A Prospective Study on Duodenitis, Duodenal Ulcer, and Gastric Metaplasia in Children Infected by Helicobacter pylori / 대한소아소화기영양학회지

PURPOSE: Helicobacter pylori (H. pylori) infection has been known to be vital in the pathogenesis of duodenal ulcer disease in children as well as in adults. But the relationship between H. pylori infection and the histopathologic findings of the duodenum has not been explained obviously in children yet. So the aim of this study is to determine whether duodenitis and/or gastric metaplasia in the duodenum increases the risk of duodenal ulcer disease in children infected by H. pylori. METHODS: From October 2001 to April 2004 gastric and duodenal biopsies were performed in 177 children who visited Department of Pediatrics, Gil Hospital, Gachon Medical School. Biopsy sections were stained with hematoxylin and eosin and also with Giemsa for identification of H. pylori. The grades of duodenitis and gastric metaplasia were classified from 0 to 3 and from 0 to 4, respectively. RESULTS: The incidence of H. pylori infection was 54% in total patients. Amongst 163 children with duodenitis there was a lack of correlation between H. pylori infection and the grade of duodenitis. Amongst 11 patients with duodenal ucler, only 4 children were infected by H. pylori. And amongst 5 patients with gastric metaplasia, H. pylori and duodenal ulcer were detected in 2 and 3 children, respectively. The occurrence of duodenal ulcer and gastric metaplasia were increased significantly in proportion to the grade of duodenitis (p<0.0001 and p=0.0365, respectively). CONCLUSION: As opposed to the results of previously reported articles, there were lacks of correlation between H. pylori infection and duodenitis, duodenal ulcer, and gastric metaplasia. So further study hould be done to clarify the effect of H. pylori on the duodenal histopathology in children infected by H. pylori.

Influence of Climate Factors and PM10 on Rotaviral Infection: A Seasonal Variation Study / 대한소아소화기영양학회지

PURPOSE: Recently, while the authors were experiencing that the epidemic period of rotaviral infection happened more in the early spring, we tried to find out how the outbreaks of rotaviral infection are changing in detail depending on the weather condition since it has something to do with the climate factors and PM10. METHODS: Fourteen hundreds seventy nine patients who were proved to be positive to rotavirus were chosen among children less than 5 years old from January 1995 to June 2003. Among various climate factors, monthly average temperature, humidity, rainfall and PM10 were selected. RESULTS: Rotaviral infection was most active in 2002 as 309 (20.9%) patients. It has been the spring that is the most active period of rotaviral infection since 2000. The temperature (RR=0.9423, CI= 0.933424~0.951163), rainfall (RR=1.0024, CI=1.001523~1.003228) and PM10 (RR=1.0123, CI= 1.009385~1.015248) were significantly associated with the monthly distribution of rotaviral infection. CONCLUSION: Through this study we determined that the epidemic period of rotaviral infection is changed to spring, which is different from the usual seasonal periods such as late fall or winter as reported in previous articles. As increased PM10 which could give serious influence to the human body, and changing pattern of climate factors such as monthly average temperature and rainfall have something to do with the rotaviral infection, we suppose that further study concerning this result is required in the aspects of epidemiology, biology and atmospheric science.

Colon Perforation during Air Enema Reduction of Intussusception

PURPOSE: Although air enema reduction has been known as a good method of diagnosis and treatment of intussusception, it could develop colon perforation. However, there have been few studies about this complication. So we analyzed the risk factors of colon perforation during air enema reduction in patients with intussusception. METHODS: We reviewed the charts of 12 colon perforation patients during air enema reduction of intussusception, who were admitted to Gil Medical Center from Jan. 1990 to Dec. 2001. Their age, sex, major symptoms, length of time till hospital visit, types of intussusception, operative findings and pathologic reports were reviewed. RESULTS: Among 657 cases, 596 patients(90.7%) were successfully treated, but 12 patients(1.83%) failed in air enema reduction and had colon perforation. In patients with colon perforation the male to female ratio was 11 : 1, and average age was 5.3 months. The most common symptom at the time of hospital visit was vomiting(91.7%). Cyclic irritability(75.0%), bloody stool(75.0%) and abdominal mass(41.7%) were also noted. The average length of time between symptom onset and hospital visit was 44.7 hours. Types of intussusception were predominantly ileocolic, ileocecal, and ileoileocolic. The site of perforation was most commonly found at the proximal part of intussusception including ascending colon(50%) and transverse colon(50%). Most cases were uncomplicated, and had a single perforation. Pathologic reports showed hemorrhagic necrosis and mesenteric laceration at the site of colon perforation. Complications of colon perforation were tension pneumoperitonium(58.3%), requiring immediate decompression. CONCLUSION: The chance of colon perforation during air enema reduction increases in cases with small bowel obstruction on simple abdominal x-ray of a patient younger than 6 months, delay in time till hospital visit and higher air pressure during reduction. Therefore more careful investigation is needed in these cases.

Two Cases of Rotor Syndrome in Siblings / 대한소아소화기영양학회지

We experienced two cases of Rotor syndrome in brothers who were a 13 year-old boy and an 11 year-old boy, respectively. They presented with icteric scleras for a few months. Their common laboratory characteristics were as follows: Direct bilirubin was more increased than indirect bilirubin, but aminotransferases were normal. Plasma indocyanine green (ICG) test revealed hepatic excretory defect: plasma ICG concentrations 15 minutes after intravenous injection were 80.45% and 78.28%, respectively. 99mTc-DISIDA Hepatobiliary scan showed that severely decreased hepatic extraction with mild cardiac blood pool, markedly delayed biliary excretion in both intra- & extra- hepatic bile ducts, delayed visualization of gall bladder, and markedly delayed intestinal biliary passage. Needle liver biopsy showed normal hepatic histology without pigmentation.