence was 47.7 per 1000 patient-days. Thirty-six cases (80.0%) were MDR-HAI. Acinetobacter baumannii was isolated more commonly in MDR-HAI group. And the followings were found more frequently in MDR-HAI group than non-MDR-HAI group: medical condition as an indication for ICU admission, mechanical ventilation, urinary catheterization and previous use of broad-spectrum antibiotics. Among the risk factors, previous use of broad-spectrum antibiotics was the independent risk factor for MDR-HAI. CONCLUSION: ICU-related HAI incidence was higher than previously reported. Previous use of broad-spectrum antibiotics was the independent risk factor for MDR-HAI. To investigate the characteristics of MDR-HAI in children admitted in ICU, further studies with a larger sample size over a longer period of time are warranted.

Clinical Characteristics of Chlamydia trachomatis Respiratory Tract Infection in Young Infants / 소아알레르기및호흡기학회지

PURPOSE: Chlamydia trachomatis (C. trachomatis) is the most prevalent etiology of sexually transmitted diseases and also a cause of respiratory infections in infants. The purposes of this study were to determine the epidemiology, presentation, and laboratory findings of C. trachomatis respiratory infection, and to investigate its severity and hospital courses. METHODS: Between February 2002 and January 2010, we enrolled infants younger than 6 months admitted to Gil Hospital with a diagnosis of acute bronchiolits and pneumonia. Clinical findings and demographic data were reviewed in all patients. Basic laboratory examinations included white blood cell and eosinophil count. C. trachomatis was detected by enzyme immunoassay for C. trachomatis specific immunoglobulin M. RESULTS: Of 1,708 patients, C. trachomatis was detected in 142 (8.3%). The incidence increased from 2002 to 2009 and was higher in spring. C. trachomatis infection was distinguished by less fever (p<0.01) and more crackle (p<0.05) on auscultation, and strongly correlated with eosinophilia (P=0.01). The severity and clinical course of C. trachomatis infection was similar to those of infections by the other etiologies. CONCLUSION: C. trachomatis is prevalent among infants younger than 6 months with a diagnosis of acute bronchiolits and pneumonia. We must consider C. trachomatis as the etiologic agent in infantile respiratory infections and must make more effort to detect C. trachomatis.

Acute Lupus Pneumonitis as Initial Manifestation of Systemic Lupus Erythematosus / 소아알레르기및호흡기학회지

We report case of a 14-year-old girl with systemic lupus erythematosus who initially presented with acute lupus pneumonitis. She had a 4-week history of exertion for the past 4 weeks, and was transferred from a regional hospital due to abnormality on chest radiographs. Chest radiographs revealed bilateral infiltration and pleural effusion on both lower lung fields. We assumed her to be infected and prescribed antibiotics. The response to antibiotics was ineffective, and viral, bacterial, and mycobacterial cultures were negative. Antinuclear and anti-dsDNA antibodies in serum were positive. The open lung biopsy revealed diffuse alveolar damage. She was diagnosed as having acute lupus pneumonitis in systemic lupus erythematosus and recovered gradually after receiving corticosteroids. Acute lupus pneumonitis may be considered even though interstitial lung involvement in systemic lupus erythematosus is relatively rare in pediatric practice and its diagnosis is difficult.

Epidemiology and Clinical Characteristics of Clostridium difficile-associated Disease in Children: Comparison between Community- and Hospital-acquired Infections / 대한소아소화기영양학회지

PURPOSE: Recent studies have reported an increase in the incidence of community-acquired Clostridium difficile-associated disease (CA-CDAD) among children. There is an overall lack of information on CA-CDAD in the pediatric population. The aim of our study was to compare the epidemiologic and clinical features between CA-CDAD and hospital-acquired C. difficile-associated disease (HA-CDAD) in children. METHODS: We retrospectively reviewed the medical records of all patients who were diagnosed with C. difficile-associated disease (CDAD) at Gil Hospital between April 2008 and March 2009. The diagnosis of CDAD was made when patients with gastrointestinal symptoms had positive results for C. difficile toxins A and B assay or stool culture. RESULTS: Sixty-one (male, 32 and female, 29) patients were included. The mean age was 3.79+/-4.54 years. Of the 61 patients, 22 (36.1%) were <1 year of age. Twenty-three patients (37.7%) had a history of antibiotic exposure in the previous 3 months. Forty-one patients (67.2%) were diagnosed with CA-CDAD. There were no significant differences in age, gender, symptoms, laboratory findings, recovery period, complications, and recurrence between the CA-CDAD and HA-CDAD groups. On the other hand, exposure to antibiotics was significantly more frequent among patients in the HA-CDAD group (p=0.005). CONCLUSION: This study suggests that the occurrence of CA-CDAD is increasing in the pediatric population, especially in younger children with no history of exposure to antibiotics and in outpatients. Awareness of the increasing incidence of CA-CDAD and prompt investigation of C. difficile in susceptible patients is needed to avoid misdiagnosis and for appropriate therapy.

Epidemiology and Clinical Characteristics of Clostridium difficile-associated Disease in Children: Comparison between Community- and Hospital-acquired Infections / 대한소아소화기영양학회지

PURPOSE: Recent studies have reported an increase in the incidence of community-acquired Clostridium difficile-associated disease (CA-CDAD) among children. There is an overall lack of information on CA-CDAD in the pediatric population. The aim of our study was to compare the epidemiologic and clinical features between CA-CDAD and hospital-acquired C. difficile-associated disease (HA-CDAD) in children. METHODS: We retrospectively reviewed the medical records of all patients who were diagnosed with C. difficile-associated disease (CDAD) at Gil Hospital between April 2008 and March 2009. The diagnosis of CDAD was made when patients with gastrointestinal symptoms had positive results for C. difficile toxins A and B assay or stool culture. RESULTS: Sixty-one (male, 32 and female, 29) patients were included. The mean age was 3.79+/-4.54 years. Of the 61 patients, 22 (36.1%) were <1 year of age. Twenty-three patients (37.7%) had a history of antibiotic exposure in the previous 3 months. Forty-one patients (67.2%) were diagnosed with CA-CDAD. There were no significant differences in age, gender, symptoms, laboratory findings, recovery period, complications, and recurrence between the CA-CDAD and HA-CDAD groups. On the other hand, exposure to antibiotics was significantly more frequent among patients in the HA-CDAD group (p=0.005). CONCLUSION: This study suggests that the occurrence of CA-CDAD is increasing in the pediatric population, especially in younger children with no history of exposure to antibiotics and in outpatients. Awareness of the increasing incidence of CA-CDAD and prompt investigation of C. difficile in susceptible patients is needed to avoid misdiagnosis and for appropriate therapy.

Predictive indicators of coronary artery complications in Kawasaki disease / 소아과

PURPOSE: Kawasaki disease-the most common cause of acquired heart disease in children-incidence is increasing yearly. Therefore, we evaluated the predictive indicators of coronary complications of Kawasaki disease based on clinical and laboratory data. METHODS: Between January 2005 and March 2008, of the 201 children with Kawasaki disease treated at the Gil Hospital of Gachon University of Medicine and Science, 51 had coronary artery lesions (Group II) and 150 had no lesions (Group I). The reasons for coronary artery lesions were deduced from the clinical and laboratory data. RESULTS: Analysis of the 2 groups revealed that fever duration and days of fever after and before initial intravenous gammaglobulin (IVIG) treatment were significantly longer in Group 2 than in Group I. IVIG infusions were statistically higher in Group II than in Group I. As per the laboratory data, C-reactive protein (CRP) value was significantly higher in Group II. Collectively, >10 days of fever duration, >48 h of fever duration after, and >10 days of fever before IVIG treatment increased the risk of coronary artery lesions 6-, 5-, and 3.5-fold, respectively. Furthermore, additional IVIG courses and higher CRP level increased the risk of coronary artery lesions 4-fold and 2.3-fold, respectively. CONCLUSION: The following 3 factors were responsible for increased risk of coronary artery lesions in children with Kawasaki disease: fever duration and days of fever after and before IVIG treatment. To identifythe predictive indicators of coronary complications, it is necessary to further elucidate the relationship between well-known forecasting factors.

Correlation between Clinical Findings of Epileptic Seizures and Electroencephalography in Children

PURPOSE: Electroencephalography(EEG) is an essential method carried out for classifying seizures and taking appropriate treatment. The aim of this study is to investigate the concordance between clinical findings of epileptic seizures and EEG in children. METHODS: We enrolled 461 patients from those who visited Gil hospital from January 1, 2000 to September 30, 2008 with the chief complaint of epileptic seizure more than once and checked their first EEG at the same hospital. The clinical findings of seizure were based on the charts and interictal waking and sleep EEGs were done. RESULTS: The mean age of the patients was 6.7 years old. 497 epileptic seizures occurred and its clinical finding included 310 of partial seizures and 187 of generalized seizures. In 315 waking EEG 158 were abnormal including 118 of partial seizures, 59 of generalized seizures and 19 of both seizures, in 431 sleep EEG 239 were abnormal including 196 of partial seizures, 77 of generalized seizures and 34 of both seizures, and in waking and/or sleep EEG 273 were abnormal including 216 of partial seizures, 97 of generalized seizures and 40 of both seizures. Epileptic syndromes were observed in 90 patients. 146(41.5%) of partial seizures, 44(23.4%) of generalized seizures, and 79(87.8%) of epileptic syndromes accorded with EEG. CONCLUSION: When diagnosing seizures in children, we must consider not only clinical findings but also accurate EEG findings.

Drug Compliance of Pediatric Patients with Epilepsy

PURPOSE: The sole available treatment for the majority of epilepsy patients is antiepileptic drug therapy. Drug compliance is an important factor for adequate treatment. This study is for investigating pediatric epilepsy patients' compliance to antiepileptic drug treatment at Gil hospital, in South Korea. METHODS: From February 1997 to July 2005, retrospective studies were made on 327 patients with epilepsy in Gil hospital of Gachon medical school. The patients who were taking medication prescribed at other hospitals, were admitted to the hospital for over 30 days, had seizures due to meningitis, encephalitis or trauma were excluded. The participants included patients followed for two years or until the seizures were no longer present. RESULTS: Of the total 327 patients, the mean drug compliance was 80.8%; over 80% for 203 patients(62.1%), 80-50% for 97, under 50% for 28(8.6%). Gender, the age of patients, dose frequency, results of the EEG, MRI abnormalities, etiology of epilepsy, and the duration of the first seizure did not significantly influence drug compliance. However, the patients taking tablets or capsules showed higher compliance than those treated with powder medication. In addition, the patients who started to take drugs after the year 2000 had higher compliance than those before 2000. CONCLUSION: The patients taking tablets or capsules and those who started after 2000 had higher compliance. Although most patients had satisfactory drug compliance, 8.6% had poor compliance(under 50% of compliance); this group requires further attention to improve their compliance.

Influence of Helicobacter pylori Infection on Gastric Motility in Children and Adolescents with Functional Dyspepsia / 대한소아소화기영양학회지

PURPOSE: In spite of many reports about Helicobacter pylori infection in children with functional gastrointestinal disorders, there are few reports about the influence of H. pylori infection to functional dyspepsia and gastric motility. Therefore, we studied the influence of H. pylori infection on gastric myoelectrical activity in children with functional dyspepsia. METHODS: Between August 2006 and December 2008 upper gastrointestinal endoscopies with biopsies, the rapid urease test and/or 13C urea breath test, and electrogastrography (EGG) were performed on 63 patients with histologic chronic gastritis; patients with chronic disorders were excluded. Comparisons about gastric myoelectrical activities were made between H. pylori-positive children (n=25) and H. pylori- negative children (n=38). RESULTS: The percentage of pre- and post-prandial normogastria was relatively lower in H. pylori-positive children than H. pylori-negative children (80% vs. 65%, and 80% vs. 68%, respectively). Compared to H. pylori-negative children, H. pylori-positive children had lower postprandial predominant power (8.18+/-22.36 dB and 32.20+/-24.18 dB, respectively; p<0.01) and a lower power ratio (deltaP; delta1.28+/-6.18 vs. +.62+/-5.93, respectively; p<0.01). CONCLUSION: It was suggested that the gastric myoelectrical activity in children with chronic gastritis can be influenced by H. pylori infection. Thus, this study indicates that H. pylori infection may be predictable in children with functional dyspepsia through analyzing the EGG parameters, and treatment may be considered in H. pylori-positive children with impaired gastric activity, especially in the lower prevalence area.

Clinical Characteristics of Childhood Henoch-Schonlein Purpura with Duodenal Involvement by Upper Gastrointestinal Endoscopy / 대한소아소화기영양학회지

PURPOSE: The aim of this study was to investigate the clinical usefulness of upper gastrointestinal (GI) endoscopy in children with Henoch-Schonlein purpura (HSP). METHODS: We retrospectively analyzed the clinical, endoscopic, and histopathologic records of children with HSP who had been admitted to the Department of Pediatrics of Gil Hospital and underwent upper GI endoscopy between January 2002 and June 2009. Patients were classified into the following two groups for statistical analysis: duodenal involvement (+) and duodenal involvement (-). RESULTS: Fifty-one children with HSP underwent upper GI endoscopy; the mean age was 7.2+/-2.9 years. The upper GI endoscopy showed abnormalities of the duodenum in 38 cases (74.5%), 22 of which had duodenal ulcers. Among the biopsy specimens obtained from the duodenum of 37 cases, 13 cases (35.1%) had leukocytoclastic vasculitis, neutrophil debri, and/or extravasation of RBCs. Steroid use was more frequent in the duodenal involvement (+) group (86.8%) than the duodenal involvement (-) group (53.8%; p=0.02). The mean length of hospitalization was 13.9+/-8.43 days in the duodenal involvement (+) group and 8.1+/-4.62 days in the duodenal involvement (-) group (p=0.003). The recurrence rate was significantly higher in the duodenal involvement (-) group than the duodenal involvement (+) group (p=0.027), whereas none of the other study parameters, such as the age of onset, renal involvement, and steroid use, led to significantly higher or lower recurrence rates. CONCLUSION: These results suggest that duodenal involvement can influence the clinical course and prognosis of HSP in children.

The Clinical and Histopathologic Findings of Lymphonodular Hyperplasia of the Colon in Infancy and Childhood / 대한소아소화기영양학회지

PURPOSE: Lymphonodular hyperplasia of the colon (LNHC) is a rare finding in children and its significance as a pathologic finding is unclear. The aim of this study was to investigate the clinical significance of LNHC by analyzing clinical and histopathologic findings in children with LNHC. METHODS: We analyzed data from 38 patients who were confirmed to have LNHC by colonoscopy. We checked age, birth history, past history, family history, and clinical symptoms. A hematologic exam, stool exam, and image studies were performed and biopsy specimens were examined by a pathologist. All patients were asked to have short- and long-term follow-up. RESULTS: The mean age of the patients was 12.5+/-14.4 months. All patients presented with complaints of bloody stool. They appeared healthy and the hematologic findings were within a normal range, with the exception of one case. There was no other identified source of bleeding. On histologic exam, 36 patients (94.7%) had lymphoid follicles and 34 patients (84.5%) fulfilled the criteria of allergic colitis. Regardless of diet modification and presence of residual symptom, there was no recurrence of bloody stool through long-term follow-up in all patients. CONCLUSION: LNHC is more common in infants who are affected by allergic colitis, but it can appear even after infancy. LNHC should be regarded as the etiology when there are any other causes of rectal bleeding, especially in healthy children. We suggest that LNHC has a benign course regardless of diet modification and it might not require excessive concerns.

A Case of Symptomatic Neurocutaneous Melanosis Associated with the Dandy Walker Complex and Excellent Response of Seizures to Topiramate

Neurocutaneous melanosis is a rare non-familial congenital neurocutaneous syndrome characterized by the presence of large or multiple congenital melanocytic nevi in association with benign or malignant proliferation of melanocytes in the leptomeninges. It is believed to be an embryonic neuroectodermal dysplasia. The Dandy Walker complex is an uncommon disorder of the CNS, also. refers to a condition with a broad posterior fossa and high tentorium insertion, hypoplasia or aplasia of the cerebellar vermis and cystic dilation of the fourth ventricle communication with the posterior fossa. We report a patient with NCM associated with the DWC that was diagnosed by MRI. The patient had multiple, small to medium-sized melanocytic nevi on the scalp and back, presenting at birth. At 6 months of age, frequent daily attacks of partial seizures were noted. T1 weighted MR images showed multiple high signal lesions in the amygdala, cerebellar folia, deep nuclei, and basis pontis, compatible with intraparenchymal melanin deposits. In addition, hypoplasia of the inferior vermis and a broad posterior fossa were identified. The patient failed to respond to oxcarbazepine. The seizure frequency did not decrease for the first three months. Vomiting and mild elevation of the liver enzymes were observed after adding valproic acid. However, after topiramate was started the frequency of the seizures decreased, and the oxcarbazepine and valproic acid were discontinued. With 5 mg/kg of topiramate treatment, the patient became seizure free for 20 months; however, infrequent seizures recurred thereafter. The dosage of topiramate was increased to 13 mg/kg, and for the following 15 months, there have been no seizures. Seizures were well controlled by topiramate for four years.

Prevalence and Risk Factors Associated with Esophagitis in Children with Abdominal Pain / 대한소아소화기영양학회지

PURPOSE: Children with esophagitis express a variety of nonspecific symptoms and signs depending on their age, and diagnosis is limited because gastrointestinal endoscopy (GFS) and biopsy are difficult to perform. The aim of this study was to examine the prevalence of esophagitis in children with upper abdominal pain, to determine the necessity of esophageal biopsy, and to evaluate the associated risk factors. METHODS: We reviewed 266 pediatric patients with upper abdominal pain who underwent history-taking, physical examination, and GFS with esophageal and gastric biopsies between January 2006 and December 2007. Esophagitis was confirmed on biopsy. We analyzed the risk factors for histologic esophagitis and the necessity of esophageal biopsy. RESULTS: The prevalence of esophagitis was 19.9% (53/266 patients). The sensitivity and specificity of endoscopic diagnosis were 41.5% and 77%. Of 53 patients with histologic esophagitis, reflux esophagitis was seen in 50 patients, eosinophilic esophagitis was seen in 2 patients, and esophageal candidiasis was seen in 1 patient. Vomiting was a significant factor in patients under 8 yr of age (p<0.05). H. pylori infection was documented in 41.5% of patients with histologic esophagitis, compared with 58.5% of patients not infected with H. pylori (p<0.05). The possibility of histologic esophagitis was higher in patients with H. pylori infection (OR 2.5, 95% CI 1.2544 to 4.8286) and in those who visited in the spring (OR 2.5, 95% CI 1.2544 to 4.8286). CONCLUSION: We believe esophageal tissue biopsy should be performed in pediatric patients with upper gastrointestinal symptoms who are undergoing GFS and stomach tissue biopsy, especially preschoolers and H. pylori-infected children in the spring.