Bowel Wall Thickening on Computed Tomography in Children: A Novel Method of Measurement and Its Clinical Significance / 대한소아소화기영양학회지

Purpose@#The clinical implications of bowel wall thickening (BWT) on abdominal computed tomography (CT) among children are unknown. We aimed to suggest a new method for measuring BWT and determining its clinical significance in children. @*Methods@#We retrospectively analyzed 423 patients with acute abdomen who underwent abdominal CT; 262 were classified into the BWT group. For this group, the pediatric radiologist described the maximal bowel wall thickness (MT), normal bowel wall thickness (mm) (NT), and their ratios for each segment of the bowel wall. @*Results@#In the thickened bowel walls, the thickness differed significantly between the small bowel (6.83±2.14 mm; mean±standard deviation) and the colon (8.56±3.46 mm; p<0.001). The ratios of MT to NT in the small bowel (6.09±3.17) and the colon (7.58±3.70) were also significantly different (p<0.001). In the BWT group, 35 of 53 patients had positive fecal polymerase chain reaction results; 6 patients infected with viruses predominantly had BWT in the small intestine, while the terminal ileum and the colon were predominantly affected in 29 patients with bacterial infections. In the initially undiagnosed 158 patients with BWT, the symptoms improved spontaneously without progression to chronic gastrointestinal disease. @*Conclusion@#This study provides a clinical reference value for BWT in the small intestine and colon using a new method in children. The BWT on abdominal CT in children might indicate nonspecific findings that can be observed and followed up without additional evaluation, unlike in adults.

Bowel Wall Thickening on Computed Tomography in Children: A Novel Method of Measurement and Its Clinical Significance / 대한소아소화기영양학회지

Purpose@#The clinical implications of bowel wall thickening (BWT) on abdominal computed tomography (CT) among children are unknown. We aimed to suggest a new method for measuring BWT and determining its clinical significance in children. @*Methods@#We retrospectively analyzed 423 patients with acute abdomen who underwent abdominal CT; 262 were classified into the BWT group. For this group, the pediatric radiologist described the maximal bowel wall thickness (MT), normal bowel wall thickness (mm) (NT), and their ratios for each segment of the bowel wall. @*Results@#In the thickened bowel walls, the thickness differed significantly between the small bowel (6.83±2.14 mm; mean±standard deviation) and the colon (8.56±3.46 mm; p<0.001). The ratios of MT to NT in the small bowel (6.09±3.17) and the colon (7.58±3.70) were also significantly different (p<0.001). In the BWT group, 35 of 53 patients had positive fecal polymerase chain reaction results; 6 patients infected with viruses predominantly had BWT in the small intestine, while the terminal ileum and the colon were predominantly affected in 29 patients with bacterial infections. In the initially undiagnosed 158 patients with BWT, the symptoms improved spontaneously without progression to chronic gastrointestinal disease. @*Conclusion@#This study provides a clinical reference value for BWT in the small intestine and colon using a new method in children. The BWT on abdominal CT in children might indicate nonspecific findings that can be observed and followed up without additional evaluation, unlike in adults.

Three Fibrotic Conditions Treated with 5% Topical Imiquimod Cream as an Antifibrotic Agent / 대한피부과학회지

Imiquimod, a toll-like receptor agonist, is a topical immunomodulator that induces the production of several cytokines including interferon-alpha, which shows antifibrotic properties. We hypothesized that the antifibrotic effect of imiquimod would soften fibrotic skin lesions. Therefore, we applied topical imiquimod with topical tacrolimus or systemic acitretin in patients with refractory lesions of myxedema, angiolymphoid hyperplasia, and generalized discoid lupus erythematosus and confirmed improvement in fibrotic lesions in these patients. Thus, we conclude that use of imiquimod improves fibrotic skin lesions. This report describes our experience with the treatment of this condition along with a review of the related literature.

Topical Methyl Aminolevulinate Photodynamic Therapy in Porokeratosis of Mibelli: An Alternative Treatment for a Refractory Disease

No abstract available.

Pirfenidone-Induced Photosensitivity in a Patient with Idiopathic Pulmonary Fibrosis

No abstract available.

Feasibility of IMP-3 as an Invasiveness Marker for Acral Lentiginous Melanoma

No abstract available.

Antibiotics-Associated Hemorrhagic Colitis Caused by Klebsiella oxytoca: Two Case Reports / 대한소아소화기영양학회지

Nowadays, Klebsiella oxytoca is described as a causative organism for antibiotic-associated hemorrhagic colitis (AAHC). Here we report two cases of pediatric AAHC, from which K. oxytoca was cultured after starting amoxicillin-clavulanate or amoxicillin treatment. The patients developed severe abdominal pain and a large amount of bloody diarrhea. K. oxytoca was obtained in intestinal fluid culture of a boy through the colonoscopy. On the other hand, colonic tissue culture and intestinal fluid culture were negative of the other patient. K. oxytoca was detected in stool culture when he was admitted. These cases showed characteristic endoscopic findings of segmental hemorrhagic colitis, and both boys recovered spontaneously within 2–3 days after they stopped taking the antibiotics. Therefore, in children who develop relatively large amount of bloody diarrhea after antibiotic treatment, we should consider AAHC caused by K. oxytoca.

A Case of Type III Hyperlipoproteinemia Accompanied by Xanthoma Striatum Palmare / 대한피부과학회지

Xanthomas are localized lipid deposits within organs that may manifest as papules, plaques, or nodules in skin. They are commonly associated with all types of hyperlipidemia. Xanthoma striatum palmare characterized by xanthomas of the palmar creases is a rare but important diagnostic physical sign of dysbetalipoproteinemia, also known as type III hyperlipoproteinemia. Type III hyperlipoproteinemia is characterized by the early onset of cardiovascular disease and peripheral vascular disease. We describe herein the case of a 51-year-old female patient affected by xanthoma striatum palmare associated with elevated plasma levels of triglycerides and cholesterol and a lipoprotein electrophoresis pattern consistent with type III hyperlipoproteinemia.

A Case of Malignancy-associated Histiocytoid Sweet Syndrome in a Patient with AML / 대한피부과학회지

Sweet syndrome is a disorder characterized by painful, erythematous, cutaneous plaques and nodules of rapid onset accompanied by fever, leukocytosis, and neutrophilia. We encountered a case of a recurrent histiocytoid Sweet syndrome in a patient with acute myeloid leukemia (AML). A 64-year-old Korean man was diagnosed with complete remission of AML and had symptomatic nodules and plaques on the dorsal sides of both hands. Approximately 3 years prior, he also had symptomatic plaques at the same site and had been diagnosed with MDS (Myelodysplastic syndrome). We performed a biopsy and diagnosed this case as a malignancy-associated histiocytoid Sweet syndrome. Most Sweet syndrome cases are acute; in contrast, this case was chronic with a relapse. In addition, histopathologic examination showed a dense histiocytic infiltration. These histiocytoid cells are usually misinterpreted as histiocytes; however, they are actually immature myeloid cells. Herein, we report a case of a recurrent malignancy-associated histiocytoid Sweet syndrome in a patient with a hematologic disorder.

Successful Treatment of Jesnner's Lymphocytic Infiltration of the Skin with Methotrexate / 대한피부과학회지

No abstract available.

Palisaded Neutrophilic and Granulomatous Dermatitis Manifested as a LE-nonspecific Skin Lesion / 대한피부과학회지

Palisaded neutrophilic and granulomatous dermatitis (PNGD) is a newly defined entity that includes various clinical entities. Histopathologically, this disease is characterized by a granulomatous inflammation with or without leukocytoclastic vasculitis. PNGD shows vasculitic lesions in the early stage, with palisaded granulomatous lesions and dermal fibrosis with minimal leukocytoclastic debris appearing in the late stage. It is frequently associated with rheumatoid arthritis, lupus erythematosus, and other autoimmune diseases. A 14-year old Korean girl presented with multiple erythematous nodules and plaques on both elbows and knees that were present for 2 years prior to the initial visit. Clinically, she had multiple arthritis with morning stiffness and decreased C3 levels, as well as positive results for antinuclear antibodies, the lupus anticoagulant test, and anti-beta 2 glycoprotein I (IgG). Skin biopsy findings from the skin lesion indicated that the foci of degenerated collagens were palisaded with histiocytes throughout the dermis and neutrophils with leukocytoclasia infiltrated with fibrin, with mucin at the center of the lesion. Based on the SLICC 2012 criteria, we diagnosed her condition as PNGD in systemic lupus erythematosus. She was treated with hydroxychloroquine and topical application of 0.1% tacrolimus ointment, which resulted in the remarkable flattening of the skin lesions after 6 months of follow-up. Herein, we report a case of PNGD that may have been an indicator of systemic lupus erythematosus.

A Case of Recalcitrant Tinea Pedis caused by Trichosporon asahii / 대한의진균학회지

No abstract available.

Nonalcoholic Fatty Liver Disease in Children / 대한소아소화기영양학회지

Obesity is significantly increasing in Korean adolescents and nonalcoholic fatty liver disease (NAFLD) is soon expected to be the most common chronic liver disease in children. The symptoms of NAFLD run a broad spectrum and NAFLD in children can lead to the development of nonalcoholic steatohepatitis, cirrhosis and end-stage liver disease, hepatocellular carcinoma (HCC), and can increases the risk of type 2 diabetes and cardiovascular disease. Definitive diagnosis can be achieved with liver biopsy. However, recent advances have shown alternative methods of screening and following patients with noninvasive biomarkers and radiologic imaging studies. The histopathology differs between children and adults, and the mechanism is expected to differ as well. Several factors, such as genes and environmental stressors work intricately to produce NAFLD. Promising medications have been reported for the management of NAFLD. However, their therapeutic effectiveness has yet to be determined. Dietary and exercise interventions remain the mainstay of treatment. By maintaining an interest in obesity and NALFD in children, NAFLD should be diagnosed early and appropriate lifestyle changes should be counseled and encouraged.

FOXP3+T Cells and TGF-beta1 in Colonic Mucosa of Children with Crohn's Disease / 대한소아소화기영양학회지

PURPOSE: Forkhead box protein 3 (FOXP3)+T cells are the major regulatory T cells controlling all aspects of the immune response. Transforming growth factor-beta (TGF-beta) is a suppressive cytokine which mediates the suppressive action of FOXP3+T cells. The aim of this study was to investigate the role of FOXP3+T cells, TGF-beta in colonic mucosa of children with Crohn's disease (CD). METHODS: Colonic mucosal biopsies were obtained from 10 children with CD (12~15 years of age) and 11 control (8~15 years of age). Frequencies of FOXP3+T, CD4+T cells and TGF-beta1 expression were examined in the lamina propria (LP) and lymphoid aggregates or follicles (LA/F) by immunohistochemistry, and later evaluated by association with disease activity. RESULTS: In the LP of CD group, frequencies of FOXP3+T, CD4+T cells, proportion of FOXP3/CD4+T cells and TGF-beta1 expression significantly increased compared to the control. In the LA/F of CD group, frequency of FOXP3+T cells, proportion of FOXP3/CD4+T cells and TGF-beta1 expression significantly increased compared to the control (p<0.05). CD4+T cells also increased compared to the control, but this finding was not significant. In the LP and LA/F of CD group, frequency of FOXP3+T cells exhibited positive correlation with CD4+T cells (p<0.05). In the LP and LA/F of CD group, TGF-beta1 expression had positive correlation with CRP, Pediatric Crohn's Disease Activity Index, and negative correlation with hematocrit and albumin (p<0.05). CONCLUSION: Increased frequency of FOXP3+T cells and TGF-beta1 expression in colonic mucosa of CD can be interpreted as a compensatory increase towards achieving down-regulation of immune responses.

Clostridium difficile Infections in Children / 이화의대지

During the past decade, rates of Clostridium difficile infection (CDI) increased worldwide. Hypervirulent strains of C. difficile such as NAP1/BI/027 and PCR ribotype 078 have emerged that have changed the epidemiology of CDI. Especially, CDI rates also have increased in the community, in children previously thought to be at low risk. Recently, the use of gastric acid suppressant that facilitates intestinal transit of the bacteria and presence of inflammatory bowel disease has been reported as risk factors. Treatment for CDI usually relies on metronidazole or vancomycin, but recurrence rates remains high. New treatment options for multiple recurrence are challenging. In this article, we reviewed recent epidemiological changes, current knowledge of virulence factors, reasonable approach to the diagnosis, and optimal treatment of CDI. But, clinical guidelines for pediatric C. difficile disease have not been defined. It seems that the consensus and recommendations for managing pediatric CDI are urgently needed.

Nutrients and Bioactive Factors in Breastmilk / 한양의대학술지

Breastmilk provides the best optimal nutrition for infants, especially for the first few months of life. In breastmilk, there are innumerable immune protective and modulating factors. Also, the nutrients in breastmilk act as immune protective factors. The advantages of breastfeeding are not only for protection from infectious diseases, but also protection from some chronic disease, such as celiac disease, atopy, and obesity. A dose-response relationship of breastfeeding has been reported. For lifelong health, breastfeeding is the first step. In Korea, the majority of mothers obtain information about breastfeeding from internet searching, books and magazines. Physicians should actively and enthusiastically recommend breastfeeding and provide detailed advice and integral information about breastfeeding.

Usefulness of the Waist Circumference-to-Height Ratio in Screening for Obesity in Korean Children and Adolescents / 대한소아소화기영양학회지

PURPOSE: To evaluate the feasibility and usefulness of the waist circumference-to-height ratio (WHTR) in screening for obesity in Korean children and adolescents. METHODS: Data, including body mass index (BMI), waist circumference (WC), and height, were obtained from the national growth surveys for children and adolescents in 2005. The WHTR was calculated dividing WC by height in subjects 2~18 years of age. Overweight and obese were defined by BMI percentiles for age and gender. The receiver operating characteristic (ROC) analysis was performed to find out the optimal cutoff values of WHTR that matched BMI-determined overweight and obesity using the STATA program. The area under the curve (AUC), a measure of diagnostic power, of WHTR was compared to WC. The influence of age on WHTR was analyzed by the SAS program. RESULTS: The WHTR significantly decreased with age, and had less correlation with age in the 6~18-year-old age group than the 2~5-year-old age group. Furthermore, the WHTR also had less correlation with age than WC in the 6~18-year-old age group. The AUC of WHTR in identifying overweight and obesity was significantly higher than the AUC of WC in the 6~18-year-old age group. The optimal cutoff values were 0.51 in boys and 0.49 in girls for obesity, and 0.48 in boys and 0.47 in girls for overweight, with all having the AUC>0.9. The optimal cutoff values of WHTR had a higher sensitivity for diagnosing obesity than WC> or =90th percentiles. CONCLUSION: The WHTR is an easy, accurate, and less age-dependent index with high applicability in screening for obesity in children and adolescents.

Usefulness of the Waist Circumference-to-Height Ratio in Screening for Obesity in Korean Children and Adolescents / 대한소아소화기영양학회지

PURPOSE: To evaluate the feasibility and usefulness of the waist circumference-to-height ratio (WHTR) in screening for obesity in Korean children and adolescents. METHODS: Data, including body mass index (BMI), waist circumference (WC), and height, were obtained from the national growth surveys for children and adolescents in 2005. The WHTR was calculated dividing WC by height in subjects 2~18 years of age. Overweight and obese were defined by BMI percentiles for age and gender. The receiver operating characteristic (ROC) analysis was performed to find out the optimal cutoff values of WHTR that matched BMI-determined overweight and obesity using the STATA program. The area under the curve (AUC), a measure of diagnostic power, of WHTR was compared to WC. The influence of age on WHTR was analyzed by the SAS program. RESULTS: The WHTR significantly decreased with age, and had less correlation with age in the 6~18-year-old age group than the 2~5-year-old age group. Furthermore, the WHTR also had less correlation with age than WC in the 6~18-year-old age group. The AUC of WHTR in identifying overweight and obesity was significantly higher than the AUC of WC in the 6~18-year-old age group. The optimal cutoff values were 0.51 in boys and 0.49 in girls for obesity, and 0.48 in boys and 0.47 in girls for overweight, with all having the AUC>0.9. The optimal cutoff values of WHTR had a higher sensitivity for diagnosing obesity than WC> or =90th percentiles. CONCLUSION: The WHTR is an easy, accurate, and less age-dependent index with high applicability in screening for obesity in children and adolescents.

Enterovirus 71-associated hand, foot and mouth diseases with neurologic symptoms, a university hospital experience in Korea, 2009 / 소아과

PURPOSE: Hand-foot-mouth disease (HFMD) is a common viral illness in children, which is usually mild and self-limiting. However, in recent epidemics of HFMD in Asia, enterovirus 71 (EV71) has been recognized as a causative agent with severe neurological symptoms with or without cardiopulmonary involvement. HFMD was epidemic in Korea in the spring of 2009. Severe cases with complications including death have been reported. The clinical characteristics in children with neurologic manifestations of EV71 were studied in Ewha Womans University Mokdong Hospital. METHODS: Examinations for EV71 were performed from the stools, respiratory secretion or CSF of children who presented neurologic symptoms associated with HFMD by realtime PCR. Clinical and radiologic data of the patients were collected and analyzed. RESULTS: EV71 was isolated from the stool of 16 patients but not from respiratory secretion or CSF. Among the 16 patients, meningitis (n=10) was the most common manifestation, followed by Guillain-Barre syndrome (n=3), meningoencephalitis (n=2), poliomyelitis-like paralytic disease (n=1), and myoclonus (n=1). Gene analysis showed that most of them were caused by EV71 subgenotype C4a, which was prevalent in China in 2008. CONCLUSION: Because EV71 causes severe complications and death in children, a surveillance system to predict upcoming outbreaks should be established and maintained and adequate public health measures are needed to control disease.

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.