Severe Disease Activity Based on the Paris Classification Is Associated with the Development of Extraintestinal Manifestations in Korean Children and Adolescents with Ulcerative Colitis

Background@#There are limited data regarding the extraintestinal manifestations (EIMs) associated with pediatric inflammatory bowel disease (IBD) in Korea. We aimed to investigate the clinical features and factors associated with the development of EIMs in Korean children and adolescents with IBD. @*Methods@#This multicenter, retrospective study was conducted from 2010 to 2017. Baseline clinicodemographic, laboratory findings, disease activity, disease phenotypes, and EIMs were investigated. @*Results@#A total of 172 patients were included. One-hundred thirty-seven (79.7%) had Crohn's disease (CD), and 35 (20.3%) had ulcerative colitis (UC). EIMs occurred in 42 patients (24.4%). EIMs developed in 34/137 diagnosed with CD (24.8%), and in 8/35 diagnosed with UC (22.9%), during a median follow-up duration of 3.2 (interquartile range, 1.9–5.4) years for CD and 3.0 (1.0–4.0) years for UC, respectively. Arthritis/arthralgia was most commonly observed (n = 15, 35.7%), followed by stomatitis/oral ulcer (n = 10, 23.8%), hepatitis (n = 5, 11.9%), nephritis (n = 4, 9.5%), pancreatitis (n = 2, 4.8%), erythema nodosum (n = 2, 4.8%), pyoderma gangrenosum (n = 1, 2.4%), primary sclerosing cholangitis (n = 1, 2.4%), uveitis (n = 1, 2.4%), and ankylosing spondylitis (n = 1, 2.4%). A significant difference in disease severity based on the Paris classification (P = 0.011) and ESR at diagnosis (P = 0.043) was observed between the EIM positive and negative group in patients with UC. According to logistic regression analyses, S1 disease severity based on the Paris classification was the only factor that was significantly associated with the development of EIMs (odds ratio, 16.57; 95% confidence interval, 2.18–287.39; P = 0.017). @*Conclusion@#Severe disease activity based on the Paris classification in pediatric patients with UC was significantly associated with EIM development. As disease severity in the Paris classification is a dynamic parameter, treatment should be focused on disease control to minimize the occurrence of EIMs in Korean children and adolescents with UC.

Characteristics and Incidence Trends for Pediatric Inflammatory Bowel Disease in Daegu-Kyungpook Province in Korea: a Multi-Center Study

BACKGROUND: Inflammatory bowel disease (IBD) is a heterogeneous chronic disease of unknown etiology. Although it is an important disease that shows a rapid increase in pediatric population, there are no pediatric studies that represent a specific region in Korea. Therefore, we studied the epidemiological and phenotypic characteristics of pediatric IBD in Daegu-Kyungpook province, Korea. METHODS: We included 122 children with pediatric IBD initially diagnosed at one of four university hospitals in Daegu-Kyungpook province between July 2010 and June 2016. We investigated the incidence trends, and the clinical characteristics at diagnosis were compared by Paris classification. RESULTS: We included 122 children: 98 with Crohn's disease (CD) and 24 with ulcerative colitis (UC). The average age at diagnosis was 13.6 years for IBD. The incidence shows an increasing trend. CD showed a significant increase, whereas UC appears to be increasing slowly. In CD, there was a significant male predominance. For disease activity sites, the most common location was L3 (77.6%), indicating ileocolonic involvement as the major type. B1 (88.8%) was the most common disease behaviors type. Perianal disease was noted in 43 patients (43.9%) and weight loss in 60 (61.2%). In UC, E4 (58.4%) was the most common disease activity site, indicating pancolonic involvement as the major type. CONCLUSION: We found that the number of pediatric patients with IBD is increasing rapidly in Daegu-Kyungpook province in Korea. Our study also revealed that the characteristics of pediatric IBD in our province differ somewhat from those of pediatric IBD in Western countries.

The association between blood cadmium level, frequency and amount of gejang (marinated crab) intake

BACKGROUND: Gejang (marinated crab) is a favorite traditional food and a main source of crab intake among Koreans. The present study aimed to identify the possibility of cadmium inflow to the body through gejang; accordingly, the relationship between gejang intake frequency and amount, and blood cadmium concentrations was investigated. METHODS: Using data from the first Korea National Health and Nutrition Examination Survey in the sixth period in 2013, means and standard errors of blood cadmium concentrations in relation to gejang intake frequency and amount, as well as the monthly intake of gejang, were obtained from 1381 participants for whom data regarding blood cadmium concentration measurements was available. RESULTS: After adjustment for confounding factors, a gejang intake frequency of four or fewer times per week and a monthly intake of 200 cm3 or less had no significant effect on blood cadmium concentrations. However, participants with gejang intake of at least five times per week had a weighted mean cadmium concentration of 2.12 μg/L (p < 0.001), and participants who had a gejang monthly intake of more than 200 cm3 had a weighted mean cadmium concentration of 1.76 μg/L (p < 0.001). CONCLUSION: These results suggest that to minimize the effect of gejang consumption on blood cadmium level, gejang intake should be limited to four or less times per week and 200 cm3 or less per month. Weekly intake of at least five times and monthly intake of more than 200 cm3 may increase blood cadmium levels.

Correlation between serum 25-hydroxyvitamin D3 and the severity of atopic dermatitis in children with allergic or nonallergenic sensitization

PURPOSE: The aim of this study was to assess the relationship between serum 25-hydroxyvitamin D3 levels and the severity of atopic dermatitis (AD), markers of atopy (total IgE, total eosinophil count, and eosinophil cationic protein) in AD children according to allergen sensitization. METHODS: This cross-sectional study was carried out on 160 AD patients aged 1 to 18 years between March 2012 and August 2014. The AD patients (AD group) were subdivided into 2 categories according to the results of the allergic skin prick and Unicap tests: the allergic and nonallergic AD groups. We compared 25-hydroxyvitamin D3 levels between the AD and control groups. We also investigated relationships between serum 25-hydroxyvitamin D3 levels, the severity of AD, and markers of AD (total IgE, total eosinophil count, and eosinophil cationic protein) in the allergic and nonallergic AD groups. RESULTS: The average 25-hydroxyvitamin D3 levels were 30.6+/-11.7 and 23.7+/-10.0 ng/mL, respectively, in the control and AD groups (P<0.001). The average 25-hydroxyvitamin D3 levels were 19.7+/-8.6 and 27.5+/-9.8 ng/mL, respectively, in the allergic and nonallergic AD groups, with clinical implications (P<0.001). The 25-hydroxyvitamin D3 levels were not significantly associated with SCORing Atopic Dermatitis index in the allergic (P=0.004, r=-0.092) or nonallergic (P=0.610, r=-0.58) AD groups. The 25-hydroxyvitamin D3 levels were not significantly associated with the aforementioned markers of atopy in the AD group. CONCLUSION: These results suggest that 25-hydroxyvitamin D3 may play a role in the pathogenesis of AD.

Probability of Food Allergy in Case of Benign Transient Non-Organic Ileus of Neonate

PURPOSE: Although the symptoms of benign transient non-organic ileus of neonate (BTNIN) are similar to that of Hirschsprung's disease (HD), the etiology underlying BTNIN remains unclear. In the present study, we aimed to compare laboratory and clinical characteristics of BTNIN with those of HD and to clarify the possibility of an association between food allergies and BTNIN. METHODS: We retrospectively reviewed the data from 34 BTNIN and 11 HD patients from January 2005 to December 2011. We compared several variables between these patients, including sex, age, feeding method, rate (%) and absolute count of serum eosinophils, and eosinophil count in the rectal mucosa. Pearson chi-square tests and independent t-tests were used for statistical analysis. RESULTS: BTNIN (N=34) is more likely to affect males as compared to HD (N=11), BTNIN had a longer duration of symptoms after birth, and BTNIN patients were more likely to be breast fed; all these factors were statistically significant (P=0.019, 0.000, and 0.000, respectively). The rate (%) and absolute count of serum eosinophils in the serum of BTNIN and HD patients was 3.9+/-2.4% and 401+/-388/HPF, respectively, and 1.4+/-0.8% and 170+/-110/HPF, respectively (P=0.001 and 0.000). Moreover, the eosinophil count in the rectal mucosa of BTNIN and HD patients was 14.4+/-12.9/HPF and 5.2+/-4.7/HPF, respectively (P=0.017). CONCLUSION: We observed that BTNIN patients exhibited a later symptom onset, and that BTNIN was more closely associated with breast feeding as compared to HD. A greater number of eosinophils were present in the serum and rectal biopsies of BTNIN patients. Thus, we suggest that BTNIN is associated with food allergy.

Difference in the distribution of onset age of intussusception after rotavirus vaccination and according to the type of rotavirus vaccine: single medical center study / 영남의대학술지

BACKGROUND: Rotavirus is the most common cause of severe gastroenteritis in children <5 years of age. The first vaccine, RotaShield was developed, but withdrawn because of its association with increased risk of intussusception. Then, RotaTeq and Rotarix were developed. Although in pre-licensure studies, they were not associated with an increased risk of intussusceptions, in recent studies, it has been controversial. Regarding increased risk of intussusception, we studied the difference in the age of intussusception after rotavirus vaccination. METHODS: A retrospective analysis was conducted on 136 patients diagnosed with intussusception at Yeungnam University Medical Center for 4 years in the pre-vaccination period (group A) and in the post vaccination period (group B). Sex, mean age and age distribution of intussusceptions were compared according to the type of rotavirus vaccine (group B-1, RotaTeq; group B-2, Rotarix). RESULTS: The median ages of group A and group B were 18.8+/-19.6 months and 15.5+/-10.2 months, with no significant differences (p=0.23). The median ages of group B-1 and group B-2 were 15.3+/-9.3 months and 15.6+/-10.8 months, with no significant differences (p=0.91). And No significant difference in the distribution of onset age was observed between groups, and only 6 patients were diagnosed with intussusceptions within 1 month after vaccination. CONCLUSION: No difference was observed in the distribution of onset age of intussusception after rotavirus vaccination and according to the type of rotavirus vaccine. Our study has a limitation in that it was conducted in part of the Daegu area. Additional study is needed.

Kikuchi-Fujimoto disease mimicking malignant lymphoma with 2-18Ffluoro-2-deoxy-D-glucose PET/CT in children / 소아과

PURPOSE: Kikuchi-Fujimoto disease (KFD) is a benign disease, which is characterized by a cervical lymphadenopathy with fever, and it often mimics malignant lymphoma (ML). 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) is a powerful imaging modality for the diagnosis, staging and monitoring of ML, with the limitations including the nonspecific FDG uptake in infectious or inflammatory processes. This study compared clinical manifestations and PET/CT findings between KFD and ML patients. METHODS: We retrospectively reviewed the medical records of 23 patients with KFD and 33 patients with ML, diagnosed histopathologically, between January 2000 and May 2013 at the Department of Pediatrics, Yeungnam University Medical Center. Among them, we analyzed the clinical manifestations, laboratory findings and characteristics, and the amount of 18F-FDG uptake between 8 KFD and 9 ML patients who had 18F-FDG PET/CT. RESULTS: The 18F-FDG PET/CT maximum standardized uptake values (SUVmax) ranged from 8.3 to 22.5 (mean, 12.0) in KFDs, and from 5.8 to 34.3 (mean, 15.9) in MLs. There were no significant differences in SUVmax between KFDs and MLs. 18F-FDG PET/CT with ML patients showed hot uptakes in the extranodal organs, such as bone marrow, small bowel, thymus, kidney, orbit and pleura. However, none of the KFD cases showed extranodal uptake (P<0.001). 18F-FDG PET/CT findings of KFD with nodal involvement only were indistinguishable from those of ML. CONCLUSION: Patients who had extranodal involvement on PET/CT were more likely to have malignancy than KFD.

Clinical characteristics of Kawasaki disease with sterile pyuria / 소아과

PURPOSE: Kawasaki disease (KD) is a systemic vasculitis and affects many organ systems. It often presents sterile pyuria, microscopic hematuria, and proteinuria due to renal involvement. The aims of this study were to define clinical characteristics of acute KD patients with pyuria and to analyze meaning of pyuria in KD. METHODS: The medical records and laboratory findings including serum and urine test of 133 patients with KD admitted to Yeungnam University Hospital from March 2006 to December 2010 were reviewed retrospectively. RESULTS: Forty patients had sterile pyuria and their clinical characteristics including age, gender and body weight were not significantly different with those who did not have pyuria. Fever duration after treatment was significantly longer in KD patients with pyuria. Erythrocyte sedimentation rate, C-reactive protein and serum concentration of alanine aminotransferase were significantly higher in patients with pyuria. Hyponatremia and coronary artery lesion were seen more often in patients with pyuria but there was no significant difference. Also serum blood urea nitrogen was significantly higher in KD patients with pyuria. Urine beta2-microglobulin was elevated in both patients groups and showed no difference between two groups. CONCLUSION: We found more severe inflammatory reaction in KD patients with pyuria. We also found elevation of some useful parameters like beta2-microglobulin that indicate renal involvement of KD through the urine test. Careful management and follow up will need for KD patients with pyuria and it is necessary in the future to study the specific parameters for renal involvement of KD.

Epidemiology and Clinical Features of Respiratory Viruses in Pediatric Inpatients in a Single Medical Center in Daegu from 2010 to 2012 / 영남의대학술지

BACKGROUND: This study was performed to investigate the epidemiologic and clinical features of acute respiratory viral infection in hospitalized children. METHODS: From 2010 to 2012, we tested nasopharyngeal swab specimen in 1,584 hospitalized children with multiple real-time polymerase chain reactions to identify 10 kinds of respiratory viruses (including influenza virus A, B (FluA, FluB), respiratory syncytial virus (RSV), human metapneumovirus (MPV), adenovirus (AdV), human coronavirus (CoronaV), human enterovirus (HEV), human bocavirus (HBoV), parainfluenza virus (PIV), and human rhinovirus (Rhinovirus)). We analyzed the positive rate, annual and seasonal variations, and clinical features (respiratory tract and non-respiratory tract) according to the retrospective review of medical records. RESULTS: Respiratory viruses were detected from 678 (42.8%) of 1,584 patients. The most common detected virus was RSV (35.0%), and then AdV (19.0%), HEV (18.1%). The critical period of the respiratory viral infection was during the first 12 months of a child's life. PIV increased by 8.4%, 12.1%, and 21.1% annually. Bronchiolitis was most frequently caused by RSV, and croup was frequently caused by PIV. The most common cause of meningitis was HEV. Hepatitis-associated respiratory virus was developed 111 in 678 cases. CONCLUSION: Although this study was confined to a single medical center for three years, we identified the epidemiology and clinical feature of respiratory viruses in Daegu from 2010 to 2012. Future surveillance will be necessary for annual and seasonal variations.

Epidemiology and Clinical Features of Respiratory Viruses in Pediatric Inpatients in a Single Medical Center in Daegu from 2010 to 2012 / 영남의대학술지

BACKGROUND: This study was performed to investigate the epidemiologic and clinical features of acute respiratory viral infection in hospitalized children. METHODS: From 2010 to 2012, we tested nasopharyngeal swab specimen in 1,584 hospitalized children with multiple real-time polymerase chain reactions to identify 10 kinds of respiratory viruses (including influenza virus A, B (FluA, FluB), respiratory syncytial virus (RSV), human metapneumovirus (MPV), adenovirus (AdV), human coronavirus (CoronaV), human enterovirus (HEV), human bocavirus (HBoV), parainfluenza virus (PIV), and human rhinovirus (Rhinovirus)). We analyzed the positive rate, annual and seasonal variations, and clinical features (respiratory tract and non-respiratory tract) according to the retrospective review of medical records. RESULTS: Respiratory viruses were detected from 678 (42.8%) of 1,584 patients. The most common detected virus was RSV (35.0%), and then AdV (19.0%), HEV (18.1%). The critical period of the respiratory viral infection was during the first 12 months of a child's life. PIV increased by 8.4%, 12.1%, and 21.1% annually. Bronchiolitis was most frequently caused by RSV, and croup was frequently caused by PIV. The most common cause of meningitis was HEV. Hepatitis-associated respiratory virus was developed 111 in 678 cases. CONCLUSION: Although this study was confined to a single medical center for three years, we identified the epidemiology and clinical feature of respiratory viruses in Daegu from 2010 to 2012. Future surveillance will be necessary for annual and seasonal variations.

Obesity and Insulin Resistance in Childhood / 영남의대학술지

More and more children are becoming obese and overweight due to several factors that include a high energy density in the diet (a high fat intake) and low energy expenditure. Consequently childhood obesity is becoming a significant health problem. Fat tissue releases many cytokines such as resistin, tumor necrosis factor-alpha, leptin, interleukin-6. These adipocytokines induce obesity-related insulin resistance. Insulin resistance is a key component of obesity-related metabolic problems such as hypertension, type 2 diabetes mellitus, dyslipidemia, non-alcoholic steatohepatitis, acanthosis nigricans and polycystic ovarian syndrome. This review article focused on insulin resistance and its related metabolic diseases.

Experience for S-OIV of Admission Pediatric Patient with S-OIV at YUMC, 2009 / 영남의대학술지

The clinical picture in severe cases of pandemic (H1N1) 2009 influenza is markedly different from the disease pattern seen during the epidemics of seasonal influenza as many of those affected were previously healthy young people. Current predictions estimate that during a pandemic wave, 12~30% of the population will develop clinical influenza (compared with 5~15% for seasonal influenza) with 4% of those patients requiring hospital admissions and one in five requiring critical care. Until July 6, 94,512 people have been infected in 122 countries, of whom 429 have died with an overall case-fatality rate of <0.5%. Most of the confirmed cases of S-OIV (Swine- Origin Influenza A Virus) infection have been characterized by a self-limited, uncomplicated febrile respiratory illness and 38% of the cases have also included vomiting or diarrhea. Efforts to control these outbreaks are based on our understanding of novel S-OIV (Swine-Origin Influenza A Virus) and the previous influenza pandemics. So, this review covers the experience with S-OIV (Swine-Origin Influenza A Virus) for the admission and background data and the clinical presentation, diagnosis and treatment of H1N1 in pediatric patient with S-OIV (Swine-Origin Influenza A Virus) at YUMC, 2009.

Recent concepts on vitamin D in children and adolescents / 소아과

Vitamin D is an important fat-soluble vitamin that functions as a prohormone and affects bone mineralization and calcium homeostasis. Vitamin D deficiency causesboth musculoskeletal manifestations, including rickets, and extra-musculoskeletal symptoms. Because vitamin D is naturally present in only some foods, intake of daily foods cannot meet the dietary reference intake for vitamin D. Sunlight is the main source of vitamin D in humans therefore, the lack of sunlight can easily cause vitamin D deficiency in children and adolescents. Vitamin D deficiency can be diagnosed on the basis ofits typical clinical manifestation, laboratory tests, and radiologic findings. Detection of vitamin D deficiency in children or adolescents necessitates the simultaneous administration of vitamin D and calcium supplements. To prevent vitamin D deficiency, 200 IU of daily vitamin D intake is recommended in infants, and 400 IU of daily vitamin D intake is recommended in Korean children and adolescents.

Current feeding practices and maternal nutritional knowledge on complementary feeding in Korea / 소아과

PURPOSE: To evaluate current feeding practices and maternal nutritional knowledge on complementary feeding. METHODS: Mothers of babies aged 9-15 months who visited pediatric clinics of 14 general hospitals between September and December 2008 were asked to fill questionnaires. Data from 1,078 questionnaires were analyzed. RESULTS: Complementary food was introduced at 4-7 months in 89% of babies. Home-made rice gruel was the first complementary food in 93% cases. Spoons were used for initial feeding in 97% cases. At 6-7 months, <50% of babies were fed meat (beef, 43%). Less than 12-month-old babies were fed salty foods such as salted laver (35%) or bean-paste soup (51%) and cow's milk (11%). The following were the maternal sources of information on complementary feeding: books/magazines (58%), friends (30%), internet web sites (29%), relatives (14%), and hospitals (4%). Compared to the 1993 survey, the incidence of complementary food introduction before 4 months (0.4% vs. 21%) and initial use of commercial food (7% vs. 39%) had decreased. Moreover, spoons were increasingly used for initial feeding (97% vs. 57%). The average maternal nutritional knowledge score was 7.5/10. Less percentage of mothers agreed with the following suggestions: bottle formula weaning before 15-18 months (68%), no commercial baby drinks as complementary food (67%), considering formula (or cow's milk) better than soy milk (65%), and feeding minced meat from 6-7 months (57%). CONCLUSION: Complementary feeding practices have considerably improved since the last decade. Pediatricians should advise timely introduction of appropriate complementary foods and monitor diverse information sources on complementary feeding.

A Case of Left Ureteral Obstruction due to Acute Appendicitis / 영남의대학술지

Appendicitis is a common cause of acute abdomen in pediatrics. Periappendiceal abscesses are frequently found in the pediatric population. Acute appendicitis in children can, at times, be a difficult clinical diagnosis because of its highly variable history? and physical manifestations and its unpredictable course. Despite the uncertainty of the diagnosis, appendicitis demands prompt treatment because of the risk of perforation, which occurs in approximately one third of cases. Urological manifestations of appendicitis and appendiceal abscess can vary. Acute appendicitis presenting with ureteral stenosis and hydronephrosis is very rare. Here, we report a case of acute appendicitis with perforation and left hydronephrosis in a 3-year-old female. This case presents a 3-year-old girl with dysuria having hydronephrosis that originated from a perforated appendix.

Transient Intestinal Ileus in Neonate: A Study of Comparison with Hirschsprung's Disease / 대한소아소화기영양학회지

PURPOSE: Severe abdominal distension is not uncommon symptom in the neonate. Two major causes of this symptom are benign transient intestinal ileus (BTII) and Hirschsprung`s disease (HD). But it is difficult to differentiate BTII from HD based on the symptoms and simple abdominal x-ray findings. The aim of this retrospective study was to assess the clinical aspects and diagnostic tests differencing two diseases. METHODS: From August 2004 to March 2009, nineteen patients with severe abdominal distension, who underwent barium enema, anorectal manometry, and rectal suction biopsy (triple tests) due to a suspicion of HD, were enrolled. A comparison of clinical data associated with BTII and HD based on the clinical features and results of triple tests. RESULTS: The age of onset of symptom was between 2 and 6 weeks in BTII and within 3 weeks in HD. On the barium enema, transitional zone revealed in 6 (50%) patients in BTII and 4 (57.1%) in HD. On anorectal manometry, the anorectal inhibitory reflex was present in 11 (91.7%) patients in BTII and 1 (14.3%) in HD. On rectal suction biopsy, ganglion cell was present in 9 (75%) patients in BTII and 0 (0%) in HD. Abdominal distension was improved within 3 months of life in all cases of BTII. CONCLUSION: We think that anorectal manometry may be more simple and useful diagnostic method than barium enema and rectal suction biopsy for differential diagnosis of transient intestinal ileus and Hirschsprung's disease.

Study on Perception of Their Body Image and Body Dissatisfaction in Adolescent in Ulsan / 영남의대학술지

BACKGROUND: In this study, we examined body image perception and dissatisfaction with weight and height in children and adolescents, according to age and body mass index. Additionally, we compared our findings with those of previous studies concerning eating disorders. MATERIALS AND METHODS: In July and August 2008, 1,501 students were sampled from elementary, middle, and high schools in Ulsan and assessed using self-completion questionnaires. We used the Korean version of the Eating Attitude Test-26 (EAT-26) to screen for eating risk groups. Participants were stratified by grade, gender, and body mass index. RESULTS: 1) Dissatisfaction with height, weight, and body image was greater in the older group. 2) Dissatisfaction with weight and body image was greater in the heavier group. 3) EAT-26 scores and the number of individuals at high risk for eating disorders were higher in the female group than in the male group. CONCLUSION: The EAT-26 score in this study was similar to those found in previous Western studies. 2) There were a number of high-risk individuals in the female group, with a tendency toward earlier presentation. Continuous health management and prevention programs are required.

Pediatric Crohn's Disease presenting as Severe Constipation and Abdominal Distension / 영남의대학술지

Crohn's disease is a chronic inflammatory bowel disease that mainly affects children and young adults. Its cause remains unknown. The incidence of pediatric Crohn's disease is increasing, so it is important for clinicians to be aware of the presentation of this disease in the pediatric population. The majority of patients complain of abdominal pain (72%), with only 25% presenting with the 'classical triad' of abdominal pain, weight loss, and diarrhea. Many children with Crohn's disease present in a 'non-classical' manner, with vague complaints such as lethargy or anorexia, which may be associated with only mild abdominal discomfort. Other symptoms include fever, nausea, vomiting, growth retardation, malnutrition, delayed puberty, psychiatric symptoms, arthropathy, and erythema nodosum. Severe constipation and abdominal distension are uncommon symptoms at diagnosis. We report a case of pediatric Crohn's disease, which was diagnosed after the patient presented with severe constipation and abdominal distension.

Outcome of typhlitis in children with cancer / 소아과

PURPOSE: Neutropenic enterocolitis is an acute, life-threatening inflammation of the small and large bowel, often seen in children with malignancies during periods of prolonged or severe neutropenia. The optimal management for typhlitis in pediatric oncology patients has been debateful between operative and nonoperative approaches. The purpose of this study was to review the outcome of medical management of patients who were diagnosed as typhlitis. METHODS: The records of 207 pediatric cancer patients who were diagnosed and treated at the pediatric department of Yeungnam University Hospital for cancer between August, 2002 and July, 2007 were reviewed. RESULTS: Among 207 patients, 12 (5.7%) children aged 9 to 14 years, were diagnosed clinically to have typhlitis. Clinical symptoms and signs of patients were fever, abdominal pain and tenderness, diarrhea, vomiting and rebound tenderness. Bowel-wall thickening (> 4mm) was seen on CT or ultrasonography. All patients were treated with antibiotics combinations of teicoplanin, carbapenem, aminoglycoside, or other third generation cephalosporin and metronidazole or clindamycin. Eight patients were treated with additional antifungal agents. Other supportive management included bowel rest, total parenteral nutrition, and G-CSF administration. All patients recovered completely and did not need any surgical management. CONCLUSION: Early diagnosis and aggressive supportive treatment appears to be important for complete recovery and survival of typhlitis.

A Case of Liver Abscess in A Child / 영남의대학술지

Liver abscess in children is rare in developed countries; the incidence is 25 per 100,000 admissions in USA. Common complications are pleural effusion, empyema, pneumonitis, hepatopleural or hepatobronchial fistula, intraperitoneal or intrapericardiac rupture, septic shock, cerebral amebiasis, etc. These complications may lead to death if the management is delayed. However, recent management results in a mortality of less than 15%. We report a case of liver abscess in a child. He manifested with fever and abdominal pain in the right upper quadrant. On computerized tomography scans, multiple cystic lesions were seen in both lobes of the liver and were 5 to 55 mm in size. In laboratory findings, neutrophilic leukocytosis, peripheral eosinophila, elevated values of ESR, C-reactive protein, and elevated serum AST, ALT, ALP and GGT were detected. Furthermore, we determined the organisms in the blood culture and serum. Blood culture was positive for Streptococcus spp., and amebic indirect hemagglutination antibody titer was increased to 1:512.