Efficacy of Nutritional Therapy in Children with Crohn Disease / 대한소아소화기영양학회지

PURPOSE: Crohn disease (CD) in children is frequently complicated by malnutrition and growth retardation. Conventional treatment with corticosteroid may also affect the growth of children, which may be alleviated by nutritional therapy. Therefore, we performed this study to evaluate the role of nutritional therapy in the treatment of CD in children. METHODS: The study cohort consisted of thirty children under the age of 17 years, admitted to the Asan Medical Center from 2001 to 2005. While 11 children received nutritional therapy (NT) with an elemental diet, 19 received conventional corticosteroid therapy (ST). Comparative analysis was performed for the rate of the induction of remission, recurrence, disease activity index of pre and post-treatment, and changes of the growth using mean standard deviation score for weight (zW) and height (zH). RESULTS: Ten of 11 children with NT and 18 of 19 children with ST completed the therapy. Two of them were lost to follow-up during the treatment. All 10 children with NT and 15 of 18 children with ST achieved remission. While there was no recurrence in children with NT, 7 with ST showed recurrence within 1 year. Pre- and post treatment Pediatric Crohn disease Activity Index (PCDAI) did not show a difference between the two groups. There were no differences in zW and zH between the two groups after 1 year of follow-up. CONCLUSION: This study showed that nutritional therapy could be considered instead of steroid therapy for treatment of children with CD. However, a long-term study will be needed to determine the long-term efficacy.

Allograft Rejection after Liver Transplantation in Children / 대한이식학회지

PURPOSE: We performed this study to assess the clinical course of acute rejection and chronic rejection after liver transplantation in children. METHODS: Seventy-six liver transplantations were performed in 75 children between December 1994 and March 2002. Twenty-five boys and 50 girls were included in this study, and the mean age was 20 months old. We analyzed the incidence, clinical course and outcome of acute and chronic rejection after liver transplantation retrospectively. RESULTS: Forty out of 75 children (53%) experienced 45 episodes of acute rejection, and 32 episodes (71%) of them occurred within 1 month after transplantation. The degree of acute rejection was mild in 16 (36%), moderate in 14 (31%) and severe in 2 (4%) cases. Younger (<2 years old) recipient experienced higher incidence of acute rejection. But there was no association with recipient's sex, ABO matching, type of donor, and the kind of immunosuppressant. All 40 children with acute rejection improved with conventional treatment. There was no significant statistical relation between acute rejection and recipient's survival. Chronic rejection occurred in 7 (9%) children, and 3 of them died of chronic rejection itself but another 3 children improved during the follow-up periods. CONCLUSION: Acute rejection occurred in more than half of the pediatric liver transplantation recipients. Most rejection episodes were mild and occurred within 1 month after transplantation. Acute rejection did not affect the recipient's survival and graft function.

Clinical Experience of 60 Pediatric Renal Transplantations at a Single Center / 소아과

PURPOSE: Renal transplantation for the management of end-stage renal disease(ESRD) in children is now the optimal treatment. We analyzed the clinical courses and characteristics of pediatric renal transplantation in Asan Medical Center. METHODS: We reviewed the charts of 60 cases of renal transplantation under the age of 18, admitted to Asan Medical Center, from Oct. 1990 to May 2003. We analyzed retrospectively to clarify the clinical courses, risk factors affecting graft survival, recurrence of the original disease, complications and growth. RESULTS: Graft was taken from 48 living donors, and 12 cadaveric donors. The mean age at transplantation was 13.1 years. The overall graft survival rates were 96.3% at one year, 84.4% at five year, 47.6% at 10 years. The overall patient survival rates were 98.1% at one year, 95.1% at five years, 95.1% at 10 years. A total of 13 grafts were lost(21.7%). The presence of acute rejection within one year after graft(P=0.0045) and recipient less than five years old(P=0.0027) were significant risk factors for poor graft survival. The recurrence rate of original disease was 8.3% and the most common complication was infection(50%). In the group less than 3 percentile of pretransplantation height, there were much longer duration of ESRD and much greater growth after transplantation(P=0.002). CONCLUSION: The graft survival rate for pediatric renal transplantation has been greatly increased, similar to those of adult renal transplantation with the development of operation techniques and immunosuppressants. Further studies into the factors improving graft survival and new immunosuppressants to reduce the rate of rejection, and efforts to reduce the incidence of infection, are needed at this time.

A Case of Micturition Syncope in a Child

Syncope in children and adolescents have a common occurrence according for up to 15% before adulthood. Micturition syncope, a kind of situational syncope, can be considered a form of reflex syncope. It can typically occur in healthy young men after rising from bed in the early morning who experience sudden loss of consciousness during or immediately after urination. The mechanism of micturition syncope is not completely understood, but it has been suggested that vasovagal reflex mediated bradycardia and peripheral vasodilation and decreased venous return due to Valsalva effect and standing position lead to the decrease in cerebral blood flow resulting in syncope. The causes of syncope are variable. So complete history taking, physical examination, electrocardiography, exercise stress test, echocardiography, head-up tilt table test, electroencephalography(EEG), brain magnetic resonance image and urodynamic study should be required for the diagnosis of micturition syncope. There were several reports about micturition syncope. However, literature of micturition syncope at the pediatric age has rarely been reported in Korea so far. Therefore, we report a case of a 9- year-old boy with micturition syncope with typical EEG findings of high amplitude delta wave and flattening during syncope.