A Clinical Observation on Children with Corrosive Esophagitis / 대한소아소화기영양학회지

PURPOSE: This study was undertaken to evaluate the clinical features and complication such as esophageal stricture in children with corrosive esophagitis. METHODS: We retrospectively reviewed medical records of 31 children who accidentally ingested corrosive materials and visited to emergency room of Chonnam National University Hospital from Jan. 1992 to Dec. 1999. Twenty-one children were examined by upper gastrointestinal(UGI) endoscopy to evaluate location and severity of caustic injury. RESULTS: 1) Among 31 patients, there were 20 males and 11 females and the ratio of male to female was 2:1. Average age at diagnosis was 2.3 years (12months to 9.8 years). Twenty-seven(87.1%) patients were accidentally ingested vinegar. 2) Initial presenting symptoms were dysphagia(54.8%), vomiting(48.3%), chemical burn on lips and skin(45.2%), excessive salivation(45.2%), coughing and respiratory grunting(32.3%) and aspiration pneumonia(9.8%). 3) UGI endoscopic examination showed caustic injury in 17 children : grade I in 8, grade II in 7 and grade III in 2. The region of caustic injury was proximal esophagus in 5, distal esophagus in 3, entire esophagus in 9 and stomach in 6. 4) Corrosive esophageal strictures developed in 6 children(19.4%) and gastric outlet stricture in 1(3.2%). All of them showed grade II or III caustic injury on endoscopic examination. CONCLUSION: The development of esophageal stricture was related to the severity of the caustic injury. Early UGI endoscopic examination in caustic ingestion seems to be useful for prediction of development of caustic stricture.

Effect of Simultaneous Administration of Hepatitis B Vaccine with DPT and Oral Polio Vaccine

PURPOSE: The universal vaccination against hepatitis B during early infancy is the only effective way to control hepatitis B infection in highly endemic areas in Korea. The purpose of this study was to assess the effectiveness of simultaneous hepatitis B vaccination with DPT and oral polio at 2, 4, 6 months of age in babies of HBs antigen negative mothers. METHODS: One hundred and eighty-one infants who were admitted to the Neonatal Intensive Care Unit (NICU), Chonnam University Hospital from August, 1994 to December, 1995 were enrolled in this study. Infants received Hepavax-B 0.5ml (10 microgram) at contralateral thigh intramuscularly, simultaneously with DPT vaccination. Antibody was assessed by MEIA (microparticle enzyme immunoassay) at seven to nine months of age. RESULTS: The seroconversion rate of Hepatitis B after vaccination was 98.3%. There were no significant differences in positive rate of antibody according to gestational age, birth weight and sex. Seroconversion rate to hepatitis B in twins was lower than in singlets. Twenty-two infants among 23 infants, who were able to assess antibody titer, showed effective antibody titer, above 100mIU/ml. CONCLUSION: The results suggest that the simultaneous administration of hepatitis B vaccine with DPT/TOPV is very effective and simplifies schedule. Moreover, this schedule will improve the compliance of vaccination.

Three Cases of Symptomatic Huge Arachnoid Cysts

Congenital arachnoid cysts are commonly located at sylvian cistern or middle cranial fossa which are usually asymptomatic and incidentally found. Posterior fossa cysts, however, are usually large when diagnosed, and symptomatic. Three cases of large posterior fossa cysts were recognized on the diagnostic MRI investigation for infantile spasm, developmental delay, and the precocious puberty. Surgical decompression of the cysts by craniectomy, cyst excision and fenestration were performed successfully in two patients with arachnoid cysts in the cerebellopontine cistern and the suprasellar, right cerebellopontine, and prepontine cisterns, but an additional cystoperitoneal shunt was needed in a case with the cyst in the quadrigemial cistern with obstructive hydrocephalus. Infantile spasm was treated with vigabatrin and pyridoxine, and the true precocious puberty was managed with LHRH analogue(Decapeptyl ).

Reappraisal of the Efficacy of Measles Vaccination

PURPOSE: Measles is one of the most highly communicable infectious disease, but has become a rare disease with the widespread use of vaccine. Recently, however, resurgence of the disease in school aged or adolescents who had received the vaccine before or at the 15 month warrants reappraisal of the efficacy of the vaccination. The purpose of this study was to investigate positive prevalence of antibody and its quantitative titers in different age groups in order to determine necessity and appropriate time of booster vaccine. METHODS: We measured measles antibody in the sera of 192 children from different age groups(61 cases from 4-6 years of age, 40 cases from 8-9 years of age, 47 cases from 12-13 years of age, 44 cases from 15-16 years of age). Eight to ten children from each group were selected and quantitative antibody titers were measured by EIA(measles Ig G EIA SEIKEN) method. RESULTS: 1) The positive prevalence of measles antibody in four to six year age group(72%) was significantly lower than the expected positive prevalence of measles antibody(95%) (p<0.001). 2) Median antibody titer in twelve to thirteen year age group tended to be relatively lower than the other age groups. 3) There was no significant differences in the positive prevalence of measles antibody and median titers between sex. CONCLUSIONS: This data supported that the booster vaccination be needed at four to six years of age.