A Case of Congenital Duodenal Web Causing Duodenal Stenosis in a Down Syndrome Child: Endoscopic Resection with an Insulated-Tip Knife

A 35-month-old girl visited our hospital with repetitive vomiting and abdominal distention; this was especially aggravated after the introduction of solid and semisolid foods. At 5 months of age, the patient, who had Down's syndrome, had undergone surgery for ventricular septal defect, atrial septal defect, and patent ductus arteriosus, and had subsequently been frequently hospitalized for respiratory infections and other viral infectious diseases. After her admission, the abdominal distension improved with fasting and intravenous fl uid therapy. Radiograph from a small-bowel series revealed a thin fi lling defect with a dilated duodenal bulb in the distal region of the second portion of the duodenum, suggesting a duodenal web, and endoscopy revealed duodenal stenosis. We therefore performed endoscopic resection with an insulated-tip knife because of the history of prior operations, fasting problems after operations, and respiratory infections. Seven days later, scar formation was noted on the second portion of the duodenum, the scope passed well at the excision site, and no retained food material was noted on the follow-up endoscopy. After the procedure, the patient's abdominal distention and repetitive vomiting subsided, and she was discharged with the ability to eat eat an age-appropriate normal diet. There were no specifi c symptoms or other complications for 1 year after the procedure.

A Newborn with Lethal Metatropic Dysplasia

Metatropic dysplasia is a rare spondylo epi metaphyseal dysplasia characterized by progressive kyphoscoliosis, short limbs with relatively large hands and feet and limited of motion and enlargement of the large joints. It is diagnosed based on the characteristic clinical and radiological features. Even though benign cases of this disease are frequently reported, metatropic dysplasia can often have a fatal outcome. We describe a sporadic case of the well-delineated lethal metatropic dysplasia.

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.